中华全科医学

Construction and application of the service performance evaluation index system for job-transfer general practitioners

LI Yan-jun, WEI Lai, FAN Sheng-gen, LU Xiao-hui, CHENG Yin-xia, CHEN Wen-zhi

2022, 20(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002396

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Abstract:
Objective To develop and apply the service performance evaluation index system for job-transfer general practitioners based on the post competency requirements of general practitioners, for providing a reference for the exploration of the capability-oriented training system for job-transfer general practitioners. Methods Literature review method was used to extract indexes, two rounds of Delphi method were adopted to screen and develop the service performance evaluation index system for the job-transfer general practitioners, and analytic hierarchy process was applied to determine the weights of indexes. A total of 150 job-transfer general practitioners were investigated by means of purposive sampling to construct indexes, and statistical analysis was then conducted in way of descriptive statistics and t-test, and analysis of variance. Results During the two rounds of expert consultations, the response rates were 100.0% and 94.1%; the judgement coefficients were 0.977 and 0.931; the familiarity rates were 0.812 and 0.789; and the authority rates were 0.895 and 0.860. The expert coordination coefficients for the first and the second consultations were 0.278 (χ²=203.014, P < 0.001) and 0.406 (χ²=259.863, P < 0.001), respectively. Finally, an index system was developed, consisting of 3 first-tier indexes, 10 second-tier indexes and 28 third-tier indexes. In terms of reliability test, the total index Cronbach ' s α coefficient was 0.973; in terms of validity test during factor analysis, three main factors were extracted for orthogonal rotation, and the cumulative variance contribution rate was 70.934%. The results of the questionnaire survey showed that the job-transfer general practitioners boasted of the best basic work competency, and there was a significant difference in the total competency self-assessment score of the general practitioners of difference genders and professional titles (all P < 0.05). Conclusion The service performance evaluation index system for job-transfer general practitioners developed in this study can provide objective and scientific reference basis and effective tools for improving the training, assessment and evaluation for the job-transfer general practitioners.

Clinical Reasoning in Primary Care in the United Kingdom(the end)

Rodger Charlton, XIE Wan-ling, LIU Man-ling

2022, 20(4): 544-545.

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Protective effect of active vitamin D₃ on airway remodelling in elderly patients with chronic obstructive pulmonary disease and vitamin D deficiency

HE Han-fu, NIE Xiao-hong, JIN Yu, LUO Li, LAI Xiao-rong, ZHU Peng-fei

2022, 20(4): 615-619. doi: 10.16766/j.cnki.issn.1674-4152.002413

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Objective To explore the protective effect of active vitamin D3 (alfacalcidol) on airway remodelling in elderly patients with chronic obstructive pulmonary disease (COPD) and vitamin D deficiency. Methods Forty healthy people (healthy control group) and 146 stable COPD patients with 25(OH)D level lower than 20 ng/mL were selected from January 2019 to January 2020. Patients with chronic obstructive pulmonary disease were randomly divided into three groups: high-dose group (n=48), low-dose group (n=49) and control group (n=49). The levels of 25(OH)D, matrix metalloproteinase-9 (MMP-9), transforming growth factor β1 (TGF-β1), tissue inhibitor of metallo-proteinase-1 (TIMP-1) in blood and HRCT were measured. The ratio of bronchial wall thickness to outer diameter (T/D) and the percentage of airway wall area to total airway cross-sectional area (WA%) were measured at the time of admission and at 3 and 6 months later. Results The 25(OH)D level in the COPD group was (13.47±5.32) ng/mL, which was significantly lower than that in the healthy control group [(20.35±8.34) ng/mL], P < 0.05. Meanwhile, the levels of MMP-9, TGF β-1, TIMP-1, T/D and WA% were significantly higher in the COPD group than in the healthy control group (P < 0.05). The levels of 25(OH)D, MMP-9, TGF-β1 and WA% in the low-dose group significantly improved after 3 months of supplementation (P < 0.05), and the levels of TIMP-1 and T/D in the low-dose group significantly improved after 6 months of supplementation (P < 0.05). The level of 25(OH)D and all airway remodelling indexes in the high-dose group after 3 and 6 months of treatment improved (all P < 0.05). The levels of 25(OH)D, TGF-β1 and WA% after 6 months of treatment were different from those in the low-dose group (P < 0.05). The 25(OH)D level negatively correlated with MMP-9, TGF-β1 and WA% (r=-0.287, -0.311, -0.389, respectively, all P < 0.05). Conclusion In elderly patients with COPD vitamin D deficiency, daily supplement of alfacalcidol exerts a better protective effect on the improvement of 25(OH)D level and airway remodelling, and high-dose supplement for 6 months exerts a better effect.

Qualitative study of disease experience in patients with end-stage heart failure

WEI Xue-ping, FAN Xi-zhen, FANG Yuan, LU Meng

2022, 20(4): 620-622. doi: 10.16766/j.cnki.issn.1674-4152.002414

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Objective To understand the real disease experience of patients with end-stage heart failure and provide a basis for the development of effective care strategies. Methods Using phenomenological research methods, semi structured in-depth interviews were conducted with 18 end-stage heart failure patients hospitalized in the heart failure center of the First Affiliated Hospital of the University of Science and Technology of China from April 2021 to June 2021, and the interview data were analyzed using Colaizzi 7-step analysis. Results Analysis of the disease experience of 18 patients with end-stage heart failure revealed that at the symptom level: the experience was deep and dominated by negative experience. At the level of psychological experience: young patients had a heavy psychological burden and were worried about the prognosis, with negative experience predominating, while older patients had good psychological coping and could face the disease openly, with positive experience predominating. At the level of quality of life: all heart failure patients had a negative experience. At the level of family support: young patients lacked family support, had a heavy financial burden, and had more negative experiences, while elderly patients had adequate family support, received more care, and had more positive experiences. At the level of disease perception: there were differences in experience among patients of different ages. Young patients changed from initial negative experience to positive experience, while elderly patients changed from initial positive experience to negative experience. Conclusion Patients with end-stage heart failure experience the coexistence of positive and negative disease experiences. All patients have negative experiences at the level of disease perception, and there are differences in experiences at the level of self-management. Patients with end-stage heart failure should have enhanced symptom management to reduce suffering and improve quality of life. Education on disease knowledge should be strengthened to provide early prevention and control disease progression, and effective care strategies should be developed to meet different needs according to the characteristics of different age groups.

Clinical significance of serum amyloid protein A and interleukin-6 expression in hand, foot and mouth disease on the basis of propensity score matching

XIANG Qiong-lian, ZHU Li-juan, ZHANG Shi-hai

2022, 20(4): 623-625. doi: 10.16766/j.cnki.issn.1674-4152.002415

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Objective To investigate the expression of serum amyloid A (SAA) and interleukin-6 (IL-6) in different types of hand, foot and mouth disease (HFMD). Methods A total of 216 children with HFMD admitted to Anhui Provincial Children's Hospital from Jan. 2017 to Nov. 2020 were randomly selected as the observation objects, including 145 children with common HFMD and 71 children with severe HFMD. Propensity score matching method was used for 1∶ 1 matching. The matching variables included age, gender, course of disease, blood collection time after admission, cough, runny nose, loss of appetite and other clinical manifestations. The distribution of enterovirus 71 (EV-A71) RNA in the faeces of HFMD patients was observed by reverse transcription polymerase chain reaction. The expression of SAA and IL-6 in venous blood of children with different types of HFMD were observed. Results The expression levels of SAA and IL-6 in patients with severe HFMD and common HFMD were (162.50±11.23) mg/L vs. (10.28±2.06) mg/L and (49.96±6.85) pg/mL vs. (23.11±4.98) pg/mL, respectively. The expression levels of SAA and IL-6 in the severe HFMD group were higher than those in the common HFMD group (all P < 0.01). The positive rate of EV-A71 in the severe HFMD group was significantly higher than that in the normal HFMD group (χ²=9.100, P=0.003). The expression levels of IL-6 and SAA in patients with EV-A71-positive HFMD were significantly higher than those in patients with EV-A71-negative HFMD in both groups (all P < 0.01). The expression levels of SAA and IL-6 in the EV-A71-positive HFMD group and EV-A71-negative HFMD group were (93.65±6.71) mg/L vs. (80.40±5.83) mg/L and (45.57±5.88) pg/mL vs. (28.37±3.15) pg/mL, respectively. The expression levels of serum SAA and IL-6 in the EV-A71-positive HFMD group were higher than those in the EV-A71-negative HFMD group (all P < 0.01). Conclusion SAA and IL-6 are involved in the pathogenesis of HFMD and closely related to HFMD typing and EV-A71 expression.

Efficacy and serological study of self-designed influenza formula in treating influenza B in children

JIN Hai-yan, ZHAN Lu, XU Bin-bin, TIAN Pu-ren

2022, 20(4): 626-629. doi: 10.16766/j.cnki.issn.1674-4152.002416

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Objective To observe the clinical efficacy of self-made influenza formula in the treatment of influenza B in children and its effect on serological Interleukin 6 (IL-6) and Interferon-γ (IFN-γ). Methods Total 60 in the standard cases of children with influenza B were selected from the Pediatric Outpatient of Zhejiang Integrated Traditional and Western Medicine Hospital from January 2019 to February 2020. They were equally divided into observation and control groups according to the random-number table method, 30 cases in each group. Both groups supported symptomatic treatment. At the same time, the observation group was given oral self-made influenza formula and the control group was given oral oseltamivir for 5 days. The serum IL-6 and IFN- γ between the two groups and before and after treatment were recorded and compared. Results After 5 days of treatment, 2 cases of leakage were found in the observation group, and 1 case of leakage was found in the control group. The total effective rate of the observation group was 96.4%, higher than the 72.4% in the control group (P < 0.05). Before treatment, no difference in serum IL-6 and IFN-γ levels were found between the two groups, and the differences in IL-6 and IFN-γ before and after treatment were statistically significant (all P < 0.05). After treatment, the IL-6 level in the observation group was 0.53(0.36, 0.66) ng/L, which was lower than that in the control group [0.69(0.46, 1.37) ng/L], and the IFN-γ level in the observation group was 3.47(1.96, 5.90) ng/L, which was lower than that in the control group [5.07(2.38, 13.12) ng/L], with statistically significant differences (all P < 0.05). Conclusion Self-designed influenza can effectively treat influenza B in children, improve clinical symptoms, and reduce serum levels of IL-6 and IFN-γ. We speculate that its mechanism may play a role by reducing the levels of IL-6 and IFN-γ inflammatory factors.

The effect of nalbuphine combined with dexmedetomidine multimodal analgesia on postoperative analgesia for patients with repeat cesarean section

JIN Wen-ran, ZHU Hai-juan, CHEN Hong-bo, LI Xiao-peng, WANG Sheng-you

2022, 20(4): 630-634. doi: 10.16766/j.cnki.issn.1674-4152.002417

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Objective To observe the effect of dexmedetomidine plus ropivacaine in bilateral transverse abdominal plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) in patients with low-dose naborphine on uterine contraction pain after cesarean section of scarred uterus. Methods From April to August 2019, 60 pregnant women who underwent cesarean section of scar uterus under spinal anesthesia in Hefei Maternal and Child Health Hospital were randomly divided into two groups: naborphine conventional dose group (NC group), naborphine low dose combined with ropivacaine and dexmedetomidine TAPB group (NDT group), with 30 cases in each group. The group of NDT received bilateral TAPB under ultrasound guidance after cesarean section, 30 mL of ropivacaine and dexmedetomidine mixture was injected into each side. Visual analog score (VAS), sleep time, incidence of adverse reactions, time of getting out of bed for the first time and satisfaction with analgesia were recorded in the two groups. Results The VAS scores of uterine contraction pain at 6, 12, 24, 36 and 48 hours after operation in NDT group [2.0 (1.0, 3.0), 3.0 (2.0, 3.0), 2.0 (2.0, 3.0), 2.0 (2.0, 2.0), 2.0 (1.0, 2.0) vs. 4.0 (3.0, 5.0), 4.0 (4.0, 5.0), 4.0(3.0, 5.0), 3.0 (2.8, 4.0), 2.0 (2.0, 3.0), all P < 0.05]. The sleep time at 24 and 48 hours after operation in NDT group was significantly longer than that in NC group [5.0 (4.8, 6.0) h/d, 6.0 (6.0, 7.0) h/d vs. 8.0 (7.0, 8.0) h/d, 8.0 (7.0, 8.0) h/d, all P < 0.05]. In NDT group, the first time out of bed was significantly shortened, the incidence of postoperative nausea, vomiting and dizziness were significantly reduced, and the satisfaction of maternal analgesia was significantly increased. Conclusion Low dose nalbuphine PCIA combined with ropivacaine, dexmedetomidine and TAPB multimodal analgesia regimen for postoperative analgesia of scar uterus after cesarean section has satisfactory effect and less adverse reactions.

Current situation and analysis of the two-way referral system in Luohe based on the mode of health alliance

WEI Jun-tao, GE Meng-ying, LIU Zhong-ling, ZHAO Yang-guang, LIU Xiao-na, CHEN Bo-lin

2022, 20(4): 635-638. doi: 10.16766/j.cnki.issn.1674-4152.002418

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Objective To understand the two-way referral system between doctors and patients in Luohe under the mode of health alliance, investigate the views and attitudes about the two-way referral implementation methods, understand the views of doctors and patients on the decision-making power of two-way referral, explore the main reason why the two-way referral is difficult to implement and put forward improvement measures to provide a theoretical and policy basis for the smooth implementation of the two-way referral system. Methods We conducted this survey from July to December 2019. Completely random sampling was used. Eight medical institutions in the area were randomly selected, including four community health service centres, two second level hospitals and two third level hospitals. A face-to-face questionnaire survey was conducted amongst 300 medical personnel and 300 patients who were hospitalised or visited the outpatient department on the same day. SPSS 21.0 statistical software was used for statistical analysis of the data. Results Five hundred and eighty-five valid questionnaires were collected. The awareness of patients on two-way referral was only 27.92%. There was a statistical difference between the doctors and patients' cognition of two-way referral (P < 0.05). Approximately 56.55% of patients chose to seek medical treatment in secondary or above hospitals, and 36.90% of patients chose to seek medical treatment in community health service centres. There was a statistical significance between hospital and community patients in terms of their intention to seek medical treatment (all P < 0.001). The differences of views on the implementation of two-way referral were statistically significant between hospital staff and patients, as was the case between community health staff and patients (P < 0.001). Approximately 55.88% of hospital doctors and 74.21% of community doctors believed that the decision of two-way referral should be made by doctors; 50.69% of patients believed that the decision should be made by patients. Both doctors and patients believed that the important reasons for two-way referral were medically driven by institutional economic interests, there was no unified two-way referral system and standards, and patients did not understand the referral system. Conclusion Insufficient cognition, weak awareness of referral, driven by the economic interests of medical institutions and the lack of unified referral system and standards have become important reasons for hindering two-way referral. The system and compensation mechanism should be improved to promote the smooth development of two-way referral.

Construction and application of community geriatric ward risk management system based on Australia and New Zealand risk management standards

SHENG Qing, ZHU Guang-hua, CAI Li-qiang

2022, 20(4): 639-642. doi: 10.16766/j.cnki.issn.1674-4152.002419

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Objective On the basis of the Australia and New Zealand (ANZ) risk management standard, a risk management system for the geriatric ward in community health service centre was constructed, implemented, applied and evaluated. Methods According to the ANZ risk management standard, risk management system of geriatric ward was established, organisational structure and post responsibilities were established, the target, environment, appraisal, analysis, evaluation and control system of risk management were planned. Using the tools of risk quantification matrix, the risk of community geriatric ward was evaluated through risk type, risk description, existing control measures, initial consequences, initial occurrence possibility, initial risk score Increase other control measures, residual consequences, residual possibility and other ways. Results According to the statistics of the hospital and the department in 2019, 63 adverse events were reported in the geriatric ward throughout the hospital. The top five events with high frequency or serious consequences were scabies (18 cases), pressure sores (13 cases), falls (8 cases), sudden death (7 cases) and suicide events (4 cases). Therefore, scabies, pressure sores, falls, sudden deaths and suicides in community geriatric wards were regarded as five important risk points. Using the risk management system and the tools of the risk quantification matrix, the five important risk points were evaluated, which had a score of 16, 15, 12, 10 and 10 points, respectively. The PDCA management cycle model was used to implement risk control, and then the residual risk was evaluated as 8, 12, 9, 5 and 5 points, respectively. Conclusion The risk management system of geriatric ward in community health service center based on ANZ risk management standards can achieve risk prevention and control. It is a management tool that can effectively control the risk of geriatric ward, which is worthy of learning and promotion.

Effect of NICE weight loss management model on weight and related indexes of overweight and obese people

WAN Hai-lin, ZHENG Min-hua, GUO Yun-ping, FENG Hai-ying

2022, 20(4): 643-647. doi: 10.16766/j.cnki.issn.1674-4152.002420

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Objective To analyse the effect of NICE weight loss management model on weight and related indexes of overweight and obese people. Methods Overweight and obese people who underwent physical examination in Taizhou Hospital of Zhejiang Province from May 2019 to July 2021 were randomly divided into the observation group (100 cases) and control group (100 cases). The control group used the conventional weight management mode, whereas the observation group used the NICE weight loss management mode. The weight changes, glucose and lipid metabolism indexes and self-management ability scores of the two groups before, 3 months and 6 months after the intervention were compared. Results No significant difference was observed in body weight, glucose and lipid metabolism indexes and self-management ability between the two groups before intervention (all P>0.05). After 6 months of intervention, the body weight, waist circumference and hip circumference of the observation group were significantly lower than those of the control group. The results of repeated measurement analysis of variance showed that the body weight, waist circumference and hip circumference of the observation group decreased gradually with the extension of time (P < 0.05). After 6 months of intervention, the proportion of people with weight loss of 10% in the observation group was 60%, which was significantly higher than that in the control group (41%), P < 0.05. The levels of fasting blood glucose, total cholesterol and triglyceride in the observation group were lower than those in the control group (all P < 0.05). The total score of self-management ability in the observation group was (44.17±4.85) points, which was significantly higher than that in the control group [(39.96±5.60) points, P < 0.05]. The results of repeated measurement analysis of variance showed that the self-management ability of the observation group increased gradually with the extension of time (P < 0.05). Conclusion The NICE weight loss management model can effectively manage the body mass index of overweight and obese people, improve blood glucose and blood lipid, improve their self-management ability and help to improve the quality of life of patients.

Diagnosis of breast lesions by molybdenum target combined with ultrasonography

LU Bin, FU Jie-ting, WENG Wen-chao, SHAO Qiao-ying, WANG Sheng-ye

2022, 20(4): 648-650. doi: 10.16766/j.cnki.issn.1674-4152.002421

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Objective To study the diagnostic efficacy of molybdenum target combined with ultrasonography in breast lesions and to provide reference for improving the clinical diagnostic rate. Methods A total of 150 patients with breast lesions treated in Jinhua Hospital Affiliated to Medical College of Zhejiang University from May 2018 to April 2021 were confirmed by surgery and pathology, including 53 cases of malignant lesions and 97 cases of benign lesions. All patients underwent molybdenum target combined with ultrasound before operation. The accuracy of molybdenum target, single ultrasonic examination and combined examination in the diagnosis of breast lesions was analysed and compared. The diagnostic efficacy of molybdenum target, single ultrasonic examination and combined examination in the diagnosis of breast lesions was evaluated on the basis of the surgical and pathological results. Results The accuracy rate of molybdenum target combined with ultrasound was 95.33%, which was higher than that of molybdenum target and ultrasound alone (78.00% and 81.33%, respectively, all P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of molybdenum target examination in the diagnosis of breast lesions were 86.79%, 73.20%, 63.89% and 91.03% respectively, those of Ultrasonic examination were 90.57%, 76.29%, 67.61% and 93.67% respectively, and those of molybdenum target combined with ultrasound were 98.11%, 94.85%, 91.23% and 98.92% respectively. The specificity, the positive predictive value and negative predictive value of molybdenum target combined with ultrasound in the diagnosis of breast lesions were higher than those of molybdenum target (all P < 0.05), and the specificity and positive predictive value of molybdenum target combined with ultrasound in the diagnosis of breast lesions were higher than those of ultrasound (all P < 0.05). Conclusion Molybdenum target combined with ultrasonography has better diagnostic efficiency for breast lesions, and the accuracy, specificity and positive predictive value are higher than those of single examination.

Research progress of the influencing factors and interventions of psychosocial distress in hematopoietic stem cell transplant patients

ZHANG Ting, HAN Ai-zhi, GE Jian, LONG Zhang-biao

2022, 20(4): 651-654. doi: 10.16766/j.cnki.issn.1674-4152.002422

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Psychological distress is an unpleasant emotional experience caused by multiple factors. These experiences can affect patients' ability to effectively cope with cancer and its physical symptoms and treatment, significantly reduce their quality of life and affect health outcomes. Psychological distress is the most common psychological problem in hematopoietic stem cell transplant (HSCT) patients, which is listed as the sixth vital sign by the International Oncology Society. It is often manifested as anxiety and depression, post-traumatic stress disorder, sleep disorder, delirium, fatigue and other uncomfortable symptoms. At present, a large number of studies have been conducted on the influencing factors and intervention methods of HSCT patients' psychological distress. These studies suggest that female, age, pain, physical function, negative coping and low family social function are the influencing factors of psychological distress in HSCT patients. At the same time, the intervention methods of HSCT patients' psychological distress were reported, including psychobehavioural therapy, exercise therapy, music therapy, health education intervention and palliative care. These intervention methods have been proved to reduce patients' bad mood, improve psychological state, reduce the level of psychological distress and improve the quality of life of patients. This series of studies provides the basis and theoretical guidance for the implementation of nursing interventions for HSCT patients. At the same time, a multi-centre, large-sample longitudinal study should be conducted in China in the future to further clarify the influencing factors and mechanism of HSCT patients' psychological distress and explore a practical, safe and feasible intervention program. This paper reviews the above content through literature review.

Prediction of traumatic coagulation disease based on the concept of hemorrhagic coagulation failure

CHEN Shao-chuan, TONG Hua-sheng

2022, 20(4): 655-660. doi: 10.16766/j.cnki.issn.1674-4152.002423

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The treatment of severe trauma is a global problem. The deaths due to severe trauma accounts for about 10% of the total deaths every year, and the traumatic hemorrhage that caused by trauma-induced coagulopathy (TIC) accounts for 30%-40% of deaths in trauma patients. TIC is comprehensively induced by multiple factors and systems, and the prevention and treatment of TIC is one of the cores of the management of severe trauma or multiple injuries. The complicated mechanism makes the diagnosis and treatment of TIC not timely. The hemorrhagic coagulation failure believes that sever tissue damage and blood loss lead to shock hypoperfusion and oxygen debt, and a series of pathological reactions of the vascular endothelium initiates the occurrence of TIC. This paper attempts to establish a combination of indicators to predict the occurrence of TIC on the basis of this theory. By selecting relevant domestic and foreign literature, the important clinical indicators that involved in the process of blood coagulation failure and the impact of them on the occurrence and progress of TIC were reviewed. The injury severity score, hemoglobin changes, mean arterial pressure, shock index, lactic acid, pH, alkali excess, vascular endothelial glycocalyx, syndecan-1, thrombomodulin (TM) and von Willebrand factor(VWF) factors all have the potential value of evaluating the occurrence and development of TIC in patients. From the perspective of the mechanism of hemorrhagic coagulation failure understanding the mechanism of TIC followed severe tissue trauma, traumatic shock and tissue hypoperfusion and the vascular endothelial disease subsequently, can be used for the implementation of early diagnosis and even treatment of TIC, and also provide reliable combined indicators.

Significance of lymphocyte subset detection in immune function evaluation of children with nephrotic syndrome

LIU Yu-meng, AN Dong

2022, 20(4): 661-664. doi: 10.16766/j.cnki.issn.1674-4152.002424

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Primary nephrotic syndrome (PNS) is a common glomerular disease in childhood, and it is also the main cause of chronic renal failure. The pathogenesis of PNS remains unclear, but long-term studies have confirmed that it may be related to immune dysfunction. Lymphocyte subsets, an indicator of immune function, are of great significance in studying the pathogenesis, guiding treatment and predicting the prognosis of PNS. Decades ago, studies have confirmed that T lymphocyte subsets may be related to the pathogenesis of nephrotic syndrome. Many studies have also confirmed the dominant role of T lymphocyte-mediated cellular immunity in the pathogenesis of PNS. In recent years, Rituximab (CD20 monoclonal antibody) has been used to treat children with refractory nephrotic syndrome, especially in children with steroid-dependent and frequent relapse nephrotic syndrome. It suggests that the abnormal function of B lymphocytes may be related to the occurrence of childhood PNS. NK cells, a kind of immune cells in the human body, are also of great value for the prognosis of children with PNS. Children with lower NK cell levels are more likely to relapse and are more likely to have the risk of infection after hormone therapy. NK cells play an important role in the occurrence and development of PNS. This article mainly summarises T lymphocyte subsets, B lymphocytes and NK cells, and discusses their relationship with PNS.

Effect of Xiaoyao Powder and Banxia Houpu Decoction on cognitive function and event-related potential P300 in patients with liver depression and spleen deficiency depression

CHEN Ke-long, CHEN Ling, SONG Cheng-cheng, LI Bin

2022, 20(4): 665-668. doi: 10.16766/j.cnki.issn.1674-4152.002425

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Objective To observe the effects of Xiaoyao Powder and Banxia Houpu Decoction on cognitive function and event-related potential P300 in patients with liver depression and spleen deficiency depression. Methods Sixty patients with liver depression and spleen deficiency depression in Wenzhou Hospital of Traditional Chinese Medicine from April 2019 to October 2021 were randomly divided into study group and control group, with 30 patients in each group. The patients in the control group were treated with escitalopram tablets orally, whereas those in the study group were treated with Xiaoyao Powder and Banxia Houpu Decoction. Before and 8 weeks after treatment, the changes of depression and cognitive function were evaluated. The changes of event-related potential P300 and adverse drug reactions were observed. Results After 8 weeks of treatment, the Hamilton Depression Scale(HAMD) score of the study group [(12.67±1.62) points] was significantly lower than that of the control group [(15.37±1.42) points, t=6.838, P < 0.001]. The performances IQ (PIQ), verbal IQ (VIQ) and full intelligence quotient (FIQ) scores [(100.13±3.47) points, (104.57±3.04) points and (102.53±2.37) points, respectively] in the study group were significantly higher than those in the control group [(96.97±3.20) points, (102.37±2.85) points and (99.87±2.21) points, respectively, all P < 0.05]. The MQ scores [(77.77±3.32) points] in the study group were significantly higher than those in the control group [(73.27±3.04) points, t=5.468, P < 0.001]. The WCST score indexes of patients in the study group were significantly lower than those in the control group (all P < 0.05). The latency of event-related potential P300 in the study group was significantly lower than that in the control group, and the amplitude of event-related potential P300 was significantly higher than that in the control group (all P < 0.05). The incidence of adverse reactions in the study group (3.33%) was significantly lower than that in the control group (26.67%, χ²=4.706, P=0.030). Conclusion Xiaoyao Powder and Banxia Houpu Decoction can effectively reduce the severity of depressive symptoms in patients with liver depression and spleen deficiency depression, improve the recovery level of cognitive function and improve the neuroelectrophysiological status. They have high safety.

Application of transcutaneous electrical acupoint stimulation in improving nutrition, gastric motility and prognosis of patients with severe cerebrovascular disease

LU Le-miao, TIAN Xin

2022, 20(4): 669-672. doi: 10.16766/j.cnki.issn.1674-4152.002426

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Objective To explore the role of early transcutaneous electrical acupoint stimulation (TEAS) in improving the nutritional status, gastric motility and prognosis of patients with severe cerebrovascular disease (SCVD), so as to provide references for clinical application. Methods A completely randomized double-blind controlled clinical trial method was adopted, and 80 patients with SCVD admitted to Lishui Central Hospital from January 1, 2018 to December 31, 2020 were selected as the research objects, and they were randomly divided into the conventional treatment group (40 cases) and the early TEAS group (40 cases). The nutritional indexes [hemoglobin (HGB), albumin (ALB), total protein (TP) and blood glucose(GLU)], total intragastric residues, ICU stay time, activity of daily living (ADL) and NIHSS scores were compared between the two groups were compared. Results There were no intergroup, time and interaction effects between the two groups of patients with HGB and GLU indicators (all P>0.05), there was no significant difference between the two groups at each time point (all P>0.05). There were inter group effects on TP, ALB and total daily residues in the stomach(all P < 0.05). In the early TEAS group, the improvement of nutrition and gastric motility was more significant (all P < 0.05), there was time effect (all P < 0.05), and there was interaction effect between grouping and time (all P < 0.05). The ICU stay time in the early TEAS group was (16.80±6.69) d, which was significantly shorter than that in the routine treatment group [(13.05±6.06) d]. After 14 days of treatment, the ADL score and NIHSS score of patients in the early TEAS group were significantly improved (all P < 0.05). Conclusion Early TEAS treatment can effectively improve the nutritional status, gastric motility and prognosis of SCVD patients, and can be used for interventional therapy at the early stage of the disease. It is safe, effective, economical and easy to implement, and has great clinical application value.

Effect of Sanhuang Sanxian Decoction on cancer-related fatigue in patients with advanced breast cancer of spleen and kidney deficiency type

REN Li-li, YAO Qing-hua, CAO Wen-ming, HU Yi-juan, ZHANG Yong-jun, ZHANG Bo, CAI Hu

2022, 20(4): 673-677. doi: 10.16766/j.cnki.issn.1674-4152.002427

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Objective To observe the effect of Sanhuang Sanxian Decoction on cancer-related fatigue (CRF) in patients with advanced breast cancer of spleen kidney deficiency type and to provide reference for improving the quality of life of patients with advanced breast cancer. Methods Eighty cases of advanced breast cancer patients of spleen kidney deficiency type in Zhejiang Cancer Hospital from September 2019 to May 2020 were randomly divided into the control group (40 cases) and observation group (40 cases). The control group was given palliative chemotherapy and symptomatic treatment, whereas the observation group was treated on the basis of the control group in combination with Sanhuang Sanxian Decoction. The Karnofsky performance scale (KPS), traditional Chinese medicine (TCM) clinical symptom score, Piper Fatigue Scale scores, serum cytokines and T lymphocyte subsets were compared before and after treatment, and the adverse reactions were recorded. Results After treatment, the TCM clinical symptom score, Piper Fatigue Scale score and tumour necrosis factor-α and interleukin (IL)-4 levels in the observation group were lower than those in the control group, whereas the KPS score and interferon-γ and IL-2 levels in the observation group were higher than those in the control group (P < 0.05). After treatment, the CD4⁺, CD8⁺ and CD4⁺/CD8⁺ ratio in the observation group were better than those in the control group (40.30±11.21)% vs. (35.06±9.37)%, (15.30±3.29)% vs. (17.17±3.53)%, (2.52±0.48)% vs. (1.90±0.41)%, respectively, all P < 0.05. The incidence of adverse reactions in the observation group was lower than that in the control group (10.00% vs. 27.50%, P < 0.05). Conclusion Sanhuang Sanxian Decoction can effectively improve the clinical symptoms and quality of life of patients with advanced breast cancer of spleen kidney deficiency type, relieve CRF symptoms of patients with advanced breast cancer, reduce the level of inflammatory factors and improve the immune capacity of the body, and it is safe and effective.

Effects of rehabilitation treatment at different time points on neurological function in elderly patients with cerebral infarction

ZHANG Shu-hong, LING Ying-Chun, SHENG Gao-yang

2022, 20(4): 678-680. doi: 10.16766/j.cnki.issn.1674-4152.002428

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Abstract:
Objective To explore the effect of rehabilitation treatment at different time points on elderly patients with cerebral infarction and its impact on neurological function, so as to provide reference basis for the formulation of clinical rehabilitation treatment plan. Methods A total of 180 elderly patients with cerebral infarction treated in the Department of Neurology of Longyou People's Hospital from May 2018 to May 2021 were randomly divided into the observation group and control group, with 90 cases in each group. The two groups received rehabilitation treatment for 4 weeks within 2 weeks and 2-4 weeks after the patient's vital signs were stable. The National Institutes of Health stroke scale (NIHSS) score, Fugl-Meyer assessment (FMA) score, Barthel Index (BI) score, levels of inflammatory factors (interleukin-6, tumour necrosis factor-α, high-sensitivity C-reactive protein) and rehabilitation effect were observed in the two groups. Results The NIHSS score of the two groups decreased significantly after treatment (P < 0.05), with the observation group having a significantly lower score than the control group [(7.61±1.87) points vs. (8.95±2.09) points, P < 0.05]. After treatment, the FMA score of the two groups increased significantly (P < 0.05), with the observation group having a significantly higher score than the control group [(73.06±6.34) points vs. (64.15±4.78) points, P < 0.05]. The BI scores of the two groups increased significantly after treatment (P < 0.05), with the observation group having a significantly higher score than the control group [(68.35±6.83) points vs. (57.11±7.29) points, P < 0.05]. The levels of interleukin-6, tumour necrosis factor-α and high-sensitivity C-reactive protein of the two groups increased significantly after treatment (P < 0.05), and the observation group had lower levels compared with the control group (P < 0.05). The total effective rate of the observation group was 84.44%, which was significantly higher than that in the control group (71.11%, P < 0.05). Conclusion Rehabilitation treatment for elderly patients with cerebral infarction within 2 weeks after the stability of vital signs can improve neurological function, limb function and activities of daily living, reduce the level of inflammatory factors, and improve the rehabilitation effect.

Analysis on the current situation and related factors of learning motivation of nursing interns

DING Jin-xia, HU Zeng-lin, DONG Yun-ya, WANG Jin-fang, WANG Ji-nian

2022, 20(4): 681-684. doi: 10.16766/j.cnki.issn.1674-4152.002429

126 2

Abstract:
Objective To investigate the status of learning motivation of nursing interns and analyse the influencing factors. Methods A total of 518 nursing interns from a tertiary hospital in Anhui Province from November 2019 to January 2020 were selected as the research objects by convenience sampling method. A cross-sectional survey was conducted on 518 nursing interns by using the general information questionnaire, learning motivation survey scale, self-directed learning instrument and nursing clinical teacher effectiveness inventor. Results The total score of the learning motivation scale for nursing interns was (134.70±23.79) points, which was above the medium level. The results of univariate analysis showed that there were significant differences in the learning motivation of nursing students whether they were party members, educational background, whether nursing major was the first volunteer, whether they were engaged in this major in the future, the length of internship, why they chose this major, and whether they liked this major (all P < 0.05). There was a correlation between each dimension of learning motivation of nursing students and each dimension of autonomous learning ability and effective teaching behaviour of clinical teachers, and the difference was statistically significant (P < 0.01). Whether it is a party member, educational background, whether the nursing major is the first volunteer, whether to engage in this major in the future, the length of internship, why to choose this major, and whether to like the three dimensions were entered into the regression equation, which could explain 61.60% of the variation of learning motivation of nursing interns (P < 0.01). Conclusion The learning motivation of nursing interns is above the middle level and affected by their own understanding of nursing value and self-learning ability. The learning motivation of nursing students in practice needs to be constantly improved through interventions that develop autonomous learning ability, so as to achieve good results in practice.

Analysis on the incidence and related factors of ventilator-related pneumonia in a general hospital

LIU Yu-ling, XIA Hong-lin, ZHANG Hui-ping, LIU Jie, HAO Wei-min

2022, 20(4): 685-687. doi: 10.16766/j.cnki.issn.1674-4152.002430

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Abstract:
Objective To investigate the incidence and related factors of ventilator associated pneumonia (VAP) in the intensive care unit (ICU) of a general hospital, and guide the prevention and control of VAP. Methods Target monitoring of VAP was carried out in the ICU of a general hospital (including ICU, EICU and NICU) from 2017 to 2018. Patients on ventilator and patients with VAP were investigated. The occurrence of VAP, related factors and pathogen characteristics were analysed. SPSS 20.0 software was used to establish a multivariate logistic regression model and analyse the related factors of VAP. Results (1) The utilisation rate of ventilators in ICU patients was 33.58%, a total of 58 cases of VAP infection occurred, and the infection rate of VAP was 5.89‰. The use rate of ventilators in ICU patients in 2018 was lower than that in 2017, and the difference was statistically significant (P < 0.05). (2) Age (P < 0.001), cerebral haemorrhage (P=0.028), tracheotomy (P=0.009), length of stay in the hospital (P < 0.001) and length of ventilator use (P < 0.001) were risk factors for VAP, whilst age, tracheotomy and length of ventilator use were independent risk factors for VAP (OR>1, P < 0.05). (3) The top VAP-related pathogens were Acinetobacter baumannii (27, 58.62%), Klebsiella pneumoniae (17, 24.14%), Proteus mirabilis (4, 6.90%) and Pseudomonas aeruginosa (4, 6.90%). Conclusion The monitoring and prevention of VAP should be strengthened, and the risk factors should be focused to reduce the incidence of VAP.

Status and influencing factors of demoralisation syndrome in patients with pancreatic cancer

CAI Xi, ZHANG Hua-li, CHEN Jing-jing, WANG Zhao-hong, DONG Yong-mei

2022, 20(4): 688-690. doi: 10.16766/j.cnki.issn.1674-4152.002431

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Abstract:
Objective To understand the current situation and influencing factors of demoralisation syndrome in pancreatic cancer patients, and to provide theoretical basis for the formulation of intervention measures. Methods A total of 162 patients with pancreatic cancer admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to June 2021 were selected as the research objects by convenience sampling method. The general information questionnaire, Demoralization Scale, Perceived Social Support Scale and Self-Perceived Burden Scale were used to conduct the questionnaire survey. Results Patients with pancreatic cancer scored (35.45±11.93) points on the demoralization scale, (55.64±7.04) points on the perceived social support scale and (34.09±8.53) points on the self-perceived burden scale. There were significant differences in the demoralisation scores amongst pancreatic cancer patients with different age, gender, educational background, marital status, per capita monthly family income, disease stage and treatment methods (all P < 0.05). The results of Pearson correlation analysis showed that the total score of perceptive social support and the scores of all dimensions were negatively correlated with the scores of demoralisation syndrome (all P < 0.01), and the total score of self-perceived burden and the scores of all dimensions were positively correlated with the scores of demoralisation syndrome (all P < 0.01). The results of multiple linear regression analysis showed that education background, disease stage, self-perceived burden and perceived social support were the main influencing factors of demoralisation syndrome (all P < 0.05), which could explain 42.1% of the total variation. Conclusion Patients with pancreatic cancer have a high level of demoralisation syndrome, and targeted intervention measures should be taken according to patients' educational background, disease stage, self-perceived burden and understanding of social support, so as to alleviate the demoralisation syndrome and improve the quality of life of patients with pancreatic cancer.

Correlation between TCM constitution and polycystic ovary syndrome: a meta-analysis

CHEN Jin-ming, ZHANG Fen, DENG Jiao, WANG Wei-bin, CHEN Qi-liang, YU Jie

2022, 20(4): 691-695. doi: 10.16766/j.cnki.issn.1674-4152.002432

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Objective To summarise the research status of traditional Chinese medicine (TCM) constitution types and polycystic ovary syndrome (PCOS), and to explore the distribution of TCM constitution of PCOS patients, so as to provide evidence-based medical evidence for TCM prevention and treatment of PCOS. Methods The databases of CNKI, CQVIP, Wanfang Data, PubMed, Cochrane and Embase were searched, and all clinical research documents of TCM constitution types of PCOS were retrieved. Meta-analysis was carried out with Stata 16.0, and the effect values were expressed in terms of rate, ratio and 95% confidence interval. Results Twenty studies were included with 4 928 individuals. The results showed that phlegm-dampness, yang deficiency, qi stagnation and qi deficiency accounted for 15.8%, 14.1%, 12.5% and 12.1% of PCOS patients, respectively. Subgroup analysis by region showed that the proportion of phlegm-dampness, yang deficiency and special was the highest in Central China, blood stasis constitutions and qi deficiency were the highest in North China, qi stagnation and damp-heat constitutions were the highest in East China, and balanced constitution and yin deficiency were the highest in South China and West China. The comparison of constitution types between PCOS patients and the general population showed that phlegm dampness (OR=1.871, 95% CI: 1.109-3.156, P=0.019) and peace (OR=0.313, 95% CI: 0.208-0.472, P < 0.001). There was no significant difference in other constitution types. Conclusion Phlegm-dampness, yang deficiency, qi stagnation and qi deficiency are the main constitution types of PCOS patients. Phlegm-dampness is a risk factor of PCOS, and balanced constitution is a protective factor of PCOS.

Current status of 3D printing technology as a health communication medium

DENG Ying-yue, ZHAO Liang, JI Ying, CHEN Jing-xi

2022, 20(4): 696-699. doi: 10.16766/j.cnki.issn.1674-4152.002433

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Abstract:
The issue of communication in medical practice is a vital challenge confronting public health worldwide. How well different groups, including healthcare workers, patients and their families, communicate can directly affect the treatment progress, quality of medical services and well-being of patients. Recent years have witnessed a spurt of progress of science and technology. With its multi-disciplinary integrating advantages, 3D printing technology follows the trend of 'Internet Plus' in healthcare services, digital doctor-patient communication and personalised medical services. 3D printing technology is characterised by physical modalities: tangibility and appreciable, which enable itself to give full play to the superiority of the materialised medical information and then participate in interactions in reality. This explains how 3D printing technology successfully integrates into the health communication context. The increasingly closer integration of 3D printing technology of medical care prompts an intriguing branch: 3D printing technology' s function as a communication medium plays a vital role in health communication. On the basis of three major bibliographic databases (PubMed, CNKI, Web of Science), we chose' 3D printing (in Chinese)' or ' 3D printing' or ' 3D printing technology' and ' medical care' or 'health communication' or ' medical care (in Chinese)' or ' health communication (in Chinese)' or ' informed consent (in Chinese)' as the key words and searched related literature. The inclusion criteria were as follows: (1) the application of 3D printing technology in clinical practice; (2) the application of 3D printing technology in doctor-patient communication; (3) the application of 3D printing technology in medical education. The exclusion criteria were as follows: studies with similar contents. Results show that as a health communication medium for communication with visualisation, personification and precision, 3D printing technology enjoys potential advantages in mitigating the strained doctor-patient relationship against the specific context of China. Overall, this study examines the application prospects and communication potential of 3D printing technology in doctor education, patient health education, doctor-patient communication before operation and clinical communication of doctors and explores the feasibility and effectiveness of 3D printing technology as an effective communication medium in future health communication.

Clinical verification and application of the modified Waterlow scale

ZHANG Zhong, LI Qing, DENG Guo-ying, WANG Mei, ZHANG Yuan, LIN Ying

2022, 20(4): 700-703. doi: 10.16766/j.cnki.issn.1674-4152.002434

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Objective After simplifying the commonly used Waterlow scale, the modified version was obtained and clinically verified. Methods A total of 204 cases were analysed retrospectively by attribute reduction method, and the improved Waterlow scale was obtained. Afterward, from June to November 2019, 249 inpatients from Shanghai General Hospital were selected for a prospective study, Paired chi square test and area under the receiver operating characteristic curve (ROC) were used to compare the prediction effect of these two scales. Results When the optimal critical value of the modified Waterlow scale was 9.5 marks, it had good sensitivity (0.893) and specificity (0.963), and the maximum value of Youden index (sensitivity + specificity-1) was 0.856. Moreover, the area under the ROC curve of the modified Waterlow scale and the traditional Waterlow scale were 0.879 and 0.931, respectively (both >0.7). The rate of positive case detection was 60.24% for the modified Waterlow scale and 76.31% for the traditional Waterlow scale. The kappa test value was 0.737 (> 0.7), and the result of McNemar test was no statistical difference, which indicated that the consistency of these two scales is established (χ²=0.042, P=0.838). Moreover, no statistical difference was observed between these two scales. Conclusion The modified Waterlow scale has highly scientific. The detection efficiency is consistent with the traditional Waterlow scale, the prediction accuracy is high, and there are few evaluation items and easy to use, which can effectively improve the efficiency of nursing work.

Prevention of incontinence-associated dermatitis by standardised nursing based on the guidelines for prevention and control

RAO Qiao-ying, HE Shan, LI Hong, XIA Jun-li

2022, 20(4): 704-707. doi: 10.16766/j.cnki.issn.1674-4152.002435

144 3

Abstract:
Objective To explore the preventive effect of standardised nursing based on the clinical guideline for prevention and treatment of incontinence-associated dermatitis (IAD) in the ICU. Methods Between October 2019 and September 2020, 155 patients with urinary and faecal incontinence admitted to the ICU of Lishui Central Hospital were selected. Using the random number table method, they were divided into two groups: study group (79 cases) and control group (76 cases). The control group received routine nursing intervention, whereas the study group received standardised nursing intervention based on the clinical guideline for prevention and treatment of IAD. The occurrence of IAD, prognosis, complications and nursing satisfaction of the two groups were compared. Results The total incidence of IAD in the study group was 15.19%, significantly lower than 34.21% in the control group (P < 0.05). The skin lesion recovery time, length of ICU stay and total length of hospital stay of the study group were (2.78±0.56) days, (4.98±0.47) days and (7.52±1.32) days, significantly shorter than those of the control group [(6.45±1.12) days, (8.46±1.55) days and (9.82±1.97) days, respectively, t=25.950, 19.067, 8.569, all P < 0.01]. The nursing satisfaction of the study group (96.20%) was significantly higher than that of the control group (67.11%, P < 0.05). Conclusion Standardised nursing based on the clinical guideline for prevention and treatment of IAD can effectively prevent and control the occurrence of IAD and its related complications, and speed up the recovery of patients whilst improving nursing satisfaction.

Career calling and its influencing factors amongst oncology nurses in Anhui Province

SHEN Ming, QIAN Zhi-gang

2022, 20(4): 708-712. doi: 10.16766/j.cnki.issn.1674-4152.002436

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Abstract:
Objective To investigate the career calling of oncology nurses and its influencing factors, and to provide reference for improving the level of career calling of oncology nurses. Methods A two-stage sampling method was adopted from February 2020 to June 2020. In the first stage, 12 tertiary and first-class general hospitals were selected according to the typical sampling method. In the second stage, 440 oncology nurses who met the inclusion criteria were selected as the study subjects by cluster sampling. General data questionnaire, calling scale and McCloskey/Mueller Satisfaction Scale were used. Results The total score of career calling of oncology nurses was (42.01±8.08) points, the average score was (3.50±0.67) points, and the job satisfaction was (3.37±0.62) points. The t-test of two independent samples and one-way analysis of variance showed that there were statistically significant differences amongst different age groups, personnel status, working years, personal annual income and one-way commuting time scores (all P < 0.05). Regression analysis results showed that female, working years of 2-5 years, annual income of 40 000-80 000 yuan and one-way commuting time of 1.0-1.5 h were the main factors affecting career calling level, which accounted for 8.7% of the variation. Pearson correlation analysis showed that the career calling of oncology nurses was positively correlated with the average score of job satisfaction (r=0.660, P < 0.01) and each dimension (all P < 0.01). Conclusions The career calling level of oncology nurses in Anhui Province is medium, and gender, length of service, income and commuting of nurses all affect the career calling level. Suggestions: on the spiritual level, career calling training should be carried out, and objective occupational outlook should be established; on objective material, a reasonable salary and flexible scheduling system should be established; on career development, the principle of fairness should be adhered, and the opportunities for learning and promotion should be increased. In order to meet the self-realisation needs of oncology nurses, the sense of career calling should be stimulated, and job satisfaction should be improved.

Effect of nursing model based on the concept of homogeneous medical service on the mood and quality of life of patients with colorectal cancer stoma

ZHOU Jie, BAO Xiang-ying

2022, 20(4): 713-717. doi: 10.16766/j.cnki.issn.1674-4152.002437

78 0

Abstract:
Objective To explore the impact of the nursing model based on the concept of homogeneous medical service on the mood and quality of life of patients with colorectal cancer stoma in order to provide a reference for clinical colorectal cancer stoma care. Methods From April 30, 2017 to December 1, 2019, 120 patients with permanent colostomy for colorectal cancer in the Second Affiliated Hospital of Zhejiang University School of Medicine were selected. Amongst them, the patients admitted from April 30, 2017 to July 31, 2018 were set as the control group, and the patients admitted from August 1, 2018 to December 1, 2019 were set as the observation group, with 60 cases in each group. Patients in the control group were given routine nursing measures for colorectal cancer stoma, and patients in the observation group were given innovative nursing measures based on homogeneous medical services. The adverse emotion score, health hope level, quality of life, complications and nursing satisfaction were compared between the two groups before and after the intervention. Results After the intervention, the scores of patient health questionnaire-9 and generalised anxiety disorder-7 in the observation group [(10.53±2.27) points, (9.73±1.91) points] were significantly lower than those in the control group [(11.85±2.73) points, (11.03±2.03) points, all P < 0.05], and the scores of health hope inventory and quality of life in the observation group [(29.59±7.38) points, (60.02±6.73) points] were significantly higher than those in the control group [(25.69±5.87) points, (76.48±7.39) points, all P < 0.05]. During the intervention, the incidence of complications in the observation group was significantly lower than that in the control group (P < 0.05), and the nursing satisfaction was significantly higher than that in the control group (P < 0.05). Conclusion The implementation of homogeneous medical-based intervention care for patients with permanent colorectal cancer stoma can effectively alleviate patients' bad mood, improve the level of health hope and reduce the occurrence of stoma complications. It will help to promote the harmony between doctors and patients and has a positive effect in improving the quality of life of patients.

2022, 20(4): 718-720. doi: 10.16766/j.cnki.issn.1674-4152.002438

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Abstract:

Prognostic value of apolipoprotein A1 in elderly patients with ischemic cardiomyopathy and heart failure

ZHONG Chong-xia, LIU Yi-hai, FANG Qi-jun, SHA Du-juan, KANG Li-na, XU Biao, NI Jie

2022, 20(4): 546-549. doi: 10.16766/j.cnki.issn.1674-4152.002397

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Abstract:
Objective To observe the level of serum apolipoprotein A1 (apoA1) in elderly patients with ischemic cardiomyopathy and heart failure, and to explore the prognostic value of serum apoA1 in elderly patients with ischemic cardiomyopathy and heart failure. Methods Elderly patients with ischemic cardiomyopathy and heart failure hospitalized in the Cardiology Department of Nanjing Drum Tower Hospital from March 2018 to December 2019 were selected retrospectively. The end events were followed up by telephone. The patients were divided into two groups according to whether cardiac death occurred or not. The baseline data (age, gender, BMI, etc.), serological indexes (BNP, apoA1, HDL-C, etc.) and imaging indexes (echocardiography) of different subgroups were compared. Results A total of 105 patients were included, of which 9 cases (8.7%) had cardiac death during follow-up. The age, gender, blood pressure, heart rate, BMI, smoking and drinking history, complications and medication history were compared between the two groups. It was found that the mortality rate of patients with higher the New York Heart Association (NYHA) grade and digoxin medication history increased (P < 0.05), but there was no significant difference in the rest between the two groups. Univariate analysis showed that the increase of BNP and globulin and the decrease of HDL-C and apoA1 were possible prognostic factors in the group of cardiac death (P < 0.05). Multivariate logistic regression analysis showed that apoA1 was an independent risk factor for cardiac death (OR < 0.001, P=0.007). The patients were divided into low value group and high value group according to the level of apoA1. It was found that the low value group had a higher level of C-reactive protein (t=3.505, P < 0.01). The ROC curve of globulin, HDL cholesterol, apoA1, BNP was drawn together, and area under ROC curve was 0.863, indicating the preferable prediction effect of the model. Conclusion ApoA1 is an independent risk factor for cardiac death in elderly patients with ischemic cardiomyopathy and heart failure.

Effect and mechanism of low ENPP1 expression on the epithelial-mesenchymal transition of oral squamous cell carcinoma cell line

ZHU Qing-qing, SUN Chen, SUN Jian-li, GAO Zhen-jie

2022, 20(4): 550-554. doi: 10.16766/j.cnki.issn.1674-4152.002398

294 14

Abstract:
Objective To investigate the effect of low expression ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) on the epithelial-mesenchymal transition (EMT) in oral squamous cell carcinoma. Methods The normal human oral mucosal epithelial cell line and human oral squamous cell carcinoma CAL-27 cells were cultured and subcultured, the expression of ENPP1 mRNA was detected. CAL-27 cells in logarithmic growth stage were transfected and divided into blank group (without treatment), control group (transfected with NC-siRNA plasmid) and transfection group (transfected with ENPP1-siRNA). The expression of ENPP1 mRNA and protein were detected. CAL-27 cells in logarithmic growth stage were transfected and divided into group A (not transfected), group B (transfected with NC-siRNA plasmid) and group C (transfected with ENPP1-siRNA plasmid + MAPK agonist), group D (transfected with ENPP1-siRNA plasmid), group E (MAPK agonist). The proliferation activity, number of invasive cells, migration ability and protein expression of phosphorylated-mitogen activated protein kinase (p-MAPK) and phosphorylated-extracellular regulated kinase 1/2 (p-ERK1/2) were detected. Results Absorbance (A) of each period, group D < group C < group A, group B < group E (all P < 0.05). The number of invasive cells in five groups were (85.23±2.22) cells/field, (85.41±1.59) cells/field, (53.67±2.10) cells/field, (37.39±2.06) cells/field and (111.08±5.20) cells/field cells/field, respectively, group D < group C < group A, group B < group E (all P < 0.05). The percentage of scratch width: group E < group A, group B < group C < group D (all P < 0.05). The relative expression levels of p-MAPK, p-ERK1 and p-ERK2 proteins: group D < group C < group A, group B < group E (all P < 0.05). Conclusion Low expression of ENPP1 can inhibit EMT, the mechanism may be related to the inhibition of MAPK signaling pathway.

Comparison of the predictive value of three scoring methods in the diagnosis of acute pulmonary embolism

WANG Yue-yue, XU Qi-xia, YAO Yu-ting, WANG Hang, CHEN Lei

2022, 20(4): 555-559. doi: 10.16766/j.cnki.issn.1674-4152.002399

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Objective To examine the predictive value of YEARS algorithm in the diagnosis of acute pulmonary embolism and compare it with two traditional scores in order to find a more suitable scoring model for clinical suspected acute pulmonary embolism. Methods A retrospective analysis was performed on 676 inpatients admitted at the First Affiliated Hospital of Bengbu Medical College from April 2018 to December 2020 who had undergone computed tomographic pulmonary angiography (CTPA) examination due to clinical suspected acute pulmonary embolism. CTPA was used as the gold standard for the diagnosis of acute pulmonary embolism, and the predictive value of YEARS algorithm, simplified Wells score, modified Geneva score and combination of simplified Wells score with different D-dimer thresholds in the diagnosis of acute pulmonary embolism was compared. Results A total of 174 patients were diagnosed with pulmonary embolism by CTPA examination. The sensitivity and negative predictive values of the YEARS algorithm (89.66% and 90.72%) were higher than those of the simplified Wells scores (66.09% and 85.95%) and modified Geneva scores (62.07% and 83.33%). However, its specificity (35.06%) was lower than that of the simplified Wells (71.91%) and modified Geneva (65.74%) scores. The area under curve (AUC) of the simplified Wells score (0.690) was greater than that of the YEARS algorithm (0.624) and the modified Geneva score (0.639). The simplified Wells score had the highest diagnostic odds ratio (DOR, 4.99), followed by the YEARS algorithm (4.68) and the modified Geneva score (3.14). In addition, combining the thresholds of different D-dimers to simplify the Wells score, the results showed that combining the simplified Wells score with D-dimer ≥0.5 mg/L achieved the highest DOR(5.08). Conclusion The sensitivity and negative predictive value of YEARS algorithm are higher, but the diagnostic efficacy is slightly lower than that of the simplified Wells score. The simplified Wells score has the highest diagnostic efficacy, and combining the simplified Wells score with D-dimer ≥0.5 mg/L may help improve the efficacy of pulmonary embolism diagnosis.

Exploring the efficacy of percutaneous puncture of the posterior tibial vein access in the treatment of acute mixed unilateral lower extremity deep vein thrombosis

ZHANG Ming-zhao, LU Ran, XIANG Jun-yi, LI Bo, QIN Rong-qing, ZHANG Yu-bo, ZHOU Bing

2022, 20(4): 560-564. doi: 10.16766/j.cnki.issn.1674-4152.002400

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Abstract:
Objective To investigate the efficacy of percutaneous puncture of the posterior tibial vein of the affected calf segment under full fluoroscopy and catheter-contact thrombolysis via this approach in the treatment of acute mixed unilateral lower extremity deep vein thrombosis (DVT). Methods The clinical data of 60 patients with acute mixed unilateral lower extremity DVT admitted to Hangzhou Normal University Hospital from January 2017 to December 2020 were retrospectively analyzed, and all of them were treated with fluoroscopic percutaneous puncture of the posterior tibial vein access to the affected calf segment with indwelling catheters for thrombolysis. The circumference difference between the healthy and affected thighs and the circumference difference between the calves, limb swelling reduction rate, the venous patency score, the time consumed for catheter placement, the occurrence of complications and post-thrombotic syndrome (PTS) were compared to evaluate the treatment effect. Results The difference in circumference between the healthy and affected thighs after treatment was [(0.98±0.86) cm and (0.82±0.57) cm], which was better than that before treatment [(4.56±1.37) cm and (3.51±0.98) cm, all P < 0.01]. The rate of swelling reduction was (78.53±17.72) % in the thigh and (75.79±17.08) % in the calf. The post-thrombolytic venous patency score [1.0(0.0, 2.0) points] was better than the pre-thrombolytic score [5.0(5.0, 6.0) points, P < 0.01]. The mean time of cannulation consumption was (37.02±9.72) minutes. Two cases had extensive subcutaneous ecchymosis near the inguinal puncture site and 1 case had blood leakage from the calf sheath placement site. No serious complications such as bleeding from vital organs occurred. Patients were followed up for a mean of 10-14 months. Seven cases had mild swelling after activity, and 1 case recurred about 10 months after the procedure. Conclusion Thrombolysis by percutaneous puncture of the posterior tibial vein access catheter in the affected calf segment under fluoroscopy for acute mixed unilateral lower extremity DVT has the advantages of precise efficacy, simple operation, few complications, high patient comfort, convenient care, and low incidence of PTS, and is worthy of clinical application.

Effect of Panax notoginseng saponins on MPO activity and radiotherapy sensitivity of cervical cancer based on the HSP70 signalling pathway

ZHOU Tao-qi, CHEN Jun, ZHOU Xin, PANG Lin-rong, YANG Wei-li, XU Yong

2022, 20(4): 565-569. doi: 10.16766/j.cnki.issn.1674-4152.002401

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Abstract:
Objective To explore the effect of Panax notoginseng saponins (PNS) on myeloperoxidase (MPO) activity and radiotherapy sensitivity of cervical cancer based on the heat shock protein 70 (HSP70) signalling pathway. Methods The exponential growth against cervical cancer cell lines were randomly divided into cervical cancer radiotherapy (group A, n=6), low doses of PNS group (group B, n=6), high dose PNS group (group C, n=6), gold finches flavin group (group D, n=6). Another group of HeLa cells was taken and HSP70 inhibitor was added, which was recorded as group E (n=6). The expression of HSP70 protein was detected by immunohistochemistry, and MPO activity was detected by using a spectrophotometer. After radiotherapy, the activity of cervical cancer cells was detected by DAPI staining, MTT assay and chamber assay. Results The expression levels of HSP70 protein in groups A, B, C and D were 3.51±0.13, 2.33±0.12, 1.25±0.11 and 1.26±0.12, respectively, and the differences were statistically significant (F=21.090, P < 0.001). The expression of HSP70 protein, MPO activity, proliferation rate and invasion number of cells in groups B, C and D were significantly decreased (all P < 0.05), and those in group C were significantly lower than those in group B (all P < 0.05). However, there was no statistically significant difference between group D and group C (all P>0.05). Compared with group A, the apoptosis rate of groups B, C and D was significantly increased (all P < 0.05), and the apoptosis rate of group C was significantly higher than that of group B (all P < 0.05). Moreover, there was no statistically significant difference between group D and group C (P>0.05). Compared with group A, Bax protein expression in groups B, C, D and E was significantly increased (all P < 0.05), and Bcl-2 protein expression was significantly decreased (all P < 0.05). The expression of these proteins in group C was significantly changed compared with that in group B (all P < 0.05). No statistically significant difference was observed between groups E, D and C (all P>0.05). Conclusion Panax notoginseng saponins can significantly reduce MPO activity and improve radiotherapy sensitivity of cervical cancer, and the mechanism may be related to the negative regulation of the HSP70 signalling pathway.

Function and significance of serum ficolin-3 level in type 2 diabetes mellitus with peripheral neuropathy

CAO Jie-qiong, PEI Xiao-yan, HU Hong-yan, JIN Guo-xi

2022, 20(4): 570-573. doi: 10.16766/j.cnki.issn.1674-4152.002402

166 2

Abstract:
Objective To explore the relationship and significance of serum ficolin-3 level in type 2 diabetic peripheral neuropathy (DPN). Methods Eighty-eight T2DM patients who were hospitalised in the First Affiliated Hospital of Bengbu Medical College from October 2020 to May 2021 were selected and divided into the T2DM group (38 cases) and DPN group (50 cases) according to whether they were complicated with diabetic peripheral neuropathy. Another 30 healthy subjects were selected as the control group (NC group). Serum ficolin-3 levels were detected by enzyme-linked immunosorbent assay. Serum complement C3 concentration was determined by scattering turbidimetric method. The general biochemical indexes were detected by conventional methods. Results Ficolin-3 and C3 levels in the DPN group were lower than those in the T2DM and NC groups [ficolin-3: (19.19±3.37) ng/mL, (25.53±4.17) ng/mL, (24.57±4.19) ng/mL; C3: (0.95±0.39) g/L, (1.27±0.52) g/L, (1.24±0.28) g/L, all P < 0.05]. Pearson correlation analysis showed that ficolin-3 was positively correlated with C3 (r=0.223, P < 0.05) and negatively correlated with CRP and HOMA-IR (r=-0.254, -0.774, all P < 0.05). Binary logistic multifactor regression analysis showed that ficolin-3 levels (OR=0.686, 95% CI: 0.541-0.870), C3 levels (OR=0.205, 95% CI: 0.043-0.988) and the duration of diabetes (OR=1.158, 95% CI: 1.022-1.312) were independently correlated with DPN (P < 0.05). Conclusion Ficolin-3 may be involved in DPN by activating the complement pathway, aggravating inflammatory response and insulin resistance.

Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of isolated mediastinal and hilar lymphadenopathy

DING Qun-li, YANG Li, WANG Hai, CHEN Zhong-bo, GU Ye

2022, 20(4): 574-577. doi: 10.16766/j.cnki.issn.1674-4152.002403

235 0

Abstract:
Objective To analyse the distribution of aetiology of isolated mediastinal and hilar lymphadenopathy (IMHL) and investigate the diagnostic value and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods A total of 124 patients with thoracic CT examinations showing IMHL, which were examined at least once using EBUS-TBNA at the Shanghai Pulmonary Hospital, Tongji University Medical School and the Affiliated Hospital of Medical School of Ningbo University from August 2018 to January 2019, were retrospectively analysed, along with their pathology, cytology and microorganism results. Pathological study or follow-up visit was performed in the same period to make a final diagnosis, analyse the distribution of aetiology of IMHL and investigate the diagnostic value and safety of EBUS-TBNA. Results The study punctured 208 lymph nodes in total, with an average of 1.68 every case. Total 118 of 124 patients with IMHL obtained etiological diagnosis, with a diagnosis rate of 95.2%, including 43 cases of sarcoidosis (34.7%), 23 cases of lymph node tuberculosis (18.5%), 21 cases of neoplasms (16.9%), of which 11 cases were postoperative recurrence of pulmonary malignant tumors, 3 cases of lymphoma (2.4%), 28 cases of reactive hyperplasia of lymph nodes (22.7%), and 6 cases of unknown diagnosis. The diagnosis rate of neoplasms was 95.2%, that of tuberculosis was 82.6%, and that of sarcoidosis was 48.8%. The diagnostic accuracy of EBUS-TBNA was 72.6%, the specificity was 100.0%, and the negative predictive value was 50.0%. Conclusion The common causes of IMHL are sarcoidosis, tuberculosis and neoplasms. EBUS-TBNA is a safe, highly sensitive method that can be used to initially investigate patients with IMHL.

Predictive effect of HPV typing, SCC-Ag and NLR on lymph node metastasis of early cervical cancer

MA Mei, JIN Mao-sheng, YE Guo-liu

2022, 20(4): 578-582. doi: 10.16766/j.cnki.issn.1674-4152.002404

191 4

Abstract:
Objective To investigate the correlation between squamous cell carcinoma antigen (SCC-Ag), neutrophil to lymphocyte ratio (NLR) and clinicopathological characteristics of patients with early cervical squamous cell carcinoma, and discuss the predictive effect of HPV typing, SCC-Ag and NLR on lymph node metastasis of early cervical carcinoma. Methods A total of 302 patients with stageⅠA2-ⅡA cervical squamous cell carcinoma with serum SCC-Ag and routine blood tests before treatment in the First Affiliated Hospital of Bengbu Medical College from January 2018 to October 2020 were selected. Among them, 194 cases were identified with HPV type. The correlation between cervical cancer with HPV type and lymph node metastasis was analyzed. Univariate and multivariate analyses of the association between NLR and SCC-Ag and clinicopathological outcomes were performed in combination with patient-related cases. The ROC curve was drawn to determine the optimal truncation value of NLR and SCC-Ag for lymph node metastasis of early cervical squamous cell carcinoma, as well as the predictive effect of combined diagnosis on lymph node metastasis of early cervical carcinoma. Results Among 194 patients with HPV typing, the sensitivity and specificity of HPV16 positive for lymph node metastasis were 52.94% and 27.50%, respectively. Multivariate analysis showed that tumor size, invasion depth and lymph node metastasis were independent risk factors for SCC Ag titer>2.0 ng/mL, and lymph node metastasis was independent risk factor for NLR>1.753. ROC curve showed that the optimal cut-off value of SCC and NLR were 4.15 ng/mL and 1.900, respectively. There was no significant difference in positive rate between combined diagnosis and clinicopathological diagnosis (χ²=0.030, P=0.869). The specificity, positive likelihood ratio and negative likelihood ratio for combined diagnosis were 81.00%, 45.71% and 81.82%, respectively, which were relatively high. Conclusion Combined diagnosis has certain predictive value for early cervical cancer metastasis.

Comparison of clinical efficacy between zirconia and Co-Cr alloy porcelain endocrown in restoring molars with large coronal destruction

WANG Nan, HOU Ai-bing, FAN Peng, XING Tian, ZHANG Su-mei, ZHENG He-yun

2022, 20(4): 583-586. doi: 10.16766/j.cnki.issn.1674-4152.002405

219 1

Abstract:
Objective To investigate the clinical effect of zirconia and Co-Cr alloy porcelain endocrown in restoring molars with large coronal destruction. Methods Clinical data of 130 molars from 110 patients treated in the Department of General Dentistry of the Affiliated Stomatological Hospital of Anhui Medical University from June 2017 to December 2018 were selected and randomly divided into the zirconia and Co-Cr alloy porcelain endocrown groups. The zirconia endocrown group (Group A) with 67 molars (n=56) and the Co-Cr alloy porcelain endocrown (Group B) with 63 molars (n=54) were set using the random number table method. Follow-up was performed at 1 year after completion of restoration to evaluate the effect of the two types of material endocrown. The periodontal condition was compared between the two groups after 1-year treatment. Results During the 1-year recall period, 1 case of minor shortcomings in marginal adaptation and 1 case of slightly weak contact point without any restoration defect, tooth fracture and secondary caries were reported in the zirconia endocrown group. Meanwhile, 3 cases of minor shortcomings in marginal adaptation, 2 cases of slightly weak contact point, 1 case of restoration or tooth with slight defect and 1 case of secondary caries were reported in the Co-Cr alloy porcelain endocrown group. No statistically significant differences were found (all P>0.05). Periodontal probing depth, gingival sulcus bleeding index and gingival index were lower in group A than in group B [(2.08±0.10) mm vs. (2.14±0.14) mm; 0.12(0.04, 0.23) vs. 0.19(0.05, 0.34); 1.22±0.21 vs. 0.38±0.13, all P < 0.05]. Conclusion Zirconia endocrown is better than porcelain endocrown in restoring molars with large coronal destruction.

Comparative analysis on the clinicopathological characteristics and prognosis of left and right colon cancer at stage Ⅰ-Ⅲ

LIU Ya-kui, WANG Shuan-hu

2022, 20(4): 587-590. doi: 10.16766/j.cnki.issn.1674-4152.002406

141 7

Abstract:
Objective To compare and analyse the clinicopathological characteristics and prognosis of patients with colon cancer at different stages and locations after radical resection. Methods The clinicopathological data of 476 patients undergoing radical surgery in the First Affiliated Hospital of Bengbu Medical College from January 2011 to December 2015 were retrospectively analysed. According to the different tumour locations, they were divided into the left colon cancer group (LCC group, 257 patients) and right colon cancer group (RCC group, 219 patients). The clinicopathological characteristics and 5-year overall survival rate of the two groups were compared, and the prognostic relationship of colon cancer patients of different stages and locations was analysed. Results The proportion of males was higher than that of females (57.78% vs. 42.22%). Compared with the RCC group, the proportion of males in the LCC group was higher. The proportion of females in the RCC group was higher than that in the LCC group. Compared with the LCC group, the RCC group mainly had anaemia, abdominal mass, larger tumour diameters and moderately and poorly differentiated adenocarcinoma. The proportion of mucinous adenocarcinoma and signet ring cell carcinoma was high, the difference was statistically significant (P < 0.05). In the LCC group, haematochezia and changes in defecation habits were the first main clinical symptoms. There was no statistical difference between the two groups in terms of pTNM stage, pT stage and pN stage (all P>0.05). The 5-year overall survival rates of the LCC and RCC groups were 66.36% and 64.29%, respectively (P>0.05). In stage Ⅰ cancers, the 5-year overall survival rates of the LCC and RCC groups were 86.96% and 83.33%, respectively (P>0.05). In pTNM stage Ⅱ and Ⅲ cancers, the 5-year overall survival rates of the LCC group were 65.89% and 59.68%, respectively, whereas those of the RCC group were 76.64% and 44.16% (all P < 0.05), respectively. Conclusion There are differences between the clinical manifestations and pathological characteristics of LCC and RCC. There is no significant difference in the 5-year overall survival rate between the two groups. Through the analysis of subgroups, the prognosis of colon cancer patients of different stages and different parts is different.

Risk factors for adjacent segment refracture after percutaneous kyphoplasty

AN Zhong-cheng, CHEN Chen, DONG Li-qiang, WU Lian-guo, ZHU Yu-chen, WEI Hao

2022, 20(4): 591-593. doi: 10.16766/j.cnki.issn.1674-4152.002407

138 1

Abstract:
Objective To analyze the risk factors for adjacent segment refracture after percutaneous kyphoplasty (PKP), so as to reduce the incidence of adjacent segmental refracture in patients with osteoporotic vertebral compression fracture (OVCF) after PKP. Methods Total 438 patients with single-segment OVCF treated by PKP in the Department of Orthopedics of the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2016 to December 2017 were collected and analyzed retrospectively. The patients were divided into refracture group (32 cases) and non-fracture group (257 cases) according to the occurrence of adjacent segment fracture after PKP. The age, gender, body mass index (BMI), proportion of injured vertebrae in thoracolumbar segment, bone mineral density, bone cement injection volume, recovery rate of vertebral height, bone cement leakage, trauma during follow-up and bone mineral density during refracture in the two groups were analyzed by univariate analysis. The statistically significant factors were put into logistic regression to analyze their correlation with adjacent segment refractures after PKP. Results The follow-up data of 289 patients were complete and included in this study, the postoperative follow-up was 12 to 24 (13.5±0.9) months. Up to the last follow-up, 32 patients had new adjacent vertebral fractures. Univariate analysis showed that the refracture of adjacent segments was correlated with bone mineral density at the time of refracture and trauma during follow-up (P < 0.05). Multivariate logistic regression analysis showed that the bone mineral density at the time of refracture (OR=0.225) was the influencing factor of postoperative adjacent segment refracture (P < 0.01). Minor trauma during follow-up (OR=5.254) might be an important external factor leading to the occurrence of adjacent segment refracture (P < 0.01). Conclusion The main causes of adjacent segment refracture after PKP are severe osteoporosis and trauma during follow-up. Therefore, early postoperative waist protection, effective anti-osteoporosis treatment and avoidance of trauma are essential.

Efficacy of the treatment with ultrasonic debridement combined with RhEGF in patients with perianal abscess infection

XU Chao-hui, ZHOU Le, JIANG Sheng-hua, XU Bao-cai, SHEN Zhong

2022, 20(4): 594-597. doi: 10.16766/j.cnki.issn.1674-4152.002408

121 1

Abstract:
Objective To explore the efficacy of the treatment with ultrasonic debridement combined with recombinant human epidermal growth factor (RhEGF) in perianal abscess infection. Methods A total of 112 patients with perianal abscess infection admitted to Quzhou Hospital of Traditional Chinese Medicine, Zhejiang Province from Feb. 2019 to Feb. 2021 were selected and divided into ultrasound group (n=37), RhEGF group (n=37) and observation group (n=38) according to different treatment methods. Three group were given conventional antibiotics, the ultrasound group was treated with ultrasonic debridement, the RhEGF group was treated with RhEGF, and the observation group was treated with ultrasonic debridement combined with RhEGF. The clinical index level, pain degree, wound bacterial clearance rate and microcirculation index level were compared of three groups. Results The wound healing time and hospital stay in the observation group [(15.49±2.18) d, (15.53±2.06) d] were lower than those in the ultrasound group [(18.06±2.01) d, (18.52±1.73) d] and RhEGF group [(17.84±1.93) d, (17.98±1.85) d, F=18.291, 26.852, all P < 0.001]. The visual analogue scale score of 3 groups after treatment 1 d was lower than that before treatment (all P < 0.05), and the observation group was lower than that in the ultrasound group and RhEGF group (F=30.093, P < 0.001). The wound bacterial clearance rate of 3 groups after treatment 3 d was higher than that in after treatment 1 d (all P < 0.05), and the wound bacterial clearance rate after treatment 1 d and 3 d in the observation group were higher than those in the ultrasound group and RhEGF group (F=22.183, 31.650, all P < 0.001). The wound blood flow, percutaneous partial oxygen pressure and the level of serum epidermal growth factor of 3 groups after treatment 1 d were higher than those before treatment (all P < 0.05), and the observation group were higher than those in the ultrasound group and RhEGF group (F=4.406, 20.210, 51.552, the P value were 0.015, < 0.001, < 0.001, respectively). Conclusion Ultrasonic debridement combined with RhEGF is effective in the treatment of perianal abscess infection, which is helpful to the early recovery of patients.

Clinical characteristics and treatment of thrombotic thrombocytopenic purpura secondary to connective tissue disease

WANG Tian-tian, CAO Jun-jie, LIU Xu-hui, FAN Zheng, PEI Ren-zhi, LU Ying

2022, 20(4): 598-601. doi: 10.16766/j.cnki.issn.1674-4152.002409

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Objective To analyze the clinical characteristics and treatment of thrombotic thrombocytopenic purpura (TTP) secondary to connective tissue disease (CTD) and explored the treatments of TTP. Methods We retrospectively reviewed clinical manifestations, laboratory examinations and treatment, efficacy, and survival of 8 TTP patients secondary to CTD admitted to the Affiliated People ' s Hospital of Ningbo University from January 2014 to June 2017. Results All 8 patients with TTP were diagnosed with CTD for the first time. All patients presented with acute onset and atypical clinical presentation. ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13, ADAMTS13) activities were 0 and its inhibitors were positive. All the patients received the treatment of plasma exchange plus steroid (1-2 mg/kg). One patient ' s platelet count increased after treatment, and then gave up treatment. In rest 7 patients, the median time of platelet recovered to normal after treatment was 12 (4-18) days, ADAMTS13 activity returned to 100% and ADAMTS13 antibody turned negative in 1 month after the treatment. Seven cases received treatment with cyclosporine, azathioprine or cyclophosphamide later. Three patients received maintenance therapy with rituximab 100 mg every 3 months. Seven patients remained in hematologic remissions. Among them, the activity of ADAMTS13 decreased to 30% and its inhibitors were positive in 2 patients at 6 months after the treatment by routine monitoring. ADAMTS13 activity returned to normal adding a small dose of rituximab therapy after 1 month. Conclusion TTP secondary to CTD has an atypical clinical manifestations, high clinical suspicion or diagnosis of TTP, as soon as possible to improve ADAMTS13 activity and inhibitor determination, and small dose of rituximab combined with plasma exchange is given as early as possible. Low-dose rituximab maintenance therapy is given to reduce relapse.

Effect of anesthesia induction with esmketamine combined with cisatracurium in emergency cesarean section

ZHENG Li-hua, YANG Shu-fen, LAN Yun-ping, XU Chen-zhan, WU Xiao-min

2022, 20(4): 602-605. doi: 10.16766/j.cnki.issn.1674-4152.002410

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Abstract:
Objective To observe the effect of anesthesia induction with esmketamine combined with cisatracurium in emergency cesarean section, and to explore a safe and effective anesthesia method to provide reference for clinical practice. Methods A total of 120 emergency cesarean section parturients treated in Quzhou People ' s Hospital from January 2020 to December 2020 were randomly divided into control group and observation group. 60 cases in the control group were induced by remifentanil combined with cisatracurium anesthesia, and 60 cases in the observation group were induced by esmketamine combined with cisatracurium anesthesia. The Vital signs of the mother, postpartum pain score, neonatal condition, depression score and adverse reactions were compared between the two groups. Results There were significant differences in heart rate and mean arterial pressure between the two groups (all P < 0.05). The heart rate and mean arterial pressure at skin cutting and fetal removal in the two groups were higher than those before anesthesia (all P < 0.05). The heart rate at the end of operation in the observation group was lower than that in the control group (P < 0.05), and the average arterial pressure at the time of skin cutting, fetal removal and the end of operation were lower than those in the control group (all P < 0.05). There was significant difference in pain scores between the two groups (all P < 0.05). The pain scores at 6, 12, 24 and 48 hours postpartum in the two groups were higher than those at 2 hours postpartum (all P < 0.05). The pain scores of the observation group at 2, 6, 12, 24 and 48 hours postpartum were lower than those of the control group (all P < 0.05). The umbilical cord blood pH and Apgar score of newborns in the observation group were higher than those in the control group (all P < 0.05). The score of Edinburgh Postpartum Depression Scale in the observation group at 6 weeks postpartum was lower than that in the control group [(7.62±3.29) points vs. (10.07±4.63) points, P < 0.05]. The incidence of adverse reactions in the observation group (3.33%) was lower than that in the control group (13.33%, P < 0.05). Conclusion The application effect of anesthesia induction of esmketamine combined with cisatracurium in emergency cesarean section is good. It can stabilize maternal vital signs, reduce postpartum pain and depression, improve the situation of newborns, and has less adverse reactions.

Intravenous optimization effect of dexmedetomidine combined with low dose remifentanil on elderly patients undergoing hip arthroplasty

LIU Lu, LIANG Su-rong, PAN Zai-li, XU Huan-hang

2022, 20(4): 606-610. doi: 10.16766/j.cnki.issn.1674-4152.002411

158 1

Abstract:
Objective To investigate the anesthetic effect of dexmedetomidine (DEX) combined with low dose remifentanil on elderly patients undergoing hip arthroplasty with lumbar plexus-sciatic nerve block. Methods A total of 90 elderly patients undergoing hip arthroplasty in our hospital from July 2018 to July 2020 were randomly divided into group A, B and C, with 30 patients in each group. Group A was given DEX pump injection, group B was given small dose remifentanil pump injection, group C was given small dose remifentanil continuous pump injection combined with DEX pump injection, the injection dose was the same as that of group A and B. All groups were treated with lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulation 10 minutes after administration. Hemodynamics, analgesia and sedation effects were observed and compared in each group, and patients ' satisfaction with anesthesia effect was compared. Results After nerve block (T1), MAP of group B and C was significantly lower than that of group A (all P < 0.05). At 15min (T2), 30 min (T3) after operation and operation completion (T4), the MAP of group C was significantly lower than that of groups A and B (all P < 0.05), and that of group B was significantly lower than that of group A (all P < 0.05). At T2-T4, HR in group C was significantly lower than that in groups A and B (all P < 0.05). At T1-T4, RR in groups B and C was significantly lower than that in group A (all P < 0.05). At T1-T4, VAS score in group C was significantly lower than that in groups A and B (all P < 0.01). At T1-T2, BIS in group C was significantly lower than that in groups A and B (all P < 0.01), and BIS in group A was significantly lower than that in group B (all P < 0.05). At T3-T4, BIS in group B was significantly higher than that in group A and C (all P < 0.01). The anesthesia satisfaction of group C (96.67%) was significantly higher than that of group A (66.67%) and B (66.67%, χ²=9.017, P=0.003). Conclusion In elderly patients undergoing hip replacement under lumbar plexus-sciatic nerve block anesthesia, intraoperative administration of DEX combined with low-dose remifentanil continuous pumping can effectively maintain hemodynamic stability, and provide better analgesia and sedative effects, with small adverse reactions, which is worthy of clinical promotion.

Effect of goal-directed fluid therapy on short-term recovery of patients undergoing laparoscopic radical resection of rectal cancer

ZHENG Qun-yan, WU Qing-hua, JI Li-ting, ZHAN Lin-sen, DONG Gui-ling

2022, 20(4): 611-614. doi: 10.16766/j.cnki.issn.1674-4152.002412

166 0

Abstract:
Objective To analyse the short-term efficacy of goal-directed fluid therapy in patients undergoing laparoscopic radical resection of rectal cancer. Methods Eighty-four patients undergoing laparoscopic radical resection of rectal cancer in Quzhou People's Hospital from June 2019 to January 2021 were randomly divided into the control group (42 cases) and observation group (42 cases). The control group was given routine infusion, and the observation group was treated with goal-directed fluid therapy. The therapeutic effects of the two groups were compared. Results The intraoperative urine volume, the amount of lens solution, the amount of colloid solution and the total amount of fluid in the observation group [(367.19±113.80) mL, (1 307.14±332.68) mL, (869.48±245.13) mL, (2 368.50±515.34) mL] were lower than those in the control group [(489.80±145.28) mL, (1 535.62±408.69) mL, (1 060.54±276.39) mL, (2 876.80±664.16) mL], t=4.306, 2.810, 3.352, 3.919, all P < 0.05. The results of repeated measurement analysis of variance showed significant differences in mean arterial pressure, heart rate and regional cerebral oxygen saturation between the two groups (all P < 0.05). After operation, the CD4⁺ and CD4⁺/CD8⁺ levels in the observation group were higher than those in the control group, and CD8⁺ level was lower than that in the control group (all P < 0.05). The extubation time, first anal exhaust time, defecation time, half fluid feeding time and hospital stay in the observation group were shorter than those in the control group (all P < 0.05). Conclusion Goal-directed fluid therapy can effectively reduce the amount of fluid in and out of patients undergoing laparoscopic radical resection of rectal cancer, maintain the stability of hemodynamic indexes and have little impact on immune function.

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2022 Vol. 20, No. 4

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