2021 Vol. 19, No. 9

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Expert Forum
Application of artificial intelligence applications in general practice
YUAN Bo, DAI Hua, WU Jia, FU Wen-jun, WEN Juan, ZHAO Qian
2021, 19(9): 1433-1436,1572. doi: 10.16766/j.cnki.issn.1674-4152.002079
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Artificial intelligence (AI) has entered a period of vigorous development although it has only 65 years since its inception. AI technology is currently widely used in finance, medical care, security, transportation, education, autonomous driving, and so on. In recent years, the concepts of 'big health', cloud computing, and medical big data have frequently appeared in the world, which have also promoted the accelerated development of AI in the medical field, such as electronic medical records, medical image recognition, disease risk prediction, health management, auxiliary diagnosis, and drug research. In 2017, the State Council issued the "New Generation AI Development Plan", which proposed to promote the application of new models and new methods of AI treatment, and establish a fast and precision medical system. Intelligent medical has received extremely high attention, and it is predicted that intelligent medical will account for 1/5 of the overall AI. Since the late 1980s, under the vigorous promotion of the government, general practice (GP) has been formally established and has achieved considerable development in China. In 2011, the State Council issued the "Guiding Opinions on Establishing a General Practitioner regime", and the GP has entered a rapid pace. In the development stage, the GP service model is gradually promoted at the grassroots level. In 2018, the State Council issued the "Opinions on Promoting the Development of ' Internet +' medical health", which proposed to explore the construction of intelligent health management and intelligent elderly community service system, optimize and promote "Internet +" family doctor contract, education and popular science services. This article summarizes the application and development status of AI in GP as follows, GP service, family doctor contract, grading diagnosis and treatment, general practitioner training, and community public health services, and also analyzes the current challenges, and finally look forward to the future development prospects.
2021, 19(9): 1437-1438.
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Effect of gamma globulin pulse therapy on patients with severe community-acquired pneumonia and on serum immune proteins and lymphocyte subsets
MA Xu-can, DING Ying-wei, ZHANG Bing-wen
2021, 19(9): 1497-1499,1583. doi: 10.16766/j.cnki.issn.1674-4152.002095
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  Objective  To explore the efficacy of gamma globulin pulse therapy in treating severe community-acquired pneumonia (SCAP), improving clinical symptoms and influencing the levels of serum immune protein and lymphocyte subsets.   Methods  A total of 100 patients with SCAP who were treated in Jinhua Central Hospital of Zhejiang Province from January 2017 to January 2020 were randomly divided into the observation group (50 cases) and control group (50 cases) by using the random number table. The control group was given symptomatic intervention, whilst the observation group received intravenous infusion of gamma globulin on the basis of the control group. After 7 days of treatment, the efficacy of the two groups was compared. Before and after treatment, the patients' partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), percutaneous oxygen saturation (SpO2), serum high-sensitivity C-reactive protein (hsCRP), procalcitonin (PCT) levels, and acute physiology and chronic health evaluation (APACHE Ⅱ) score were recorded. The serum immunoglobulin G/A/M (IgG/A/M), complement levels and lymphocyte subset ratio were measured.   Results  The total effective rate in the observation group (94.00%) was higher than that in the control group (80.00%, χ2=4.332, P=0.037). Moreover, the PaO2 and SpO2 of both groups after treatment were higher than those before treatment, and the values were higher in the observation group compared with the control group. The levels of PaCO2, hsCRP, PCT and APACHE Ⅱ score were lower after treatment than before treatment, and they were lower in the observation group than in the control group (all P < 0.05). The IgG level of the observation group after treatment was higher than that before treatment, and the observation group had higher IgG level than the control group (P < 0.05). Moreover, the concentrations of CD4+ and CD4+/CD8+ in the observation group were higher after treatment than before treatment, and the observation group had higher concentrations than the control group. Meanwhile, the concentration of CD8+ was lower after treatment than before treatment, and the observation group had lower concentration than the control group (all P < 0.05).   Conclusion  Gamma globulin pulse therapy can improve the immune system function and lymphocyte subset ratio of patients with SCAP.
Risk factors of carbapenem-resistant Acinetobacter baumannii infection in a hospital
HUANG Yi-gui, CHEN Yu, FU Zheng-gao, ZHONG Pei-xiong, HAO Jin-xiang, XU Mei-sha, ZHOU You-ling
2021, 19(9): 1500-1503. doi: 10.16766/j.cnki.issn.1674-4152.002096
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  Objective  To explore and analyse risk factors affecting carbapenem-resistant Acinetobacter baumannii (CRAB) infection in our hospital and to provide evidence for infection prevention and control and clinical treatment.   Methods  From January 2017 to December 2019, 572 patients with Acinetobacter baumannii (AB) infection in our hospital were selected as the research objects. According to the results of drug sensitivity, they were divided into the CRAB group (387 cases) and carbapenem-sensitive Acinetobacter baumannii (CSAB) group (185 cases). The clinical data of both groups were collected. Single-factor and multivariate logistic regression were used to analyse the risk factors of CRAB infection.   Results  Amongst 572 patients with AB infection, the CRAB infection rate was 67.66% (387/572). Univariate analysis showed that history of diabetes, chronic lung disease, use of incision drainage tube, bronchoscopy, use of adrenal glucocorticoids, use of tigecycline, use of carbapenem antibiotics and use β-lactamase inhibitor antibiotics of CRAB group and CSAB group were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that diabetes history (OR=2.884, 95% CI: 1.105-7.206), use of incision drainage tube (OR=5.106, 95% CI: 1.834-14.270), bronchoscopy (OR=4.497, 95% CI: 1.704-12.365), use of tigecycline (OR=3.514, 95% CI: 1.482-8.945) and use of carbapenem antibiotics (OR=5.282, 95% CI: 2.146-15.308) were risk factors for CRAB infection (all P < 0.05).   Conclusion  Many risk factors are associated with CRAB infection. The management of patients with CRAB infection should be strengthened, and antibiotics should be used rationally to reduce the CRAB infection rate.
Correlation analysis of CAT score with lung function and blood gas analysis in patients with chronic obstructive pulmonary disease
QI Yu-feng, SHAO Qiang, SHEN Bing
2021, 19(9): 1504-1506. doi: 10.16766/j.cnki.issn.1674-4152.002097
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  Objective  To investigate the relationship between pulmonary function, blood gas analysis, pulmonary systolic pressure and CAT score in patients with chronic obstructive pulmonary disease (COPD).   Methods  Total 106 patients with COPD admitted to the Department of Perspiratory Medicine of Lu'an People's Hospital from September to December 2019 were classified into mild group (11 cases), moderate group (28 cases), severe group (41 cases) and very severe group (26 cases) according to CAT score. The pulmonary function of COPD patients in different disease states, including FEV1, FVC, PEF, PaO2, PaCO2, and sPAP were compared, and the correlation between each index and CAT score was discussed.   Results  The lower the cat score, the lung function indexes were higher (FEV1, FEV1/FVC, PEF) (all P < 0.05); The lower cat score was, the PaO2 was higher, the PaCO2 was lower (all P < 0.05), and the sPAP was lower (P < 0.05); Especially in patients with cat score >20, the above differences were particularly significant. Pearson correlation analysis shown that FEV1%, FEV1/FVC, PEF% and PaO2 were negatively correlated with CAT score, while PaCO2 and sPAP were positively correlated with CAT score.   Conclusion  The CAT score of COPD patients was correlated with pulmonary function, pulmonary artery systolic pressure and blood gas analysis. It is proved that CAT score can effectively predict the air exchange dysfunction and ventilation dysfunction of COPD patients, and evaluate the pulmonary function of COPD patients.
Clinical observation of high-intensity non-invasive positive pressure ventilation in the treatment of AECOPD patients complicated with type Ⅱ respiratory failure
HU Zhi-min, ZHANG Yong, QIAN Chao-xia
2021, 19(9): 1507-1509,1607. doi: 10.16766/j.cnki.issn.1674-4152.002098
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  Objective  To investigate the effect of high-intensity and conventional pressure non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with type Ⅱ respiratory failure.   Methods  A total of 72 patients with AECOPD and type Ⅱ respiratory failure in the Respiratory Department of Bengbu Third Hospital from October 2018 to January 2020 were included. They were divided into the high-intensity group (36 cases) and conventional pressure group (36 cases) by simple random method. The inspiratory pressure was set to (24.7±1.8) cm H2O and (16.1±1.2) cm H2O, respectively. The pH, PaCO2, PaO2 between the two groups and within 2, 6, 24, 48, 72 h after treatment, adverse effects of non-invasive ventilation, tracheal intubation rate and fatality rate, hospitalisation days, re-admission rate 28 days after discharge and 6-minute walking distance were compared.   Results  The differences in pH, PaO2 and PaCO2 between both groups before treatment were not statistically significant (all P>0.05). The differences in pH and adverse reactions after treatment were not statistically significant (all P>0.05). The differences in PaO2 and PaCO2 were statistically significant (all P>0.05). The tracheal intubation rate was 8.33% (3/36) and 13.89% (5/36). The fatality rate was 2.78% (1/36) and 8.33% (3/36); the difference were not statistically significant (all P>0.05). The number of hospitalisation days were (10.0±1.7) and (13.2±1.9) days. The difference was statistically significant (P < 0.05). No significant difference was observed in the readmission rate and 6-min walking distance of patients 28 days after discharge (both P>0.05).   Conclusion  The application of high-intensity non-invasive positive pressure ventilation can improve PaO2 and PaCO2 in patients with AECOPD combined with type Ⅱ respiratory failure more quickly, without a significant increase in adverse reactions. Moreover and shorten the hospital stay.
Analysis of clinical and laboratory characteristics of infectious mononucleosis in children
HU Yan-yan, PAN Jia-hua, ZHOU Hao-quan
2021, 19(9): 1510-1513. doi: 10.16766/j.cnki.issn.1674-4152.002099
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  Objective  To analyse the clinical characteristics and laboratory examination indicators of children with infectious mononucleosis (IM) and improve the understanding of clinicians.   Methods  The clinical data of 114 children with IM hospitalised in the First Affiliated Hospital of the University of Science and Technology of China from May 2019 to April 2020 were retrospectively analysed to summarise and analyse their clinical characteristics.   Results  The 114 patients included 66 males and 48 females. The male-to-female ratio was 1.375∶ 1. The age distribution was as follows: < 3 years old, 39 cases; 3-6 years old, 60 cases; >6 years old, 15 cases. The seasonal distribution was as follows: 34 cases in spring, 27 cases in summer, 36 cases in autumn and 17 cases in winter. The clinical manifestation was as follows: 107 cases of fever, 107 cases of pharyngitis, 93 cases of cervical lymph node enlargement, 41 cases of liver enlargement, 65 cases of spleen enlargement, 56 cases of eyelid oedema and 23 cases of rash. The total number of peripheral leukocytes ranged between 10×109/L and 20×109/L. The characteristics of laboratory tests were as follows: the lymphocyte ratio ranged between 50% and 70%, the prevalence of atypical lymphocytes in peripheral blood was 68.42%, a total of 59 cases had liver function impairment. The positive rate of capsid antigen IgM antibody was the highest. The positive rate of Epstein-Barr virus nucleic acid (EBV-DNA) in whole blood was 92.86%.   Conclusion  IM in children is more common in males and ages 3 to 6 years. The incidence rate is high in spring and autumn. The clinical symptoms include pneumonia and myocardial damage. Most of them have good prognosis. Capsid antigen IgM antibody detection combined with whole blood EBV-DNA detection can improve the positive detection rate and reduce clinical missed diagnosis and misdiagnosis.
Application of non-invasive high-frequency oscillatory ventilation in infant respiratory distress syndrome
GUO Mei, WANG Qi-wei, LIU Ding-li, WANG Lei
2021, 19(9): 1514-1517,1556. doi: 10.16766/j.cnki.issn.1674-4152.002100
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  Objective  To investigate the clinical effect of non-invasive high-frequency concussion ventilation and continuous positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome, whether it can reduce the incidence of complications and whether it can shorten the length of stay and reduce the number of hospitalisations.   Methods  A total of 74 cases of neonatal respiratory distress syndrome admitted in the NICU in our department from January 2018 to December 2019 were included. According to random number table method, the patients were divided into the non-invasive high-frequency group (NHFV group, 36 cases) and non-invasive positive pressure ventilation group (NCPAP group, 38 cases). The arterial blood oxygen levels, complications, duration of ventilator use and total length of hospital stay were compared before and after treatment at 12, 24, 48 and 72 h.   Results  PO2, A/APO2 and SaO2 in the NHFV group were higher than those in the NCPAP group at 12, 24, 48 and 72 h after respiratory support, and PaCO2 levels in the NHFV group at 12, 24, 48 and 72 h were lower than those in the NCPAP group, respectively (all P < 0.05). Both groups were treated and discharged, and no statistical significance was observed in the incidence of complications such as air leakage, persistent pulmonary hypertension, bronchopulmonary dysplasia, retinopathy, pulmonary haemorrhage, intracranial haemorrhage and other complications (all P>0.05). The duration of ventilator use and hospital stay in the NHFV group were shorter than those in the NCPAP group, and the difference was statistically significant (all P < 0.05).   Conclusion  Non-invasive high-frequency ventilation is an effective method for the treatment of neonatal respiratory distress syndrome. Compared with the traditional CPAP ventilation mode, it can significantly reduce CO2 retention, improve oxygenation index and shorten the length of hospital stay in children with respiratory distress syndrome, which is worthy of further clinical study.
Clinical effect and inflammatory factor analysis of nebulised inhalation of acetylcysteine solution combined with budesonide in the treatment of infant pneumonia
WANG Ji-sheng, WU Li-cun, WU Hui, WANG Lei, ZHOU Rui
2021, 19(9): 1518-1521. doi: 10.16766/j.cnki.issn.1674-4152.002101
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  Objective  To explore the clinical effect of nebulised inhalation of acetylcysteine solution combined with budesonide in the treatment of infant pneumonia and its effect on inflammatory factors.   Methods  Sixty-six infants and young children with pneumonia admitted to the hospital from July 2019 to August 2020 were selected. They were divided into the control group (n=31) and observation group (n=35) according to the drug regimen. The control group was treated with basic symptomatic treatment and 2 mL of budesonide twice a day for 7 days. On the basis of treatment of the control group, the observation group was treated with combined atomisation inhalation of 0.3 g acetylcysteine solution twice a day for 7 days. The clinical efficacy, disappearance time of clinical symptoms and occurrence of adverse reactions in both groups were compared, and the differences of serum inflammatory factors and lung function indicators in both groups before and after treatment were compared.   Results  The total effective rate (88.57%) of the observation group was higher than that of the control group (64.52%, χ2=5.147, P=0.020). The disappearance time of clinical symptoms and the temperature recovery time in the observation group were obviously shorter than those in the control group (all P < 0.05). The incidence of adverse reactions in both groups showed no significant difference (P>0.05). Serum interferon-γ, interleukin-6, interleukin-2, procalcitonin and C-reactive protein in both groups were significantly lower after treatment than before treatment, but the levels of inflammatory factors in the observation group were remarkably lower than those in the control group (all P < 0.05). The lung function indexes of both groups were significantly improved after treatment compared with those before treatment, and the improvement was more obvious in the observation group than in the control group (all P < 0.05).   Conclusion  Nebulised inhalation of acetylcysteine solution combined with budesonide in the treatment of infant pneumonia has significant clinical efficacy. It can significantly shorten the disappearance time of various symptoms, reduce serum inflammation factors and help restore lung function. Moreover, it is relatively safe and is worthy of clinical promotion.
Healthcare-seeking behaviours and their influencing factors among community residents under the context of "1+1+1" type of contracted family doctor service
Hui JI
2021, 19(9): 1522-1525. doi: 10.16766/j.cnki.issn.1674-4152.002102
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  Objective  To analyse the characteristics and of healthcare-seeking times in community and their influencing factors among community residents under the context of "1+1+1" type of contracted family doctor service and so as to provide a basis for further improving the work of contracting family doctors services.  Methods  Random sample surveys were conducted among the outpatients in Huaihai Zhonglu Community Health Service Centre in Huangpu District, Shanghai, in 2018 from June 2019 to November in 2019. The sociological information, health status and data on the medical behaviour of these patients were collected. Data were analysed using SPSS 24.0. P values was under 0.05, results were considered statistically significant.  Results  The median number of community visits for 1 204 residents was 3 (1, 11), and the number of visits per patients was 10.4. Single factor analysis revealed that people with different signing statuses, signing durations, age, occupations, retirement statuses, education levels, marital status, monthly disposable income, diseases (such as hypertension, hyperlipidaemia, diabetes, stroke, heart disease, digestive tract diseases etc.), requiring long-term medication or not and requiring prescription or basic diagnosis and treatment or not, showed statistically significant difference in terms of the number of community visits (all P < 0.05). Multifactor analysis results showed that signing statuses, signing durations, age, gastrointestinal diseases and dispensing medicines were independent influencing factors for the number of community visits (all P < 0.05). Signing a (long-term) contract, seniority and the need for dispensing medicines were the factors that induce residents to visit the community; by contrast, gastrointestinal diseases were the factors that hinder residents to visit the community.  Conclusion  The "1+1+1" type of contracted family doctor services is helpful in promoting visits to community health service centres. Given that this type of service attracts residents to communities, community health service centres should improve the clinical skills of their health care providers to meet the diverse health management needs of residents.
Mental health knowledge of the elderly in different age community groups and its influencing factors in Tianjin
ZHOU Jia-nan, LIU Yuan-yuan, YIN Hui-fang, XU Guang-ming
2021, 19(9): 1526-1529. doi: 10.16766/j.cnki.issn.1674-4152.002103
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  Objective  To understand the response, mastery and influencing factors of elderly mental health knowledge amongst community populations of different ages in Tianjin.  Methods  A multi-stage random sampling was used to select residents in Tianjin's community using the elderly mental health knowledge questionnaire as a tool to conduct a survey on them. A total of 1 606 people were included, of which 447 were 18-39 years old, 498 were 40-54 years old, and 661 were 55 years old and above.  Results  The average score of the elderly mental health knowledge questionnaire in Tianjin community population was (71.34±5.92) points. The average score was (79.78±6.33) points for males and (64.95±5.13) points for females. The correct response rate for each item was 28.5%-99.0%. The average score of the 18-39-year-old group was (64.37±5.96) points, of which the average score was (65.78±5.26) points for males and (62.37±4.87) points for females. The average score for the 40-54-year-old group was (72.24±7.55) points, of which the average score was (78.65±6.28) points for males and (63.77±6.24) points for females. The average score for the 55-year-old and above group was (75.45±7.28) points, of which the average score was (81.32±7.54) points for males and (66.36±7.54) points for females. As the age increases, the scores gradually increase, and the difference was significant (F=14.572, P=0.015). Statistically significant differences were observed in items 3, 4, 5, 6, 7, 8, 9 and 10 in each age group (all P < 0.05). Compared with the poorly mastered group, the differences in gender, occupation, whether living alone and age were statistically significant (all P < 0.05). Logistic regression analysis suggested that gender, age and whether living alone were factors influencing the mental health knowledge score of the elderly.  Conclusion  There are significant differences in the knowledge of elderly mental health amongst residents of different ages in Tianjin communities. Females, residents living alone and younger residents have insufficient knowledge of mental health, suggesting that these groups can be targeted for publicity and education in the future.
Correlation between intestinal flora and clinical symptoms in patients with schizophrenia
WANG Zhong-xian, ZHANG Ai-guo, YAO Li-hui, CHENG Xia-long, CHENG Peng, ZHU Cui-zhen, SU Hong, ZHANG Xu-lai
2021, 19(9): 1530-1534. doi: 10.16766/j.cnki.issn.1674-4152.002104
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  Objective  This study aimed to explore the correlation between the structural characteristics of schizophrenia flora and clinical symptoms.  Methods  Patients who were diagnosed with schizophrenia in the fourth hospital in Hefei from October 2018 to June 2019 were included in this study: 32 patients in the acute stage (group A), 30 in the remission stage (group B) and 34 in the healthy control group (group C). The 16SrRNA technique was used to analyse the difference of bacterial flora and its correlation with clinical symptoms.  Results  (1) The abundance of other mycobacteria in group A was higher than that in group C (F=2.575, P=0.017), whereas the abundance of thiobacillus in group A was lower than that in group C (F=3.940, P=0.023). The abundance of macrococcidia in groups A and B was higher than that of group C (F=11.720, P < 0.001), and the abundance of trichoderma and coprococcus in groups A and B was lower than that of group C (F=4.279、3.670, all P < 0.05). The abundance of Bacteroidetes, haemophilus and Clostridium tyrosine in group A was higher than that in group B (F=2.977, 4.840; F=2.655, P < 0.05), and the abundance of vibrio succinate was lower than that of group B (F=6.190, P=0.003). (2) Microbacilli were negatively correlated with depression factors (r=-0.269, P=0.034). Macrosomonas was positively correlated with the total PANSS score (r=0.291, P=0.022). Bacteroidetes was positively correlated with positive factors (r=0.282, P=0.029).  Conclusion  The structural changes of the microflora in the acute and remission stages of schizophrenia and the relative abundance of some microflora were correlated with clinical symptoms.
The application of mind mapping in health education of perioperative with ileal bladder stoma
WANG Lei, LI A-wen, LU Shan, GONG Ling, LI Yan, DING Qian-qian
2021, 19(9): 1535-1538，1614. doi: 10.16766/j.cnki.issn.1674-4152.002105
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  Objective  To explore the application effect of the mind mapping model to the health education of patients with bladder cancer undergo cystectomy+ileal replacement of bladder urinary diversion.  Methods  According to the inclusion and exclusion criteria, patients who underwent total cystectomy and Bricker urinary diversion in The First Affiliated Hospital of University of Science and Technology of China from August 2016 to December 2019 were enrolled in the study. According to the randomized principle, patients included in the study were divided into the control and observation groups, 34 cases in each group. The control group was given health education by traditional nursing education, and the observation group used design and mind map for health education. The health education effect and satisfaction were evaluated when the patient was discharged from the hospital. Patients were regularly followed up after discharge to evaluate their stoma-related knowledge, their self-management ability and the occurrence of stenosis-related complications.  Results  A total of 68 cases were recruited in this experiment, and the average age was (64.31±7.87) years old. No statistical differences in age, gender, body mass index, general illness and education level were found between the two groups (all P>0.05). Patients in the observation group had 79.41% complete knowledge rate of ostomy-related knowledge, which was significantly higher than in the control group (Z=-2.690, P=0.007). Patients in the observation group showed significantly enhanced rate of self-management (Z=-2.265, P=0.024). The satisfaction of the observation group with health education was significantly higher than that of the control group (Z=-2.149, P=0.032). In terms of the occurrence of ostomy-related complications, the incidence of ostomy-related complications in the observation group was significantly lower than that in the control group (2 vs. 9), similar results were found for ostomy leakage (3 vs. 10) and peri-ostomy dermatitis (5 vs. 12), all P < 0.05.  Conclusion  Patients with bladder cancer undergo cystectomy+ileal replacement of bladder urinary diversion. The introduction of mind mapping in perioperative health education is a satisfactory postoperative health education method that is worthy of clinical promotion and application in the future.
Intervention effect of individualised psychological counselling combined with ear acupoint pressing on anxiety and depression during puerperium
YUAN Dan-dan, ZHOU Jing, WU Ning-ning, HU Meng-meng, YE Guo-liu
2021, 19(9): 1539-1541, 1568. doi: 10.16766/j.cnki.issn.1674-4152.002106
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  Objective  To explore the effect of individualised psychological counselling combined with ear acupoint pressing beans on anxiety and depression during puerperium.  Methods  According to the inclusion criteria, 100 women who gave birth in Bozhou People's Hospital from January 2019 to January 2020 were randomly selected. Using the random number table method, they were divided into observation group and control group, with 50 cases each. The pregnant women in the control group only received routine nursing care, whilst the observation group was given individualised psychological counselling combined with ear acupoint pressing on the basis of routine nursing care. The Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD) and mental health knowledge awareness scores were compared between the two groups before and after delivery.  Results  No significant differences were observed in the age, pregnancy cycle, education level and other indicators of the two groups (all P>0.05). The awareness rate of the puerperal health knowledge questionnaire in the observation group reached 94.00%, which was significantly higher than that in the control group (74.00%), and the difference was statistically significant (P < 0.05). The HAMA score (11.74±1.20) and HAMD score (12.10±2.35) of the control group before delivery were not significantly different from those (11.72±1.99 and 12.04±2.37) of the observation group (all P>0.05). One week after delivery, the HAMA and HAMD scores of the control group (11.38±0.75 and 11.80±0.98) and observation group (5.90±0.54 and 7.29±1.55) were statistically different (all P < 0.05).  Conclusion  In puerperium nursing, individualised psychological counselling combined with ear acupoint pressing can effectively improve the anxiety and depression, improve the self-care ability and promote the recovery of the puerpera.
Analysis of the distribution characteristics and drug resistance of pathogenic bacteria of blood infection
SHI Ming-Mei, GUO Pu
2021, 19(9): 1542-1544. doi: 10.16766/j.cnki.issn.1674-4152.002107
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  Objective  To provide reference and support for clinical diagnosis and treatment of bloodstream infections, a retrospective analysis was performed to determine the distribution characteristics of pathogens of bloodstream infections and the drug resistance of common bacteria.  Methods  The positive blood culture specimens of outpatients and inpatients in our hospital from July 2018 to July 2019 were included in the study. Duplicate strains of the same patient were eliminated, as these confirmed that the contaminating bacteria were eliminated. The pathogen of bloodstream infection was isolated according to the unified program, and the blood culture specimens were cultured, identified and analysed for drug sensitivity.  Results  According to statistics, 708 non-repetitive pathogenic bacteria were collected, including 326 Gram-positive bacteria (46.05%), 373 Gram-negative bacteria (52.68%) and 9 fungi (1.27%). The first five pathogens were coagulase-negative Staphylococcus, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa. The results of drug sensitivity analysis showed that Staphylococcus and Enterococcus were 100% sensitive to vancomycin, linezolid and teicoplanin, and their drug resistance rates to erythromycin were higher than 70%. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamase were 47.02% and 30.15%, respectively. The drug resistance rates to ceftriaxone and ceftazidime were 30%-50%. The resistance rates of Pseudomonas aeruginosa to tested antibiotics were less than 30%, and the resistance rates of all isolated Gram-negative bacteria to carbapenems were less than 5%.  Conclusion  Blood culture pathogens isolated from the bacteria spectrum are many and varied. Considering the significant resistance of these pathogens to some drugs, clinicians should promote blood culture consciousness and strengthen the monitoring of blood culture pathogen distribution and antimicrobial sensitivity as soon as possible. Diagnosis and treatment of patients need to be individualized as they vary from person to person and should be performed in accordance with the rational use of antimicrobial agents in consideration of pathogen susceptibility. Clinicians need to strengthen the detection of drug resistance situation and changes thereof to guide clinical rational drug use, effective control of blood flow to the emergence and spread of drug-resistant bacterial infection.
Ultrasound diagnosis and pathological analysis of highly differentiated endometrial carcinoma
CAI Ting-ting, XU Ya-fen, SHU Yan, SHI Chun-xia, LU Wen-ming, MAO Li-min, LIU Ming-song
2021, 19(9): 1545-1548. doi: 10.16766/j.cnki.issn.1674-4152.002108
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  Objective  To evaluate the diagnostic coincidence rate of ultrasound on the degree of endometrial carcinoma infiltration by analysing the characteristics of patients with highly differentiated endometrial carcinoma.  Methods  A total of 42 patients with highly differentiated endometrial cancer admitted at our hospital during January 2016 to October 2019 were retrospectively included as study groups, and 30 patients with endometrial hyperplasia admitted at our hospital during the same period were selected as control groups. The endometrial thickness, resistance index (RI) and pulsation index (PI) in both groups were measured by ultrasound. According to the gold standard of pathological diagnosis, the diagnostic coincidence rate of ultrasound in the degree of myometrial invasion in the study group was analysed. The ultrasonic test results of three groups with different muscle layer infiltration degree were compared.  Results  The endometrial thickness of the study group was (2.09±0.64) mm, which was significantly higher than that of the control group [(1.76±0.53) mm, t=2.313, P=0.024]. The RI and PI of the study group were 0.68±0.25 and 0.47±0.12, which were significantly lower than those of the control group (1.03±0.34, 0.66±0.13, t=5.037, 6.397, both P < 0.001). The endometrial thickness were (2.02±0.62) mm, (1.97±0.61) mm and (2.90±0.00) mm; the RI were 0.64±0.23, 0.65±0.22 and 1.02±0.25; and the PI were 0.46±0.11, 0.44±0.11 and 0.64±0.01, respectively. The endometrial thickness in the deep myometrial infiltration group was significantly higher than that in the superficial myometrial infiltration group (all P < 0.05), whereas the RI and PI of patients in this group were significantly higher than those in the other two groups (all P < 0.05). The diagnostic coincidence rates of ultrasound in patients with no, shallow and deep myometrial infiltration with highly differentiated endometrial carcinoma were 89.3%, 80.0% and 75.0%, respectively.  Conclusion  The diagnosis of highly differentiated endometrial cancer patients by ultrasound shows high consistency with the pathological results, which is worthy of clinical application.
Research progress and application of Raman spectroscopy in virus detection
WANG Xiao-jing, ZHANG Hui, LI Lian-you, FU Wei-ling, ZHANG Yang
2021, 19(9): 1549-1552, 1588. doi: 10.16766/j.cnki.issn.1674-4152.002109
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Viruses can cause humans to suffer from infectious diseases, conventional methods for detecting viruses are cumbersome, insensitive, and time-consuming. New, simple, rapid, and highly sensitive virus detection methods are urgently needed. In recent years, surface enhanced Raman spectroscopy (SERS) has shown great application prospects in the biomedical field due to its unique advantages such as fingerprinting, high resolution, and non-destructive testing. Among them, Raman spectroscopy is expected to obtain disruptive technological innovations in the rapid identification and drug resistance analysis of pathogenic microorganisms. This paper focuses on the research progress of Raman spectroscopy in virus detection, starting with the technical methods applied in Raman spectroscopy. The application examples of SERS based technology in Zika virus, dengue virus, influenza virus, M13 bacteriophage, human immunodeficiency virus, avian influenza virus, respiratory syncytial virus and hepatitis B virus (HBV) are summarized in detail, and the application prospects of SERS technology in clinical examination are also forecasted. By reviewing the application of SERS detection technology in different viruses, this paper hopes to provide new ideas for clinical researchers to develop new rapid, simple and sensitive virus detection methods, and provide a new technology for early detection of virus in clinical laboratories.
Role of general practitioners in the integrated management of atrial fibrillation
LIU Lu, LIU Xiao-yu
2021, 19(9): 1553-1556. doi: 10.16766/j.cnki.issn.1674-4152.002110
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Atrial fibrillation (AF) is an important and highly prevalent arrhythmia that increases the risk of stroke and heart failure. It is also associated with palpitation, fatigue and chest tightness. Despite the development of treatment methods such as non-vitamin K antagonist oral anticoagulant, left atrial appendage closure and catheter ablation, the all-cause mortality has not been significantly improved, and the disability rate is still on the rise under traditional treatment modes of AF. AF poses a significant burden to patients and healthcare systems globally. The integrated management of AF has been proposed and proved to significantly reduce hospitalisation and mortality. Integrated AF management requires a coordinated multidisciplinary team composed of general practitioners, stroke specialists, cardiologists, cardiac surgeons and pharmacists to manage patients with AF synthetically, comprehensively and continuously. In the primary prevention of AF, general practitioners can screen and evaluate the risk factors, provide health education to residents and promote a healthy lifestyle and diet, so as to control or eliminate the impact of risk factors on AF. In the secondary prevention of AF, the early detection, diagnosis and treatment of AF can be achieved through routine physical examination and outpatient follow-up. For patients with AF, general practitioners can prevent stroke, heart failure, bleeding and other complications through timely and effective anticoagulation, symptom control with rate or rhythm control treatment and monitoring. From the perspective of integrated management of AF, this article analyses the role of general practitioners in the prevention of AF and provides the basis for the process of general practitioners in the management of AF.
Circulatory system manifestations of antiphospholipid antibody syndrome
ZHANG Jin, LI Cheng, HAN Xiao-rong, CHEN Zhong-bo, WANG Ying-hui, WANG Hong, WANG Yong-gang
2021, 19(9): 1557-1561. doi: 10.16766/j.cnki.issn.1674-4152.002111
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Antiphospholipid syndrome is an autoimmune disease characterized by persistent positive antiphospholipid antibodies in the blood and associated with the risk of thrombosis, miscarriage and other disorders. The current diagnosis of antiphospholipid syndrome is based on meeting at least one of the clinical manifestations in the latest Sapporo Classification Criteria and at least one clinical laboratory standard. At present, antiphospholipid syndrome is more and more considered as a multi-organ and multi-system disease, and its clinical manifestation spectrum is gradually expanding, which can involve different organ systems. The circulatory system is one of the main target organ systems involved in antiphospholipid syndrome. The pathogenesis of antiphospholipid syndrome is mainly manifested in two aspects, namely, autoimmunity and thrombosis. The common clinical manifestations of circulatory involvement include thrombosis, valvular heart disease, ischemic cardiomyopathy, atherosclerosis, pulmonary hypertension and ventricular dysfunction. Non-invasive imaging techniques such as vascular ultrasound, echocardiography, computed tomography, magnetic resonance imaging and nuclear medical examination are the preferred methods used for investigating the circulatory system manifestations associated with antiphospholipid syndrome. Invasive heart tests, such as coronary arteriography, increase the risk of clots and are not recommended as routine tests. Anticoagulation is the basis of treatment of patients with antiphospholipid syndrome. The anticoagulation regimen should be selected on the basis of risk stratification of patients with antiphospholipid syndrome. The feasibility of percutaneous coronary intervention and surgical intervention is still controversial in patients with antiphospholipid syndrome. This review describes the possible circulatory manifestations, pathogenesis, imaging examination and treatment strategies of patients with antiphospholipid syndrome.
Clinical study of Jiedu Tongmai Granule for the treatment of lower extremity arteriosclerosis obliterans
ZHANG Xiao-hua, QIAN Feng, ZHAI Ying, SUN Ying, ZHOU Jie, ZHOU Shu-ping, LIU Shu-rong
2021, 19(9): 1562-1564. doi: 10.16766/j.cnki.issn.1674-4152.002112
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  Objective  To evaluate the clinical efficacy of Jiedu Tongmai Granule for the treatment of lower extremity arteriosclerosis obliterans (ASO) and provide clinical case data for the development of hospital preparations.  Methods  Seventy-two patients with ASO were randomly divided into a treatment group and a control group, with 36 cases in each group. The treatment group was administered with Western medicine and additionally received Jiedu Tongmai Granules (1 bag, 10 g) twice a day for 4 weeks. Before and after the treatment, ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV) and TCM syndrome scores were observed and the clinical efficacy was evaluated.  Results  With regard to the curative effects of TCM syndrome, the total effective rate was 83.3% in the treatment group and 58.3% in the control group. Results of rank sum test showed that the treatment group was superior to the control group, and the difference was statistically different (P < 0.05). After the treatment, ABI in both groupswassignificantly improved (P < 0.05). After the treatment, baPWV decreased with varying degrees in both groups, and the difference was statistically significant (all P < 0.05). After the treatment, the difference between the two groups on the right side was statistically significant (P < 0.05). The clinical efficacy of Jiedu Tongmai Granule for the treatment of ASO was better in the treatment group than that in the control group. However, the difference between the two groups on the left side was not statistically significant (P>0.05).  Conclusion  For patients with ASO, the addition of Jiedu Tongmai Granule to the standardised treatment using Western medicines can alleviate the clinical symptoms, increase ABI index and decrease baPWV level, thereby reducing the clinical symptoms, improving the clinical signs, and enhancing the quality of life of patients. This study provides guidance for further research on and wide clinical applications of Jiedu Tongmai Granule.
Effect of Pei86tu Guben Moxibustion on chemotherapy-related cancer-related fatigue of gastrointestinal tumour
LENG Yu-ling, WU Yong, ZHOU Xian-yang, XU heng, HAO Wan-rong, DING Yan-qi, ZENG Yong-lei, XIA Ke-chun
2021, 19(9): 1565-1568. doi: 10.16766/j.cnki.issn.1674-4152.002113
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  Objective  To investigate the clinical effect of the Peitu Guben Moxibustion in the chemotherapy-related cancer-related fatigue and its effect on the levels of adrenocorticotropic hormone (ACTH) and cortisol hormone (COR).  Methods  Total 50 patients with cancer-related fatigue caused by gastrointestinal cancer who were admitted to the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2018 to November 2020 were selected and divided into treatment group (25 cases) and control group (25 cases) according to random number table method. The two groups were treated with standard chemotherapy regimen. On this basis, the treatment group was treated with the Peitu Guben Moxibustion therapy regimen, once a day, once a week as a course of treatment, for two courses of continuous treatment. After the treatment, the change of cancer-related fatigue degree and quality of life (EORTC-QLQ-C30) before and after treatment were compared between two groups. The levels of ACTH and COR were compared between the two groups before and after treatment, and investigated the correlation with cancer-related fatigue.  Results  After treatment, the mild fatigue, medium fatigue and severe fatigue patients in the treatment group were respectively 14 cases, 8 cases and 3 cases; in the control group, the mild fatigue, medium fatigue and severe fatigue patients were respectively 2 cases, 14 cases and 9 cases. The difference between the two groups after treatment was statistically significant (Z=-3.435, P=0.001). After treatment, the improvement of physical function, role function and emotional function in the treatment group was better than that in the control group (all P < 0.05). There were no significant changes in cognitive function and social function (all P>0.05). After treatment, the COR level of treatment group was higher than that of control group (P < 0.05), while the ACTH level of treatment group was lower than that of control group (P < 0.05).  Conclusion  The Peitu Guben Moxibustion in the treatment of chemotherapy-related cancer-related fatigue can effectively improve the fatigue symptoms and improve the quality of life score of patients, and increase the level of COR and decrease the level of ACTH in patients. The changes of COR and ACTH levels may be related to the degree of cancer-related fatigue.
The application of scenario simulation teaching method combined with mini-clinical examination exercise in resident standardized training of thoracic surgery
WU Gao, WU Xian-ning
2021, 19(9): 1569-1572. doi: 10.16766/j.cnki.issn.1674-4152.002114
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  Objective  To explore the application of scenario simulation teaching method combined with mini-clinical examination exercise (Mini-CEX) in resident standardized skill training of thoracic surgery to improve the clinical teaching quality and assessment effect.  Methods  A total of 47 students who attended and graduated successfully from the Thoracic Surgery Department of the First Affiliated Hospital of University of Science and Technology of China between March 2019 and December 2019 were randomly divided into the traditional teaching group (24 people) and the situational simulation teaching group (23 people) according to the odd-even number of students in the course month. Students with odd number of months were classified into the traditional teaching group, whereas students with even number of months were classified into the situational simulation teaching group. The Mini-CEX scale was used to score the ability of the two groups of students quantitatively from seven aspects, namely, interview of surgical consent, physical examination, operational skills, clinical judgment, humanistic care, surgical organizational effectiveness and overall performance. The difference between the two groups in the simulation examination achievement and satisfaction survey was determined.  Results  The total mean score of mini-CEX in the scenario simulation teaching group [(7.53±0.49) points] was higher than that in the traditional teaching group [(6.62±0.49) points]. The total mean score of clinical judgment was higher in the scenario simulation teaching group [(6.24±0.28) points] than in the traditional teaching group [(5.94±0.19) points], and the difference was statistically significant (all P < 0.01). Students in the scenario simulation teaching group were more satisfied with teaching than those in the traditional teaching group. The differences were statistically significant (all P < 0.05) according to whether the learning interest was improved, whether the autonomous learning ability was improved, whether the clinical thinking ability was trained and whether the doctor-patient communication ability was improved.  Conclusion  Scenario simulation teaching method can improve the teaching effect of standardized skill training for thoracic surgery residents. The Mini-CEX quantitative assessment can more comprehensively reflect the clinical comprehensive ability of trainees, leading to higher satisfaction. It is worth promoting in clinical thoracic surgery teaching.
Application of comprehensive ability cultivation in standardized training of ophthalmic resident physicians
LI Juan, WANG Jian-feng, ZHOU Qi, ZHAO Peng-peng, LI Ning
2021, 19(9): 1573-1577. doi: 10.16766/j.cnki.issn.1674-4152.002115
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  Objective  To explore the reform on the basis of the national standardized training courses for resident ophthalmologists, in order to train ophthalmologists with higher comprehensive practice ability, to import high-quality ophthalmologists for the country, and provide theoretical basis for the teaching reform of other disciplines.  Methods  This research took ophthalmic residents as the research object, reformed and innovated the training plan and training content on the basis of the national standardized resident training course, divided the three-year training course into three stages with different emphasis in each stage, each stage of the training had a different focus, and established an effective assessment system. In this study, "outpatient practice training" was added, hoping to improve the knowledge framework of ophthalmology residents and improve their clinical thinking ability through the way of "teaching and apprenticing". According to the characteristics of their knowledge structure, different training plans and programs were adopted for residents with different starting points, so that they could make progress in the competition and shorten the gap. At present, the medical environment still existed many problems, such as uneven distribution of medical resources, the doctor-patient relationship nervous, violence injury medical, karoshi, and a series of problems, these problems could start from the resident training level, in the standardized resident training courses to strengthen the medical humanistic quality training, guide the resident set up professional sense of responsibility and the right values, improve to communicate with people, teamwork, self-management, life-long learning ability, and improve the medical environment for a long time.  Results  We added the "outpatient practice training" process to the resident training courses, which could further improve the knowledge framework of ophthalmology resident doctors and improve clinical thinking ability. For residents at different starting points, according to their knowledge structure characteristics, we could formulate personalized training plans and programs, teaching students in accordance with their aptitude, significantly improve learning efficiency. In view of the complex domestic medical environment, strengthening the training of medical humanities for residents could make the doctor-patient relationship more harmonious.  Conclusion  To explore a standardized training system for ophthalmology residents, and to cultivate residents with different starting points in a personalized way, the sustainable development of ophthalmology personnel training can be realized.
Network Pharmacology-Based Study on the mechanism and targets of Yigu Decoction in the treatment of osteoporosis
CHEN Zhi-neng, XIE Li-li, CHEN Hua, YAN Kun, LI Gui-jin, YAO Xin-miao
2021, 19(9): 1578-1583. doi: 10.16766/j.cnki.issn.1674-4152.002116
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  Objective  To investigate the molecular basis of Yigu Decoction (YGD) and its predictive targets and clarify the potential targets and mechanisms of YGD in the treatment of osteoporosis.  Methods  The active components and their targets corresponding to the herbs by traditional Chinese medicine systems pharmacology database (TCMSP) were determined via network pharmacology. The relevant targets of YGD in the treatment of osteoporosis were predicted using OMIM and GeneCards databases. A network of 'drug component-target disease' was constructed. A component-based target network for the treatment of osteoporosis with YGD components was constructed using Cytoscape software. A protein-protein interaction (PPI) network was constructed using STRING database. Gene Ontology (GO) enrichment and KEGG signalling pathways of the targets were analysed using a biological information annotation database.  Results  A total of 159 effective active components and 589 drug targets related to six herbs were found in YGD. Protein interaction analysis suggested that INS, AKT1, IL6, MAPK3 and VEGFA were the core targets of protein interaction network. A total of 334 targets were retrieved according to their orders, which were further enriched in 3 148 GO terms (all P < 0.05). A total of 175 signalling pathways were significantly enriched (all P < 0.05), including the PI3K-Akt signalling pathway, the MAPK signalling pathway, the cGMP-PKG signalling pathway, the Wnt signalling pathway and osteoclast differentiation.  Conclusion  The herbs, compounds and targets related to the compounds of YGD are effective carriers for YGD according to their orders. The targets and pathways of YGD not only regulate the functions of osteoblasts and osteoclasts but also intervene in bone microcirculation, which reflect the material basis of the treatment of osteoporosis by Bushen Jianpi Huoxue and conforms to the pathophysiological mechanism of osteoporosis.
Relationship between gastrointestinal symptoms and quality of life in patients with atrial fibrillation after different ablation methods
YAO Yu-fei, CHEN Hong-wu, WANG Lin, DAI Wei-si, JIANG Hong-mei, CHEN Yu-jie, SUN Guo-zhen
2021, 19(9): 1584-1588. doi: 10.16766/j.cnki.issn.1674-4152.002117
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  Objective  To compare the differences in patients with atrial fibrillation (AF) after two different ablation methods.  Methods  From September 2019 to May 2020, a total of 87 patients with ablation of AF who were admitted at the Department of Cardiology, Jiangsu Province Hospital were analysed. The patients were divided into two groups: circumferential pulmonary vein ablation (CPVI) group (44 patients) and circumferential pulmonary vein combined with left atrial posterior wall isolation (CVPI-LAPWI) group (43 patients). We evaluated the relevant symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) scale.  Results  The incidences of abdominal pain (34.88% vs. 4.55%, P < 0.001) and heartburn (62.79% vs. 22.73%, P < 0.001) in the CPVI-LAPWI group were significantly higher than those in the CPVI group. However, the incidences of increased exhaustion (11.63% vs. 29.54%, P=0.039) and incomplete defecation (6.98% vs. 27.27%, P=0.013) were significantly lower in the CPVI-LAPWI group than in the CPVI group. According to the GSRS score, the symptoms of abdominal pain (P=0.005), reflux (P < 0.001) and constipation (P=0.033) in the CPVI-LAPWI group were more serious than those in the CPVI group. A negative correlation was observed between the AFEQT score and the GSRS score in all AF patients (r=-0.359, P=0.001). The correlation coefficient of the CPVI-LAPWI group was -0.440 (P=0.003), and that of the CPVI group was -0.328 (P=0.030).  Conclusion  The quality of life of patients with AF after ablation is closely related to gastrointestinal symptoms. Nurses should pay more attention to abdominal pain, reflux and heartburn of patients undergoing CPVI-LAPWI.
Verification of Chinese version of anorexia/cachexia subscale-12 in patients who undergo lung cancer radiotherapy
GU Yu-yan, YANG Si-yu, SHEN Xiao-ying, YANG Xi, XIE Shu-ping
2021, 19(9): 1589-1592. doi: 10.16766/j.cnki.issn.1674-4152.002118
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  Objective  Patients with lung cancer often suffer from anorexia and malnutrition during radiotherapy. However, tools to specifically evaluate anorexia in these patients are currently lacking. The Chinese version of anorexia/cachexia subscale-12 (A/CS-12) was validated and its clinical application value in patients who undergo lung cancer radiotherapy was explored in this study.  Methods  From January 2018 to June 2018, 128 patients with lung cancer who were admitted in the Department of Chest Tumour Radiotherapy of Zhejiang Cancer Hospital and underwent radiotherapy were surveyed via a convenient sampling method. The patients' 24-hour diet records for the past 3 days were collected, and their daily average calorie intake was calculated to evaluate their reliability and validity.  Results  Exploratory factor analysis revealed that five common factors with feature roots greater than 1 could be extracted, and the content validity of each item ranged from 0.800 to 1.000. The content validity of the total scale was 0.950. The score of the scale was compared with the patient's average daily food intake (not a table but a graph), which provided 24 points corresponding to the best cut-off value. The confidence interval ranged from 0.644 to 0.951. The correlation coefficients of various factors were between -0.145 and 0.399 (P < 0.001), and the correlation coefficients between 3 factors and the total table are 0.670-0.764 (P < 0.001). Cronbach's α coefficient of the total table was 0.739, and the retest correlation coefficient was 0.980.  Conclusion  The Chinese version of A/CS-12 not only has a good reliability and validity but also has a diagnostic effect on the reduction in the food intake of lung cancer patients during radiotherapy. It can be used as evaluation tool for anorexia among Chinese patients undergoing lung cancer radiotherapy.
Effects of goal-directed colloid infusion on short-term recovery and immune function during colorectal cancer resection
JIN Jing, ZHOU Yi-nong, JIANG Ming, ZHENG Jie, ZHAN Lin-sen
2021, 19(9): 1593-1596. doi: 10.16766/j.cnki.issn.1674-4152.002119
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  Objective  To analyse the clinical value of goal-directed infusion of colloidal fluid in promoting short-term recovery and improving immune function in patients undergoing colorectal cancer resection.  Methods  The clinical data of 164 colorectal cancer resection patients who underwent colorectal cancer resection in our hospital from January 2019 to August 2020 were retrospectively analysed. According to whether colloidal fluid was injected after intraoperative general anaesthesia induction, the observation group (86 cases) received colloidal fluid peripherally, whilst the control group (78 cases) received crystal fluid peripherally. The perioperative information, central venous oxygen saturation (ScvO2), lactate (Lac) and blood glucose (Glu) concentrations at different time points, the occurrence of surgical complications, and the level of humoral immunity in both groups were compared.  Results  No statistically significant differences were observed in both groups in terms of operation time, intraoperative blood loss, fluid replacement and urine volume (all P>0.05). The first exhaust time, defecation time, half flow diet time and hospital stay in the observation group were shorter than those in the control group (all P < 0.05). At the end of surgery, the concentrations of ScvO2, Lac and Glu in both groups were not statistically significant (all P>0.05). The incidence of nausea and vomiting in the observation group was 8.14%, which was lower than that in the control group (20.51%), and the difference was statistically significant (P < 0.05). Postoperative humoral immune indexes in both groups were lower than those before surgery. Three days after surgery, the serum IgG and C4 levels in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05).  Conclusion  Goal-directed infusion of colloidal fluid can shorten the length of hospital stay, reduce nausea and vomiting and protect the immune function of patients after colorectal cancer resection, which deserves further research and application.
Application of body surface gastrointestinal pacemaker in patients with abdominal distension after fibercolonoscopy
WANG Qun-cui, ZHU Bing, XU Fang-fang
2021, 19(9): 1597-1599. doi: 10.16766/j.cnki.issn.1674-4152.002120
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  Objective  The surface gastrointestinal pacemaker combined with routine care was applied to patients with abdominal distension after colonoscopy, and its clinical effects were observed  Methods  From August 2019 to October 2020, 60 patients with abdominal distension after electronic colonoscopy in Hefei First People's Hospital were selected, and they were divided into experimental and control groups with 30 patients each by random number table method. The control group was given routine nursing care after electronic colonoscopy, whilst the experimental group was given combined body surface gastrointestinal pacemaker and routine nursing care. The relief rate of abdominal distension, first anal exhaust time, complete relief time of abdominal distension and patient satisfaction after 30 min of intervention were compared in both groups.  Results  No significant difference was observed in the degree of abdominal distension in both groups after colonoscopy (P>0.05). The relief rate of abdominal distension in the experimental group after 30 min of intervention was significantly higher than that in the control group (43.33% vs. 16.67%, χ2=5.079, P=0.024). The time of the first anal exhaust [(13.56±9.69) min vs. (25.99±10.23) min, t=4.832, P < 0.001)] and the time to complete remission of abdominal distension were significantly shorter in the experimental group compared with those in the control group [(33.79±11.57) min vs. (160.26±41.89) min, t=15.940, P < 0.001]. Patient satisfaction in the experimental group was significantly higher than that in the control group (96.67% vs. 73.33%, P=0.026).  Conclusion  Surface gastrointestinal pacemaker combined with routine nursing can effectively reduce the degree of abdominal distension after colonoscopy and improve nursing satisfaction, which is suitable for clinical promotion and application.
Influence of narrative nursing on mental state and quality of life of elderly patients with chronic diseases
SHAO Hui-di, ZHONG Xiao-hua, SHEN Ai-juan, LUO Jie-ping, JIN Yi-ming
2021, 19(9): 1600-1603. doi: 10.16766/j.cnki.issn.1674-4152.002121
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  Objective  To explore the application effect of narrative nursing in the treatment of elderly patients with chronic diseases.  Methods  A total of 210 elderly patients with chronic diseases who were admitted to our hospital from December 2018 to December 2020 were selected as the research subjects. According to the convenience sampling method, they were divided into the intervention and control groups. A total of 108 patients were in the intervention group, and 102 patients were in the control group. Patients in the control group were treated with conventional nursing mode, whereas patients in the intervention group were treated with narrative nursing on the basis of the control group. The two groups were compared for symptoms of depression and anxiety, quality of life, treatment compliance and subjective well-being (Memorial University of Newfoundland Well-Being Scale).  Results  Before intervention, no significant differences in depression and anxiety symptom scores, quality of life scores and subjective well-being scores were found between the two groups (all P>0.05). After intervention, the SDS and SAS scores of the intervention group were (46.25±2.03) points and (45.33±1.89) points, which were significantly lower than those of the control group [(49.27±2.42) points and (48.01±2.05) points], respectively (all P < 0.05). The SF-36 score of the intervention group was significantly higher than that of the control group (P < 0.05). After intervention, the subjective well-being score of the intervention group was (79.25±6.12) points, which was significantly higher than that of the control group [(70.37±6.75) points, P < 0.05]. The treatment compliance of the intervention group was 90.74%, which was significantly higher than that of the control group (73.50%, P < 0.05).  Conclusion  Narrative nursing can effectively relieve the symptoms of depression and anxiety in elderly patients with chronic diseases, as well as improve their quality of life, treatment compliance and subjective well-being.
Observation on the effect of PDCA nursing model of integrated medical and nursing on newborn PICC nursing
HAN Min, ZHU Li, XU Bing
2021, 19(9): 1604-1607. doi: 10.16766/j.cnki.issn.1674-4152.002122
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  Objective  To explore the effects of the integrated PDCA nursing model of medical and nursing in the application of PICC nursing in newborns, so as to summarise safer and more effective measures related to PICC nursing management of severely ill newborns.  Methods  From January 1, 2018 to December 31, 2019, 59 severely ill newborns who were admitted to the Department of Pediatrics and PICC in Huaibei Maternal and Child Health Hospital of Anhui Province were selected as the research objects. Amongst them, 23 cases intubated from January to December 2018 were used as control group (using routine quality management), and 36 cases intubated from January to December 2019 were used as observation group (using the integrated PDCA nursing model of medical and nursing). The incidence of PICC-related bloodstream infection and PICC complications before and after model application was compared.  Results  In the control group, 23 severely ill newborns were placed with PICC, and the total number of days with the tube was 426 days. Amongst them, 4 cases of PICC-related bloodstream infection occurred, and the infection rate was 9.30‰; 36 cases of severely ill newborns with PICC were placed in the observation group, and the total number of days with the tube was 714 days. On the same day, only 1 case of PICC-related bloodstream infection occurred, with an infection rate of 1.40‰, and a statistical difference was observed in the rate of PICC-related bloodstream infection between the two groups (P < 0.05). In the control group, 2 cases (8.69%) of severe neonatal phlebitis (8.69%), 3 cases (13.04%) of bleeding and 1 case (4.34%) of tube block were observed. No broken tube was noted. In the observation group, 1 case (2.78%) of phlebitis without tube blockage, broken tube and blood oozing was observed. The related complications after PICC catheterization in the two groups were statistically different (P < 0.05).  Conclusion  The integrated PDCA nursing model of medical and nursing can effectively reduce the incidence of PICC-related bloodstream infections and complications in newborns, ensure the safety of neonatal treatment and improve nursing compliance. It is worthy of clinical promotion.
2021, 19(9): 1608-1611. doi: 10.16766/j.cnki.issn.1674-4152.002123
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2021, 19(9): 1612-1614. doi: 10.16766/j.cnki.issn.1674-4152.002124
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General Practice Research
Efficacy and prognosis of catheter-directed thrombolysis combined with iliac vein stenting for deep vein thrombosis
WANG Wen-bin, ZHAN Yan-qing, HAN Long, LI Yang-yang, LI Yong-sheng
2021, 19(9): 1439-1441,1446. doi: 10.16766/j.cnki.issn.1674-4152.002080
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  Objective  To compare the efficacy between catheter-directed thrombolysis combined with iliac vein stent implantation and peripheral thrombolysis in the treatment of lower extremity deep vein thrombosis with iliac vein stenosis.   Methods  A retrospective analysis was performed on patients diagnosed with deep vein thrombosis combined with iliac vein stenosis in our institution from December 2014 to December 2019. A total of 42 cases were included in this study, 15 of which underwent peripheral thrombolysis (systematic thrombolysis group) and 27 of which received catheter-directed thrombolysis combined with iliac vein stenting (catheter-directed thrombolysis group). Clinical data including complications, effective rate of thrombolysis and incidence of post-thrombotic syndrome were collected and compared between the two groups.   Results  The thrombolytic doses of the systemic thrombolysis group and catheter-directed thrombolysis group were (3.35±1.34) and (3.04±1.16) million U, respectively. Three patients in the systematic thrombolysis group and two patients in the catheter-directed thrombolysis group had complications. No significant difference was observed in the thrombolytic dose and complication rate between the two groups (all P>0.05); the effective rate of thrombolysis in the systemic thrombolytic group was 53.33%, whilst the rate was 88.89% in the catheter-directed thrombolysis group, which was higher than that in the systematic thrombolysis group (P < 0.05). The average Villalta score of the systematic thrombolysis group was 2.53 points, and that of the catheter-directed thrombolysis group was 1.77 points. The incidence of post-thrombotic syndrome was lower in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01). In addition, the VEINES-QOL/Sym scores in the systematic thrombolysis group were 35.33 and 32.67 points, whilst those in the catheter-directed thrombolysis group were 49.00 and 45.67 points. The scores were significantly higher in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01).   Conclusion  Catheter-directed thrombolysis combined with iliac vein stent has a better curative effect for patients with deep vein thrombosis of lower extremities with iliac vein stenosis.
Value of peripheral inflammatory markers NLR, PLR and LMR in predicting the efficacy of neoadjuvant chemotherapy for breast cancer
PAN Wan-wan, DONG Meng-hao, YU Fa-zhi, WAN Ling-feng, WU De-lin, LIU Feng, MENG Fan-lun, MA Xiao-peng
2021, 19(9): 1442-1446. doi: 10.16766/j.cnki.issn.1674-4152.002081
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  Objective  To investigate the value of peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) in evaluating the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer.   Methods  The clinical data of 102 breast cancer patients who received NAC from December 2018 to October 2020 at the First Affiliated Hospital of the University of Science and Technology of China were retrospectively analysed, and pathological complete response (pCR) was used to evaluate the efficacy of NAC for breast cancer. We analysed the correlation between NLR, PLR and LMR before NAC and pCR using single-factor and multiple-factor analysis.   Results  Amongst 102 breast cancer patients, 24 (23.53%) reached pCR after receiving NAC. After univariate and multivariate analysis, no significant correlation was found between age, tumour size, clinical stage, ER status, PR status, HER-2 status, molecular typing and Ki-67 level and whether the patients achieved pCR after receiving NAC (all P>0.05). Logistic regression analysis revealed that the level of peripheral blood NLR and PLR before NAC was significantly correlated with pCR rate (all P < 0.05). The pCR-attainment rate in the low-NLR group was significantly higher than that in the high-NLR group (P=0.010, 95% CI: 0.145-0.768). The pCR-attainment rate in the low-PLR group was significantly higher than that in the high-PLR group (P=0.014, 95% CI: 0.153-0.808). However, no significant correlation was observed between peripheral blood LMR level and pCR-attainment rate (P>0.05).   Conclusion  The NLR and PLR levels in the peripheral blood of breast cancer patients before NAC are significantly correlated with the pCR rate after accepting NAC, which has certain reference value for guiding the treatment of locally advanced breast cancer with NAC.
Effects of Changyuning Decoction on protein expression of claudin-1, ZO-1 and occludin in colonic tissue of rats with ulcerative colitis
ZHANG Bing, XIE Jing-ri, SUN Tao
2021, 19(9): 1447-1450, 1577. doi: 10.16766/j.cnki.issn.1674-4152.002082
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  Objective  To investigate the effect of Changyuning Decoction on the expression of key proteins occludin, claudin-1 and zona occludens-1 (ZO-1) in the tight junction (TJ) of colonic tissue of model rats with ulcerative colitis (UC).   Methods  Sixty healthy male SD rats were randomly divided into the blank control group, model control group, Changyuning group and mesalazine group, with 15 rats in each group. The UC rat model was prepared by single enema with 2, 4, 6-trinitrobenzenesulfonic acid (TNBS)/ethanol complex solution (100 mg/kg TNBS+0.25 mL of 50% ethanol). After successful modelling, drug intervention was performed for 7 days. A light microscope was used to observe the pathomorphological changes of rat colon tissues, a transmission electron microscope was employed to observe the ultrastructure of rat colon mucosa, and immunofluorescence staining was utilised to determine the fluorescence intensities of occludin, claudin-1 and ZO-1 proteins in rat colon tissues.   Results  Light and electron microscopic observations showed that the colonic mucosa of UC model rats was congested and oedematous, with obvious inflammatory exudation and broken intercellular TJs. After Changyuning intervention, the pathological status of the colonic mucosa of rats was significantly improved, and a small part of intercellular TJs was broken. The results of immunofluorescence staining showed that the fluorescence intensities of claudin-1, ZO-1 and occludin protein in the colon tissue of UC model rats (0.11±0.01, 0.11±0.01, 0.09±0.01) were significantly lower than those in the blank control group (0.14±0.01, 0.15±0.03, 0.13±0.00, all P < 0.05). After Changyuning intervention, the fluorescence intensities of claudin-1, ZO-1 and occludin in the colon tissue of rats were significantly higher than those in the model control group (0.13±0.00, 0.14±0.02, 0.12±0.01, all P < 0.05).   Conclusion  Changyuning Decoction can repair colonic mucosal injury to treat UC by up-regulating the expression of key proteins of TJ including claudin-1, ZO-1 and occludin.
Study on the correlation between serum homocysteine and blood lipid levels and white matter lesions in patients with Parkinson's disease
YANG Guang, XU Chen-chen, WANG Jia-wei, DING Ting-ting, LIU Li-jun, LIU Fei-fei, WU Tong, WANG Xun
2021, 19(9): 1451-1454, 1503. doi: 10.16766/j.cnki.issn.1674-4152.002083
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  Objective  To find out the risk factors of leukoencephalopathy (WML) in patients with Parkinson's disease (PD) and the correlation between homocysteine levels and WML.   Methods  From January 2015 to January 2020, 200 patients with PD who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University were selected as the study group, and 110 patients with healthy physical examination during the same period were selected as the control group. Medical history and demographic data were collected. The level of biochemical indicators in each group were determined. The Fazekas classification was used to divide the study group into four groups. The differences in clinical data and biochemical indicators between the four groups were compared, and logistic regression analysis and Spearman correlation analysis were used to determine the influencing factors of PD patients with WML.   Results  The level of Hcy and the incidence and severity of WML in the study group were higher than those of the control group, and the blood lipid level was lower than that of the control group (all P < 0.05), the Hcy and WML were positively correlated (r=0.556, P < 0.001). After adjusting for demographics and confounding factors, the Hcy level was still positively correlated with the severity of WML (r=0.400, P < 0.001). The AUC of Hcy on WML in PD patients was 0.717 (95% CI: 0.673-0.861, P < 0.001); WML severity was positively correlated with PD patients' HY score and UPDRS exercise score (r=0.460, r=0.360, P < 0.001).   Conclusion  Elevated blood Hcy level may be an independent risk factor for PD patients with WML. Elevated HDL-C level is a protective factor for PD patients with WML. The Hcy may be used as a biomarker for PD patients with WML.
Improved effect of PPARγ activator on bleomycin-induced pulmonary fibrosis in mice
LI Xing, ZHU Zhen-hua, WU Zhong-min, DONG Liang, YE Bin, CAI He-fei
2021, 19(9): 1455-1458,1473. doi: 10.16766/j.cnki.issn.1674-4152.002084
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  Objective  To explore the effect of peroxisome proliferator-activated receptor-γ (PPARγ) activator on bleomycin-induced pulmonary fibrosis in mice and its related mechanisms.   Methods  Thirty-six BALB/c mice were randomly divided into control group, model group and PPARγ-activated group, 12 mice in each group. Except for the control group, the other groups of mice were injected intratracheally with 5 mg/kg bleomycin to induce pulmonary fibrosis. After 24 h, the mice in the PPARγ-activated group were orally administered with 100 mg/kg rosiglitazone solution. The lung coefficient was calculated. The contents of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), hydroxyproline (HYP) and transforming growth factor-β1 (TGF-β1) in lung tissue were detected by ELISA. HE and masson staining were used to observe the pathological changes of lung tissue. The contents of PPARγ, peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and nuclear factor erythroid-2-related factor (Nrf2) protein in lung tissue were detected by western blot.   Results  The lung coefficient, Ashcroft score of lung tissue, and the levels of HYP, TGF-β1 and MDA in the model group were significantly higher than those in the control group and PPARγ-activated group (all P < 0.05). The levels of SOD and GPx in the lung tissues of the model group were significantly lower than those of the control group and PPARγ-activated group (all P < 0.05). Compared with the model group, the expression of PPARγ, PGC-1α, and Nrf2 proteins in the lung tissue of rats in the PPARγ activation group increased significantly (all P < 0.05).   Conclusion  PPARγ activator can inhibit bleomycin-induced lung fibrosis in mice, which may be related to reducing inflammation and oxidative stress.
Treatment of Judet Ⅳ type radial neck fracture in young children with Kirschner wire percutaneous leverage reduction and elastic intramedullary nail fixation under elbow arthrography
LI Yang, XIE Kang, YUAN Yi, SUN Jun
2021, 19(9): 1459-1462. doi: 10.16766/j.cnki.issn.1674-4152.002085
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  Objective  To investigate the application of elastic intramedullary nail internal fixation after Kirschner wire (K-wire) percutaneous leverage reduction with elbow arthrography in the treatment of Judet Ⅳ type radial neck fracture in young children.   Methods  A total of 29 children (including 11 males and 18 females, aged 3 years and 3 months to 6 years and 11 months) in the Department of Orthopedics of Anhui Children's Hospital from September 2017 to September 2020 were selected. All children suffered Judet Ⅳ type radial neck fracture within one week after trauma. All patients underwent surgery under general anaesthesia after hospitalisation. The contrast agent was 1 mL iohexol, mixed with normal saline in a ratio of 1∶ 1 and injected into the elbow joint in the posterior space of the elbow. C-arm fluoroscopy showed the cartilage and epiphysis at the broken end of the fracture, which had not been developed before. The broken end of the fracture was reduced by K-wire pry, and the fracture was fixed by retrograde penetration of elastic intramedullary nail from the distal end of the radius. The functional position of the elbow was fixed in plaster for four weeks after surgery.   Results  According to Metaizeau's revision standard, 24 cases were excellent, 3 cases were good, and 2 cases were fair. The 29 children were followed up for 6-36 months in the outpatient department. According to Metaizeau's curative effect standard, 26 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 96.5%. Postoperative follow-up radiographs showed no fracture redisplacement and necrotic absorption of the radial head. No complications such as fracture nonunion, myositis ossificans, radial nerve injury and elbow joint dysfunction were observed in all cases.   Conclusion  Elbow arthrography can clearly show the cartilage and epiphysis at the broken end of the fracture without development in the treatment of the Judet Ⅳ type of radial neck fracture in young children. The trauma of reduction by K-wire prying is small, and the internal fixation by elastic intramedullary nail is firm. This method is especially effective for the treatment of Judet Ⅳ type radial neck fracture in young children, and the long-term joint function recovery is good.
Study on the clinical significance of bone metabolism types in young adult patients with ankylosing spondylitis
ZOU Yu-qiong, ZHANG Ying-ying, LI Ya-song
2021, 19(9): 1463-1465,1603. doi: 10.16766/j.cnki.issn.1674-4152.002086
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  Objective  To investigate the relationship between bone metabolism and bone mineral density in young adults with active ankylosing spondylitis (AS) and to provide a basis for the prevention and treatment of bone mineral density decline in these patients.   Methods  A total of 103 patients with AS who were treated in our hospital from February 2015 to November 2020 were enrolled in the study. The correlation between different bone metabolism types and bone mineral density was analysed.   Results  Forty-nine patients had normal BMD, and 54 patients had low BMD. In the low BMD group, the mean values of type I collagen cross-linked C-telopeptide β-collagen specific sequence (β-CTX), osteocalcin (OC) and N-terminal propeptide of type I precollagen (P1NP) were significantly higher than those in the normal BMD group (P < 0.001). The low BMD group was divided into low to moderate and high conversion groups. The T value of femoral neck BMD in the high conversion group was -1.56±0.82, which was significantly lower than that in the low to medium conversion group (-1.01±0.92, P=0.029). However, no significant difference was found in T value of lumbar BMD between the two groups (P=0.080). In the low to medium conversion group, the BMD of femoral neck [(0.92±0.09) g/cm2] after treatment was significantly improved compared with that before treatment [(0.89±0.08) g/cm2, P=0.022]. However, in the high conversion group, no significant difference in BMD of femoral neck was found after the treatment (P=0.080).   Conclusion  The serum levels of β-CTX, OC and P1NP are significantly increased in young adult patients with decreased bone mineral density, showing high loss of bone turnover high conversion bone loss. Patients with low to moderate conversion of bone mineral density reduction can be effectively treated through active basic disease inflammation control. However, more effective treatments should be explored for patients with high conversion of bone mineral density reduction.
Effect of continuous serratus anterior plane block on postoperative recovery in elderly patients undergoing thoracoscopic radical resection of lung cancer
JIANG Yu-yu, YU Ru, YIN Tian-yue, LI Xiao-yu, CHENG Xiang-yang
2021, 19(9): 1466-1469,1487. doi: 10.16766/j.cnki.issn.1674-4152.002087
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  Objective  To explore the effect of continuous serratus anterior plane block (SAPB) guided by ultrasound on postoperative analgesia and recovery in elderly patients undergoing thoracoscopic radical resection of lung cancer.   Methods  From October 2019 to June 2020, 60 patients in the First Affiliated Hospital of Bengbu Medical College undergoing thoracoscopic radical resection of lung cancer were selected and divided into the P group and SP group with 30 cases each by a simple random method. Patients in the P group received intravenous patient-controlled analgesia, whilst those in the SP group received continuous SAPB analgesia. The VAS scores of rest and activity, quality of postoperative recovery (QoR-40) scores, CD4+, CD4+/CD8+ and postoperative adverse events were compared between the two groups before and after 1, 3 and 7 days of surgery.   Results  The resting and active pain scores of the SP group were 1.6±0.2, 2.3±0.4, 1.4±0.3 and 1.9±0.3, which were lower than those of the P group (2.5±0.3, 3.7±0.3, 2.1±0.2, 2.9±0.4, all P < 0.05). The QOR-40 scores, CD4+ and CD4+/CD8+ in the SP group were 170.7±3.2, 173.3±2.9, 40.8±6.4, 42.3±6.4, 1.5±0.1, 1.6±0.1 at 1 and 3 days after surgery, which were higher than those in the P group (162.8±3.7, 167.9±2.7 and 36.2±6.2, 39.0±5.0, 1.3±0.2, 1.4±0.2, all P < 0.05). The postoperative adverse reaction rate in the SP group was 4.6%, which was significantly lower than that in the P group (17.3%, P < 0.05).   Conclusion  As a postoperative analgesic strategy, continuous SAPB guided by ultrasound can significantly reduce postoperative pain, reduce stress response and immunosuppression, and promote early recovery of elderly patients undergoing thoracoscopic radical resection of lung cancer.
Effect of thymosin α 1 on T lymphocytes and TLR9 signaling pathway in patients with sepsis
LI Yuan-si, CHENG Ling, ZHANG Qi, NIE Wei-qun, LIN Yan-lin
2021, 19(9): 1470-1473. doi: 10.16766/j.cnki.issn.1674-4152.002088
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  Objective  To observe the effects of thymosin α1 on changes in indicators such as immunity in patients with sepsis, and to seek evidence-based evidence for its application in the treatment of sepsis.   Methods  According to the random number table, 50 patients with sepsis admitted to the ICU of the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2017 to August 2020 were divided into control group and observation group with 25 cases in each group. Patients in the control group were given conventional comprehensive treatments such as anti-infection, improvement of organ function for 7 days. Patients in the observation group were treated with thymosin α1 on the basis of the conventional comprehensive treatments for 7 days. The T cell indicators such as the T cell subsets CD3+, CD8+, CD4+/CD8+ ratio before and after treatment in the two groups, inflammation indicators procalcitonin(PCT), C reactive protein(CRP) levels and TLR9, NF-κB protein expression in the TLR9 signaling pathway, disease severity indicators sequential organ failure assessment (SOFA) score and acute Physiology and chronic health evaluation (APACHE Ⅱ) score were observed.   Results  After treatment in the observation group, CD3+ increased, CD8+ decreased, and CD4+/CD8+ ratio increased. Compared with the control group, the difference was statistically significant (t=4.874, 3.864, 2.162, all P < 0.05). Compared with the control group, the inflammatory index PCT, CRP levels and the TLR9 and NF-KB protein expression levels in the observation group were significantly lower than those in the control group (t=4.833, 7.081, 5.871, 8.361, all P < 0.05). The disease severity indicators SOFA score and APACHE Ⅱ score decreased significantly. The SOFA score and APACHE Ⅱ score of the observation group decreased after treatment, and the degree of decline was significantly lower than that of the control group (t=3.672, 5.354, all P < 0.05).   Conclusion  Thymosin α1 can well regulate the immune function of patients with sepsis and reduce the inflammatory response of sepsis.
MiR-182 enhances and promotes the proliferation and invasion of melanoma cells
LI Xu-wen, SONG Pei-jun, LI Wei, XU Jing, ZHANG Li
2021, 19(9): 1474-1476,1548. doi: 10.16766/j.cnki.issn.1674-4152.002089
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  Objective  To investigate the effects of miR-182 on the proliferation and invasion of human melanoma cell line WM-115 and to elucidate its mechanisms of action.   Methods  Patients with melanoma in our hospital from March 2018 to March 2019 were selected. The expression levels of miR-182 in melanoma tissues and adjacent tissues were detected by real-time quantitative polymerase chain reaction (RT-qPCR). MiR-182 mimics or inhibitor was transfected into WM-115 cells by lipofectamine 2000 package. Cell Counting Kit-8 was applied to detect the viability of WM-115 cells, and transwell chamber assay was used to measure the invasion of WM-115 cells. The expression levels of zinc finger protein 36 like (Zfp36L) mRNA and protein were detected by RT-qPCR and Western blotting, respectively.   Results  MiR-182 expression in melanoma tissues was significantly higher than that in para-cancer tissues (4.500±1.102 vs. 1.214±0.286, t=7.070, P=0.001). Compared with the control group, miR-182 overexpression significantly increased the proliferation and invasion ability of WM-115 cells (all P < 0.05) and obviously increased the expression levels of Zfp36L mRNA and protein (all P < 0.05), however, miR-182 silencing showed the opposite results.   Conclusion  The reinforcing effect of miR-182 overexpression on the proliferation and invasion of WM-115 cells may be related to the up-regulation of Zfp36L.
Efficacy analysis of albumin paclitaxel and radiotherapy in locally advanced oesophageal cancer
LIU Jin-feng, WANG Zhang-gui, CUI Zhen
2021, 19(9): 1477-1479,1496. doi: 10.16766/j.cnki.issn.1674-4152.002090
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  Objective  Synchronous radiotherapy and chemotherapy is the first choice for inoperable treatment of locally advanced oesophageal cancer. Taxane chemotherapy drugs combined with cisplatin and concurrent radiotherapy and chemotherapy have been widely used in clinical practice. Therefore, the purpose of this study is to observe the safety and clinical efficacy of albumin paclitaxel combined with cisplatin and concurrent radiotherapy and chemotherapy in locally advanced oesophageal cancer.   Methods  Retrospective analysis was performed on a total of 45 patients with locally advanced esophageal cancer admitted to the Department of Radiotherapy of the Second People's Hospital of Anhui Province from January 2018 to July 2019. All received radical concurrent radiotherapy and chemotherapy, Among them, 22 patients received concurrent chemotherapy with albumin paclitaxel and cisplatin (experimental group) and 23 patients received concurrent chemoradiotherapy with cisplatin (control group), Three months after the end of concurrent radiotherapy and chemotherapy, chest CT, barium meal and other examinations were performed to evaluate the clinical efficacy, and the patients were followed up by telephone for a 1-year disease-free survival rate.   Results  The objective response rate (ORR) of the albumin paclitaxel+cisplatin concurrent radiotherapy and chemotherapy group was 77.3%, and the ORR of the cisplatin concurrent radiotherapy and chemotherapy group was 47.8%. The difference between the two groups was not statistically significant (P < 0.05). The overall survival rate (90.2%) of the albumin paclitaxel+cisplatin concurrent radiotherapy and chemotherapy group was higher than that of the cisplatin concurrent radiotherapy group (78.0%). A statistically significant difference was observed in peripheral nerve injury (P < 0.05), but most of them were grade 1 to 2 reactions, which could be tolerated by patients.   Conclusion  The clinical effect of albumin paclitaxel combined with cisplatin concurrent radiotherapy and chemotherapy on locally advanced oesophageal cancer is good, the 1-year survival rate is high, and the adverse reactions are tolerable.
Analysis of clinical features and prognosis of antineutrophil cytoplasmic antibody with infection
LIU Jiao, FANG Ru-meng, WANG Tao, LI Zhi-jun
2021, 19(9): 1480-1483. doi: 10.16766/j.cnki.issn.1674-4152.002091
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  Objective  To analyse the clinical characteristics of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) co-infection and to explore the main risk factors that affect the occurrence of infection and the impact of infection on the prognosis of patients.   Methods  A retrospective analysis was conducted on 118 AAV patients admitted to our hospital in the past 6 years. The patients were divided into the infected group (72 cases) and non-infected group (46 cases). The clinical data of the two groups were compared, and the clinical characteristics of co-infection were analysed. Single factor analysis was used to analyze the risk factors of infection. Then, logistic regression analysis was used to explore the independent risk factors that affect the occurrence of infection. The patient's survival curve was drawn, and the impact of infection on patient's prognosis was explored.   Results  About 61.02% AAV patients had co-infection, fever, cough and sputum, malaise, muscle aches and severely increased ESR and CRP. significant increase in the infected group. Univariate analysis showed that there was significant difference between the two groups in advanced age, increased white blood cell count, decreased lymphocyte count, reduced haemoglobin, reduced albumin, increased C-reactive protein, increased erythrocyte sedimentation rate, electrolyte disturbances (decreased serum sodium ion concentration, serum chloride ion concentration, serum potassium ion concentration), higher BVAS score, use of cyclophosphamide. Multivariate analysis showed that decreased lymphocyte count and decreased serum potassium ion concentration were independent risk factors affecting infection in AAV patients; co-infection could significantly shorten the survival period of patients.   Conclusion  AAV is prone to co-infection, with respiratory infections being the most common. Multiple risk factors often lead to infection in AAV patients, amongst which decreased lymphocyte count and serum potassium ion concentration are independent risk factors for co-infection. Infection can accelerate the death of patients. Active prevention and treatment of infection can improve the prognosis of AAV patients.
General Clinical Research
Comfort and safety of patients undergoing percutaneous endoscopic lumbar discectomy with different anaesthesia methods
JIN Xue-ting, ZHA Xiao-liang, QIU Zheng-hong, CHEN Fang, ZHANG Rong-yi, WANG Li-kui
2021, 19(9): 1484-1487. doi: 10.16766/j.cnki.issn.1674-4152.002092
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  Objective  To investigate the effects of different anaesthesia methods on the comfort and safety of patients undergoing percutaneous endoscopic lumbar discectomy (PELD).   Methods  From February 2017 to May 2020, 60 patients with lumbar intervertebral disc herniation who planned to undergo PELD in the Department of Pain, Chaohu Hospital, Anhui Medical University, were divided into experimental group (M group) and control group (L) using a random number table method, with 30 cases in each group. In addition to the different anaesthesia methods, the surgical instruments, surgical methods and monitoring indicators used in both groups were the same. The L group was treated with 0.5% lidocaine for local infiltration anaesthesia, whilst the M group received continuous intravenous injection of dexmedetomidine and remifentanil on the basis of the L group. The NRS score, maximum value of MAP and HR of patients with low back pain in four time periods, entrance (T0), intraoperative puncture (T1), foramen expansion (T2) and microscopic operation (T3) were recorded. The rate of change of MAP and HR at T1, T2 and T3 compared with T0 was calculated. The occurrence of respiratory depression, postoperative vomiting and urinary retention during the operation was recorded. The satisfaction survey of patients was carried out after the operation.   Results  Both groups of patients had pain in the lower back and back during the operation. Compared with the L group, the NRS pain score of the M group was significantly lower. Compared with the change rate of MAP and HR (ΔMAP, ΔHR), the difference was statistically significant (all P < 0.05). Comparing the two groups of patients, no statistically significant difference was observed in the incidence of intraoperative respiratory depression, postoperative urinary retention and postoperative vomiting (all P>0.05). The satisfaction score of the M group [(8.2±0.9) points] was significantly higher than that [(4.1±1.1) points] of the L group, and the difference was statistically significant (P < 0.05).   Conclusion  PELD with intravenous-assisted analgesia and sedation can provide patients with better analgesia and sedation, with significantly improved comfort. Moreover, it does not increase the incidence of complications, has high safety and is worthy of clinical promotion.
Effect of 270° autogenous bone replantation around the intervertebral cage on vertebral fusion rate and efficacy after lumbar fusion
WU Hao, YU Hai-yang, ZHAI Yun-lei, LIANG Cheng-min, CUI Xi-long
2021, 19(9): 1488-1491. doi: 10.16766/j.cnki.issn.1674-4152.002093
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  Objective  To investigate the effect of 270° autologous bone replantation around the cage of the intervertebral space on the efficacy of lumbar fusion and the fusion rate of the vertebral body.   Methods  A total of 64 patients with lumbar spinal stenosis who underwent posterior decompression of the lumbar spine and pedicle screw internal fixation with interbody cage placement and fusion in our hospital from June 2017 to December 2019 were selected as the research objects. According to the random number table method, the patients were divided into control group and observation group, with 32 cases each group. The observation group was given 270° autogenous bone graft around the ring cage, whilst the control group was given anterior edge bone graft of the intervertebral space combined with the cage filled with autogenous bone. After the drainage tube was removed, the two groups of patients were re-examined by X-ray, and the lumbar dynamics and CT were re-examined 12 months after the operation. The Suk and Siepe methods were used to compare the intervertebral fusion rate and the change of intervertebral space height in both groups to evaluate different vertebrae, the effect of lumbar intervertebral fusion and the clinical curative effect of patients under the interfusion mode.   Results  The patients were followed up for 12 to 18 months, and re-examinations were performed at 1 week and 12 months after the operation. The fusion rate in the observation group was higher than that in the control group at 12 months after the operation. The height of the intervertebral space and the height of the intervertebral foramen were significantly improved at 1 week and 1 year after the operation, and the difference was statistically significant (all P < 0.05).   Conclusion  The comparison suggests that the 270° autologous bone replantation around the cage in the intervertebral space has a higher fusion rate than the simple intervertebral cage implantation. Therefore, the same kind of autologous bone should be implanted in the intervertebral space before and after the cage implantation, which is more conducive to the fusion of the intervertebral space.
Outcomes of thoracoscopy versus thoracotomy for oesophageal atresia with tracheoesophageal fistula repair
ZUO Wei Wei, LIU Xiang Xiang, GAO Wei, ZHANG Yan-min, ZHAO Ping, WU Gong-jing, LI Qing-zhi, WANG Fu-long
2021, 19(9): 1492-1496. doi: 10.16766/j.cnki.issn.1674-4152.002094
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Abstract:
  Objective  To compare the clinical efficacy of thoracoscopic surgery versus thoracotomy for congenital oesophageal atresia with tracheoesophageal fistula.   Methods  A retrospective analysis was conducted on 101 cases of congenital oesophageal atresia treated by surgery in our hospital from March 2011 to February 2019, which were divided into the thoracoscopic surgery group (50 cases) and open thoracotomy group (51 cases) according to the surgical approaches. The preoperative data, perioperative indicators and postoperative recovery of both groups were compared. At the same time, according to the learning curve, the cases in the thoracoscopic surgery group were divided into early stage and late stage (25 cases each), and the changes of various indicators at different periods and the occurrence of postoperative complications were compared.   Results  (1) No significant difference was observed in the preoperative clinical data in both groups (all P>0.05). (2) Comparison of perioperative conditions in both groups showed that the mean operative time of the thoracoscopic surgery group [(191.42±48.56) min] was slightly longer than that of the open thoracotomy group [(129.02±25.08) min], and the difference was statistically significant (t=8.163, P < 0.001), the time of initial oral feeding was (11.98±2.92) days versus (16.88±4.33) days, and the difference was statistically significant (t=-2.364, P=0.020). (3) Comparison of postoperative complications in both groups showed no significant differences in the incidence of anastomotic leakage, anastomotic stenosis and recurrence rate of tracheoesophageal fistula (all P>0.05). (4) Comparison of the two stages in the thoracoscopic surgery group showed that the operative time and postoperative ventilation time of the late stage were significantly shorter than those of the early stage, and the differences were statistically significant (all P < 0.05). In addition, the incidence of postoperative anastomotic leakage was also decreased significantly, but the difference was not statistically significant (P>0.05).   Conclusion  The effect of thoracoscopic surgery on congenital oesophageal atresia combined with tracheal oesophageal fistula was similar to that of thoracotomy. With the continuous improvement of surgical techniques, the clinical effect may be enhanced.

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