中华全科医学

Progress in the application of general practice intervention after mild traumatic brain injury

HE Xiaoman, LIU Yumei, MAO Mintao, ZHAO Zhijie, YANG Xi-tao, ZHENG Ruizhe

2021, 19(8): 1251-1254. doi: 10.16766/j.cnki.issn.1674-4152.002033

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Abstract:
More than 50 million people suffer from traumatic brain injury (TBI) every year in the world, and it is estimated that about half of the population will have one or more TBIs over their lifetime. In all TBI patients, mild traumatic brain injury (mTBI) plays the dominant role, and most of them benefiting from the diagnosis and treatment of specialists. However, a majority of mTBI patients often present with a persistent and injury related activities of daily living difficulties and interpersonal dysfunction after the acute phase of injury, which indicates that the prognosis of those patients are not so "mild". In the term of the management of such symptom, the application of specialized treatment is limited due to most symptoms are result from a complex interplay of biopsychosocial factors. Recently, with the rapid development of general practice, family and community resources are gradually using to provide long-term care for patients with mTBI to overcome the low follow-up rate and recovery rate after injury. Unfortunately, there is no standardized general practice guideline for mTBI, and the most important decision-making factors are based on the clinical practice. At present, there are two modes of general practice intervention for mTBI: online and offline. The online mode means mainly include online guidance and procedural operation intervention based on network, and the offline mode means mainly include art therapy, occupational therapy, music therapy and traditional Chinese medicine therapy. With a view to pushing the development of the "combination of general practice and special treatment" mode in the future, this article reviewed the general intervention methods that can be used in mild traumatic brain injury.

2021, 19(8): 1255-1256.

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Study on risk factors of N-terminal pro-brain natriuretic peptide abnormalities in non-dialysis patients with chronic kidney disease

JIN De-wei, TAO Min, MA Xiao-yan, WANG Yi, SHENG Li-li, LIU Na

2021, 19(8): 1314-1317. doi: 10.16766/j.cnki.issn.1674-4152.002049

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Abstract:
Objective To investigate the risk factors of N-terminal pro-brain natriuretic peptide (NT-proBNP) abnormalities in non-dialysis patients with chronic kidney disease (CKD). Methods Non-dialysis patients hospitalized in the Department of Nephrology from January 1, 2018 to December 31, 2019 at the Shanghai East Hospital were enrolled. According to the level of NT-proBNP, patients were divided into NT-proBNP normal group (Ⅰ: NT-proBNP < 125 ng/L) and NT-proBNP abnormal group (Ⅱ: NT-proBNP≥125 ng/L). There were 129 patients in group Ⅰ and 130 patients in group Ⅱ. Multivariate Logistic regression and ROC curve were used to analyze the influencing factors of patients' NT-proBNP abnormalities. Results Logistic regression showed that age (P=0.008) was an independent risk factor for NT-proBNP abnormality, and hemoglobin (P=0.014) and eGFR (P < 0.001) were protective factors for patients with NT-proBNP abnormality. ROC analysis showed that when the patient's age was>75.5 years (AUC=0.658, P < 0.001), hemoglobin < 124.5 g/L (AUC=0.769, P < 0.001), eGFR < 47.5 [mL/(min·1.73 m²)] (AUC=0.810, P < 0.001), the risk of NT-proBNP increase will increase significantly. Conclusion Age is an independent risk factor for the increase of NT-proBNP, while hemoglobin and eGFR are protective factors.

Control study on outpatient Morita therapy and cognitive behavioural therapy in the adjuvant treatment of chronic insomnia

SHI Yu-xin, XIA Zhong, RONG Wei

2021, 19(8): 1318-1321. doi: 10.16766/j.cnki.issn.1674-4152.002050

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Abstract:
Objective To compare the efficacy of outpatient Morita therapy and cognitive behavioural therapy (CBT-I) in the treatment of chronic insomnia and to understand the difference between the two therapies and to promote the clinical application of outpatient Morita therapy. Methods Sixty patients with chronic insomnia who returned to the Fourth People's Hospital of Wuhu City from June 2019 to November 2019 were included and divided into the study and control groups by random number table method. The subjective sleep quality, constraint symptoms and anxiety symptoms of the two groups were compared before and after intervention by Morita therapy and CBT-I. Results After the intervention, the scores of the study group except those for hypnotic drugs were found to be significantly different from the scores obtained before the treatment. The scores of the control group were lower after treatment than before the treatment, except the scores for sleeping time and hypnotic drugs. After intervention, sleep quality (1.47±0.63), sleep time (1.73±0.91), daytime dysfunction (1.37±0.93) and total score of PSDI (12.23±4.18) in the study group were significantly lower than those in the control group [(1.80±0.48), (2.67±0.66), (2.03±0.77), (14.23±3.07)]. In SSTN, each dimension and total score of the study group were significantly reduced compared with before the intervention, whereas only symptom tolerance dimension of the control group differed from that before the treatment. In HAMA, after the intervention, the scores of the study group (3.50±2.86) and the control group (4.73±2.46) were significantly lower than before treatment, and no significant difference was found between the two groups before and after treatment. Conclusion Both treatments are effective for chronic insomnia. Outpatient Morita therapy is better than CBT-I in terms of sleep quality, time to fall asleep, daytime dysfunction and overall sleep evaluation. Outpatient Morita therapy can relieve the symptoms of confinement in patients and can be promoted in clinic.

Comparison of LISA technique and INSURE technique in the treatment of respiratory distress syndrome in premature infants

SONG Fei-fei, ZHANG Lan

2021, 19(8): 1322-1325,1429. doi: 10.16766/j.cnki.issn.1674-4152.002051

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Objective To compare the outcomes and side effects between the less invasive surfactant administration (LISA) and the intubate surfactant extubate (INSURE) method in premature infants with respiratory distress syndrome. Methods In the experimental group, 20 children who met the inclusion criteria were recruited from eight neonatal intensive care units in Anhui Province from August 2019 to April 2020 to complete pulmonary surfactant (PS) administration by LISA technology. In the control group, 36 children were recruited from Anhui Provincial Hospital from January 2017 to January 2020 to complete PS administration by INSURE technology. The basic information of children and mothers, arterial blood gas values before and after administration, oxygen saturation and heart rate during administration, complications and oxygen use during hospitalisation were collected and compered. Results The pH value of the LISA group after administration was significantly higher than that before administration (P < 0.001). The PCO₂ value in the LISA group after administration was significantly lower than that before administration (P=0.005). The PO₂ changes in the LISA group before and after administration were not statistically significant. The pH, PCO₂ and PO₂ values of the INSURE group showed no significant changes before and after administration. The LISA group tended to have a normal pH range compared with the INSURE group (P=0.009). The decrease of blood oxygen saturation during the administration was statistically significant between the two groups (P=0.041). No statistically significant difference was observed in the incidence of bronchopulmonary dysplasia (BPD), noninvasive failure rate and time of noninvasive ventilation between the two groups. Conclusion LISA technology can be performed in infants with spontaneous breathing, and it can significantly improve alveolar ventilation without increasing the incidence of complications such as BPD.

Influencing factors analysis of intracranial hemorrhage in premature infants

LIN Yang, MIN Hong, ZHOU Hao-quan, CHEN Ming-wu, PAN Jia-hua

2021, 19(8): 1326-1329. doi: 10.16766/j.cnki.issn.1674-4152.002052

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Objective Intracranial hemorrhage is a common complication in premature infants, which can leave different degrees of neurological sequelae. The purpose of this study was to investigate the high risk factors of intracranial hemorrhage in premature infants and provide theoretical basis for early intervention. Methods A total of 299 preterm infants who were admitted to the Neonatal Intensive Care Unit (NICU) of the First Affiliated Hospital of University of Science and Technology of China during January 2019 and December 2020. Total 114 preterm infants with intracranial hemorrhage were selected as study group, and other 185 premature infants without intracranial hemorrhage at the same period were selected as control group. Single factor and multivariate logistic regression analysis were used to identify risk factors for intracranial hemorrhage. Results Single factor analysis indicated pregnancy induced hypertension, late gestation infection, premature rupture of membranes, gestational age, birth weight, vaginal delivery, amniotic fluid pollution, 1 minute Apgar score, 5 minute Apgar score, NRDS (neonatal respiratory distress syndrome) and mechanical ventilation associated with the development of intracranial hemorrhage in preterm neonates (the chi square values were 4.376, 7.205, 5.042, 16.194, 15.982, 13.320, 4.859, 31.988, 25.855, 36.436, 29.262, all P < 0.05). Multivariate logistic regression analysis showed vaginal delivery, 1 minute Apgar score and NRDS were independent risk factors for intracranial hemorrhage (all P < 0.05). Conclusion Intracranial hemorrhage in premature infants is related to many factors, such as pregnancy induced hypertension, late gestation infection, premature rupture of membranes, gestational age, birth weight, vaginal delivery, amniotic fluid pollution, 1 minute Apgar score, 5 minute Apgar score, NRDS and mechanical ventilation, so comprehensive evaluation, early diagnosis and early treatment should be carried out in clinical work.

Construction and practice of cardiac rehabilitation in the community projects aims at constructing the clinical path of community general practice care under hierarchical medical system

WANG Ying, CHEN Bi-hua, LI Qing, JING Ling, WANG Lin-chuang

2021, 19(8): 1330-1335，1418. doi: 10.16766/j.cnki.issn.1674-4152.002053

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Objective For summary and evaluation of the protype at practice, this research recruited cardiac rehabilitation professionals for in-depth interviews to know the status quo of cardiac rehabilitation service carried out at Longhua community and comb the cardiac rehabilitation in the community to carry out the conditions and requirements and the clinical path of community general practice care to provide reference for the construction. Methods From March 25 to March 31, 2019, nine members of the institute who participated in the construction of the cardiac rehabilitation project were interviewed voluntarily through a one-on-one structured interview. The nine members fully covered the Departments of General Practice, Nursing, Rehabilitation and Management which were involved in cardiac rehabilitation. The outline of the interview was prepared according to the research objectives, involving three aspects of service targets, service content and resource allocation. The interview method was phone interview, which lasted 40-60 minutes. The interview outline was issued in advance to inform the purpose of the interview. The interview was recorded after permission. The results of the interview were structured according to the service target's admission and pre-entry assessment, service intervention measures, related resource allocation goals and current situation. Results After 448 days of construction, the construction of team members' ability has been basically completed. To implement and run cardiac rehabilitation regularly, corresponding equipment and facilities, software system support and human resources allocation need to be improved. Conclusion Cardiac rehabilitation is suitable to be carried out in the community, and the appropriate combination and coordination of relevant participants can be qualified for the intervention of the five major prescriptions(rational drug use, regular sports, good mentality, weight and diet control, quit smoking and drink) for cardiac rehabilitation. However, because cardiac rehabilitation matches the characteristics of general practice, it has considerable complexity and comprehensiveness. To run normally, the top-level design at the beginning of the project and the resources in the running process are timely in place, which is very important and determines the speed and effectiveness of the project construction.

Analysis on vision and refraction of primary and middle school students in urban rural areas of Shanghai

WANG Yu-lin, XU Qi, HU Die, FU Hua

2021, 19(8): 1336-1338,1342. doi: 10.16766/j.cnki.issn.1674-4152.002054

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Objective To investigate the current situation and epidemiological characteristics of vision and refraction amongst primary and secondary school students in urban rural areas of Shanghai, and to provide reference for the prevention and treatment of myopia amongst primary and secondary school students in this area. Methods Using cluster sampling method, a total of 4 508 students from grade 1 to grade 8 at nine schools in a community in Shanghai were selected. The vision examination included naked vision, wearing glasses vision and no mydriasis optometry. SPSS 21.0 statistical software was used for data analysis, and statistical significance was considered at P < 0.05. Results The rate of poor vision was 60.3% (2 718/4 508), including 43.5% (1 962/4 508) for myopia, 34.6% (1 562/4 508) for astigmatism, 16.1% (724/4 508) for anisometropia and 2.0% (73/4 508) for hyperopia. The prevalence of myopia was 34.1% (1 077/3 162) in primary school students and 65.8% (885/1 346) in junior middle school students. The prevalence of myopia increased with grade (P < 0.01). The prevalence of myopia was lower in boys than in girls (P < 0.05), whereas the prevalence of astigmatism was higher in boys than in girls (P < 0.05). The degree of myopia in the junior middle school group was higher than that in the primary school group (P < 0.05). Conclusion The poor vision rate of primary and secondary school students in this area is high, and the main eye disease is myopia. Relevant departments should take corresponding measures to prevent the occurrence and development of myopia according to the epidemiological characteristics of myopia in primary and secondary school students.

Effect of empowerment education model on patients with poor blood glucose control in diabetes mellitus

HU Xiao-rong, LI Xiu-ying, XU Juan, WU Qing-qing

2021, 19(8): 1339-1342. doi: 10.16766/j.cnki.issn.1674-4152.002055

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Objective To explore the influence of empowerment education mode on self-management ability and blood glucose control level of patients with poor glucose control in diabetes mellitus. Methods Total 90 patients with type 2 diabetes who had poor glucose control were selected from Department of Endocrinology, No.1 People's Hospital of Hangzhou, Zhejiang University from January to December 2019. They were randomly divided into control group (45 cases) and intervention group (45 cases). The control group was given routine health education, and the intervention group was given empowerment education mode. The levels of fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c) and self-management behavior ability of the two groups before and after the intervention were evaluated and compared. Results After 6 months of intervention, the levels of FBG, PBG and HbA1c in the observation group were (6.55±1.23, 9.34±2.34, 6.56±1.93) mmol/L, which were better than those of the control group (7.86±1.43, 13.25±3.12, 7.72±1.16) mmol/L, and the differences were statistically significant (t=4.392, 6.341, 3.455, P < 0.05). The total score of self-management behavior in the intervention group (104.51±7.63) was significantly higher than that in the control group (74.13±9.57), the difference was statistically significant (t=16.724, P < 0.05). Conclusion Empowerment and empowerment education mode can help to improve the self-management ability of diabetic patients and improve the level of blood glucose control.

Psychological correlation status and causes of tumour patients at different stages of treatment during the COVID-19 epidemic

HUANG Ze-han, DU Yi-heng, SONG Ya-ting, YAO Huang, YANG Sheng-li, HU Jian-li

2021, 19(8): 1343-1346,1407. doi: 10.16766/j.cnki.issn.1674-4152.002056

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Objective To investigate the psychological state and related causes of tumour patients in different treatment stages during the COVID-19 epidemic. Methods The mental health questionnaire of tumor patients in different stages of the COVID-19 epidemic was designed by self-designed questionnaire, and the questionnaire was distributed through the Internet. Meanwhile, a strict questionnaire was selected for sorting out and statistical analysis. Results The common problem of cancer patients at different stages of treatment during the epidemic was that the sleep quality of many patients was affected to different degrees. Patients in the early diagnosis stage were more affected than patients in other stages in "worrying that the epidemic situation will affect the operation" (72.22%). During the treatment period, patients were most affected by the epidemic situation because of their serious condition, "after the epidemic situation, the factors of tumor's psychological distress (84.13%)" and "whether they will feel serious (75.93%)" were more affected than patients in other stages. In the later stage of rehabilitation, patients had a greater impact on "whether they will feel serious" (68.52%). At the stage of regular review, patients were less affected by the epidemic, but were affected in the aspect of "delaying review" (61.31%). Conclusion During the COVID-19 epidemic, tumour patients at different stages of treatment will be affected to different degrees in different aspects (P < 0.05). Relevant interventions should be implemented according to the characteristics of patients at different stages.

Clinical application of CT enterography and double-balloon enteroscopy in the diagnosis of suspected small intestinal bleeding

DIAO Lei, HONG Ru-tao, HAN Wei, HU Jing, CHEN Xi

2021, 19(8): 1347-1350. doi: 10.16766/j.cnki.issn.1674-4152.002057

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Objective The clinical data of patients with suspected small bowel bleeding in our hospital were analyzed retrospectively to explore the application value of CT enterography (CTE) and double-balloon enteroscopy (DBE) in the diagnosis of suspected small bowel bleeding. Methods The clinical data of 54 patients with suspected small bowel bleeding hospitalized in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from October 2019 to October 2020 were analyzed retrospectively. The positive results of CTE and DBE in the diagnosis of suspected small bowel bleeding and the cases of complications were counted. The results were counted by the 2 test or exact probability method of Fisher test. The diagnostic rate and complication rate of intestinal hemorrhage were compared by CTE and DBE, and the diagnostic value and safety of CTE and DBE were discussed. Results All the 54 patients completed CTE and DBE examination, with a success rate of 100%. The lesions mainly included diverticulum, ulcer, vasodilation, tumor and Crohn's disease. The diagnosis rate of lesions by CTE was 53.7% (29/54) compared with 79.6% (43/54) by DBE and the difference was significant (χ²=8.167, P < 0.01). In terms of safety comparison, there was no complications in all patients who underwent CTE examination (0/54). However, the incidence of complications in 54 patients examined by DBE was only 1 case, and the incidence of complications was 1.9% (1/54). No significant difference was observed in the incidence of complications between CTE and DBE (P>0.05). Conclusion The diagnostic rate of DBE in small bowel bleeding is significantly higher than that of CTE, and without serious complications. The diagnostic rate of CTE for ulcer and vasodilation is not high, but it is sensitive to diverticulum, tumor and Crohn's disease. CTE combined with DBE examination can effectively avoid missed diagnosis of small bowel bleeding.

Application of ultrasound combined with sonohysterography in intrauterine adhesion

SHU Yan, CAI Ting-ting, LIU Ming-song, ZHANG Wei-feng, LU Wen-ming

2021, 19(8): 1351-1353,1366. doi: 10.16766/j.cnki.issn.1674-4152.002058

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Objective With hysteroscopy as the gold standard, the diagnostic sensitivity and grade and type of intrauterine adhesion (IUA) detected by ultrasound combined with sonohysterography (SHG) were analysed, and the application value of ultrasound combined with SHG in detecting IUA was discussed. Methods Sixty-five patients diagnosed with IUA by hysteroscopy in our hospital from April 2018 to October 2019 were selected. The subjects were examined by three-dimensional transvaginal ultrasound (3D-TVUS) and SHG, and the diagnosis results of 65 patients evaluated using 3D-TVUS combined with hysteroscopy were compared. Results The combined examination of 3D-TVUS and SHG resulted in 62 confirmed cases with a sensitivity of 95.38%, which was not significantly different from the results of hysteroscopy (P>0.05). There were 15 cases (23.08%) with mild adhesions, 18 cases (27.69%) with moderate adhesions and 32 cases (49.23%) with severe adhesions diagnosed by hysteroscopy. There were 15 cases (23.08%) with mild adhesions, 19 cases (29.23%) with moderate adhesions and 28 cases (43.08%) with severe adhesions diagnosed by ultrasound combined with hysteroscopy. There was no significant difference between the two examinations (P>0.05), Kappa value was 0.801 (P < 0.001). Among the types of uterine adhesions by hysteroscopy, 15 cases (23.08%) were diagnosed as simple cervical adhesions, 33 cases (50.77%) were diagnosed as intrauterine adhesions, 17 cases (26.15%) were diagnosed as mixed adhesions, and 14 cases (21.54%), 30 cases (46.15%) and 18 cases (27.69%) were detected by 3D-TVUS combined with SHG respectively, with no significant difference (P>0.05), Kappa value was 0.900 (P < 0.001). Conclusion Ultrasound combined with sonohysterography is suitable for the diagnosis of patients with IUA and has high diagnostic accuracy, which is worthy of clinical popularisation and use.

The concept, estimation and application of lung age

LIANG Xiao-lin, XIE Yan-qing, ZHENG Jin-ping, FEI Yue

2021, 19(8): 1354-1357,1361. doi: 10.16766/j.cnki.issn.1674-4152.002059

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Lung age is a term that uses effective age to quantify the physiological function of lung. It was firstly proposed to evaluate the lung function impairment caused by smoking. Estimation of lung age can be derived from the lung age predictive equation based on spirometric indices. The predictive equation of lung age can be developed by the rearrangement of the predictive equations of spirometric indices, or the multiple regression analysis based on large data of healthy population. Six studies have developed predictive equations of lung age based on date from different countries (America in 1985, Australia in 2010, America in 2010, Japan in 2012, North Africa in 2014, Japan in 2015). However, limitations in study design, sample size, population source and statistical analysis are shown in these six studies. As for the application of lung age, studies show that lung age may motivate smoking cessation. Lung age is the independent predictor of complications after esophagectomy and the surgery for non-small cell lung cancer, it can be used in the assessment of the treatment efficacy of Reslizumab in asthmatic patients, and it has good sensitivity and specificity in diagnosing lung function dysfunction. Also, lung age is shown to be related to obesity, dyspnea, smoking, chronic obstructive pulmonary disease, asthma, age and height. As a simplification of spirometry results, although lung age cannot offer the complete information of spirometry, it can be easily understood by general public and be implemented by the health care providers, which enables lung age to be a useful tool in the prevention and management of chronic respiratory diseases. It is especially suitable for the application and promotion of primary medical institutions and general practitioners. The present review introduced the concept, estimation and clinical application of lung age, and proposed suggestions about the prospect of lung age.

The clinical application value of homocysteine

LIN Ni, KE Qu-qing, JIANG Ling-yan, OU Lan-zhi, LIU Die-mei, WU Yu-yan, DU Qing-feng

2021, 19(8): 1358-1361. doi: 10.16766/j.cnki.issn.1674-4152.002060

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Homocysteine (Hcy) is produced in the process of essential amino acid methionine to cysteine conversion, and participates in DNA metabolism through methylation. In recent years, many studies have shown that serum Hcy levels were directly or indirectly related to various diseases, such as arteriosclerosis, cardiovascular disease, hypertension, neurological disease, diabetes, cancer, pregnancy disease, eye disease and osteoporosis. The normal range of Hcy in human plasma is 5-15 μmol/L, and >15 μmol/L is hyper homocysteine (HHcy). Gene mutations, malnutrition caused by folic acid, vitamin B₆, and B₁₂ deficiency, and a high-methionine diet are common causes of elevated Hcy. Studies have confirmed that the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism is associated with the susceptibility to elevated plasma Hcy levels, and the expression of the MTHFR 677TT genotype in the Chinese population is significantly higher than that of other races. The pathogenic mechanism of increased serum Hcy levels may be: promotion of inflammation and vascular calcification, impaired lipid peroxidation and antioxidant processes, stimulation of the production of reactive oxygen species, induction of oxidative stress and vascular dysfunction, endothelial cell toxicity and dysfunction, inhibit the release of neurotransmitters, and so on. Other pathogenic mechanisms still need to be further studied. The level of Hcy is important for the risk prediction of the disease, the controlling of the disease complications and the prognosis of the disease. The overall prevalence of HHcy in Chinese population is high, and the regional differences are significant. With the increase of age, the prevalence also increases. Monitoring of Hcy is conducive to early detection and diagnosis of diseases and prevention of serious complications. To provide reference for the clinical application of Hcy, this study comprehensively explores the relationship between Hcy and disease and its pathogenic mechanism on the basis of the latest literatures.

The research progress of serum tumor markers in the diagnosis of ovarian cancer

GUO Yu, XU Peng, WANG Bei-di, LI Li-yang, GAO Shuang, KUANG Ye

2021, 19(8): 1362-1366. doi: 10.16766/j.cnki.issn.1674-4152.002061

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Ovarian cancer (OC) is one of the three gynecological malignancies in the world. Due to the lack of obvious clinical symptoms and effective screening methods in early OC, the patients have a high fatality rate, and their prognosis is poor. In recent years, early detection of OC is the hot spot of research for the clinical and scientific research workers. Transvaginal ultrasound combined with biomarker detection is the most common screening strategy at now. Cancer antigen 125 (CA125) is a high molecular weight, highly glycosylated transmembrane mucin glycoprotein, which can be directly determined by immunoassay. It is currently the most widely used tumor protein marker, but the serology diagnosis for CA125 is lacking of sensitivity and specificity. At present, the exploration of new diagnostic targets is very urgent. Many serum tumor markers, including circulating tumor DNA (ctDNA), microRNA (miRNA) and circular RNA (circRNA), are attracting extensive attention of researchers. The combined detection of serum tumor markers has an important clinical significance. In-depth research on emerging tumor markers is not only conducive to early diagnosis and early treatment of OC, but help to promote the further exploration of mechanisms such as proliferation, invasion, metastasis, and drug resistance. This article aims to review the research progress of serum tumor markers with potential in the diagnosis of OC in recent years, in order to provide help for the early diagnosis of OC, increase the clinical detection rate, and improve the prognosis of patients.

Clinical study of the effects of threshold pressure load respiratory muscle training on respiratory function rehabilitation in patients with brain trauma

LIU Wei-li, ZHANG Xiao-xiao, LI Fei-xiang, LI Jing-jing, YIN Xian-yin, LI Shu-qiang, LUO Xun, WEN Jun, CUI Jian, WU Rui

2021, 19(8): 1367-1369,1381. doi: 10.16766/j.cnki.issn.1674-4152.002062

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Objective The aim of this study was to observe of the effect of threshold pressure load respiratory muscle training on respiratory function rehabilitation in patients with traumatic brain injury. Methods Sixty patients with brain trauma from March 2018 to June 2019 in the Second Affiliated Hospital of Zhengzhou University were included in the study. They were divided into the observation group (30 cases) and the control group (30 cases) according to the random number table method. Both groups underwent routine medical treatment and rehabilitation. The observation group also underwent threshold pressure loaded respiratory muscle training, treatment for 6 weeks. The pulmonary function indexes, arterial blood gas analysis, inspiratory muscle function and pulmonary infection were evaluated before and after treatment between the two groups. Results At the end of 6 weeks of treatment in the observation group, the maximum ventilatory volume [MVV, (85.23±1.21)%], forced expiratory volume in one second [FEV₁, (2.41±0.28)L/s], forced vital capacity [FVC, (3.26±0.35)L], one second rate [FEV₁/FVC, (85.90±2.60)%], maximum inspiratory pressure [MIP, (87.40±6.82) cm H₂O], peak of inspiratory flow[PIF, (5.39±0.12) L/s] were significantly higher than those before the treatment (all P < 0.05), and MVV, FEV₁, FVC, FEV₁/FVC, MIP, PIF at the end of treatment in the control group were also significantly higher than those before the treatment (all P < 0.05), and the observation group improved more significantly as compared with the control group after the treatment (all P < 0.05). After the treatment, arterial partial pressure of carbon dioxide (PaCO₂) and arterial partial pressure of oxygen (PaO₂) in the observation group [(38.10±1.50) mm Hg and (89.31±1.60) mm Hg] were significantly improved when compared with those before the treatment [(40.21±1.63) mm Hg and (75.66±1.68) mm Hg], all P < 0.05. The pulmonary infection rate in the observation group (6.7%) was significantly lower than that in the control group (30.0%), P < 0.05. Conclusion Threshold pressure-loaded respiratory muscle training can significantly improve the respiratory function of patients with traumatic brain injury, increase the partial pressure of arterial oxygen, and significantly reduce the rate of pulmonary infection.

Clinical effect of local acupoint selection combined with back transport acupoint embedding in the treatment of dysphagia after stroke

ZHANG Hui-he, CHEN Miao, LI Wei, ZHAO Na, ZHU Zheng-yu

2021, 19(8): 1370-1372,1389. doi: 10.16766/j.cnki.issn.1674-4152.002063

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Objective To explore the clinical effect of local acupoint selection combined with back transport acupoint embedding in the treatment of swallowing disorder after stroke. Methods A total of 96 patients with swallowing disorder after stroke from April 2019 to April 2020 were selected and randomly divided into the observation group and control group according to the random number table method (n=48). Patients in both groups were treated with standardised drugs. Patients in the control group received routine rehabilitation training on the basis of standardised drug therapy, whereas those in the observation group received local acupoint selection combined with back transport acupoint embedding therapy on the basis of routine rehabilitation training in the control group. Both groups received continuous treatment for 4 weeks. Swallowing function before and after treatment was assessed by Koubm Water Swallowing test (KWST) and Video fluoroscopic swallowing study (VFSS), and the quality of life before and after treatment was assessed by the Health Survey Summary table (F-36 scale). The clinical efficacy of the two groups of patients were observed and compared. Conclusion The clinical effect of local acupoint selection combined with back transport acupoint embedding in the treatment of dysphagia after stroke is remarkable, which can significantly improve the swallowing function of patients and improve the quality of life. It is worth promoting and using in clinical practice.

Exploration and practice of virtual reality technological diagnosis and treatment system in clinical teaching application

LIU Yan-quan, SHEN Jian-zhen, CHEN Qiang, LIU Ting-bo, CHEN Yi, LI Chao, FU Hai-ying

2021, 19(8): 1373-1377. doi: 10.16766/j.cnki.issn.1674-4152.002064

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Objective To analyze and discuss the practical problems and application effects of the diagnosis and treatment platform system of virtual reality (VR) in clinical diagnosis, treatment and teaching, and to provide a new perspective for the reform and development of medical education in my country at this stage. Methods Through an in-depth analysis of the current situation and prospects of VR technology, combined with the construction and development of the 2019 national VR diagnosis and treatment platform system of Fujian Medical University and its exploration and application in clinical diagnosis and teaching practice, the effectiveness of practice in diagnosis, treatment and teaching applications of VR technology in the affiliated hospitals were analyzed and discussed. Results Medical education had explored new teaching models and teaching reform schemes by using technological and intelligent technical means such as VR technology. At the same time, it had deepened the intersection and integration of medical disciplines, and created an excellent virtual platform system for practical skills. While optimizing the allocation of clinical teaching resources, it also introduced clinical teaching and training assessment to a higher level, making clinical continuing education resources in various disciplines were more technological, intelligent, extensive, time-effective and popular, forming a real-time, convenient, shared and interoperable clinical teaching network to better serve clinical diagnosis and treatment and skill practice teaching. Conclusion Under the background of the new era, VR technology is one of the core means to promote the informatization and intelligence of medical education. It integrates and develops with clinical diagnosis and treatment, teaching and scientific research, forming a cutting-edge and novel VR diagnosis and treatment system. While improving practical teaching conditions, enhancing the level of clinical diagnosis and treatment and teaching quality, it also avoids the potential risks of clinical diagnosis and treatment, innovates and perfects the current medical education training model and clinical practice teaching system, and provides a more convenient and efficient diagnosis and treatment and teaching environment to help to achieve the goal of "Healthy China".

Practice and exploration of integration of school and hospital promote reform of training mode for general practitioners of traditional Chinese Medicine

LI Xian-qiang, GUO Li, MA Su-fen, GUO Dong

2021, 19(8): 1378-1381. doi: 10.16766/j.cnki.issn.1674-4152.002065

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The construction of "Integration of school and hospital" is one of the important paths to realize the coordinated development of medical education and research, and it is of great significance for medical colleges and universities to deepen the cooperation of medical education and promote the innovation and reform of competency-oriented talent training mode. Starting from the operation mode of "Integration of school and hospital", this paper discusses the scientific, reasonable, operational and diversified construction methods. Bedside teaching is a construction mode of "Integration of school and hospital" which focuses on the reform of clinical practice teaching. In addition, in terms of talent cultivation mode and education management system and mechanism, the innovation and construction of the "School Affiliated Hospital" mode and "Medical teaching research integration tutor system" education mode can promote the organic combination of theoretical teaching and practical teaching, the integration of clinical practice with teaching content and students' learning activities, the integration of scientific inquiry methods into teaching activities; and the formation of systematic coordination of cooperation and education. General practitioners of traditional Chinese Medicine are the new force of development of basic level TCM, and medical colleges and universities are the core of cultivating general practitioners of traditional Chinese medicine. In order to strengthen the construction of general practice talent team, medical colleges and universities should take the concept of medical teaching research cooperation as the guide to promote the construction of "Integration of school and hospital". Medical institutions and universities as a community of interests, through the integration of high-quality resources, to form a joint force, be able to deal with problems effectively of theoretical knowledge and practical ability need to be improved and the long period and differentiation of talent training are not consistent with the rapid development of medical demand in the process of general practice personnel training, and so on, further deepen the reform of the training mode of general medical talents, and promote the coordination of medical education.

Research on the demand of curriculum construction of general practice medicine in undergraduate education

ZHAO Rui, LIU Feng, ZHU Kun, DING Nan-nan

2021, 19(8): 1382-1385. doi: 10.16766/j.cnki.issn.1674-4152.002066

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Objective In order to provide reference for the further promotion of general practice medicine education in colleges and universities, this paper studied the needs of the curriculum construction of general practice medicine in undergraduate education stage. Methods Key event interviews were conducted with the teaching management personnel, professional leaders of general practice and teachers who undertook the course introduction to general practice in 5 medical colleges and universities. At the same time, students of clinical specialties who have completed the course of general practice of medicine were selected for the questionnaire survey. Results The 26 experts interviewed believed that the curriculum construction of general practice in undergraduate education still needed to be further improved, the curriculum management team was not sound, the teaching methods were single, and the curriculum evaluation method was traditional. Of 300 students, according to the results of the questionnaire survey of 183 people (61.00%) considered it necessary to offer the course general introduction to medical, 173 people (57.67%) were interested in an introduction to the general medical courses, only 116 people (38.67%) were satisfied with the current teaching method of the course, there were 148 people (49.33%) preferred teaching + case analysis, 234 people (78.00%) believed that the communities of practice content of the course arrangement was reasonable, 157 people (52.33%) were satisfied with the assessment method. Only 161 people (53.67%) believed that learning the course helped increase cognition and change perceptions. Conclusion Colleges and universities should further strengthen the course construction and teaching staff training in general medicine, innovation community-oriented teaching mode, adopt multiple integration of teaching design, build multivariate dynamic course evaluation and feedback mechanism, the concept into the stage of undergraduate education in general medicine curriculum construction, lay a foundation for the sustainable development of the general medicine.

Application effect of flipped teaching mode based on network platform in ultrasonic imaging teaching

LI Liang, ZHOU Wang, ZHANG Chao-xue, WANG Ji-nian

2021, 19(8): 1386-1389. doi: 10.16766/j.cnki.issn.1674-4152.002067

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Objective To explore the application effect of flipped teaching mode based on network platform in the teaching process of ultrasonic medicine during the coronavirus outbreak. Methods Two classes of sophomores selected randomly from the 5 classes majoring medical imaging from March to May 2020, which divided into control group (35 students) and observation group (35 students), were involved in this study. The 2 groups were respectively taught the same content with the same teacher. The control group was taught by the conventional teaching mode and the observation group was taught by the flipped class mode. In the observation group, the students independently studied the content arranged by the teacher before class, then played a leading role during online class with discussion and questioning. Meanwhile the teacher only responsible for answers and guidance. After class, the theoretical sore and the image recognition score were graded online and compared between the two groups to evaluate the learning outcome. The satisfaction degree with the teaching process were evaluated online and compared between the two groups. Comments and suggestions were also gathered after class. Results The theoretical score and the image recognition score in the observation group were higher than that in the control group with statistical significance (P < 0.05). The satisfaction degree was higher in the control than that in the observation group with statistical significance (P < 0.05). The two groups offered comments and suggestions on the teaching mode. Conclusion The flipped teaching mode based on the network platform has a good application effect in the course of ultrasonic imaging, which helps to improve the students' theoretical knowledge level and image discrimination ability. However, the teaching content and assessment methods need to match the teaching mode, and the technical support of the network platform still needs to adapt to the large-scale network teaching.

Buffering effect of trait mindfulness on the stress response and negative emotion caused by the new coronary pneumonia epidemic

QIU Xiao-ying, ZHANG Lin-na, CHU Cheng-jing

2021, 19(8): 1390-1394. doi: 10.16766/j.cnki.issn.1674-4152.002068

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Objective This study aimed to investigate the role of trait mindfulness as a buffer against negative emotions and stress responses in community populations during the COVID-19 epidemic. Methods Online questionnaire was used to investigate the demographic data from February 4, 2020 to March 18, 2020 of 354 community population, and the scores of Trait Mindfulness Inventory (MAAS), Stress Response Questionnaire (SRQ) and Depression-Anxiety Stress Inventory (DASS-21) were collected. The stress level and negative emotional status of different trait mindfulness groups were analysed, and the moderating effect of trait mindfulness on stress response was analysed by Process macro program. Results Amongst the 354 subjects, the rates of stress, anxiety and depression were 30.79%, 38.7% and 45.48%, respectively. The scores of trait mindfulness, stress response and negative emotion were 65.00 (57.00, 75.25), 48.00 (36.00, 68.00) and 52.00 (24.00, 80.00), respectively. Correlation analysis results showed that the characteristics of mindfulness and the total score of negative emotions and stress response were negatively correlated (r=0.554, 0.613, all P < 0.01); Negative emotions were positively correlated with the total score of stress reaction (r=0.768, P < 0.01). Moreover, the moderating effect showed that the interaction terms between trait mindfulness and depression (t=-2.248, P=0.025) and stress (t=-3.016, P=0.003) were significant, but the interaction terms between trait mindfulness and anxiety were not significant (t=-1.611, P=0.108). Conclusion Trait mindfulness is negatively correlated with stress response, negative emotion and its severity, and the severity of negative emotion decreases with the increase of trait mindfulness score. Stress plays a role in the high mindfulness between stress and depression.

Study on clinical nutrition quality service units via SWOT analysis

YANG Ting-ting, WANG Wen, YANG Yang, GUAN Ke, WANG Wei-xiang, XU Zhen, GAN Yong, SHEN Li-jun

2021, 19(8): 1395-1397. doi: 10.16766/j.cnki.issn.1674-4152.002069

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Abstract:
Objective To explore the application value of clinical nutrition quality service units, hoping to provide guidance for the establishment of efficient and standardised clinical nutrition service modes and accelerating the development of nutrition departments in hospital. Methods With the model of clinical nutrition quality service units developed by the Nutrition Department of Henan People's Hospital as an example, the strengths of, weaknesses of, opportunities for and threats to the development of clinical nutrition quality service units were analysed via SWOT (strengths, weaknesses, opportunities, and threats) analysis. Some suggestions to achieve this goal were proposed. Results The strengths of the development of clinical nutrition quality service units were the sense of belonging, work efficiency and service quality of nutritionists. The weaknesses were the shortage of nutrition department personnel, the lack of nutrition diagnosis instruments and inconsistency in nutrition diagnosis standards. An opportunity for the development of such units was the existence of a national health plan, which emphasises that the proportion of nutrition screening and malnutrition diagnosis and treatment of inpatients should be increased. Moreover, this plan offers guidance for the acceleration of rehabilitation in perioperative period by developing a multidisciplinary cooperation mechanism with the participation of nutrition departments. The threats were serious shortage of nutritionists, Some clinicians have insufficient knowledge of nutrition and patients nutrition awareness and the lack of nutrition awareness among patients and their families. Conclusion The establishment of high-quality clinical nutrition service units is important to the construction of nutrition departments and the development of rehabilitation centres. The factors that influence the establishment of such units are the shortage of personnel, the lack of instruments for nutrition diagnosis and diagnostic standards and the lack of knowledge and awareness on nutrition and wellness. Therefore, nutrition departments should gradually improve their operation standards of nutrition diagnosis and treatment. Moreover, they should intensify information and education campaigns on the importance of nutrition among patients and promote the further education of doctors. The hospital management department should pay more attentions to the nutrition department, increase medical investment in the nutrition department, expand the training of clinical nutrition professionals, introduce advanced nutrition diagnostic equipment and technologies, and provide good economic and technical support for the comprehensive promotion of nutrition therapy.

Analysis of clinical characteristics and risk factors of death in 51 AIDS patients with disseminated Talaromycosis marneffei in Wenzhou

WU Lian-peng, HE Gui-qing, HU Xing-zhong, PAN Yong, TANG Shao-hua

2021, 19(8): 1398-1402. doi: 10.16766/j.cnki.issn.1674-4152.002070

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Objective To understand the clinical characteristics of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou, and to statistically analyze the risk factors of death, so as to provide a basis for clinical diagnosis, treatment and reduction of mortality of patients with these diseases in this area. Methods The medical records of 51 AIDS patients with Talaromycosis marneffei treated in Wenzhou Central Hospital from January 2016 to May 2020 were collected. The epidemiological characteristics, clinical manifestations, laboratory and imaging examination results and treatment outcome of the patients were analyzed. According to the treatment outcome, the patients were divided into improvement group (42 cases) and death group (9 cases), and the risk factors of death were compared and analyzed. Results From 2016 to 2020, the number of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou area increased year by year, mainly in young adults (64.71%, 33/51). The most common clinical manifestations were fever and lymph node enlargement. The average number of CD4⁺ T lymphocytes in patients was 9(5, 19) cells/μL, of which 47 cases were less than 50 cells/μL (92.16%). The positive rates of G test and GM test were 70.00% (28/40) and 75.00% (30/40). 50 patients performed by chest CT examination were abnormal, the fatality rate was 17.65% (9/51). The analysis of influencing factors of death showed that the time from hospitalization to antifungal therapy in the death group was longer than that in the improvement group, and the rate of ART in the death group was significantly lower than that in the improvement group, the difference was statistically significant (P < 0.05). Conclusion The incidence of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou is increasing year by year. The CD4⁺ T lymphocyte count of the patients is often less than 50 cells/μL, and the clinical manifestations are diversified. Timely antifungal therapy and antiretroviral therapy can significantly reduce the mortality of the patients.

Process management of biological samples in phase Ⅰ clinical trials

ZENG Li-yan, WANG Qian, MENG Xian-min, KE Jing, DONG Hua-juan, LU Hong-zhou

2021, 19(8): 1403-1407. doi: 10.16766/j.cnki.issn.1674-4152.002071

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Objective The quality of biological sample management in phase Ⅰ clinical trials directly affects the authenticity and accuracy of clinical trial results. In recent years, the management of biological samples has become one of the research issues of great concern in China and abroad. This study established a process management system for biological samples in phase Ⅰ clinical trials, aiming to improve the quality and efficiency of biological samples and provide a reference for standardising biological sample management in phase Ⅰ clinical trials. Methods The experience from the standardisation and information requirements of biological sample management was summarised, and the procedures that affect the quality of biological samples in phase Ⅰ clinical trials, including personnel, labelling, reception, transfer, processing, equipment, materials, standard operating procedure (SOP), document management and sample information management, were described. Results A set of standardised process management system of biological samples has been established relying on biological sample information management system, temperature intelligent monitoring and alarm management system, professional sample management personnel, complete system and SOP to improve the quality of sample management. By the end of December 2020, it has been inspected on site by the National Medical Products Administration for 42 times and the provincial Medical Products Administration for 5 times, and exempted for inspection for 29 times, covering more than 60 drugs, all of which have passed the inspection successfully. Conclusion High-quality clinical biological samples are one of the core factors for the reliability, completeness and scientificity of phase Ⅰ clinical research data and results. The establishment of a standardised process of sample management system can improve the research quality of drug clinical trials, effectively prevent or reduce the occurrence of problems such as sample transportation, sample processing, in-and-out storage and daily management during the process management of biological samples, and ensure the accuracy, comparability and repeatability of drug clinical trial results.

Survey on awareness rate and coping strategies of osteoporosis risk factors among community residents in Bengbu area

WANG Tao, ZHANG Song, SUN Juan, MENG Jing-nan, CHEN Lin-jie

2021, 19(8): 1408-1410,1426. doi: 10.16766/j.cnki.issn.1674-4152.002072

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Objective To investigate the awareness status and related risk factors of osteoporosis among the community residents in Bengbu area, and provide theoretical basis and experience for the extensive development of health education in this area and the reduction and prevention of osteoporosis in community residents. Methods Questionnaire about osteoporosis knowledge and risk factors was used to conduct a random survey among community residents in Bengbu area from January 2019 to December 2020. The survey content includes basic characteristics (gender, age, height, weight, etc.), "Major Risk Factors of Osteoporosis" and "IOF Osteoporosis Risk One-minute Test Questions". SPSS 19.0 statistical software was used for data analysis. Results A total of 540 valid questionnaires were completed. Men and residents over 60 years of age were less willing to participate in the survey, 37.78% and 5.01%, respectively. The awareness rate of risk factors such as low weight, smoking, and low-age menopause was low, which were 9.63%, 17.59%, and 13.51%, respectively. Risk factors such as low physical activity, smoking, and high-sodium diet were relatively high among community residents, which were 73.33%, 11.85%, and 14.07%, respectively. Conclusion Community residents in Bengbu area do not have comprehensive knowledge of osteoporosis. On the one hand, it is necessary to increase publicity and education to improve the awareness rate of osteoporosis and its risk factors, on the other hand, for the residents who already have risk factors, it is also necessary to carry out bone mineral density testing, early diagnosis and early treatment, especially to prevent the occurrence of brittle fracture.

The effect of oral lidocaine hydrochloride mucilage combined with sodium phosphate in colonoscopy

CHAI Xian-deng, LI Lun-lan, YANG Gui-fang, LI Yang, SUN Bin

2021, 19(8): 1411-1414,1432. doi: 10.16766/j.cnki.issn.1674-4152.002073

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Abstract:
Objective To explore the application effect of oral lidocaine hydrochloride mucilage combined with sodium phosphate solution in bowel preparation in common colonoscopy and to improve the efficiency and quality of colonoscopy. Methods Total 293 patients who underwent general colonoscopy in our hospital from April to June 2020 were enrolled and randomly divided into two groups according to the random number table method, including 145 cases in the experimental group and 148 cases in the control group. The patients in the control group used the traditional method of taking sodium phosphate in two doses for bowel preparation. The patients in the experimental group were given 20 mL lidocaine hydrochloride mucilage 4-6 hours before the examination on the basis of the control group. Morisky Medication Compliance Scale, Boston Bowel Intestinal Preparation Scale, Bubble Score, and Pain Numerical Score were used to compare the medication compliance, cleanliness of intestinal preparation, intestinal bubble score, and the degree of pain during the examination between the two groups of patients. Results There were no significant difference in medication compliance, intestinal cleanliness, pain degree, and polyp detection rate between the two groups of patients (all P>0.05). The score of the intestinal bubble score of the test group was (2.57±0.69) points, which was higher than the score of the control group [(2.24±0.78) points], and the difference was statistically significant (t=3.833, P < 0.001). The time to withdraw the lens in the experimental group was (6.82±1.23) minutes, which was less than (7.88±1.77) minutes in the control group, and the difference was statistically significant (t=5.941, P < 0.001). Conclusion The intestinal preparation method of oral lidocaine hydrochloride mucilage combined with sodium phosphate can effectively reduce the amount of bubbles in the intestine, shorten the time of colonoscopy, and improve the efficiency and quality of colonoscopy.

Study on the effect of cluster nursing on quality of life of elderly patients with osteoporosis

YU Fang-zhen, WU Xiao-xia, JIANG Xin-hua

2021, 19(8): 1415-1418. doi: 10.16766/j.cnki.issn.1674-4152.002074

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Objective To observe the effect of cluster nursing on elderly patients with osteoporosis. Methods Total 110 elderly patients with osteoporosis in Zhejiang Quhua Hospital from October 2017 to October 2020 were selected as the research objects and randomly divided into control group and study group, with 55 cases in each group. The control group received routine nursing intervention, while the study group received cluster nursing intervention. Visual analogue scale (VAS) was used to evaluate the degree of pain reaction before and after nursing. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the psychological status of anxiety and depression before and after nursing. World Health Organization Quality of life scale (WHOQOL-100) was used to evaluate the quality of life before and after nursing, and the satisfaction level of patients with nursing measures was investigated. Results The VAS score of the study group [(3.46±0.49) points] was significantly lower than that of the control group [(4.93±0.57) points, t=14.336, P < 0.001]. HAMA score [(9.41±1.05) points] and HAMD score [(10.63±1.18) points] in the study group were significantly lower than those in the control group [(12.57±1.39) points and (14.49±1.63) points, t=13.684, 14.221, all P < 0.001]. The overall scores of life field, psychological field, independence field, social relationship field, environment field, spiritual support/personal belief/religion field and quality of life in the study group were significantly higher than those in the control group (all P < 0.001). The overall nursing satisfaction of the study group (98.18%) was significantly higher than that of the control group (85.45%, χ²=4.356, P=0.037). Conclusion Cluster nursing mode can effectively relieve the pain reaction of elderly patients with osteoporosis, improve the mental health of patients, and improve the quality of life and nursing satisfaction of patients.

Observation on the application effect of continuing care based on WeChat platform in patients with gastrointestinal tumors using PICC

HUANG Xiao-qin, LYU Dong-lai, ZHOU Li-mei

2021, 19(8): 1419-1422. doi: 10.16766/j.cnki.issn.1674-4152.002075

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Objective To explore the application effect of WeChat platform in PICC continuous care for patients with gastrointestinal cancer chemotherapy. Methods The 102 patients with PICC intubation gastrointestinal tumors in our hospital from October 2017 to October 2019 were divided into observation group and control group by random number table, with 51 cases in each. The control group was given conventional nursing mode, and the observation group provided professional guidance on the WeChat platform for continuous nursing intervention on the basis of control. A total of 16 weeks of intervention were conducted to observe the catheter indwelling time of the two groups of patients and the expected incidence of complications throughout the intervention. After the intervention, the satisfaction was investigated, and the self-management ability of the two groups before and after intervention was analyzed. Results The catheter indwelling time in the observation group [(167±32) days] was significantly longer than that in the control group [(121±25) days]. The PICC-related complications of the observation group were phlebitis (P=0.038), displacement and blockage (P=0.029), infection (the incidence of P=0.046) were lower than that of the control group. Patients in the observation group had a higher level of service attitude (P=0.035), technical level (P=0.025), degree of concern (P=0.008), content and frequency of publicity and education (all P < 0.001). Satisfaction was higher than that of the control group. The self-management ability of patients in the observation group was significantly improved before and after the intervention (P < 0.001). After the intervention, the self-management ability of patients in the observation group was also better than that of the control group (P < 0.001). Conclusion The use of WeChat platform in continuing care is beneficial for cancer patients to know PICC-related knowledge, can avoid related complications, and improve the satisfaction of patients and their families and the patients' self-intervention ability.

Application of the concept of rapid rehabilitation surgery in perioperative nursing of knee arthroscopy

MA Man-li, SHU Gui-lin, LIU Jun, HE Ke-wu, DU Yi-bin

2021, 19(8): 1423-1426. doi: 10.16766/j.cnki.issn.1674-4152.002076

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Objective To explore the application effect of rapid rehabilitation concept in perioperative nursing of knee arthroscopic surgery. Methods A total of 66 patients undergoing knee arthroscopic surgery in Hefei BOE Hospital from April 2019 to August 2020 were randomly divided into the observation group (33 cases, the concept of routine nursing + rapid rehabilitation) and the control group (33 cases, routine nursing). The preoperative basic information (including age, gender, pain and knee joint activity, etc.), postoperative complication rate, pain score (VAS score), range of motion score (HSS score), length of hospital stay and nursing satisfaction of the two groups were compared to explore the application effect of rapid rehabilitation concept in perioperative nursing of knee arthroscopy. Results Compared with the control group, the incidence of postoperative complications in the observation group was lower (0.00% vs. 18.18%, P < 0.05), and postoperative knee pain was significantly reduced [(0.67±0.65) points vs. (2.67±0.48) points, P < 0.05]. The average length of stay in the observation group was shorter than that in the control group [(5.84±0.71) d vs. (11.90±1.42) d, P < 0.05], and the range of motion after knee joint surgery was better [(92.48±2.42) points vs. (79.27±2.85) points, P < 0.05]. The satisfaction of the observation group was significantly higher than that of the control group during hospitalization (P < 0.05). Conclusion The application of rapid rehabilitation nursing can reduce the incidence of postoperative complications in patients undergoing knee arthroscopy, reduce postoperative pain and the average length of stay, improve knee joint activity and increase patient satisfaction.

2021, 19(8): 1427-1429. doi: 10.16766/j.cnki.issn.1674-4152.002077

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2021, 19(8): 1430-1432. doi: 10.16766/j.cnki.issn.1674-4152.002078

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Abstract:

Effect of myosin light chain regulated by cardiac myosin light chain kinase on cardiac hypertrophy

HE Mingyuan, GE Junfeng, HUANG Ling, WANG Shixiang, YAN Yi

2021, 19(8): 1257-1261, 1402. doi: 10.16766/j.cnki.issn.1674-4152.002034

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Objective To investigate the effect of cardiac myosin light chain kinase (cMLCK) on the pathological cardiac hypertrophy induced by AngⅡ. Methods The cMLCK was purified and the active sites of cMLCK were explored in vitro. Wild type cMLCK (WT cMLCK) and its N-terminal knockout variants (ΔNT-cMLCK) adenovirus were prepared. The primary cardiomyocytes were infected and randomly divided into 6 groups: control group, AngⅡ group, WT cMLCK group, WT cMLCK+AngⅡ group, Δ NT cMLCK group, Δ NT cMLCK+AngⅡ group, 3 samples in each group. The expression of ANP and β-MHC, which are the heart failure relative factor, was detected by RT-PCR. The expression of cMLCK and MLC2v were detected by western blot. The area of cardiomyocytes was detected by immunofluorescence. Results WT-cMLCK could phosphorylated MLC2v effectively, which was abrogated in ΔNT-cMLCK. After treated with AngⅡ, the cell area [(1 787.0±142.6) μm² vs. (2 458.0±211.3) μm², P < 0.001] and expression of ANP and β-MHC in neonatal rat cardiomyocyte (NRCM) increased (all P < 0.05). The expression of cMLCK and p-MLC2v were upregulated (all P < 0.05). However, the cardiac hypertrophy induced by AngⅡ was reversed by WT-cMLCK overexpression [(2 527.0±116.4) μm² vs. (1 775.0±88.5) μm², P < 0.001], while ΔNT-cMLCK overexpression group lost its protective effect [(1 775.0±88.5) μm² vs. (2 613.0±118.4) μm², P < 0.001]. Conclusion The protective effect of cMLCK to pathological cardiac hypertrophy induced by AngⅡ depends on its N terminal.

Relationship between fasting triglyceride glucose index and arteriosclerosis in patients with essential hypertension

ZENG Rong, YAN Jiafu, ZHENG Keyang, WANG ZAuoguang, QU Fengxue, MU Yifan, CHENG Wenli

2021, 19(8): 1262-1264, 1286. doi: 10.16766/j.cnki.issn.1674-4152.002035

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Objective To study the ambulatory blood pressure and brachial-ankle pulse wave velocity (ba-PWV) in essential hypertension patients with different fasting triglyceride glucose index (TyG index) groups, and to explore the correlation between TyG index and ba-PWV. Methods This retrospective study selected 466 inpatients with essential hypertension from August 2014 to December 2015. According to TyG index, the patients were divided into three groups by trisection. The differences of ambulatory blood pressure and ba-PWV among the three groups were compared, and the influencing factors of ba-PWV were analyzed by multiple linear regression model. Results With the increase of TyG index, the ratios of hyperlipidemia and diabetes of the patients raised, the average BMI increased, and the levels of total cholesterol, triglyceride, low density lipoprotein cholesterol, uric acid and fasting blood glucose evaluated gradually. The average systolic and diastolic blood pressure of 24 hours in the highest TyG index group were significantly higher than those in the lowest TyG index group [(132.3±14.8) mm Hg vs. (127.0±14.9) mm Hg, P=0.003; (81.1±11.8) mm Hg vs. (77.8±11.5) mm Hg, P=0.038], the average heart rate of 24 hours in the highest TyG index group was significantly higher than that in the lowest TyG index group (P=0.002). Ba-PWV was significantly higher in the highest TyG index group than that in the lowest TyG index group [(1 734.6±908.1) cm/s vs. (1 560.2±312.5) cm/s, P=0.022]. Multiple linear regression analysis showed that age, 24-hour systolic blood pressure and TyG index were the affecting factors of ba-PWV. Conclusion TyG index was positively correlated with blood pressure, heart rate and ba-PWV. It can be used to predict atherosclerosis in clinical practice.

Analysis of risk factors for delayed discharge of patients undergoing day surgery for urinary stones

QIU Ling, LIU Chunxiang, ZHU Wei, ZHONG Wen, ZHEN Yuling, HAO Fengling

2021, 19(8): 1265-1268. doi: 10.16766/j.cnki.issn.1674-4152.002036

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Objective To explore the risk factors delayed discharge of patients undergoing day surgery for urinary stones. Methods The electronic medical records of 749 patients undergoing day surgery for urinary stones in the First Affiliated Hospital of Guangzhou Medical University in 2019 were retrospectively collected. Patients were divided into delayed discharge group (71 cases) and normal discharge group (678 cases). The general data, 1 hour postoperative vital signs and common hematological indexes were compared between the two groups. Logistic regression analysis was used to explore the risk factors of patients' delayed discharge. Results The incidence of delayed discharge of patients undergoing day surgery for urinary stones was 9.5%. Logistic regression analysis showed that age (OR=3.209, 95% CI: 1.621-6.352, P=0.001), PCNL treatment (OR=2.212, 95% CI: 1.290-3.793, P=0.004), temperature (OR=4.363, 95% CI: 1.967-9.682, P < 0.001), neutrophil ratio (OR=1.973, 95% CI: 1.156-3.370, P=0.013), hemoglobin (OR=2.776, 95% CI: 1.170-6.582, P=0.020) and serum potassium (OR=2.680, 95% CI: 1.162-6.177, P=0.021) were independent risk factor for patients' delayed discharge. Conclusion Patients with advanced age, undergoing PCNL, 1 hour postoperative temperature>38 ℃, neutrophil ratio>70%, hemoglobin < 90 g/L and hypokalemia have an increased risk of delayed discharge. Medical workers should focus on and respond in time to reduce the risk of day surgery and improve their quality and safety.

Analysis of influencing factors of pain in patients after oocyte retrieval of in vitro fertilization-embryo transfer

LUO Guiying, WANG Jieyu, WANG Chunyan, SONG Linlin, YUAN Lanlan, CAO Yunxia

2021, 19(8): 1269-1272,1321. doi: 10.16766/j.cnki.issn.1674-4152.002037

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Objective To explore the influencing factors of pain after transvaginal aspiration for oocyte retrieval, and to provide theoretical basis for clinical analgesia intervention. Methods A total of 755 patients who underwent in vitro fertilization-embryo transfer vaginal puncture for oocyte retrieval in the Reproduction Center of the First Affiliated Hospital of Anhui Medical University from April to July 2020 were selected. The scores of their self-rating anxiety scale and self-rating depression scale were evaluated at 20:00 on trigger day. The numeric rating scale was used to evaluate the pain degree at 30 minutes and 1 hour after oocyte retrieval, and the adverse reactions such as nausea and vomiting were recorded at 30 minutes after operation. The pain degree at 6, 12 and 24 hours after surgery was followed up by telephone with numeric rating scale. Univariate ordered multiple logistic regression analysis and multivariate ordered multiple logistic regression analysis were used to investigate the influencing factors of pain. Results Univariate ordered multi-classification logistic regression analysis showed that age years, family per capita monthly income, pethidine hydrochloride analgesia, operation time, number of follicles obtained and total ovarian volume were the potential influencing factors of postoperative pain (all P < 0.05). Multivariate ordered multi-classification logistic regression analysis showed that the number of follicles obtained (OR=0.692, 95% CI: -0.784 to -0.048), ovarian volume (< 2 000 mm³, OR=0.252, 95% CI: -1.846 to -0.908; 2 000-3 999 mm³, OR=0.632, 95% CI: -0.803 to -0.113) were the influencing factors of postoperative pain (all P < 0.05). Conclusion The greater the number of follicles obtained (≥ 20) and the larger the ovarian volume (≥ 4 000 mm³), the more intense the pain may be. Controlling the number of follicles and the volume of ovaries during superovulation may reduce pain in patients.

Comparison of the effect of resin and high-strength fiber periodontal splints in repairing periodontitis with loss of teeth

ZHANG Lei, LIU Yi, LI Guomin, CHEN Chunhui, LI Xiaofang

2021, 19(8): 1273-1276. doi: 10.16766/j.cnki.issn.1674-4152.002038

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Objective To explore the repair effect of resin splint and high-strength fiber periodontal splint in patients with periodontitis and tooth loss, in order to improve the reference for the choice of clinical treatment. Methods Total 86 patients with periodontitis and missing teeth admitted to Jinhua Central Hospital from August 2016 to December 2019 were selected and divided into control group and observation group according to the random number table method, with 43 patients in each group. The control group was treated with resin splint and the observation group was treated with high strength fiber periodontal splint. The clinical efficacy of patients, the levels of soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-1 (IL-1), procalcitonin (PCT), osteocalcin (OPG), alkaline phosphatase (ALP), runt-related transcription factor 2 (Runx2), osteocalcin (OCN), complications and patient satisfaction were compared between the two groups. Results The total effective rate of the observation group [95.35% (41/43)] was significantly higher than that of the control group [79.07% (34/43), P < 0.05)]. After treatment, the levels of sICAM-1, IL-1β and PCT in the observation group were significantly lower than those in the control group, and the levels of OPG, ALP, Runx2 and OCN in the observation group were significantly higher than those in the control group (all P < 0.05). After treatment, the total incidence of complications in the observation group [9.30% (4/43)] was significantly lower than that in the control group [27.91% (12/43), P < 0.05], there was no statistically significant difference in total satisfaction between the two groups (P=0.058). Conclusion The clinical efficacy of high-strength fiber periodontal splint in the treatment of periodontitis combined with tooth loss is better than resin splint, which can effectively reduce the inflammatory response of patients, ameliorate bone metabolism and periodontal tissue, and the patients have a high degree of satisfaction.

Analysis on risk factors of anastomotic leakage after anterior resection for rectal cancer

WANG Shuanhu, LIU Yakui, SHI Yi, GUAN Jiajia, LIU Mulin

2021, 19(8): 1277-1279. doi: 10.16766/j.cnki.issn.1674-4152.002039

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Objective With the application of total mesorectal excision (TME), the long-term effect of rectal cancer has been greatly improved. However, the incidence of postoperative anastomotic leakage of rectal cancer is not significantly reduced, so it is very important to explore the risk factors of postoperative anastomotic leakage of rectal cancer. Methods A retrospective case-control study was conducted to analyze the cases of anterior resection for rectal cancer in Department of Gastrointestinal Surgery, of the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2019. According to the occurrence of anastomotic leakage, the patients were divided into anastomotic leakage group (38 cases) and non-anastomotic leakage group (395 cases). Univariate and multivariate analysis were carried out to explore the risk factors of anastomotic leakage. Results Anastomotic leakage occurred in 38 patients (9.62%) of 395 patients with rectal cancer who underwent anterior resection. Chi-square test showed that gender (P=0.005) and the number of distal rectal cut closure (P=0.031) were significantly associated with anastomotic leakage. Multivariate logistic regression analysis revealed that male (OR=3.145, 95% CI: 1.344-7.356, P=0.008) and more than 2 staples of distal rectal cut closure (OR=2.083, 95% CI: 1.026-4.229, P=0.042) were independent risk factors for anastomotic leakage. Conclusion The incidence of anastomotic leakage in patients undergoing anterior resection is 9.62%. The high risk factors for anastomotic leakage are male and more than 2 staples of distal rectal cut closure. In order to reduce the occurrence of anastomotic leakage, it is helpful to reduce use frequency of staples of distal rectal cut closure.

Effect of periodontal basic treatment on liver function and lipid levels in periodontitis patients with non-alcoholic fatty liver disease

DING Cheng, MA Yuzhuo, HUANG Xingzhao, HUANG Jinping, ZHONG Liangjun, CHEN Xing

2021, 19(8): 1280-1282, 1299. doi: 10.16766/j.cnki.issn.1674-4152.002040

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Objective To evaluate the effects of periodontal basic treatment on liver function and lipid levels in periodontitis patients with non-alcoholic fatty liver disease (NAFLD). Methods Thirty moderate or severe periodontitis cases with NAFLD were selected from July 2018 to June 2019 in Department of Periodontics, Affiliated Hospital of Hangzhou Normal University. All enrolled patients were treated with periodontal basic treatment. Periodontal clinical index, lipid levels and liver function examination were determined at baseline and 3 months after treatment. Paired t test was used to compare the data. Results Compared with periodontal basic treatment, the periodontal probing depth decreased from (3.76±0.46) mm to (2.30±0.37) mm, the clinical attachment level decreased from (4.90±0.48) mm to (3.90±0.49) mm, and the percentage of bleeding on probing decreased from (88.93±5.05) % to (20.47±5.98) %. Meanwhile, the alanine aminotransferase decreased from (61.60±12.07) U/L to (45.82±11.82) U/L, and the aspartate aminotransferase decreased from (54.71±11.20) U/L to (44.87±11.36) U/L. In addition, total cholesterol reduced from (5.63±0.24) mmol/L to (5.23±0.24) mmol/L, triacylglycerol decreased from (1.90±0.10) mmol/L to (1.63±0.13) mmol/L, low-density lipoprotein decreased from (2.78±0.30) mmol/L to (1.78±0.43) mmol/L, and high-density lipoprotein increased from (1.25±0.05) mmol/L to (1.39±0.06) mmol/L. Conclusion Periodontitis patients with NAFLD can obtain good clinical efficacy through periodontal basic treatment, which not only significantly improves their periodontal status, but also improves their liver function and blood lipid level. Therefore, periodontal basic treatment may be one of the treatment approaches for periodontitis patients with NAFLD.

Effect of Ginkgo biloba extract on bFGF/Notch1 pathway in hippocampus of rats models with Alzheimer's disease

ZHAO Ping, LI Xin, CUI Jing, XIA Xiaoshuang, TIAN Wenjie

2021, 19(8): 1283-1286. doi: 10.16766/j.cnki.issn.1674-4152.002041

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Objective To explore the mechanism of Ginkgo biloba extract (GBE) in repairing AD rats' neurons related to Aβ25-35. Methods According to the random method, 60 rats meeting the requirements were divided into model group, normal control group, sham operation group, Ginkgo biloba experimental group (high, medium, low), 10 rats in each group. Model was built by intrathecal injection of Aβ25-35. All rats were studied by testing the memory and learning abilities were tested by Morris water maze. The expression levels of RBP-JK, Hes1, bFGF and Notch1 protein in hippocampus were detected by immunoblotting method. Results The time of finding platform in the AD model group [(60.190±3.821) s] was significantly longer than that in the normal control group (P < 0.01), and the frequency of finding the original platform position (4.310±2.057) was significantly reduced (P < 0.01). Compared with the model group, the time of finding the platform for the first time in the Ginkgo biloba high, middle and low dose groups were significantly reduced (P < 0.05), and the number of crossing platform was significantly more than that in the model group (all P < 0.01). The expression of bFGF (0.542±0.036), Notch1 (0.185±0.032) and Hes1 (0.153±0.022) in the model group were significantly decreased, while RBP-JK protein expression (0.800±0.047) was significantly increased (all P < 0.01). The protein expression of bFGF, Notch1 and Hes1 in the hippocampus of the Ginkgo biloba extract high, middle and low group were higher than that in the model group (all P < 0.05), while the protein expression of RBP-JK was decreased (all P < 0.05). Conclusion Ginkgo biloba extract may promote the expression of Notch1, bFGF and Hes1 and inhibit the expression of RBP-JK by activating the Notch pathway, thereby improving the learning ability and memory ability of AD rats.

Correlation between ApoE genotype and carotid atherosclerosis and cerebral infarction

HUANG Liu, DAI Xinyu, TIAN Xue, YAO Jingqing, DAI Yue, LI Yunlao

2021, 19(8): 1287-1291. doi: 10.16766/j.cnki.issn.1674-4152.002042

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Objective To study the correlation between apolipoprotein E (ApoE) genotype and the stability and location of carotid atherosclerotic plaque and cerebral infarction. Methods Total 275 patients from the Second Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2019 were divided into three groups according to the results of carotid ultrasound examinations: control group (88 cases), stable plaque group (71 cases) and unstable plaque group (116 cases). The ApoE genotype and blood lipid were determined. Patients with carotid atherosclerosis were inspected using head MRI. CAS patients were divided into the cerebral infarction group and no cerebral infarction group according to the MRI results. Results (1) The frequencies of ε2, ε3 and ε4 genes in the population were 10.7%, 78.2% and 11.1%, respectively, which conform to the law of genetic balance. (2) Significant differences were observed in the genotype distribution (P=0.008) between the unstable plaque group and the control group, and ε3/ε4 genotype (OR=3.115, 95% CI: 1.314-7.388) was more likely to lead to unstable plaques than the ε3/ε3 genotype. (3) The ApoE genotype had no significant relationship with the location of carotid plaque (χ²=3.190, P=0.527). (4) ε2 carriers (χ²=4.285, P=0.038) were less likely to have cerebral infarction than non- ε2 carriers with carotid atherosclerosis. (5) The ε2 allele was a protective factor for cerebral infarction in CAS patients after adjusting for age, sex, hypertension and diabetes (P=0.023, OR=0.352, 95% CI: 0.144-0.865). Conclusion The ε3/ε4 genotype may be a risk factor for the formation of unstable carotid atherosclerotic plaque. The ApoE genotype is not related to the location of carotid atherosclerotic plaque. The ε2 allele is a protective factor for cerebral infarction in CAS patients.

Expression of microRNA-1246 in the serum of hepatocellular carcinoma and its effect on biological function of HepG2 cells

WANG Pan, WANG Yichao, YU Dandan, CHEN Wenju, ZHONG Qianyi, TONG Binxin

2021, 19(8): 1292-1295,1313. doi: 10.16766/j.cnki.issn.1674-4152.002043

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Objective To investigate the expression of microRNA-1246 (miR-1246) in hepatocellular carcinoma (HCC) serum and its effect on the biological function of HepG2 cells. Methods Serum miR-1246 was determined by qRT-PCR in HCC patients and healthy controls. MiR-1246 mimics and NC mimics were transfected into HepG2 cells separately. The effect of miR-1246 on the biological function of HepG2 cells was examined by transwell chamber assay, scratch test and cell clone formation test. The expression of NFE2L3, Vimentin and GAS1 were detected by qRT-PCR. Results The expression levels of miR-1246 in the serum of healthy controls and HCC patients were 1.079 (0.740, 1.534) and 0.132 (0.068, 0.324), respectively, and the difference was statistically significant (P < 0.001). After transfection of miR-1246 mimics into HepG2 cells, the number of HepG2 cells passing through matrigel was (128.000±9.900), which was significantly lower than that of the NC mimic group (251.500±24.749, P=0.023). Forty-eight hours after scratch, the relative mobility of HepG2 cells was (24.833±3.351) %, which was significantly lower than that in the NC mimic group (31.859±7.194) % (P=0.046). The relative expression levels of Vimentin, GAS1 and NFE2L3 were (0.318±0.213), (0.479±0.157) and (0.755±0.044), respectively, which were significantly lower than those in the NC mimic group (P=0.046, P=0.043 and P=0.030, respectively). Conclusion The expression levels of miR-1246 were decreased in HCC serum. MiR-1246 could inhibit the invasion and migration of HepG2 cells by down-regulating the expression of Vimentin, GAS1 and NFE2L3.

HAN Shuai, ZHAO Yu-peng, ZHOU Ping-hui, XIAO Yu-zhou

2021, 19(8): 1296-1299. doi: 10.16766/j.cnki.issn.1674-4152.002044

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Objective To investigate and analyse the related risk factors of poor incision healing after operation for lumbar closed fracture. Methods A total of 342 patients with closed lumbar fracture who were admitted to the department of orthopaedics in the First Affiliated Hospital of Bengbu Medical College from May 2017 to May 2020 were included in the study. The incidence of poor incision healing and related risk factors were studied and analysed retrospectively. Results (1) Among the 342 patients, 28 cases had poor incision healing, with an incidence of 8.2%. Univariate analysis showed that gender, the length of incision, use of electric knife, use of antibiotics before and after the operation and drainage time of the drainage tube had no effect on postoperative incision healing, and the difference was not statistically significant (all P>0.05). Age of >45 years, operation time of >3 h, diabetes, hypertension, BMI of >28 and waist and back fat thickness of >3 cm were significantly correlated with poor wound healing after operation. (2) Multi-factor logistic regression analysis showed that age, operation time, diabetes, hypertension, body mass index and low back fat thickness were independent risk factors for poor incision healing after operation for lumbar closed fracture when poor wound healing was used as a dependent variable. (3) Among the 28 patients with poor wound healing, incision infection was the most common, accounting for 57.14%. Staphylococcus aureus was the most common infection bacteria, accounting for 37.5%. Conclusion Patients' age, operation time, diabetes, hypertension, body mass index and low back fat thickness are the risk factors for poor incision healing after lumbar closed fracture operation.

Clinical study of thromboelastography in the diagnosis of traumatic coagulopathy after craniocerebral injury

ZHNAG Zhi-hua, YU Guo-feng

2021, 19(8): 1300-1302,1329. doi: 10.16766/j.cnki.issn.1674-4152.002045

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Objective To observe the clinical effect and prognostic value of thromboelastography (TEG) in the diagnosis of traumatic coagulopathy after craniocerebral injury. Methods Total 200 patients with acute craniocerebral injury in our hospital were selected as the research objects from December 2018 to February 2021. All patients were detected by routine coagulation test and TEG test. The detection of traumatic coagulopathy by routine coagulation test and TEG test at different time after craniocerebral injury was statistically analyzed. The TEG indexes of patients with craniocerebral injury at different time and different prognosis levels were compared, and the related risk factors of death in patients with traumatic coagulopathy were analyzed. Results ]The detection rate of TEG in 4 hours and 12 hours of traumatic coagulopathy (34.50% and 63.00%) after craniocerebral injury was significantly higher than that of conventional coagulopathy (18.50% and 40.50%, χ²=13.143, 20.275, P < 0.001), and the incidence of traumatic coagulopathy in patients with severe craniocerebral injury (84.81%) was significantly higher than that in patients with non-severe craniocerebral injury (48.76%, χ²=26.647, P < 0.001). The R and K values at 12 h after injury were significantly higher than those at 4 h after injury, while the angle and Ma values were significantly lower than those at 4 h after injury (P < 0.001). There was no significant difference between the R value of the dead patients and the survival patients (t=1.583, P=0.116), but the K value was significantly higher than the survival patients, and the angle value and MA value were significantly lower than the survival patients (P < 0.001). The MA value was the related risk factor of death in patients with traumatic coagulopathy. Conclusion TEG detection can dynamically monitor the early changes of coagulation function in patients with craniocerebral injury, effectively identify the occurrence of traumatic coagulopathy, and can be used for early evaluation of prognosis of patients with traumatic coagulopathy after craniocerebral injury.

Clinical efficacy of dapagliflozin in the treatment of type 2 diabetes mellitus

SUN Wei, WANG Fei, YANG Guang-shu, YU Ying

2021, 19(8): 1303-1305. doi: 10.16766/j.cnki.issn.1674-4152.002046

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Objective To observe the clinical therapeutic effect, safety and tolerance of dapagliflozin combined with premix insulin in treatment for type 2 diabetes mellitus with poor glucose control. Methods Total 60 patients with type 2 diabetes mellitus with poor glycemic control treated with oral insulin aspartate 30 and metformin were treated in Huaibei People's Hospital from January 2019 to March 2020 were divided into 2 groups, 30 cases in each group according to the clinical treatment. The observation group received the treatment of dapagliflozin combined with insulin aspart 30 and metformin, and the control group was only treated with insulin aspart 30 and metformin. Two groups of the patients adjust insulin dose according to the level of plasma glucose. The patient's fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), hemoglobin A1c (HbA1c), plasma glucose controlling time, insulin doses, presence of hypoglycemic events, weight change and adverse reaction were recorded. Results After 12 weeks of treatment, the fasting plasma glucose, 2-hour postprandial blood glucose and hemoglobin A1c in the two groups were lower than before treatment (P < 0.05). Fasting plasma glucose (6.60±0.52) mmol/L, plasma glucose controlling time (6.67±1.60) d, insulin dosage (40.17±7.01) U/d and body mass index (23.41±2.11) in the observation group were lower than the control group (P < 0.05). Two patients in the observation group had hypoglycemia, while eight patients in the control group had hypoglycemia. The incidence of hypoglycemia in the control group was higher than that in the observation group. There was statistical difference between the two groups (P < 0.05). Conclusion The clinical efficacy of dapagliflozin combined with premix insulin is significant in the treatment of type 2 diabetes. It has the advantages of weight loss, good safety and tolerance.

Observation of curative effect of bevacizumab combined with targeted treatment of EGFR mutant lung cancer

JIANG Yi-ling, ZHANG Chuan-ling, CHEN Cheng, YU Hong-jin, LI Wei-na, FANG Jing, FANG Yong

2021, 19(8): 1306-1309. doi: 10.16766/j.cnki.issn.1674-4152.002047

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Objective To investigate the effect of bevacizumab combined with targeted therapy on the short- and long-term prognosis, immune status, and side effects of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC), in order to provide reference for the choice of clinical treatment. Methods A total of 80 EGFR-mutant NSCLC patients who were diagnosed and treated in our hospital from September 2017 to September 2018 were selected and divided into control group and observation group according to the random number table method, with 40 cases in each group. The control group was treated with icotinib hydrochloride tablets, and the observation group was treated with bevacizumab combined with icotinib hydrochloride tablets. The clinical efficacy, tumor marker levels, and immune index levels were compared between the two groups of patients, and the survival and toxicity of the two groups were compared. Results The disease control rate (DCR) of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the levels of vascular endothelial growth factor (VEGF), carbohydrate antigen 125 (CA125), and cytokeratin 19 fragment (CYFRA21-1) in the two groups were significantly lower than those before treatment, and the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of CD3⁺, CD4⁺/CD8⁺ in the two groups were significantly higher than those before treatment, and the observation group were significantly higher than those in the control group (P < 0.05). The survival of patients in the observation group was better than that of the control group (P < 0.05). The total incidence of side effects in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion Bevacizumab combined with icotinib hydrochloride in the treatment of EGFR mutant NSCLC patients has a significant effect, which can effectively inhibit the proliferation of tumor cells, reduce the tumor volume, improve the body's immune function, and improve the survival rate of patients.

Effect of ultrasound-guided iliac fascia nerve block on hemodynamics and stress response in elderly patients with proximal femoral fracture

ZHU Jian-guo, ZHANG You-chuan, FENG Yi-cheng, ZHU Jun-jian, ZHAN Lin-sen

2021, 19(8): 1310-1313. doi: 10.16766/j.cnki.issn.1674-4152.002048

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Objective To analyze the application of ultrasound-guided iliac fascia nerve block in the anesthesia of elderly patients with proximal femoral fracture and its effect on hemodynamics and stress response. Methods Eighty-two cases of elderly patients with proximal femoral fracture in our hospital from March 2019 to December 2020 were selected and randomly divided into group A and group B, 41 cases in each group. Group A was given general anesthesia, and group B was given ultrasound-guided iliac fascia nerve block combined with general anesthesia. The hemodynamic indexes, stress reaction, anesthetic effect and adverse reactions of the two groups were compared. Results The arterial pressure of group B after laryngeal mask insertion [(94.70±3.83) mm Hg], 5 min after operation [(96.64±4.05) mm Hg] and at the end of operation [(98.10±3.16) mm Hg] were higher than those of the group A, and the heart rate (88.98±5.54) times/min, (84.17±3.86) times/min, (79.76±4.02) times/min were lower than that of group A (P < 0.05). The postoperative serum cortisol, atrial natriuretic peptide, plasma epinephrine and norepinephrine of group B (11.85±1.72) μg/dL, (0.28 ± 0.02) nmol/L, (37.13±5.95) ng/L, (154.71±45.87) ng/L were lower than those of group A (P < 0.05). The dosage of propofol, recovery time and extubation time of group B (413.03±66.19) mg, (9.86±1.62) min, (12.58±2.79) min were less than those of group A (P < 0.05). The incidence of adverse reactions of group B (7.32%) was lower than that of group A (24.39%), P < 0.05. Conclusion Iliac fascia nerve block under ultrasound has little effect on hemodynamics and stress reaction in elderly patients with proximal femoral fracture, and has good anesthetic effect and less adverse reactions, which is worthy of application.

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2021 Vol. 19, No. 8

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