2022 Vol. 20, No. 1

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Expert Forum
Trends and suggestions on the development of China's public-health discipline under the new situation
SHI Jin-huan, WANG Hui
2022, 20(1): 1-5. doi: 10.16766/j.cnki.issn.1674-4152.002262
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The public-health system is an important part of national security, and public-health discipline is the basis of the national public-health system. Strengthening the construction of public-health discipline is the key to cultivating high-quality public-health talent teams, improve the public health-service level, and the ability to deal with public-health emergencies in the region to strengthen national security governance. In recent years, public-health discipline in China has transformed, such as discipline setting from specialisation to integration, talent training from academic-oriented to applied-oriented, professional accreditation from free access to standardisation, and scientific research evaluation from paper based to comprehensive evaluation. The new situation brought about by the novel coronavirus pneumonia epidemic prevention and control put forward new requirements for public-health discipline in China. This paper outlines the enlightenment of public-health discipline construction in developed countries, referring to the experience of the United States, Europe, and other Asian countries in public-health discipline construction and explores China's model of public-health discipline development combined with China's practice. Suggestions ranging from more flexibility and autonomy to the discipline setting in Colleges and universities are made to promote the deep cross-integration of multi-disciplines and medical discipline. Improvement in applied talents' training level and scale in public health to strengthen professional education and elite education, as well as providing strong talent support for the national public health-service system, is recommended. Discipline-evaluation standards should be established and improved by building standards for talent-training qualification access, public-health education certification, discipline certification, and evaluation to lay a good foundation for the effectiveness of public-health practice in China. By reshaping the discipline-development values, optimising the scientific-research organisation system and mechanism, reforming the scientific-research evaluation index system, and reforming the scientific research-evaluation system, the discipline-construction direction can be guided to realise the purpose of discipline development serving the society.
Development of General Practice in the United Kingdom (to be continued)
Rodger Charlton, LIU Man-ling, XIE Wan-ling, YAO Mi
2022, 20(1): 6-7.
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Regional differences in the prevalence and influencing factors of hypertension amongst people over 40 years old in Anhui Province
WU Xiao-xiao, ZHANG Lin-lin, WANG Xu-fan, DI Dong-sheng, LENG Rui-xue, ZHA Zhen-qiu
2022, 20(1): 68-71. doi: 10.16766/j.cnki.issn.1674-4152.002279
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  Objective  To analyse the differences in the prevalence, awareness rate, control rate and related risk factors of hypertension amongst people aged ≥ 40 years in North Anhui, Central Anhui and South Anhui and provide targeted suggestions for hypertension prevention and treatment in different regions.  Methods  Using the Yangtze and the Huaihe River as the boundary, Anhui Province was divided into three areas: North Anhui, South Anhui and Central Anhui. Multi-stage stratified cluster sampling was used to investigate the prevalence, awareness, control and related factors of hypertension in Anhui Province in 2015 using a questionnaire survey and physical measurement. χ2 test was used to analyse the regional differences in the weighted prevalence rate, awareness rate and control rate of hypertension. In addition, weighty logistic stepwise regression was conducted to analyse the risk factors of hypertension. Logistic stepwise regression was used to analyse the influencing factors of hypertension awareness and control rate.  Results  A total of 2 967 residents aged ≥ 40 years were included in this study. The overall prevalence of hypertension in Anhui Province was 37.7% (40.1% in Central Anhui, 38.6% in North Anhui and 34.3% in South Anhui). The prevalence of hypertension in people aged ≥ 60 years in North Anhui was significantly higher than that in Central Anhui and South Anhui. The awareness rate of hypertension was 52.5%, and the control rate was 18.6%. The difference amongst the three regions was statistically significant. The awareness rate and control rate of hypertension in South Anhui were 2.19 times and 3.88 times as high as those in Central Anhui, which were higher than those in North Anhui, and this difference was significant (all P < 0.05).  Conclusion  The prevalence of hypertension amongst people aged ≥ 40 years was high in Anhui Province, and the control rate of hypertension in North Anhui was lower than that in South Anhui. Age, BMI and the level of education were considered as factors affecting the prevalence and control rate of hypertension. Great differences in the level of preventive health care were found between North and South of Anhui Province and between urban and rural areas.
Clinical application of central venous percutaneous transluminal angioplasty in the replacement of tunnel-cuffed catheter
LIU Man-man, XU Li-yun, WANG Sha-sha, CHEN De-jun
2022, 20(1): 72-75. doi: 10.16766/j.cnki.issn.1674-4152.002280
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  Objective  To investigate the clinical application of percutaneous transluminal angioplasty (PTA) in catheter replacement of haemodialysis patients with catheter-related central vein disease.  Methods  Clinical data were collected from 10 patients admitted to the Taizhou Hospital of Zhejiang Province between January 2018 and December 2019 with catheter-related central venous disease and vascular access requiring tunnel-cuffed catheter (TCC). All patients underwent angiography to determine the narrow area, extent, degree of the narrow central veins, underwent PTA treatment, and then placed into the new TCC, followed-up 3 to 6 months to observe the patient's clinical efficacy.  Results  After dilation, the central-vein stenosis significantly improved in all patients compared with the previous. New TCC was successfully replaced, and no surgically related complications occurred, such as arrhythmic disorder, cardiac tamponade, balloon rupture, and catheter through the central vein into the mediastinum or chest resulting in haemothorax, haemopneumothorax, mediastinal hematoma, and other complications. Postoperative X-ray showed satisfactory catheter position. Immediately after the operation, catheters were used for haemodialysis, and blood flow reached 250 mL/min observed five times. The patients were followed up for 3-6 months after the operation. Catheter blood flow during dialysis reached 250 mL/min in all patients, and no catheter dysfunction or infection occurred.  Conclusion  When patients take TCC as a long-term vascular access and continued use of the original TCC is not possible, angiography should be performed. If there is serious central-vein stenosis, it would be safer to replace the new TCC after PTA treatment with a high success rate. This study provides a new idea for the clinical establishment of vascular access in such patients.
Analysis between postpartum pelvic floor dysfunction and delivery related factors in primipara
WANG Qi, CHENG Xian-ying
2022, 20(1): 76-79. doi: 10.16766/j.cnki.issn.1674-4152.002281
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  Objective  To explore the effect of delivery related factors on early pelvic floor dysfunction (PFD) in primipara.  Methods  By convenient sampling, 167 primiparas from March to August 2020 were selected as the research objects. All primiparas were screened by inclusion and exclusion criteria. According to the results of their routine follow-up 42 days after delivery, the primiparas were divided into PFD and non-PFD groups. The delivery mode, delivery process and fetal condition were compared between the two groups.  Results  (1) The PFD group had 14 cases of caesarean section, and the non-PFD group had 29 cases. The caesarean-section rate in the PFD group was significantly lower than that in the non-PFD group (χ2=5.233, P < 0.05). The PFD group had 23 cases of forceps delivery, and the non-PFD group had 1 case. The forceps delivery rate in the PFD group was significantly higher than that in the non-PFD group (χ2=20.167, P < 0.01). (2) The PFD group had 14 cases of natural process of labor, and the non-PFD group had 39 cases. The number of natural process of labor in the PFD group was significantly lower than that in the non-PFD group (χ2=11.792, P < 0.01). The numbers of abnormal first and second stages of labor in the PFD group were 27 and 21, whereas those in the non-PFD group were 7 and 4, respectively. The incidences of abnormal first and second stage of labor in the PFD group were significantly higher than those of the non-PFD group (all P < 0.01). (3) The numbers of persistent occipitotransverse position and persistent occipitoposterior position in the PFD group were 39 and 20, whereas those in the non-PFD group were 6 and 4, respectively. The incidences of persistent occipitotransverse position and persistent occipitoposterior position in the PFD group were significantly higher than those in the non-PFD group (all P < 0.01). (4) The PFD group had 10 cases of foetal macrosomia, and the non-PFD group had 2 cases. The incidence of foetal macrosomia in the PFD group was significantly higher than that in the non-PFD group (χ2=5.333, P < 0.05).  Conclusion  We should pay close attention to the process of labor and foetal condition. When abnormal labor process occurs, targeted treatment is needed. Only in this way can the incidence of pelvic floor dysfunction be reduced.
Clinical analysis of 74 children with hand-foot-mouth disease encephalitis without typical rash
WEI Jin-feng, WU Su-ling, TENG Shu
2022, 20(1): 80-82, 128. doi: 10.16766/j.cnki.issn.1674-4152.002282
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  Objective  To analyse the clinical characteristics of hand-foot-mouth disease (HFMD) encephalitis in children without typical rash, as well as to guide the early clinical detection, diagnosis, and treatment and provide reference for its prevention and control.  Methods  We retrospectively analysed the clinical data of 74 children with confirmed HFMD encephalitis without typical rash admitted to Hangzhou Children's Hospital from January 2018 to December 2019, including epidemiological data, clinical manifestations, laboratory examination results, and aetiological test results.  Results  The mean age of the 74 patients was (6.92±2.72) years old, and 82.5% were 5 years old or older. Forty-two cases and 32 cases were examined in 2018 and 2019, respectively, and there was no significant difference in the detection rate between two years(P>0.05), the highest detection rates were found in June and July, which were 35.7% (15/42 cases) and 42.9% (18/42 cases) in 2018 and 28.1% (9/32 cases) and 37.5% (12/32 cases) in 2019, respectively, which was consistent with the epidemic time of typical HMFD prevalence. Fever, headache, and vomiting were the main clinical manifestations in this group of cases, without the typical rashes of hands, feet, and buttock and herpes in the isthmus. The rashes of the cases showed sparse and small maculopapule without herpes, and the distribution was atypical, primarily around the mouth, ear, neck, trunk, and limbs. Most of them were single site, accounting for 87.8%. Peripheral blood routine and cerebrospinal fluid changes in all cases were consistent with the characteristics of HFMD. Tests were positive for enterovirus universal type, and EV71, CV-A6, CV-A10 and CV-A16 were undetected. All cases were cured without complications or sequelae.  Conclusion  During the epidemic season of HFMD, HFMD encephalitis primarily manifesting as fever, headache, and vomiting in older children, without typical rash, requires increased attention to avoid misdiagnosis and missed diagnosis.
Effect of peer-support education combined with general practice team-management mode on the level of knowledge, attitude, and practice of type-2 diabetes patients in the community
GAO Yuan-yuan, CAI Pei-fen, LIANG Feng, ZHU Jing-sheng, ZHU Yi-ping, LU Ying-fei, REN Tian-cheng
2022, 20(1): 83-87. doi: 10.16766/j.cnki.issn.1674-4152.002283
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  Objective  To explore the effect of peer-support education combined with general practice team-management mode on the level of knowledge, attitude, and practice (KAP) of T2DM patients in community, and evaluate the effect of this model.  Methods  Total 196 patients with T2DM in Tangshan, Lukou and Dongshan community health-service centres in Jiangning District of Nanjing were selected as the research objects from July 2018 to October 2018, and divide into intervention group (100 cases) and control group (96 cases) used a random-number table method. The intervention group adopted peer-support education combined with general practice team-management mode, whereas the control group adopted conventional community-management mode. One year after the model was implemented, the differences in KAP levels between the two groups were compared.  Results  The patients who finally completed the follow-up included 95 cases in the intervention group and 93 cases in the control group. After one year of intervention, the diabetes-related knowledge scores of patients in the intervention group were significantly higher than those in the control group (P < 0.05). The scores of self-efficacy in both groups increased compared with the baseline. Amongst them, the average scores of blood glucose monitoring, disease control, and total efficacy were statistically significant (all P < 0.05). The score of glucose monitoring, foot care, and pharmaceutical administration for self-management ability in the intervention group were 5.2±1.4, 4.5±1.9, 6.5±2.1, whereas the values of these indicators in the control group were 4.2±1.8, 3.8±2.2, 5.8±1.9, the differences between two groups were statistically significant (all P < 0.05). There were no significant differences in scores of diet management and exercise management between two groups (all P>0.05).  Conclusion  Peer-support education combined with general practice team-management mode can improve the knowledge level of patients with T2DM, and help them master the correct self-management behaviour.
A survey on the recognition of "Specialist-General Practitioner" family medicine team by TCM general practitioners in a district of Beijing
TIAN Yao, LI Yun, ZHOU Yuan
2022, 20(1): 88-91. doi: 10.16766/j.cnki.issn.1674-4152.002284
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  Objective  Because of the insufficient Traditional Chinese Medicine (TCM) general practice service capacity in community, general practitioners of TCM (TCMGPs) should face to explore new service mode based on existing experience. The purpose of this paper is to provide a theoretical basis for the implementation of the new pattern of "Specialist-General Practitioner" family medicine team among TCMGPs through questionnaire survey.  Methods  Using cluster sampling, 138 TCMGPs from 9 community health service centers in Dongcheng District were selected as the respondents of this study. Questionnaire was designed and evaluated, and then filled through WeChat APP from January 4 to January 7, 2020. The content of the questionnaire involved personal information, their demand for assembling "Specialist-General Practitioner" family medicine teams, the status quo and willingness of cooperation.  Results  (1) The working years of TCMGPs in this urban area were mainly less than 5 years and 6-10 years (41.0%, 35.1%), the education background was mainly bachelor's degree and master's degree or above (45.5%, 48.5%), and the professional titles were mainly primary and intermediate (35.8%, 54.5%). (2) In terms of demand, the status quo and willingness, 99.3% of TCMGPs needed specialists' support, and 79.9% of TCMGPs were able to seek the advice of specialists through various ways; 71.6% of TCMGPs were optimistic about the future of this kind of cooperative team.  Conclusion  TCMGPs in Dongcheng District have shorter working years, but better educational background and higher professional titles. Their capacity could be further improved via "Specialist-General practitioner" family medicine team mode. And this mode may be a way to help them carry out community health work better.
Investigation and analysis of anxiety and depression status of residents standardised training student in a hospital during the COVID-19 pandemic
PENG Tian-yuan, SONG Gui-qi, FAN Xi-zhen, FU Wei
2022, 20(1): 92-94,108. doi: 10.16766/j.cnki.issn.1674-4152.002285
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  Objective  To understand the anxiety and depression status of residents standardised training students during the Corona Virus Disease-19 (COVID-19) epidemic, and to establish an evidence-based strategy for improving the mental health of residents and curriculum construction.  Methods  A questionnaire survey was conducted by combining the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) in Feb. 12-Feb. 19, 2020 through the Ding Talk APP. The participants were resident students of the First Affiliated Hospitals of China University of Science and Technology.  Results  A total of 529 questionnaires were distributed, and 484 valid questionnaires were returned, with a recovery rate of 91.49%. During the COVID-19 epidemic, we found that 14.67% (71/484) of the residents were in an anxious state, and the mean scores of SAS was (38.96±9.16) points. Meanwhile, 23.97% (116/484) residents were in a depressed state, and the mean scores of SDS was (40.00±11.35) points. The severity of anxiety (H=5.635, P=0.018) and depression (H=10.029, P=0.002) was related to gender. The severity of depression was significantly different in different personnel groups (H=10.844, P=0.004), there was a significant correlation between anxiety and depression in this group (r=0.731, P < 0.001), and the distribution of severity was significantly different (Kendall=0.433, P < 0.001).  Conclusion  During the COVID-19 epidemic, resident students are faced with multiple pressures such as epidemic and employment, and the incidence rates of anxiety and depression are considerably higher than those of the general population and postgraduate students, especially in the male and unsigned group. Comorbid anxiety and depression also easily occurred. Sufficient attention and intervention measures should be actively taken by the hospital education section for the prevention of depression and anxiety.
Analysis of the effect of sensory integration training on children with attention deficit hyperactivity disorder
ZHANG Xun, SUN Yu-yan, KANG Juan, LIAO Wen-jing, ZHOU Guo-ling
2022, 20(1): 95-98. doi: 10.16766/j.cnki.issn.1674-4152.002286
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  Objective  To analyze the effect of drug therapy, sensory integration training and behavioral therapy on children with attention deficit hyperactivity disorder (ADHD).  Methods  A total of 72 children with ADHD admitted to the outpatient Department of Child Psychology of Hangzhou Seventh People's Hospital from January 2017 to June 2019 were selected as the research objects. They were randomly divided into control group (behavior therapy+drug treatment) and observation group (sensory integration training+behavior therapy+drug treatment), 36 cases in each group. The Conners parental questionnaire, sensory integration ability score, SNAP-4 score and C-WISC score were compared between the two groups before and after the intervention. The satisfaction rate of family members of the two groups was compared.  Results  After the intervention, the scores of sensory integration ability of the two groups were improved, and the observation group was higher than the control group (all P < 0.05). The Conners parental behavior table of the two groups decreased, and the observation group [(39.01±0.15) points] was lower than the control group [(41.65±0.16) points, t=72.224, P < 0.001]. The SNAP-4 of the two groups decreased, and the observation group [(56.21±3.21) points] was lower than the control group [(62.03±3.09) points, t=7.838, P < 0.001]. The C-WISC scores of the two groups were increased, and the observation group was higher than the control group (all P < 0.05). The satisfaction rate of family members in the observation group (97.22%) was higher than that in the control group (77.78%, χ2=4.571, P=0.033).  Conclusion  Sensory integration training on the basis of behavioral therapy and drug therapy can further improve children's sensory integration ability, improve their behavior, improve their intelligence level and family members' satisfaction with the intervention effect, which is worthy of promotion.
Epidemiological study on the HBV-M results in infants under 1 year of age in Xi'an area
AN Zhe, LI Si-peng, ZHANG Ni, DONG Wei, MENG Hao, LIU Hai-long, ZHOU Yuan, GUO Zhi, QIN Rui-hong, ZHU Huan-ge, SONG Lin-lan
2022, 20(1): 99-103. doi: 10.16766/j.cnki.issn.1674-4152.002287
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  Objective  To analyse the results and characteristics of hepatitis B virus markers (HBV-M) in infants before 1 year of age retrospectively.  Methods  From January 2019 to November 2019, 815 infants and 219 mothers with HBV-M were examined in the clinical laboratory of the Second Affiliated Hospital of Xi'an Jiaotong University. The infants were divided into three groups: group 1, which included infants aged 7-11 months; group 2, which included infants aged 1-6 months; and group 3, which included infants aged below 1 month. The HBV-M quantitative test was performed by chemiluminescent immunoassay with Abbott's Alinity immunoassay instrument. All samples of HBsAg were centrifuged at high speed and rechecked, and the rechecked results were taken as the final results.  Results  The positive rates of HBsAg were 0.00%, 0.47% and 6.66%, respectively, in the three groups. The positive rates of anti-HBs in the three groups were 94.29%, 84.65% and 66.06%, respectively. The positive rates of anti-HBc in the three groups were 6.67%, 20.47% and 27.27%, respectively. The HBsAg positive rate was 0% in infants born from 8 HBsAg-positive mothers. The consistency rate was 85.53% between 76 HBV-M-negative mothers and their infants, and consistency rates of anti-HBs, anti-HBc and anti-HBe were 100.00%, 95.00% and 77.27%, respectively. The main features of HBV-M in 31 HBsAg-positive infants were: HBsAg negative in their mothers, HBsAg level 0.19 IU/mL (0.05-0.54 IU/mL), anti-HBc negative, regular follow-up HBsAg can turn negative, HBV vaccine and NHB may be the main reason for false positive, the detection time does not exceed 10 days after vaccination.  Conclusion  The HBSAG positive rate and anti-HB positive rate of 7-11-month-old infants are the lowest, which indicates that the protective effect of HBV vaccine is good at present HBsAg was mainly found in 1-10-day-old newborns, which could turn negative during regular follow-up.
Association and research progress between potentially inappropriate medication and the risk factors of frailty in the elderly
DU Lin-na, LIU Shan, GUO Yan, WANG Min-juan
2022, 20(1): 104-108. doi: 10.16766/j.cnki.issn.1674-4152.002288
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China is entering the ageing stage, and elderly pharmacokinetics and pharmacodynamics very easily causes drug accumulation in body drug-related adverse reactions. Multi-drug use and potential inappropriate medication (PIM) are at high risk in the elderly, and the development of a catalogue of PIM can effectively screen the drugs causing adverse reactions in the elderly to regulate their rational use of drugs. Frailty is a common disease in the elderly, which can lead to high hospitalisation rate, prolonged hospitalisation, disability, and death. It is one of the major public-health problems in China. As the need for health becomes more common, the perception of frailty becomes more important. Age, income, lifestyle, health status, nutrition status, multiple drug use, and so on are the risk factors of frailty. The identification of risk factors can lead to a more comprehensive and systematic cognitive frailty for effective intervention at an early stage, delay the occurrence and development, improve the quality of life of the elderly, and reduce medical burden. Many studies have shown that a significant correlation existed between PIM and frailty and the risk factors of frailty, but few relevant literature exists in China. In this study, the correlations amongst physical function, cognitive function, sleep disorder, malnutrition, and other aspects of the elderly are reviewed through relevant literature at home and abroad. To standardise the rational use of drugs in the elderly, we should pay more attention to the PIM, the individual treatment, and the detection of adverse drug reactions. Our findings can serve as a reference for the research on China's declination.
Advance in research on postpartum outcome and follow-up of women with gestational diabetes mellitus
LIU Ming-yi, MA Xiu-hua
2022, 20(1): 109-112,116. doi: 10.16766/j.cnki.issn.1674-4152.002289
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Gestational diabetes mellitus (GDM) is a condition in which glucose intolerance is initially recognised during pregnancy, when the progressive increases in insulin resistance cannot be adequately accommodated by an additional pancreatic β-cell response, and it is a common complication during pregnancy. Hyperglycaemia during pregnancy can lead to adverse short-term and long-term outcomes for the mother and child. It may cause deformity, stillbirth and miscarriage in the early pregnancy. In the late pregnancy, undesirable results such as giant babies, caesarean section, shoulder dystocia, neonatal transfer to paediatrics and neonatal hypoglycaemia can occur. In addition, GDM is associated with an increased risk for long-term maternal complications such as type 2 diabetes mellitus and cardiovascular disease and components of metabolic syndrome, including central obesity, hypertriglyceridemia, low HDL levels and hypertension. Glycaemic control can modify the risk for GDM recurrence in subsequent pregnancy. With the change of lifestyle and the development of economy, the prevalence of GDM increases. Although relevant domestic and foreign guidelines recommend blood glucose screening during postpartum follow-up, the time and method of screening recommended by each guideline are not uniform. Multiple barriers are identified when receiving postpartum screening, such as the lack of a physician order for the postpartum glucose test and failure by the woman to obtain the glucose test. The follow-up rate is generally low, which makes timely management of high-risk women difficult. Moreover, the postpartum results are not optimistic. Complete blood glucose screening amongst pregnant women with gestational diabetes before discharge after delivery, reminding after delivery timely, paying attention to the propaganda and education of patients and enhancing the responsibility awareness of doctor can improve the postpartum follow-up status of women with gestational diabetes and provide interventions to improve their future outcomes. This paper reviews the research progress of postpartum outcome and follow-up of women with GDM.
Effect of intermittent nasogastric feeding on patients with severe traumatic brain injury and dysphagia
WU Chao, LU Ai-lan, CHEN Qiao-ge
2022, 20(1): 113-116. doi: 10.16766/j.cnki.issn.1674-4152.002290
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  Objective  To observe the clinical effect of intermittent nasogastric feeding on patients with severe brain injury and dysphagia.  Methods  Total 70 patients with severe traumatic brain injury with dysphagia in the Affiliated Jinhua Hospital, Zhejiang University School of Medicine from April 2017 to March 2020 were randomly divided into treatment (35 cases) and control (35 cases) groups according to the random-number table. The control group was treated with continuous nasogastric tube indwelling for nutritional support, whereas the treatment group was treated with intermittent nasogastric feeding technology. Improvements in the swallowing function, nutritional status, and sleep quality of the two groups before and after treatment were observed, and the clinical efficacy and complications during treatment were compared.  Results  After treatment, the result of water-drinking test in the treatment group was significantly better than that in the control group (Z=-2.684, P < 0.05), body mass index, serum albumin, prealbumin, and haemoglobin levels in the treatment group were significantly higher than those in the control group (t=3.431, 3.530, 3.143, 3.155, all P < 0.05). The Pittsburgh sleep quality index (PSQI) score in the treatment group was lower than that of the control group (t=7.930, P < 0.05). The incidence of pulmonary infection and abdominal distension complications in the treatment group were lower than those in the control group (χ2=6.437, 4.590, both P < 0.05). The total effective rate was 97.14% (34/35) in the treatment group, which was much better than the 77.14% (27/35) in the control group (χ2=4.590, P < 0.05).  Conclusion  Intermittent nasogastric feeding for patients with severe traumatic brain injury and dysphagia can significantly improve the swallowing function and nutritional status and improve sleep quality. The incidence of complications is low, and the effect is significant.
Curative effect of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis
YIN Wen-hao, JIN Meng-zhu, DAI Qing
2022, 20(1): 117-120. doi: 10.16766/j.cnki.issn.1674-4152.002291
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  Objective  To observe the clinical efficacy of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis and the changes of endostatin (ES) and angiostatin (AS) levels before and after treatment.  Methods  A total of 105 patients with lower leg plaque psoriasis treated in the First Hospital of Jiaxing from May 2019 to April 2020 were selected and randomly divided into the conventional treatment group, fire acupuncture group and combined treatment group, with 35 cases in each group. The conventional treatment group was treated with external application of halcinonide cream combined with NB-UVB irradiation, the fire acupuncture group was treated with fire acupuncture combined with acupuncture, and the combined treatment group was treated with the above-mentioned treatments simultaneously. All the three groups were treated for 8 weeks. The clinical efficacy was evaluated by PASI score, and the serum levels of ES and AS were detected before treatment and 4 and 8 weeks after treatment.  Results  The PASI scores of the three groups decreased after 8 weeks of treatment (all P < 0.05). After treatment, no significant difference in PASI score was found between the conventional treatment group and fire acupuncture group (P>0.05), but the PASI score of the combined treatment group was lower than that of the conventional treatment group and the fire acupuncture group (all P < 0.05). In addition, no significant difference in the total effective rate was found between the conventional treatment group (54.29%) and fire acupuncture group (60.00%, P>0.05). The total effective rate of the combined treatment group (85.71%) was higher than that of the conventional treatment group and fire acupuncture group (all P < 0.05). The serum levels of ES and AS in the three groups increased with time (all P < 0.05). The serum ES level of the combined treatment group was higher than that of the conventional treatment group and fire acupuncture group after 4 weeks of treatment (all P < 0.05), and the serum AS level of the combined treatment group after 8 weeks of treatment was higher than that of the conventional treatment group and fire acupuncture group (all P < 0.05).  Conclusion  The curative effect of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis is similar to that of conventional treatment. Combined treatment can improve the curative effect, and its mechanism may be related to the increase of ES and AS levels and the inhibition of angiogenesis.
Application of combing thumbtack needle with ear point pressing beans in knee osteoarthritis patients with syndrome of qi and blood weakness
ZHOU Xue-lai, DENG Dun, SHEN Bin, WU Feng-miao, CHEN Qiong-dan, LIN Ye-yan
2022, 20(1): 121-124. doi: 10.16766/j.cnki.issn.1674-4152.002292
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  Objective  To observe the application of combing thumbtack needle with ear point pressing beans in mild-to-moderate knee osteoarthritis patients with syndrome of qi and blood weakness.  Methods  A total of 112 mild-to-moderate knee osteoarthritis patients with syndrome of qi and blood weakness admitted from March 2019 to March 2020 were recruited and randomly divided into two groups using the random number table, six cases were shed in each group and 50 cases were included in each group for study. The control group was given routine rehabilitation treatment, whereas the research group was given thumbtack needle and ear point pressing beans. Knee joint swelling, tenderness, activity, serum C-reactive protein (CRP), function, pain and stiffness of WOMAC indicators were compared between the two groups before and after treatment.  Results  After treatment for 4 weeks, the knee joint swelling [(1.43±0.32) points], tenderness [(1.01±0.13) points], activity [(1.06±0.24) points], CRP [(5.32±1.68) mg/L], WOMAC function [(18.13±6.45) points], pain [(7.35±2.19) points], stiffness [(2.43±1.03) points] and total score [(26.43±9.51) points] in the research group were lower than those in the control group [knee joint swelling (2.68±0.75) points, tenderness (1.98±0.77) points, activity (2.34±0.98) points, CRP (10.67±2.93) mg/L, WOMAC function (24.32±5.17) points, pain (14.15±4.38) points, stiffness (3.69±1.15) points and total score (48.19±8.43) points]. The differences were statistically significant (all P < 0.05).  Conclusion  Combing thumbtack needle with ear point pressing beans can ease swelling, pain, tenderness and symptom, reduce the CRP level and improve knee joint function and quality of life of mild-to-moderate knee osteoarthritis patients with syndrome of qi and blood weakness.
Exploration of the MOOC model in the clinical laboratory English course during the COVID-19 pandemic
LI Jing, YANG Yan-qing, ZHENG Jing, GUO Shu-fa
2022, 20(1): 125-128. doi: 10.16766/j.cnki.issn.1674-4152.002293
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This research aims to apply massive open online courses (MOOC) in the teaching of English for Clinical Laboratory and determine the outcomes to ensure 'non-stop teaching and learning' during the COVID-19 pandemic. To achieve the above goals, English for Clinical Laboratory (2003 version) was used for special English teaching in the junior year. The teaching contents were selected and edited on the basis of MOOC guidelines. Sixty-eight junior year students with clinical laboratory major were selected as the participants of the research. Seventy-two medical students taking the conventional online learning mode was set as the control group. The online learning process, quiz scores, discussion participation, answer relevance and scores of the final test were monitored to evaluate the outcomes of the MOOC mode. After a session of 10 weeks, the results showed that the participation, completion, passing rate, relevance and final scores of junior year students undertaking MOOC mode of Special English were optimal. Special English in MOOC mode successfully aroused and kept students' interests and enhanced their learning habits. MOOC may be a practical and efficient teaching method in the pandemic. It has a scientific and sound makeup, defies restrictions in time and space, and provides effective interactions between students and teachers. MOOC is proved to be a desirable method to safeguard the intactness of the English teaching system, and it can be used as a quality teaching measure against the pandemic.
Professional identity and influencing factors amongst general practitioner students
LI Rong, WU Ge, FENG Gong, WANG Yang
2022, 20(1): 129-133. doi: 10.16766/j.cnki.issn.1674-4152.002294
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  Objective  To understand the status quo and influencing factors of the professional identity of rural free order-oriented students (hereinafter referred to as "directional students") and non-directional students (hereinafter referred to as "non-directional students") of general practice medicine.  Methods  A questionnaire on the professional identity of general medical students was prepared, which included four dimensions: professional cognition, professional emotion, professional learning behaviour and professional matching. Taking a medical local university in Northwest China as the research object, 602 directional and non-directional students from freshman to fifth grade were randomly selected by stages and levels through the Campus All-in-one Card big data system to conduct a questionnaire survey on the professional identity of general medicine. Descriptive statistics analysis, t test, correlation analysis, classification and logistic regression analysis were used for statistical processing.  Results  A total of 602 questionnaires were valid, and the total score of professional identity were (3.52±0.55) points. A total of 518 (86.05%) cases had high professional identity. The total mean scores of professional cognitions, professional emotion, professional learning behaviour and professional matching were (3.51±0.72) points, (3.24±0.81) points, (3.78±0.58) points, (3.55±0.66) points, respectively. The results of single-factor analysis showed that orientation and non-orientation, different age stages, grades, orientation regions, college entrance examination scores, students' origin and major selection consulting methods all had statistical significance with students' professional identity (all P < 0.05). Using binary logistic regression analysis, it was found that the professional identity of the students in the lower grades and who had received professional selection consultation and before entering school was significantly higher than that of the students in the higher grades and who had not received professional selection consultation (all P < 0.05).  Conclusion  The professional identity of general medical students is at a high level at present, and the main factors affecting the professional identity are orientation and non-orientation, different grades and whether they have had professional choice consultation. The suggestions are as follows: pay attention to students' psychological quality education in adolescence, carry out policy interpretation and employment guidance in layers and stages, set up a professional general practice consultation or publicity team to solve practical problems from the root of the team construction of the general practice medical system, strengthen the direction of resource supply side, and improve the professional identity of general practice students.
Investigate on status quo of doctor-patient communication skills in standardized training of general practice
PENG Tao, TANG Zhen-hai, ZOU Chuan, XU Leng-lan, ZHANG Jing-yi, YUAN Hui, SHEN Hua-lin, DAI Hong-xun
2022, 20(1): 134-137,168. doi: 10.16766/j.cnki.issn.1674-4152.002295
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  Objective  To investigate the doctor-patient communication level of resident physicians in standardized training of general practice, and to provide reference for the construction of doctor-patient communication training system.  Methods  On December 27, 2019, the standardized patient (SP) mode was adopted for admissions. Total 103 resident physicians in standardized training in the Department of General Medicine of Chengdu Fifth People's Hospital were observed and scored using the doctor-patient communication evaluation scale (SEGUE) to evaluate their doctor-patient communication ability.  Results  The total score of SEGUE scale was 4-22 points, with an average of (13.5±4.8) points. The preparation stage score was (2.7±1.2) points, the information collection stage score was (5.5±2.1) points, the information giving stage score was (2.5±1.1) points, the comprehend patient stage score was (2.3±1.1) points, and the end questioning stage score was (0.5±0.7) points. The score of SEGUE scale of senior standardized training physicians was higher than that of lower grade (P < 0.05). The scores of general practitioners in the following communication items were low: protecting patient privacy (29.1%), letting patients tell their views on the process of disease development and/or health problems (26.2%), understanding the impact of diseases on their lives (35.0%), verifying the information obtained (34.0%), encouraging patients to ask questions and verifying whether patients understand (22.3%), recognizing the patient's efforts, changes and difficulties (17.5%), asking patients if there are any other problems to be discussed (22.3%).  Conclusion  The clinical communication skills of resident physicians in standardized training of general practice need to be further improved, and an effective training course of doctor-patient communication is urgently necessary.
Brief talk on the experience of medical English learning in endocrinology teaching
WU Dao-ai, SHI Zhao-ming, JIN Guo-xi
2022, 20(1): 138-140. doi: 10.16766/j.cnki.issn.1674-4152.002296
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English is a common bridge tool to communicate with the world. With the continuous development of society and the increase of academic exchanges at home and abroad, the study of professional English is important. As far as medicine is concerned, its professional English is widely used in the field of medicine and nursing information exchange, which has the characteristics of large vocabulary, long words, difficult to remember and strong professionalism. At present, the English course of medical students in the university stage is relatively basic. Most colleges and universities still focus on public English, which is not closely combined with the medical specialty, and the degree of specialisation is not strong. To date, professional English is generally ignored in colleges and universities all over the country, which is in a weak state. Even in colleges and universities that have set up professional English, their teaching mode is also relatively unstable, and professional teaching materials and teachers are lacking. The solutions to these problems are in active exploration, and our school is no exception. The author finds that medical English is seldom used in endocrine teaching. Basically, medical English is only learned when it is needed, and our school do not have enough time to learn it. In addition, most medical English is obtained by self-study after class or by using multimedia or translation software. Nowadays, our school does not pay enough attention to medical English. At the college stage, English learning is also based on public English, and medical English course, specialised English learning materials and professional medical English teachers are not available. This article presents the corresponding solutions to the existing problems of professional English in our school to find a set of learning methods suitable for medical professional English in our school at this stage and improve the medical professional English of teachers and students in our school in the near future.
Functional enrichment and pathway analysis of differential expression of exosome lncRNA in colorectal cancer
ZENG Wei, LIU Yi, LI Wen-ting, ZHU Jin-feng
2022, 20(1): 141-143, 164. doi: 10.16766/j.cnki.issn.1674-4152.002297
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  Objective  To explore the role of differential expression of exosome lncRNA and its regulated signal pathway in the occurrence and development of colorectal cancer and provide a new target for the diagnosis and treatment of colorectal cancer.  Methods  The linear regression model package limma of R software was used to analyse the differential expression of lncRNA and mRNA. By calculating the Pearson correlation coefficient between differentially expressed lncRNA and mRNA, their co-expression was obtained. The positive co-expression of lncRNA-mRNA was screened by using a correlation coefficient. Go function and KEGG pathway enrichment of mRNA co-expressed with lncRNA were analysed to indirectly predict the function of lncRNA.  Results  A total of 202 differentially expressed exosome lncRNAs and 1014 exosome mRNA were screened from 32 healthy volunteers and 12 colorectal cancer patients. Ten pairs of lncRNA-mRNA co-expression were verified. Functional enrichment of mRNA co-expressed by lncRNA showed that differentially expressed exosome lncRNA may be closely related to B cell receptor signal pathway, NF-KB signal pathway, JAK-STAT signal pathway, antigen processing and presentation signal pathway and NOD-like receptor signal pathway activation.  Conclusion  In-depth exploration of differential expression, functional enrichment and pathway activation of exosome lncRNA in colorectal cancer is important to provide new ideas for the diagnosis and treatment of colorectal cancer.
Investigation on the current situation of knowledge of medical protective equipment amongst nurses in public hospitals in Anhui Province
FU Min, HU Shao-hua, WANG Ting, CHEN Yong-hui, ZHANG Xian-cui, SUN Li-qin, LIANG Yu-hua, FU Qin, XIE Run-yue, YUE Yan-hong
2022, 20(1): 144-147. doi: 10.16766/j.cnki.issn.1674-4152.002298
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  Objective  To understand the knowledge of nurses regarding medical protective equipment in public hospitals in Anhui Province, analyse its shortcoming and influencing factors, and provide basis for further training.  Methods  A total of 6 586 nurses from 56 public hospitals in Anhui Province were investigated by convenience sampling method. Questionnaire were designed according to the literature review and documents of the National Health Commission. Multiple linear regression method was used to investigate the influencing factors of nurses' knowledge regarding medical protective equipment.  Results  A total of 6 502 valid questionnaires were received. The average score of the scale was (54.42±5.73) points, and the correct rate of knowledge items ranged from 40.31% to 99.71%. Univariate analysis showed that education level, hospital grade, department, participation in the treatment of infectious diseases, handling of COVID-19 patients and participation in training regarding protective equipment had a statistically significant difference (all P < 0.05). Regression analysis showed that the knowledge score was significantly influenced by the educational level, participation in the treatment of infectious diseases, handling of COVID-19 patients and participation in training regarding protective equipment (all P < 0.05).  Conclusion  The application and removal of medical protective equipment are the weak points of nurses' personal protection knowledge in public hospitals in Anhui Province. Nurses who have a bachelor's degree or above, participate in the treatment of infectious diseases, handle COVID-19 patients and receive training regarding protective equipment have higher scores. Besides theoretical knowledge training, managers can improve nurses' occupational protection skills through scenario simulation, operation demonstration and other skills training methods.
Analysis on the current situation and influencing factors of fear of cancer recurrence in patients with colorectal cancer undergoing chemotherapy
CHEN Si-si, YAO Hai-xin, CHEN Yu
2022, 20(1): 148-151. doi: 10.16766/j.cnki.issn.1674-4152.002299
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  Objective  To investigate the current situation and influencing factors of fear of cancer recurrence amongst patients with colorectal cancer undergoing chemotherapy and provide theoretical basis for the development of clinical intervention measures.  Methods  A total of 219 patients with colorectal cancer receiving chemotherapy in our hospital from July to December 2020 were selected as the research objects by convenience sampling. The general data questionnaire, the Fear of Cancer Recurrence Inventory, the Posttraumatic Growth Inventory and the Family Hardiness Index were used for the questionnaire survey. SPSS 23.0 software was used for t test, analysis of variance, Pearson correlation analysis and multiple linear regression analysis.  Results  The scores of fear of cancer recurrence, posttraumatic growth and family hardiness were (101.11±18.92) points, (60.70±9.13) points and (56.49±7.82) points, respectively, in patients undergoing colorectal cancer chemotherapy. Statistically significant differences in fear of cancer recurrence scores were found amongst patients undergoing chemotherapy for colorectal cancer with different ages, educational background, family per capita income, postoperative time, disease stage and complications (all P < 0.05). Pearson correlation analysis showed that the scores of posttraumatic growth and family hardiness of patients undergoing chemotherapy for colorectal cancer were negatively correlated with the scores of fear of cancer recurrence (r=-0.325 and -0.328, respectively), with statistical significance (all P < 0.01). Multiple linear regression analysis showed that disease stage, family hardiness, posttraumatic growth and level of education were correlated with patients' fear of cancer recurrence (β values were 0.380, -0.232, -0.190, -0.216, respectively), with statistical significance (all P < 0.05).  Conclusion  The level of fear of cancer recurrence in patients undergoing chemotherapy for colorectal cancer is high, and intervention measures should be in accordance with patients' disease stage, family hardiness, posttraumatic growth and educational background to alleviate the fear of cancer recurrence and improve the quality of life of patients.
Analysis of virulence and drug resistance of pan drug resistant Klebsiella pneumoniae
MAO Guo-feng, ZHOU Jie, LYU Li
2022, 20(1): 152-156. doi: 10.16766/j.cnki.issn.1674-4152.002300
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  Objective  To identify resistance genes, virulence factors and homology of two strains of pan drug resistant Klebsiella pneumoniae with different origins.  Methods  Two strains of pan drug resistant bacteria were isolated from the urine of two inpatients in early 2019. The minimal inhibitory concentration of the strain was determined by broth dilution, and the carbapenemase phenotype was screened by EDTA and PBA. Using the third-generation sequencing platform for genome sequencing and screening of drug-resistant genes and virulence factors, the sequencing Results were spliced, assembled and annotated. Multilocus sequence typing (MLST) was conducted for genotyping of strains.  Results  The two strains were resistant to most antibiotics including carbapenems except tigecycline and polymyxin. The synergistic test of EDTA and PBA suggested that carbapenemase might be carried. The two strains all carried one chromosome and two plasmids. The difference of chromosome genes was 1 192 bp, and the number of plasmids was the same. β-lactam resistance genes such as SHV-28, DHA-18, NMC, SPM and AIM, efflux system such as AcrA-AcrB-TolC, and outer membrane protein deletions of OmpK35 and OmpK36 were detected. The virulence factors included iron uptake system, pili, capsule, endotoxin and binary regulatory system. All MLST types were ST15.  Conclusion  β-lactam resistance genes combined with the loss of outer membrane proteins are the main reasons for the resistance of bacteria to carbapenems. NMC, SPM and AIM β-lactam resistance genes are detected in Klebsiella pneumoniae for the first time. There may be clonal transmission of pan drug resistant Klebsiella pneumoniae.
Relationship between uric acid level and cardiovascular risk factors in overweight and obese children in Tangshan City
LI Dan, SUN Guo-hua, CHEN Xin-chun, KOU Yong-mei
2022, 20(1): 157-160. doi: 10.16766/j.cnki.issn.1674-4152.002301
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  Objective  To understand the relationship between uric acid level and cardiovascular risk factors in overweight and obesity children in Tangshan, and to provide theoretical basis for preventing hyperuricemia and reducing the risk of cardiovascular disease.  Methods  Total 560 overweight and obesity children screened by physical examination of school-age children in Tangshan City from 2018 to 2019 were taken as the research objects. Height, weight, waist circumference (WC), blood pressure (BP) were measured, body mass index (BMI) was calculated. Uric acid (UA), fasting blood glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were detected. The relationship between uric acid and cardiovascular risk factors was analyzed by sex stratification.  Results  (1) The detection rates of boys and girls hyperuricemia were 36.50% and 26.26% respectively (P < 0.05). (2) With the increase of UA level, SBP and DBP increased and HDL-C decreased in boys, SBP, FPG, TC, TG, LDL-C increased and HDL-C decreased in girls, the difference between groups was statistically significant (all P < 0.05). (3) UA level in boys was negatively correlated with HDL-C (r=-0.154, P < 0.05), positively correlated with TG and SBP (r=0.141, 0.238, all P < 0.05), meanwhile UA level in girls was negatively correlated with HDL-C (r=-0.700, P < 0.05), and positively correlated with LDL-C and TG (r=0.615, 0.341, all P < 0.05). (4) The influencing factors of hyperuricemia in boys were age, low HDL-C, abnormal fasting blood glucose, overweight/obesity, meanwhile the influencing factors of hyperuricemia in girls were age, high TC, low HDL-C, high TG, overweight/obesity and hypertension.  Conclusion  UA level of overweight and obesity children in Tangshan City is related to cardiovascular risk factors. Uric acid levels of overweight and obesity children should be monitored regularly.
Influence of lateral violence amongst nurses on the solidarity degree of clinical nurses
KE Yan-qiong, WU Shu-min, ZHU Hui-bin, YAN lei-lei, JIN Qian-qian
2022, 20(1): 161-164. doi: 10.16766/j.cnki.issn.1674-4152.002302
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  Objective  To investigate the status quo of clinical nurses' solidarity and lateral violence behaviour amongst nurses and analyse its influence on clinical nurses' solidarity.  Methods  Using convenience sampling, 478 in-service nurses in our hospital were investigated from May to July 2020. A lateral violence questionnaire and solidarity scale were used to investigate the lateral violent behaviour and solidarity amongst nurses, and the relationship amongst them was discussed.  Results  A total of 478 questionnaires were filled in, and 472 were valid, with an effective recovery rate of 98.7%. The total score of lateral violence amongst nurses was (71.23±2.16) points, and the total score of solidarity amongst clinical nurses was (57.56±1.23) points. Univariate analysis showed that the total score of clinical nurses' work solidarity had statistical significance with regard to length of service, title and organisation (all P < 0.05). Correlation analysis showed a negative correlation between the total score of lateral violence behaviour and the total score of solidarity amongst nurses and the scores of each dimension (all P < 0.05). Stratified regression analysis showed that the length of service and professional title affected 17.6% variation of solidarity amongst nurses. After controlling for demographic characteristics, explicit and implicit violence could explain 38.2% of the variation in nurses' work solidarity.  Conclusion  Lateral violence amongst nurses is common, and the degree of solidarity amongst nurses is tolerable. The clinical nursing solidarity of nurses with long working time and high professional title is higher than that of nurses with junior seniority and low professional title. Lateral violence amongst nurses is a negative factor that reduces the degree of clinical nurses' solidarity. Young nurses may be the key link of the influence of relational lateral violence on the degree of clinical nurses' solidarity, particularly emotional solidarity.
Study on the preventive value of infection prevention and control system for perioperative nosocomial infection in patients with traumatic fracture
ZHOU Cong-cong, LIN Chu-jun, HONG Jing
2022, 20(1): 165-168. doi: 10.16766/j.cnki.issn.1674-4152.002303
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  Objective  Infection is a common complication of traumatic fracture, which can be life-threatening in severe cases. It is necessary to effectively prevent nosocomial infection in patients with traumatic fracture. By discussing the value of constructing infection prevention and control system, we can provide guidance for clinical prevention of nosocomial infection.  Methods  Total 88 patients with traumatic fracture collected in our hospital from July 2019 to September 2020 were randomly divided into control group (routine intervention) and observation group (construction of infection prevention and control system). The nosocomial infection rate, inflammatory factor index, fracture healing and complication rate of the two groups were compared.  Results  The incidence of nosocomial infection in the observation group (2.27%) was significantly lower than that in the control group (18.18%), the difference was statistically significant (P < 0.05). Before intervention, there was no significant difference in the level of CRP, IL-1β and TNF-α in the two groups (all P>0.05). After intervention, the levels of CRP [(7.89±1.40) mg/L], IL-1β [(20.08±3.11) pg/mL] and TNF-α [(7.89±1.20) pg/mL] in the observation group were lower than those in the control group [(11.01±1.42) mg/L, (25.11±3.34) pg/mL, (12.01±1.40) pg/mL, all P < 0.05]. The clinical healing rate (93.18%) and fracture healing rate (100.00%) in the observation group were higher than those in the control group (77.27% and 81.82%, all P < 0.05). The incidence of complications in the observation group (4.55%) was lower than that in the control group (20.45%, P < 0.05).  Conclusion  The construction and application of infection prevention and control system has a significant effect, which can effectively reduce the incidence of postoperative complications of traumatic fracture and improve inflammatory indexes and fracture healing.
Effect of collaborative rehabilitation nursing intervention on self-care ability and quality of life of patients with chronic heart failure
ZU Dong-liang, ZHANG Shuang, WANG Nan
2022, 20(1): 169-171. doi: 10.16766/j.cnki.issn.1674-4152.002304
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  Objective  To analyse the influence of collaborative rehabilitation nursing intervention model on the self-care ability and quality of life of patients with chronic heart failure.  Methods  A total of 120 patients with chronic heart failure admitted to the Qinhuangdao First Hospital from November 2018 to July 2020 were included in the study. The patients were divided into the observation group and control group using the random number table method, with 60 cases in each group. The patients in the control group received routine cardiology nursing measures, and the patients in the observation group performed a collaborative rehabilitation nursing intervention model based on the control group. The intervention period was 12 weeks. The self-care index scale and the Minnesota heart failure patient quality of life scale were applied. The self-care ability and quality of life of the two groups of patients before and after intervention were assessed and followed up for half a year, and the readmission rate was compared.  Results  After the intervention, all dimensions of the self-care ability of the intervention group were significantly higher than those of the control group (tmaintenance=9.363, P < 0.001; tmanagement=11.896, P < 0.001; tmaintenance=7.453, P < 0.001), whereas the quality of life and total score of each dimension were significantly lower than those in the control group (ttotal score=-4.152, P < 0.001; tbody=-4.025, P < 0.001; temotion=-2.929, P=0.004; tother=-2.680, P=0.009), and the difference was statistically significant (P < 0.05). After follow-up for half a year, the re-admission rate of patients in the observation group was 8.33% (5/60), and the control group was 31.67% (19/60). The observation group was significantly lower than the control group, and the difference was statistically significant (χ2=10.208, P=0.001).  Conclusion  The model of collaborative rehabilitation nursing intervention applied to patients with chronic heart failure can improve the self-care ability and quality of life of patients and reduce the readmission rate, and this model has a good clinical application potential.
2022, 20(1): 172-174. doi: 10.16766/j.cnki.issn.1674-4152.002305
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General Practice Research
Serum expression levels and clinical significance of miR-483-5p in elderly patients with gastric cancer
GU Ting, LIU Xiao-qing, CAO Feng, ZHANG Feng-bo
2022, 20(1): 8-10, 124. doi: 10.16766/j.cnki.issn.1674-4152.002263
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  Objective  To investigate the relative expression levels of serum miR-483-5p and its clinical significance in elderly patients with gastric cancer.  Methods  A total of 65 elderly patients with gastric cancer and 40 healthy individuals were enrolled in the First Affiliated Hospital of Xinjiang Medical University between January 1, 2017, and January 1, 2019. The difference in the relative expression levels of serum miR-483-5p amongst the subjects was detected and compared by RT-PCR. The relationship between the relative expression levels of serum miR-483-5p and clinical characteristics of elderly patients with gastric cancer was also analysed. The influencing factors affecting the relative expression levels of serum miR-483-5p were analysed by Logistic regression analysis. The clinical efficacy of miR-483-5p in the diagnosis of gastric cancer was analysed by the receiver operating characteristic (ROC) curve.  Results  Compared with the control group, the relative expression levels of serum miR-483-5p in elderly patients with gastric cancer were significantly higher (P < 0.001). The invasion levels (OR=4.123), TNM stage (OR=3.548) and lymph node metastasis (OR=4.015) were considered as the risk factors for the increased serum relative expression levels of miR-483-5p in elderly patients with gastric cancer. The ROC curve showed that the relative expression levels of serum miR-483-5p had a high clinical efficacy in the diagnosis of gastric cancer. Therefore, at a cutoff value of 0.812, the sensitivity and specificity were 91.2% and 95.3%, respectively.  Conclusion  The serum relative expression levels of miR-483-5p in elderly patients with gastric cancer are significantly high and related to the clinical characteristics. Therefore, miR-483-5p may be considered as a potential biomarker for gastric cancer screening.
Clinical characteristics of patients with extremely high level of high-density lipoprotein cholesterol
SUN Lu-fan, JIA Da-lin
2022, 20(1): 11-13, 79. doi: 10.16766/j.cnki.issn.1674-4152.002264
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  Objective  Extremely high level of high-density lipoprotein cholesterol (HDL-C) has been proven to increase cardiovascular mortality. This study aimed to investigate clinical characteristics of cardiovascular patients with extremely high level of HDL-C, providing information for further research concerning the relationship between HDL-C and cardiovascular diseases, as well as mechanisms of HDL metabolism.  Methods  All adult blood-lipid data in the Department of Cardiology in the First Hospital of China Medical University throughout the entire year of 2019 were retrospectively analysed. Extremely high level of HDL-C was defined as HDL-C ≥ 2.59 mmol/L (100 mg/dL). Gender, age, and medical information of each patient were evaluated. Their lipid profiles were compared with healthy individuals who underwent a checkup in the same hospital during the same period with matched gender and age.  Results  A total of 20 655 patients were included in the final analysis, and patients with an extremely high level of HDL-C covered only 0.16%; they were primarily females and outpatients. Their average age was (60.21±10.27) years, higher than those with normal HDL-C. Their average total cholesterol (TC) level, triglyceride (TG) level, low-density lipoprotein cholesterol (LDL-C) level, and non-high-density lipoprotein cholesterol (non HDL-C) were (6.22±0.95) mmol/L, (0.82±0.36) mmol/L, (3.05±0.75) mmol/L, and (3.30±0.80) mmol/L, respectively. Compared with matched healthy individuals, they had elevated TC and HDL-C/TC ratio (P < 0.001), reduced TG (P < 0.001), and comparable LDL-C (P=0.756) and non HDL-C (P=0.058), irrespective of gender.  Conclusion  Patients with extremely high HDL-C are primarily females and outpatients with elder age. Compared with matched healthy individuals, they have reduced TG and comparable LDL-C and non-HDL-C, probably indicating irrelevance between increased cardiovascular risks and LDL-C, TG, and apolipoprotein B.
Baseline analysis of a multicenter prospective heart-failure cohort in Anhui Province
CHEN Kang-yu, YAN Ji
2022, 20(1): 14-17, 98. doi: 10.16766/j.cnki.issn.1674-4152.002265
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  Objective  Heart failure is one of the most common cardiovascular diseases, and its prevalence rate is increasing yearly. This study aimed to understand the epidemiological characteristics of hospitalised patients with heart failure in Anhui province.  Methods  This study was a prospective cohort one. Patients hospitalised for heart failure from December 2016 to October 2018 were selected. We included 16 hospitals in Anhui Province. The clinical data of patients including demographic characteristics, complications, laboratory examination, auxiliary examination, drug application, and events during hospitalisation were collected through case report forms.  Results  A total of 2 794 patients were enrolled, with an average age of 68 years old, primarily male (60.5%) and NYHA Ⅲ (50.3%). Hypertension (51.5%), coronary heart disease (45.5%), and atrial flutter or fibrillation (35.6%) were the top three complications. The proportion of HFpEF and HFrEF patients were 43.1% and 39.0%, respectively. The utilisation rates of ARNI/ACEI/ARB, beta blocker, and aldosterone receptor antagonist were 65.6%, 64.1%, and 89.4%, respectively. The average length of hospital stay was 9 days, which was longer in the HFrEF group than in the HFpEF gourp (P=0.005). The in-hospital mortality was 1.8%, and no significant difference existed amongst different types of heart failure.  Conclusion  The population characteristics of hospitalised patients with heart failure in Anhui are similar to those in China. The standardised drug-use rate has improved, but there is still a gaps in the guidelines remain.
The death risk factors of Stanford A aortic dissection surgery
LI Yan-li, GAO Qing-yun, FENG Jun-bo, ZHANG Cheng-xin, GE Sheng-lin
2022, 20(1): 18-21, 103. doi: 10.16766/j.cnki.issn.1674-4152.002266
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  Objective  To explore the death risk factors after Stanford A aortic dissection surgery based on the perioperative data of patients with Stanford A aortic dissection.  Methods  A total of 68 patients with Stanford A aortic dissection from January 2012 to January 2020 were enrolled in the Cardiovascular Surgery Department of the First Affiliated Hospital of AnHui Medical University for the retrospective analysis. Based on clinical outcome, patients were divided into survival group (n=50) and death group (n=18). The preoperative, intraoperative and postoperative clinical data was summarized and studied retrospectively. Univariate analysis was performed by t/χ2 test and further, multivariate analysis was performed by logistic regression based on significant results from univariate analysis to identify the death risk factors after Stanford A aortic dissection surgery.  Results  There were significant differences between two groups by univariate analysis for preoperative LVEF < 50%, preoperative hypotension, preoperative pericardial effusion, preoperative neurological disorder, involved coronary arteries, involved aortic valve, intraoperative lactic acid, ultrafiltration, urine volume and supportive cardiopulmonary by pass running time (all P < 0.05). Subsequently, preoperative LVEF < 50% (OR=33.163, P=0.037) and supportive cardiopulmonary bypass running time (OR=1.248, P=0.004) were significant factors by logistic regression analysis. Postoperatively, there were significant differences for extubation time, reoperation, re-intubation, awaking time, CRRT, postoperative lactic acid and ICU stay (all P < 0.05).  Conclusion  Both preoperative LVEF < 50% and supportive cardiopulmonary bypass running time are the death risk factors of Stanford A aortic dissection surgery.
Effect and mechanism of berberine-targeted regulation of TLR4 signaling pathway on the biological behaviour of malignant melanoma
WANG Yong-chao, ZHENG Zeng-guang
2022, 20(1): 22-26, 53. doi: 10.16766/j.cnki.issn.1674-4152.002267
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  Objective  To explore the regulatory effect of berberine on the TLR4 signaling pathway in malignant melanoma, to evaluate its effect on the proliferation, migration, and apoptosis of malignant melanoma A375 cells induced by lipopolysaccharide (LPS), and to provide a new drug (berberine) treatment basis for the prevention and treatment of malignant melanoma.  Methods  Western blotting was used to detect the intervention effects of different concentrations of berberine on the expression of TLR4 and NF-κB in A375 cells. The experimental groups were as follows: group A was control group, group B was LPS group, group C was TAK-242 group, group D was LPS+TAK-242 group, group E was LPS+TAK-242+80 μmol/L berberine group, and group F was LPS+TAK-242+120 μmol/L Berberine group. CCK-8, Transwell and flow cytometry assays were used to detect the effects of berberine targeting TLR4 on the proliferation, migration, and apoptosis of A375. We used enzyme-linked immunosorbent assay to detect the expression of IL-10 and TGF-β in the supernatant of each group of cell influences.  Results  With increased concentration of berberine, the expression of TLR4 and NF-κB protein was down-regulated more significantly (all P < 0.05). Compared with group A, the proliferation and migration ability of group B was enhanced, but no difference existed in apoptosis. The proliferation and migration ability of group C was weakened, and apoptosis was increased. The proliferation and migration ability of group D was weaker than that of group B and stronger than that of group C. Compared with group D, the proliferation and migration ability of E and F groups weakened, and apoptosis increased. At high concentrations of berberine, the cell proliferation and migration ability weakened more obviously (all P < 0.05). The expression levels of IL-10 and TGF-β in group B increased (all P < 0.05), the expression level of IL-10 in group C decreased, and the expression of TGF-β did not change significantly. The IL-10 of group D was lower than that of group B and increased compared with that of group C. The expression levels of IL-10 and TGF-β in group F were significantly reduced (all P < 0.05).  Conclusion  Berberine inhibits the proliferation and migration of LPS-induced malignant melanoma cells and promotes their apoptosis by inhibiting the TLR4/NF-κB signaling pathway. Berberine may be used as a medicine to treat malignant melanoma.
Efficacy of pelvic short-course palliative radiotherapy for advanced rectal cancer
DING Shu-bo, ZHOU Zhen-zhen, LI Ming, HU Wang-yuan
2022, 20(1): 27-30. doi: 10.16766/j.cnki.issn.1674-4152.002268
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  Objective  To evaluate the efficacy and safety of pelvic short-course palliative radiotherapy in advanced rectal cancer with local symptoms, and to provide treatment strategies for palliative radiotherapy for advanced rectal cancer.  Methods  Total 51 patients with advanced rectal cancer who were admitted to Affiliated Jinhua Hospital, Zhejiang University School of Medicine from May 2016 to April 2020 were selected as the research subjects. The age ranged from 43 to 74 years, and the median age was 61 years old. There were 28 males and 23 females. The rates of pain, bleeding and intestinal obstruction in 51 patients were 66.7%(34/51), 68.6%(35/51), 39.2%(20/51), respectively. All 51 patients were underwent pelvic 5 Gy×5F short-course radiotherapy. The changes in the scores of pain, bleeding and intestinal obstruction symptoms before and after treatment were compared using the symptom score of 0-3 method. The side effects of short-course radiotherapy and the duration of symptom relief were assessed.  Results  In 51 cases, the complete and partial relief of pain was 61.8%(21/34) and 29.4%(10/34), the complete and partial relief of rectal hemorrhage was 74.3%(26/35) and 20.0%(7/35), the complete and partial relief of intestinal obstruction was 55.0%(11/20) and 35.0%(7/20), respectively. The overall symptom complete response was 21.6%, and the partial response was 43.1%. The side effects of pelvic radiotherapy were slight. The median effective duration of pain, hemorrhage, and obstruction were 6.5 months, 8.9 months, and 3.8 months, respectively. Five patients with initial unresectable and 8 patients with potentially resectable advanced stage underwent radical surgical resection. One patient with an initial obstruction score of 2 points underwent enterostomy after 5.5 months of radiotherapy. The overall 1-year, 2-year, and 3-year survival rates were 86.3%(44/51), 62.7%(32/51)and 45.1%(23/51), respectively.  Conclusion  The short-course radiotherapy of pelvic 5Gy×5F has a good palliative effect on the advanced rectal cancer. Short-course radiotherapy allows most patients with intestinal obstruction to avoid surgery, improves the radical operation rate of advanced rectal cancer. It has important significance for the transformation treatment of advanced rectal cancer.
Effect evaluation of ceramic onlays on endodontically treated molars restored with partical and all coverage
YU Jian, XU Guo-chao, XIAO Jia-ling
2022, 20(1): 31-34. doi: 10.16766/j.cnki.issn.1674-4152.002269
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  Objective  The aim of the study is to compare the clinical effect of ceramic onlays with two different coverages to restore root canal treated molars.  Methods  The sample of 105 endodontically treated molars restored by ceramic onlays were collected from 92 patients seen in Department of Stomatology, Zhejiang Hospital from December 2016 to December 2017. The 105 molars were randomly divided into partial coverage group and all coverage group by tossing a coin. After complete restoration procedures, the molars were evaluated in accordance with the modified United States Public Health Service criteria at 6-month, 12-month, 18-month and 24-month recalls. The statistical analyses of within group and between group changing over time differences of each criteria were carried out using Generalized Linear Mixed Model(GLMM). The between group differences at the same time point recall were analyzed by chi-square test. Results For within group comparison, over time, all coverage (AC) group demonstrated significant decreased of gingiva health rate(P < 0.05); partial coverage (PC) group showed dramatic decrease scale in terms of restoration integrity, marginal adaptation, tooth integrity and secondary caries(all P < 0.05). As for between group comparison, AC and PC groups showed significant differences in tooth integrity and secondary caries at 24 month after onlay insertion(all P < 0.05). The coverage types didn't affect other clinical effect criteria at all these time points (all P > 0.05). In addition, there is no interaction between time and group(all P > 0.05).  Conclusion  Statistical analysis showed that the all coverage onlay has good comprehensive performance. It is a better choice to restore mild to moderate molar defect after root canal therapy. It is reasonable to expect that all coverage onlay will improve the restoration effect on endodontically treated molars in a long-term clinical use when compared to partial coverage onlay.
Regulation of mitochondrial dynamic-related protein 1 on glucose metabolism in liver cancer cells
GENG Xi-lin, ZHANG Ying, LI Hao, ZHANG Yu, CHANG Hu-lin
2022, 20(1): 35-38. doi: 10.16766/j.cnki.issn.1674-4152.002270
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  Objective  To explore the effect of mitochondrial dynamic-related protein 1 (DRP1) on glucose metabolism reprogramming in liver cancer cells.  Methods  After DRP1 was knocked down by siRNA in liver cancer SNU-739 cells, (1) To explore the effect of DRP1 on glycolysis of liver cancer, glucose uptake and lactate production were determined. (2) To explore the effect of DRP1 on oxidative phosphorylation of liver cancer, the oxygen consumption rate and ATP production were determined. (3) The effects of DRP1 knockdown on the levels of metabolites in glycolysis and the TCA cycle were determined by mass spectrometry analysis.  Results  (1) Down regulation of DRP1significantly inhibited glucose uptake and lactate production in SNU-739 cells (siCtrl: si-DRP1#1: si-DRP1#2=1.000±0.069:0, 417±0.032: 0.400±0.040: F=141.400, P < 0.001) and lactate production (siCtrl: si-DRP1#1: si-DRP1#2= 1.00±0.050:0.327±0.040: 0.310±0.036; F=256.700, P < 0.001). (2) Down regulation of DRP1 markedly increased the rate of oxygen consumption (siCtrl: si-DRP1#1: si-DRP1#2=1.000±0.069: 1.623±0.081: 1.591±0.046; F=81.720, P < 0.001) and ATP production (siCtrl: si-DRP1#1: si-DRP1#2= 1.000±0.062: 1.813±0.093:1.850±0.070; F=119.200, P < 0.001). (3) Down regulation of DRP1 decreased the levels of glucose, pyruvate and lactate (all P < 0.001) in glycolysis metabolism, but increased the levels of citrate, fumarate and malate (all P < 0.001) metabolites in the TCA cycle.  Conclusion  DRP1 reprogrammed glucose metabolism of liver cancer cells through increasing glycolysis and decreasing oxidative phosphorylation.
Clinical observation of single-docking robot-assisted laparoscopic radical nephroureterectomy for renal pelvic carcinoma
WEI Hai-bin, MIAO Jia, ZHANG Qi, QIAN Lin, LI En-hui, XU Xiao-bo, LYU Jia, LIU Feng, QI Xiao-long, ZHANG Da-hong
2022, 20(1): 39-42, 71. doi: 10.16766/j.cnki.issn.1674-4152.002271
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  Objective  To evaluate the clinical efficacy and safety of single-docking technique for robot-assisted laparoscopic radical nephroureterectomy in the treatment of renal pelvic carcinoma.  Methods  Total 42 consecutive patients with renal pelvic carcinoma were enrolled for the retrospective study in our hospital from September 2014 to September 2018. There were 27 male and 15 female patients. All patients were underwent Da Vinci Si robot-assisted laparoscopic radical nephroureterectomy. The robotic camera port was placed in the affected side 6-8 cm beside the abdominal midline at the level of the umbilicus. The No. 1 robotic port and the No. 2 robotic port were respectively located parallel to the abdominal midline and 8 cm from the camera port. They were symmetrically distributed to the camera port line. The operative time, perioperative blood loss and postoperative complications were recorded. All patients were followed up for 12-48 months, and tumour recurrence was recorded.  Results  All operations were successfully completed, without transition to laparoscopic or open surgery. The blood loss was 90 (50, 260) mL, the operating time was 140 (100, 205) min, and the postoperative hospital stay was 8 (6, 12) days. Postoperative pathology confirmed renal pelvic malignant tumours, 16 cases of grade Ⅰ, 17 cases of grade Ⅱ, 4 cases of grade Ⅲ and 5 cases of grade Ⅳ. In 15 patients (35.7%), lymphadenectomy was performed with mean lymph node count of 14 (4, 24), and 5 patients were positive for lymph nodes. Postoperative complication rate: the incidence rate of Clavien grade 2 was 9.5% (2 patients required blood transfusion, 2 other patients with lung infections required anti-infective treatment), Clavien grade 3 complications occurred in 4.8% of patients (2 patients underwent thoracic drainage because of pleural effusion). The incidence of complications was generally low. The median follow-up time was 16.5 months. During the follow-up period, 3 patients had intravesical tumour recurrence and transurethral resection of bladder tumour.  Conclusion  Single-docking technique for robot-assisted laparoscopic radical nephroureterectomy is a safe and effective minimally invasive procedure with the advantages of larger operation space and more convenient operation for the treatment of renal pelvic carcinoma.
Establishment and verification of a prognostic model for patients with gastric cancer based on clock gene promoter methylation
HUANG Yi-bo, NIU Ying-qun, HUANG Guo-qiang, HU Ru-ying
2022, 20(1): 43-46. doi: 10.16766/j.cnki.issn.1674-4152.002272
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  Objective  To establish and certificate a prognostic model for gastric cancer patients based on methylation of the promoter region of the clock gene.  Methods  A total of 459 patients with gastric cancer admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2015 to January 2018 were selected. They were followed up for 2 years after operation and were divided into the recurrence group and non-recurrence group according to the recurrence. The differences in the general data, surgery-related data and methylation frequency of the clock gene promoter region between the two groups were compared. Multivariate logistic regression analysis was performed to determine the independent influencing factors of recurrence, and R software was used to establish a predictive model of recurrence and verify its efficacy.  Results  During follow-up, 5 cases were lost to follow-up. Among the remaining 454 patients, 217 had recurrence and were classified as the recurrence group, and the remaining 237 cases without recurrence were classified as the non-recurrence group. The recurrence rate of gastric cancer was 47.80% (217/454). There were statistically significant differences in the degree of differentiation, lymph node metastasis, tumour growth pattern and methylation frequency of the per1, per2, cry1 and clock gene promoter regions between the two groups (P < 0.05). Multivariate logistic regression analysis showed that the degree of differentiation (OR=0.519, P < 0.05), lymph node metastasis (OR=2.365, P < 0.05), tumour growth pattern (OR=0.616, P < 0.05), per1 (OR=24.108, P < 0.05), per2 (OR=2.152, P < 0.05), cry1 (OR=3.131, P < 0.05) and clock (OR=1.676, P < 0.05) were independent factors affecting gastric cancer recurrence. The prediction model showed that the consistency index of recurrence was 0.906 (95% CI: 0.879-0.938).  Conclusion  The degree of differentiation, lymph node metastasis, tumour growth pattern and methylation of the per1, per2, cry1 and clock gene promoter regions as influencing factors can effectively predict the recurrence of gastric cancer, and have good application value.
Clinical study of Nd: YAG laser combined with triamcinolone acetonide in the treatment of oral submucosal fibrosis
SHI Fang-chuan, DI Chun-hong, HE Rui, WANG Jin-tao, ZHANG Yuan
2022, 20(1): 47-49,58. doi: 10.16766/j.cnki.issn.1674-4152.002273
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  Objective  To investigate the repair and healing of fibrotic tissue and the progress of the disease in patients with oral submucosal fibrosis after treatment with Nd: YAG laser combined with triamcinolone acetonide.  Methods  A total of 80 patients with submucosal oral fibrosis admitted to Affiliated Hospital of Hangzhou Normal University from June 2018 to October 2019 were selected, and random numbers were used. No significant difference was observed in VAS scores between the two groups after treatment (P>0.05). The area of oral mucosal lesions in the treatment group was smaller than that in the control group. According to table method, the patients were divided into treatment and control groups with 40 cases in each group. The control group was treated with triamcinolone acetonide injection, and the treatment group was treated with Nd: YAG laser on this basis. Both groups were treated continuously for 9 weeks. VAS score, mouth opening degree and oral mucosal lesion area, serum levels of VEGF, TSP, MMP-2, and serum levels of IL-6 and TNF-α were compared between the two groups before and after treatment.  Results  After treatment, the oral mucosal lesion area was (1.47±0.62) cm2 in the control group and (0.86±0.23) cm2 in the experimental group. The oral mucosal lesion area in the experimental group was lower than that in the control group (P < 0.05). Serum VEGF increased in both groups, and the treatment group was higher than the control group [(0.75±0.19) pg/mL vs. (0.61±0.23) pg/mL, P < 0.05], whereas serum TSP, MMP-2, IL-6, and TNF-α decreased, and the treatment group was lower than the control group (all P < 0.05).  Conclusion  Nd: YAG laser combined with triamcinolone acetonide can effectively relieve the burning pain in the mouth of patients with oral submucosal fibrosis, inhibit the development of fibrosis, promote the repair and healing of fibrotic tissue, and control the development of the disease.
Effect of doxycycline on the expression of alpha-SMA, fibronectin and collagen I in MRC-5 cell line induced by TGF-beta1
YANG Ming-feng, ZHANG Bin, YANG Yan-ying, WANG Yi-wen, GU Juan-fang, WANG Hong-zhi
2022, 20(1): 50-53. doi: 10.16766/j.cnki.issn.1674-4152.002274
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  Objective  To explore the effect of doxycycline (Doxy) on Transforming growth factor -β1 (TGF-β1) induced conversion in lung fibroblast, and to provide a theoretical basis for the treatment of pulmonary fibrosis.  Methods  Human embryonic lung fibroblast (MRC-5) were cultured in vitro, treated with different concentrations of doxycycline (0, 2.5, 5.0, 10.0, 20.0, 40.0, 80.0 μg/mL) for 72 hours, 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay was used to detect the cell survival to determine the concentration of doxycycline. TGF-β1 was used to induce the conversion in MRC-5 cell, and treated with different concentrations of doxycycline (0, 2.5, 5.0, 10.0, 20.0 μg/mL) for 72 hours. Western blotting, RT-PCR, immunity fluorescence were used to detect the expression of α-smooth muscle actin (α-SMA), fibronectin (FN), collagen Ⅰ (Col Ⅰ).  Results  The MRC-5 cell viability decreased which the concentration of Doxy was 40.0 μg/mL and 80.0 μg/mL, relative to the control group were 0.93±0.03 and 0.83±0.08. qRT-PCR showed that the relative expressions of α-SMA, FN, and Col Ⅰ mRNA in the TGF-β1 10 ng/mL group were significantly higher than those in the control group (1.62±0.04 vs. 0.94±0.05, 4.33±0.28 vs. 0.98±0.06, 2.25±0.97 vs. 1.04±0.04, all P < 0.05), while the expressions of α-SMA, FN, and Col Ⅰ mRNA in the Doxy 10.0 μg/mL group and Doxy 20.0 μg/mL group were significantly lower than those in the TGF-β1 10 ng/mL group (0.70±0.15, 0.41±0.11 vs. 1.62±0.04; 1.19± 0.85, 0.79±0.06 vs. 4.33±0.28, 0.94±0.12, 0.52±0.07 vs. 2.25±0.97, all P < 0.05). Western blotting and immunofluorescence also found the same trend.  Conclusion  Doxy can exert anti-fibrosis effect by inhibiting the conversion of lung fibroblast induced by TGF-β1.
General Clinical Research
Value of FDG-PET/CT in the assessment of brain function and its risk factors in patients with acute cerebrovascular disease and consciousness disorder
ZHANG Chao, YE Yu-ping, CUI Ke, WANG Jin-dong, ZHAO Hui, SONG Wei-jun
2022, 20(1): 54-58. doi: 10.16766/j.cnki.issn.1674-4152.002275
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  Objective  To investigate the value of fluoride deoxyglucose (FDG)-PET/CT in the assessment of brain function in patients with acute cerebrovascular disease with consciousness disorder and analyse its risk factors.  Methods  A total of 170 patients with acute cerebrovascular disease and consciousness disorder, who were treated in our hospital from December 2015 to December 2020, were selected as the research objects, and they were divided into the consciousness recovery group (73 cases) and the unconsciousness group (97 cases) based on the scores of the Revised Coma Recovery Scale (CRS-R) at the time of discharge from the hospital. The clinical data were collected. FDG-PET/CT examination was performed, and the standard uptake values (SUVs) of different brain regions of interest on the left and right sides were measured. The ROC curve was used to analyse the evaluation value of SUV in different brain regions of interest for the recovery of consciousness in patients with acute cerebrovascular disease, and the multivariate Logistic regression model was used to analyse the risk factors affecting the recovery of consciousness.  Results  The CRS-R score and SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia in the unrecovered consciousness group were significantly lower than those in the recovered consciousness group (all P < 0.05), but the composition ratio of the hydrocephalus in the recovered consciousness group was significantly higher than that in the consciousness recovery group (P < 0.05). No statistically significant difference in SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia was found between the left and right brain of patients with the unconsciousness group (all P>0.05). The area under the curve of the combination of SUVs in different brain regions of interest in the assessment of the recovery of consciousness in patients with acute cerebrovascular disease was higher than that of SUV of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia alone (all P < 0.05). The sensitivity was 96.90%, and the specificity was 85.10%. The SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia were considered as risk factors affecting the recovery of consciousness in patients with acute cerebrovascular disease (all P < 0.05).  Conclusion  FDG-PET/CT examination is important to assess the brain function of patients with consciousness disorder and acute cerebrovascular disease.
Surgical treatment for complex type-B aortic dissection involving the arch
BEN Chen, CHEN Lei, YANG Da-bin, SHI Chao
2022, 20(1): 59-61,133. doi: 10.16766/j.cnki.issn.1674-4152.002276
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  Objective  To evaluate the efficacy of intraoperative stenting combined with left subclavian artery-left common carotid artery diversion for the treatment of complex type-B aortic dissection involving the distal aortic arch.  Methods  From November 2018 to April 2020, six patients with Stanford type-B aortic dissection involving the distal aortic arch received intraoperative stenting combined with left subclavian artery-left common carotid artery diversion in the Department of Cardiothoracic Surgery, Huaibei Coal Miners General Hospital. All patients were males with an average age of 51 years old and had a definite diagnosis of hypertension. The maximum diameter of the arch was greater than 40 mm, and the rupture was located in the distal aortic arch, less than 1.5 cm away from the opening of the left subclavian artery. The cardiopulmonary bypass time, intraoperative block time, selective cerebral perfusion time, ventilator-assisted time, perioperative mortality, incidence of postoperative cerebral infarction, paraplegia, and secondary thoracotomy haemostasis were analysed. All patients were followed up. Aortic CTA was reviewed 1 week, 3 months, and 12 months after surgery.  Results  The average duration of CPB was (145±37) min, from 80 to 207 min. The average duration of intraoperative occlusion was 34.5 min, and the average duration of selective cerebral perfusion was 12 min. The duration of postoperative ventilator assistance exceeded 24 h in 3 patients (41, 44, 26 h, respectively). The average ventilator-assisted time was 16.48 h. No symptoms of dizziness and no cerebral infarction were observed. No incidence of paraplegia, secondary thoracotomy haemostasis, and perioperative death were found. Follow-up time ranged within 3-18 months. All patient lived well. Postoperative aortic CTA showed 100.0% (6/6) occlusion rate at the distal end of the stent.  Conclusion  The application of intraoperative stenting combined with left subclavian artery-left common carotid artery diversion in the treatment of patients with complex Stanford type-B dissection is safe and efficient. However, the number of patients in this group is small and the follow-up time is short, so the long-term clinical effect requires further evaluation through long-term follow-up.
Clinical effect and neuroendocrine effect of low-frequency repetitive transcranial stimulation on patients with primary insomnia
NI Zhe, LIU Lu
2022, 20(1): 62-64. doi: 10.16766/j.cnki.issn.1674-4152.002277
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  Objective  To explore the clinical effects and neuroendocrine effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with primary insomnia (PI) and the mechanism of rTMS for clinical application.  Methods  A total of 100 patients with PI admitted to our hospital from July 2019 to July 2020 were selected as the research objects and randomly divided into the observation group (50 cases) and control group (50 cases) using the random number table method. The control group was treated with alternating magnetic field therapy, and the observation group was treated with rTMS therapy. The PSQI scores, glycine, glutamate and GABA levels were compared between the two groups before and after treatment.  Results  The PSQI score of the two groups had an inter-group effect (P < 0.05). The treatment effect of the observation group was better than that of the control group, and the total effective rate of treatment was higher than that of the observation group (96.00% vs. 74.00%; χ2=9.490, P=0.002). An inter-group effect on neurotransmitter levels was observed (all P < 0.05), the improvement effect of the observation group was better than that of the control group. In addition, a time effect (P < 0.05) and an interaction effect between grouping and time (P < 0.05) were observed between the two groups. The levels of each neurotransmitter of the patients could change over time, and the effect of the time factor was more significant in the observation group.  Conclusion  rTMS has evident therapeutic effects on patients with PI. Furthermore, improving the sleep state of patients can simultaneously regulate neuroendocrine levels, which has certain clinical application value.
Value of serum procalcitonin in the pathogenic classification of bacterial infection in emergency patients
MAO Xiao-qiang, CHEN Yu, JIN Jing
2022, 20(1): 65-67, 75. doi: 10.16766/j.cnki.issn.1674-4152.002278
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  Objective  To explore the value of serum procalcitonin (PCT) in the pathogen classification of bacterial infection in emergency patients and to provide reference for rational drug use in clinical antibacterial treatment.  Methods  A total of 240 infectious patients were selected in the Emergency Department of our hospital, and 120 healthy people were also selected for this study in the physical examination centre. Enzyme-linked immunosorbent assay was used to quantitatively detect serum PCT concentration. The diagnostic test was designed to comprehensively evaluate the value of PCT in the pathogen classification of bacterial infection in emergency patients, including the diagnostic test in the control group and bacterial infection group, diagnostic tests in gram-positive and gram-negative patients.  Results  The concentration of serum PCT was higher in the bacterial infection group than in the control group (P < 0.05). The PCT concentration in the gram-negative group was significantly higher than that in the gram-positive group. Results of diagnostic test between the bacterial infection and control groups showed that the area under AUC curve was 0.978 (95% CI: 0.958-0.991, P < 0.001), with a sensitivity of 91.5% and a specificity of 99.4% on the best cut-off value of 1.36 ng/mL. Diagnostic test results between gram-positive and gram-negative bacterial infection patients were that the area under AUC curve was 0.817 (95% CI: 0.757-0.868, P < 0.001), with a sensitivity of 80.0% and a specificity of 97.3% when the best cut-off value was 3.61 ng/mL.  Conclusion  Serum PCT is a good biomarker for pathogen classification in bacterial infection, and it may serve as a reference for the rational use of antibacterial drugs.

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