2022 Vol. 20, No. 6

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Expert Forum
Construction and exploration of standardized diagnosis and treatment system of general practice of traditional Chinese medicine with SOAP interrogation and six meridian syndrome differentiation
YUAN Li, HUANG Zhe, LI Wei, YUAN Ai-hong
2022, 20(6): 903-907. doi: 10.16766/j.cnki.issn.1674-4152.002484
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Preliminary results have been achieved in general medicine teaching of traditional Chinese medicine (TCM). In clinical practice of general practice of traditional Chinese medicine, there are many puzzles in discipline characteristics and long-term development of general practitioners ' career in community hospitals and general hospitals. As one of the first bases of general medicine teaching of traditional Chinese medicine in Shanghai, the Department of General Medicine of Shanghai TCM-integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine has been established for 4 years and the road of discipline development has been explored. To introduce the preliminary construction of standardized diagnosis and treatment system in the Department of General Medicine of Shanghai TCM-integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. By sorting and analyzing its practical experience, we summarized five aspects including theoretical design, clinical practice, results, problems and deficiencies, next development direction. The theoretical design was the construction of standardized diagnosis and treatment system of general practice of traditional Chinese medicine taken SOAP interrogation and six meridian syndrome differentiation as a core. In clinical practice, it presented the clinical service process of the institute in the unit and the connotation of technology and service operation in each link. The achievements mainly included the changes in the number of patients, changes in the geographical distribution of patients, and the treatment process of patients which showed the gradual deepening and growth of the service. The problems mostly included the original innovative technology of the discipline and the dissemination of the discipline idea. The next development focused on the use of theory to accelerate practical exploration, and found three theoretical models on three aspects of influence construction, original technology research and development, and interaction of medical treatment, teaching and research.
The Doctor-Patient Relationship in United Kingdom General Practice(the end)
Rodger Charlton, MAO Jing, LIU Man-ling
2022, 20(6): 908-909.
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Sinicization, reliability and validity of the simplified Chinese Treatment Burden Questionnaire for chronic disease
LIN Kai, GUO Li-hong, HUANG Zhou-hong, CHEN Yong-song
2022, 20(6): 974-977. doi: 10.16766/j.cnki.issn.1674-4152.002502
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  Objective  To introduce and translate the chronic disease Treatment Burden Questionnaire (TBQ) in simplified Chinese and conduct a clinical validation study.  Methods  The original English version of the questionnaire was translated, cross-cultural adapted and verified in a clinical context.From June to November 2020, 352 patients with chronic diseases who were hospitalised and treated in community health centres in eastern Guangdong were selected as the research objects to carry out reliability and validity tests.The reliability was tested by Cronbach's α, Spearman-Brown value and retest reliability.The validity was tested by content validity, structure validity and convergence validity.  Results  The Chinese TBQ had a Cronbach's α of 0.91, Spearman-Brown value of 0.87 and retest reliability of 0.80.The CVI was 0.80-1.00.The structure validity was tested by Bartlett's test and calculated to be 2 466.45[P < 0.01, KMO=0.91(>0.80)].Exploratory factor analysis showed that the variance explanatory rates of the three common factors were 23.14%, 20.89% and 16.37%, respectively, and explained 60.40% of the total variance.Convergence validity analysis showed that there is significant correlation amongst global scores and quality of life, number of comorbidities and health status.  Conclusion  The simplified Chinese TBQ for chronic diseases has good reliability and validity.The questionnaire is simple, convenient and acceptable for clinical practice and research of the treatment burden amongst Chinese patients with chronic diseases and comorbidity.
Risk factors of cardiovascular disease in maintenance haemodialysis patients
GUO Jia-jia, MA Sheng-yin, LIU Li-hua, GAO Jun, GONG Feng
2022, 20(6): 978-981. doi: 10.16766/j.cnki.issn.1674-4152.002503
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  Objective  To study the risk factors of cardiovascular disease in maintenance haemodialysis patients.  Methods  A total of 126 patients in the uremic phase of chronic renal insufficiency who underwent maintenance haemodialysis in the haemodialysis unit of the Third Affiliated Hospital of Bengbu Medical College from January 2019 to October 2020 were retrospectively enrolled.They were divided into the cardiovascular complication group (n=74) and group without cardiovascular complications (n=52) according to whether the patients developed cardiovascular disease.The differences of general information and laboratory examination indexes between the two groups were compared, and the risk factors of cardiovascular disease in maintenance haemodialysis patients were analysed by binary logistic regression.  Results  Age, long dialysis age, serum uric acid, homocysteine, high sensitivity C-reactive protein and interleukin-6 levels were higher, whereas prealbumin, high-density lipoprotein cholesterol and serum magnesium levels were lower in the group with cardiovascular complications than in the group without cardiovascular complications (all P < 0.05).Binary logistic regression analysis showed that age, dialysis age, hyperhomocysteinemia, hyperuricemia, high levels of high-sensitivity C-reactive protein and interleukin-6 were independent risk factors for the development of cardiovascular disease in maintenance haemodialysis patients (OR=1.441, P=0.029;OR=2.212, P=0.019;OR=1.384, P=0.030;OR=5.056, P < 0.001;OR=3.163, P=0.013;OR=3.802, P=0.009).  Conclusion  Old age, long dialysis age, hyperhomocysteinemia, hyperuricemia, high levels of high-sensitivity C-reactive protein and interleukin-6 may be independent risk factors for cardiovascular disease in maintenance haemodialysis patients.
Application of ultrasound-guided sacral canal block in laparoscopic inguinal hernia surgery in children
ZHANG Guang-lei, ZHANG Ping, FENG Xue-hui, DUAN Rui, FAN Hui-min, CHENG Feng, HU Jun, LI Ren-hu
2022, 20(6): 982-985. doi: 10.16766/j.cnki.issn.1674-4152.002504
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  Objective  To investigate the role of sacral canal blocks in paediatric laparoscopic hernia surgery.  Methods  Ninety children (American Society of Anesthesiologist grade Ⅰ-Ⅱ, aged 1-8 years old) undergoing elective inguinal hernia repair in Lu'an people's hospital were divided into the control group (group C) and sacral canal group (D) by random number table method, with 45 cases in each group.Group D underwent sacral canal puncture after general anaesthesia intubation, and all patients were injected with 1 mL/kg of 0.2% ropivacaine after successful puncture, whereas group C did not have sacral canal block.The Narcotrend index (NI) was maintained at C2-D1(69-47) for both groups.The heart rate (HR) and mean arterial pressure (MAP) of children in both groups were evaluated before anaesthesia, 5 min after sacral block, at the beginning of surgery, at the end of surgery and at extubation.The children's face legs activity crying consolability (FLACC) scores were recorded at the time of extubation and 4, 8, 12, 16 and 24 h postoperatively.The postoperative agitation score, agitation incidence, nausea, vomiting and urinary retention was recorded.  Results  The FLACC pain scores of children in group D at tube drawing time[(3.75±0.71) points vs.(5.84±0.97) points], 4 h after operation[(3.02±0.50) points vs.(4.88±0.71) points]and 8 h after operation[(2.91±0.36) points vs.(4.53±0.75) points]were significantly lower than those in group C (all P < 0.05).When the children in group D woke up, their agitation score (2.44±0.54) and agitation incidence (6.67%) were significantly lower than those in group C[(3.29±0.69) points and 22.22%, all P < 0.05].There was no statistical significance in general situation, operation time, waking time, HR, MAP and postoperative adverse reaction incidence between the two groups of children (all P>0.05).  Conclusion  Sacral canal block can effectively reduce the incidence of waking agitation, which has excellent postoperative pain relief and can accelerate recovery after operation.
Effect of Yishen Quyu Decoction combined with Western medicine in the treatment of threatened abortion with uterine haematocele and its influence on ultrasound indexes
QIAN Yan-qing, SUN Yun
2022, 20(6): 986-989. doi: 10.16766/j.cnki.issn.1674-4152.002505
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  Objective  To study the effect of Yishen Quyu Decoction on threatened abortion with uterine haematocele, so as to provide basis for clinical treatment.  Methods  From January 2019 to June 2020, 126 patients with threatened abortion and intrauterine haematocele admitted in Wenzhou Traditional Chinese Medicine Hospital were selected and randomly divided into the Western medicine group (63 cases) and combined group (63 cases).The Western medicine group was treated with low-molecular-weight heparin combined with didroxyprogesterone, and the combined group was treated with Yishen Quyu Decoction and Western medicine.The traditional Chinese medicine (TCM) syndrome score, ultrasound index, pregnancy outcome, sex hormone, carbohydrate antigen 125(CA125) and inflammatory factor levels of the two groups were compared.  Results  After treatment, the main symptom and secondary symptom scores of the two groups were significantly decreased, and the scores of the combined group were lower than those of the Western medicine group (all P < 0.05).After treatment, the ultrasound indexes of the two groups were significantly improved.The end diastolic blood flow velocity (EDV) and peak systolic blood flow velocity (PSV) levels of the combined group were higher than those of the Western medicine group, and resistance index (RI) was lower than that of the Western Medicine group (all P < 0.05).After treatment, the levels of serum sex hormone and CA125 in the two groups were significantly improved.The levels of progesterone (P), estradiol (E2) and human chorionic gonadotropin (HCG) in the combined group were significantly higher than those in the control group, and the CA125 level in the combined group was lower than that in Western medicine group (all P < 0.05).After treatment, the levels of inflammatory factors in both groups were significantly improved.The levels of IL-4, IL-10, INF-γ and IL-2 in the combined group were lower than those in the Western medicine group (all P < 0.05).The success rate of foetus preservation in the combined group was 93.65%, which was only 80.95% in the Western medicine group (P < 0.05).  Conclusion  Yishen Quyu Decoction combined with Western medicine can significantly improve the clinical symptoms of threatened abortion patients with uterine haematocele, regulate the levels of serum sex hormones and Th1/Th2 cytokines, improve the blood supply of the uterine artery and reduce the CA125 level, and has a higher success rate of foetal protection.
Effects of magnesium isoglycyrrhizinate on liver function, T lymphocyte subset and CMV-DNA in infants with anicteric cytomegalovirus hepatitis
WANG Hong, GUO An-ying
2022, 20(6): 990-992. doi: 10.16766/j.cnki.issn.1674-4152.002506
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  Objective  To study the effect of magnesium isoglycyrrhizinate injection on liver function, T lymphocyte subsets and CMV-DNA in infants with anicteric cytomegalovirus (CMV) hepatitis.  Methods  A total of 60 infants with anicteric CMV hepatitis admitted to Ningbo Women and Children's Hospital from August 2017 to June 2020 were randomly divided into control group (n=30) and observation group (n=30).The control group was treated with reduced glutathione injection, whereas the observation group was treated with magnesium isoglycyrrhizinate injection for 2 weeks.The indexes of liver function, T lymphocyte subsets and CMV-DNA copies before and after treatment were compared between the two groups.The incidence of adverse reactions was also compared between the two groups.  Results  After treatment, the levels of ALT, AST and ALP in the observation group were significantly lower than those in the control group[(48.05±12.53) U/L vs.(72.34±20.60) U/L, (46.90±16.54) U/L vs.(81.35±22.36) U/L, (51.67±13.85) U/L vs.(80.21±16.39) U/L, t=5.518, 6.784, 7.285, all P < 0.001].The CD3+ and CD8+ levels were significantly lower in the observation group than those in the control group (all P < 0.001).The CD4+ and CD4+/CD8+ levels were significantly higher in the observation group than those in the control group (all P < 0.001).The copy number of CMV-DNA was significantly lower in the observation group than that in the control group (P < 0.001).The incidence of adverse reactions in the two groups were 20.00% and 13.33% respectively, with no significant difference (P=0.488).  Conclusion  Magnesium isoglycyrrhizinate is effective in the treatment of anicteric CMV hepatitis in infants, which can improve immune function and promote the recovery of liver function with less adverse reaction.
Analysis of the epidemiological characteristics and pathogenic detection results of hand, foot and mouth disease in a tertiary hospital in Wuhu City from 2020 to 2021
FANG Xu-lan, WANG Bing-song, LI Zhen, LAN Ting
2022, 20(6): 993-995. doi: 10.16766/j.cnki.issn.1674-4152.002507
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  Objective  To analyse the epidemiological and pathogenic characteristics of hand, foot and mouth disease in a tertiary hospital in Wuhu City from 2020 to 2021 and to provide a reference for the city to formulate prevention and control strategies for hand, foot and mouth disease.  Methods  Epidemiological analysis was performed on 200 samples of hand, foot and mouth disease, and pathogenic detection was performed by real-time fluorescent quantitative PCR.  Results  In 200 cases of hand, foot and mouth disease, the male-to-female ratio was 1.9:1.Scattered children under 3 years of age accounted for the highest proportion of the total number of people, and 81.0% were at high risk of contracting the disease.From 2020 to 2021, the pathogens of hand, foot and mouth disease in this city were mainly CoxA16(96 cases, 48.0%) and EV71(90 cases, 45.0%), showing a common epidemic situation.In terms of detection rate, throat swabs were the highest (38.5%), and herpes fluid was the lowest (29.0%).However, the detection rates of various viruses were relatively close (P>0.05).Among the 200 cases, 133 cases were normal type (66.5%) and 67 cases were severe syndrome type (33.5%).Compared with the normal type, the incidence of symptoms such as body temperature>39℃, arrhythmia, impatience, limb shaking and neck stiffness in severe group were significantly increased (all P < 0.05).  Conclusion  The distribution of hand, foot and mouth disease has certain differences in different populations, times and regions.CoxA16 and EV71 enterovirus types have become the dominant virus types of hand, foot and mouth disease.Therefore, it is necessary to further strengthen its pathogenic monitoring, and at the same time conduct related knowledge education to improve the doctor's ability to identify case manifestations.
Professional ability and influencing factors of COPD family long-term oxygen therapy of community medical staff in one community healthcare centre in Shanghai
WEI Li-jun, FU Hua, SHI Jian-wei
2022, 20(6): 996-999. doi: 10.16766/j.cnki.issn.1674-4152.002508
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  Objective  To explore the professional ability and influencing factors of family long-term domiciliary oxygen therapy of community medical staff, so as to provide theoretical basis for the community management and application of family oxygen therapy for chronic obstructive pulmonary disease (COPD).  Methods  A comprehensive questionnaire survey was conducted amongst the medical staff of one community health service centre in Shanghai from May to November 2020.The χ2 test and logistic regression were used to analyse the status and influencing factors of family oxygen therapy professional ability of community medical staff.  Results  The pass rate of family oxygen therapy professional knowledge of community medical staff was 73.60%.Analysis of the qualified rate in each item showed that there were significant differences amongst six items, including the function, principle, oxygen flow concentration and control range, high concentration of oxygen inhalation on COPD patients, daily oxygen inhalation time and judgment of oxygen therapy effect index (all P < 0.05).In total, the number of females was significantly higher than that of males (OR=3.300, P=0.003).The professional knowledge of public health (OR=0.250, P=0.009) and medical technicians (OR=0.103, P < 0.001) was generally weaker than that of clinicians.The 50-59 years old group (OR=0.179, P=0.005) was significantly lower than the young group.  Conclusion  There are some shortcomings in the professional ability of community medical staff in COPD long-term family oxygen therapy, especially for some medical staff with special characteristic.The application and management ability of community medical staff in COPD long-term family oxygen therapy should be improved through multiple channels and ways.
Analysis of assessment results of general practice clinical quality control in Yangpu District, Shanghai
JIANG Wei-ping, CHEN Yuan-hong, ZHANG Xiao-mang, HUANG Chen, YE Jian-hua, GU Jian-fei, JI Chen, SHEN Fei
2022, 20(6): 1000-1002. doi: 10.16766/j.cnki.issn.1674-4152.002509
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  Objective  To understand the assessment results of general practice clinical quality control in Yangpu District, Shanghai, consolidate the team of general practitioners and talent construction, improve the clinical ability of general practitioners, enhance general medical services.  Methods  The assessment data of 12 community health service centers in Yangpu District from November 2017 to November 2019 were collected, including general practice clinical thinking, SOAP (Subjective Objective Assessment Plan) medical history writing, routine skill operation, electrocardiogram reading diagnosis, X-ray diagnosis, common chronic disease management capabilities, the configuration of general practitioners, clinical capabilities of general practitioners, and general medical research capabilities.  Results  The number of general practitioners per 10 000 population in the district was 3.34, 3.36, and 3.32 in the three years.Among them, the proportion of general practitioners with intermediate titles and above was 83.12%, 88.70%, and 93.21%, respectively.The electrocardiogram reading and diagnosis ability score was 5.60 rose to 7.67(standard score of 10).Chronic disease management ability assessment scores were 9.71, 9.90, and 10.25(standard score of 15), respectively.In terms of general scientific research capabilities: 12 community health service centers undertook 15 municipal-level projects, 21 district-level projects, 11 college-level projects, 2 nursing district-level projects, 2 city-level and district-level projects for rehabilitation, 1 district-level public health projects, and 2 of them had no community-level projects within 3 years.About 50 papers were published each year, and the proportion of the core information science periodicals was less than 30%.  Conclusion  The number of general practitioners is relatively insufficient, and the clinical capabilities and general practice research capabilities are relatively weak.It is necessary to further improve and implement various general practice clinical quality control assessment and management systems and related standards, actively explore the construction and training of excellent general practice talents, improve the level of general medical care and scientific research capabilities, and assume the responsibility of the"gatekeeper"of residents'health.
Investigation and analysis of factors affecting anxiety and depression in patients with chronic obstructive pulmonary disease in general wards
ZHOU Xiao-ping, FANG Rong-hua
2022, 20(6): 1003-1006. doi: 10.16766/j.cnki.issn.1674-4152.002510
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  Objective  To investigate the current situation and factors of anxiety and depression in patients with chronic obstructive pulmonary disease in general wards and to provide scientific basis for targeted nursing interventions.  Methods  Participants were 178 chronic obstructive pulmonary disease patients who were included from the general ward of West China Hospital of Sichuan University during October 2017 to October 2020.The"Huaxi Emotional-distress Index"(HEI) scale developed by the Mental Health Center in West China Hospital of Sichuan University and the general situation questionnaire designed by the research team were used to screen the prevalence of anxiety and depression.HEI>8 points was determined as anxiety and depression.Demographic characteristics and HEI scores of the respondents were analysed, and multivariate logistic regression was adopted to analyse the influencing factors of anxiety and depression.  Results  Amongst 178 patients with chronic obstructive pulmonary disease, 80 cases (44.94%) had anxiety and depression.Age, disease stage, complications, body mass index, nutritional risk score, activity of daily living (ADL) score, education level and marital status were related to anxiety and depression (all P < 0.05), whereas gender and cost were not significantly correlated with anxiety and depression (all P>0.05).Multivariate logistic regression analysis suggested that ADL score and nutritional risk score were the main risk factors for anxiety and depression in these patients (all P < 0.05).  Conclusion  Anxiety and depression are common in patients with chronic obstructive pulmonary disease in the general ward.Low ADL and high nutritional risk are associated with higher risk of developing anxiety and depression.We suggest that clinical medical staff should pay more attention to these patients and identify and screen their influence factors early, so that targeted interventions can be taken to improve their prognosis and quality of life.
Diagnostic value of preoperative ultrasound combined with BRAF gene in lymph node staging in patients with papillary thyroid carcinoma
LEI Wei, LI Hui, MA Zhi-qiang
2022, 20(6): 1007-1011. doi: 10.16766/j.cnki.issn.1674-4152.002511
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  Objective  To investigate the difference in the preoperative diagnostic rate of papillary thyroid carcinoma (PTC) by using ultrasound combined with BRAF gene mutation detection, and to provide scientific and reliable imaging and molecular basis for the selection of surgical treatment and surgical method.  Methods  A total of 120 patients with PTC admitted to our hospital from January to October 2020 were retrospectively analysed.According to the American Joint Committee on Cancer thyroid cancer staging system standard, patients with PTC were divided into three groups: N0, N1a and N1b.All 120 patients underwent preoperative ultrasound examination and thyroidectomy, and the pathological diagnosis was the gold standard.PTC ultrasonography, gender, age, BRAF gene test results and Hashimoto's thyroiditis background were analysed between N0 and N1 groups and between N1b and non-N1b groups.Univariate and multivariate logistic regression analysis were used to compare the related factors that may affect PTC N staging.  Results  Amongst 120 PTC patients, 63 patients were pathologically diagnosed as N0 stage, 38 as N1a stage, 19 as N1b stage and 57 as N1 stage.Ultrasonic diagnosis showed that 57 cases were N0 stage, 45 cases were N1a stage, 18 cases were N1b stage, and 63 cases were N1 stage.Preoperative ultrasound assessment of N stage was consistent with pathological diagnosis, and the difference was statistically significant (Kappa=0.725, P < 0.05).There were significant differences in age, tumour diameter and BRAF gene mutation between N0 and N1 patients (all P < 0.05).There were significant differences between non-N1B stage and N1b stage patients in tumour diameter, multiple lesions and extracapsular invasion (all P < 0.05).Multivariate logistic regression analysis showed that age, tumour diameter and BRAF gene mutation were independent influencing factors for N0 stage and N1 stage (all P < 0.05), while tumour diameter>1 cm, multiple lesions and extracapsular invasion were independent risk factors for N1b stage (all P < 0.05).  Conclusion  Combined with ultrasound examination, age, tumour diameter, BRAF gene, multiple lesions and extracapsular invasion, clinical-related influencing indicators are correlated with N stage of PTC.Preoperative ultrasonography can be used to evaluate PTC N staging, which is helpful to assist clinical diagnosis and treatment.
The value of color Doppler ultrasound in screening cataract patients
GUO Juan-juan, JIANG Sheng-qun, LIU Chao, HU Jun-yan, SUN Yi-xue
2022, 20(6): 1012-1015. doi: 10.16766/j.cnki.issn.1674-4152.002512
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  Objective  To retrospectively analyze the difference of color Doppler ultrasound (color ultrasound), A-mode ultrasound (A ultrasound) and intraocular lens biometric instrument (IOLMaster 700) in preoperative ocular axis measurement of cataract patients, and explore whether color ultrasound and A ultrasound can replace IOLMaster 700.  Methods  A total of 100 senile cataract patients (100 eyes) who received cataract surgery in the Department of Ophthalmology of the First Affiliated Hospital of Bengbu Medical College from May 2020 to May 2021 were selected.All the enrolled patients underwent preoperative IOLMaster 700, A ultrasound and color ultrasound, and the axial length of both eyes (AL) of the same patient was measured and repeated for 5 times to obtain the average value.The AL values measured by IOLMaster 700, A ultrasound and color ultrasound were observed and compared.  Results  The AL measured by IOLMaster 700 was 23.75(22.91, 24.36) mm, the AL measured by A-ultrasound was 23.75(22.93, 24.36) mm, and the AL measured by color ultrasound was 23.80(22.98, 24.40) mm.The intra-group correlation coefficient ICC of the three devices was 0.998.The intra-group correlation coefficient (95%CI) was 0.997-0.999, indicating high consistency among the three devices.The Pearson correlation analysis showed that IOLMaster 700 was positively correlated with the AL value of Aultrasound measurement (r=0.999, P < 0.001).There was a positive correlation between IOLMaster 700 and AL value measured by color ultrasound (r=0.992, P < 0.001).There was a positive correlation between the AL values measured by A ultrasound and color ultrasound (r=0.994, P < 0.001).Blandaltman scatter results showed that the AL data of pairwise comparison between the three devices were in good agreement within the 95% difference range.  Conclusion  There was no significant difference between color Doppler ultrasound, Amode ultrasound and IOLMaster 700 in ocular axis measurement.Color Doppler ultrasound has high application value in preoperative screening of cataract patients in primary hospitals, and can be routinely used in preoperative ocular axis measurement of cataract.
Application value of transcranial Doppler ultrasound foaming test in screening cryptogenic stroke caused by patent foramen ovale
MAO Ying, WANG Fang, CHI Ju-fang, ZHONG Fang-fang
2022, 20(6): 1016-1018. doi: 10.16766/j.cnki.issn.1674-4152.002513
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  Objective  To analyse the application value of transcranial Doppler ultrasound foaming test (C-TCD) in screening cryptogenic stroke (CS) caused by patent foramen ovale (PFO).  Methods  A total of 204 patients with CS treated in Shaoxing People's Hospital from January 2017 to June 2021 were examined by C-TCD and transoesophageal echocardiography (TEE), and the positive detection rate of PFO was compared. According to the PFO detection of C-TCD, the positive patients were included in the positive group, and the negative patients in the negative group. The microbubble signal classification of the patients in the positive group was analysed, and the imaging characteristics of the vascular distribution areas (anterior circulation, posterior circulation, combined anterior and posterior circulation, anterior cerebral artery, middle cerebral artery and vertebrobasilar artery) and each region were compared between the two groups.  Results  The positive rate of PFO in C-TCD was 55.39% (113/204), which was higher than that in TEE (42.65%, 87/204, P < 0.05). A total of 113 cases of PFO were positive in C-TCD, including 26 cases of grade 0 (23.01%), 34 cases of grade Ⅰ (30.09%), 27 cases of grade Ⅱ (23.89%) and 26 cases of grade Ⅲ (23.01%). There was no significant difference in the distribution of anterior circulation, posterior circulation, combined anterior and posterior circulation, anterior cerebral artery, middle cerebral artery and vertebrobasilar artery in the positive and negative groups (P>0.05). The detection rate of cortical/subcortical area in the positive group was 57.52%, which was higher than that in the negative group (27.59%), P < 0.05. The detection rate of deep grey matter in the positive group was 22.12%, which was lower than that in the negative group (40.23%), P < 0.05. The detection rate of infratentorial area in the positive group was 14.16%, which was close to that in the negative group (16.09%), P>0.05.  Conclusion  C-TCD has a certain application value in the screening of CS caused by PFO. Patients' lesions are mostly distributed in cortical/subcortical areas, which can be used as a means of screening the aetiology of CS.
Correlation analysis of serum glycosylated haemoglobin, interleukin-6 and cystatin C with GFR in elderly patients with diabetic nephropathy
WANG Li-zhi, HUANG Ruo-fei, LYU Mei-yan, TIAN Yuan
2022, 20(6): 1019-1021. doi: 10.16766/j.cnki.issn.1674-4152.002514
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  Objective  To investigate the correlation of serum glycosylated haemoglobin (HbA1c), IL-6 and cystatin C (CysC) with the glomerular filtration rate (GFR) in elderly patients with diabetic nephropathy.  Methods  A total of 78 elderly patients with diabetic nephropathy who were treated in Yongkang First People's Hospital from January 2020 to June 2021 were selected as the observation group, and 77 elderly patients with simple diabetes who were treated in our hospital during the same period were selected as the control group. During the same period, 80 persons who underwent physical examination and were confirmed to be healthy were regarded as the healthy group. The levels of HbA1c, IL-6 and CysC and GFR were analysed in the three groups. GFR was determined by renal dynamic imaging method. The levels of various indexes in different stages of the observation group were compared. The correlation between the levels of HbA1c, IL-6 and CysC and GFR was further analysed.  Results  In the observation group, the HbA1c, IL-6, CysC and GFR were (8.15±1.94) %, (40.37±11.79) ng/L, (3.25±1.06) mg/L, (49.64±6.54) mL/min, respectively. In the control group, the HbA1c, IL-6, CysC and GFR were (7.24±1.15) %, (14.22±65.98) ng/L, (1.52±0.55) mg/L, (103.21±4.85) mL/min, respectively. In the healthy group, the HbA1c, IL-6, CysC and GFR were (5.16±0.33) %, (10.70±3.22) ng/L and (0.86±0.22) mg/L, (123.43±3.18) mL/min, respectively. The levels of HbA1c, IL-6 and CysC in the observation group were significantly higher than those in the other two groups. The levels of these indexes in the control group were higher than those in the healthy group (P < 0.05). The GFR in the observation group was significantly lower than those in the other two groups (P < 0.05). The GFR in the control group was lower than that in the healthy group (P < 0.05). With the increase of clinical stage, the levels of HbA1c, IL-6 and CysC gradually increased, and the GFR gradually decreased, and the differences between groups were statistically significant (all P < 0.05). The levels of HbA1c, IL-6 and CysC were negatively correlated with GFR levels in patients with diabetic nephropathy (r=-0.537, -0.838, -0.709, all P < 0.05).  Conclusion  The levels of HbA1c, IL-6 and CysC in patients with diabetic nephropathy are negatively correlated with the level of GFR. In clinical work, the levels of HbA1c, IL-6 and CysC can be measured to evaluate the patient's condition.
Research progress of rehabilitation effect and mechanism of traditional Chinese and Western medicine on skeletal muscle injury after stroke
HONG Xing, LI Rui, WEI Lu-gang, ZHANG Ping, ZHANG Peng-yue, LU Jing-yi
2022, 20(6): 1022-1026. doi: 10.16766/j.cnki.issn.1674-4152.002515
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Stroke is a disease in which a blood vessel in the brain bursts or a blockage causes damage to brain tissue. Stroke is the second leading cause of death in the world and the main cause of disability, resulting in about 5.5 million deaths every year. About 60% of patients are disabled after stroke, bringing a great burden to their families and society. At present, the treatment of stroke focuses on restoring cerebral blood supply and treating nerve damage caused by stroke, but studies on the treatment of peripheral system disorders caused by stroke are relatively few. As the peripheral functional organ is affected by stroke, the damage of the nervous system after stroke will lead to muscle denervation, resulting in hemiplegia or decreased muscle strength. Lack of nerve innervation makes the muscle unable to produce the muscle strength required for movement, so daily tasks may not be completed. Various secondary changes occur in skeletal muscle during the whole process, including skeletal muscle weakness, skeletal muscle spasm and skeletal muscle atrophy, leading to limb dysfunction. Studies on the mechanism of skeletal muscle changes confirmed that skeletal muscle structure and metabolism change significantly after stroke, amongst which abnormal neuromuscular junction function, increased inflammatory markers in skeletal muscle, degradation of skeletal muscle protein and phenotypic transformation of muscle fibres are closely related to skeletal muscle dysfunction after stroke. Therefore, skeletal muscle repair and functional recovery after stroke are critical. Existing rehabilitation therapy showed that skeletal muscle recovery after stroke has a good repair effects, such as reducing the expression of inflammatory cytokines, recovery of neuromuscular connection link, strengthening the peripheral and central link and promoting the growth of muscle fibre, to achieve the recovery of limb function. In this paper, the rehabilitation of skeletal muscle after stroke was reviewed, and the relevant mechanisms were elucidated to provide a reference for the rehabilitation of skeletal muscle on the affected side after stroke.
Research progress on the molecular mechanism of panax notoginseng saponins against ischemic stroke
FANG Bin-yu, ZHU Ting, ZHANG Shu-xia, SUN Xiao-bo, SUN Gui-bo, YU Lei
2022, 20(6): 1027-1030. doi: 10.16766/j.cnki.issn.1674-4152.002516
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Stroke has a high recurrence rate, high disability rate and high fatality rate. Ischemic stroke is a common type of stroke, accounting for 70% of the incidence of stroke, it is a risk factor that reduces the life expectancy of Chinese residents. The pathological mechanism of ischemic stroke is complex, and previous neuroprotective methods are limited to a single mechanism. Such drugs cannot fully inhibit the complex pathophysiological cascade of patients with ischemic stroke. Drugs derived from natural products contain complex chemical components and can act on different targets of the disease at the same time. Therefore, the use of traditional Chinese medicine to combat ischemic stroke remains the current focus of research and development. The traditional Chinese medicine panax notoginseng has a long history of medicinal use. It is derived from the dry roots and rhizomes of panax notoginseng, a plant belonging to the family Araliaceae. Saponins include glycol-type ginsenosides, triol-type ginsenosides and special types of saponins. Panax notoginseng saponins have a definite protective effect on ischemic stroke. It has been reported that they can inhibit calcium overload, anti-oxidative stress, anti-inflammatory, anti-pyrolysis and anti-apoptosis agents, repair the blood-brain barrier, promote angiogenesis, and regulate intestinal flora. At the same time, panax notoginseng saponins have shown a synergistic effect in the combined application with astragaloside IV, geniposide, salvia polyphenolic acid and borneol. Panax notoginseng saponins have shown potential application value and great value in the prevention and treatment of stroke, indicating their prospects for the development of medicinal use. Therefore, we will summarise the three aspects of the saponin chemical components in notoginsenosides, the pharmacological effects of panax notoginseng saponins against ischemic stroke and the combination of notoginsenosides against ischemic stroke.
Research advances of common gynaecological diseases in twin cohorts
ZHAO Zi-chen, ZHU Lan
2022, 20(6): 1031-1035. doi: 10.16766/j.cnki.issn.1674-4152.002517
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Twin study is an economical and effective method to analyse genetic and environmental factors in complex diseases. It is extensively used to explore the aetiology of many diseases. The heritability of diseases has been analysed by comparing the phenotypes of monozygotic twins and dizygotic twins in a classical twin study. With the development of molecular biology, the combination of twin study and omics is becoming an emerging and promising method. The study of twin pairs with inconsistent disease phenotypes is a powerful improvement to the traditional case-control study. In the area of gynaecology, Western countries have used the twin study to analyse the aetiological characteristics of several common gynaecological diseases in the Caucasian population, including pelvic floor disease, uterine leiomyoma, endometriosis, polycystic ovary syndrome, and some other diseases. The main findings include the following: in stress urinary incontinence and pelvic organ prolapse, environmental factors contribute more than genetic factors; genetic factors have a greater impact on the incidence of uterine fibroids than environmental factors; the random environmental effects have a great impact on endometriosis, amongst which infertility is closely related to endometriosis; genetic factors are important in the aetiology of polycystic ovary syndrome; and female orgasmic disorders have a genetic basis, etc. However, no twin study of gynaecological diseases in Asian populations has been conducted. The Chinese National Twin Registry has recruited more than 20 000 pairs of female twins. In combination with molecular biological methods, we believe that a breakthrough in understanding common gynaecological diseases in China will occur and provide better clinical guidance. The main difficulties in the future will be the expansion and long-term maintenance of the twin cohort.
Effect of repetitive transcranial magnetic stimulation of different frequencies on the cognition and movement of stroke patients
MAO Jing, HONG Yong-feng, FENG Xiao-jun, TANG Xiao-xiao, ZHANG Jin-niu, KAN Xiu-li, SHEN Xian-shan, WU Jian-xian
2022, 20(6): 1036-1040. doi: 10.16766/j.cnki.issn.1674-4152.002518
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  Objective  To compare the effects of different intensities of repetitive transcranial magnetic stimulation (rTMS) on cognition and movement in patients with cognitive impairment after stroke.  Methods  A total of 63 stroke patients who were hospitalised in the Department of Rehabilitation Medicine of the Second Hospital of Anhui Medical University from October 2018 to March 2020 were included. They were randomly divided into three groups (22 cases in control group, 20 cases in low-frequency group and 21 cases in high-frequency group). The control group was treated with routine rehabilitation training. One Hz rTMS treatment was added to the low frequency group. Ten Hz rTMS treatment was added to the high frequency group. The duration of the above treatment was three weeks. The patients were evaluated using the Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Fuel-Meyer assessment(FMA) and modified barthel index (MBI) before and after treatment.  Results  The scores of MOCA, MMSE, FMA and MBI in the three groups were significantly higher than those before treatment (all P < 0.05). After treatment, the total scores of the high-frequency and low-frequency groups were better than those of the control group (all P < 0.05). Before and after treatment, there were significant differences in MOCA difference [(6.71±1.76) points vs. (4.85±2.03) points], MMSE difference [(3.05±1.07) points vs. (2.10±1.02) points], FMA difference [(7.52 ± 2.36) points vs. (5.30±3.25) points] and MBI difference [(10.00±4.74) points vs. (6.25±3.58) points] between high frequency group and low frequency group (all P < 0.05). The scores of visual space, executive function and orientation ability in the high-frequency and low-frequency groups before and after treatment were statistically significant (all P < 0.05). There was a significant positive correlation between the difference of MOCA and FMA after treatment (high-frequency group r=0.906, low-frequency group r=0.902, control group r=0.886, all P < 0.01).  Conclusion  Routine rehabilitation training combined with high-frequency or low-frequency rTMS can effectively improve patients ' cognition, movement and self-care ability, amongst which routine rehabilitation combined with high-frequency rTMS has the best effect. The cognitive and movement functions of stroke patients promote each other.
Effect of neuromuscular activation technology based on suspension therapy on motor function of stroke patients with hemiplegia
LIU Ying-jiao, ZHANG Hong, CHEN Ai-lian, FU Wen-jun
2022, 20(6): 1041-1044. doi: 10.16766/j.cnki.issn.1674-4152.002519
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  Objective  To explore the clinical effect of neuromuscular activation technology based on suspension therapy on motor functions such as trunk control, gait and balance in stroke patients with hemiplegia.  Methods  A total of 80 patients with hemiplegia after stroke hospitalized in the Rehabilitation Medicine Department of Hunan Provincial People's Hospital from January to November 2019 were randomly divided into control group and observation group, with 40 cases in each group. The control group was received routine rehabilitation training, while the observation group was given neuromuscular activation technology based on suspension therapy. The patients' balance, trunk control, lower limb motor function, balance, quality of life, as well as the temporal and spatial parameters of lower limb gait during walking were evaluated before and after training.  Results  After treatment, the balance ability, trunk control ability, lower limb motor function and walking function in the observation group [(37.61±4.36) points, (83.41±8.61) points, (80.71±9.19) points, (3.86±0.23) points] were higher than those in the control group [(34.86±4.11) points, (76.83±7.36) points, (72.37±9.57) points, (3.66±0.34) points, all P < 0.05]. The scores of quality of life in the observation group were higher than those in the control group (all P < 0.05). The gait speed, gait frequency and stride length of gait spatiotemporal parameters in the observation group were higher than those in the control group (all P < 0.05). The stride period and the proportion of support phase in the observation group were lower than those in the control group (all P < 0.05).  Conclusion  The neuromuscular activation technology based on suspension therapy can effectively optimize the gait function of stroke patients with hemiplegia, improve their trunk control ability, balance ability, walking ability and quality of life, which is worthy of clinical promotion.
Application and effect evaluation of integrated medicine-oriented teaching mode in gastroenterology teaching
MA Zhen-zeng, SHOU Guang-li, GU Lin, ZHU Yu, YAN Shan-jun, WANG Qi-zhi, DENG Min, WANG Jian-chao, ZHAO Rui, WANG Meng
2022, 20(6): 1045-1048. doi: 10.16766/j.cnki.issn.1674-4152.002520
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  Objective  Digestive diseases are so complex that the traditional method of teaching cannot easily improve the level of students' learning and problem-solving ability in clinical practice. The purpose of this study is to investigate the application and evaluate the effect of integrated medicine-oriented teaching mode in gastroenterology teaching.  Methods  From January 2021 to December 2021, 140 medical students practicing in the gastroenterology department were included as research subjects and randomly divided into the control (n=70) and experimental groups (n=70). The control group was given the same teaching content of the experimental group via traditional teaching method. However, the experimental group was taught with integrated medicine as the guiding ideology. The results were analysed via theoretical examination of digestive diseases and medical record analysis and mini-CEX, and questionnaire was used to evaluate students' teaching effect and satisfaction.  Results  The scores of theoretical examination and medical record analysis in the experimental group were (45.16±4.37) points and (42.71±5.05) points, respectively. However, those in the control group were (43.57±3.81) points and (40.44±4.32) points, respectively. The scores in the experimental group were higher than those in the control group (all P < 0.05). For the mini-CEX test, the scores of the experimental group, including medical history collection, physical examination, disease diagnosis, doctor-patient communication skills, humanistic care, organisational efficiency and overall performance, were higher than those in the control group (all P < 0.01). The results showed that there were 29 very satisfied and 35 satisfied persons in the experimental group, respectively; while there were 20 very satisfied and 29 satisfied persons in the control group, respectively; and the satisfaction in the experimental group was higher than that in the control group (P < 0.01). The integrative medical-oriented teaching mode significantly improved the medical history collection and practical problem-solving ability, deepened the understanding of theoretical knowledge, facilitated the combination of theoretical knowledge with clinical practice, and improved their learning initiative (P < 0.01).  Conclusion  Integrated medicine-oriented teaching mode has significant teaching effect in the teaching of digestive diseases, which is beneficial to improve the theoretical examination results and the ability of analysing medical records and to cultivate students' ability of medical history collection.
Application of practical multi-modal fusion teaching method in neurosurgery training
YANG Chi, WANG Jian-biao, YANG Si-ming, HONG Wen-ming, WANG Bin
2022, 20(6): 1049-1051. doi: 10.16766/j.cnki.issn.1674-4152.002521
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  Objective  To change the shortcomings of single and rigid traditional clinical teaching methods, this study integrated multiple teaching modes into the teaching process in order to explore the application effect of multi-modal fusion teaching method with practice as the core in neurosurgery clinical teaching.  Methods  From January 2019 to December 2019, 30 foreign postgraduates who were rotated in Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into the experimental group (15 students) and control group (15 students). The experimental group adopted the practical multimodal fusion teaching method, whereas control group adopted the traditional teaching method. After one month of training, the final examination and questionnaire survey were conducted. The test scores and questionnaire survey results of the two groups were statistically analysed to evaluate the actual effect of multimodal teaching method.  Results  The average scores of basic knowledge test (89.5±5.2) points, anatomy knowledge test (92.6±4.3) points and skill operation test (90.1±5.4) points in the experimental group were higher than those in the control group[(76.4±4.7) points, (70.2±5.4) points and (74.7±4.9) points, respectively, all P < 0.05]. The questionnaire showed the satisfaction rates of students in the experimental group with regard to the teaching mode, learning efficiency and learning results were 86.7%, 93.3% and 86.7%, respectively, which were significantly higher than those of the control group (40.0%, 26.7% and 33.3%, all P < 0.05).  Conclusion  Compared with the traditional teaching mode, the multimodal fusion teaching method based on practice has obvious effect on improving students' learning efficiency, achievement and interest, and it is an effective teaching method that keeps pace with the time.
Application of augmented reality technology and mixed reality technology based on "Internet Plus" in the standardised training of orthopaedic doctors
ZHU Zhong-lian, GAO Xu-bin, GUAN Jian-zhong
2022, 20(6): 1052-1055. doi: 10.16766/j.cnki.issn.1674-4152.002522
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  Objective  To analyse the application effects of augmented reality (AR) technology and mixed reality (MR) technology based on "Internet Plus" in the standardised training of orthopaedic doctors.  Methods  Taking the implementation time (March 2019) of orthopaedics teaching and training of AR/MR based on "Internet Plus" in the First Affiliated Hospital of Bengbu Medical College as the dividing line, 30 resident doctors in the Department of Orthopaedics who were enrolled before the implementation (from March 2018 to February 2019) were included in the control group and received conventional orthopaedics training, and 32 resident doctors enrolled after the implementation (between April 2019 and May 2020) were enrolled in the observation group and given the new training method. The improvement status of theoretical and operational results of the two groups was statistically analysed at the end of the training, and the self-evaluation of clinical teachers on the training was recorded. The training satisfaction of the two groups of resident doctors was compared.  Results  No statistical differences were observed in the theoretical and operational results between the two groups before training (P>0.05). At the end of the training, the improvement rates of theoretical [(26.74±5.12) %] and operational [(16.59±2.14) %] results in the observation group were significantly higher than those in the control group [(18.89±4.06) % and (7.05±1.02) %, all P < 0.05]. The scores of overall arrangement and management ability, application ability of multimedia teaching materials and teaching awareness of clinical teachers under the AR/MR teaching model were significantly higher than those of conventional orthopaedics teaching model (P < 0.05). At the end of the training, the training satisfaction scores of resident doctors were significantly higher in the observation group than in the control group (all P < 0.05).  Conclusion  The application of AR/MR based on "Internet Plus" in the standardised training of resident doctors in the Department of Orthopaedics can effectively improve the clinical teaching ability of orthopaedics teachers and improve the training satisfaction and assessment results of resident doctors, with good promotion significance.
Meta-analysis of tonifying kidney and invigorating spleen in the treatment of recurrent abortion
WU Tong, WANG Yuan-zhong, LI Wei-li, YU Xin-hui
2022, 20(6): 1056-1061. doi: 10.16766/j.cnki.issn.1674-4152.002523
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  Objective  To systematically evaluate the clinical efficacy of tonifying kidney and invigorating spleen in the treatment of recurrent abortion using Meta-analysis.  Methods  Literature on the treatment of recurrent abortion by tonifying kidney and spleen was retrieved from the database construction until September 2021. Meta-analysis was conducted by RevMan 5.4 software.  Results  Finally, 17 literatures were included. Meta-analysis showed that the effective rate of the tonifying kidney and invigorating spleen treatment group was higher than that of the control group without tonifying kidney and invigorating spleen therapy [risk ratio (RR)=1.34, 95% CI: 1.26 to 1.43, P < 0.001]. The success rate of pregnancy of the treatment group was better than that of control group (RR=1.38, 95% CI: 1.22 to 1.56, P < 0.001). Traditional Chinese medical syndrome score of the treatment group was better than the control group [standard mean difference (SMD)=-1.69, 95% CI: -2.20 to-1.18, P < 0.001]. There was no significant difference in the positive conversion of closed antibody between the two groups (RR=1.12, 95% CI: 0.92 to 1.36, P=0.250). There was no significant difference in blood human chorionic gonadotrophin (HCG) value between the two groups [mean difference (MD)=33 861.57, 95% CI: -25 012.30 to 92 735.43, P=0.260]. The progestin value of the treatment group was better than the control group (MD=7.31, 95% CI: 2.17 to 12.46, P=0.005).  Conclusion  The method of tonifying kidney and invigorating spleen has advantages in improving the clinical effective rate, pregnancy success rate, TCM syndrome score and blood progestin, but there is no significant difference in blocking antibody positive conversion and blood HCG value compared with western medicine. However, due to the limited sample size and relatively low article quality in this study, as well as selection bias and measurement bias, the results are affected to varying degrees. Therefore, more high-quality controlled clinical trials are needed for validation in future studies.
Investigation and analysis on the changes of lifestyle and body weight in physical examination population during the novel coronavirus pneumonia epidemic prevention and control stage
CHEN Tong-hua, CHI Chun-hua, ZHOU Guo-peng
2022, 20(6): 1062-1065. doi: 10.16766/j.cnki.issn.1674-4152.002524
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  Objective  To explore the related risk factors of life style and health status on physical examination population in the epidemic prevention and control stage, so as to provide a theoretical basis for health intervention.  Methods  Physical examinees who had a health examination in Peking University First Hospital from June to July 2021 were selected by convenient sampling method, and their body weight and lifestyle changes during the epidemic were analysed through descriptive analysis and inferential analysis by multiple linear regression.  Results  A total of 392 examinees were enrolled, with a male-to-female ratio of 0. 8∶ 1 and an average age of (38.89±12.45) years old. After the outbreak of the epidemic, the body weight of the physical examination population increased by (0.84±3.24) kg (t=5.135, P < 0.001). According to gender, age group, occupation, education, marital status and BMI stratification, we found that female (t=4.361, P < 0.001), young (t=4.660, P < 0.001), underweight (t=5.231, P < 0.001), normal weight (t=4.378, P < 0.001), married (t=4.221, P < 0.001), employed (t=5.252, P < 0.001) and undergraduate population (t=3.944, P < 0.001) had significant weight gain. Multiple linear regression analysis showed that snack intake (B=0.440, P=0.015), cereal intake (B=0.830, P=0.001) and wake-up time (B=0.430, P=0.041) were positively correlated with body weight changes while total exercise time (B=-0.353, P=0.033) and intake of fruit and vegetable (B=-0.618, P=0.008) were negatively correlated with body weight changes.  Conclusion  The body weight of the examination population increases after the epidemic, which is related to lifestyle changes such as diet, exercise, work and rest status. It is necessary to focus on the health status of healthy people and strengthen health management in regular epidemic prevention and control stage.
Analysis of the expression and clinical significance of POSTN in head and neck squamous carcinoma based on TCGA database
ZHANG Man, ZHOU Lan-zhu, SUN Zhe, WU Jun, WANG Wen-zhong
2022, 20(6): 1066-1070. doi: 10.16766/j.cnki.issn.1674-4152.002525
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  Objective  To analyse the clinical significance of POSTN differential expression in the diagnosis and prognosis of head and neck squamous cell carcinoma using online databases and bioinformatics methods and to find new biomarkers for this disease.  Methods  TCGA public database was used to obtain basic information of head and neck squamous carcinoma patients, the expression of POSTN and the correlation between POSTN and clinicopathological parameters of head and neck squamous carcinoma patients. The Kaplan-Meier Plotter was used to analyse the survival curve of head and neck squamous carcinoma patients with different POSTN expression levels. TIMER analysis was used to determine the correlation between POSTN and various immune cell infiltrations in head and neck squamous carcinoma. GEPIA database analysis was used to determine the correlation between POSTN expression and immune cell marker expression. GO and KEGG gene enrichment analysis were used to explore the function of differentially expressed genes and their pathways of action.  Results  POSTN was highly expressed in head and neck squamous carcinoma (P < 0.05), and its expression was positively correlated with prognosis of head and neck squamous carcinoma patients, the cumulative survival rate of head and neck squamous carcinoma patients was correlated with the degree of infiltration of multiple immune cells. POSTN expression level was positively correlated with the degree of macrophage infiltration in head and neck squamous carcinoma (P=0.024) and significantly positively correlated with M2 macrophage markers (P < 0.001), with high POSTN expression promoting macrophage polarisation towards M2 type. Enrichment analysis showed that POSTN was associated with extracellular matrix regulatory processes.  Conclusion  POSTN expression is associated with prognosis and immune infiltration in patients with head and neck squamous carcinoma, and it may contribute to poor patient prognosis by regulating macrophage polarisation.
Diabetes health literacy and influencing factors of nurses in the Endocrinology Department of a tertiary hospital in Henan Province
QU Rui-jie, CHENG Qiu-hong, LI Rui-ling, LI Hao, WANG Hai-bo
2022, 20(6): 1071-1074. doi: 10.16766/j.cnki.issn.1674-4152.002526
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  Objective  To explore the current status of diabetes health literacy amongst nurses in the Department of Endocrinology in Henan Province's top three hospitals, analyse its influencing factors and provide reference basis for improving nurses' ability to manage diabetes symptoms.  Methods  The cluster sampling method was adopted to select 400 endocrinology nurses from 6 provincial-level tertiary general teaching hospitals in Henan Province from June to July 2020 as the research objects, and the questionnaire survey was conducted using the general information questionnaire, nurses' diabetes health literacy scale, and organisation support scale. SPSS 21.0 statistical software was used for data analysis. T-test or one-way analysis of variance was used to study the relationship between different demographic characteristics and diabetes health literacy amongst nurses in the Endocrinology Department, and its influencing factors were analysed through multiple linear regression.  Results  A total of 400 questionnaires were returned, and 387 valid questionnaires were collected. The total score for diabetes health literacy amongst nurses in the Endocrinology Department was (98.83±22.00) points. The questionnaire was divided into three dimensions with a total of 28 items. The scores of the three dimensions from high to low were critical literacy [(3.74±0.72) points], functional literacy [(3.46±0.85) points] and interactive literacy [(3.43±0.88) points]. Single-factor analysis showed that diabetes health literacy was statistically significant in terms of age, educational background, personality characteristics and health literacy-related training (all P < 0.05). Multiple linear regression analysis showed that educational background, personality characteristics, health literacy-related training and sense of organisational support were the influencing factors of diabetes health literacy amongst nurses in the endocrinology department (all P < 0.05).  Conclusion  The diabetes health literacy amongst nurses in the Endocrinology Department is at an intermediate level. Nursing managers should carry out relevant training to enhance the positive emotional experience of nurses' perception of organisational support, so as to improve the diabetes health literacy of nurses in the endocrinology department.
Application of WeChat management in cardiac rehabilitation nursing of discharged patients with coronary heart disease after PCI
CHEN Xiao-xi, ZHU Xiu-ruo, ZHANG Ping-mei, JIANG Wen-bing, SHEN Cheng-ji
2022, 20(6): 1075-1079. doi: 10.16766/j.cnki.issn.1674-4152.002527
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  Objective  To explore the effect of WeChat management in continuous nursing care of discharged patients with coronary heart disease after percutaneous coronary intervention (PCI).  Methods  A total of 100 patients with coronary heart disease who underwent PCI in the Department of Cardiology of Wenzhou People's Hospital from October 2017 to March 2018 were selected. They were divided into the control group and observation group with 50 patients in each group according to the random number table method. The control group was given conventional discharge and manual, whereas the observation group established a WeChat group and made an 8-week rehabilitation plan in addition to routine discharge education and manual. The quality of life score, rehospitalisation rate, incidence of cardiovascular adverse events and compliance of cardiovascular risk factors were evaluated and compared between the two groups at 3 and 6 months after discharge.  Results  The quality of life scores of the observation group were (79.22±8.52) points and (79.42±7.80) points at 3 and 6 months after discharge, which were better than those of the control group [(61.38±8.29) points and (62.74±11.45) points, respectively, all P < 0.05]. The frequency of revisit and rehospitalisation and frequency of chest pain within 6 months after discharge in the observation group were all lower than those in the control group (all P < 0.05). The total incidence of adverse cardiovascular events in the observation group was 6.0% and 12.0% within 3 and 6 months after discharge, respectively, which were lower than those in the control group (22.0% and 42.0%, all P < 0.05). At 6 months after discharge, the compliance rates of cardiovascular risk factors such as blood pressure, LDL-C and fasting blood glucose in the observation group were 94.0%, 92.0% and 98.0%, respectively, which were better than those in the control group (70.0%, 66.0% and 72.0%, all P < 0.05).  Conclusion  The continuous nursing method of WeChat management can effectively control the main cardiovascular risk factors of patients discharged after PCI, reduce the rate of revisit and rehospitalisation, reduce the occurrence of cardiovascular adverse events, improve the quality of life and benefit the prognosis of patients.
Application effect of "Internet +" medical care model in the family ward of obstetrics trinity
JI Jian-ying, ZHENG Cong-xia, HE Xue-fei, YE Wei-juan, WU Yi-jun
2022, 20(6): 1080-1084. doi: 10.16766/j.cnki.issn.1674-4152.002528
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  Objective  To construct an "Internet +" medical care model suitable for obstetric trinity family wards and improve the level of maternal and child VIP health management services.  Methods  A total of 240 full-term primiparous women who gave birth in the Trinity Family Ward of the Obstetrics Department of Lishui Maternal and Child Health Hospital from December 2018 to June 2020 were selected and divided equally into the control and observation groups. The control group adopted the routine obstetric VIP nursing model, and the observation group adopted the new model of obstetric nursing based on "Internet +". The nursing effect of the two groups was compared.  Results  At 24 h after delivery, the score of the intervention group [(28.63±7.64) points] was significantly lower than that of the control group [(32.81±8.16) points]. The self-efficacy score of the intervention group [(259.04±60.15) points] was significantly higher than that of the control group [(232.10±63.73) points, t=4.099, -3.368, all P < 0.05]. The bleeding volume [(190.13±34.98) mL] in the observation group at 2 h post-partum was significantly less than that in the control group [(218.07±41.19) mL, t=5.667, P < 0.05]. The 90.00% (108/120) breastfeeding rate at 42 days post-partum in the observation group was significantly higher than the 78.33% (94/120) in the control group (χ2=6.128, P < 0.05). The satisfaction score of the observation group for out-of-hospital care [(24.57±3.44) points] was significantly higher than that of the control group [(18.59±4.61) points, t=-11.387, P < 0.05].  Conclusion  The "Internet +" medical care model has a good application effect in the obstetric trinity family ward, which can significantly reduce the fear of childbirth, improve self-efficacy, reduce post-partum bleeding and increase breastfeeding rate and nursing satisfaction.
General Practice Research
Effects of removing blood stasis and resolving phlegm on the nerve function in Wilson's Disease
MA Shou-liang, YANG Wen-ming, HAN Bing, LI Yue-yue, XU Zhi-hao, SONG Cheng-wei, HAN Hui
2022, 20(6): 910-913. doi: 10.16766/j.cnki.issn.1674-4152.002485
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  Objective  To observe the effect of removing blood stasis and resolving phlegm on the nerve function in patients with Wilson ' s disease.  Methods  A total of 60 Wilson's disease patients with phlegm and blood stasis who were hospitalised in the Encephalopathy Center of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2019 to June 2021 were treated for the research. These patients were randomly divided into treatment group and comparison group according to the random number table method, with 30 patients in each group. The treatment comprised two courses. During the treatment, Wilson ' s disease neurological function score, clinical efficacy and 24 h urine copper in the two groups were observed.  Results  At the end of 2 courses of treatment, the neurological function scores of the treatment and comparison group [(25.63±9.06) points and (57.13±12.03) points] were lower than those before treatment [(64.03±11.41) points and (66.40±13.27) points, all P < 0.05]. At the end of 2 courses of treatment, the neurological function score of the treatment group was lower than that of the comparison group (P < 0.05). The clinical efficacy of the treatment group was more significant (93.3% vs. 70.0%, χ2=5.455, P=0.020). At the end of 2 courses of treatment, the 24 h urinary copper values in the treatment and comparison groups [(1 690.40±369.90) μg/24 h and (1 376.75±311.91) μg/24 h] were higher than those before treatment [(202.33±38.11) μg/24 h and (206.66±38.38) μg/24 h, all P < 0.01]. The urine copper value in the treatment group was significantly higher than that in the comparison group after treatment (P < 0.05).  Conclusion  Removing blood stasis and resolving phlegm can significantly improve the neurological function of patients with Wilson's disease, the clinical efficacy and the quality of life of patients.
Effect of radiofrequency thermocoagulation on semilunar ganglion in treating different degrees of vascular associated trigeminal neuralgia
GUO Yan, WANG Li-kui, ZHU Ben-fan, MAO Yu
2022, 20(6): 914-918. doi: 10.16766/j.cnki.issn.1674-4152.002486
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  Objective  To observe the clinical efficacy of trigeminal nerve radiofrequency thermocoagulation in the treatment of different degrees of vascular associated trigeminal neuralgia.  Methods  A total of 101 patients with trigeminal neuralgia from September 2015 to November 2020 in the First Affiliated Hospital of Anhui Medical University were enrolled in the retrospective analysis, including 32 patients with no trigeminal nerve associated with peripheral blood vessels (group A), 40 patients with the trigeminal nerve closely related to peripheral vascular (group B) and 29 patients with vascular compression of trigeminal nerve (group C). Radiofrequency thermocoagulation of the semilunar ganglion guided by CT was performed in all three groups. Visual analogue scale (VAS), quality of life, carbamazepine dose and excellent and good rate of treatment were observed and compared before and after 1, 3, 6 and 12 months in the three groups.  Results  There were statistically significant differences in VAS scores among the 3 groups, and there were statistically significant differences between groups and at different time points within groups (Fintergroup/time/interaction=125.402, 261.255, 20.994; all P < 0.05). There were statistically significant differences in the dose of carbamazepine among the 3 groups, and statistically significant differences between groups and at different time points within groups (Fintergroup/time/interaction=126.065, 266.616, 15.125; all P < 0.05). VAS score and carbamazepine dose in group A were lower than those in group B and group C (all P < 0.05), and there was no statistical significance between group B and group C (all P>0.05). VAS score and carbamazepine dose in three groups were significantly decreased after operation compared with before operation (all P < 0.05). The quality of life of patients in the three groups was significantly improved after surgery (all P < 0.05). The excellent and good rates of the three groups after 12 months were 90.63%, 82.5% and 86.21%, respectively.  Conclusion  CT-guided radiofrequency thermocoagulation on semilunar ganglion can significantly relieve pain and improve the quality of life of patients with trigeminal neuralgia. Vascular nerve association affects the outcome of surgery.
Three-dimensional versus two-dimensional imaging systems in extraperitoneal radical prostatectomy for prostate cancer: A bicenter and retrospective cohort study
HANG Ze-hai, HUANG Xiao-min, CHEN Ze-rong, WANG Zi-ming, CHEN Ke-li
2022, 20(6): 919-922. doi: 10.16766/j.cnki.issn.1674-4152.002487
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  Objective  To compare the efficacy and safety of three-dimensional (3D) and two-dimensional (2D) imaging systems in laparoscopic extraperitoneal radical prostatectomy (LERP) for prostate cancer.  Methods  The clinical data of 122 consecutive patients diagnosed with prostate cancer was analyzed. Those patients were underwent LERP with 2D or 3D imaging systems in Nanfang Hospital and Guangdong General Hospital between January 1st, 2015 to 1 January 1st, 2018. Patients were divided into 3D (n=40) and 2D (n=82) groups according to different endoscopic methods. The patients in 2D group and 3D group were matched by propensity score matching method according to age, BMI, prostate volume, preoperative total prostate specific antigen (PSA) and Gleason score of prostate puncture pathology. After matching, 40 cases were included in each group. The matched patients were further followed up with urinary incontinence quality of life scale (I-QOL) and international index of erectile function-5 (IIEF-5). The effects of the two surgical methods were analyzed, and the safety was compared and analyzed.  Results  The operation time of 3D group was shorter than that of 2D group [2.3 (2.0, 3.0) h vs. 3.0 (2.3, 4.0) h, P=0.023], and the blood loss of 3D group was less [50.0 (50.0, 137.5) mL vs. 275.0 (112.5, 337.5) mL, P < 0.001]. There were no statistically significant differences in positive surgical margin rates, urinary leakage rate, recovery rate of urinary control, recovery of sexual function and biochemical recurrence rate between the two groups (all P>0.05).  Conclusion  3D LERP has a better surgical field, shorter operation time, and less blood loss compared to 2D LERP. However, the long-term follow-up results of the two groups were similar in the positive surgical margin rates, the recovery rate of urinary control, the recovery of sexual function and biochemical recurrence rate.
Treatment of severe benign central airway stenosis with laser under bronchoscope
LI Meng-yi, GONG Bei-lei, LI Wei, SHEN Yuan-bing, WU Jing, XU Yuan-yuan, ZHANG Ya-ting, CHEN Yu-qing
2022, 20(6): 923-926. doi: 10.16766/j.cnki.issn.1674-4152.002488
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  Objective  The aetiology of benign central airway stenosis is complex, and the treatment is challenging. This paper discusses the safety and effectiveness of laser under bronchoscope for treating severe benign hyperplasia central airway stenosis.  Methods  Total 23 patients with benign hyperplasia central airway stenosis treated by laser under bronchoscope in the First Affiliated Hospital of Bengbu Medical College from March 2016 to September 2021 were studied retrospectively. The improvement of airway patency and quality of life were evaluated by using the modified Medical Research Council Dyspnea Scale (mMRC) and short form 36 questionnaire (SF-36), the effectiveness of treatment was dynamically evaluated. The complications were monitored, and the safety was evaluated.  Results  The average age of patients was (57.43±10.85) years old, and the male-to-female ratio was 1.87 5∶ 1. Previous tracheotomy was the most common cause of stenosis (56.5%), followed by endotracheal intubation (43.5%). The symptoms of 23 patients (23/23, 100.0%) were improved, the airway was unobstructed, and the quality of life was improved. The SF-36 score [(107.02±10.72) points] was significantly higher than that before operation [(70.34±6.17) points, t=-19.877, P < 0.001], and the mMRC score decreased significantly (P < 0.001). There were no intraoperative and postoperative complications. Twenty-three patients were followed up for 1-60 months, with an average of 14.39 months and a median of 8.0 (4.0, 23.0) months. Seventeen cases (17/23, 73.9%) had re-stenosis during follow-up, of which 12 cases (12/17, 70.6%) needed interventional treatment.  Conclusion  Laser ablation of benign hyperplasia central airway stenosis through endoscopy is safe and effective, which shows the significant improvement of patients' respiratory function and quality of life, especially for critically ill patients.
Effects of tranexamic acid and controlled hypotension on hemorrhage in spinal surgery
YANG Hui-hong, YAN Lei, XU Gui-ping
2022, 20(6): 927-930. doi: 10.16766/j.cnki.issn.1674-4152.002489
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  Objective  To investigate the effect of tranexamic acid combined with controlled hypotension on perioperative bleeding after spinal surgery.  Methods  A total of 120 spinal surgery patients in the People ' s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2020 were selected and divided into 3 groups by random number table method: S group, TXA group and TXA + CH group. In S group, 0.2 mL/kg of normal saline was intravenously injected immediately after anesthesia induction, and was pumped at a rate of 0.1 mL/(kg·h) until the end of surgery. TXA group was injected with tranexamic acid 20 mg/kg at a rate of 10 mg/(kg·h) by intravenous pump until the end of operation. In the TXA+CH group, on the basis of the TXA group, sodium nitroprusside was pumped for controlled blood pressure until the main operation was completed. The indicators before and 1 day after operation and the occurrence of adverse events in one week after operation were recorded.  Results  Compared with S group, intraoperative blood loss in TXA group and TXA+CH group [(434.2±73.4) mL vs. (287.6±73.6) mL vs. (236.2±59.4) mL], postoperative drainage volume [110.0 (91.3, 145.0) mL vs. 77.5 (60.0, 95.0) mL vs. 60.0 (50.0, 70.0) mL], intraoperative visual field quality score [(3.3±0.5) points vs. (2.4±0.5) points vs. (2.2±0.4) points], days of hospitalization [8.5 (7.0, 15.0) d vs. 6.5 (5.0, 9.0) d vs. 6.0 (5.0, 7.8) d], the differences were statistically significant (all P < 0.05). Compared with TXA group, intraoperative blood loss and SSFQ score of TXA+CH group were decreased (all P < 0.05), and there was no significant difference in the length of hospital stay and 24-hour postoperative drainage volume (all P>0.05). There was no statistical significance in the biochemical indexes between the three groups before operation (all P>0.05). There were differences in RBC, HB, and HCT among the three groups at 1 d after operation (all P < 0.05). There were no adverse reactions in the three groups of patients.  Conclusion  Tranexamic acid can reduce blood loss in patients undergoing spinal surgery, and tranexamic acid combined with controlled hypotension has the best effect on reducing blood loss.
Observation on the effect of individualised length of epidural catheter for labour analgesia under ultrasound guidance
WANG Guang-long, ZHANG Cong-li, YIN Feng-wei, ZHANG Yun-chun
2022, 20(6): 931-933. doi: 10.16766/j.cnki.issn.1674-4152.002490
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  Objective  To observe the effect of individualised length of epidural catheter for labour analgesia under ultrasound guidance.  Methods  Total 100 obstetric patients who received labour analgesia in the Obstetrics Department of the First Affiliated Hospital of Bengbu Medical College from October 2019 to December 2020 were selected. They were divided into conventional group and ultrasound group by random number table method, with 50 cases in each group. In the conventional group, the epidural catheter was placed 4 cm, and in the ultrasound group, the epidural catheter was placed in the L2 vertebral body length. The range of anaesthesia plane block at 15 min after epidural injection, VAS score at 30, 60 and 90 min after pump operation, adverse reactions of catheter, local anaesthetic dosage, pump pressing times, maternal delivery mode, neonatal 1 and 2 min Apgar score, and maternal adverse reactions were compared between the two groups.  Results  The range of anaesthesia plane block in the ultrasound group [(5.24±1.89) segments] was higher than that in the conventional group [(4.26±1.86) segments, P < 0.05]. The 30, 60 and 90 min VAS scores of the ultrasound group [(4.38±1.74) points, (3.52±1.92) points, (3.28±1.88) points] were lower than those of the conventional group [(5.50±2.10) points, (4.46±1.98) points, (4.30±1.91) points], all P < 0.05. The incidence rate of catheter adverse reactions, local anaesthetic dosage and pump pressing times in the ultrasound group [10.0%, (21.96±12.01) mL and (3.48±1.88) times] were lower than those in the conventional group [64.0%, (38.14±9.10) mL and (4.38±1.74) times], all P < 0.05, and other indicators showed no significant difference.  Conclusion  Ultrasound-guided epidural catheterisation with individualised length for labour analgesia can reduce the dosage of local anaesthesia, adverse reactions of catheter and number of pump compressions, do not affect the outcome of mother and child, and has a good analgesic effect.
Application of bedside electronic bronchoscopic alveolar lavage in the treatment of severe pulmonary infection
LIU Shan-qing, WANG Nan, ZHANG Yan-bei
2022, 20(6): 934-936. doi: 10.16766/j.cnki.issn.1674-4152.002491
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  Objective  To investigate the effect of electronic bronchoscopic alveolar lavage in the treatment of severe pneumonia.  Methods  Forty patients with severe pulmonary infection complicated with respiratory failure admitted to the Intensive Care Department of the Fourth Affiliated Hospital of Anhui Medical University from December 2018 to January 2021 were selected. They were divided into the observation group and control group according to treatment methods, with 20 patients in each group. The control group was treated with anti-infection, mechanical ventilation, sputum aspiration and other conventional treatments, whereas the observation group was treated with electronic bronchoscopic alveolar lavage on the basis of conventional treatment. The clinical efficacy, blood gas analysis, inflammatory indicators and operation safety of the two groups were observed.  Results  The curative effect of the observation group was higher than that of the control group(Z=2.054, P=0.040). After treatment, the observation group had higher arterial partial pressure of oxygen [(113.88±17.52) mm Hg vs. (91.36±16.70) mm Hg, P < 0.001, 1 mm Hg=0.133 kPa] and oxygenation index [(308.42±55.25) mm Hg vs. (258.43±64.02) mm Hg, P=0.012] and lower arterial partial pressure of carbon dioxide [(34.33±3.92) mm Hg vs. (37.37±2.72) mm Hg, P=0.007] than the control group. The white blood cell count [(7.42±1.82)×109/L], high-sensitivity C-reactive protein [22.43 (11.66, 31.02) mg/L] and procalcitonin [0.32 (0.14, 0.44) ng/mL] in the observation group were lower than those in the control group [(9.66±2.57)×109/L, 44.79 (16.03, 87.01) mg/L and 0.73 (0.17, 2.29)ng/mL, respectively, all P < 0.05]. There were no serious adverse reactions during bronchoalveolar lavage in the observation group.  Conclusion  Bronchoscopic alveolar lavage is safe, can improve lung function and has significant effect on the control of pulmonary infection.
Effects of 10-methacryloxy decyldihydrogen phosphate-conditioned adhesive in improving the bonding strength and marginal sealing of zirconia ceramics and resin
LIU Fang, XIE Xiao-fei, ZHANG Rong-xiu, XU Li, GAO Yi-lin, LI Jian-cheng
2022, 20(6): 937-940. doi: 10.16766/j.cnki.issn.1674-4152.002492
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  Objective  To evaluate the effects of 10-methacryloxy decyldihydrogen phosphate (MDP)-conditioned adhesive in improving the bonding strength and marginal sealing of zirconia ceramics and resins.  Methods  This study consisted of in vitro and clinical trials. Eighty zirconia ceramic specimens were prepared by in vitro test, and randomly divided into two groups with 40 specimens in each group. The conventional group received the direct adhesion of zirconia ceramics with resin, while the test group received the adhesion of zirconia ceramics under MDP-conditioned zirconia with resin. Eighty patients whose mandibular first molar treated with zirconia all-ceramic crowns after root canal therapy in our hospital were selected as research subjects. According to the random number table method, the patients were assigned to two groups, with 40 cases in each group. The clinical operation was consistent with the in vitro test method. The bonding strength, marginal sealing in vitro and patient's satisfaction from clinical trials were compared.  Results  Before thermocycling treatment, the bonding strength in the test group [(20.35±0.59) MPa] was significantly higher than that in the conventional group [(16.03±0.51) MPa, P < 0.01]. The bonding strength in the two groups significantly decreased after thermocycling treatment (P < 0.01), whereas the descending degree of the bonding strength in the test group was lower than that in the conventional group. After treatment with methyl blue solution, the leakage of fault surface in the test group [(0.63±0.01) μm] was clearly lower than that in the conventional group [(1.34±0.02) μm, P < 0.01]. The overall satisfaction in the test group (90.00%) was markedly higher than that in the conventional group (72.50%, P < 0.05).  Conclusion  The MDP-conditioned zirconia can improve the bonding strength and marginal sealing of zirconia ceramics and resin, extend the application time of zirconia ceramics and increase patients' satisfaction. It is recommended to be used in clinical practice.
Application value of D-dimer and fibrinogen combined with venous patency score in thrombolysis of deep venous thrombosis of lower extremities
ZHU Wei, LU Ran, YU Chao-wen, NIE Zhong-lin, CHEN Shi-yuan, SONG Tao
2022, 20(6): 941-943. doi: 10.16766/j.cnki.issn.1674-4152.002493
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  Objective  To analyze the changes of D-dimer, fibrinogen and venous patency score during catheter-directed thrombolysis (CDT) in deep venous thrombosis of lower limbs, and to evaluate their clinical application value.  Methods  Thirty-seven patients diagnosed with acute lower extremity deep vein thrombosis at the First Affiliated Hospital of Bengbu Medical College from June 2019 to June 2021 were included as the research objects. All patients were treated with inferior vena cava filter surgery, anticoagulation and CDT. During the treatment, D-dimer and fibrinogen were measured and recorded 1 day before operation and twice a day after operation until 7 days after operation, and the venous patency scores were calculated 1 day before operation, 3 days after operation and 7 days after catheter thrombolysis.  Results  None of the 37 patients had pulmonary embolism symptoms such as dyspnoea, haemoptysis and chest pain during CDT. In this treatment group, there were 2 patients with popliteal puncture site bleeding, 1 patient with gingival bleeding, without special treatment, and no serious bleeding and other complications. In the process of CDT for deep vein thrombosis of lower limbs, the average value of D-dimer firstly increased during DVT thrombolytic process, and reached the highest level at 77.4 mg/L two days after the operation, and then gradually decreased to the normal level. The average value of fibrinogen generally showed a downward trend during DVT thrombolytic process. The venous patency score was (3.7±0.9) points 3 days after surgery, and (2.4±0.7) points 7 days after surgery, the difference was statistically significant (P < 0.05).  Conclusion  D-dimer can be used to monitor thrombolysis time and therapeutic effect, fibrinogen can be used to monitor thrombolysis stop and bleeding, and the change of venous patency score can be used as an indicator of thrombus clearance in the process of CDT in deep vein thrombosis of lower limbs.
The predictive value of neutrophil-lymphocyte ratio in the prognosis of patients with cardiac arrest
YAO Rui, JI Xiao-wei, ZHONG Lei, WANG Hai-li, XIE Bo
2022, 20(6): 944-947. doi: 10.16766/j.cnki.issn.1674-4152.002494
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  Objective  To evaluate the use of neutrophil-lymphocyte ratio (NLR) upon admission to an intensive care unit (ICU) in predicting mortality amongst patients who suffered cardiac arrest (CA).  Methods  This study was a retrospective cohort study using the latest version of the Intensive Care Database (MIMIC-Ⅲ v1.4). Adult CA patients (≥ 18 years old) admitted to the ICU for the first time from June 2001 to October 2012 were analysed, and clinical data were extracted by relevant qualified personnel. The primary endpoints were as follows: ICU and 28-day all-cause mortality. NLR was divided into three groups in accordance with tertiles, defined by ranges of < 7.00, 7.00-13.60 and ≥ 13.60. The related clinical data of these patients were analysed based on those three groups. Survival analyses were carried out to analyse the ICU and 28-day cumulative survival rates in these groups by using the Kaplan-Meier curves and log-rank test. Meanwhile, the Cox proportional hazard models were used to identify independent predictors of 28-day all-cause mortality amongst CA patients.  Results  A total of 593 adult participants with CA were involved in our study. The ICU and 28-day all-cause mortality of CA patients were 34.74% and 46.37%, respectively. Except for the remaining indicators, the variables of NLR, SOFA score, buffer excess, white blood cells, platelets and 28-day all-cause mortality showed significant differences amongst these three groups (all P < 0.05). Kaplan-Meier analysis revealed that the difference in the cumulative survival rate of the 28 days was no significant (log-rank test, χ2=5.900, P=0.052). The univariate Cox proportional hazard model showed that an increased level of NLR (≥ 13.60) was a risk factor for 28-day all-cause mortality in CA patients. This result was still supported by the multivariate Cox proportional hazard models analysis, even after controlling for the confounders.  Conclusion  An elevated NLR (≥13.60) is associated with poor prognosis for CA patients, and it can be used as an independent predictor for risk of 28-day all-cause mortality. In conclusion, as a novel prognostic marker in CA patients, monitoring the changes in NLR have important clinical value in assessing the prognosis of these patients.
Expression and significance of heparanase, E-cadherin, and N-cadherin in oral squamous cell carcinoma
DAI Si-yuan, JIANG Jie, HAN Rui, XU Jin-cheng
2022, 20(6): 948-951. doi: 10.16766/j.cnki.issn.1674-4152.002495
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  Objective  To study the expression of heparanase (HPA), epithelial marker E-cadherin and interstitial marker N-cadherin in oral squamous cell carcinoma (OSCC), and to explore the relationship between the three proteins and the clinicopathological features of OSCC.  Methods  The protein levels of HPA, E-cadherin and N-cadherin were assessed in OSCC tissues from 46 patients and normal tissues from 15 controls by immunohistochemistry. χ2 test was used to analyze the expression of three proteins in OSCC, and to detect the relationship between them and the clinicopathological characteristics of OSCC. Then the independent influencing factors were screened by multivariate binary logistic regression analysis. At the same time, Spearman rank correlation analysis was used to analyze the relationship between the expression of the three proteins.  Results  The positive expression rate of HPA in OSCC was 73.9%, while it was negative in normal oral mucosal epithelium (P < 0.001). There were significant differences in the positive expression rates of E-cadherin (56.5% vs. 93.3%) and N-cadherin (47.8% vs. 13.3%) between OSCC and normal oral mucosal epithelial tissues (all P < 0.05). There was significant difference in the positive expression rate of HPA in patients with different clinical stages, degrees of differentiation and lymph node metastasis (P < 0.05). Logistic regression analysis showed that clinical stage, degree of differentiation and lymph node metastasis were related to the positive expression of HPA. HPA expression was negatively correlated with E-cadherin expression (r=-0.321, P < 0.05), but it was positively correlated with N-cadherin expression (r=0.371, P < 0.05).  Conclusion  HPA is highly expressed in OSCC, which is closely related to the clinical stage, degree of differentiation and lymph node metastasis. HPA is negatively correlated with E-cadherin, but positively correlated with N-cadherin. The potential mechanism is that HPA may regulate epithelial interstitial transformation (EMT) in OSCC. Therefore, the expression of HPA can promote the invasion and metastasis of OSCC, and this effect may be achieved by HPA inducing epithelial mesenchymal transformation in OSCC.
Prognostic analysis of hepatic arterial chemoembolization and radiofrequency ablation combination with different time intervals for patients with advanced hepatocellular carcinoma
YING Xi-hui, LAI Lin-qiang, CHEN Li, YANG Hong-yuan, JI Jian-song, TU Jian-fei
2022, 20(6): 952-955. doi: 10.16766/j.cnki.issn.1674-4152.002496
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  Objective  To investigate the appropriate interval between transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in treatment of advanced hepatocellular carcinoma (HCC).  Methods  The clinical data of 99 patients with HCC in Department of Radiology Lishui Hospital of Zhejiang University was retrospectively collected from February 2012 to December 2017. All patients received sequential treatment of TACE and RFA. The treatment interval of TACE and RFA was calculated, and the patients were divided into 3 subgroups: group A (0-5 days, n=30), group B (6-22 days, n=54), and Group C (>22 days, n=15). Recursive segmentation was used to select the most appropriate TACE-RFA interval threshold. The primary study endpoint was overall survival (OS), and the secondary study endpoint was tumor progression-free survival (PFS) and treatment-related adverse events.  Results  The last follow-up time was December 30, 2020. The data showed that longer TACE-RFA time intervals were associated with poor OS (group A vs. group B, P=0.694; group A vs. Group C, P=0.037; group B vs. group C, P=0.023). Among the 15 patients in group C, 73.3% (11/15) died. The median OS of the 3 subgroups were 32.3, 34.1, and 23.2 months, respectively.  Conclusion  The time interval between TACE and RFA is related to the prognosis of HCC patients. The shorter time intervals can improve OS and PFS in HCC patients. However, the optimal time interval still needs to be confirmed by large-scale multi-center clinical trials.
General Clinical Research
The effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft
HAN Jun-zhu, ZHU Xun-bing, ZHANG Zhong-chuan, XU Wen-di, WANG Xu-dong
2022, 20(6): 956-959. doi: 10.16766/j.cnki.issn.1674-4152.002497
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  Objective  To explore the effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft to provide a reference for the treatment of this kind of clinical problem.  Methods  From January 2018 to December 2019, nine patients with old medial malleolus fracture because of sprain were admitted. They went through non-surgical treatment for different times. The treatment course ranged from 43 to 128 (83.0±34.6) days. The patients were treated with open reduction and lag screw fixation and autogenous cancellous bone graft via anterior medial approach. Three cases with deltoid ligament injury were repaired with suture anchor. Fracture healing time and operative complications were observed after the operation. The medial malleolus gap width and AOFAS score were compared before operation and at the last follow-up.  Results  Nine patients were followed up for 12-36 (24.7±7.6) months. The fracture healing time was 3-5 (3.8±0.7) months. No complications such as blood vessel and nerve injury, unstable ankle and traumatic arthritis were observed. At the last follow-up, the medial malleolus gap width decreased from (4.4±0.9) mm to (2.4±0.3) mm, and the AOFAS score increased from (47.3±6.2) points to (93.4±9.3) points. There were significant differences between preoperative values and values at the last follow-up (all P < 0.01). According to the AOFAS score, six cases were excellent, two cases were good, and one case was fair. The excellent and good rate was 88.9%.  Conclusion  In the treatment of old medial malleolus fracture, lag screw fixation and autogenous bone graft via anterior medial approach have the advantages of high rate of fracture healing, few complications and good recovery of foot-ankle function.
Multivariate analysis of pulmonary infection in patients with cerebral haemorrhage
WU Kai-qin, CHENG Jing-jing, LU Wei-wei, CHEN Dan
2022, 20(6): 960-963. doi: 10.16766/j.cnki.issn.1674-4152.002498
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  Objective   To investigate the incidence, influencing factors and related interventions of pulmonary infection in patients with cerebral haemorrhage.  Methods  A total of 207 patients with intracerebral haemorrhage who were admitted in our hospital from January 2016 to November 2020 were selected as the research objects.All patients were divided into the pulmonary infection group (group A, n=91) and non-pulmonary infection group (group B, n=116).To explore the influencing factors of cerebral haemorrhage complicated with pulmonary infection, patient demographic data, medical history and condition were analysed.  Results   The proportion of pulmonary infection in patients with cerebral haemorrhage was 43.96%(91/207).Unconditional binary logistic regression analysis showed that age ≥65 years (OR=1.102, 95%CI: 1.006-2.135), COPD (OR=2.679, 95%CI: 1.085-6.678), diabetes (OR=3.175, 95%CI: 2.170-4.156), GCS≤8(OR=4.500, 95%CI: 3.189-5.865), surgical treatment (OR=8.282, 95%CI: 1.182-31.483) and hypoproteinaemia (OR=3.864, 95%CI: 1.170-6.696) were independent risk factors for cerebral haemorrhage complicated with pulmonary infection.  Conclusion   Patients with cerebral haemorrhage have a higher incidence of lung infections.Age≥65 years, diabetes, COPD, low GCS score, surgical treatment and hypoproteinaemia can independently affect the occurrence of pulmonary infection in patients with cerebral haemorrhage.Therefore, we should strengthen the intervention according to the relevant influencing factors to reduce the occurrence of pulmonary infection and reduce the mortality rate.
Multiple-ligament injury of knee joint combined with tibial plateau fracture and correlation analysis between ligament injury and classification of tibial plateau fracture
YAN Feng, YU Can-ming, DING Zhi-qing, LIU Li
2022, 20(6): 964-966. doi: 10.16766/j.cnki.issn.1674-4152.002499
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  Objective  To analyse the situation of multiple-ligament injury of knee joint combined with tibial plateau fracture and the correlation between multiple-ligament injury of knee joint and the classification of tibial plateau fracture so as to provide reference basis for clinical diagnosis and treatment.  Methods  Sixty-two patients with knee multiple-ligament injury complicated with tibial plateau fracture diagnosed and treated in the department of orthopaedics and traumatology of Taizhou Hospital of Traditional Chinese Medicine from January 2020 to January 2021 were selected as the research objects.The situation of multiple-ligament injury of knee joint was analysed.Schatzker, AO and Duparc classification methods were used to classify tibial plateau fracture.Logistic regression analysis was used to analyse the correlation between multiple-ligament injury of knee joint and the classification of tibial plateau fracture.  Results  The incidence of Anterior cruciate ligament injury (ACL), posterior cruciate ligament injury (PCL), medial collateral ligament injury (MCL), posterolateral angle injury (PLC), ACL+PCL, ACL+MCL, ACL+PLC, PCL+MCL, PCL+PLC and MCL+PLC were 30.65%, 8.06%, 12.90%, 27.42%, 1.61%, 3.23%, 8.06%, 1.61%, 3.23% and 3.23%, respectively.In Schatzker's classification, 12, 12, 4, 23, 7 and 4 cases had Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ classification, respectively.In AO classification, 33 and 29 cases had type B and type C, respectively.In Duparc classification, there were 16, 15, 7, 13 and 11 cases of lateral platform fracture, medial platform fracture, double platform fracture, intercondylar ridge fracture and posterior medial fracture, respectively.Logistic analysis showed that Schatzker and AO typing were significantly correlated with ACL, MCL and PLC.Duparc classification had obvious correlation with MCL and PLC.  Conclusion  There is a certain correlation between the multiple-ligament injury of knee joint and the Schatzker, AO and Duparc classification of tibial plateau fracture in patients with multiple-ligament injury of knee joint combined with tibial plateau fracture.
Effect of indomethacin on helper T cells in peripheral blood after endoscopic retrograde cholangiopancreatography
YANG Qing-feng, WANG Hua-guan, HAN Liang, LEI Jia-cai, HUANG Hai-tao, YAN Shan-jun
2022, 20(6): 967-969. doi: 10.16766/j.cnki.issn.1674-4152.002500
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Abstract:
  Objective  To investigate the possible cytological mechanism of indomethacin suppository in the prevention of pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP).  Methods  Forty patients who were hospitalised in the Department of Gastroenterology of the First Affiliated Hospital of Bengbu Medical College from March 2017 to October 2017 and planned to undergo ERCP were randomly divided into the observation group and control group, with 20 cases in each group.The peripheral venous blood Treg, Th17 and Treg/Th17 values of the two groups were measured before and 12 h after ERCP.  Results  In the control group, the preoperative Treg, Th17 and Treg/Th17 values were 2.94(1.52, 3.71)%, 1.42(0.87, 4.47)% and 1.57(0.69, 2.88), and the postoperative values were 1.92(1.22, 3.25)%, 2.02(1.12, 4.93)% and 0.77(0.37, 1.75), respectively.There were significant differences in the preoperative and postoperative changes.In the observation group, the preoperative Treg, Th17 and Treg/Th17 values were 1.57(0.97, 2.37)%, 1.92(1.27, 3.05)% and 0.74(0.39, 2.28), and the postoperative values were 1.63(1.03, 1.86)%, 2.26(1.36, 3.65)% and 0.65(0.38, 1.64), respectively.There was no significant difference between the preoperative and postoperative changes.There was no significant difference in other indexes between the two groups except for the preoperative Treg difference (Z=-2.259, P=0.024).  Conclusion  The possible mechanism of indomethacin suppository in preventing PEP after ERCP is to maintain the immune balance of Treg and Th17 cells and control the early inflammatory response after ERCP.
The value of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children
XIAO Wei-xing, ZHOU Hai-jun, CHEN Bing-rong, YU Sheng-cheng, ZHOU Jun
2022, 20(6): 970-973. doi: 10.16766/j.cnki.issn.1674-4152.002501
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Abstract:
  Objective  To discuss the value of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children.  Methods  Seventy-two patients with inguinal hernia aged between 1 and 12 who were treated in the Department of General Surgery of Jiaxing Hospital of Traditional Chinese Medicine from October 2018 to December 2020 were selected as the research object.According to random number table method, the patients were divided into observation group and control group, with 36 cases in each group.The children in the control group were treated with high ligation of hernia sac under traditional laparoscopy, while the children in the observation group were treated with suspension pneumoperitoneum-free laparoscopic surgery.The excellent and good rate of postoperative pain score, operation time, discharge time, recurrence rate 3 months after operation and stress index were observed in the two groups.  Results  The excellent rate of pain score in the observation group was significantly higher than that in the control group (χ2=4.571, P=0.033).The duration of surgery and hospital stay in the observation group were shorter than those in the control group[(13.63±3.66) min vs.(16.25±2.17) min, (3.38±0.65) d vs.(4.06±0.23) d, all P < 0.01].After operation, the observation group had lower levels of cortisol, IL-6, IL-10 and TNF-α than the control group, and the difference had statistical significance (all P < 0.05).There was no significant difference in recurrence rate 3 months after surgery between the two groups (P=0.999).  Conclusion  The application of suspension pneumoperitoneum-free laparoscopic surgery in the treatment of inguinal hernia in children can shorten the operation time and postoperative recovery time, and reduce the degree of postoperative pain, and relieve stress response, which is worth applying and popularizing.

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