2022 Vol. 20, No. 7

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Expert Forum
Self-management of hypertensive patients in China from the perspective of general practice
HUANG Wen-bo, FENG Xian, YAO Yuan-long, WANG Liu-yi
2022, 20(7): 1085-1088. doi: 10.16766/j.cnki.issn.1674-4152.002529
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As one of the chronic diseases with the largest number of patients in China, hypertension not only brings a heavy burden to patients and their families but also seriously affects the sustainable development of China's social economy. In July 2019, the State Council issued opinions on the implementation of healthy China action. It clearly implemented the prevention and treatment of cardiovascular and cerebrovascular diseases and strengthened the standardised management of hypertension, hyperglycaemia and dyslipidaemia. At present, the incidence of hypertension in China is still increasing. The traditional medical and health care service model relying solely on outpatient treatment has limited effect on the prevention and treatment of hypertension. The prevention and health care of hypertension are often carried out in families and communities. The management of patients and their families on hypertension has become an important link in the management of hypertension. Effective self-management model not only has an obvious effect on blood pressure control of patients with hypertension but also improves physiological indices and self-management ability. With the continuous improvement of hierarchical diagnosis and treatment mechanism in China, grass-root healthcare institutions have become the main place for hypertension management. Their management level has a far-reaching effect on the development trend of hypertension management in China in the future. Therefore, exploring a set of hypertension self-management models suitable for China is of great importance. From the perspective of general practice, this paper summarises the concept, influencing factors, evaluation forms and management status of self-management of domestic patients with hypertension to explore the hypertension self-management model suitable for China's national conditions and provide new ideas for general practitioners on hypertension management. This study also provides ideas for clinical effective self-management to improve patients' self-management ability and quality of life and relieve the pressure of medical and healthcare institutions.
Patient Management in United Kingdom General Practice(to be continued)
Rodger Charlton, XIE Wan-ling, LIU Man-ling
2022, 20(7): 1089-1090.
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Analysis of safety and efficacy of emergent carotid artery stenting in patients with acute anterior circulation stroke with tandem lesion treated with mechanical thrombectomy
ZHANG Dong-huan, LIU Yi-feng, KANG Mei-juan, WANG Ning, SUN Jun, WEN Chang-ming
2022, 20(7): 1143-1146. doi: 10.16766/j.cnki.issn.1674-4152.002543
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  Objective  To explore the treatment options of mechanical thrombectomy for extracranial carotid artery lesions in patients with acute anterior circulation tandem occlusion stroke, and to evaluate its efficacy and safety.  Methods  From January 2018 to December 2019, 18 patients with acute tandem occlusion of the extracranial internal carotid artery and intracranial large artery were admitted to Department of Neurology, Nanyang City Central Hospital and treated by endovascular treatment. There were 9 males and 9 females, aged 60 to 70 years old. According to different treatment methods, 18 patients were divided into emergency stent group (11 cases) and emergency non-stent group (7 cases). The immediate intraoperative recanalization of blood vessels during the operation was judged according to the classification of cerebral infarction thrombolysis (mTICI), and the 90-day modified Rankin Scale (mRS) score of 0-2 was defined as a good clinical prognosis.  Results  There was no statistically significant difference in clinical baseline data such as age, gender distribution, preoperative National Institutes of Health Stroke Scale (NIHSS) score, preoperative Alberta stroke project early CT (ASPECT) score, etiology classification, treatment method, lesion type, blood vessel occlusion site in two groups (all P > 0.05). The rates of successful recanalization of blood vessels (mTICI class 2b-3) of the emergency stent group and emergency non-stent group was 72.7% and 71.4%, respectively; however, there was no statistically significant difference (P > 0.05). The rates of symptomatic intracranial hemorrhage were 9.1% and 0, respectively. Also, there was no statistically significant difference (P > 0.05). There was no statistically significant difference in the modified mRS score and 90-day mortality between the two groups of patients after 90 days (all P > 0.05). The difference in the residual stenosis rate between the two groups was statistically significant (P < 0.05).  Conclusion  In the endovascular treatment of acute anterior circulation tandem occlusion, emergency extracranial carotid artery stenting may be effective and safe.
Study on the effect of increased creatinine level after antihypertensive treatment on the risk of cardiovascular events in patients
HU Fang-ying, FANG Hong-wei, LIN Ping, ZHANG Qiu-shi, MA Jing, CHEN Yue-fang
2022, 20(7): 1147-1150. doi: 10.16766/j.cnki.issn.1674-4152.002544
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  Objective  Decreased renal function associated with renin-angiotensin inhibitors in antihypertensive therapy is associated with an increased risk of cardiovascular disease. However, few studies on other antihypertensive drugs are available. This study aimed to investigate the incidence of cardiovascular events associated with elevated plasma creatinine following first-line antihypertensive medication.  Methods  A total of 182 patients with hypertension who visited Hangzhou Third People's Hospital from October 2015 to June 2020 were enrolled, including 96 males and 86 females, aged (60.5±6.4) years. All patients received renin-angiotensin inhibitors, calcium channel blockers or thiazide antihypertensives during this time period. The correlation between the incidence of 6-month cardiovascular events (ischemic cardiomyopathy, heart failure or stroke) and elevated creatinine was explored.  Results  In accordance with creatinine level, the patients were divided into group A (0%-9%, 79 cases), group B (10%-19%, 40 cases), group C (20%-29%, 27 cases), group D (30%-39%, 20 cases) and group E (>40%, 16 cases). Amongst them, 43.4% (79/182) of patients had an elevated creatinine level of 0%-9%. Six cardiovascular events (3.3%) occurred during the 6-month follow-up period, and no patient died. The creatinine elevations of 0%-9% and 30%-39% corresponded to 6-month cardiovascular event rates of 0.6% and 3.4%, respectively. The total follow-up time was 3.1 (1.8, 5.8) years, the overall incidence of cardiovascular events was 8.2% (15/182) and the incidence in groups D and E was significantly higher than that in other groups (P < 0.001). Higher age and reduced renal function were strongly associated with increased odds of cardiovascular events but not with type of antihypertensive medication.  Conclusion  A greater than 30% increase in plasma creatinine levels in patients starting first-line antihypertensive therapy in primary prevention is associated with increased short-term (6 months) and long-term (3 years) incidence of cardiovascular events.
Serum AMPK-α mRNA, SIRT1 and GDF-8 levels in patients with sarcopenia
WANG Qin, LIN Ping, REN Qian, FENG Li, XIE Xiao-feng, ZHANG Bin, GAO Kang-lu
2022, 20(7): 1151-1154. doi: 10.16766/j.cnki.issn.1674-4152.002545
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  Objective  To investigate the level of serum AMP-activated protein kinase-α mRNA (AMPK-α mRNA), silent mating type information regulation 2 homolog-1 (SIRT1) and growth differentiation factor-8 (GDF-8) in patients with sarcopenia.  Methods  A total of 81 elderly patients treated in Hangzhou Third People's Hospital from January 2019 to June 2020 were selected. According to appendicular skeletal mass index (ASMI), grip strength and walking speed, the patients were divided into sarcopenia group (41 cases) and non-sarcopenia group (40 cases). The level of AMPK-α mRNA, SIRT1 and GDF-8 in serum were detected. The correlation was analyzed by Pearson and Spearman correlation. The diagnostic value of GDF-8 was analyzed by ROC curve.  Results  The data of several indexes of patients in sarcopenia group and non sarcopenia group were as follows [AMPK-α mRNA: 0.26 (0.24, 0.29) vs. 0.29 (0.27, 0.32), SIRT1 (ng/L): 582.68±35.92 vs. 646.50±39.08, GDF-8 (μg/L): 20.97±5.10 vs. 14.76±1.59], the difference was statistically significant (all P < 0.01). SIRT1 and AMPK-α mRNA were negatively correlated with GDF-8 (P < 0.001, P=0.001). The grip strength was positively correlated with AMPK-α mRNA and SIRT1 (P=0.028, P < 0.001), and was negatively correlated with GDF-8 (P=0.001). The critical value of GDF-8 for the diagnosis of sarcopenia was 17.25 μg/L, and AUC was 0.884 (P=0.040).  Conclusion  AMPK-α mRNA and SIRT1 are decreased and GDF-8 is increased in sarcopenia group. GDF-8 can be used as an auxiliary reference index for the diagnosis of sarcopenia.
Relationship between depression in mothers of 3-month-old infants and their feeding style, parenting confidence and infant temperament type
ZHANG Xiao-tian, ZHANG Yue, ZHANG Feng-hua, ZENG Ting, CAI Zhi-ling, YE Ya, XU Tao
2022, 20(7): 1155-1157. doi: 10.16766/j.cnki.issn.1674-4152.002546
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  Objective  To understand the state of depression in mothers of 3-month-old infants, explore its correlation with mothers' confidence in parenting and infant temperament and provide a theoretical basis for the study of related interventions.  Methods  A total of 415 mothers of 3-month-old infants who were examined in 4 maternal and child health care hospitals including Chongqing Maternal and Child Health Hospital from January to December 2019 were selected as the research objects. A self-developed questionnaire was used to collect basic information about mothers and their babies. The Edinburgh Postpartum Depression Scale was used to evaluate the mother's depression, the Karitane Parenting Confidence Scale was used to evaluate the mother's parenting confidence, and the Early Infant Temperament Questionnaire was used to obtain infant temperament types. Univariate analysis was used to analyse the influence of factors such as maternal feeding style, parenting confidence and infant temperament type on mothers' depression. Unconditional logistic regression was used to calculate the OR and 95% CI after adjusting for confounding factors.  Results  In this study, the detection rate of depression in mothers of 3-month-old infants was 27.0%. After controlling for other factors, depression in mothers of 3-month-old infants was found to be associated with their parenting confidence (OR=5.413, 95% CI: 1.580-18.544) and infant's difficult-to-nourish temperament (OR=11.808, 95% CI: 2.037-68.454).  Conclusion  The relationship between depression in mothers of 3-month-old infants, parenting confidence and infant temperament types is conducive to the identification and discovery of mothers' depression. Paediatric health clinics should pay more attention and provide support to infants with difficult temperament and mothers with insufficient parenting confidence, monitor their emotional state, detect negative emotions in time and provide guidance, so as to effectively reduce the incidence of depression in the mothers of infants.
Analysis of the curative effect of Yinzhihuang oral liquid combined with bifidobacterium tetragenous viable bacteria in the treatment of neonatal jaundice
WANG Jie-jie, WANG Guo-kai
2022, 20(7): 1158-1161. doi: 10.16766/j.cnki.issn.1674-4152.002547
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  Objective  To evaluate the efficacy and safety of the combined application of bifidobacterium tetragenous viable bacteria and Yinzhihuang oral liquid in the treatment of neonatal jaundice.  Methods  Total 50 patients with neonatal jaundice in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from May 2019 to December 2020 were selected and randomly divided into control and observation groups, with 25 cases in each group. Both groups were treated with blue light phototherapy and oral administration of liver enzyme inducer phenobarbital. The control group was treated with conventional treatment + bifidobacterium tetragenous viable bacteria 0.5 g with warm water three times/day. On the basis of the control group, the observation group was treated with Yinzhihuang oral liquid 5 mL/time, oral, 3 times/d. The differences of various indexes between the two groups before and after treatment were compared.  Results  There was no significant difference in total bilirubin, direct bilirubin and indirect bilirubin between the two groups before treatment (all P > 0.05). After treatment, there was no significant difference in indirect bilirubin between the two groups (P > 0.05), meanwhile, the total bilirubin and indirect bilirubin of the observation group [(118.78±23.43) and (106.89±22.39) μmol/L] were significantly lower than those of the control group [(135.41±28.66) and (123.31±27.77) μmol/L, all P < 0.05]. The incidence of adverse reactions in the observation group was 4.00% (1/25), and that in the control group was 24.00% (6/25). There was no statistically significant difference between the two groups (P > 0.05). The total time of phototherapy, the total cost of phototherapy and the length of stay in the observation group were significantly lower than those in the control group, and the difference was statistically significant (all P < 0.05).  Conclusion  On the basis of conventional treatment for neonatal jaundice, the combined application of bifidobacterium tetragenous viable bacteria and Yinzhihuang oral liquid has a significant clinical effect, reduces hospitalisation time and the cost of phototherapy, and is a safe and effective treatment method.
Effect of modified chest percussion combined with non-invasive sputum suction technique in the treatment of infants with acute bronchiolitis
LI Hai-yan, ZHAO Guang-yun, PENG Wan-sheng
2022, 20(7): 1162-1165. doi: 10.16766/j.cnki.issn.1674-4152.002548
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  Objective  To discuss the advisability and validity of modified chest percussion combined with non-invasive sputum suction technique in children with acute bronchiolitis.  Methods  Total 90 children with acute bronchiolitis hospitalized in the sixth ward of the Pediatrics Department of Lu'an People's Hospital from December 2019 to December 2020 were selected and divided into observation group (48 cases) and control group (42 cases) using tables of random numbers. The two groups were both cured with classical anti-inflammatory, atomized inhalation, and other symptomatic and supportive treatments. The conventional percussion combined with the traditional sputum suction technique were used for the control group, by contrast, modified chest percussion with the non-invasive sputum suction technique were used for the observation group. The sputum excretion effect, clinical symptoms, respiratory function and other indexes of the two groups were compared before and after treatment. The therapeutic effects of the two groups were compared.  Results  The sputum expectoration effect of the observation group was better than that of the control group. Only 2 cases in the observation group were ineffective, the effective rate was 95.83%, and 10 cases in the control group were ineffective, the effective rate was 76.19% (χ2=7.479, P=0.006). There were significant differences in cough, wheezing, breath holding, lung rales and hospital stay between the observation group and the control group (all P < 0.05). The indexes of respiratory function in the observation group were better than those in the control group (all P < 0.05). The incidence of mucosal injury in the observation group was 2.08% (1/48), which was significantly lower than 28.57% (12/42, P < 0.05). The satisfaction of parents in the observation group was higher than that in the control group (P < 0.05).  Conclusion  The modified chest percussion combined with non-invasive sputum suction technology in infants with acute bronchiolitis can significantly improve the therapeutic effect of children with acute bronchiolitis, quickly relieve children's airway obstruction, relieve children's wheezing symptoms, improve children's respiratory function, and reduce the incidence of sputum suction complications, shortening the hospital stay. It can alleviate the suffering of children, improve the satisfaction of parents, and the operation is convenient, which is worthy of promotion.
Association between number of pregnancies and bone mineral density in older females
ZHU Zhong-xin, SHENG Li-fang, YAO Xiao-cong
2022, 20(7): 1166-1169. doi: 10.16766/j.cnki.issn.1674-4152.002549
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  Objective  The rapid mineralisation of foetal bones in the third trimester and the continuous loss of calcium from breast milk during lactation may lead to the loss of bone mass and the decline of bone mineral density (BMD) in pregnant women. However, evidence regarding the association between number of pregnancies and risk of osteoporosis in older females remains limited and inconsistent. Thus, we aimed to explore the association between number of pregnancies and BMD using a population-based sample database.  Methods  We conducted a study on older females aged 60-80 years with complete data who participated in the National Health and Nutrition Examination Survey (NHANES) in 2007-2010, 2013-2014 and 2017-2018. The independent variable was number of pregnancies. The dependent variable was BMD. We performed multivariable regression models to evaluate the associations between number of pregnancies and BMD.  Results  There were 2 096 subjects in the final analysis, including 264 subjects with one child [age=(67.5±6.1) years], 593 subjects with two children [age=(67.9±6.5) years], 506 subjects with three children [age=(69.5±6.6) years] and 733 subjects with four children or more [age=(71.7±6.5) years]. In the fully adjusted model, there were no significant associations in number of pregnancies with femoral neck BMD, total femur BMD, or Ward's triangle BMD after adjusting for age, race, marital status, time of last menstrual period, education level, moderate exercise, family income to poverty ratio, body mass index, blood urea nitrogen, serum uric acid, serum phosphorus and serum calcium (all P > 0.05).  Conclusion  Having two or multiple births is not a risk factor for osteoporosis for women at old age.
Analysis on status and influencing factors of physical inactivity among the elderly in community
CAI Wei-wei, XIE Hui, WANG Fei, ZHANG Rui-xin
2022, 20(7): 1170-1173. doi: 10.16766/j.cnki.issn.1674-4152.002550
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  Objective  To investigate the current status of physical inactivity of the elderly in community, analyze its influencing factors, and provide reference for the further intervention strategy to improve the level of physical activity of elderly population.  Methods  Total 652 elderly people from a community health in Bengbu signs detection from January 2019 to March 2021 were collected as the research objects. The general information questionnaire, international physical activity questionnaire (long) and related indicators measuring health signs were performed by a unified training of graduate students of health indicators testing. The SPSS 26.0 statistical software was used for descriptive statistics, χ2 test, Wilcoxon rank sum test and binary Logistic regression analysis.  Results  Results showed that 35.7% of the elderly people in the community (233) were physically inactive, and the total amount of physical activity was (418.04±139.74) METs-min/week. Multivariate Logistic regression analysis showed that factors including age (P < 0.001), gender (P=0.017), education level (P < 0.001), BMI (P=0.015), chronic diseases comorbidities (P=0.012), bone mineral density (P=0.010), arteriosclerosis (P=0.012) and smoking (P=0.013) mainly influenced the physical inactivity of the elderly in the community.  Conclusion  Community workers for health management should strengthen related health education and guidance for the elderly especially the male elderly with low cultural level, overweight, chronic diseases comorbidities, abnormal bone mineral density, a hardening of the arteries, and smoking habit, which contributes to cultivate their regular physical activity habits and improve the quality of life of the elderly.
A survey on training needs of basic level children's health service personnel in Beijing based on the common diseases of children
YIN De-lu, WANG Xi, YIN Tao
2022, 20(7): 1174-1177. doi: 10.16766/j.cnki.issn.1674-4152.002551
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  Objective  To understand the common children's diseases in Beijing and explore the relative personalised ability training needs of children's health service personnel in different positions based on common children's diseases to provide reference for strengthening the training of children's health service personnel at the grassroots level.  Methods  Community health service centres in 7 sample areas of Beijing City were selected as sample units. A self-designed questionnaire was used to fill in the questionnaire voluntarily and anonymously by the medical and health care staff of the sample centres. A total of 940 cases were successfully investigated. Excel was used for data processing and SAS 9.1 statistical software was used for data processing.  Results  The top five diseases in Beijing were acute upper respiratory tract infection, pneumonia, diarrhoea, eczema and caries. According to the five common children's diseases, the number of health personnel with training needs for each disease accounted for 65.11%, 40.53%, 55.00%, 58.72% and 31.17%, respectively. The total number of health personnel with different training contents corresponding to each disease were 1 113, 648, 902, 1 003 and 460, respectively. The total number of training needs for the above-mentioned five common diseases of children by the children's health service personnel of primary medical post and health care post were 1 307 and 2 359, respectively.  Conclusion  There are differences in the training needs of children's health service personnel in different grassroots positions in Beijing. The training contents should be designed scientifically to improve the pertinence and accuracy of the training as much as possible, thereby meeting the different training needs of different positions for varying diseases.
Management of "Internet plus" procedural follow-up program in renal transplant recipients
YANG Jiao-di, SONG Jun, ZHU Qian, YE Qing, WU Cun-zao
2022, 20(7): 1178-1181. doi: 10.16766/j.cnki.issn.1674-4152.002552
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  Objective  To explore the clinical effect of "Internet plus" procedural follow-up program in mobile phone APP WeChat terminal for deep integration, and to achieve the professional, standardized, durable, personalized and programmed follow-up management for renal transplant recipients.  Methods  According to the order of admission time, 79 renal transplant recipients who successfully underwent first kidney transplantation in our hospital were selected as the research objects. Forty renal transplant recipients who received routine follow-up from January to December 2019 were selected as the routine group, whereas 39 renal transplant recipients who were followed up by the "Internet plus" procedural follow-up program from January to December 2020 were selected as the intervention group. The self-management ability and quality of life scores of both groups before and after intervention were compared and analysed.  Results  After the intervention, the total score of self-management ability in the four dimensions of diet management, physical activity management, treatment management and social psychological management in the intervention group was (106.58±17.73) points, and that in the routine group was (83.77±14.70) points. The difference was statistically significant (t=6.232, P < 0.001). After the intervention, the total score of physiological function, psychological function, social function and disease treatment of renal transplant recipients in the intervention group was (150.77±14.50) points, and that in the routine group was (130.26±12.72) points, the difference was statistically significant (t=6.688, P < 0.001).  Conclusion  The "Internet plus" procedural follow-up program are deeply integrated with the WeChat APP as the carrier, professional, standardised, lasting, personalised and procedural follow-up management was implemented for renal transplant recipients. They can effectively improve the self-management ability and quality of life of renal transplant recipients.
Application of the 6Sigma-DMAIC Concept Management in the prevention of falls of elderly inpatients
YANG Xian-zhu, XU Xue-xue, CHEN He-zhen, HU Yue-feng, SHENG Sun-ren
2022, 20(7): 1182-1185. doi: 10.16766/j.cnki.issn.1674-4152.002553
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  Objective  To study the application of the 6Sigma-DMAIC Concept Management in the prevention and control of falls in elderly inpatients, and to provide a reference for reducing the incidence of falls in elderly inpatients.  Methods  A total of 216 cases of elderly patients who were hospitalised in the Second Affiliated Hospital of Wenzhou Medical University from March 2019 to September 2020 were selected as the subjects of this study. All patients were divided into control group and study group according to the random number table method, with 108 cases in each group. The patients in the control group received routine fall prevention interventions during hospitalisation, whereas those in the study group implemented preventive measures based on the 6Sigma-DMAIC Concept Management on the basis of routine intervention. The causes of falls in elderly hospitalised patients was counted. Patients' mastery of fall prevention knowledge, the incidence of falls and patients' satisfaction with clinical intervention management measures were compared between the two groups.  Results  The patients in the study group had a higher level of mastery of fall prevention knowledge, fall handling knowledge, fall prevention facilities and fall prevention techniques than those in the control group, and the difference was statistically significant (all P < 0.05). The total incidence of falls during hospitalisation in the study group (0.93%, 1/108) was lower than that of the control group (7.41%, 8/108), the difference was statistically significant (P < 0.05). Approximately 97.22% (105/108) of the patients in the study group were satisfied with fall prevention management, which was significantly higher than that in the control group (87.04%, 94/108), the difference was statistically significant (P < 0.05).  Conclusion  The 6Sigma-DMAIC Concept Management has high application value in the fall prevention of elderly inpatients. It can significantly strengthen the knowledge of fall prevention for elderly inpatients and their families, reduce the risk of falls and improve the satisfaction of intervention management.
Application of 64-slice spiral CT multiplanar reconstruction and volume rendering technique in complex tibial plateau fractures
SUN Da-yong, MA Xiao-kai, CHEN Liu-cheng, LIU Hao, YANG Bo, GUO Jun-ning
2022, 20(7): 1186-1189. doi: 10.16766/j.cnki.issn.1674-4152.002554
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  Objective  To investigate the value of 64-slice spiral CT multiplanar reconstruction (MPR) and volume rendering (VR) technique in the diagnosis, classification and treatment plan of tibial plateau fractures.  Methods  The clinical data of 69 suspected patients with tibial plateau fracture in the Third people's Hospital of Bengbu from June 2020 to December 2021 were selected. The relevant data of tibial fracture were obtained by CT scanning, and the data were reconstructed and volume reconstructed by ADW4.4 workstation to diagnose the patient's condition. Compared with diagnostic of X-ray, the diagnostic coincidence rate and typing accuracy were analyzed and studied.  Results  A total of 65 patients with tibial plateau fractures were diagnosed, including 35 males and 30 females, the average age was (49.69±15.91) years. In this study, patients aged 50-59 years accounted for the highest proportion (26.2%), followed with patients aged 40-49 years (23.1%). Schatzker type Ⅰ tibial plateau fracture was the most common type, with 19 cases (29.2%), followed by Schatzker type Ⅱ(26.2%), Schatzker type Ⅲ(13.8%) and Schatzker type Ⅳ(13.8%). There was no significant difference in Schatzker classification between Sexes (P > 0.05). Compared with the standard of surgical classification, the accuracy of X-ray diagnosis was 81.5% (53/65), and the accuracy of CT MPR+VR was 98.5% (64/65), with statistically significant difference (χ2 =10.342, P < 0.01).  Conclusion  64-slice spiral CT multiplanar reconstruction and volume reconstruction technology can well identify and diagnose the true situation of tibial fracture, and deeply explore the hidden damage around the joint, which can provide a powerful basis for clinical treatment.
Value of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 in identifying T staging of oesophageal cancer
ZHANG De-sheng, ZHU Xiao-lei, HE Jian, ZHENG Yi-feng, WU Xiao, CHU Hai-Rui, GUO Dong-chuang
2022, 20(7): 1190-1193. doi: 10.16766/j.cnki.issn.1674-4152.002555
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  Objective  To analyse the value of high-strength MRI combined with serum cytokeratin 19 fragment (CYFRA21-1), carbohydrate antigen 72-4 (CA72-4) and carbohydrate antigen 125 (CA125) in identifying T staging of oesophageal cancer.  Methods  From July 2017 to January 2020, 104 patients with esophageal cancer who were to be surgically treated in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Huzhou Central Hospital were selected as research objects. The image quality of high-field-intensity MRI and the value of high-field-intensity MRI combined with serum CYFRA21-1, CA72-4, CA125 were analysed. Kappa consistency analysis was used in identifying T staging of oesophageal cancer.  Results  There were 6 cases with high-strength MRI image quality scoring 2 points, 16 cases scoring 3 points, 40 cases scoring 4 points and 42 cases scoring 5 points. The accuracy of high-strength MRI for the diagnosis of T staging of oesophageal cancer was 92.30% (96/104). The accuracy rate of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 for the diagnosis of T staging of oesophageal cancer was 95.19% (99/104), which was significantly different from that of single MRI (P < 0.05). However, the specificity, accuracy, positive predictive value for stage T2; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for stage T3; and sensitivity, accuracy, negative predictive value for stage T4a of combined diagnosis were higher than those of single high-strength MRI.  Conclusion  Single high-strength MRI or its combination with serum CYFRA21-1, CA72-4 and CA125 can effectively identify the T staging of oesophageal cancer, and the efficiency of combined diagnosis is slightly improved.
Research progress and function of mitophagy in myocardial infarction
ZHANG Wen-jing, LI Xiao-feng, SUN Ming-ming, PENG Hu
2022, 20(7): 1194-1198. doi: 10.16766/j.cnki.issn.1674-4152.002556
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Myocardial infarction (MI) refers to myocardial ischemic necrosis caused by persistent and severe acute ischemia and hypoxia caused by acute reduction or interruption of perfusion blood flow after the coronary artery that nourishes the heart. The mechanism of myocardial injury in patients with MI needs to be clarified urgently. The research on the mechanism of MI and the search for intervention targets have important clinical value. The mitochondria, as organelles that provide energy, is the key organelles for the continuous contraction and relaxation of cardiac muscle cells. They are responsible for adenosine triphosphate generation and energy metabolism. The loss of mitochondrial integrity and function is a key pathological factor that changes the structure and function of the heart. Mitochondrial dysfunction during MI is an important mechanism of myocardial injury. Mitochondrial quality control refers to maintaining a balance between mitochondrial production and clearance, which is particularly essential for maintaining cell survival and function. Mitophagy is associated with various diseases, such as neurodegenerative diseases, cardiovascular diseases and cancer. Mitophagy is a selective autophagy that uses damaged mitochondria as an autophagy substrate to maintain cardiovascular homeostasis. Mitophagy controls the quality of the mitochondria by promoting the degradation and recycling of damaged mitochondria and protects cardiomyocytes from ischemic injury. For normal cardiomyocytes, sufficient mitochondrial production could ensure sufficient energy supply. However, in the process of MI, mitochondrial damage occurs in cardiomyocytes and if the damaged mitochondria are not cleared in time, cardiomyocyte damage and even apoptosis could be induced. The process of mitophagy is complex, involving many physiological and pathological processes, and it is regulated by various substances, such as proteins and RNAs. In this article, the important roles and related mechanisms of mitophagy in MI are reviewed.
Advances of the pathological mechanism and related factors of cognitive impairment in neuromyelitis optica spectrum disorders
RUI Qian-yun, CAO Shu-gang, ZHOU Xiao-ling, WANG Xiao-yuan, XUE Qun
2022, 20(7): 1199-1202. doi: 10.16766/j.cnki.issn.1674-4152.002557
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Neuromyelitis optica spectrum disorders (NMOSDs) are recurrent autoimmune inflammatory disorders of the central nervous system, with uni- or bilateral optic neuritis, transverse myelitis and brainstem syndromes as clinical hallmarks. Aquaporin-4 immunoglobulin G antibody (AQP4-IgG) is a specific pathogenic antibody to NMOSD. Numerous studies have demonstrated the presence of cognitive impairment in multiple sclerosis (MS) and the problem of cognitive impairment in NMOSD has previously been ignored because of its more prominent neurophysiological disability. In recent years, with the development of neuroimaging and measurement of cognitive scales, a series of studies has demonstrated that cognitive impairment may be present in NMOSD with or without brain lesions, thus revealing possible occult brain pathology damage in the disease process. Considering the high incidence rates of recurrence and disability, NMOSD insidiously progressing to comorbid cognitive impairment could bring serious economic and mental burdens to patients and families. The problem of cognitive impairment in NMOSD is gradually attracting the attention of clinical and scientific researchers and making progress, including neuroimaging predictors of cognitive impairment, neuropathological changes and molecular indicators of blood. In this article, the major studies on cognitive impairment in NMOSD are reviewed. The current status of research, pathological mechanisms, cognitive scales, neuroimaging advances and the effects of other factors of cognition in NMOSD is also systematically described, providing clinicians with a basis of assessing cognitive changes, disease progression and treatment prognosis in NMOSD in their clinical work.
Progress in the clinical treatment of oral submucosal fibrosis
WANG Feng-feng, WANG Tao, LI Chuan-zhen
2022, 20(7): 1203-1206. doi: 10.16766/j.cnki.issn.1674-4152.002558
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Oral submucosal fibrosis (OSF) is a chronic oral mucosal disease characterised by epithelial atrophy, excessive accumulation and degeneration of collagen fibres in the lamina propria and submucosa and changes in microvascular quality. It has no symptoms at the early stage. However, symptoms gradually manifest including limited mouth opening; white, stiff and inelastic mucosa; burning sensation whilst eating, especially spicy and other stimulating foods; dry mouth; and functional decline in chewing, speech and taste. OSF has a tendency to become oral cancer (7%-30%). Therefore, WHO and IARC included in the queue of potential oral malignant diseases. It's a double whammy to the patient's life and spirit. Early intervention in mild OSF patients to slow down or even stop the development of the disease has become particularly important. The prevention and treatment of OSF have been the focus of scholars in China and abroad. In recent years, researchers have been trying to explore more effective methods of prevention and treatment of OSF by means of drug therapy, hyperbaric medicine and surgical treatment. At the same time, the study of OSF pathogenesis continues to deepen. In medicine mainly around Curcuma Longa, Salvia Miltiorrhiza, aloe, placenta extract and so on, in the physiotherapy focus on Hyperbaric medicine, whilst exploring a variety of surgical procedures, both oral function and aesthetic repair of postoperative defects. At present, the effect of OSF is not good, and no definite radical therapy has been found. Individualised treatment and relief of clinical symptoms and signs are still the main ways to treat OSF. In this paper, we summarise the research progress of the treatment of OSF from three aspects of drug therapy, physical therapy and operation therapy to provide a basis for the clinical treatment of OSF by stomatologists.
Effects and research progress of transcranial magnetic stimulation on glial cells in the central nervous system
GAO Min, GAO Chang-yue
2022, 20(7): 1207-1210. doi: 10.16766/j.cnki.issn.1674-4152.002559
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Transcranial magnetic stimulation (TMS) non-invasively stimulates neurons by generating a localised magnetic field, which could induce an electrical current in the brain. TMS can regulate brain activity in different patterns. TMS has been applied to the diagnosis and treatment of different diseases because of its effects on neurons and glial cells. Glia comprise the majority of cells in the adult brain, far exceeding neurons in number and diversity. Glial cells can be divided into five types: adult neural stem cells, which generate new neurons that are required for learning and memory; astrocytes, which perform a diverse range of functions, including neurotransmitter uptake and the buffering of extracellular potassium ion concentration; oligodendrocytes, which support axons through myelin production and favour trophic growth; oligodendrocyte progenitor cells, which can promote the proliferation and generation of new oligodendrocytes; and microglia, which are the resident immune cells of the brain. Each type of glial cell could be influenced by electrical activity directly or indirectly, making them possible cellular effectors of TMS. TMS can promote the proliferation of adult neural stem cells/progenitor, but its influence on cell survival and differentiation is unclear. TMS can stimulate astrocytes and then influence the formation, maturation, synaptic pruning and shape of dendritic spines. The research data of TMS on astrocytes and microglia are limited. The TMS of oligodendrocytes can dynamically regulate nerve conduction velocity. Data relating to the response of oligodendrocyte-lineage cells to this treatment are lacking. However, glial cells play a vital role in the central nervous system. Thus, the influence of TMS on glial cells warrants careful examination.
Effects of Jianpi Tongluo Decoction on chronic obstructive pulmonary disease complicated with depression
YAN Fei-fei, XU Xu-dong, ZHANG Hai-bo, JI Ya-feng
2022, 20(7): 1211-1214. doi: 10.16766/j.cnki.issn.1674-4152.002560
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  Objective  To observe the effect of Jianpi Tongluo Decoction on the respiratory symptoms, pulmonary ventilation function and psychological state of patients with chronic obstructive pulmonary disease complicated with depression (Fipi Qixu Tanyu Zufei syndrome).  Methods  A total of 84 patients with chronic obstructive pulmonary disease complicated with depression treated in the Department of Respiratory and Critical Care Medicine of Putuo Hospital from September 2019 to September 2020 were randomly divided into observation group and control group, with 42 patients in each group. The control group was treated with conventional Western medicine, such as expectorant and antispasmodic, and the observation group was treated with Jianpi Tongluo Decoction on the basis of the control group. One course of treatment in both groups was 4 weeks, with a total of three courses of treatment. The respiratory symptoms, CAT, BODE index, HAMD, SDS and pulmonary ventilation function index (FEV1, FEV1/FVC, MIP and MEP) scores were compared. The clinical efficacy and adverse reactions of the two groups were evaluated.  Results  The total effective rates of the observation and control groups were 92.86% and 76.19%, respectively. The observation group had a significantly higher rate than the control group (P < 0.05). After treatment, the respiratory symptoms, CAT, BODE index, SDS and HAMD scores of the observation group were significantly lower than those of the control group (all P < 0.05). Meanwhile, the FEV1, FEV1/FVC, MEP and MIP index levels of the observation group were significantly higher than those of the control group (all P < 0.05). No obvious adverse reactions were observed in both groups.  Conclusion  The application of Jianpi Tongluo Decoction could improve pulmonary ventilation function, alleviate respiratory symptoms and improve depression in patients with chronic obstructive pulmonary disease complicated with depression.
Effect of aerobic endurance training combined with electroacupuncture stimulation therapy on postoperative rehabilitation of patients with scoliosis
CHEN Yan-hong, TANG Yang-hua, WANG Hong-ya, WANG Wei-wei
2022, 20(7): 1215-1217. doi: 10.16766/j.cnki.issn.1674-4152.002561
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  Objective  To explore the effect of aerobic endurance training combined with electroacupuncture stimulation on postoperative rehabilitation, VAS score and SRS-22 score of patients with scoliosis.  Methods  A total of 120 patients who received rehabilitation therapy after scoliosis surgery in Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from September 2018 to September 2019 were selected. The patients were divided into observation group and control group according to the random number table method, with 60 cases in each group. The patients in the control group were given aerobic endurance training, and the patients in the observation group were treated with electroacupuncture stimulation on the basis of the control group. Both groups were treated continuously for 30 days. The rehabilitation effect, VAS score and SRS-22 score of the two groups were observed.  Results  There were statistically significant differences in the time of first standing [(2.92±0.33) d vs. (3.87±0.41) d], the duration of first standing [(9.34±1.22) min vs. (6.97±1.32) min] and the strength of left and right lateral flexors after 30 days of treatment between the two groups (all P < 0.05). After 30 days of treatment, the pain, self-image, activity function, mental health, treatment satisfaction and total score in the observation group were higher than those in the control group and the observation group before treatment, and the differences were statistically significant (all P < 0.05). After 7 and 30 days of treatment, the VAS scores of the observation group were lower than those of the control group [(6.47±0.82) points vs. (5.75±0.67) points, (3.21±0.36) points vs. (3.98±0.34) points], and the difference was statistically significant (all P < 0.05).  Conclusion  Aerobic endurance training combined with electroacupuncture stimulation therapy has a better rehabilitation effect on patients with scoliosis after surgery. It can effectively reduce the VAS score, improve the SRS-22 score value, and better improve the quality of life of patients.
Exploration of "online and offline" blended teaching mode of physiology under the background of post-epidemic period
YU Ying, ZHANG Wei-ping, HU Jie, YE Hong-wei, ZHENG Ling, MA Shan-feng, GAO Qin
2022, 20(7): 1218-1222. doi: 10.16766/j.cnki.issn.1674-4152.002562
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  Objective  To compare the teaching effect of online teaching method and traditional teaching method in physiology course.  Methods  Seventy-one undergraduates majoring in the Nutrition and Food Hygiene major of Bengbu Medical College were selected as the research objects. They were divided into two groups. The research group consisted of 36 undergraduates of 2019 and received Superstar learning link + Tencent classroom online teaching mode. The control group consisted of 35 undergraduates of 2018 and adopted the traditional classroom teaching mode. After the course, the learning effect was tested by comparing the test scores of the two groups of students. The evaluation effect of the two groups was analysed by the course grades. An anonymous questionnaire survey was also used to evaluate the learning initiative, learning interest, learning motivation, expression ability, independent thinking ability, teamwork ability, innovation ability, successful experience, self-confidence improvement and teaching mode arrangement satisfaction of the two groups.  Results  The scores of the research group and the control group were (83.15±5.91) points and (86.10±8.06) points, respectively. No statistically significant difference was found in the scores of course and the good rate between the two groups (P>0.05). The research group was higher than the control group in terms of interest in curriculum, expression ability, teamwork ability and the satisfaction of teaching methods and teaching innovation and the differences were statistically significant (all P < 0.05). However, in terms of teamwork, experience of success and self-confidence, the research group was statistically lower than the control group (all P < 0.05).  Conclusion  The online teaching mode needs to be improved constantly and the traditional classroom teaching by teachers is still an important part. In the post-epidemic period, the combination of online and offline teaching is an inevitable trend.
Application of PDCA and participatory teaching model in the experiment teaching of prosthodontics
TIAN Rui-xue, LI Jian-cheng, YANG Dong-kun, LU Xiao-miao, ZHAO Li-li
2022, 20(7): 1223-1225. doi: 10.16766/j.cnki.issn.1674-4152.002563
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  Objective  On the basis of the shortcomings of the current traditional practice teaching of prosthodontics, a new teaching method, which combines PDCA [P (plan), D(do), C (check), A (action)] with participatory teaching mode, is adopted. Teachers and students participate in classroom teaching quality management and the new method is applied in teaching plate in a circular manner to discuss its teaching effect.  Methods  A total of 99 students, who were admitted from stomatology major in 2017 at Bengbu Medical College, were randomly divided into observation group (49, participatory reaching + PDCA) and control group (50, traditional teaching model). The students in both groups were tested using a questionnaire survey. At the end of the semester, the theoretical knowledge achievement and the clinical skill ability of the two groups were evaluated and compared. Meanwhile, the questionnaire survey was conducted to make a subjective evaluation of the teaching methods of this semester and evaluate the mastery of the courses of this semester.  Results  The theoretical scores of the observation group and the control group were (81.35±5.21) points and (76.86±6.33) points, respectively. The operation scores were (83.73±6.87) points and (77.69±5.29) points, respectively. The differences was statistically significant (all P < 0.01). According to the questionnaire survey, the observation group was better than the control group in the four aspects of teacher-student interaction, learning interest mobilisation, innovative thinking ability and literature review ability, and the difference was statistically significant (χ2=21.881, 16.412, 58.394 and 29.952, respectively, all P < 0.05). No significant difference was found in classroom discipline performance between the two groups (P>0.05).  Conclusion  The participatory teaching method combined with PDCA mode has a good effect in testing clinical teaching and it could be applied in the test clinical practice teaching.
The relationship between low-density lipoprotein cholesterol and mild decline of renal function in hypertensive patients of Anqing rural area
ZHANG Ru-shan, TANG Gen-fu, WANG Rui, ZOU Jian-fei, XU Ya-ping, ZHANG Xu, CHEN Hao, WU Qian
2022, 20(7): 1226-1229. doi: 10.16766/j.cnki.issn.1674-4152.002564
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  Objective  To evaluate the relationship between plasma low density lipoprotein cholesterol and mild decline of renal function, and provide clues for early prevention of hypertension complicated with chronic kidney disease.  Methods  In this study, a multi-stage random sampling method was used in seven randomly selected townships of Anqing City rural areas from June to September 2020, including 1 959 hypertensive patients. The general information and plasma low density lipoprotein cholesterol level of the subjects were obtained and logistic regression was used to analyze the relationship between LDL-C and mild decline of renal function.  Results  The average age of 1 959 hypertensive patients was (69.2±7.0) years, including 1 231 patients with mild renal dysfunction (62.8%). After optimizing gender and other related factors, there was a significant positive correlation between LDL-C and mild renal decline in hypertensive patients. When plasma LDL-C increased by 1 mmol/L, the risk of mild renal decline will increase 57% in patients with hypertension (OR=1.570, 95% CI: 1.359-1.813). Dividing LDL-C concentrations into 3 grades, compared with the patients with the lowest tertile of LDL-C (T1, < 2.2 mmol/L), the patients with the median tertile of LDL-C (T2, ≥2.2 and < 2.9 mmol/L) and the highest teitile of LDL-C (T3, ≥2.9 mmol/L) had a 1.028-fold (OR=2.028, 95% CI: 1.578-2.605) and 2.721-fold (OR=3.721, 95% CI: 2.814-4.920) increased risk of mild renal decline, respectively. In addition, there was a synergistic effect on increasing the risk of mild renal decline between elevated diastolic blood pressure and increased LDL-C levels (diastolic blood pressure < 90 mm Hg vs ≥ 90 mm Hg, 1 mm Hg=0.133 kPa, P for interaction=0.006).  Conclusion  There was a positive correlation between LDL-C and mild renal function decline in hypertensive patients, especially in those with increased diastolic blood pressure. It is suggested that controlling LDL-C and blood pressure in patients with hypertension can reduce the risk of mild renal function decline and reduce the early damage of renal target organs.
Systematic Review on the Efficacy of Atrial Fibrillation Screening Using Wearable Devices
GAO Chen-xi, CHEN Qing-yong
2022, 20(7): 1230-1234. doi: 10.16766/j.cnki.issn.1674-4152.002565
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  Objective  To carry out a systematic review of randomised controlled trial (RCT) studies on atrial fibrillation (AF) detection rates by wearable devices and provide the integrated evidence in supporting the clinical application of wearable devices that have been shown to be significantly effective in enhancing AF detection rates.  Methods  MEDLINE (PubMed), Ovid, Clinical Trials, Wanfang Medical Network and CNKI databases were searched for RCT studies on AF screening efficacy using wearable devices, published from establishment of the databases to October 30, 2021. The data related to AF detection rates were extracted, summarised and analysed according to "Preferred Reporting Items for Systematic Reviews and Meta-Analyses".  Results  A total of 11 RCT papers with a total of 41 565 intention-to-screen participants were identified. On continuous ECG(cECG) patches, 5 RCTs showed significantly higher AF detection rates compared with conventional detection methods. Of 6 RCT studies on handheld intermittent ECG detection devices, only 2 showed significantly higher AF detection rates compared with conventional methods.  Conclusion  AF can be more effectively screened using continuous cECG-based wearable devices compared with conventional detection methods. The effect of handheld intermittent ECG devices on AF screening was inconsistent, and further research is needed.
Expression and significance of SEC61G in invasive breast cancer
WANG Yan, LIU Xian-fu, XU Bo, ZHANG Bo
2022, 20(7): 1235-1239. doi: 10.16766/j.cnki.issn.1674-4152.002566
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  Objective  To analyze the expression of SEC61G in invasive breast cancer from tumor Genome Map (TCGA) database and its relationship with clinical prognosis.  Methods  The RNAseq data of 1 222 patients with invasive breast cancer were collected from TCGA database. Wilcoxon rank sum test was used to analyze the difference of SEC61G expression between normal and tumor tissues. Logistic regression was used to analyze the relationship between SEC61G expression and clinicopathological features. Kaplan-Meier method and Cox regression analysis were used to evaluate the role of SEC61G in prognosis.  Results  The expression of SEC61G in invasive breast cancer was significantly higher than that in normal breast tissue (P < 0.001). T stage (P=0.028), N stage (P=0.009), pathological stage (P=0.003), ER status (P < 0.001), PR status (P < 0.001), HER2 status (P=0.025) and histological type (P < 0.001) were significantly correlated with SEC61G expression. Univariate Cox regression analysis showed that the high expression of SEC61G was associated with DSS (P < 0.001, HR=0.426, 95% CI: 0.272-0.668). Multivariate Cox analysis showed that high expression of SEC61G was an independent risk factor for DSS (P=0.009, HR=0.479, 95% CI: 0.276-0.831). The K-M curve of each group showed that the higher the expression of SEC61G in tumor tissue, the worse the prognosis of invasive breast cancer patients (P < 0.05).  Conclusion  The high expression of SEC61G is related to the poor prognosis of invasive breast cancer and can be used as an effective biomarker to predict the survival of patients with invasive breast cancer.
Design of surgical drapes for bladder lithotomy position and its application value
ZHU Rong-rong, CHEN Rong-zhu, PENG Cheng, WANG Gui-hong, WANG Wen-ji, JIANG Qin-qin
2022, 20(7): 1240-1243. doi: 10.16766/j.cnki.issn.1674-4152.002567
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  Objective  The surgical drapes for bladder lithotomy position are designed to meet the needs of precise operation support, save cost and reduce draping time.  Methods  A surgical drape for bladder lithotomy position was designed, created and compared with traditional surgical drapes. A total of 100 cases of patients requiring bladder lithotomy in the Department of Gynaecology, The First Affiliated Hospital of USTC from May 2020 to December 2020 were selected as the research objects. Fifty cases were randomly chosen as the control group and another 50 cases as the observation group. The two groups of surgical kits were compared in terms of time spent on the draping, cost of consumables used, number of shifts of the dressing during operation and time of added draping and number of tool drops in the two groups.  Results  The total laying time of the observation group was 5 339 s (no added draping required), shorter than that of the control group, which was 8 683 s (total of 9 106 s with additional 423 s for the added draping due to intraoperative overlays). The difference was statistically significant (P < 0.001). The number of intraoperative overlays in the observation group was 0, significantly less than that in the control group, which was 11, and the difference was statistically significant (P < 0.001). The number of tool drops in the observation group was only 2, less than 5 in the control group, with no statistical difference (P>0.05).  Conclusion  The proposed surgical drape design for bladder lithotomy position exhibits an integrated configuration with separate areas for clean and dirty tools during surgical operation. It is flat and beautiful in appearance, easy to operate, hassle free and cost saving. The special bagging design makes it possible to separate clean and dirty areas, thus reducing the chances of tool dropping and avoiding infection on surgery. In addition, the unique "time out" design enhances strict inspections from all three parties involved, which contributes to ensuring patient safety. Therefore, the proposed design is worthy of promotion and application.
Practice and effect of postoperative transitional care of pediatric supracondylar humerus fracture under orthopedic rehabilitation nursing clinic
CHEN Xiao-yan, ZHOU Li-hua, FANG Ji-hong, YIN Ying, LI Dun-hui, DUAN Yong-xian
2022, 20(7): 1244-1247. doi: 10.16766/j.cnki.issn.1674-4152.002568
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  Objective  To evaluate the intervention effect of transitional care upon orthopedic rehabilitation clinic on the rehabilitation of pediatric supracondylar humerus fracture.  Methods  Between July 2020 and October 2020, 86 cases of pediatric Supracondylar humerus fractures (Gartland Ⅱ/Ⅲ) were selected in Anhui Provincial Children's Hospital from patients who underwent surgery with operated in closed reduction and percutaneous pinning, they were divided into control group (n=40) and observation group (n=46) by using random number table. All the candidates were received the transitional care characterized by video guided functional exercise that combined with Wechat platform tracking, besides, the patients in observation group were under the management of orthopedic nursing rehabilitation clinic with rehabilitation specialist and orthopedic specialist nurse. The compliance of rehabilitation exercise, the satisfaction of the parents, the MEPS (Mayo elbow performance score), and the score of ROM (range of motion) were compared between the two groups.  Results  When comparing between the observation group and the control group, the score of compliance of rehabilitation exercise were (83.20±13.82) points and (71.00±16.49) points, respectively (P < 0.001), the score of parents'satisfaction were (77.17±20.97) points and (66.25±21.60) points, respectively (P=0.020), and the MEPS were (88.04±8.33) points and (82.50±7.33) points, respectively (P=0.002), the referred indicators between the two groups had statistical difference. The ROM scores associated with flexion, extension, pronation and supination of elbow function in the observation group were higher than that of the control group (all P < 0.05).  Conclusion  The transitional care in orthopedic rehabilitation clinic can promote the postoperative rehabilitation of elbow joint of pediatric supracondylar humerus fracture, which improving the rehabilitation training compliance and increasing the satisfaction of the parents.
Evaluation of intervention effect of precision nursing model for retinal detachment
YU Bai-yuan, BI Jing-cai, CHEN Yin-hua, ZHANG Ling, JIANG Yi-lian, FAN Ling-ling
2022, 20(7): 1248-1251. doi: 10.16766/j.cnki.issn.1674-4152.002569
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  Objective  To explore the effect and mechanism of precision nursing mode in the surgical treatment and quality of life of patients with retinal detachment.  Methods  Sixty patients with retinal detachment hospitalised in the Department of Ophthalmology of the First Affiliated Hospital of Anhui Medical University from December 2018 to December 2019 were selected. They were randomly divided into the observation group and control group by random number table method, with 30 cases in each group. The patients in the observation group were given precise nursing, whereas those in the control group were given routine nursing. The differences of body position compliance rate, medication compliance rate, medication accuracy rate, postoperative complication rate, recurrence rate, percentage of patient satisfaction, visual acuity change, length of stay, treatment cost and quality of life between the two groups were compared, and the effects were analysed.  Results  The body position compliance rate, medication accuracy rate and satisfaction percentage of the observation group were significantly higher than those of the control group (all P < 0.05). The incidence of complications and recurrence rate of the observation group were significantly lower than those of the control group with statistically significant differences (all P < 0.05). No significant difference was observed in the medication compliance rate between the two groups (P=0.306). The visual acuity of the observation group at admission and discharge was not significantly different from that of the control group (all P>0.05). The visual acuity of the observation group at 15 (0.15, 0.40) and 30 days (0.18, 0.45) of discharge was significantly better than that of the control group [(0.10, 0.30) and (0.10, 0.25)], all P < 0.05. In the observation group, the treatment cost [(14 916.96±3 966.91) yuan] and hospital stay [(8.77±3.38) days] were significantly better than those in the control group [(23 763.22±8 098.87) yuan and (15.20±4.21) days, respectively, all P < 0.05]. There was no significant difference in the quality of life score before admission between the observation group and the control group (P=0.916). The quality of life scores of the observation group at discharge [(34.97±3.43) points], 15 days after discharge [(40.96±4.96) points] and 30 days after discharge [(46.25±5.23) points] were significantly better than those of the control group [(27.56±2.87) points, (30.41±4.51) points and (35.43±5.23) points, respectively], the differences were statistically significant (all P < 0.05).  Conclusion  Precision nursing can effectively improve the surgical effect and quality of life of patients with retinal detachment surgery and has a distinct advantage over routine nursing.
Application of intensified psychological intervention in young and middle-aged patients with haemorrhagic stroke
LI Xin-jun, LI Miao-miao, WEI Juan, SHI Bei-tian, YAO Guo-quan, HOU Shi-qiang, LIN Ning, ZHANG Lan-lan
2022, 20(7): 1252-1254. doi: 10.16766/j.cnki.issn.1674-4152.002570
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  Objective  To explore the clinical application value of intensified psychological interventions in the conservative treatment of young and middle-aged patients with basal ganglia haemorrhage.  Methods  A total of 86 young and middle-aged patients with basal ganglia haemorrhage who underwent conservative treatment at the First People's Hospital of Chuzhou from December 2016 to April 2021 were selected as the research objects. The observation group and control group were divided via random number table. Forty patients in the observation group accepted intensified psychological intervention and 46 patients in the control group accepted normal neurosurgery nursing. The nursing satisfaction during hospitalisation and the scores of depression, anxiety and ability of daily living after 8 weeks between the two groups were compared and analysed.  Results  The nursing satisfaction of the observation group and the control group were 97.50% and 93.48%, respectively, during hospitalisation, with no significant difference (P=0.620). Eight weeks later, the observation group's depression score was (48.28±4.26) points, significantly lower than that of the control group [(51.00±6.71) points], and the difference was statistically significant (P=0.030). Meanwhile, the observation group's anxiety score was (40.73±4.87) points, significantly lower than that of the control group [(43.48±7.15) points], and the difference was statistically significant (P=0.043). The observation group's score for ability of daily living was (86.75±11.47) points, significantly higher than that of the control group [(79.35±12.18) points], and the difference was statistically significant (P=0.005).  Conclusion  Intensified psychological intervention could not only effectively improve the depression and anxiety of young and middle-aged patients with basal ganglia haemorrhage but also enhance the function recovery. It is conducive to comprehensive rehabilitation and has certain clinical popularisation value.
Application of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection
LIANG Rui, LIU Na-na, LI Li, WANG Mei, YUAN Sha-sha, YANG Shan-shan, PANG Qing
2022, 20(7): 1255-1258. doi: 10.16766/j.cnki.issn.1674-4152.002571
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  Objective  To explore the clinical application value of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection.  Methods  The clinical data of 80 patients who underwent laparoscopic hepatocarcinoma resection at the Department of Hepatobiliary Surgery in First Affiliated Hospital of Bengbu Medical College from August 2019 to October 2020 were retrospectively analysed. Random table method was used for grouping. Forty cases were categorized into observation group, who received nursing measures with the concept of accelerated rehabilitation. Another 40 cases were categorized into control group, who received traditional nursing measures. The differences in postoperative pain score, perioperative index, postoperative stress index and nursing satisfaction index between the two groups were compared.  Results  The pain scores of patients in the observation group at 24 h (t=5.300, P < 0.01) and 48 h (t=6.030, P < 0.01) after operation were significantly lower than those of the control group and the differences were statistically significant. Meanwhile, the postoperative exhaust time [(2.68±1.01) d vs. (3.21±1.13) d], postoperative defecation time [(3.56±1.02) d vs. (4.55±1.21) d], abdominal drainage tube removal time [(3.39±1.05) d vs. (4.14±0.99) d], hospital stay [(7.53±1.74) d versus (9.28±2.13) d] and other perioperative indicators in the observation group were better than those in the control group, and the difference was statistically significant (all P < 0.05). By contrast, no statistical difference was found in the operation time, intraoperative blood loss and hepatic port occlusion time between the two groups (all P>0.05). The fasting blood glucose and C-reactive protein indices of the observation group were better than those of the control group on the 1st and 4th day after operation and the difference was statistically significant (all P < 0.05). The nursing satisfaction of the observation group was significantly higher than that of the control group (90.00% vs. 70.00%) and the difference was statistically significant (P < 0.05).  Conclusion  Accelerated rehabilitation concept in nursing measures could reduce postoperative pain in patients with laparoscopic hepatocarcinoma resection, promote postoperative recovery, reduce postoperative stress response and improve patients'satisfaction with medical care. These measures have good safety and clinical practicability.
Application of continuous nursing based on timing theory in patients with atrial fibrillation and chronic heart failure
ZHENG Ai-di, WANG Yong-mei, XU Jing, ZOU Hai-ying
2022, 20(7): 1259-1262. doi: 10.16766/j.cnki.issn.1674-4152.002572
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  Objective  To explore the effect of continuous nursing intervention based on timing theory on the compliance of anticoagulant medication and anticoagulant effect in patients with atrial fibrillation and chronic heart failure.  Methods  A total of 100 patients with atrial fibrillation and chronic heart failure admitted to Hangzhou First People's Hospital from January 2019 to June 2019 were selected. The patients were randomly divided into observation group and control group with 50 cases each. The patients in the control group were provided with routine nursing and discharge guidance. The patients in the observation group were provided with continuous nursing guidance based on the timing theory on the basis of the control group. Compliance with anticoagulant medication after 3 and 6 months discharge, International normalized ration (INR) compliance and complications were compared between the two groups.  Results  Before the nursing intervention, no significant difference in basic data was found between the two groups. After the nursing intervention, the medication compliance score (MMAS-8) of the observation group was significantly higher (7.42±0.87) than that of the control group (6.54±1.52, P=0.001) 3 months after the patients were discharged from the hospital. Six months after discharge, the medication compliance score (7.33±0.89) was also higher than that of the control group (6.39±1.49, P=0.001). The INR compliance rate of the 3-month follow-up observation group after discharge was significantly higher than that of the control group (P=0.009). The compliance rate 6 months after discharge was higher in the observation group than in the control group, but the difference was not significant (P=0.075). The number of complications in the follow-up examination 6 months after discharge (3 cases) was lower than that in the control group (9 cases), but the difference was not significant (P=0.065).  Conclusion  Implementing scientific and comprehensive continuation nursing based on timing theory for patients with atrial fibrillation and chronic heart failure can significantly improve the patient's medication compliance, increase the patient's INR compliance rate and reduce complications, leading to a good prognosis. Thus, this intervention is worthy of clinical application and promotion.
Gene type of a patient with Kartagener syndrome and literature review
HU Ying-ying, ZHANG Guo-xiu, YANG Ming-he, ZHANG Bin, JIANG Hong-wei
2022, 20(7): 1263-1266. doi: 10.16766/j.cnki.issn.1674-4152.002573
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The clinical data of one Kartagener syndrome (KS) case were retrospectively analyzed, and the reported KS cases in the past 10 years were analyzed and summarized by searching the database. The patient was a 23-year-old male with recurrent sinusitis and pulmonary infection since childhood. Complete auxiliary examination showed the whole group of paranasal sinusitis, bronchiectasis with infection, dextrocardia, and peritoneal situs inversus totalis. Two pathogenic variants were detected in DNAH5 gene of primary ciliary dyskinesia type 3 with or without splanchnic ectopic. Two rare variants in the NME8 gene associated with autosomal recessive inheritance primary ciliary dyskinesia type 6 were identified, which was diagnosed as KS. General practitioners should pay attention to genetic diseases and rare diseases such as KS, expand diagnosis and treatment ideas through literature retrieval, assist clinical diagnosis with genetic testing technology, achieve early diagnosis and early management, and implement the patient-centered philosophy of general practice.
General Practice Research
Value of transvaginal ultrasound and magnetic resonance in the diagnosis of endometrial cancer
AN Lan-fen, JIN Zhi-shan, HUA Teng, ZHANG Jun, SHI Rui, YU Zhi-cheng, WEI Si-tian, WANG Hong-bo
2022, 20(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.002530
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  Objective  To analyse the value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the preoperative diagnosis of endometrial cancer.  Methods  We retrospectively collected and analysed a total of 257 patients with endometrial cancer who had undergone TVS and MRI examinations and were pathologically diagnosed after surgery in the Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2008 to June 2021. Graphpad Prism 8.3.0 statistical software was used to analyse the preoperative TVS and MRI detection rate and consistency of endometrial cancer. P < 0.05 was considered statistically significant.  Results  The pathological diagnosis results showed 161 cases of endometrial cancer in stage ⅠA, 37 cases in stage ⅠB and 59 cases in stages Ⅱ-Ⅲ. The difference in the total detection rate of endometrial cancer between TVS and MRI before surgery was statistically significant (85.99% and 94.16%, χ2=9.818, P=0.002). The results of consistency analysis showed that the Kappa value of TVS and MRI in the diagnosis of endometrial cancer was 0.293, indicating that the consistency of TVS and MRI in the diagnosis of endometrial cancer was poor. The consistency analysis between TVS and MRI and the pathological diagnosis results of tumour staging showed that the Kappa value of TVS and pathological diagnosis results was 0.498, and the Kappa value of MRI and pathological diagnosis results was 0.867. Thus, TVS and pathological diagnosis results have moderate consistency, and MRI and pathological diagnosis results have excellent consistency, indicating that the consistency of MRI and pathological diagnosis results is better than that of TVS.  Conclusion  For the evaluation of preoperative endometrial cancer, TVS examination is limited, whereas MRI examination is more accurate.
Effect of self-designed cancer pain analgesic plaster combined with oxycodone hydrochloride on refractory cancer pain
DU Li, XU Yuan, ZHANG Lian, XU Gui-hua, WANG Gui-fen, LIU Zhen-jie
2022, 20(7): 1094-1097. doi: 10.16766/j.cnki.issn.1674-4152.002531
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  Objective  To observe the effect of self-designed external application of cancer pain analgesic plaster combined with oxycodone hydrochloride in the treatment of refractory cancer pain.  Methods  A total of 102 patients with refractory cancer pain admitted to Quzhou Hospital of Traditional Chinese Medicine from January 2019 to June 2020 were selected and divided into the control group and observation group, with 51 cases in each group. The control group was given oxycodone hydrochloride sustained-release tablets, and the observation group was treated with self-designed external application of cancer pain analgesic plaster on the basis of the control group. The clinical pain treatment effect, digital pain score (NRS), dosage of oxycodone, frequency of pain outbreak, average starting time of pain relief, Karnofsky functional status (KPS) score, self-rating anxiety scale (SAS) score and daily sleep time changes were compared. The serum levels of pain-causing mediators and immunoregulatory factors were monitored.  Results  The effective rate of observation group was 93.62%(44/47), which was significantly higher than that of the control group (77.78%, 35/45, P < 0.05). The NRS score of the observation group was significantly lower than that of the control group at 1 day and 1 week after treatment (all P < 0.05). After treatment, compared with the control group, the dose of oxycodone in the observation group was reduced, the number of pain bursts was less and the average time to start pain relief was significantly shortened (all P < 0.05). In the observation group, the KPS score of quality of life significantly increased, the anxiety SAS score was lower, sleep time was significantly increased, the serum pain transmitters SP and PGE2 were significantly decreased and β-EP content significantly increased (all P < 0.05). The IL-2 level in the observation group was significantly higher than that in the control group (all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).  Conclusion  Self-designed external application of cancer pain analgesia plaster combined with oxycodone hydrochloride in the treatment of refractory cancer pain is safe and effective. Its mechanism may be related to the regulation of serum substance P(SP), prostaglandin E2(PGE2), β-EP and IL-2 levels to relieve pain and enhance immune function.
Influence of individualised blood pressure management strategy on postoperative acute kidney injury in the elderly patients who underwent gastrointestinal surgery
HUANG Jin, LIU Xun-qin, LI Ang-qing, CHENG Cen, LIU Xue-sheng, GU Er-wei
2022, 20(7): 1098-1101. doi: 10.16766/j.cnki.issn.1674-4152.002532
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  Objective  To explore the effect of individualised blood pressure management strategy on postoperative acute kidney injury (AKI) in elderly patients who underwent gastrointestinal surgery to provide certain clinical data for reducing the incidence of AKI.  Methods  A total of 166 patients who underwent elective gastrointestinal surgery in the First Affiliated Hospital of Anhui Medical University from September 2018 to December 2019 were selected. The patients were randomly divided into individualised blood pressure management group (IM group, n=84) and standard blood pressure management strategy group (CON group, n=82). The mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine (CRE), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR) and incidence of AKI (acute kidney injury) were observed at each time point in the two groups.  Results  No statistically significant difference was found in the general data between the two groups (P > 0.05).During the operation, two groups of the MAP, SBP (before endotracheal intubation to at the end of the operation) and DBP (one hour after the operation)comparative difference was statistically significant (|t| > 2.330, all P < 0.05). The levels of serum creatinine in both groups changed with time and the difference was statistically significant (F=188.547, P < 0.001). The values of BUN did not significantly change with time but with statistical difference between the two groups (F=1.919, P=0.125).The postoperative value of eGFR increased in both groups compared with the preoperative value but no statistical difference was observed (F=1.121, P=0.291).However, a statistical difference was found in the number of AKI between the two groups [3(3.6%) vs. 10(12.2%), χ2=4.275, P=0.039].  Conclusion  Individualised blood pressure management strategy is helpful to reduce the incidence of AKI after gastrointestinal surgery in the elderly.
Therapeutic effect of sodium aescinate tablet combined with flunarizine hydrochloride in the treatment of migraine
LI Yu-yu, MA Bo, XU Li
2022, 20(7): 1102-1105. doi: 10.16766/j.cnki.issn.1674-4152.002533
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  Objective  To explore the efficacy of sodium aescinate tablets combined with flunarizine hydrochloride capsules in the treatment of migraine and the occurrence of adverse reactions.  Methods  A total of 100 migraine patients diagnosed and treated in the First Affiliated Hospital of Bengbu Medical College from April 2020 to April 2021 were selected and divided into the control group (50 cases) and observation group (50 cases) according to the random number table method. The control group was treated with flunarizine hydrochloride capsule, whereas the observation group was treated with sodium aescinate tablets combined with flunarizine hydrochloride capsule. The treatment efficiency rate, pain score, cerebral blood flow velocity, high-sensitivity C-reactive protein (hs-CRP) level and occurrence of adverse reactions in the two groups were observed.  Results  There was no statistically significant difference in the basic data between the two groups before treatment, which was comparable. After treatment, the pain score of the observation group was (3.7±1.3) points, and that of the control group was (4.3±1.5) points. The pain score of the observation group was significantly reduced, and the difference was statistically significant (P < 0.05). After treatment, the total effective rate was 92.0% in the observation group and 70.0% in the control group, and the difference was statistically significant (P < 0.05). After treatment, the cerebral blood flow velocity of the anterior cerebral artery, middle cerebral artery, posterior cerebral artery and vertebral artery in the two groups decreased, and the decrease was more significant in the observation group, with statistical significance (P < 0.05). After treatment, the hs-CRP level in the observation group was (4.2±0.4) mg/L, and that in the control group was (4.5±0.6) mg/L. The decrease of the hs-CRP level in the observation group was more significant, and the difference was statistically significant (P < 0.05).  Conclusion  Sodium aescinate tablet combined with flunarizine hydrochloride capsule in the treatment of migraine can significantly increase the efficacy, significantly relieve the pain symptoms of patients, reduce the pain score, cerebral blood flow velocity and hs-CRP level, and does not increase adverse reactions.
Correlation between plasma homocysteine and blood pressure variability in patients with coronary heart disease complicated with hypertension
ZHANG Fang, CHEN Guo-fan, WANG Ming-wei, REN Kai-han
2022, 20(7): 1106-1108. doi: 10.16766/j.cnki.issn.1674-4152.002534
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  Objective  To investigate the correlation between plasma homocysteine (Hcy) and blood pressure variability (BPV) in patients with coronary heart disease (CHD) complicated with hypertension.  Methods  A total of 146 cases of patients with CHD with high blood pressure from February 2019 to June 2020 in the hospital treatment were selected. In accordance with high Hcy, they were divided into observation group (78 cases, Hcy≥10 mmol/L) and control group (68 cases, Hcy levels < 10 mmol/L). The related clinical data of the two groups were compared. The correlation between plasma Hcy levels and BPV was analysed.  Results  Uric acid (UA), total cholesterol (TC), fasting blood glucose, Hcy, 24-h systolic blood pressure (24-h SBP), 24-h diastolic blood pressure (24-h DBP), 24-h systolic blood pressure variation (24-h SPV) and 24-h diastolic blood pressure variation (24-h DPV) in the observation group were significantly higher than in the control group (t=23.379, 4.233, 2.632, 111.075, 4.254, 9.452, 20.989 and 8.631, respectively; all P < 0.01). Pearson correlation analysis showed that UA, Hcy and TC were correlated with 24 h SBP, 24 h DBP and 24-h SPV, respectively, whilst DPV was positively correlated (r=0.349, 0.286, 0.413, 0.351, 0.507, 0.512, 0.518, 0.568, 0.326, 0.198, 0.348, 0.192, all P < 0.05). The results of multiple linear regression analysis showed that the influence of UA and TC on BPV index was adjusted Hcy level was positively correlated with 24 h SBP (β=0.023, P=0.029), 24-h DBP (β=0.028, P=0.034), 24-h SPV (β=0.156, P=0.005) and 24-h DPV (β=0.035, P=0.039).  Conclusion  A positive correlation existed between Hcy and BPV in patients with CHD complicated with hypertension. Hcy and BPV may interact with each other in promoting the occurrence and development of CHD. The changes of Hcy and BPV in these patients should be closely monitored clinically and the levels of Hcy and BPV should be actively controlled to improve the prevention and treatment effect of CHD.
Clinical efficacy of hyperthermia combined with concurrent chemoradiotherapy on advanced cervical cancer and influence of serum heat-shock protein 90α expression
XIAO Xin, SHENG Xiao-an, SHI Xian-feng, DONG Juan-juan, XU Juan, WANG Chao
2022, 20(7): 1109-1112. doi: 10.16766/j.cnki.issn.1674-4152.002535
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  Objective  To investigate the clinical efficacy of hyperthermia combined with concurrent chemoradiotherapy in patients with advanced cervical and endocervical cancer (CESC), the changes in serum heat-shock protein 90α (HSP90α) expression before and after treatment and the value of predicting the therapeutic effect.  Methods  A total of 80 patients with advanced CESC who were admitted to Chaohu Hospital Affiliated to Anhui Medical University from January 2017 to June 2019 were selected as the research subjects. Amongst then, 40 patients who were treated with simple concurrent chemoradiotherapy were included in the control group. On the basis of the control group, 40 patients with combined hyperthermia were included in the study group. The short-term efficacy and toxicity between the two groups were compared and the changes in serum HSP90α indices in patients before and after treatment were detected.  Results  The total effective rate of the study group was 87.5%, which was significantly better than that of the control group (65.0%), and the difference was statistically significant (P < 0.05). The 2-year survival rate of the study group was significantly higher than that of the control group (P < 0.05). By contrast, no significant difference was found in the incidence of adverse reactions between the two groups (all P>0.05). In patients, the difference in the comparison of HSP90α changes before and after treatment was statistically significant (P < 0.05).  Conclusion  Hyperthermia combined with concurrent chemoradiotherapy could significantly improve the short-term curative effect in patients without significantly increasing the side effects of treatment and improve their 2-year overall survival rate. The expression of serum HSP90α decreased significantly in patients with middle-advanced CESC who have been effectively treated and the curative effect is good, hence worthy of promotion.
Application of nomogram in the prognostic evaluation of patients after intrahepatic cholangiocarcinoma resection
DING Sheng, LEI Jia-sheng, WANG Dong-dong, ZHAO Guan-ru, MA Shuo-shuo, LU Zheng
2022, 20(7): 1113-1116. doi: 10.16766/j.cnki.issn.1674-4152.002536
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  Objective  To analyse the survival factors of patients with intrahepatic cholangiocarcinoma after radical resection and establish a nomogram to evaluate whether the nomogram can effectively predict individual survival time.  Methods  The clinicopathological data of 80 patients with intrahepatic cholangiocarcinoma who underwent radical hepatectomy in the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2019 were retrospectively analysed. Cox regression model was used to analyse the independent risk factors affecting the survival of patients, and R language was used to establish survival nomogram of patients with intrahepatic cholangiocarcinoma after radical resection. The consistency index and calibration curve were used to verify the performance of the nomogram, and the area under the ROC curve (AUC) was used to compare the predictive effect of the nomogram and TNM staging on postoperative patient survival.  Results  Multivariate Cox analysis showed that CA19-9, tumour number, tumour differentiation and prognostic nutritional index were independent risk factors affecting the survival time of patients with intrahepatic cholangiocarcinoma after surgery, and a nomogram was constructed. The nomogram consistency index C was 0.692, and the calibration curve was close to the diagonal line, indicating that the nomogram had good differentiation and accuracy. The AUC values of the nomogram time-dependent ROC curve for predicting the 1-, 2- and 3-year survival rates of patients with intrahepatic cholangiocarcinoma after surgery were 0.783, 0.711 and 0.726, respectively. The AUC of the nomogram was 0.741, which was greater than that of TNM staging (0.509).  Conclusion  The nomogram constructed from CA19-9, tumour number, tumour differentiation and prognostic nutritional index is more effective than TNM staging in predicting the survival time of postoperative patients with intrahepatic cholangiocarcinoma and has the ability to estimate individual survival probability.
Analysis of relationship between non-invasive cardiac output determination and heart rate recovery after exercise
CHI Jing-jing, HAN Wei-xing, LI Jie-hua, LI Long-long, WANG Jing, ZHANG Xin
2022, 20(7): 1117-1121. doi: 10.16766/j.cnki.issn.1674-4152.002537
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  Objective  To investigate the correlation between cardiac function during secondary limited exercise load test and heart rate recovery after exercise and its clinical significance.  Methods  A total of 74 patients admitted to Fuyang Hospital Affiliated to Anhui Medical University from August 1, 2019 to September 9, 2021 were randomly selected from secondary limited exercise treadmill test and exercise cardiac output test. They were divided into abnormal group (n=35) and normal group (n=39) in accordance with the cardiac output (CO) level of the exercise centre. The clinical data, exercise cardiac function index and Submaximal treadmill exercise test data were compared and analysed.  Results  (1) No significant difference was observed in the baseline data (age, gender, body mass index and medical history) between the two groups (all P > 0.05). (2) No statistical difference was found in the ejection fraction (EF), resting state cardiac index (CI), left cardiac work index (LCWI) and systemic vascular resistance (SVR) between the two groups (all P > 0.05). (3) The peak movement of CI and LCWI of the abnormal group were significantly lower than those of the normal group (all P < 0.01), whilst SVR of the abnormal group was significantly higher than that of the normal group (P < 0.05). (4) For stroke volume (SV) in static, the resting heart rate of abnormal group was lower than that of normal group at peak rest and exercise, with statistical difference (P < 0.05). (5) The resting heart rate of abnormal group [(87.688±12.966) times/min] was higher than that of normal group [(77.359±11.226) times/min, P < 0.05]. (6) For heart rate recovery after exercise, the HRR1 [(22.971±8.259) times/min] and HRR2 [(37.229±8.110) times/min] of abnormal group were significantly lower than those of normal group [(27.769±8.110) times/min and (42.513±10.298) times/min, all P < 0.05].  Conclusion  Resting heart rate and post-exercise heart rate recovery are closely related to exercise cardiac function. High resting heart rate and poor heart rate recovery after exercise may indicate impaired or poor cardiac function.
Analysis of complications and influencing factors of sinus tarsal incision mini-plate combined with hollow nail internal fixation for treatment of calcaneal fractures
ZHOU Ming-ping, ZHENG Qiang, ZOU Guang-yi
2022, 20(7): 1122-1125. doi: 10.16766/j.cnki.issn.1674-4152.002538
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  Objective  To explore the complications and influencing factors of calcaneal fractures treated with tarsal sinus incision microplate combined with cannulated screw internal fixation.  Methods  From July 2018 to June 2020, 84 patients with calcaneal fractures admitted to the Department of Traumatology and Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine were selected, and their clinical data were retrospectively studied. They were divided into control group and tarsal sinus group in accordance with different surgical procedure, with 42 cases in each group. The control group underwent lateral "L"-shaped incision internal fixation and the tarsal sinus group underwent minimally invasive tarsal sinus incision plate and cannulated screw axial internal fixation. The Bohler angle, Gissane angle, improvement rate of hind ankle and hindfoot function and complication rate were determined. Logistic regression was used to analyse the influencing factors of postoperative complications.  Results  The length of incision, the amount of blood loss, the time for detumescence and the time for healing and removing sutures in the sinus tarsi group were shorter than those in the control group, the differences were statistically significant (all P < 0.05). The Bohler angle was higher in the sinus tarsi group than in the control group and the difference was statistically significant (P < 0.05). On the contrary, no significant difference was found in the Gissane angle between the two groups (P>0.05). The total improvement rate of the sinus tarsi group was 90.5% (38/42), which was higher than that of the control group at 61.9% (26/42), and the difference was statistically significant (P < 0.05). The incidence of complications in the sinus tarsi group (28.6%, 12/42) was lower than that in the control group (50.0%, 21/42) and the difference was statistically significant (P < 0.05). Regression analysis showed that operation method, swelling time, suture removal time, Bohler angle, age, and functional improvement were independent risk factors for postoperative complications.  Conclusion  Tarsal sinus incision microplate combined with cannulated screw internal fixation is better than L-shaped incision in the treatment of calcaneal fractures. Factors such as surgical method, detumescence time, healing and suture removal time, Bohler angle, age and functional improvement affect the prognosis of surgery.
Study on the inhibitory effect of propofol on upregulation of DR5 expression based on mouse melanoma lung metastasis model
ZHOU Chao-rui, MA Wei-bin, YE Xiao-qian, CHEN Na, LI Ming-juan
2022, 20(7): 1126-1130. doi: 10.16766/j.cnki.issn.1674-4152.002539
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  Objective  Melanoma is a skin cancer caused by a malignancy of melanocytes. The incidence of melanoma is rapidly increasing worldwide, thus resulting in public health problems. Surgical resection is still the main method of early treatment. As a commonly used intravenous general anaesthesia drug, propofol has been reported to have a certain inhibitory effect on cell proliferation. This study aims to explore the inhibitory effect of propofol on lung metastasis of B16F10 melanoma in mice to provide a theoretical basis for propofol to be more suitable for surgical anaesthesia of malignant melanoma.  Methods  Cell viability was measured by CCK-8 assay. Flow cytometry was used to detect the apoptotic rate and Western blotting was used to detect the expression of DR5. In the in-vivo experiment, tumour cells were injected into the caudal vein to establish a lung metastatic model. Twenty-four male C57BL/6J mice were divided into 4 groups by random number table method, namely normal control group, melanoma lung metastasis model group, propofol 50 mg/kg, 10 mg/kg groups, 6 mice in each group. The effect of intraperitoneal injection of propofol on tumour metastatic nodules in the lung tissue of mice was observed.  Results  In the in-vitro experiment, the relative proliferation capacity (490 nm OD value) of cells in the control group and 10 μmol/L, 50 μmol/L, 100 μmol/L groups at 72 h were 0.91±0.03, 0.81±0.02, 0.71±0.02 and 0.61±0.02, respectively. The apoptotic rates of B16F10 cells treated with 100 μmol/L propofol were (8.09±1.01) %, (26.04±1.10) %, (32.94±1.30) % at 24, 48 and 72 h, respectively. In the in-vivo experiment, intraperitoneal injection of propofol at a dose of 50 mg/kg could significantly inhibit the number of nodules in lung metastatic melanoma and the immunohistochemical results showed that the expression of DR5 in lung tissue significantly increased in the propofol group.  Conclusion  Propofol could inhibit lung metastatic melanoma in mice and the mechanism may be related to the up-regulation of DR5 protein expression.
General Clinical Research
Effect of mirror therapy combined with neuromuscular electrical stimulation on functional recovery of lower limbs in stroke patients with hemiplegia
HU Jun, LIN Yuan-shao, XU Chao-qun, LYU Hai-yue, XU Shu-fen
2022, 20(7): 1131-1134. doi: 10.16766/j.cnki.issn.1674-4152.002540
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  Objective  To investigate the therapeutic effect and value of mirror therapy (MT) combined with neuromuscular electrical stimulation (NMES) on lower limb function of stroke patients with hemiplegia, and provide data support for improving lower limb function and improving patient satisfaction.  Methods  A total of 64 cases of stroke patients with hemiplegia who met the requirements in the Quzhou Hospital Affiliated of Wenzhou Medical University from October 2019 to July 2020 were included in the study, and randomly divided into observation group and control group, with 32 cases in each group. The control group received conventional treatment and NMES intervention, and the observation group received NMES combined with MT treatment on the basis of conventional treatment. Berg balance scale (BBS) and FuGL-Meyer scale (FMA-LE) were used to measure the lower limb motor function and balance function of patients in the two groups before and after treatment. Meanwhile, the self-designed patient satisfaction questionnaire used in our hospital was used to investigate the satisfaction of patients in the two groups, and corresponding statistical methods were conducted for statistical analysis.  Results  BBS score and FMA-LE score improved in the two groups after treatment, and the improvement effect of the above indicators in the observation group was significantly better than that in the control group [BBS score: (30.78±6.03) points vs. (26.65±5.22) points; FMA-LE score: (18.53±3.42) points vs. (16.43±2.94) points], and the difference was statistically significant (tBBS=2.634, P=0.011; tFMA-LE=2.929, P=0.005). Statistical analysis showed that the satisfaction degree of the observation group (100.00%) was significantly higher than that of the control group (75.00%, χ2=9.143, P=0.005).  Conclusion  The application of mirror therapy combined with neuromuscular electrical stimulation in the rehabilitation of patients with hemiplegia after stroke can significantly improve the function of lower limbs and enhance patient satisfaction, indicating that it has practical significance in clinical application.
Effects of argatroban combined with butylphthalide soft capsule on NIHSS score and quality of life in patients with perforating cerebral infarction
CHEN Jia, CHEN Xiang-yu, LUO Song
2022, 20(7): 1135-1138. doi: 10.16766/j.cnki.issn.1674-4152.002541
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  Objective  To determine the clinical effect of argatroban combined with butylphthalide soft capsules in the treatment of perforating cerebral infarction.  Methods  Seventy-six patients with perforating cerebral infarction were enrolled and randomly divided into the study group (n=39) and control group (n=37). The patients in the control group were given clopidogrel bisulphate tablets on the basis of conventional therapy, and those in the study group were given argatroban and butylphthalide soft capsules. The National Institute of Health stroke scale (NIHSS) score, Barthel index (BI), incidence of progressive muscular dystrophy (PMD) and neurological recovery (mRS score) were compared. The World Health Organization Quality of Life-100 was used to evaluate the quality of life.  Results  At the 12th week, the NIHSS scores of the study group and control group were (4.1±1.7) points and (5.6±1.5) points, respectively. The study group had a significantly lower score (P < 0.05). The BI scores of the study group and control group were (76.9±16.3) points and (68.3±13.7) points, respectively. The study group had a significantly higher score (P < 0.05). The mRS scores of the study group and control group were (2.6±0.6) points and (2.9±0.8) points, respectively, with no statistical difference (P > 0.05). The results of the quality of life evaluation showed that the scores of physiological health, social relations and independent ability of the study group were significantly higher than those of the control group (all P < 0.05).  Conclusion  Argatroban combined with butylphthalide soft capsules has a good therapeutic effect and high application value on patients with perforating cerebral infarction.
Effect of pressure-controlled ventilation-volume guaranteed on lung ventilation in elderly patients undergoing laparoscopic Trendelenburg postural colon surgery
ZHU Guang-feng, WANG He-jie, JIANG Yi, GU Ye-chun, LI Yi-zheng
2022, 20(7): 1139-1142. doi: 10.16766/j.cnki.issn.1674-4152.002542
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Abstract:
  Objective  To observe the effect of pressure-controlled ventilation volume guaranteed (PCV-VG) on lung ventilation in elderly patients undergoing Trendelenburg position laparoscopic colon surgery.  Methods  Total 60 patients with colon surgery in Wenzhou Integrated Traditional Chinese and Western Medical Hospital from May 2020 to April 2021 were randomly divided into volume control ventilation group (V group, n=30) and PCV-VG group (P group, n=30).The mean arterial pressure (MAP), heart rate (HR), dynamic compliance (Cdyn), inspiratory peak pressure (Ppeak), plateau airway pressure (Pplat) and the partial pressure of end- tidal carbon dioxide (PetCO2) were recorded at different time point (T1-T6). The pH, PaO2 and PaCO2 were determined by blood gas analysis and oxygenation index (OI) and pulmonary complications were calculated within 5 days after operation.  Results  There was no statistical significance in MAP and HR between V and P group. The HR at T1-T6 in both groups was higher than that in T0 (P < 0.05). Patients in both groups with T4 and T5 had lower PH compared to T1. The PaO2 and OI decreased and PaCO2 increased in both group with the increase in body position change time (P < 0.05). In T5, compared with P group, the PaO2 and OI values were decreased while PaCO2 values increased in V group. At T3-T6, Ppeak and Pplat were increased and Cdyn decreased in V group compared with p group. The Cdyn at T4-T5 in P group was decreased compared with V group. At the time point of T5: Ppeak value was (25.4±2.1) cm H2O (1 cm H2O=0.098 kPa) in V group vs. (16.3±2.1) cm H2O in P group; the Pplat value was (9.0±0.5) cm H2O in V group vs. (7.0±0.6) cm H2O in P group, and the Cdyn value was (33.2±6.3) mL/cm H2O in V group vs. (40.3±5.2) mL/cm H2O in P group. The percentage of hypercapnia in group P (3.3%, 1/30) was lower than that in group V (23.3%, 7/30), but the difference was not statistically significant (χ2=3.606, P=0.057).  Conclusion  PCV-VG can effectively reduce airway pressure of lung ventilation, improve oxygenation index and reduce postoperative complications for elderly patients undergoing laparoscopic Trendelenburg colon surgery.

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