2022 Vol. 20, No. 2

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Expert Forum
The status quo and prospect of "Internet Plus" community empowerment
DAI Hua, DENG Hong-yu, YUAN Bo, WU Jia, ZHAO Qian
2022, 20(2): 175-178. doi: 10.16766/j.cnki.issn.1674-4152.002306
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For achieving the strategic objectives of "Healthcare for all" and "Healthy China 2030" proposed by the World Health Organization and the Chinese government, how to maximize the leading role of general practice in primary medical care has become a key problem to be solved. In our researches on the concept, development history, status, and future prospects of "Internet Plus" and "community empowerment", we found that the theoretical system of "community empowerment" emphasized enhancing the control of community members in primary medical care, optimizing the allocation of medical resources, optimizing the structure of community medical care organization, and comprehensively improving primary medical care service. "Internet Plus" enables the theory of "community empowerment" to be realized and endowed with more powerful functions, and it has been widely used in primary medical services, public health, family contracts, drug security, medical settlement, medical education, and medical management. The combination of "Internet Plus" and "community empowerment" can maximize the allocation of medical resources, improve the quality and efficiency of chronic diseases management, enrich the means of training basic medical personnel, and enhance the ability to respond to public health emergencies. Although the practical application of "Internet Plus" and "community empowerment" still exist some problems such as the low level of cognition and acceptance of the masses, the confidentiality of information and privacy, the lack of laws and policies, etc., it is undeniable that the combination of Internet plus and community empowerment is a powerful weapon for general practice to play a key role in primary health care in the future. It's important to keep exploring how to maximize the use of limited primary medical resources by the combination of "Internet Plus" and "community empowerment".
Development of General Practice in the United Kingdom（the end）
Rodger Charlton, LIU Man-ling, XIE Wan-ling, YAO Mi
2022, 20(2): 179-180.
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Construction and analysis of predictive model of poor olfactory improvement in patients with chronic rhinosinusitis after endoscopic surgery
DAI Li-li, TANG Wei, XIE Dao-yu, WU Hong-lin, CHEN Chao-hui
2022, 20(2): 246-250. doi: 10.16766/j.cnki.issn.1674-4152.002324
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  Objective  To provide guidance for clinical work by constructing a predictive model of poor olfactory improvement in patients with chronic rhinosinusitis (CRS) after nasal endoscopic treatment.  Methods  The clinical data of 125 patients with CRS who underwent endoscopic sinus surgery in the Department of Otorhinolaryngology, Affiliated Hospital of Hangzhou Normal University from March 2018 to March 2021 were retrospectively analysed. All patients were accompanied by olfactory disorders. The improvement of olfactory disorders was divided into satisfactory group and unsatisfactory group. Factors affecting olfactory improvement were screened through single-factor analysis, and logistics multi-factor analysis was carried out. A prediction model was constructed according to the logistics regression equation, and its prediction performance was analysed.  Results  The clinical data of 125 patients, including 84 cases in the satisfactory group and 41 cases in the unsatisfactory group, were analysed. Logistics multivariate analysis revealed that a history of allergic diseases (B=1.145, OR=3.141, 95% CI: 1.282-7.693), nasal polyps (B=0.905, OR=2.472, 95% CI: 1.025-5.962) and long-term reduction congestion (B=1.043, OR=2.837, 95% CI: 1.164-6.917) is a risk factor for olfactory recovery. Adherence to comprehensive treatment (B= -1.225, OR=0.294, 95% CI: 0.107-0.807) is a risk factor for olfactory recovery. The nomogram model predicted that the C-index of CRS patients with poor olfactory improvement after nasal endoscopic treatment was 0.745(0.739-0.819). The calibration curve showed that the absolute error of the prediction probability of the nomogram model was 0.043.  Conclusion  A history of allergic diseases, nasal polyps, long-term decongestants and post-operative adherence to comprehensive treatment are the factors affecting olfactory recovery. The nomogram model established based on the above indicators can be used for olfactory improvement after nasal endoscopic treatment in patients with CRS patients.
The correlation between peritoneal fibrosis and the levels of SGLT1, TGF-β1, and VEGF in peritoneal dialysis patients and its application value
WANG Chao-chao, LIN Yong-qiang, CHEN Tian-tian, ZHOU Ying, CAI Xiao-qiao, LIN Sheng-fen
2022, 20(2): 251-254. doi: 10.16766/j.cnki.issn.1674-4152.002325
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  Objective  To investigate the correlation between peritoneal fibrosis and the levels of sodium-glucose transporter 1 (SGLT1), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF) and its application value.  Methods  Twenty-five cases of patients with peritoneal fibrosis on maintenance hemodialysis were selected as study group, and 35 cases of peritoneal dialysis patients without peritoneal fibrosis were selected as the control group in Department of Nephrology, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from June 2012 to June 2021.The levels of SGLT1, TGF-β1 and VEGF of two groups were compared. The application value of SGLT1, TGF-β1, and VEGF of diagnosis of peritoneal fibrosis were analyzed by diagnosis of peritoneal fibrosis.  Results  The levels of SGLT [(128.85±22.58) pg/mL vs. (85.42±15.68) pg/mL], TGF-β1 [(432.32±54.18) pg/mL vs. (245.72±32.10) pg/mL], and VEGF [(903.25±61.45) ng/mL vs. (612.85±32.10) ng/mL] were statistically different between the two groups (all P < 0.05). The ROC curve analysis showed that the maximum area under the curve (AUC) were 0.865 (95% CI: 0.708-0.952), and the sensitivity and specificity were 85.02% and 82.14% when the three were diagnosed jointly.  Conclusion  Abnormally elevated levels of SGLT1, TGF-β1, and VEGF are closely related to the occurrence of peritoneal fibrosis. The levels of SGLT1, TGF-β1, and VEGF can effectively predict the occurrence of peritoneal fibrosis.
The chain mediating effect between illness perception and self-management behavior in maintenance hemodialysis patients
RAO Hai-ying, YE Bai-ru, JIN Ling-wei, ZHANG Jing
2022, 20(2): 255-258, 289. doi: 10.16766/j.cnki.issn.1674-4152.002326
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  Objective  To explore the relationship amongst illness perception, cognitive fusion, rumination, and self-management behaviour in patients with maintenance haemodialysis and to provide some reference and basis for clinical nursing intervention.  Methods  A total of 312 patients who underwent haemodialysis were selected from the haemodialysis centre of a tertiary hospital in Zhejiang Province between April and October 2020 through convenience-sampling method. The basic data questionnaire, Brief Illness Perception Questionnaire, Chinese version of Nolen-Hoeksema Ruminative Responses Scale, cognitive fusion questionnaire, and haemodialysis patients' self-management behaviour questionnaire were used in the investigation. Amos17.0 software was used to construct the structural equation-model diagram and perform the intermediary effect test.  Results  The scores of illness perception, cognitive fusion, and rumination were (50.12±13.78) points, (63.15±14.58) points, and (47.63±10.30) points, respectively. The score of self-management behaviour was (66.73±13.18) points at a lower level overall. The specific mediating effect and chain-mediating effect of rumination and cognitive fusion between illness perception and self-management behaviour were all established. The specific mediating effect of rumination accounted for 30.7% of the total indirect effect, and that of cognitive fusion accounted for 19.2% of the total indirect effect. The chain-mediating effect accounted for 7.7% of the total indirect effect.  Conclusion  In the nursing intervention of maintenance hemodialysis patients, medical personnel should pay attention to help them objectively face the disease and treatment, reduce their rumination thinking, ease their negative emotions, block their cognitive integration and psychological rigidity, improve their self-management behavior and quality of life.
Effect of vitamin D supplementation on FEV1%, FeNO and control level in children with uncontrolled bronchial asthma
CHU Wei-hong, PENG Shao, MA Ying-ying, ZHANG Man, XU Li-yan, GAO Yi-wei, GAO Yuan, MIAO Xue-yan
2022, 20(2): 259-262. doi: 10.16766/j.cnki.issn.1674-4152.002327
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  Objective  To explore the effect of vitamin D (VD) supplementation on forced expiratory volume for 1 second expressed as a percentage of the forced vital capacity (FEV1%), fractional exhaled nitric oxide (FeNO) and control level in children with uncontrolled asthma.  Methods  Children with uncontrolled asthma who visited the children's asthma clinic of the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2019 were selected as study subjects and randomly divided into the observation and control groups. The observation group received inhaled glucocorticoid+β2 receptor agonist + leukotriene receptor antagonist+VD. The control group received the same treatment without VD. Serum 25 hydroxy vitamin D(25OHD), lung function and FeNO were tested, and clinical control level were evaluated at monthly follow-up for 3 months.  Results  (1) Statistical significance in FEV1% and FeNO was found between the two groups, between each time point and in interaction between group and time (FFEV1%=9.545, 600.842, 12.018, FFeNO=7.037, 1 118.111, 37.062, all P < 0.05). (2) At 1, 2 and 3 months of treatment, a significant difference in FEV1% was found between the two groups (tFEV1%=2.032, 2.310, 2.562, all P < 0.05). FEV1% increased faster in the observation group than in the control group. (3) The difference was significant at 1, 2 and 3 months (t=-2.332, -5.940, -5.024, all P < 0.05) in FeNO between the two groups. FeNO decreased faster in the observation group than in the control group. (4) The good control rate of the observation group was higher than that of the control group in the second month of treatment (51/20 vs. 28/32, χ2=8.602, P=0.003). There was no significant difference between the two groups in the first and third months (all P>0.05).  Conclusion  VD supplementation in children with uncontrolled asthma may increase FEV1% and decrease FeNO quickly and allow asthma control in advance.
Clinical diagnostic characteristics of children with epilepsy combined with febrile seizures plus caused by SCN1A gene mutation
SHENG Fang, JIANG Xue-yan, MEI Jin-zhi, WANG Ye-ping, RUAN Zhe-nan, WANG Kai-xuan
2022, 20(2): 263-266, 319. doi: 10.16766/j.cnki.issn.1674-4152.002328
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  Objective  To study the clinical diagnostic characteristics of children with epilepsy combined with febrile seizures plus (EFS+) caused by SCN1A gene mutation and to provide a theoretical reference for diagnosis and treatment.  Methods  A total of 46 children with EFS+ who were admitted to Jinhua Hospital Affiliated to Medical College of Zhejiang University from May 2018 to May 2021 were selected as participants. The second-generation high-throughput gene sequencer was used to detect SCN1A gene mutations in children, and the clinical diagnostic characteristics of patients with different SCN1A genotypes were compared.  Results  A total of 46 children with EFS+ had an initial age of 12-18 months. Among them, 36 cases of SCN1A gene mutation were positive, and the mutation rate was 78.26%, including 18 cases of mis-sense mutations, 18 cases of truncation mutations. Truncation mutations included 3 cases (8.33%) of splicing mutations, 10 cases (27.78%) of frameshift mutations, 2 cases (5.56%) of large fragment deletions and 3 cases (8.33%) of non-sense mutations. A heterozygous mutation (nucleotide change c.1499A > G) was found in the SCN1A gene of the tested child, and the 1499th nucleotide in the coding region was changed from G to T, resulting in the 946th amino acid being changed from Arg to Cys, that was p.(Arg946Cys). A heterozygous mutation was found in the SCN1A gene of the tested child (nucleotide change was c.2891T > G), and the 2891st nucleotide in the coding region was changed from T to G, which changed amino acid 542 from the original leucine (L) to arginine (R), namely, p.L542R. This mutation was a mis-sense mutation. The mutation sites were distributed in the DⅡS5-S6 junction loop of the sodium channel alpha subunit protein domain, which was not a polymorphic change.  Conclusion  Children with EFS+ are at high risk of SCN1A gene mutations, and the phenotypic characteristics of children with febrile seizures plus are closely related to the type and location of SCN1A gene mutations, which can provide a targeted reference for clinical diagnosis and treatment.
Clinical effect of endometrial polyps treated by hysteroscopic surgery combined with natural progesterone
YU Ping-zhi, LI Fei-fei
2022, 20(2): 267-269. doi: 10.16766/j.cnki.issn.1674-4152.002329
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  Objective  To investigate the clinical effect of endometrial polyps treated by hysteroscopic surgery combined with natural progesterone.  Methods  Seventy cases of endometrial polyps admitted to the Third People's Hospital of Hefei from March 2019 to March 2020 were selected. According to the admitted time, they were divided into control group and observation group, with 35 cases in each group. The control group was treated with hysteroscopic endometrial polypectomy alone, and the observation group was treated with hysteroscopic endometrial polypectomy combined with natural progesterone. Both groups were treated with antibiotics to prevent infection, stop bleeding and correct anaemia. The therapeutic effect of the two groups was compared. The improvement of menstruation and the recurrence of endometrial polys were compared between the two groups at 12 months after surgery.  Results  No statistically significant difference in average haemoglobin value was found between the two groups before surgery (P > 0.05). At 12 months after surgery, the average haemoglobin value of the observation group was significantly higher than of the control group (t=34.552, P < 0.001). No statistically significant difference in average menstrual period was found between the two groups before surgery (P > 0.05). At 12 months after surgery, the average menstrual period of the observation group was significantly shorter than of the control group (t=4.398, P < 0.001). The recurrence rate of endometrial polyps 12 months after operation was 14.29% in the observation group and 60% in the control group. The recurrence rate of the observation group was significantly lower than that of the control group (χ2=15.664, P < 0.001).  Conclusion  The effect of hysteroscopic surgery combined with natural progesterone on endometrial polyps is better than that of hysteroscopic polypectomy alone. It is worthy of clinical promotion in gynaecology.
Influencing factors of resident satisfaction with the family doctor system in Shanghai
ZHANG Wei-qi, YUAN Hui-yun
2022, 20(2): 270-273. doi: 10.16766/j.cnki.issn.1674-4152.002330
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  Objective  By understanding the status quo of residents' satisfaction with the family doctor system in Shanghai and comparing the differences between the residents who signed the contract and those who did not, this study explored the influencing factors of satisfaction with the family doctor system to provide countermeasures and suggestions for improving the family doctor system in Shanghai.  Methods  A total of 1 786 community residents from nine districts in Shanghai were investigated by convenience sampling method and self-designed questionnaire in February 2019. Descriptive analysis, Chi-square test and logistic regression analysis were used to analyse the status quo of residents' satisfaction with the implementation of the family doctor system in Shanghai and its influencing factors.  Results  The residents' overall satisfaction with the family doctor system in Shanghai was high, and the satisfaction indicators of the residents who signed the contract were generally higher than those who did not sign the contract (P < 0.05). The results of multiple factor regression showed that the satisfaction of residents was affected by four factors: monthly income of family, monthly medical expenses of family, district and county, and whether to sign a contract (P < 0.05). Among them, residents' income, medical expenses and whether to sign a contract were risk factors, which were negatively correlated with satisfaction (B value is - 0.248 to -0.500).  Conclusion  Regression results shows that the older the age, the lower the average monthly income of the family, and have signed the contract, the higher the satisfaction of the Shanghai family doctor system. "Whether to sign a contract" is an important influencing factor and improving the signing rate is conducive to the improvement of satisfaction. Learning from successful community experience and a new service model of "Internet plus health" can be created to enhance the residents' satisfaction.
Analysis of related factors of cognitive decline in elderly patients with type 2 diabetes in Hangzhou community
LI Xiu-ying, YANG Xiang-ying, WU Qing-qing, KONG Li-ping, ZHU Qun-ying
2022, 20(2): 274-277. doi: 10.16766/j.cnki.issn.1674-4152.002331
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  Objective  To understand the prevalence of cognitive decline in elderly patients with type 2 diabetes in Hangzhou community and analyze the related factors in order to provide reference for prevention and intervention of cognitive decline in elderly diabetic patients.  Methods  From August to December 2020, 252 elderly patients with type 2 diabetes mellitus (over 60 years old) in 3 communities in Hangzhou were selected by convenience sampling method. The general data inventory, the fatigue, resistance, ambulation, illness, and loss of weight scale (FRAIL scale), mini mental state examination scale (MMSE), simplified version of the Depression Scale (GDS-15) and mini nutritional assessment (MNA-SF) were used for the investigation. Univariate and multivariate logistic regression models were used to analyze the related factors of cognitive decline in elderly patients with type 2 diabetes.  Results  Among the 252 elderly patients with type 2 diabetes, there were 22 cases of cognitive impairment, accounting for 8.73%. Univariate analysis showed that age, family income per month, living style, educational level, marital status, regular exercise, sleep duration, hearing impairment, combined chronic type, nutritional status, and depression were associated with cognitive decline in elderly diabetic patients (P < 0.05). Logistic regression analysis showed that education level (high school: OR=0.191; college and above: OR=0.287), regular exercise (OR=0.325), malnutrition (OR=4.081) and depression (OR=2.754) were the influencing factors of cognitive decline in elderly patients with type 2 diabetes (P < 0.05).  Conclusion  The incidence of cognitive decline in elderly patients with type 2 diabetes mellitus is relatively high. Health care workers should pay close attention to the screening and intervention of cognitive decline in elderly diabetic patients with low cultural level, no exercise habits, lack of nutrition and depressive symptoms.
Investigation and analysis of mental health status of residents in standardized training in Bengbu during the COVID-19 normalization of prevention and control
LI juan, WEI Dao-xiang, XIE jing
2022, 20(2): 278-281. doi: 10.16766/j.cnki.issn.1674-4152.002332
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  Objective  To understand the mental health status of standardized training residents under the COVID-19 normalization of prevention and control, find out the psychological problems of standardized training residents as soon as possible, and to analyze the possible causes, so as to provide scientific basis for promoting mental health and also contribute to the clinical teaching.  Methods  A network questionnaire was used to investigate the mental health status of 220 standardized at three grade 3A general hospitals in Bengbu from August 1, 2020 to October 31, 2020. The questionnaire included symptom checklist-90 (SCL-90), Adult Psychological Stress Scale, Minnesota satisfaction scale, Social adaptability scale, Self- Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS).  Results  The scores of SAS [(44.74±8.09) points] and SDS [(46.24±12.27) points]of the 220 standardized training residents were higher than those of the national norm [SAS: (37.23±12.49) points, SDS: (41.88±10.57) points, all P < 0.05], and there was no significant difference in the scores of SAS and SDS between male and female. The scores of obsessive-compulsive symptoms [(1.80±0.77) points], interpersonal sensitivity [(1.64±0.75) points], depression [(1.65±0.76) points], anxiety [(1.50±0.67) points], fear [(1.39±0.62) points] and psychoticism [(1.43±0.64) points] of SCL-90 were higher than those of the national norm (all P < 0.05). There was no significant difference in the scores of SCL-90 between male and female. The overall level of social adaptive ability of regular students was strong, the score of social adaptive ability of male students [(35.69±5.67) points] was lower than that of female students [(37.10±6.21) points], and the difference was not statistically significant.  Conclusion  During the COVID-19 normalization of prevention and control, the mental health status of standardized training residents is poor, so it is necessary to carry out psychological intervention to standardized training residents.
Whole process management by MDT mode in elderly orthopaedic patients during the peri-operative period
WANG Lin-xia, PENG Mian-mian, JIN Xi-xi, ZHU Si-pin
2022, 20(2): 282-285. doi: 10.16766/j.cnki.issn.1674-4152.002333
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  Objective  To explore the application effect of whole process management by MDT mode in elderly orthopaedic patients during the peri-operative period.  Methods  According to the order of admission time, 139 elderly surgical patients who were treated in the Orthopaedics Department of Yuying children's Hospital of the Second Affiliated Hospital of Wenzhou Medical University from March to September 2019 and received the traditional management mode during the peri-operative period were taken as the routine group. Then, 143 elderly patients who were treated in the Department of orthopaedics from October 2019 to April 2020 and used the whole process management by MDT mode during the peri-operative period were selected as the intervention group. The whole process management by MDT mode of pre-operative multidisciplinary team evaluation → intraoperative management → rapid post-operative rehabilitation → discharge follow-up was adopted. The pre-operative waiting time and hospitalisation time of the two groups were compared. The incidence of peri-operative complications, such as joint dysfunction, pressure injury, pulmonary infection and lower extremity deep venous thrombosis, were compared between the two groups.  Results  The pre-operative waiting time of 2 (2, 4) days in the intervention group was shorter than 6 (3, 7) days in the routine group. The hospitalisation time of 10 (6, 14) days in the intervention group was shorter than the 14 (10, 17) days in the routine group (all P < 0.05). The incidence of peri-operative complications in the intervention group (1.40%) was significantly lower than that in the routine group (10.07%, P < 0.05).  Conclusion  Application of whole process management by MDT mode in the peri-operative period of elderly orthopaedic patients can effectively shorten the pre-operative waiting time and hospitalisation time of elderly orthopaedic patients and reduce the incidence of peri-operative complications in elderly orthopaedic patients. It has certain guiding significance for the promotion and application of whole process management by MDT mode in the clinical practice of elderly orthopaedic patients.
Factors affecting the quality of transvaginal four-dimensional contrast-enhanced tubal ultrasound
GUO Jin-miao, ZHANG Li, CHEN Shu-xia, HU Yin-feng
2022, 20(2): 286-289. doi: 10.16766/j.cnki.issn.1674-4152.002334
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  Objective  To explore the related factors which may influence the quality of transvaginal four-dimensional contrast-enhanced tubal ultrasound.  Methods  Fifty-four patients with infertility in the Ultrasound Department of the People's Hospital of Fenghua District, Ningbo City from June 2016 to December 2019 were selected as participants. According to image quality, the patients were divided into excellent quality group (42 cases) and general quality group (12 cases). The clinical data, examination results and ultrasonic operations of the two groups were recorded. The general data and the relevant data during ultrasound examination of the two groups were compared, and a regression analysis was performed.  Results  The proportion of primary infertility in the excellent quality group was higher than that in the general quality group (P=0.010). The history of fallopian tubes or the history of uterine surgery was lower than that of the general quality group, and the difference between groups was statistically significant (all P < 0.001). Significant differences in balloon size during operation were found between the two groups, with the balloon in the general quality group significantly larger than that in the good quality group (P < 0.001). Logistic analysis showed that balloon size [OR=15.211 (5.412-42.755), P=0.002], history of uterine surgery [OR=8.353 (0.780-89.452), P=0.017] and history of tubal surgery [OR=7.575 (0.399-143.836), P=0.049] were influencing factors for image quality.  Conclusion  The operation history of the fallopian tube and the uterus exerts a significant effect on the image quality of 4D contrast-enhanced ultrasonography of the fallopian tube.
Diagnostic value of endoscopic ultrasonography for submucosal tumors of digestive tract
ZHA Zheng-wei, GAN Hui-zhong, PENG Qiong, KONG De-run
2022, 20(2): 290-293. doi: 10.16766/j.cnki.issn.1674-4152.002335
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  Objective  To explore the value of endoscopic ultrasound (EUS) in the diagnosis of submucosal tumors (SMT) of digestive tract.  Methods  Total 82 patients with SMT accepted EUS examination and treated at the First People's Hospital of Hefei from July 2015 to August 2020 were recruited. According to EUS results, different surgical methods were choose, including endoscopic submucosal dissection (ESD), endoscopic submucosal excision (ESE), submucosal tunnel endoscopic tumor resection (STER), and endoscopic full-thickness resection (EFTR) etc. The diagnostic coincidence rate between EUS and pathological results, and the coincidence rate between the preoperative plan based on EUS diagnosis and the actual surgical plan were compared.  Results  EUS could clearly display the layer of origin, size, echo, and the relationship with surrounding tissues of the SMT. Among 85 lesions diagnosed by EUS, 12 cases were different from pathological and EUS, including 2 cases of esophageal stromal tumor, 2 cases of gastric stromal tumor, 1 case of gastric antral hemangioma, 1 case of accessory spleen, 1 case of schwannoma, 1 case of adenomyoma and 1 case of fibroma misdiagnosed as leiomyoma, 2 cases gastric leiomyoma and 1 case of gastric ectopic pancreas misdiagnosed as stromal tumors. The coincidence rate of EUS and pathological diagnosis was 85.9% (73/85). There were 40 cases of ESD operation, 34 cases of ESE operation, 2 cases of STER operation and 9 cases of EFTR operation, of which 2 cases were converted to laparoscopy. There were no complications such as bleeding and perforation after operation. The coincidence rate between the preoperative plan formulated according to EUS and the actual surgical plan was 97.6% (83/85).  Conclusion  EUS is a highly accurate method to diagnose SMT of digestive tract in the gastrointestinal tract, and has important guiding value for the choice of endoscopic treatment.
Value of contrast-enhanced ultrasound in evaluating the efficacy of digital subtraction angiography-guided hepatic artery chemoembolisation in patients with hepatocellular carcinoma
FAN Xiao-hua, CHEN Cun-guo, GUAN Jian-min, LU Wen-ming, ZOU Tao
2022, 20(2): 294-297. doi: 10.16766/j.cnki.issn.1674-4152.002336
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  Objective  To investigate the role of contrast-enhanced ultrasound in evaluating the efficacy of digital subtraction angiography (DSA) -guided hepatic artery chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC).  Methods  A total of 68 patients with HCC who were admitted to Huzhou First People's Hospital and Taizhou Hospital of Zhejiang Province from January 2020 to April 2021 were selected as study participants. All patients underwent DSA-guided TACE treatment, and contrast-enhanced ultrasound was used to evaluate the efficacy before and after treatment.  Results  (1) The initial increase time, peak time and peak acceleration time significantly increased after treatment (t=11.701, 10.383, 10.119, all P < 0.05), whereas the initial growth rate and the enhancement rate significantly reduced (t=9.636, 11.318, all P < 0.05). (2) The initial increase time, peak time and peak acceleration time were significantly longer after than before treatment (P < 0.05) in the effective group (t=7.867, 12.407, 16.127, all P < 0.05). The initial increase rate and enhancement rate were significantly lower after than before treatment (t=12.134, 23.613, all P < 0.05). (3) The initial increase time, peak time, peak acceleration time, initial increase speed and enhancement rate AUC were 0.657, 0.718, 0.642, 0.669 and 0.714, respectively.  Conclusion  The peak time and enhancement rate in contrast-enhanced ultrasound have high value in predicting the therapeutic effect of TACE in patients with HCC.
Research progress of microRNA in thyroid cancer
LI Yong, GUO Min, KANG Ying-ying
2022, 20(2): 298-301, 351. doi: 10.16766/j.cnki.issn.1674-4152.002337
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MiRNAs are short, single-stranded non-coding RNAs that exist in organisms widely and can regulate a lot of pathological and physiological processes. It is also differentially expressed in blood, urine and exosomes outside tissues. With the rapid development of detection technology, continuous improvement of research methods and continuous improvement of researcher' operational skills, miRNA has entered people' sight due to its stable molecular structure and abundant biological functions. Its differential expression and specific regulatory mechanisms in life processes such as inflammation, immune regulation, oxidative stress, fibrosis, information transmission, virus dissemination and tumor malignant progression are constantly being explored and confirmed, especially in the regulation of thyroid's occurrence, invasion, metastasis and drug resistance, indicating that it's expected to become a new indicator for precise diagnosis, treatment and prognosis evaluation of thyroid cancer. Furthermore, the research on miRNAs of their unknown functions and specific expression in different types of thyroid cancer is not only of great significance for diagnosis, identification and treatment of different pathological types of thyroid cancer, but also helps to dynamically observe the condition evolution of patients with thyroid cancer. This review summarizes the research progress, biology function of miRNA and its recent researches in different types of thyroid cancer, aiming to provide references for the diagnosis and treatment of thyroid cancer, enrich the diagnosis and treatment strategies for patients with thyroid cancer and improve the quality of their lives furtherly.
Advances in the associated study of cardiovascular disease with depression and anxiety in general hospitals
YANG Xue-ping, HE Ru
2022, 20(2): 302-306, 335. doi: 10.16766/j.cnki.issn.1674-4152.002338
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Cardiovascular disease (CVD) has high incidence and fatality rate in general hospitals, and its risk factors and disease prevention have been the focus of research. In recent years, because of the important influence of psychological factors, such as depression anxiety on CVD patients, psychological factors as controllable factors have become the focus of research. Depression and anxiety can increase the incidence of CVD. People with depression and anxiety are likely to develop CVD than normal. Depression and anxiety can exacerbate adverse consequences of CVD, such as increased fatality. Patients with CVD can also develop depression and anxiety. For patients with CVD, the occurrence of depression and anxiety is related to various factors. For example, disease-related events can be used as a stress factor to cause depression and anxiety. During the recovery period of the disease, different levels of physical activity, quality of life and other possible cognitive impairment can also be associated with depression and anxiety. Psychological therapy and drug therapy can be considered as treatment for CVD patients combined with depression and anxiety. Given the effectiveness and safety of psychotherapy, it has also become a trend of treatment in recent years, but the specific form of implementation should be based on a specific situation. For medications, the use of anti-depressants, such as selective serotonin reuptake inhibitors, can significantly improve depression and anxiety and reduce the risk of cardiovascular events. However, inappropriate drug use may also increase the risk of CVD. Therefore, the use of drugs must be scientifically evaluated, carefully selected and correctly applied.
Mechanism of Kangyi capsule in the treatment of ischaemic stroke based on "pathology-prescription syndrome"
ZHANG Kui-ming, CUI Ying-lin, GE Luan-die, HOU Lu-yang, MA Rui-hong
2022, 20(2): 307-310. doi: 10.16766/j.cnki.issn.1674-4152.002339
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Ischaemic stroke, also known as cerebral infarction, is a heterogeneous neurological disease induced by sudden onset and multi-environmental risk factors and is accompanied by symptoms of neurological impairment. In recent years, the renewal of antiembolic drugs and the improvement in interventional therapy have greatly enhanced the therapeutic effect of ischaemic stroke and improved the quality of life of patients. However, the limitation of the thrombolytic window period and the specificity of interventional therapy seriously restrict its benefits. Moreover, the 5-year recurrence rate and mortality rate of the disease remain high. With the characteristics of multi-component, multi-link, multi-target, and overall treatment, traditional Chinese medicine is simple and low cost. It is effective in the clinical treatment of ischaemic stroke. Therefore, from the perspective of pathology to explore the molecular biological mechanism of ischaemic stroke, theoretical studies on the commonness of cerebral ischaemic disease, combined with modern research on prescription and syndrome pharmacology, are effective ways to explore the disease. Kangyi capsule is a hospital preparation formulated by experts in the Henan Hospital of Traditional Chinese Medicine on the basis of predecessors and according to the aetiology and pathogenesis of ischaemic stroke. It has the effect of replenishing qi and activating blood circulation, removing blood stasis, and dredging collaterals. It has unique advantages in the treatment of ischaemic stroke with complex pathology. Modern pharmacological studies have proven that Kangyi capsule can improve the nerve injury of ischaemic and hypoxic cerebrovascular diseases. Drugs in the prescription can improve the energy metabolism of ischaemic nerve cells, eliminate oxygen free radicals, inhibit inflammatory cascade reaction, relieve intracellular calcium overload, block the process of apoptosis, protect the damaged blood-brain barrier, reduce blood lipids, inhibit platelet aggregation, promote thrombolysis, and play an anti-embolism role. The author summarises the modern pathophysiological mechanism of ischaemic stroke, the theoretical understanding of traditional Chinese medicine, and the prescription and syndrome study of Kangyi capsule to provide a basis for the theoretical research and clinical application of Kangyi capsule.
Application of rehabilitation theory of "paying equal attention to sinew and bone" in postoperative Pilon patients and its preventive effect on deep vein thrombosis
YANG Tao, WANG Wen-hui, JIANG Tao
2022, 20(2): 311-314. doi: 10.16766/j.cnki.issn.1674-4152.002340
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  Objective  To explore the application of rehabilitation theory of "paying equal attention to sinew and bone" in postoperative patients with distal tibial burst fracture (Pilon fracture) and its preventive effect on deep venous thrombosis (DVT).  Methods  A total of 86 cases of tibial Pilon fracture treated in Dalian Second People's Hospital from June 2017 to December 2019 were selected for open reduction and internal fixation. They were randomly divided into control group (routine rehabilitation training) with 42 cases and observation group (rehabilitation theory of paying equal attention to sinew and bone) with 43 cases. The general data of the patients were collected and compared. The swelling degree of ankle joint, ankle joint function, and joint activity scores of the two groups were recorded one day, two weeks, and four weeks after operation. The edema-regression time, bone healing time, and complications were recorded.  Results  No significant difference was observed between the control and observation groups (all P > 0.05). Two and four weeks after operation, the degree of ankle swelling, ankle joint function, and joint activity in the observation group were better than those in the control group (all P < 0.05). Edema-regression time and bone-healing time in the control group were significantly longer than those in the observation group. In the control group, 6 cases were local infection (14.28%), 4 cases were DVT (9.52%), 1 case was local infection (2.32%), and 2 cases were DVT (4.65%). The incidence of complication in the control group was significantly higher than that in the observation group (P < 0.05). No significant difference was observed in the expected values of rehabilitation between the two groups (P > 0.05), but the satisfaction of the observation group was higher than that of the control group (P < 0.05).  Conclusion  Rehabilitation training guided by the rehabilitation theory of "paying equal attention to sinew and bone" can effectively prevent postoperative DVT formation in Pilon patients and is thus worthy of clinical application and promotion.
Practice for the course of "community prevention and health care" in the teaching dialogue mode using problem-based learning
FAN Xing-jun, GU Hong-mei, QI Yue, YANG Yong, GAO Jin-xia, YU Feng-bo
2022, 20(2): 315-319. doi: 10.16766/j.cnki.issn.1674-4152.002341
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  Objective  To explore the teaching effect of the dialogue teaching model based on PBL in the course of Community Prevention and Health and provide a reference for the study of dialogue teaching model based on PBL.  Methods  A total of 131 students enrolled in the Department of General Medicine of Mudanjiang Medical College in 2015 were randomly divided into the control group (63 people) and the research group (68 people). The control group used traditional lecture-style teaching, and the research group used PBL-based dialogue teaching mode. After the course, the same test papers were used for assessment, and the questionnaires were used to evaluate the teaching effect, teaching satisfaction and the teaching content indicated the general medical thinking.  Results  The theoretical test scores, practical skill test scores and total scores of the research group were higher than those of the control group, and the differences were statistically significant (all P < 0.05). The research group was better than the control group in cultivating self-learning ability, improving learning enthusiasm and initiative ability, cultivating general medical and clinical preventive service thinking and ability, strengthening clinical screening ability, independent thinking and analysis of community problems based on the population, training three-level prevention strategy thinking and ability, promoting communication and communication amongst classmates and enhancing teamwork and other aspects (all P < 0.05). The satisfaction rate of the students in the research group with the teaching method was 73.53%, whereas that of the control group was 53.97%. The research group was better than the control group with health-centred, group-targeted, comprehensive community preventive health care evaluation of individual-group-oriented medical care, tertiary prevention-oriented evidence-based medical care, horizontal management of family-based health care projects and chronic disease management, and the difference was statistically significant (all P < 0.05).  Conclusion  The PBL-based dialogue teaching model can improve the teaching effect of the course of Community Prevention and Health, which may stimulate the interest of general students in understanding primary health, and promote the cultivation of multiple qualities and capabilities. The PBL-based dialogue teaching model is worthy of further research and promotion.
Analysis on the current status and influential factors of job satisfaction amongst the primary subject lectures of the standardised training of residents in Yunnan
SUN Mei-na, DONG Mei-juan, HUANG Qiao-yun, LI Wei-ming, YUAN Dan, LI Ya-li, ZI Rong
2022, 20(2): 320-323. doi: 10.16766/j.cnki.issn.1674-4152.002342
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  Objective  To analyse the current status and influential factors of job satisfaction amongst the primary subject lectures of the standardised training of residents in Yunnan and provide basis and measures for improving the quality of medical personnel in Yunnan.  Methods  From July to October 2018, a cluster sampling method was used to randomly select six training bases from 25 standardised training bases for resident physicians in Yunnan according to the nature of the training bases, three training bases were randomly selected from the provincial and municipal level three A (referred to as the "Three A") bases and conduct on-site questionnaire surveys of the 2016 and 2017 trainees, and a total of 541 trainees were surveyed. The survey content included the basic information of the trainees and trainees' satisfaction evaluation of the content of the primary subject lectures, training forms, clinical teachers, examination mode, teaching management, training bases and management departments. Descriptive statistics, rank sum test and ordered multi-classification logistic regression analysis were performed on valid data.  Results  The overall satisfaction of trainees with primary subject lectures was 62.41%, and the lowest satisfaction with centralised teaching was 25.75%. After the rank sum test, differences in trainees' satisfaction with the primary subject lectures in terms of grades and whether or not there was a medical practitioner certificate were found (all P < 0.05). After orderly multi-category logistic regression analysis, gender was considered as a factor affecting trainees' satisfaction with the primary subject lectures, and boys were more satisfied than girls.  Conclusion  Trainees' satisfaction with the primary subject lectures of the standardised training residents in Yunnan is average, and the primary subject lectures must be further improved. It is suggested that the training bases should improve the ideological awareness and strengthen the management of the primary subject lecture process, relevant government departments develop a scientific and reasonable assessment system, implement the dynamic management and process assessment mechanism of the bases to achieve the pass rate of the unified examination and improve the practicality of training effectively.
Development of social network addiction tendency scale for adolescents and its reliability and validity
WANG Su-ping, CAI Yong, ZHU Rui, LI Si-cong, LIU Xin-yi, GONG Rui-jie
2022, 20(2): 324-326. doi: 10.16766/j.cnki.issn.1674-4152.002343
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  Objective  To develop a social network addiction tendency scale for adolescents and to evaluate the reliability and validity of the scale in undergraduate students.  Methods  A convenient sampling survey was carried out among the undergraduates in Shanghai Jiao Tong University School of Medicine. A total of 665 valid questionnaires were collected. After the interval of 2 months, 46 individuals were retested. Factor analysis, correlation analysis and Mann Whitney U test were used to evaluate the validity of the scale. Internal consistency reliability, half reliability and retest reliability were used to evaluate the reliability of the scale. Area under receiver operating characteristic curve was used to evaluate the predictive power and optimal cut-off value of the scale.  Results  Of the total patients, 290 were males (43.6%) and 375 were females (56.4%) with an average age of (19.39±1.35) years. The Kaiser-Meyer-Olkin value was 0.869. Bartlett's sphericity test (P < 0.001) indicated that it was suitable for factor analysis. The results of exploratory factor analysis were single dimension, which could explain 53.02% of the total variation. The factor loading of items ranged from 0.424 to 0.671. The results of confirmatory factor analysis showed that the structure and validity of the scale were good (χ2/df=2.842, GFI=0.957, CFI=0.971, RMSEA=0.076). The S-CVI of the scale was 0.90, the correlation coefficient between each item and the scale was higher than 0.64 (all P < 0.001) and the score of internet addicts was significantly higher than that of non-addicts (P < 0.001). The internal consistent reliability of the scale was 0.880, half reliability 0.817 and retest reliability 0.788. The area under the curve of the scale was over 0.7 (P < 0.001).  Conclusion  The social network addiction tendency scale has good reliability and validity in undergraduate students.
Survey of physical development in children aged 3 to 18 years in Inner Mongolia
LIU Chong, YUN Hui-cong, ZHANG Xiu-lan, LIU Bao-feng, GE Qi-qi, ZHOU Yan-hua, GUAN Li-dong, TIAN Jia, YAO Li-ping
2022, 20(2): 327-331. doi: 10.16766/j.cnki.issn.1674-4152.002344
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  Objective  To investigate physical development in children aged 3 to 18 years in Inner Mongolia.  Methods  Stratified cluster sampling was adopted. The height, weight and body mass index were collected from 15, 199 children in four cities including Hohhot City, Baotou City, Tongliao City and Hulunbuir City from Inner Mongolia from October 2017 to October 2018. Using the survey data of physical development in children from nine provinces in 2005, the rates of overweight and obesity were calculated, and their characteristics were analysed.  Results  There were two peaks of height growth in boys and girls aged 3 to 18 in Inner Mongolia, boys are 3-4 years old and 11 years old; girls are 4-5 years old and 10-11 years old. No significant pattern of weight gain with age was observed. A single peak of increase occurred around puberty (15 and 10 years of age in boys and girls, respectively). The average height and weight in children aged 3 to 18 years were significantly higher than the 2005 national reference value (P < 0.001). Six-year-old boys and 13-year-old girls were significantly taller than the national standard. Seven-year-old boys and 10-year-old girls were significantly heavier than the national standard. The detection rates of overweight and obesity were 12.31% and 20.27%, respectively. The rates of overweight were 11.55% and 13.10% in boys and girls, respectively. However, the difference was not statistically significant (P=0.132). The rates of obesity were 22.67% and 17.76% in boys and girls, respectively, and the difference was statistically significant (P < 0.001).  Conclusion  The overall physical development of children aged 3 to 18 years in Inner Mongolia is good. Attention should be focused on the high incidence of overweight and obesity. Relevant departments should pay attention to children's physical development and strengthen the management of children's health and development of healthy life habits.
Characteristics and causes of excessive medical treatment in intensive care units
WU Shu-lu, FAN Jun-hong, DENG Xi-ming
2022, 20(2): 332-335. doi: 10.16766/j.cnki.issn.1674-4152.002345
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  Objective  To study the phenomenon of excessive medical treatment in ICU, discuss the characteristics and manifestations of excessive medical treatment in ICU, analyze the causes of its occurrence, and make suggestions to avoid excessive medical treatment in ICU.  Methods  The inpatient medical records of patients admitted to the comprehensive ICU of a third-grade A hospital the First Affiliated Hospital of Bengbu Medical College, Bengbu from July 2019 to December 2019 were selected as the research objects. The medical records of patients were analyzed by three senior ICU experts using case analysis method, and the cases of patients judged as excessive medical treatment were analyzed at the same time.  Results  A total of 359 cases were included in this study, among which 32 cases were determined by 3 experts to have excessive medical treatment, including 19 cases of invalid medical treatment, 11 cases of defensive medical treatment and 2 cases of inappropriate application of high and new technology, with a total incidence of 8.9%. Its characteristics were as follows: invalid medical treatment, defensive medical treatment and inappropriate application of high and new technology were the main manifestations. In the process of excessive medical treatment, the doctor was the giver of medical treatment, but the role of the doctor was sometimes not subjective and intentional, just a passive implementor. The reasons were mainly related to doctors' risk aversion, medical information asymmetry and inappropriate requirements of patients' family members.  Conclusions  Excessive medical treatment exists in ICU, and its characteristics and causes are related to social factors and the special diagnosis and treatment in ICU. Its forming factors include economic, social and ethical factors, as well as the medical level of doctors and the understanding of diseases. In view of these characteristics and forming factors, countermeasures and suggestions include perfecting the construction of laws and regulations, improving the doctor-patient relationship, striving to build a harmonious social environment in which doctors are respected and valued, and strengthening the management of high and new technology, strictly implementing the access system of new and high technologies, and strengthening the supervision of the application of new and high technologies.
Correlation between fear of pain and mental workload of nurses with occupational low back pain
LIN Hai-niao, JIA Man, LI Qun, ZHANG Chun-mei, YAN Lei-lei
2022, 20(2): 336-339, 343. doi: 10.16766/j.cnki.issn.1674-4152.002346
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  Objective  To explore the current situation of fear of pain in nurses with occupational low back pain, analyse its influence on mental workload and provide some reference and basis for the management of clinical nurses.  Methods  A total of 495 nurses with occupational low back pain were recruited from three tertiary hospitals from May to August 2020 by convenience sampling. A basic information questionnaire, Fear of Pain Questionnaire-Ⅲ and National Aeronautics and Space Administration-Task Load Index were used in the investigation. The differences of fear of pain among the subjects were statistically analyzed. Pearson coefficient was used to indicate the correlation between fear of pain and workload.  Results  The score of fear of pain in nurses with occupational low back pain was (82.09±22.36) points, and the scores of each dimension from high to low were severe pain, medical pain and minor pain. The nurses with pain course >5 years reported that pain occurred every day, and the heaviest pain score of 7-10 in the last week was the highest. The score of mental workload was (67.95±6.47) points, and the scores of each dimension from high to low were physical requirement, time limit requirement, feeling of frustration, degree of effort, mental requirement and self-expression. A significant positive correlation between fear of pain and mental workload was found (P < 0.01).  Conclusion  Nursing managers should pay attention to the current situation of fear of back pain amongst nurses, help them correctly understand and deal with pain, particularly those with long course of disease, frequent attacks and heavy pain intensity, take targeted intervention measures to reduce their fear of pain and mental workload and improve the quality of clinical nursing services.
Investigation on psychological stress of nurses in COVID-19 isolation wards in Shiyan City
YANG Bao-yi, LI Long-ti, YU Ke-fei, XIA Jun-lin, WANG Rong
2022, 20(2): 340-343. doi: 10.16766/j.cnki.issn.1674-4152.002347
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  Objective  To explore the current status of psychological stress and its influencing factors among nurses in COVID-19 isolation wards in Shiyan City.  Methods  A total of 202 nurses who participated in the treatment task in COVID-19 centralised isolation wards in Shiyan City from February to March 2020 were selected as study subjects by convenient sampling. The self-compiled general information questionnaire and Symptom Checklist 90 (SCL-90) were used to investigate the symptoms.  Results  The total score of nurses SCL-90 in COVID-19 centralised isolation wards in Shiyan City was (113.58±30.36) points, and the scores of each dimension were somatisation (15.57±4.89) points, compulsion (14.36±4.97) points, interpersonal sensitivity (11.07±3.65) points, depression (15.04±4.89) points, anxiety (12.56±3.86) points, hostility (7.03±2.08) points, terror (8.01±2.13) points, paranoia (6.89±1.98) points, psychotic (11.44±2.98) points and other (10.40±3.65) points. Single-factor analysis showed that gender, length of service, presence or absence of infections of relatives and friends and the time of entering the isolation ward were the influencing factors of the SCL-90 score of nurses in COVID-19 isolation Ward in Shiyan City (all P < 0.05). Multiple stepwise regression results showed that gender and presence or absence of infections of relatives and friends were the main influencing factors of SCL-90 scores for nurses in COVID-19 isolation wards (all P < 0.05).  Conclusion  The mental health status of nurses in COVID-19 isolation wards in Shiyan City is generally good. Nursing managers should take targeted measures to alleviate the mental health of female nurses and nurses with friends or colleagues who have been infected with new coronary pneumonia.
Study on the influence of pediatric nurses' professional quality of life on pain empathy
SUN Rui-rui, LI Dan, JIANG Xiao-yan, XU Xiao-hong
2022, 20(2): 344-347. doi: 10.16766/j.cnki.issn.1674-4152.002348
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  Objective  To explore the current status of pediatric nurses' professional quality of life and pain empathy, and analyze the correlation and influence between professional quality of life and pain empathy.  Methods  The convenience sampling method was adopted. From July to October 2020, the general situation survey form of pediatric nurses, the Chinese version of the professional quality of life scale for nurses, and the pain empathy scale were used to evaluate 132 pediatric nurses in the third-level A of 2 institutes in Wenzhou City, Zhejiang Province. SPSS statistical software was used for data analysis.  Results  The items of the pain empathy scale for pediatric nurses were averagely scored (2.63±0.73), which was at a moderate level. On the dimensional scores of the professional quality of life scale, 18.94% of pediatric nurses were at low empathy satisfaction level, 21.21% were pediatric nurses at high burnout level, and 25.75% were pediatric nurses at secondary traumatic stress level. Empathy satisfaction was positively correlated with pain empathy total score and various dimensions (r=0.174 to 0.308, all P < 0.01). Burnout, secondary traumatic stress were negatively correlated with pain empathy total score and each dimension (r=-0.295 to -0.151, all P < 0.05).There were statistically significant differences in the scores of the pediatric nurses pain empathy scale in the number of years of pediatric work, whether they were children, whether they participated in in relevant training, and whether they suffered from workplace violence (all P < 0.05). Hierarchical regression analysis showed that burnout, empathy satisfied and secondary traumatic stress were influencing factor of pediatric nurses' pain empathy, which could explain 18.2% of the total variation (all P < 0.01).  Conclusion  Pain empathy ability of pediatric nurses is at an intermediate level, and pain empathy ability can be improved by improving professional quality of life.
Parallel controlled study of parental involvement in pre-term infant care and routine care in the neonatal intensive care unit
ZHAO Wei, XUE Yun-li, LI Ling, LIU Feng-le, JU Min, LI Le
2022, 20(2): 348-351. doi: 10.16766/j.cnki.issn.1674-4152.002349
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  Objective  To explore the effect and feasibility of implementing the parent-participatory nursing model in the nursing of premature infants in the neonatal intensive care unit.  Methods  Based on a parallel control design study plan, 261 premature infants who met the inclusion criteria in the NICU of Nanyang Central Hospital from July 2018 to December 2019 were matched and grouped in accordance with the criteria of similar gestational age, weight and diagnosis at birth. The study group included 35 cases, and the control group included 70 cases. Under the guidance of specialist nurses, the parents of the study group and the specialist nurses jointly completed the life care, condition observation, feeding care and skin care of the child and participated in 4 h every day until the child was discharged. The children in the control group were nursed by specialist nurses. Family members visited 3 times a week, 30 min each time. The weight gain of the two groups of children was observed, and the incidence of nosocomial infection, secondary hospitalisation and family complaints, medical expenses and department expenditures was determined.  Results  When entering the intensive care unit, no significant difference in the average weight of the two groups of children was found [(1 890.75±317.57) g vs. (1 888.91±320.73) g, t=0.028, P=0.978]. When leaving the intensive care unit, the average weight of the study group was significantly higher than that of the control group [(2 473.97±284.72) g vs. (2 267.59±316.54) g, t=3.254, P=0.002]. The weight gain rate of the study group was higher than that of the control group. The average treatment cost, length of stay, family complaint rate and incidence of secondary admission within 30 days after discharge were lower in the study group than in the control group, and the difference was statistically significant (all P < 0.05). No significant difference in the incidence of nosocomial infection was found between the two groups (P>0.05). During the study period, department expenditures increased than before.  Conclusion  The implementation of the parent-participatory care model in NICU can promote the weight gain of premature infants, reduce the medical expenses and the incidence of secondary hospitalisation and does not increase the incidence of nosocomial infections. It is safe and feasible, but the department expenditures have increased.
2022, 20(2): 352-353, 356. doi: 10.16766/j.cnki.issn.1674-4152.002350
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2022, 20(2): 354-356. doi: 10.16766/j.cnki.issn.1674-4152.002351
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General Practice Research
Risk assessment model of diabetic nephropathy with "same disease and different syndromes" in traditional Chinese medicine based on multi-label machine learning
TONG Xu, YANG Chun, MENG Qing-gang
2022, 20(2): 181-185, 227. doi: 10.16766/j.cnki.issn.1674-4152.002307
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  Objective  To construct a risk assessment model of diabetic nephropathy with "same disease and different syndromes" in traditional Chinese medicine based on the multi-label machine learning algorithm and compare its effectiveness, and to provides an efficient way to assist traditional Chinese medicine in preventing and treating diabetic nephropathy.  Methods  Based on the data of 8 795 diabetic nephropathy, feature selection was carried out based on the complex network community detection algorithm. Under the two algorithms of "transformation problem" and "algorithm adaptation", the SVM, AdaBoost, ML-RBF and ML-KNN algorithms were used to construct the multi-label learning model, and five evaluation indexes were used to compare the model efficiency.  Results  A multi-label dataset of diabetic nephropathy with 8 795 samples, 113 characteristics and 15 syndrome types was constructed. In terms of model evaluation, ML-KNN had the best performance in Hamming loss, ranking loss and coverage indicators; SVM had three minimum values on one error index, but the average value of one error index of KNN was still the best. The average precision of the four models was more than 90%, and the performance of ML-KNN and ML-RBF were relatively the best. The above four models had better diagnostic efficiency in the multiple syndrome risk assessment of diabetic nephropathy with "same disease and different syndromes", and ML-KNN performance was relatively optimal.  Conclusion  The multi-label machine learning algorithm can be applied to the risk assessment of complex syndromes, such as TCM. It provides a reference for assisting Chinese medicine in the prevention and treatment of diabetic nephropathy and provides a methodological reference for the application of multi-label machine learning in clinical multi-disease diagnosis and treatment in general practice.
Analysis of the influencing factors of neurological improvement in acute ischemic stroke on the basis of propensity score matching
TANG Ai-jie, NIU Shu-zhen, LIU Yi-fan, WANG Wen-qing, YANG Hong-yan, DAI Xiu-juan, WU Qian
2022, 20(2): 186-189. doi: 10.16766/j.cnki.issn.1674-4152.002308
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  Objective  To explore the factors influencing the improvement of neurological function in patients with acute ischemic stroke (AIS).  Methods  A total of 247 patients with first ischemic stroke from June 2019 to June 2020 in Shanghai Tenth People's Hospital were selected as the research objects, and the patients were divided into the non-significantly improved group (< 46%) and significantly improved group (≥ 46%) according to the percentage reduction in National Institutes of Health Stroke Scale (NIHSS) at discharge. The 1∶ 1 propensity score matching method was used to control the general data of patients the admission NIHSS score, and logistic regression was used for matched patients to analyse the influencing factors of neurological function improvement.  Results  Before matching, MBI (Z=2.030, P=0.042), mRs (Z=2.996, P=0.003), admission NIHSS score (Z=2.501, P=0.012), sleep duration (χ2=9.486, P=0.009) and cognitive impairment (χ2=31.598, P < 0.001) showed a statistically significant difference between both groups. After matching, sleep duration (χ2=8.161, P=0.017), diabetes (χ2=6.092, P=0.014) and cognitive impairment (χ2=21.066, P < 0.001) showed a statistically significant difference between both groups. After matching, the variables (diabetes, sleep duration, cognitive impairment) with P < 0.1 in the comparison between both groups were entered into logistic regression analysis. Results showed that sleep duration (OR=1.667, 95% CI: 1.043-2.664, P=0.033) and MoCA (OR=4.697, 95% CI: 1.973-11.185, P < 0.001) were risk factors affecting the improvement of neurological function.  Conclusion  Shorter sleep duration and early cognitive dysfunction after stroke have an adverse effect on the short-term prognosis of AIS.
Diagnostic value of ROMA and CPH-I in early epithelial ovarian cancer
NIE Dan-dan, WANG Li-hua, LI Yan-hua
2022, 20(2): 190-194. doi: 10.16766/j.cnki.issn.1674-4152.002309
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  Objective  To investigate the diagnostic value of risk of ovarian malignancy algorithm (ROMA) and Copenhagen index (CPH-I) in early epithelial ovarian cancer (EOC).  Methods  A total of 139 patients with epithelial ovarian tumour (including 52 patients with early EOC, 24 patients with epithelial ovarian borderline tumour and 63 patients with epithelial ovarian benign tumour) admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2020 were retrospectively studied. Age, menopausal status and serum HE4 and CA125 values were collected for ROMA and CPH-I. The diagnostic accuracy of these indicators was measured by plotting the area under the curve (AUC), and the sensitivity and specificity of CA125, HE4, ROMA and CPH-I for each group were calculated.  Results  The AUC of CPH-I, ROMA and HE4 was superior to that of CA125 in all groups. The Results of inter-group comparison showed that the four indexes were early malignant group>borderline group>benign group. The differences were statistically significant (P < 0.001). CA125 and ROMA were more sensitive than HE4 and CPH-I in predicting benign or malignant ovarian neoplasms (88.46%, 92.31% vs. 82.69%, 86.54%). HE4 and CPH-I were more specific than CA125 and ROMA (93.65%, 96.83% vs. 76.19%, 90.48%). After grouping according to menopausal status, in the comparison between the early malignant group and the benign group, post-menopausal ROMA and CPH-I had higher AUC, sensitivity and specificity than pre-menopausal ROMA (0.995, 0.992 vs. 0.905, 0.935; 96.77%, 96.77% vs. 85.71%, 71.43%; 95.83%, 95.83% vs. 87.18%, 94.87%).  Conclusion  ROMA is more sensitive to early EOC diagnosis, and CPH-I is more specific than ROMA. ROMA and CPH-I have high sensitivity and specificity in post-menopausal patients.
Analysis of factors related to cervical lymph node metastasis in 208 patients with papillary thyroid carcinoma
GUO Bin, CHEN Rui, WANG Sheng-ying, PENG Mei
2022, 20(2): 195-198, 262. doi: 10.16766/j.cnki.issn.1674-4152.002310
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  Objective  To explore the related factors of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC), so as to provide the basis for clinical treatment decision-making and prognosis evaluation.  Methods  The ultrasonic, pathological and clinical data of 208 cases with PTC confirmed by pathology in the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from June 2019 to December 2019 were collected. Univariate and multivariate logistic regression analysis was used to analyse the related factors of the cervical lymph node metastasis group and non-metastasis group.  Results  Amongst the 208 patients, 126 had cervical lymph node metastasis, and the rate of metastasis was 60.6%. A significant difference was observed in the cervical lymph node metastasis rate amongst different gender, age, tumour location, tumour length and diameter, abnormal lymph nodes, tumour aspect ratio >1, multifocal lesions, bilateral lesions, capsule invasion, nodal calcification and PTC patients with nodular goitre (all P < 0.05). The Results of multivariate logistic analysis showed that female (OR=0.386) was a protective factor for cervical lymph node metastasis in patients with PTC, and tumour located in the lower pole(OR=3.057), abnormal lymph nodes in ultrasound (OR=6.277) and multifocal lesions (OR=2.889) were independent risk factors for cervical lymph node metastasis in patients with PTC.  Conclusion  Cervical lymph node metastasis in PTC patients is closely related to many factors. Paying attention to and analysing these factors have important clinical significance for clinical staging, treatment decision-making and prognosis evaluation.
Relationship between biomarkers and risk stratification and prognosis of acute pulmonary embolism
PANG Ying-ying, LIU Hai-tao
2022, 20(2): 199-201, 281. doi: 10.16766/j.cnki.issn.1674-4152.002311
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  Objective  To explore the application value of biomarkers in the risk stratification and prognosis of acute pulmonary embolism.  Methods  From January 2018 to November 2019, 90 patients with acute pulmonary embolism diagnosed by multi-slice spiral CT pulmonary angiography were selected as the observation group. In accordance with the 2014 European Heart Association (The European Society of Cardiology, ESC) guidelines, the patients were divided into a high-risk group (20 cases), a moderate-risk group (21 cases) and a low-risk group (49 cases). Another 50 healthy subjects of similar age in the same period were selected as the control group. The levels of B-type brain natriuretic peptide (BNP), troponin I (TnI) and ischaemic modified albumin (IMA) were measured by enzyme-linked immunosorbent assay, rapid quantitative detector and albumin cobalt binding assay, respectively.  Results  The serum levels of BNP, TnI and IMA in the observation group were significantly higher than those in the control group (P < 0.05). The median values of serum IMA, TnI and BNP in the high-risk group were 88.78 (85.63, 99.55) U/mL, 0.73 (0.19, 0.85) ng/mL and 2.63 (1.32, 5.48) ng/mL, respectively, and the levels in the high-risk group were significantly higher than those in the middle- and low-risk groups. In addition, the expression level in middle-risk group was significantly higher than that in the low-risk group. The median values of IMA, TnI and BNP in the dead group were 86.23 (82.06, 92.17) U/mL, 0.74 (0.35, 0.78) ng/mL and 2.42 (0.69, 5.60) ng/mL, respectively. The serum levels of BNP, TnI and IMA in the dead group were significantly higher than those in the survival group (all P < 0.05).  Conclusion  BNP, TnI and IMA can reflect the risk stratification and prognosis of acute pulmonary embolism, which is worthy of clinical reference.
Free anterolateral thigh flap in maxillofacial tissue defect application in transplantation and reconstruction
ZHU Wei-zheng, CHEN Chuan-jun
2022, 20(2): 202-205, 297. doi: 10.16766/j.cnki.issn.1674-4152.002312
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  Objective  To explore the clinical treatment of oral and maxillofacial malignant tumours (primarily oral squamous cell carcinoma) with free anterolateral thigh flap. The therapeutic effects of transplantation and reconstruction of large tissue defects in head, neck, and maxillofacial area after radical resection of malignant tumour were examined.  Methods  From April 2015 to August 2020, 66 cases of maxillofacial defects after radical oral cancer were reconstructed by free anterolateral femoral flap transplantation in the Oral and Maxillofacial Surgery Department of Anhui Provincial Hospital. Data including general information, repair site, recovery of oral speech, chewing and swallowing functions after surgery, and satisfaction degree of postoperative appearance were collected. Related postoperative follow-up data were retrospectively analysed through questionnaire and SPSS 23.0 statistical software analysis. A detailed study of the advantages and disadvantages of free femoral anterolateral flap in clinical design preparation, data reconstruction, postoperative complications, and patient's appearance and function was conducted.  Results  A total of 64 of the 66 patients survived the first stage of the flap, including two patients with postoperative skin flap necrosis due to vascular embolisation, with a success rate of 96.97%. No serious complications occurred in the donor area of postoperative flap. In addition to the T4 patients with excessively large primary lesions, whose oral and maxillofacial tissue defects seriously affected the normal physiological function after surgery, the remaining 85% of patients could recover their speech and eating function satisfactorily 3 months after surgery. More than 93.94% of patients were satisfied or acceptable with the postoperative appearance. Statistically significant differences in mouth opening, food intake, and speech function existed amongst all kinds of oral cancer patients before and after surgery (all P < 0.05).  Conclusion  The free anterolateral femoral flap is the first choice for the reconstruction of head and neck tissue defects in oral and maxillofacial surgery due to its advantages such as simple preparation, flexible design, powerful function, and concealed donor area.
Clinical analysis of safety and reduce consumables of thoracoscopic pulmonary segmentectomy
ZHANG Lei, LI Xiao-jun, GONG Hui-yuan, WANG Biao
2022, 20(2): 206-208, 331. doi: 10.16766/j.cnki.issn.1674-4152.002313
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  Objective  To discuss the effect of the operation mode of controlling the use of high-value consumables on the safety and efficacy of thoracoscopic pulmonary segmentectomy.  Methods  A retrospective analysis of 33 patients who had thoracoscopic pulmonary segmentectomy in the Thoracic Surgery Department of the First Affiliated Hospital of Bengbu Medical College from December 2018 to December 2019 was conducted. The patients included 6 males and 27 females, with an age range of 31-75 years and an average age of (55.33±10.25) years. Depending on their lesions, the patients were subjected to single pulmonary segment resection, combined pulmonary segment resection or pulmonary segment+wedge resection. The veins between segments were retained by treating the pulmonary arteries and veins with ligation. The intersegmental boundary was confirmed using the expansion and collapse method, the target pulmonary segment was separated from the target centre to the periphery with the energy instruments. The remaining intersegmental plane was cut with the cutting and stitching instrument. The pulmonary wedge was resected with the clamp and stitched after resection. The cost of surgical consumables was controlled through individualised methods, whereas the operation safety and efficacy were ensured.  Results  Operation was successfully completed for the 33 patients, which was in line with the pre-operative plan. Of the 33 patients, 14 underwent single pulmonary segment resection, 11 underwent combined pulmonary segment resection and 8 underwent pulmonary segment + wedge resection; 42 lesions were resected. The use of consumables for pulmonary vascular resection, wedge resection and intersegmental plane treatment was reduced. No apparent air leakage and haemorrhage were observed at the intersegmental plane treated with energy instruments, and no apparent pressing was found at the intersegmental plane treated with the cutting and stitching instrument. The post-operative pulmonary expansion was satisfactory, with a total drainage volume of 100-2 330 mL, an indwelling time of chest drainage tube of 2-18 days and a post-operative LOS of 4-18 days. No serious complication occurred after operation, and 6 patients with slight air leakage were recovered after drainage.  Conclusion  Thoracoscopic pulmonary segmentectomy can ensure the operation safety, economy and short-term efficacy by the operation mode of controlling the use of surgical consumables, which is conducive to the promotion of the operation.
Correlation between peripheral blood neutrophil to lymphocyte ratio level and T lymphocyte subsets in patients with multiple myeloma and its impact on prognosis
SU Chuan-yong, TAO Die-hong, REN Li, GUO Shu-ping, ZHOU Wen-fei, WU Hai-ying, JIANG Hui-fang
2022, 20(2): 209-211, 232. doi: 10.16766/j.cnki.issn.1674-4152.002314
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  Objective  To investigate the correlation between the ratio of peripheral blood neutrophil to lymphocyte (NLR) level and T lymphocyte subsets in patients with multiple myeloma (MM) and its effect on prognosis.  Methods  Eighty patients with MM who were treated in Zhejiang Tongde Hospital from June 2016 to January 2018 were selected as the MM group; 60 healthy people who were examined in our hospital during the same period were selected as the healthy control group. The levels of NLR, peripheral blood T cell subsets and NK cells were compared between the two groups. Pearson method was used to analyse the correlation between NLR and T cell subsets levels in the MM group. In addition, the patients with MM were divided into the high NLR level group (NLR≥2.69; 38 cases) and low NLR level group (NLR < 2.69; 42 cases). The survival curves were drawn, and the survival rates were compared between the two groups.  Results  The levels of NLR and CD8+ in the MM group were significantly higher than those in the healthy control group [2.69±0.74 vs. 1.72±0.45, (44.34±5.04)% vs. (25.36±3.54)%, t=9.614, 26.133, all P < 0.05], the levels of CD3+, CD4+ and CD4+/CD8+ in the MM group were obviously lower than those in the healthy control group (all P < 0.05), and no significant difference in the level of NK cells was found between the two groups (P>0.05). In the patients with MM, NLR negatively correlated with CD3+, CD4+, CD4+/CD8+ (r=-0.483, -0.481, -0.595, all P < 0.05) and positively correlated with CD8+ (r=0.318, P < 0.05). The two-year survival rate and the two-year progression-free survival rate of the high NLR group was obviously lower than those of the low NLR group (all P < 0.05).  Conclusion  The CD3+, CD4+ and CD4+/CD8+ levels in the patients with MM are obviously lower than those in healthy people, and the NLR and CD8+ levels in the patients with MM are obviously higher than those in healthy people. The level of NLR is closely related to the immune function of patients. High NLR levels and abnormal expression of peripheral T lymphocyte subsets suggest a poor prognosis in patients with MM.
Clinical significance of the expression of algogenic substances and the change in immune function before and after control of cancer pain
HUANG Xian-da, SHI Wei, GONG Quan, LI Shi-juan, ZHANG Li-juan, ZHOU Chun-yan, CHEN Xi, ZHUANG Li, WANG Cun-de
2022, 20(2): 212-215. doi: 10.16766/j.cnki.issn.1674-4152.002315
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  Objective  To explore the relationship between cancer pain and algogenic substances and immune function to screen out sensitive indicators for cancer-pain assessment and curative-effect monitoring, as well as to preliminary explore the role of algogenic substances in cancer pain.  Methods  A total of 60 patients with cancer pain diagnosed at the Yunnan Cancer Hospital from January 2016 to January 2019 were selected as the test group, and 30 healthy people and 30 patients with painless tumours were selected as the control group. Enzyme-linked immunosorbent assay was used to determine the levels of TNF-α, IL-6, β-endorphin, NGF, and LPA in plasma. Flow cytometry was used to detect the change in peripheral blood T lymphocyte subsets before and after cancer-pain control. The relationship of the expression of algogenic substances with the degree of cancer pain, outbreak pain, and distant metastasis was analysed statistically.  Results  The contents of TNF-α, IL-6, β-endorphin, NGF, and LPA in the experimental group were significantly higher than those in the control group. The levels of TNF-α, IL-6, β-endorphin, and NGF in serum after cancer-pain control were (87.77±11.60) ng/L, (33.33±6.43) ng/mL, (24.00±5.93) ng/mL, and (19.85±3.78) pg/mL, respectively. It was significantly lower than the level before cancer-pain control [(220.20±32.11) ng/L, (59.48±10.26) ng/mL, (38.62±8.01) ng/mL, (34.32±6.21) pg/mL], but no significant difference existed in LPA expression before and after cancer-pain control. The contents of TNF-α, IL-6, NGF, and LPA were related to the degree of cancer pain, outbreak pain, and distant metastasis. The expression level of β-endorphin was related to the degree of cancer pain and distant metastasis. The percentages of CD3+, CD4+, and CD4+/CD8+ after cancer pain control were significantly higher than those before cancer-pain control, but the percentage of CD8+ after cancer pain control was significantly lower than before cancer pain control, and the difference was statistically significant.  Conclusion  TNF-α, IL-6, β-endorphin, NGF, and LPA may play certain roles in cancer pain, which can be used to evaluate cancer pain and monitor therapeutic effect. Cancer pain can reduce the body's immune function.
Effects of thoracic paravertebral nerve block on hemodynamics during induction of anesthesia and postoperative recovery in patients undergoing coronary artery bypass grafting
LIU Lei, LI Hai-hui, FENG Tao, WU Zhang, TAO Jing, LIANG Qi-sheng
2022, 20(2): 216-219. doi: 10.16766/j.cnki.issn.1674-4152.002316
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  Objective  To investigate the effects of thoracic paravertebral nerve block (TPVB) on hemodynamics during induction of anesthesia and postoperative recovery in patients undergoing coronary artery bypass grafting (CABG).  Methods  Fifty patients were selected for elective CABG at the First Affiliated Hospital of Bengbu Medical College from August 2020 to August 2021. The patients were divided into two groups using the random number table method: TPVB combined with general anesthesia group (group P) and conventional general anesthesia group (group G), each group contained 25 patients. The mean arterial pressure (MAP) and heart rate (HR) before induction of anesthesia (T0), before tracheal intubation (T1), immediately after tracheal intubation (T2), 1 min (T3) and 5 min (T4) after tracheal intubation, intraoperative sufentanil dosage, postoperative mechanical ventilation time, the visual analogue scale (VAS) scores after extubation, 12 and 24 h postoperatively, 24 h postoperative remedial analgesia cases, length of stay in the cardiac surgical intensive care unit (CSICU), postoperative hospital stay, and postoperative adverse effects were all recorded and analyzed accordingly.  Results  MAP at T2-T4 in group P were (74.84±10.05) mm Hg (1 mm Hg = 0.133 kPa), (74.96±10.03) mm Hg, (74.72±9.18) mm Hg, which were lower than those of group G [(85.08±10.57) mm Hg, (89.16±10.00) mm Hg, (81.04±8.92)mm Hg, all P < 0.05]; HR at T2-T4 in group P were lower than those in group G (all P < 0.05). Intraoperative sufentanil dosage, postoperative mechanical ventilation time, and length of stay in the CSICU in the group P were less than those in group G (all P < 0.05). The VAS scores at all postoperative time points in the group P were lower than those in the group G (all P < 0.05). The number of cases of remedial analgesia at 24 h postoperatively in the group P was less than that in the group G (P < 0.05). There was no statistically significant difference in the incidence of nausea and vomiting and pulmonary infection between the two groups (all P > 0.05).  Conclusion  TPVB can maintain stable hemodynamics during the induction period of anesthesia in patients undergoing coronary artery bypass grafting. It also alleviates postoperative pain, reduces the amount of analgesic drugs, and facilitates the early postoperative recovery of patients.
Establishment and evaluation of risk nomgram model for in-stent restenosis after stent implantation in metaphase and advanced oesophageal carcinoma
JIN Xiao-sheng, CHEN Lu-xi, LI Rong-zhou, JI Ting-ting, YU Wei-lai, YANG Qing
2022, 20(2): 220-223. doi: 10.16766/j.cnki.issn.1674-4152.002317
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  Objective  To analyse the related factors of in-stent restenosis (ISR) after stent implantation in patients with metaphase and advanced oesophageal carcinoma and to establish and evaluate an individual nomogram model for predicting the risk of ISR.  Methods  From May 2015 to June 2019, 160 patients with metaphase and advanced oesophageal carcinoma who were diagnosed and hospitalised for stent implantation in the Department of Gastroenterology in Ruian People's Hospital were selected as participants. According to the occurrence of ISR after stent implantation, the patients were divided into post-operative ISR group (n=26) and non-postoperative ISR group (n=134). A logistic regression model was used to analyse the independent risk factors of ISR after stent implantation. A nomogram model for predicting the risk of ISR after stent implantation was developed using nomogram online website. The receiver operating characteristic curve (ROC), calibration curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the nomogram model.  Results  The logistic regression model showed that age, oesophageal fistula and clinical stage were independent risk factors for ISR after stent implantation in patients with metaphase and advanced oesophageal carcinoma (all P < 0.05), and radiotherapy after stent implantation was a protective factor for ISR risk (P < 0.05). ROC results showed that the area under the curve (AUC) for predicting the risk of ISR after stent implantation was 0.869. The calibration curve was a straight line with a slope close to 1, and Hosmer-Lemeshow goodness-of-fit test showed χ2=5.661, P=0.685.  Conclusion  Based on age, radiotherapy after stent implantation, oesophageal fistula and clinical stage, the nomogram model for predicting the risk of ISR after stent implantation for metaphase and advanced oesophageal carcinoma has good discrimination and accuracy.
Predictive value of the pre-operative prognostic nutrition index for the survival of patients undergoing radical prostatectomy
LIANG Yu-jie, ZHANG Yong-qi, CHEN Meng-jie, GUAN Han, LI Wen-yong, LIU Bei-bei, LIU Jian-min
2022, 20(2): 224-227. doi: 10.16766/j.cnki.issn.1674-4152.002318
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  Objective  To explore whether or not the prognostic nutrition index (PNI) can be used to evaluate the prognosis of patients undergoing the radical resection of prostate cancer.  Methods  Retrospective analysis was performed on 156 patients who underwent radical resection of prostate cancer in the First Affiliated Hospital of Bengbu Medical College from January 2014 to January 2015. Clinical data and follow-up data of patients with prostate cancer were determined on the basis of the results of the first blood examination at the time of radical surgery. Pre-operative PNI, neutrophil-to-lymphocyte ratio and lymphatic-to-monocyte ratio were calculated. On the basis of the characteristics of receiver operating characteristic curve, the optimal cut-off value on the curve was intercepted. The overall survival (OS) of patients was analysed by Kaplan-Meier survival curve, and the association between the prognosis of patients undergoing radical surgery and pre-operative PNI was analysed by Cox proportional risk model.  Results  The pre-operative PNI of patients was 49.58±6.69, the best cut-off value was 50.77. The high PNI group (≥ 50.77, 75 patients) had a significantly higher 5-year OS rate than the low PNI group (< 50.77, 81 patients). PNI was an independent risk element for 5-year OS after the radical resection of prostate cancer.  Conclusion  Pre-operative PNI is an independent risk factor affecting the survival of patients with prostate cancer after radical surgery, and it has a certain clinical application value to evaluate the prognosis of patients with prostate cancer undergoing radical surgery.
Clinical effect of cryoballoon catheter ablation in patients with atrial fibrillation Combining with heart failure
ZHOU A-pei, CHEN Dong, HU Kai, SHEN Wei, SU Hao, TANG Bi
2022, 20(2): 228-232. doi: 10.16766/j.cnki.issn.1674-4152.002319
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  Objective  To evaluate the safety and efficacy of cryoballoon catheter ablation (CCA) in patients with atrial fibrillation Combining with heart failure.  Methods  A retrospective analysis of 3 patients with atrial fibrillation Combining with heart failure diagnosed at the First Affiliated Hospital of the University of Science and Technology of China from June 2020 to November 2020 was performed to observe the safety of CCA treatment. The results of echocardiography, dynamic electrocardiogram, cardiac function grading and N-terminal B-type natriuretic peptide (NT-proBNP) were examined after 3 and 6 months to observe the effectiveness of CCA therapy.  Results  All patients successfully achieved complete pulmonary vein isolation (PVI). Patient 1 converted to atrial flutter after PVI, which was proven to be typical atrial flutter and dependent on tricuspid isthmus by activation and entrainment mapping, and then turned to sinus rhythm after tricuspid isthmus isolation. Electrocardioversion of patients 2 and 3 turned to sinus rhythm following pulmonary vein isolation, and atrial voltage was mapped under sinus rhythm. All three patients had neither matrix modification nor complications. Echocardiography significantly improved (LVEF increased by 28%, 32% and 21% at 6 months post-operation, respectively; LVEDD and LAD significantly reduced), and NYHA functional class all improved to Ⅰ. The BNP of all patients reduced to the normal range. However, recurrence was found in patient 1 at 6 months follow-up. The successful CCA treatment was administered again, and no AF occurred at 6 months follow-up.  Conclusion  CCA for patients with atrial fibrillation Combining with heart failure is safe, which may improve cardiac function and cardiac structure and reduce NT-proBNP.
General Clinical Research
Relationship between plasma B-type natriuretic peptide and severity of craniocerebral injury and its predictive effect on cerebral heart syndrome
LUO Jian, XU Zhao-jun
2022, 20(2): 233-236. doi: 10.16766/j.cnki.issn.1674-4152.002320
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  Objective  To analyse the relationship between plasma B-type natriuretic peptide (BNP) and the severity of craniocerebral injury and its predictive effect on cerebral heart syndrome.  Methods  A total of 186 patients with craniocerebral injury admitted to our hospital from January 2016 to October 2020 were selected as participants. They were divided into mild, medium and severe groups according to the Glasgow Coma Score (GCS) on admission. The changes in plasma BNP levels in each group were observed. The levels of plasma BNP, neuron-specific enolase (NSE), myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP) in the three groups were compared. Area under receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficacy of plasma BNP in cerebral heart syndrome.  Results  The BNP levels of patients with craniocerebral injury on the 1st, 3rd and 7th day after injury are (74.75±21.54)ng/L, (123.89±51.47)ng/L and (93.00±31.28)ng/L.The plasma BNP levels in mild, moderate and severe groups increased on day 1 after injury, peaked on day 3, and decreases significantly on day 7, with statistical significance(P < 0.05). The more severe the head injury was, the lower the GCS score was on the 3rd day after injury and the higher the plasma BNP, NSE, MBP and GFAP levels were; the difference was statistically significant (all P < 0.05). Pearson correlation analysis showed that the levels of BNP, NSE, MBP and GFAP negatively correlated with GCS score at the 3rd day after craniocerebral injury (all P < 0.05). Univariate and multivariate logistic regression analyses revealed that plasma BNP, NSE, MBP and GFAP were all independent predictors of cerebral heart syndrome (all P < 0.05). ROC curve analysis showed that the AUC of the 3rd day plasma BNP after craniocerebral injury was 0.924.  Conclusion  Plasma BNP level is related to the progression of craniocerebral injury and is effective in predicting cerebral heart syndrome. Thus, it is worthy of clinical attention.
Correlation analysis of white matter lesions and motor symptoms and non-motor symptoms in Parkinson's patients
WANG Wei, CAO Qing-hua, SUN Guang-ling, SU Hang
2022, 20(2): 237-239. doi: 10.16766/j.cnki.issn.1674-4152.002321
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  Objective  To investigate the effect of white matter lesion (WML) on motor and non-motor symptoms in patients with Parkinson disease (PD).  Methods  Total 148 patients with primary PD from the Affiliated Hospital of Ningbo University School of Medicine from May 2017 to April 2020 were selected and divided into WML group (83 cases) and non-WML group (65 cases) according to whether they were accompanied by WM. According to Fazekas score, there were 65 cases in WML 0 group, 25 cases in grade 1 group, 30 cases in grade 2 group and 28 cases in grade 3 group. The general data of WML group and non-WML group, PD score scale Ⅲ (UPDRS Ⅲ) and PD non-motor symptom questionnaire (NMSQ) of different WML grading groups were compared, and the relationship between WML and PD patients with motor symptoms and non-motor symptoms was analyzed by Logistic regression.  Results  The UPDRS Ⅲ score of the WML group was (25.52±4.24) points, which was higher than the (18.65±4.12) points of the non-WML group (t=9.905, P < 0.05), and the degree of dyskinesia was more serious than that of the non-WML group (χ2=50.776, P < 0.05). The NMSQ score of the non-WML group was (12.65±1.32) points, the NMSQ score of the WML group was (17.25±3.12) points, and the NMSQ score of the WML group was higher than that of the non-WML group (t=11.126, P < 0.05). The results of multivariate regression analysis showed that the higher the UPDRS Ⅲ score, the higher the proportion of severe H &Y staging, and the higher the NMSQ score were all risk factors for PD patients with severe WML staging (P < 0.05).  Conclusion  WML can increase PD motor symptoms and non-motor symptoms, and the degree of risk is related to the WML classification.
Clinical observation of different hepatotoxic reactions of anti-tuberculosis drugs in the liver
LIU Yi-hui, GUO Yan, FENG Hui, XU Hong, HAN Ying
2022, 20(2): 240-242. doi: 10.16766/j.cnki.issn.1674-4152.002322
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  Objective  To observe the clinical characteristics of different hepatic toxicity in anti-tuberculosis treatment.  Methods  Retrospective analysis was performed on 90 cases of initially treated pulmonary tuberculosis in Hangzhou Red Cross Hospital. According to the different reactions of anti-tuberculosis drugs, the patients were divided into tolerance group, susceptible group and adaptive group, with 30 cases in each group. Age, gender, underlying diseases, alcohol consumption, duration of medication, type of liver injury and degree of liver injury were observed.  Results  The differences in age, basic liver disease and drug allergy history among the tolerance, susceptible and adaptation groups were statistically significant (F=7.193, χ2=6.398, χ2=8.580, all P < 0.05). No significant difference in gender and drinking history was found among the three groups (χ2=1.148, 2.917, all P>0.05). The incubation period of the adaptive group was significantly longer than that of the susceptible group [(4.39±1.24) weeks vs. (2.33±0.91) weeks], whereas the recovery period of the adaptive group was significantly shorter than that of the susceptible group [(2.28±0.90) weeks vs. (4.67±1.09)weeks, t=-5.666, 7.208, all P < 0.05]. The proportion of liver injury types in the two groups was significantly different(χ2=41.429, P < 0.001), and the proportion of liver injury degree in the two groups was significantly different (U=3.506, P=0.001).  Conclusion  The different reactions of anti-tuberculosis drugs in the liver are related to age, basic liver disease and drug allergy history but not related to gender and alcohol consumption. In the susceptible group, the short latency recovery is slow, whereas in the adaptive group, the long latency recovery is fast. In the susceptible group, hepatocyte injury is more common. In the adaptive group, biochemical abnormalities are more common. Mild and moderate liver injuries are common in both groups.
Clinical features and risk factors of subdural effusion following decompressive craniectomy in patients with traumatic brain injury
WANG Geng-huan, SHEN He-ping, CHU Zheng-min, SHEN Jian-guo, ZHANG Li-tao, ZHU Kun-can
2022, 20(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.002323
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  Objective  To investigate the clinical characteristics of subdural effusion following decompressive craniectomy in patients with traumatic brain injury and analyse its influencing factors to provide clinical evidence for early active prevention and intervention.  Methods  A total of 608 patients with craniocerebral injury treated with decompressive craniectomy from January 2010 to November 2019 in the Second Affiliated Hospital of Jiaxing University were selected as participants. They were divided into the subdural effusion group (120 cases) and the no subdural effusion group (488 cases). The clinical characteristics of the subdural effusion group were analysed, and various related factors of the two groups were analysed and compared.  Results  A total of 120 cases of subdural effusion occurred in 608 patients 4-22(10.3±4.2)d after surgery. The effusion volume was 12.2-120.8(25.4±10.3)mL. Subdural effusion was located on one side in 97 cases and on both sides in 23 cases; 95 cases were treated conservatively, and 25 cases were treated surgically. Univariate analysis showed that gender, age, hematoma volume, admission glasgow coma scale(GCS), midline shift, large bone flap, bilateral craniotomy, and diabetes were statistically different (P < 0.05). Univariate analysis showed that there were significant differences in gender, age, hematoma volume, admission GCS, median shift, large bone flap, bilateral craniotomy and diabetes (all P < 0.05). Multivariate logistic regression analysis showed that age, hematoma volume, admission GCS score, midline displacement and large bone flap were the influencing factors of subdural effusion after bone flap decompression (all P < 0.05).  Conclusion  The incidence of subdural effusion after decompressive craniectomy is high. Age, haematoma volume, GCS, midline shift and large bone flap are risk factors for subdural effusion following decompressive craniectomy in patients with traumatic brain injury.

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