中华全科医学

Connotation of the community health management models of chronic non-communicable diseases and its revelations to our country

TIAN Jia-he, LIU Xiang, CHEN Hong, CAO Zi-long, DAN Zcm, CHEN Yi-qi, WANG Zhao-xin, YU Wen-ya

2022, 20(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.002754

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Abstract:
With the acceleration of the aging process of the Chinese population and the rising prevalence of chronic non-communicable diseases, a strategy for the accurate and effective management of chronic non-communicable diseases in community health service centres is crucial for health and social development of the Chinese population. Based on the background and development of community health management of chronic non-communicable diseases, this study systematically discusses the connotation, principles and methods of community health management of chronic non-communicable diseases, summarises foreign and domestic community health management models for chronic non-communicable diseases, analyses the shortcomings and relevant improvement measures in China, and explores the future development direction of community health management of chronic non-communicable diseases in China. Nowadays, community health management of chronic non-communicable diseases in China still lacks progress. Domestic management models include the family-doctor contract service model, hospital-community-family linkage model and medical-care combination model. By contrast, the concept of community health management of chronic non-communicable diseases in foreign countries is proposed earlier, and a series of distinctive and practical models, such as the National Diabetes Prevention Program, New South Wales Chronic Disease Prevention and Management Model in Australia and Innovative Care for Chronic Conditions Framework, has been developed. The above management model has certain reference significance for our country, including the systematic and efficient integration of resources, formulation of chronic disease management plans based on the characteristics of specific communities and a focus on residents ' awareness of self-health management. At present, China ' s chronic non-communicable disease control system has made significant progress, but there are still problems such as structural imbalance and low efficiency of medical resource allocation, imperfect hierarchical diagnosis and treatment system, and lack of awareness and ability of self-health management of the population. In the future, it is still necessary to carry out targeted health education on chronic diseases, establish a long-term communication mechanism for talent training, and improve the hierarchical diagnosis and treatment system based on families.

2022, 20(12): 2000-2001.

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Clinical characteristic analysis of different inflammatory phenotypes in bronchial asthma

WANG Ying, YUN Chun-mei, LIU Ke-han, JIA Pei-feng, LIU Hong-yan, GAO Xiao-yu

2022, 20(12): 2055-2058. doi: 10.16766/j.cnki.issn.1674-4152.002768

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Objective To analyse the clinical characteristics of different inflammatory phenotypes of bronchial asthma (BA) and compare the clinical indicators before and after treatment, so as to provide a basis for clinical diagnosis and treatment of asthma. Methods A total of 110 asthma patients in chronic duration in the Outpatient Ward of Inner Mongolia People ' s Hospital were recruited from July 2018 to January 2019, and divided into four groups with different airway inflammation phenotypes based on the results of induced sputum, such as eosinophilic asthma (EA), neutrophilic asthma, mixed granulocytic asthma (MGA) and paucigranulocytic asthma. The differences in clinical characteristics were compared, and the clinical indicators before and after treatment were compared and analysed. Results No significant differences were observed in the clinical symptoms and control level between inflammatory phenotypes (both P>0.05). Compared with the other groups, the EA group showed a significantly increased exhaled nitric oxide (FeNO) and significantly decreased FEV₁ /FVC and FEV₁ % (all P < 0.05). The number of eosinophil (Eos) was positively correlated trend with the values of FeNO (r=0.541), and negatively correlated with the values of FEV₁ /FVC and FEV₁ % (r=-0.301, -0.284). The clinical indicators of asthma before treatment and 1 month after treatment (low-dose inhale corticosteroids+long-acting inhale β₂-agonist) were compared. The Eos and FeNO in EA and MGA groups significantly decreased after treatment compared with those before treatment (EA: t=3.564, 6.761; MGA: t=3.068, 4.093, all P < 0.05). FEV₁ /FVC and FEV₁ % in the EA group were significantly higher than those before treatment (t=-2.755, -2.729, both P < 0.05). Conclusion Lung function decline is pronounced in the Eos-increased phenotype (EA), and FeNO is closely associated with eosinophilic inflammation. Low-dose ICS+LABA is effective in Eos-increasing phenotype asthma patients.

Clinical value of plasma adiponectin in the diagnosis of chronic heart failure

CHEN Dong, FENG Jun, SU Hao, ZHANG Jing

2022, 20(12): 2059-2062. doi: 10.16766/j.cnki.issn.1674-4152.002769

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Objective To investigate the clinical value of plasma adiponectin (APN) in the diagnosis of chronic heart failure (CHF). Methods A total of 48 patients with CHF diagnosed in Anhui Provincial Hospital from May 2018 to May 2019 were included as CHF group, and 40 healthy volunteers were included as control group. The levels of plasma APN and NT-proBNP in the two groups were compared, the left ventricular ejection fraction (LVEF) in CHF group was obtained, and the correlation between plasma APN, NT-proBNP and LVEF in CHF group was analyzed. CHF patients were divided into groups by cardiac function classification of New York Heart Association (NYHA), and plasma APN, NT-proBNP and LVEF were compared between subgroups. Plasma APN, NT-proBNP and LVEF were collected before and 3 and 6 months after treatment in CHF group, and the diagnostic value of APN in CHF was preliminarily analyzed. Results In the CHF group, the age was 45-91 (60.98±13.98) years, with 34 males and 14 females. In the control group, the age was 51-93 (57.88±13.76) years, with 28 males and 12 females. The plasma APN and NT-proBNP in the CHF group were (23.08±9.39) μg/mL, 5 455.00 (1 256.00, 8 552.25) pg/mL, respectively, which were higher than those in the control group [(12.06±3.28) μg/mL and 55.50 (32.00, 78.50) pg/mL], the differences were statistically significant (all P < 0.05). Pearson linear relationship analysis showed that the plasma APN was positively correlated with NT-pro BNP and negatively correlated with LVEF in the CHF group. The APN and NT-proBNP increased significantly with the increase of cardiac function grade, but LVEF decreased significantly. During the follow-up, the plasma APN and NT-proBNP decreased significantly with the improvement of the disease, but LVEF increased significantly. Conclusion The plasma APN is positively correlated with NT-proBNP and negatively correlated with LVEF in patients with CHF, which is consistent with NYHA cardiac function grade. It has certain predictive value for clinical diagnosis of CHF.

Effect of modified oral exercise intervention on oral feeding ability and outcome of premature infants

WANG Ju, ZHANG Ran, WANG Qin, ZHAI Fang, ZHANG Xue

2022, 20(12): 2063-2067. doi: 10.16766/j.cnki.issn.1674-4152.002770

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Objective To explore the effect of modified oral exercise intervention on oral feeding ability and outcome of premature infants. Methods A total of 146 premature infants who were hospitalised in the Neonatal Intensive Care Unit (NICU) of Nanyang Central Hospital from May 2018 to July 2020 were selected as research objects. The infants were divided into study and control groups using a random-number table method, with 73 cases in each group. The control group received conventional treatment, and for developmental support intervention, a modified oral exercise intervention was adopted for premature infants in the study group until the intervention can be a complete oral feeding. The oral feeding ability, feeding process and performance of the two groups of children and the occurrence of adverse reactions were observed. Results On the day of intervention, no significant difference was observed in the scores in the Chinese version of preterm infant oral feeding readiness assessment scale (PIOFRA Scale-CV) between the two groups of preterm infants (P>0.05). With the extension of intervention period, the PIOFRA Scale-CV scores of the two groups showed an upward trend. The differences between groups were statistically significant (F_{between group}=14.297, P_{between group} < 0.001). No statistically significant difference was noticed between the intravenous nutrition time and the effectiveness of oral feeding (all P>0.05). The transition time of complete oral feeding, efficiency of starting oral feeding, efficiency of complete oral feeding, and the weight at the time of complete oral feeding were statistically significant (both P < 0.05). The total incidence of adverse reactions reached 18.31% and 29.17% in the study and control groups, respectively, and the difference was not statistically significant (χ²=2.325, P=0.127). The incidences of single adverse reaction of decreased oxygen saturation and fatigue in the study group were lower than those in the control group, and the difference was statistically significant (all P < 0.05). Conclusion Improved oral exercise intervention can improve the oral feeding ability of premature infants, shorten the transition time to total oral feeding, improve the feeding efficiency and reduce the incidence of oxygen saturation decline and fatigue adverse reactions.

Risk factors of gestational diabetes mellitus in advanced age and analysis of maternal and infant outcomes

GONG Li, ZHAO Jing, CHEN Shu-xin, CUI Huan-huan, LIU Jing

2022, 20(12): 2068-2070. doi: 10.16766/j.cnki.issn.1674-4152.002771

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Objective To explore the risk factors and maternal and infant outcomes of gestational diabetes mellitus (GDM) in this area. Methods Data of 938 pregnant women who were treated in Huishan District People' s Hospital of Wuxi City from September 2017 to December 2020 were collected in this study. Based on the oral glucose tolerance fest results, they were divided into four groups: group A [advanced age (≥ 35 years) GDM group, 64 cases], group B (non-advanced age GDM group, 188 cases), group C (advanced age non-GDM group, 112 cases), and group D (non- advanced age non-GDM group, 574 cases). The baseline data of four groups of pregnant women were compared. Taking the occurrence of GDM as the dependent variable, the independent risk factors of advanced age GDM were further analysed by logistic factors and a comparative analysis was carried out. The chi-square test was used to compare the differences in maternal and infant outcomes among the four groups. Results The elderly accounted for 25.40% (64/252) of all GDMs. The BMI (27.89±8.74), the proportion of pregnancies with more than one parity (87.5%), the proportion of macrosomia (25.00%) and the proportion of family history of DM (12.50%) in the elderly GDM group were significantly higher than those in the elderly non-GDM group (25.59±2.56, 53.57%, 8.93% and 3.57%). 25(OH)D₃ in the elderly GDM group [17.76 (14.71, 20.00) ng/mL] was significantly lower than that in the elderly non GDM group [21.34 (15.10, 30.13) ng/mL]. Multivariate analysis showed that serum 25(OH)D₃ level (OR=0.901, 95% CI: 0.815-0.996) and pregnancy of more than one parity (OR=6.412, 95% CI: 1.559-26.380) were independent influencing factors for the occurrence of GDM in the elderly parturient population, of which 25(OH)D₃ was negatively related. The caesarean section rate (15.63%), polyhydramnios rate (12.50%) and macrosomia delivery rate (9.38%) of the elderly GDM group were significantly higher than those in the of the elderly non-GDM group (3.57%, 3.57% and 1.79%). Conclusion The detection rate of gestational diabetes in elderly pregnant women is high. The 25(OH)D₃ in the third trimester and pregnancies over one parity are independent influencing factors for the occurrence of GDM in the population of elderly pregnant women. Hence, the higher maternal and infant pregnancy outcomes of elderly pregnant women with GDM deserve more clinical attention.

Status and influencing factors of undiagnosed abnormal postpartum blood loss during caesarean section

HUANG Nan, CHEN Xiang-jun, XU Li-yan, QIU Ya-fen

2022, 20(12): 2071-2074. doi: 10.16766/j.cnki.issn.1674-4152.002772

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Objective To analyse the status of undiagnosed abnormal postpartum blood loss (UPPBL) during caesarean section and related influencing factors. Methods The clinical data of 415 women with caesarean section who were hospitalised in Affiliated Hospital of Hangzhou Normal University from January 2019 to June 2020 were retrospectively analysed. Based on the definition of postpartum haemorrhage (PPH) and UPPBL, they were divided into PPH (n=13), UPPBL (n=41) groups and the control group (n=361) without postpartum haemorrhage. The general clinical data of the three groups were compared with the level of haemoglobin (Hb) in the first week before caesarean section and the second day after caesarean section, and the related factors affecting UPPBL in caesarean section were analysed. Results The incidence of UPPBL in 415 parturients was 9.88% (41 cases). Compared with the control group, the UPPBL and PPH groups showed significantly higher values in terms of age, gestational order, delivery order, proportion of premature delivery, incidence of hypertension during pregnancy, incidence of placental adhesion and other aspects (all P < 0.05). The age of UPPBL group was significantly higher than that of the PPH group, but the number of pregnancies was significantly lower (all P < 0.05). No significant difference was observed in the Hb level between the three groups 1 week before the caesarean section (P>0.05). The Hb level in UPPBL and PPH groups on the second day after caesarean section was significantly lower than that in the control group (all P < 0.05), and the Hb level before and after caesarean section in the two groups was significantly higher than that in the control group (P < 0.05). Age, gestational order, delivery order, gestational hypertension, placental adhesion and premature delivery were influence factors that affected UPPBL. Conclusion The incidence of UPPBL is high in women who deliver by caesarean section. Age, gestational order, delivery order, gestational hypertension, placental adhesion and premature delivery are influence factors affecting the occurrence of UPPBL in women who deliver by caesarean section. Relevant measures should be implemented clinically to reduce the risk of UPPBL.

Factors associated with taking antihypertensive traditional Chinese medicine only among community-dwelling middle-aged and elderly adults

HUANG Ya-fang, GUO Xiang-yu, DU Juan, LIU Yan-li

2022, 20(12): 2075-2079. doi: 10.16766/j.cnki.issn.1674-4152.002773

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Objective To investigate the factors associated with antihypertensive traditional Chinese medicine (TCM) intake only among community-dwelling middle-aged and elderly adults in China. Methods The analysis was based on the national representative China Health and Retirement Longitudinal Study (CHARLS) in 2018. Community-dwelling adults aged 45 years old or above and who were either taking TCM or western modern medicine (WMM) only were included. Multivariate logistic regression analysis was used to examine the factors associated with taking TCM only for hypertension. Results A total of 5 184 patients with hypertension were included, including 312 TCM and 4 872 WMM users. The odds of patients with other types of medical insurances and who used TCM alone was 0.347 times that of patients without medical insurance. The odds of patients in economic development areas of > 000-7 000 and who used TCM alone was 3.197 times that of patients in economic development areas above 000. The odds of obese patients were 0.629 times more than the patients with normal body mass index and who used TCM alone. The odds of patients with self-reported very poor health status and who used TCM alone was 0.331 times that of patients who self-reported very good health status. The odds of patients with more than three types of chronic diseases were 0.167 times more than those with hypertension and used TCM alone. The odds of patients who received TCM for other diseases was 7.271 times that of patients used TCM alone and who were not receiving TCM for other diseases. Conclusions Patients in the middle or deprived economic development region, with very good self-reported health status, without other diagnosed chronic disease and under TCM treatment for other diseases are more likely to take TCM for hypertension compared with other patients. In the future, it is necessary to further prospectively observe the difference in the improvement of cardiovascular and cerebrovascular end point outcomes between the two groups of TCM and WMM, so as to provide higher quality evidence for the treatment of hypertension with TCM.

XGboost prediction model for osteoarthritis risk based on community big data

LI Li-qiu, XU Cheng-yan, WANG Xiao-li, CAO Yong-qi, LI Yan, ZHAO Liang, WANG Zhao-xin, JIA Huan

2022, 20(12): 2080-2083. doi: 10.16766/j.cnki.issn.1674-4152.002774

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Objective To explore the construction of osteoarthritis risk warning model by community medical big data and machine learning model, provide a quantitative tool for the early warning of osteoarthritis in the community, to provide an efficient management method for the prevention and treatment of osteoarthritis in the elderly. Methods The data of health records, health examinations and diagnosis and treatment data of six community health service centres in Shanghai from January 1, 2019 to December 31, 2019, were integrated to form an original database containing more than 40 000 samples and 126 variables. After data pre-processing and compound feature selection to screen the model characteristics, the XGBoost algorithm was used to construct a risk assessment model for osteoarthritis patients. Results Fourteen characteristics were screened in this study: diet with balanced meat and vegetables, height, weight, body mass index (BMI), time of each exercise, total cholesterol, high-density lipoprotein, low-density lipoprotein, hypertension, limb trauma, etc. High-density lipoprotein, total cholesterol, BMI, low-density lipoprotein and frequency of drinking were the top five characteristic factors in importance ranking, and their characteristic importance was more than 0.1. The XGBoost model of osteoarthritis risk assessment was constructed with 'osteoarthritis' as the output variable, and 14 features were screened by feature engineering as the input variable. After the XGBoost model was trained by eightfold cross-validation, the model was validated on the test set with an accuracy rate of 92%, a precision rate of 71% and recall rate of 65%, F1_score was 0.68, the area under the receiver operating characteristic curve reached 0.82, and the KS value was 0.48. Conclusion In this study, a risk warning model of osteoarthritis is constructed using community medical big data, and the overall fit and feature rationality of the model are good, which provides a tool for the early warning of osteoarthritis in the community and is conducive to the early diagnosis and treatment of osteoarthritis in the community.

WEI Chang-yun, GUO Xue-jie, ZHAO Pei-yu, LIU Jia, LIU Hong-xia

2022, 20(12): 2084-2087. doi: 10.16766/j.cnki.issn.1674-4152.002775

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Objective To analyze the current status of self-management at home of kidney transplant recipients and explore the effects of self-efficacy, anxiety, depression and self-management support to self-management. Methods Using the convenience sampling method, we selected 270 kidney transplant recipients (KTRs) in three class A tertiary hospitals (two hospitals in Beijing and one in Changsha) from October 2020 to February 2021 and administered the general data questionnaire, chronic disease self-efficacy scale, Hospital Anxiety and Depression Scale questionnaire, kidney transplant recipient self-management scale and self-management support scale. Results We collected 265 valid questionnaires, and the total score of self-management of KTRs was 95 (84, 103) points. For the dimensions, the scores were 35(30, 40) for the problem-solving subscale, 14 (12, 16) points for the partnership subscale and 45 (40, 49) points for the self-care behaviour subscale. Self-management of KTRs and their anxiety (r=-0.259, P < 0.01) and depression (r=-0.332, P < 0.01) were negatively correlated and showed a positive correlation with self-efficacy (r=0.399, P < 0.01) and self-management support (r=0.500, P < 0.01). The results of multiple linear stepwise regression analysis revealed that the age, residence, time after transplantation, depression, self-efficacy and self-management support were independent factors influencing self-management in KTRs (all P < 0.05). Conclusion The self-management level of renal transplant recipients is satisfactory, but half of the patients are still at a medium level. Nursing staff should pay attention to the KTRs' self-efficacy, negative emotions and self-management support on the influence of their self-management behaviour through psychological counselling, continuous nursing intervention and increased beneficial interaction with patients to improve the level of self-management.

Analysis of social integration status of schizophrenia patients and its influencing factors

WANG Yan, WANG Tie-hu

2022, 20(12): 2088-2091. doi: 10.16766/j.cnki.issn.1674-4152.002776

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Objective To analyse the social integration status of schizophrenia patients and its influencing factors, and provide theoretical basis for improving the social integration of patients. Methods A total of 145 patients with schizophrenia admitted to Hangzhou Seventh People' s Hospital from February 2018 to February 2020 were selected as the research objects. The social integration status and related factors were analysed by self-assessment questionnaire, social function assessment scale for inpatients, social support rating scale and family function assessment scale. Results The total score of social integration of schizophrenia patients was (49.08±4.86) points. The results of univariate analysis showed that the social integration scores of male, employed, highly educated, married, ≤45 years old, without social function defects, with higher total scores of social support and family function were significantly higher than those of female, unemployed, with low educational level, unmarried or divorced, >45 years old, with social function defects, with lower total scores of social support and family function (all P < 0.05). The results of logistic regression analysis showed that age, unmarried or divorced, and social function defect were the risk factors for social integration score (all P < 0.05), and good social support and family function of the patients were the protective factors for social integration score (all P < 0.01). Conclusion The score of social integration of schizophrenia patients is low, and there are various factors affecting the score of social integration of patients. Among them, age, unmarried or divorced, and social dysfunction are risk factors affecting the score of social integration, and social support and family function are protective factors. Therefore, clinical measures should be taken to improve the social integration of patients.

Research on quantitative or semi-quantitative assessment of placental function in pationts with hypertension of pregnancy by dual-mode ultrasound

YU Hai-jing, LI Yang, GUO Yan, DU Yan-wei, DUAN Yuan-yuan

2022, 20(12): 2092-2095. doi: 10.16766/j.cnki.issn.1674-4152.002777

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Objective To explore the value of dual-modal ultrasound in quantitative or semi-quantitative evaluation of placental function in patients with hypertension of pregnancy. Methods A total of 163 pregnant women admitted to Suzhou Municipal Hospital from January 2018 to June 2021 were selected, and their gestational weeks were 30-41 weeks. Among them, 103 were patients with hypertension in pregnancy (38 cases of severe preeclampsia, 65 cases of preeclampsia), and 60 were normal pregnant women. The placental blood flow filling was monitored by three-dimensional power Doppler ultrasound, and placental energy histograms (VI, FI, VFI) were obtained. The fetal umbilical artery, middle cerebral artery, maternal uterine artery spectrum (PI, RI, S/D) were monitored by spectral Doppler ultrasound. Results With the disease progresses, three-dimensional power placental blood flow filling histogram data (VI, FI, VFI) of patients with hypertension of pregnancy decreased (P < 0.05), the fetal umbilical artery blood flow spectrum (PI, RI, S/D) increased (P < 0.05), the fetal middle cerebral artery blood flow spectrum (PI, RI, S/D) decreased (P < 0.05), and the pregnant women' s uterine artery blood flow spectrum (PI, RI, S/D) increased (P < 0.05). The ROC curve analysis found that monitor fetal umbilical artery S/D, middle cerebral artery PI, maternal uterine artery spectrum PI and energy histograms VFI had high diagnostic value for severe preeclampsia/preeclampsia (AUC=0.893, 0.827, 0.912, 0.880, all P < 0.05), and the diagnostic value of combined detection of the four was the highest (AUC=0.957, P < 0.05). After 30 weeks of gestation, when umbilical artery S/D was higher than 3.010, middle cerebral artery PI was lower than 1.575, uterine artery PI was higher than 1.215, placental VFI was lower than 4.755, there was a high sensitivity and specificity in the diagnosis of impaired placental function in gestational hypertension. Conclusion Dual-modal ultrasound imaging can quantitatively or semi-quantitatively analyze the changes of placental blood perfusion, and provide guidance for clinical evaluation of placental function in patients with hypertension of pregnancy.

Value of vesical imaging reporting and data system combined with intravoxel incoherent motion sequences in the evaluation of muscle invasion in bladder cancer

MENG Qing-tao, LI Jun, JIANG Hui-dong, WANG Xue-qiang, XIANG Li

2022, 20(12): 2096-2100. doi: 10.16766/j.cnki.issn.1674-4152.002778

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Objective To investigate the value of vesical imaging reporting and data system (VI-RADS) and intravoxel incoherent motion (IVIM) in the diagnosis of muscle invasive bladder cancer (MIBC). Methods A total of 50 cases (52 tumours) with surgery and pathologically confirmed bladder cancer at the First People' s Hospital of Chuzhou from June 2018 to February 2022 were analysed retrospectively. All patients underwent routine multiparameter MRI scan (including T₂WI, DWI and DCE sequence) and IVIM sequence before surgery. Among the cases, 30 lesions were non-MIBC (NMIBC), and 22 were MIBC. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of different cut-off values in diagnosing MIBC were calculated by scoring MR images according to VI-RADS. IVIM parameters (ADC_st, D, D* and f values) were measured. The diagnostic efficacy of VI-RADS, IVIM parameters and their combinations in muscle invasion was evaluated by receiver operating characteristic (ROC) curve. Results The ADCst, D and f values of the NMIBC group were significantly higher than those of the MIBC group (all P < 0.01), and the areas under curve (AUC) were 0.904, 0.889 and 0.780, respectively (all P < 0.01). Using VI-RADS score ≥ 4 as the cut-off, muscle invasion was predicted with the highest Youden index of 0.603 and AUC of 0.871. When the VI-RADS combined with ADC_st and D values, the Yoden index rose to 0.636, and the AUC was 0.916. Conclusion The VI-RADS ≥ 4 and ADC_st, D and f values decline, which indicate the greater possibility of muscle invasion of bladder cancer, and the combination of VI-RADS and ADC_st and D values can significantly improve the diagnostic efficacy.

Study on the magnetic resonance colonography combined with fecal calprotectin in the diagnosis of ulcerative colitis

HUANG Hong, XU Bao-cai

2022, 20(12): 2101-2104. doi: 10.16766/j.cnki.issn.1674-4152.002779

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Objective To observe the clinical value of magnetic resonance colonography (MRC) combined with fecal calprotectin (FC) in the diagnosis and evaluation of ulcerative colitis (UC). Methods A total of 80 UC patients and 80 healthy subjects during the same period admitted to Quzhou Hospital of Traditional Chinese Medicine from June 2019 to June 2022 were selected as the research objects. All the subjects were examined by colonoscopy, MRC and FC. The MRC image characteristics and FC content of UC patients with different activity levels and healthy subjects were compared. The results of colonoscopy were used as the gold standard to evaluate the efficacy of MRC imaging feature score, FC content and their combination in the diagnosis of UC. Results There were statistically significant differences in the proportions of MRC imaging features such as mucosal enhancement, intestinal wall thickening, intestinal wall layering enhancement, comb tooth sign, intestinal wall lymph node enlargement, mucosal and submucosal defects and DWI signal enhancement in healthy subjects and UC patients with different activity levels (all P < 0.05), and there were statistically significant differences in the proportion of MRC imaging features such as intestinal wall stratification enhancement, comb tooth sign, intestinal wall lymph node enlargement in UC patients with different activity levels (P < 0.05). The difference of FC content between healthy subjects and UC patients with different activity levels was statistically significant (P < 0.01). The FC content of UC patients was (3 186.11±291.80) μg/g, significantly higher than that of healthy subjects [(2 699.47±249.67) μg/g, P < 0.05], while the FC content in UC patients with different activity levels was not statistically significant (P>0.05). The area under the ROC curve of MRC image feature score, FC content and MRC image feature score combined with FC content in diagnosing UC were 0.956, 0.895 and 0.984, respectively. Conclusion MRC and FC, as two non-invasive diagnostic techniques, can be used as an alternative or auxiliary means of colonoscopy pathology for UC diagnosis and disease evaluation. The combined application of MRC and FC can improve the diagnostic efficiency of UC.

Research progress on evaluation indicators of blood glucose fluctuation in patients with diabetes

SHI Rui, FENG Lei, TANG Ling-tong, ZHANG Chun-ting, LUO Bei-bei, BI Qian-ye, CAO Hui-ying, ZHANG Yan-bi

2022, 20(12): 2105-2109. doi: 10.16766/j.cnki.issn.1674-4152.002780

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Since some scholars proposed in 2001 that blood glucose fluctuation can aggravate the vascular endothelial injury in patients with diabetes, blood glucose fluctuation is getting more and more attention, a large number of studies have confirmed that blood glucose fluctuation can promote the occurrence and development of complications of diabetes. Internationally, the treatment concept of "fine hypoglycemic, stable and up to standard" has been proposed. We should not only strictly control the glycosylated hemoglobin, fasting blood glucose and postprandial blood glucose, but also try to reduce the amplitude and frequency of blood glucose fluctuation. Monitoring and evaluating blood glucose fluctuation has become an important link to realize the fine management of blood glucose. At present, there are many evaluation indicators of blood glucose fluctuation. However, the clinical evaluation efficacy of various indicators for different diabetes complications is still being explored. At the same time, in view of the limitations of various indicators, new blood glucose fluctuation evaluation indicators appear. There are a wide variety of new indicators, each with its advantages and disadvantages. The evaluation and prediction efficiency of the new indicators for different diabetic complications has also become a research hotspot. At this stage, because the monitoring methods are too complex and expensive, it is not conducive to the outpatient follow-up of diabetics. Therefore, exploring blood glucose fluctuation screening indicators with good clinical applicability has become an urgent problem to be solved. This paper briefly summarizes the research progress of the evaluation indicators of blood glucose fluctuation in diabetes patients and it' s relationship with diabetes complications, so as to provide new ideas for the next step to improve the evaluation system of blood glucose fluctuation in patients with diabetes and explore the screening indicators of blood glucose fluctuation.

Research progress of oral inorganic iodine for Graves' disease

WANG Xin-pan, ZHAO Cheng-cheng, LI Lu-yang, ZHENG Xu-qin

2022, 20(12): 2110-2113. doi: 10.16766/j.cnki.issn.1674-4152.002781

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Iodine is one of the important trace elements in the human body and the basic raw material for thyroid hormone synthesis. Oral inorganic iodine is divided into dietary and therapeutic iodine and is closely related to thyroid immunity and metabolism. Graves' disease (GD), also known as diffuse toxic goitre, is characterised by hyperthyroidism and high iodine metabolism. Clinically, we often advise patients with GD to limit or avoid iodine diet. The latest research progress shows that the interference of dietary iodine in antithyroid drug therapy may be overestimated, and strict restriction of inorganic iodine before radioactive iodine therapy and the use of inorganic iodine compulsorily before elective surgery are unnecessary. In addition, inorganic iodine can be used as a therapeutic drug for GD, and its exploratory application in patients with mild hyperthyroidism, low thyroid autoantibody concentration, small thyroid volume and high iodine diet has shown good results. When traditional antithyroid drugs have side effects, and patients still prefer conservative treatment, inorganic iodine may be an alternative. Given its low teratogenicity, blood toxicity and bone marrow toxicity, inorganic iodine can play a unique role in special groups, such as patients in pregnancy, lactation and tumour radiotherapy and chemotherapy. This paper summarises the research progress, biological function, applicable population and application under specific circumstances of dietary and therapeutic iodine to provide reference for the diagnosis and treatment of GD, enrich the diagnosis and treatment strategies of GD patients and further improve the quality of life of GD patients.

Advances in pathogenesis of protein disulfide isomerase in thrombotic disease

WANG Li-yao, WANG Bing-kun, LI Wen, A-RI-FU A-yi-mai-li-ka, BAI Tian-yu, XU Meng, SU Li-bo

2022, 20(12): 2114-2118. doi: 10.16766/j.cnki.issn.1674-4152.002782

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Protein disulfide isomerase (PDI), the prototypical member of the PDI family, is encoded by the prolyl 4-hydroxylase subunit beta (P4HB) gene and is the β subunit of the P4H protein, so it is also called P4HB. It is mainly found in the endoplasmic reticulum (ER) and plays an important role in pathophysiological processes by promoting correct protein folding through enzymatic activity and molecular chaperone function. Related studies on PDI in China and abroad have explored the mechanisms of action in diseases, such as cancer and neurodegenerative diseases. In addition to its key role in ER, the role of cell surface PDI in initiating the thrombosis process is particularly prominent. PDI can be rapidly secreted from activated platelets and endothelial cells at the site of vascular injury to promote platelet activation and fibrin formation and mediate the activation of coagulation factor, its release and the coagulation pathway. Inhibition of PDI with antibodies or small-molecule inhibitors may prevent thrombosis. Given the important role of extracellular PDI in the regulation of thrombosis, scholars should aim to understand the pathogenic mechanism of PDI thrombotic disease. Efforts are ongoing to identify extracellular PDI substrates that participate in the network pathway between PDI and thrombosis. In this paper, we summarise our current understanding of the mechanism of PDI-mediated thrombosis, discusses the research progress in blocking thrombosis by targeted PDI and provide new ideas for further exploration of the application of this substance in the prevention and treatment of thrombotic diseases.

Effect of scalp acupuncture on swallowing function in children with pharyngeal dysphagia of cerebral palsy

XU Jin-bo, HAN Hui, TONG Guang-lei

2022, 20(12): 2119-2122. doi: 10.16766/j.cnki.issn.1674-4152.002783

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Objective To observe the therapeutic effect of scalp acupuncture for pharyngeal dysphagia of cerebral palsy on the basis of neuromuscular electrical stimulation (NMES) and swallowing rehabilitation training. Methods A total of 40 patients with pharyngeal dysphagia who were admitted to Anhui Hospital Affiliated to the Pediatric Hospital of Fudan University from June 2020 to June 2022 were selected and randomized into a scalp acupuncture group and a rehabilitation group, 20 cases in each group. Routine rehabilitation training was given in both groups. NMES and swallowing rehabilitation training were adopted in the rehabilitation group. On the basis of the treatment in the rehabilitation group, scalp acupuncture was given in the scalp acupuncture group. Scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal. The treatment was given once a day, 6 days a week for 4 weeks. Before and after treatment, the videofluoroscopic dysphagia scale (VDS) score, Kubota water swallowing test grade, eating and drinking ability classification system (EDACS) grade, and dysphagia disorder survey (DDS) score were observed in both groups. Results After treatment, the VDS score and the DDS score were decreased compared before treatment (all P < 0.05), and the Kubota water swallowing test grade and EDACS grade were improved compared before treatment (all P < 0.05) in both groups. The VDS score and DDS score of the scalp acupuncture group were lower than those of the rehabilitation group [(29.20±1.99) points vs. (31.30±3.92) points, (10.55±1.63) points vs. (11.80±1.58) points, all P < 0.05]. The improvement degree of Kubota water swallowing test grade and EDACS grade in the scalp acupuncture group were better than those in the rehabilitation group (all P < 0.05). Conclusion Based on NMES and swallowing rehabilitation training, scalp acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of cerebral palsy, and improve the patients' swallowing function and quality of life.

Clinical effect of early comprehensive rehabilitation therapy on improving the motor functions and activities of daily living in middle-aged and elderly stroke patients with hemiplegia

WU Jin-yi, WU Min-jie, WEI Peng, LEI Xiu-qiang, PAN Yu-xiao, WU Huan-le

2022, 20(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.002784

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Objective To explore the effective method of early comprehensive rehabilitation treatment for improving the activities of daily living (ADL) of elderly stroke patients with hemiplegia. Methods A total of 71 convalescent hemiplegia patients who were treated in the Neurology Department of Anji People ' s Hospital and transferred to the Rehabilitation Department from December 2018 to March 2020 were retrospectively collected as research subjects. Based on the year of admission, they were divided into conventional and comprehensive groups. The conventional group (36 cases) included patients who received conventional rehabilitation treatment measures from 2018 to 2019, and the comprehensive group comprised those who received comprehensive rehabilitation treatment afterward (35 cases). In the comprehensive group, physical therapy, occupational therapy supplemented by psychological rehabilitation, cognitive training, intensive exercise and balance function training and guided education were carried out. The patients' limb motor function and ADL were evaluated by Fugl-Meyer assessment (FMA) and Barthel index (BI), respectively. Results After treatment, the FMA and BI scores of the conventional group were (44.51±6.60) points and (49.24±13.11) points, respectively, and those of the comprehensive group were (50.28±7.20) points and (59.36±8.74) points, respectively. The differences were statistically significant (t=3.517, 3.837, all P < 0.001). The motor function and ADL of the two groups improved significantly compared with those before treatment, and the improvement of the comprehensive group was more significant (all P < 0.05). Conclusion Comprehensive rehabilitation therapy can effectively improve the motor function and ADL, and improve the quality of life of stroke patients with hemiplegia.

Application of in-class test + error correction teaching method in the teaching of Diagnostics Experiment

CHEN Yu-juan, LIU Min, LIN Xiu-ping, WANG Jun, TAN Ying, LI Xian-qiang

2022, 20(12): 2127-2130. doi: 10.16766/j.cnki.issn.1674-4152.002785

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Objective To explore the application effect of in-class test + error correction teaching method on the course of Diagnostics Experiment and to improve the practical skills of medical students as practicing physicians. Methods The study was conducted from March 2021 to June 2021 at Shandong University of Chinese Medicine during the Diagnostics Experiment curriculum classes of the experimental (traditional Chinese medicine 2018 undergraduates, 121 students) and control groups (traditional Chinese medicine Huimin class of 2018 undergraduates of general medicine, 112 students). The traditional teaching method was adopted in the control group. The experimental group adopted the basis of the traditional teaching method + error correction method with the in-class test, that was, in the student test drill, the teacher pointed out the operation mistakes of the tested students in real time and corrected them and analysed and explained them when necessary. The effect evaluation was divided into two parts: one was the comparison of the final examination scores of the two groups of students; the second was the use of questionnaires in the experimental group to understand student feedback on the application of in-class test + error correction teaching method in the course of Diagnostics Experiment to evaluate its application effect. Results The final exam scores of the experimental and control groups were (90.64±2.58) and (84.61±8.58) points, respectively, and the difference was statistically significant (t=7.154, P < 0.001). The experimental group was superior to the control group. A questionnaire survey was conducted on the experimental group, and 109 valid questionnaires were collected. The results showed that the teaching method of in-class test + error correction had good teaching effect and high recognition. Students generally believed that the teaching method can be used to standardise operations, promote understanding and strengthen memory. Conclusion With the increase in the teaching hours of Diagnostics Experiment, the teaching effect of in-class test + error correction teaching method is better than that of traditional teaching method, which is helpful to improve the clinical practice skills of medical students and can be popularised and applied.

Effect evaluation of OSCE teaching based on post competence in nursing practice teaching

MA Jie, LI Xiu-chuan, ZHOU Ping-hui, CHEN Wei-dong, LEI Ting-ting, ZHANG-YANG Xi-bei, SHAO Yan, HUANG Jun-mei, QIN Ling-wei

2022, 20(12): 2131-2133. doi: 10.16766/j.cnki.issn.1674-4152.002786

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Objective To explore the application effect of objective structured clinical examination (OSCE) teaching assessment model on the post competence of practice nurses. Methods A total of 108 orthopaedic practice nurses from July 2019 to July 2021 in the First Affiliated Hospital of Bengbu Medical College were selected and divided into control and observation groups in accordance with the random-number table method, with 54 cases in each group. The control group adopted the current traditional teaching mode for teaching and learning. For the observation group, on the basis of the traditional teaching mode, standardised patient (SP) training and teaching of OSCE assessment mode were implemented. Real typical cases of lumbar intervertebral disc herniation in orthopaedics were selected, SP and OSCE case databases were established, relevant assessment sites were set up, and a homogeneous teaching and assessment mode was implemented in five orthopaedics wards. One week before the end of nursing practice, the operation and theoretical knowledge assessment were conducted based on six sites. After completing the teaching plan, the scores of theory, skills, assessment and intervention, communication, critical thinking, stress handling and humanistic nursing were compared between the two groups of nursing students, and the competency of their positions was evaluated. Satisfaction of nurses of two groups with teaching effect was evaluated. Results The total satisfaction rate of teaching in the observation group was 90.74% (49/50), which was higher than that in the control group (66.67%, χ²=9.336, P=0.002). After the training, the theoretical and skills assessment scores of the observation group were higher than those of the control group (both P < 0.05). The scores in other five dimensions of post core competencies, namely, assessment and intervention, communication, critical thinking, stress handling and humanistic nursing, were also higher than those of the control group, and the differences were statistically significant (all P < 0.05). Conclusion OSCE training and assessment model can improve satisfaction in nursing teaching and improve the core competencies of practice nurses.

Application on flipped classroom combined with Case-based learning in the standardized training of residents in cardiology

GE Jun, XUAN Ling, SHA Sha, LU Yu, WANG Mao-song, WANG Zhao-hui, LI Yi-feng, RU Dong-mei

2022, 20(12): 2134-2137. doi: 10.16766/j.cnki.issn.1674-4152.002787

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Objective Case-based learning (CBL) is a case oriented teaching method, and flipped classroom is a teaching method that is loose in teaching and subversive in teaching process. This article aims to explore the effect of the application of flipped classroom combined with CBL in the standardized training of cardiology residents, so as to improve the teaching quality. Methods A total of 60 trained doctors who received 3-month standardized training in the Department of Cardiology of the Second Affiliated Hospital of Bengbu Medical College from April 2021 to July 2022 were selected as the subjects. They were divided into observation group and control group according to random number table method, with 30 doctors in each group. The observation group adopted the flipped classroom combined with CBL, and the control group adopted the traditional teaching method teaching mode. The teaching effects of the two teaching modes were compared and analyzed. After three months of standardized training, residents were assessed in the form of basic theory examination, practical skills and case analysis, and questionnaire survey to evaluate the effects of the two teaching methods. Results The basic theory scores [(93.1±5.3) points], skill operation scores [(89.2±10.1) points] and case analysis examination scores [(90.2±6.7) points] in the observation group were significantly higher than those in the control group [(88.5±8.9) points, (81.3±11.4) points, (85.3±5.9) points], the differences were statistically significant (all P < 0.05). The scores of questionnaire survey satisfaction were also significantly higher than that in the control group, the difference was statistically significant (P < 0.05). Conclusion Flipped classroom combined with CBL is conducive to improving the quality of standardized training for cardiology residents, stimulating residents' interest in learning, increasing teaching satisfaction, improving their ability to solve clinical problems, and improving their independent self-study ability and practical operation skills, which is conducive to future learning and improving the clinical teaching effect.

Effects of Dance/Movement therapy experience on the psychological state of patients with depression

CHENG Zeng-yan, ZHANG Ping, WANG Yong, PENG Min

2022, 20(12): 2138-2142. doi: 10.16766/j.cnki.issn.1674-4152.002788

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Objective To compare the impact of movement intervention informed by authentic movement and that of compulsory movement intervention on the psychological state of patients with depression, and investigate the underlying mechanisms. Methods Twenty-six outpatients with depression were recruited from the Psychiatry Department of Union Shenzhen Hospital, and randomly assigned into an experimental group and a control group, 13 cases in each group. The experimental group received a movement intervention informed by authentic movement, and the control group received a compulsory movement intervention. Before and after the intervention, the participants completed the Chinese version of perceived stress questionnaire, multidimensional assessment of interoceptive awareness, Heidelberg state inventory, and body self-efficacy scale. Results After the intervention, a significant improvement on perceived stress [(2.89±0.97) points vs. (3.84±0.94) points, P < 0.001], well-being [(3.51±1.04) points vs. (4.10±0.89) points, P < 0.001] and interoceptive awareness [(3.70±0.59) points vs. (4.37±0.63) points, P < 0.001] were observed in the experimental group, while a significant improvement on perceived stress [(3.17±0.72) points vs. (3.59±0.67) points, P=0.003] and well-being [(3.50±0.82) points vs. (4.04±0.95) points, P=0.006] were observed in the control group. The experimental group improved more significantly in perceived stress (t=2.394, P=0.023) and interoceptive awareness (t=2.400, P=0.025) compared to the control group. Interoceptive awareness had completely mediated the effects of different movement styles on the improvement of the participants' perceived stress. The mediating effect was 0.243 (P < 0.05) and its contribution to the total effect was 46%. Conclusion A single movement intervention informed by the discipline of Dance/Movement therapy significantly improves the psychological state of patients with depression. The mediation effect of interoceptive awareness might help explain the mechanism of why improvisational movement intervention informed by authentic movement is more effective than compulsory movement intervention in alleviating perceived stress of psychiatric patients with depression.

Big data mining analysis of the clinical characteristics and direction in seeking medical service of cough patients in regional medical centres

XIE Ren-wei, WANG Zhao-xin, LI Yun-xia, SHEN Yu, HE Lin, SHI Jian-wei, JIANG Li-qiu, SHI Bao-ping, XIAO Jie-wen

2022, 20(12): 2143-2146. doi: 10.16766/j.cnki.issn.1674-4152.002789

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Objective To analyse the clinical characteristics and direction in seeking medical service of patients with cough symptoms in regional medical centres, understand the clinical characteristics of cough patients, provide epidemiological basis for related clinical research, and offer a reference for regional medical centres to optimise the triage of cough patients. Methods This study collected three-year outpatient data of a regional medical centre in Shanghai from January 1, 2017 to December 31, 2019 and analysed the symptoms, main diagnosis and direction in seeking medical service of patients with cough symptoms. Results A total of 110 240 outpatients with cough symptoms were received from 2017 to 2019, accounting for 5.85% of the total outpatients. The number and proportion of outpatients with cough symptoms showed an increasing trend. The average age of patients was 51.0 (21.5, 64.0) years old, with 57 868 female (52.49%) and 52 372 male (47.51%) patients. The proportion of female patients was higher than that of male (χ²=274.002, P < 0.001). According to the classification of cough duration, 94.07% (103 702) had acute cough (cough time < 3 weeks), 3.03%(3 343) had subacute cough (cough time 3-8 weeks), and 2.90% (3 195) had chronic cough (cough time > 8 weeks). The distributions of different types of coughs in age and gender groups differed (all P < 0.05). The top three associated symptoms of cough patients were expectoration, fever and runny nose. The top three main diagnoses were respiratory tract infection, acute pharyngitis and acute upper respiratory tract infection. The distributions of cough associated symptoms and main diagnosis in different cough types and different age groups were different. In addition, the main departments receiving patients with cough were Emergency Department, Paediatrics and Respiratory Medicine. Conclusion The number of outpatients with cough symptoms shows an increasing trend, and the distributions of different types of coughs in the population group is different.

Analysis of risk factors affecting fear of exercise after anterior cruciate ligament reconstruction and related intervention measures

CHEN Yan-yan, LYU Chang, LIU Xiao-li, CHEN Zhen-zhen, TAO Ai-ping

2022, 20(12): 2147-2150. doi: 10.16766/j.cnki.issn.1674-4152.002790

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Objective To explore the risk factors of exercise fear after anterior cruciate ligament reconstruction and analyse related intervention measures. Methods A total of 216 cases of patients who underwent anterior cruciate ligament reconstruction at the Second Affiliated Hospital of Wenzhou Medical University from May 2019 to October 2021 were selected as subjects of the study. The patients were investigated with tampa scale for kinesiophobia (TSK), general self-efficacy scale (GSES) and numeric rating scale (NRS). Multivariate logistic regression analysis was used to analyse the risk factors of exercise fear in patients after anterior cruciate ligament reconstruction. Results Among the 216 patients who underwent reconstruction of anterior cruciate ligament injury, 72 developed fear of movement (33.33%). The TSK score of the non-kinaesthetic group was lower than that of the kinaesthetic group [(24.32±3.18) points vs.(45.27±4.51) points, t=39.495, P < 0.001]. The results of multivariate analysis showed that junior high school education and below, unemployed, family monthly income < 3 000 yuan, number of injuries ≥ 3 times, weakened muscle strength of injured knee and thigh, insomnia, GSES score < 25 points and moderate/severe postoperative pain were risk factors for the fear of exercise after anterior cruciate ligament reconstruction (all P < 0.05). Conclusion Patients who underwent anterior cruciate ligament reconstruction are affected by various factors, such as educational level and weakened muscle strength of the injured knee and thigh and pain, and are prone to exercise fear. Targeted intervention measures should be implemented to eliminate the patients ' fear of exercise, improve their exercise enthusiasm and accelerate their exercise and recovery process.

Application of nurse-led enteral nutritional feeding strategies in neurological intensive care unit patients

FAN Xiao-ning, SUN Pan-pan, JIN Yu-ping, YAO Le, XU Chuang-hu, TANG Rui, FANG Xiang

2022, 20(12): 2151-2155. doi: 10.16766/j.cnki.issn.1674-4152.002791

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Objective To explore the effect of nurse-led enteral nutrition feeding strategy on enteral nutrition (EN) in neurological intensive care unit patients through the establishment of an EN management group. Methods A total of 130 patients hospitalised in the Department of Neurointensive Care Unit at the First Affiliated Hospital of University of Science and Technology of China from January 2021 to August 2021 were selected as research objects. Based on the order of admission, the patients were divided into the control (62 cases) and observation (68 cases) groups. The traditional EN method was used in the control group, whereas the nurse-led EN feeding strategy was implemented in the observation group. The nurses independently conducted interventions, such as gastrointestinal function assessment, EN tolerance assessment, bedside ultrasound gastric residual amount monitoring, feeding speed and dose adjustment and increased monitoring frequency to ensure the smooth progress of EN. Comparison of feeding intolerance, EN target achievement, albumin and other nutritional indicators and the number of adjustments of EN speed was conducted. Results The incidence of feeding intolerance was 33.9% in the control group and 17.6% in the observation group (χ²=4.507, P=0.034). The value-added values of serum protein, prealbumin and haemoglobin index significantly increased compared with those in the control group (P < 0.05). The number of EN speed adjustments [(13.28±3.57) times] was significantly higher than that in the control group [(7.42±1.17) times, t=12.210, P < 0.001]. The achievement rate of EN goal in the control group was 72.6%, while that in the observation group was 82.4%, which was higher than that in the control group, but the difference was not statistically significant (P>0.05). Conclusion Nurse-led EN feeding strategy can reduce the incidence of feeding intolerance, improve nutritional indicators, but also increase the number of adjustments for nurse EN speed. In the clinical nursing work, nurses should strengthen the study of EN knowledge, dynamic evaluation, actively carry out nursing intervention, predictably deal with EN complications, and improve the nutritional indicators of patients.

Effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children undergoing day surgery

WU Xin-yan, HAN Ding, WANG Yu, CHEN Mei-li, YANG Xue-jing, PAN Shou-dong

2022, 20(12): 2156-2159. doi: 10.16766/j.cnki.issn.1674-4152.002792

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Objective To explore the effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children having day surgery. Methods A total of 451 children aged 1-14 years old and undergoing day surgery at Children ' s Hospital Affiliated to Capital Institute of Pediatrics from January 2020 to December 2020 were enrolled, and they were randomly divided into the control (n=227) and observation (n=224) groups based on the random number table method. The control group was subjected to standard nursing. The observation group received comfort nursing. The preoperative anxiety level of children was assessed with modified Yale preoperative anxiety scale (mYPAS). The post-anaesthesia emergence agitation score was determined, and the rate of post-anesthesia emergence delirium (those with a score > 12 points) was calculated. Three days after surgery, a telephone follow-up was conducted to investigate the incidence of negative behaviour change in the children with post-hospitalisation behaviour questionnaire and to investigate the satisfaction grade of parents with medical care services. Results Compared with the control group, the mYPAS score [5.0 (5.0, 7.0) points versus 10.0 (8.0, 15.0) points], incidence of agitation during recovery [23 (10.3%) versus 101 (44.5%)] and incidence of postoperative adverse behaviour change [5 (2.2%) versus 40 (17.6%)] significantly decreased (all P < 0.05) in the observation group, and the satisfaction grade of parents was better (P < 0.05). Conclusion Comfort nursing is effective in relieving preoperative anxiety and reducing the incidence of anaesthesia emergence agitation and negative postoperative behaviour changes in children undergoing day surgery, and should be popularised in children ' s day surgery centres.

Influence of leadership style perception on ingratiation behaviour of clinical nurses

XIA Chun-xiao, NI Le-dan, WU Jie, FENG Yong-zeng, CHENG Jian-wei

2022, 20(12): 2160-2163. doi: 10.16766/j.cnki.issn.1674-4152.002793

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Objective To explore the influence of leadership style perception on ingratiation behaviour in clinical nurses of tertiary hospitals and the role of regulatory focus between them, and provide a new perspective and reference for clinical nursing management. Methods A total of 392 nurses were selected from two tertiary hospitals in Wenzhou, Zhejiang Province from June to September 2021 by convenience sampling. The basic data questionnaire, leadership styles scale, ingratiation characteristics scale and regulatory focus scale were used in the investigation. Results The leadership style was scored from high to low as follows: transformational leadership (3.58±0.76) points, transactional leadership (3.20±0.69) points and laissez-faire leadership (2.79±0.58) points. The score of ingratiation behavior was (87.15±16.57) points with the item average score of (3.62±0.72) points. The scores of prevention focus and promotion focus were (3.55±0.62)points and (3.13±0.63)points, respectively. The scores of prevention focus and promotion focus were Prevention focus played a moderating role in the influence of transactional leadership style on ingratiation behaviour (△R²=0.043, β=0.168, P < 0.01). Promotion focus played a moderating role in the influence of transformational leadership style on ingratiation behaviour (△R²=0.072, β=0.204, P < 0.01). Conclusion Clinical nursing managers should recognise the existence of ingratiation behaviour, construct a harmonious, mutually beneficial and inclusive organisational environment, properly guide the direction of ingratiation behaviour, understand the regulatory focus of clinical nurses and their own leadership style, reasonably assign posts and improve the enthusiasm of clinical nurses.

Influence of management mode based on WeChat platform on the psychological mood, postoperative complications and quality of life of patients with retinal detachment after surgery

XIE Min, DENG Hong-yan, LI Zheng-ya, ZOU Yu-ping, SONG Bi-ying

2022, 20(12): 2164-2167. doi: 10.16766/j.cnki.issn.1674-4152.002794

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Objective To explored the influence of management mode based on WeChat platform on anxiety, depression, complications and quality of life of patients with retinal detachment after surgery through a prospective, randomised, single-centre study. Methods A total of 92 patients with retinal detachment (RD) who were treated by surgery in Ophthalmology Department of General Hospital of Southern Theatre Command from September 2018 to November 2019 were selected as the study subjects. They were randomly divided into the control group and WeChat group, with 46 cases in each group. The control group was given routine nursing, and the WeChat group was given the management mode based on WeChat platform on the basis of routine nursing. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to evaluate the psychological emotion of patients before and after intervention. The quality of life of patients was evaluated by the quality of life questionnaire (QLQ-C30V3.0), and the incidence of postoperative complications and nursing satisfaction were compared between the two groups. Results After nursing, the WeChat group attained lower SAS and SDS scores than the control group (P < 0.05). The incidences of neck-and-back muscle pain, headache and dizziness and insomnia complications in the WeChat group were lower than those in the control group (2.17% vs. 19.57%, 2.17% vs. 13.04%, 2.17% vs. 4.35%), and the difference between the two groups was statistically significant (χ²=7.180, 3.866, 4.929, P < 0.05). After nursing, the WeChat group revealed higher scores in the quality of life compared with the control group (all P < 0.05). The satisfaction rate in the WeChat group was higher than that in the control group [95.65% (44/46) vs. 80.43% (37/46)], and the difference was statistically significant (χ²=5.059, P=0.024). Conclusion The management mode based on WeChat platform can help alleviate the anxiety and depression of patients with RD after surgery and promote the improvement of patients ' quality of life and satisfaction.

Application value of predictive nursing in preventing postoperative complications of cervical cancer

ZHOU Juan, ZHANG Jing, SHI Hui-hui

2022, 20(12): 2168-2171. doi: 10.16766/j.cnki.issn.1674-4152.002795

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Objective To summarise the application value of predictive nursing in the prevention of perioperative complications in cervical cancer. Methods Patients with cervical cancer admitted to the Department of Obstetrics and Gynecology, the First People ' s Hospital of Bengbu City from January 2017 to May 2019 were selected. A total of 52 patients were screened as study subjects, and all patients were divided into observation group and control group according to random number table, with 26 cases in each group. Patients in the control group were given conventional care, whereas those in the observation group were given additional predictive nursing based on the original care measures simultaneously. The incidences of postoperative complications of cervical cancer in the two groups were counted and recorded. Results The incidences of deep vein thrombosis (0), urinary retention (7.69%, 2/26), lymphatic cyst (3.85%, 1/26) and intestinal obstruction (7.69%, 2/26) in the observation group after predictive nursing were lower than those in the control group [7.69% (2/26), 19.23% (5/26), 7.69% (2/26) and 11.54% (3/26), respectively]. The total incidence of complications between the two groups was statistically significant (χ²=4.282, P=0.039). The nursing satisfaction of the observation group was higher than that of the control group [24 (92.30%) vs. 18 (69.23%), χ²=4.457, P=0.035]. Conclusion The application of predictive nursing after cervical cancer surgery can reduce the complication rate in patients and increase their satisfaction, and clinical care application is effective, which can be recommended in the first line of clinical applications.

2022, 20(12): 2172-2173. doi: 10.16766/j.cnki.issn.1674-4152.002796

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2022, 20(12): 2174-2176. doi: 10.16766/j.cnki.issn.1674-4152.002797

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Abstract:

Effect of baicalin on expression of inflammatory factors in human gingival fibroblasts induced by lipopolysaccharide

GAO Juan, WU Yan, ZHENG Zhi-jun, WANG Qing-yun, LIU Shu, DANG Ni

2022, 20(12): 2002-2005. doi: 10.16766/j.cnki.issn.1674-4152.002755

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Objective To investigate the effects of baicalin on the injury of human gingival fibroblasts (HGFs) induced by Lipopolysaccharide (LPS) through PI3K/Akt/NF-κB signaling pathway and its mechanism. Methods LPS induced HGFs injury models were established and divided into normal control group, model group and model + baicalin (1, 10 and 20 μg/mL) groups. Each group was set with 3 repetitions. After treatment with different concentrations of baicalin, Western blotting was used to detect the expression of p-Akt, Akt and NF-κB p65, and the expressions of inflammatory factors TNF-α, IL-1β and IL-6 were detected by qPCR. After treated with PI3K inhibitor LY294002 for half an hour, baicalin was used to intervene, and the genes and proteins expressions of Akt, p-Akt, NF-κB p65, TNF-α, IL-1β and IL-6 were detected by qPCR and Western blotting. Results Compared with the model group, low, medium and high dose baicalin could effectively reduce the mRNA expression levels of TNF-α, IL-6 and IL-1β, promote the protein expression of P-Akt and inhibit the nuclear protein expression of NF-κB p65 in a dose-dependent manner (all P < 0.05). Compared with the model group, the expression of p-Akt in the model + baicalin group was increased (P < 0.05), and the expression of NF-κB p65 was decreased (P < 0.01). After the treatment of PI3K inhibitor LY294002, the expression level of p-Akt /Akt in the model + baicalin group was increased (0.63±0.18) compared with that in the model group (0.56±0.14, P < 0.05), and the expressions of NF-κB p65, IL-6, IL-1β and TNF-α in the model + baicalin group were decreased compared with those in the model group (all P < 0.01). After baicalin treated LY294002, the expression levels of p-Akt/Akt, NF-κB p65, IL-6, IL-1β and TNF-α were not significantly different from those of the model group. Conclusion Baicalin can inhibit the inflammatory response induced by LPS-induced human gingival fibroblast injury, and its mechanism may be related to promote the phosphorylation of Akt, inhibit NF-κB p65 nuclear transcription and the release of inflammatory factors.

Effects of Shexiang Baoxin Pills on cardiac function, ventricular remodeling and vascular endothelial factor in elderly patients with chronic heart failure

ZHANG Fang, CHEN Guo-fan, REN Kai-han, WANG Ming-wei

2022, 20(12): 2006-2009. doi: 10.16766/j.cnki.issn.1674-4152.002756

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Objective To analyze the effect of Shexiang Baoxin Pills on cardiac function, ventricular remodeling and vascular endothelial factor in elderly patients with chronic heart failure (CHF), so as to provide reference for clinical treatment of CHF. Methods A total of 100 elderly patients with CHF in the Affiliated Hospital of Hangzhou Normal University from January 2018 to December 2019 were selected and divided into control group and observation group by random digital table method, 50 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with western medicine combined with Shexiang Baoxin Pills. The cardiac function, ventricular remodeling, hemodynamics, endothelial cell function and adverse reactions were compared between the two groups. Results After treatment, the levels of left ventricular ejection fraction, 6 min walking test, cardiac index in the two groups were significantly higher than those before treatment (all P < 0.05), and those in the observation group were significantly higher than those in the control group [(52.16±3.39) % vs. (44.24±4.73) %, (453.46±23.20) m vs. (417.25±22.52) m, (3.34±0.38) L/(min·m²) vs. (2.88±0.46) L/(min·m²), t=9.624, 7.919, 5.452, all P < 0.05]. After treatment, the levels of the left ventricular end diastolic diameter, left ventricular posterior wall thickness, interventricular septal end systolic thickness, left ventricular mass index, pulmonary artery wedge pressure, total peripheral resistance, angiotensin Ⅱ, aldosterone, endothelin-1 in the two groups were significantly lower than those before treatment (all P < 0.05), and the observation group were significantly lower than the control group (t=7.440, 7.083, 3.733, 6.272, 12.507, 11.399, 9.234, 7.876, 10.218, all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ²=0.444, P>0.05). Conclusion Shexiang Baoxin Pills can effectively improve endothelial function, cardiac function and hemodynamics in elderly patients with CHF, delay ventricular remodeling, and has good safety.

Significance of rapid-eye-movement apnoea-hypopnea index for the evaluation of the mild obstructive sleep apnoea-hypopnea syndrome

ZHAI Yao-yao, LIU Xiao-xia, MENG Chan, WU Da-hai, LI Shu-hua

2022, 20(12): 2015-2018. doi: 10.16766/j.cnki.issn.1674-4152.002758

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Abstract:
Objective To select the appropriate index in polysomnogram (PSG) to evaluate the severity of patients with mild obstructive sleep apnoea-hypopnea syndrome (OSAHS) and explore its significance in evaluating the patients with mild OSAHS. Methods A total of 166 patients with mild OSAHS from General Hospital of Northern Theater Command from January 2016 to December 2020 were examined by PSG. Every index in the PSG and the results of Epworth sleepiness score (ESS), Pittsburgh sleep quality index (PSQI) and Montreal cognitive assessment (MoCA) were recorded, and the correlation between them was analysed. Strong relevance indexes were selected, and the groups were compared based on the index values. Results The correlation between ESS and rapid-eye-movement apnoea-hypopnea index (REM-AHI) was positive in the two correlation tests (r=0.248, 0.192, both P < 0.05), and that between the MoCA score and REM-AHI was negative (r=-0.260, -0.201, both P < 0.05). The comparison of ESS, PSQI and MoCA results among the REM-AHI groups were all statistically significant (all P < 0.05), but the comparison among the lowest-saturation-oxygen (LSO₂) groups showed no statistically significant results (all P>0.05). Conclusion REM-AHI is more meaningful for the evaluation of the severity of mild OSAHS than other indexes such as LSO₂. In particular, mild OSAHS patients with moderate-to-severe REM-AHI suffer from more damage to their bodies than the general ones.

Clinical study of individualized nutritional intervention in elderly patients with tumors

LIAO Zhi-jun, YANG Zhi-yong, HUANG Ying, HUANG Ren-hua

2022, 20(12): 2019-2021. doi: 10.16766/j.cnki.issn.1674-4152.002759

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Objective To explore the effects of individualized nutrition intervention on nutrition, Karnofsky performance score (KPS), quality of life and life span in elderly cancer patients. Methods A total of 100 elderly cancer patients treated in the Department of Oncology, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from January 2016 to December 2019 were selected and randomly divided into test group and control group, with 50 patients in each group. The control group adopted routine supportive treatment and palliative anti-tumor treatment according to the patient ' s condition and clinical symptoms with reference to the national comprehensive cancer network (NCCN) guidelines and the routine diagnosis and treatment. While, the test group carried out individualized nutritional intervention on the basis of the control group. Individualized nutrition intervention measures included nutrition risk screening and evaluation. According to the screening results, nutrition education and dietary guidance, oral nutrition and supplementary nutrition, enteral nutrition and parenteral nutrition intervention were given respectively. BMI, KPS and quality of life score of all patients were checked at the time of enrollment and 2 months after enrollment, and survival time of enrolled patients was calculated at 6 months after enrollment. Results After the intervention, the BMI and KPS scores of the two groups were statistically significant (all P < 0.05). The quality of life score of the test group [(20.75±1.67) points] was higher than that of the control group [(18.23±3.19) points, P < 0.001]. The median survival time was 172.0 days in the test group and 162.5 days in the control group, and the difference between the two groups was statistically significant (P < 0.001). Conclusion Individualized nutritional intervention can delay the decline of BMI, inhibit the decline of KPS score, limit the decline of quality of life and extend the life of elderly patients with tumors, which is worth promoting in clinical practice.

Clinical effects of endoscopic minimally invasive and surgical treatment of gastric stromal tumours

LIU Ru, YAN Shan-jun, DENG Min, WANG Jian-chao, KE Xi-quan, ZHU Yu, GU Lin

2022, 20(12): 2022-2024. doi: 10.16766/j.cnki.issn.1674-4152.002760

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Objective To observe and compare the clinical effects of endoscopic minimally invasive surgery and surgical surgery on the treatment of gastric stromal tumours with tumour diameter ≤4 cm. Methods Patients with gastric stromal tumour treated at the First Affiliated Hospital of Bengbu Medical College from March 2019 to March 2021 were retrospectively analysed and divided into endoscopic and surgical groups based on the different treatment methods. The general data, perioperative indicators, postoperative complications and recurrence in the two groups were analysed and compared. Results A total of 128 patients with confirmed gastric stromal tumours were included. Exactly 98 cases were included in the endoscopic group, including 57 cases of endoscopic submucosal dissection, 32 cases of endoscopic full-thickness resection, 5 cases of endoscopic submucosal tunneling for tumor dissection and 4 cases of endoscopic submucosal excision. The surgical group comprised 30 cases, including 4 cases of open surgery, 10 cases of laparoscopic wedge resection and 16 cases of laparoscopic subtotal gastrectomy. No significant differences were observed in the gender, age, body mass index (BMI), diabetes and other general data between the two groups (P>0.05). The most common tumor sites in the two groups were fundus, body, antrum and cardia. No significant differences were observed in tumour diameter, immunohistochemical parameters (positive rates of CD117, DOG-1 and CD34), NIH risk and mitotic number between the two groups (all P>0.05). The operation time, postoperative first oral feeding time, postoperative hospital stay and hospitalisation cost of the endoscopic group were significantly lower than those of the surgical group [(63.99±35.19) h vs. (125.10±49.33) h, (2.63±1.03) d vs. (4.90±2.23) d, (6.43±1.54) d vs. (7.67±1.92) d, (27 048.44±4 613.41) yuan vs. (49 022.00±9 795.40) yuan, all P < 0.05]. One case of delayed bleeding occurred in the endoscopic group, and one case of abdominal infection occurred in the surgical group. No serious postoperative complications, such as anastomotic leakage and peritonitis, were observed. During the follow-up period of 12-36 months, no recurrence was found in the two groups. Conclusion For gastric stromal tumours with tumour diameter ≤4 cm, endoscopic treatment can achieve comparable short-term and long-term efficacies with surgery, accelerate postoperative recovery, shorten postoperative hospital stay and reduce medical costs.

Evaluation of the efficacy of extracorporeal membrane oxygenation assisted transcatheter aortic valve implantation by speckle tracking

JI Shu-jiao, LI Yu-zhen, SUN Jia, FENG Yan-fen

2022, 20(12): 2025-2028. doi: 10.16766/j.cnki.issn.1674-4152.002761

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Abstract:
Objective To investigate the application value of tissue mitral annular displacement (TMAD) speckle tracking technique in extracorporeal membrane oxygenation (ECMO) assisted transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS). Methods A total of 16 patients with severe AS with left ventricular ejection fraction (LVEF) < 25% underwent ECMO assisted TAVI in Henan Provincial Chest Hospital from September 2019 to March 2021 were retrospectively analyzed. The changes of speckle tracking parameters [tissue motion tracking of mitral annular average displacement (TMADmid), tissue motion tracking of mitral annular average displacement rate (TMADmid%), global longitudinal strain (GLS)] and conventional echocardiographic parameters [LVEF, left ventricular diastolic end diameter (LVEDd), stroke volume (SV)] were statistically analyzed before TAVI treatment, immediately after ECMO removal and 1 month after operation. The evaluation value of speckled tracking technique in the postoperative efficacy of ECMO assisted TAVI was analyzed. Results The TMADmid [(3.2±1.3) mm, (6.9±1.3) mm, (11.2±2.5) mm], TMADmid% [(3.5±2.6) %, (7.0±3.8) %, (10.1±2.1) %] and GLS [(5.9±3.5) %, (8.9±2.7) %, (13.2±3.9) %] increased gradually before TAVI treatment, immediately after ECMO removal and 1 month after operation, and the differences were statistically significant (all P < 0.05). One month after operation, LVEF [(42.2±5.3) %] was significantly higher than that before operation [(22.2±5.5) %] and immediately after ECMO removal [(23.8±2.5) %, P < 0.05]. Compared with pre-operation, LVEF increased immediately after ECMO removal, with no significant difference (P>0.05). The TMADmid and TMADmid% were positively correlated with GLS (r=0.499, 0.586, all P < 0.05). Conclusion The tissue mitral annular displacement speckle tracking technique can be used as a sensitive reference index to evaluate the diagnosis and treatment effect of TAVI in patients with AS. The ECMO assisted TAVI is safe and effective in the treatment of severe AS.

Mechanism of miR-373-3p in reversing cisplatin resistance in bladder cancer cells by regulating caveolin 1

JIN Yue-wei, MAO Zu-jie, HU Lin-yi, PAN Yong-zhi, WANG Jun-jie, YANG Pan, ZHENG Min-chao, ZHENG Yong-qiang, ZHU Long

2022, 20(12): 2029-2033. doi: 10.16766/j.cnki.issn.1674-4152.002762

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Abstract:
Objective To investigate the effect of microRNA-373-3p (miR-373-3p) targeting caveolin 1 (Cav1) on the cisplatin (DDP) resistance of bladder cancer cell. Methods The DDP-resistant bladder cancer cell line T24/DDP were established. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect the expression of miR-373-3p in T24 and T24/DDP cells. miR-373-3p was overexpressed, or the expression of Cav1 was inhibited in T24/DDP cells. Each group of experiments was set up with six replicate wells. MTT method was used to detect the half inhibitory concentration (IC₅₀) of DDP on T24/DDP cells and cell proliferation activity. Flow cytometry was used to detect cell apoptosis, and Western blotting was used to determine the expressions of Cav1, multidrug resistance associated protein (MRP) and P-glycoprotein (P-gp) proteins in cells. Dual luciferase reporter gene experiment was used to verify the targeting relationship between miR-373-3p and Cav1. Results Compared with T24 cells, the expression level of miR-373-3p in T24/DDP cells decreased (0.34±0.06 vs. 1.00±0.18, t=8.521, P < 0.001), and that of Cav1 protein increased (0.95±0.10 vs. 0.41±0.06, t=11.342, P < 0.001). Dual luciferase reporter experiment proved that miR-373-3p could target and negatively regulate Cav1 expression. After the overexpression of miR-373-3p or inhibition of Cav1 expression in T24/DDP cells, the apoptosis rate significantly increased (all P < 0.05), and the cell proliferation activity, IC₅₀ of DDP to the cell and protein expression levels of MRP and P-gp significantly decreased (all P < 0.05). The overexpressed Cav1 could reverse the inhibitory effect of the overexpression of miR-373-3p on the drug resistance of T24/DDP cells. Conclusion MiR-373-3p can target and down regulate Cav1 expression and reverse the DDP resistance of T24/DDP cells.

Application of nalbuphine combined with dexmedetomidine in painless ultrasound bronchoscopy

CHEN Nian-ping, HOU Hai-yan, QIU Yuan-li, SONG Cheng, ZHU Ya-fang, XU Liang

2022, 20(12): 2034-2037. doi: 10.16766/j.cnki.issn.1674-4152.002763

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Objective To investigate the influence of nalbuphine or sufentanil combined with dexmedetomidine on hemodynamics, respiratory rate and pain score in painless ultrasonic bronchoscopy. Methods Fifty patients planned to undergo painless ultrasound bronchoscopy in Affiliated Hospital of Shaoxing University from December 2019 to October 2021 were randomly divided into sufentanil combined with dexmedetomidine group (SD group) and nalbuphine combined with dexmedetomidine (ND group), 25 patients in each group. On the basis of topical anesthesia with lidocaine, the patients in the two groups were injected with dexmedetomidine 1 μg/kg (15 min) intravenously. The patients in the ND group were intravenously injected with nalbuphine 0.1 mg/kg and patients in the SD group were given sufentanil 0.1 μg/kg intravenously, then propofol was used to maintain anesthesia in both groups. The changes of blood pressure, heart rate, pulse oxygen saturation and respiratory rate were monitored before medication, at fibrobronchoscope entered glottis, biopsy and the end of examination. The amount of propofol, operation time, recovery time, anesthesia effect classification during the examination and the occurrence of adverse reactions after administration were observed and recorded. The VAS score before operation, 1 hour, 2 hours, 4 hours and 6 hours after operation were also evaluated and recorded. Results The changes in blood pressure, heart rate, pulse oxygen saturation and respiratory rate during bronchoscopy in the ND group were lower than those in the SD group (all P < 0.05). There was no significant difference in the dosage of propofol [(210.4±30.3) mg vs. (232.2±58.5) mg], operation time [(28.9±9.4) min vs. (30.1±8.8) min], recovery time [(8.3±2.2) min vs. (9.1±3.1) min] and excellent rate of anesthesia effect (96.0% vs. 72.0%) between the two groups (all P>0.05). The postoperative VAS score and the incidence of adverse reactions in the ND group were significantly lower than those in the SD group (all P < 0.05). Conclusion Nalbuphine combined with dexmedetomidine used in painless ultrasound bronchoscopy has stable hemodynamics and few adverse reactions. It is one of the safe and effective substitutes for sufentanil.

Influence of sacubitril/valsartan on related indexes of ventricular remodeling and cardiac function in patients with chronic heart failure

XIE Cai-xia, XUAN Ling, KANG Pin-fang, HUANG Yu-li, ZHANG Heng, TANG Bi

2022, 20(12): 2010-2014. doi: 10.16766/j.cnki.issn.1674-4152.002757

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Objective By measuring the levels of blood cyclophilin A (CyPA), galectin-3, matrix metalloproteinase-2(MMP-2), MMP-9, N-terminal B type natriuretic peptide (NT-proBNP) in patients with chronic heart failure (CHF) before and after the application of sacubitril/valsartan, the effects of sacubitril/valsartan on related indexes of ventricular remodeling and cardiac function in patients with chronic heart failure were discussed. Methods We selected 99 cases with CHF treated with sacubitril/valsartan at the First Affiliated Hospital of Bengbu Medical College from December 2018 to June 2022. Blood samples were collected before and 3 months after treatment by sacubitril/valsartan, and the blood CyPA, galectin-3, MMP-2, MMP-9 and NT-proBNP levels before and after treatment by sacubitril/valsartan were compared. Results After treatment, the levels of blood CyPA, Galectin-3, MMP-2, MMP-9 and NT-proBNP in patients with CHF showed significant differences compared with those before treatment [CyPA: (7.75±3.18) ng/mL vs. (10.13±3.32) ng/mL; Galectin-3: (9.66±5.20) ng/mL vs. (16.74±3.18) ng/mL; MMP-2: (12.02±5.69) ng/mL vs. (18.40±8.41) ng/mL; MMP-9: (8.32±4.34) ng/mL vs. (11.45±4.51)ng/mL; NT-proBNP: (1 319.24±404.11) ng/mL vs. (4 187.48±1 967.92) ng/mL, all P < 0.01]. Conclusion Sacubitril/valsartan can significantly reduce the levels of blood CyPA, Galectin-3, MMP-2, MMP-9 and NT-proBNP in patients with CHF and improve cardiac function, which may have certain effects on the evaluation of treatment with CHF.

Dermatoscogic manifestations and diagnostic value analysis of basal-cell carcinoma

DENG Fan-zhi, ZHANG Qun, ZOU Wei-yan, WU Yu-hong, HU Feng, WANG Wei

2022, 20(12): 2038-2040. doi: 10.16766/j.cnki.issn.1674-4152.002764

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Objective To explore the dermatoscogic manifestations of basal cell carcinoma of the skin and analyze its diagnostic value, in order to understand the accuracy of dermatoscope in the diagnosis of basal cell carcinoma. Methods A total of 62 patients with suspected basal cell carcinoma were selected from the Dermatology Clinic of Fuyang People ' s Hospital from July 1, 2017 to December 31, 2019, including 29 males and 33 females, with an onset age of (70.34±4.41) years. The skin lesions of outpatients were observed by digital camera and dermatoscope, and pathological biopsy was performed. The results of pathological examination were taken as the gold standard, the accuracy of dermatoscope in the diagnosis of basal cell carcinoma was evaluated, and the consistency of dermatoscope and histopathological classification was analyzed. Results Among the 62 patients with suspected basal cell carcinoma, 47 were diagnosed as basal cell carcinoma by dermatoscope and pathology. The diagnostic sensitivity of dermatoscope was 95.92%, the specificity was 92.31%, the total coincidence rate was 95.16%, the misdiagnosis rate was 7.69%, the missed diagnosis rate was 4.08%, the Youden index was 0.882, the Kappa value was 0.858, and the consistency with pathological diagnosis was high (P=0.999). Among the dermatoscopic related indexes of basal cell carcinoma, there were significant differences in the positive rates of dermatoscogic features such as ulcer, multiple superficial erosion, bright red and white unstructured area, blue-gray oval nest, leafy structure and so on (all P < 0.05). Conclusion The diagnosis of basal cell carcinoma by dermatoscope is highly consistent with the results of pathological examination, and it has the characteristics of non-invasive, convenient and high accuracy, which is worthy of clinical promotion.

Application of racquet-shaped incision mammoplasty in breast-conserving surgery for early-stage breast cancer patients

XU Qi, ZHENG Li, XU Dan-ying, LIU Yue, SHEN Jing

2022, 20(12): 2041-2044. doi: 10.16766/j.cnki.issn.1674-4152.002765

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Objective To compare the clinical efficacy of racquet-shaped incision mammoplasty and traditional breast-conserving surgery for early-stage breast cancer. Methods A total of 84 patients with early-stage breast cancer at the Second Hospital of Jiaxing and its Nanhu Branch from January 2019 to December 2020 were divided into experimental and control groups according to the random number table method, 42 cases in each group. The experimental group was treated with racquet-shaped incision mammoplasty, and the control group was treated with traditional breast-conserving surgery. The cosmetic effect, operation time, intraoperative blood loss, resected volume, rate of seroma, rate of positive margins in first resection, rate of infection and rate of mastectomy were compared between the two groups. Results An excellent to good rate of cosmetic effect was observed in the experimental group, with a value of 90.5%, which was higher than that of the control group (61.9%, P < 0.01). The resected volume in the experimental group was (89.4±23.1) mL, which was larger than that in the control group [(67.7±23.9) mL, P < 0.01]. The rate of seroma in the experimental group was 4.8%(2 cases), which was lower than that in the control group (45.2%, 19 cases, P < 0.01). The rate of positive margins in the first resection of the experimental group was 4.8% (2 cases), which was lower than that of the control group (19.0%, 8 cases, P < 0.05). No significant difference was observed in operative time, intraoperative blood loss, rate of infection and rate of mastectomy between the two groups (all P>0.05). The mean follow-up period was 25 months. All patients were free of local recurrence. There was 1 case of distant metastasis in each group, and there was no significant difference in the rate of distant metastasis between the two groups (P>0.05). Conclusion For early-stage breast cancer, racquet-shaped incision mammoplasty can improve breast aesthetics after operation and reduce the rates of seroma and positive margins in the first resection compared with traditional breast-conserving surgery. It is worth popularizing and applying.

Association of low glucose-6-phosphate dehydrogenase enzyme activity with hepatitis B virus infection in adult males

GUAN Ting, ZHANG Yue, ZHANG Dong-mei, YANG Juan, MA Xu, ZHAO Jun

2022, 20(12): 2045-2049. doi: 10.16766/j.cnki.issn.1674-4152.002766

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Objective To investigate the association between low glucose-6-phosphate dehydrogenase (G6PD) enzyme activity and hepatitis B virus (HBV) infection in adult males. Methods A case-control study was conducted on 85 286 adult males who participated in the National Free Pre-conception Health Checkup Project in Shenzhen from January 2013 to December 2019 and met the inclusion and exclusion criteria. The relationship between low G6PD enzyme activity and HBV infection was analysed by multivariate logistic regression models, and their influence on glutamic-pyruvic transaminase (ALT) elevation was observed. Results Adult males with a low G6PD enzyme activity had a 20.4% (OR=1.204, P < 0.001) increased risk of HBV infection compared with those with non-low G6PD enzyme activity. Compared with adult males without low G6PD enzyme activity and without HBV infection, those with HBV infection alone had a 60.3% (OR=1.603, P < 0.001) and 123.8% (OR=2.238, P < 0.001) increased risk of mild and moderate/severe elevation of ALT, respectively. Meanwhile, those with combined low G6PD enzyme activity and HBV infection had 69.3% (OR=1.693, P < 0.001) and 190.2% (OR=2.902, P < 0.001) increased risk of mild and moderate/severe elevation of ALT, respectively. Conclusion Adult males with a low G6PD enzyme activity will increase the risk of HBV infection, and increase the risk of elevated ALT in HBV-infected individuals. In the case of adult males with a low G6PD enzyme activity and HBV infection, the collaborative management method of the two diseases must be explored for clinical settings.

A retrospective analysis of the clinical and pathological features of colorectal polyps and gastric polyps

LI Wei-wei, WANG Yu-long, DING Qian-nan, YAO Liu-xu, LI Yu-hong

2022, 20(12): 2050-2054. doi: 10.16766/j.cnki.issn.1674-4152.002767

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Objective To analyse the clinical and pathological features of colorectal polyps, gastric polyps and gastric polyps combined with colorectal polyps in Shaoxing People ' s Hospital. Methods The clinical and pathological features of 1 001 cases of colorectal polyps and 1 219 cases of gastric polyps found by endoscopy in Shaoxing People ' s Hospital from June 2017 to November 2017, as well as the clinical and pathological features of gastric polyps combined with colorectal polyps were retrospectively analysed. The detection rate, location, the number and pathological types of colorectal and gastric polyps in different age groups and genders were compared. Results The detection rate for colorectal polyps (14.35%) was higher than that for gastric polyps (8.15%, χ²=200.568, P < 0.001). The detection rate for both polyps increased with age (P < 0.001). The detection rate for gastric polyps in women was higher than that in men, whereas the detection rate for colorectal polyps was higher in men than in women (P < 0.001). Single colorectal polyps (91.71%) were more common than single gastric polyps (73.17%, χ²=232.500, P < 0.001), and colorectal polyps ≥ 1.0 cm (18.58%) were more common than gastric polyps (5.50%, χ²=93.200, P < 0.001). The detection rates for inflammatory and adenomatous polyps were statistically significant (P < 0.001). The canceration rate of gastric polyps was lower than that of colorectal polyps (P < 0.001). The detection rate of colorectal polyps in patients with gastric polyps was higher than that of the general population (33.43% vs. 14.35%, P < 0.001), and characterised by multiple sites, multiple lesions and less canceration. Conclusion Gastric polyps, colorectal polyps and gastric polyps combined with colorectal polyps have different clinical and pathological features from the general population, which provide a reference for clinical diagnosis and treatment.

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2022 Vol. 20, No. 12

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