中华全科医学

Healthy China, healthy community and healthy family

BAO Yong

2022, 20(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.002620

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In 2013, the country proposed the health service industry, and in 2016, the country put forward the grand blueprint of a healthy China. The implementation of a healthy China requires healthy communities and healthy families. However, the concept and practice of healthy China healthy community and healthy family are not well known. In view of this, this paper expresses the views from three aspects of healthy China healthy community and healthy family, so as to play the role of outline. In the healthy China, the article first gives the concept of healthy China, and describes the important contents of healthy China: popularizing healthy life, optimizing health services, improving health security, building a healthy environment, and developing the health industry. Then it discusses the great significance of a healthy China. Finally from 15 aspects gives the index: the implementation of health knowledge popularization action, implement reasonable diet action, national fitness action, tobacco control action, health environment promotion action, mental health promotion action, maternal and child health promotion action, health promotion action of primary and secondary schools, occupational health protection action, elderly health promotion action, cardiovascular disease prevention action, cancer prevention and control action, etc. In the healthy community, the article first gives the concept of healthy community and describes the great content and significance of healthy community. In terms of healthy family, the article first gives the concept of healthy family, describing the great content and significance of healthy family. A healthy China was a strategic outline for healthy communities and healthy families. Healthy community was a platform and resource for healthy China. Healthy family was the basic element of the realization of healthy China.

Development of Lifelong Learning in Primary Care in the United Kingdom

Rodger Charlton, REN Rong, LIU Man-ling

2022, 20(9): 1453-1454.

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A comparative study of clinical efficacy and safety between Lvis and Solitaire stent-assisted embolization for unruptured wide-necked ophthalmic segment aneurysms of internal carotid artery

YU Guo-song, RUAN Shan-ping, ZHAO Zhi-xin, HU Xiao-ming

2022, 20(9): 1502-1505. doi: 10.16766/j.cnki.issn.1674-4152.002634

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Objective To compare the clinical efficacy and safety of Lvis and Solitaire stent-assisted embolization in the treatment of unruptured wide-necked ophthalmic segment aneurysms of internal carotid artery. Methods The clinical data of 53 patients with unruptured wide-necked ophthalmic segment aneurysms treated by Lvis or Solitaire stent-assisted embolization from March 2018 to July 2019 in Taizhou Hospital of Zhejiang Province were analysed retrospectively. A total of 29 patients were treated with Lvis stents, whereas 24 were treated with Solitaire stents. The surgical efficacy of the two groups was compared by Raymond classification based on immediate postoperative angiography, and follow-up results were based on digital subtraction angiography (DSA) at 6 - 12 months. The incidence of perioperative complications was used to compare the safety of the two groups. Results Statistical analysis showed no significant differences in patients after the procedure in the instant Raymond classification (P>0.05). DSA immediately after the embolization showed that 24 (82.8%) received Raymond grade Ⅰ and 5 (17.2%) were Raymond grade Ⅱ in the Lvis stent group, whereas 17 (70.8%) received Raymond grade Ⅰ, 6 (25.0%) received Raymond grade Ⅱ and 1 (4.2%) received Raymond grade Ⅲ. The follow-up results based on DSA at 6 - 12 months in the Lvis stent group were better than those in the Solitaire stent group, and the difference was statistically significant (P < 0.05). The incidence of surgery-related complications in the Lvis stent group was 13.8% (4/29), which was higher than 4.2% (1/24) in the Solitaire stent group. Conclusion Lvis stent and Solitaire stent-assisted coil embolization have their own advantages and disadvantages in the treatment of unruptured wide-necked ophthalmic segment aneurysms of the internal carotid artery. Lvis stent-assisted embolization for unruptured wide-necked ophthalmic segment aneurysm is beneficial to decrease recurrence rate, whereas Solitaire stent has a good safety level.

Improvement of mood, psychological resilience and sleep quality in patients with first-episode depression by networked mindfulness-based cognitive group therapy

LU Sha, CHEN Guang-lie

2022, 20(9): 1506-1508. doi: 10.16766/j.cnki.issn.1674-4152.002635

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Objective To explore the effects of networked mindfulness-based cognitive group therapy on depression, anxiety, psychological resilience levels and sleep quality in patients with first-episode depression. Methods Eighty-four patients with first-episode depression who attended the Hangzhou Seventh People ' s Hospital from January 2020 to September 2021 were selected and randomly divided into a control group (conventional medication, n=40) and an intervention group (medication+networked mindfulness-based cognitive group therapy, n=44) according to a random number table. Changes in depression, anxiety, psychological resilience and sleep quality were explored in the two groups after 8 weeks of treatment. Results After 8 weeks of treatment, the scores of depression, anxiety, psychological resilience scores and sleep quality significantly improved in both the control and intervention groups compared with those before the treatment (each P < 0.001). Comparison between groups after treatment revealed that the scores of depression, anxiety, psychological resilience scores and sleep quality in the intervention group [(5.84±3.50) points, (8.07±2.65) points, (80.68±6.66) points, (5.93±1.87) points] were better than those in the control group [(9.38±4.54) points, (11.23±4.88) points, (72.28±5.29) points, (7.73±2.03) points, all P < 0.001]. The scores of depression at baseline were negatively correlated with their psychological resilience scores (r=-0.747, P < 0.001) and positively correlated with their sleep quality scores (r=0.892, P < 0.001). Conclusion Networked mindfulness-based cognitive group therapy can alleviate depression and anxiety, increase psychological resilience and improve sleep quality in patients with first-episode depression.

Effect of platelet-rich plasma combined with sodium hyaluronate in the treatment of knee osteoarthritis

SU Hong-nian, SIMA Liang-jie, YANG Mu-qiang, XI Li-feng

2022, 20(9): 1509-1512. doi: 10.16766/j.cnki.issn.1674-4152.002636

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Objective To investigate the effect of injection of platelet-rich plasma and sodium hyaluronate on knee osteoarthritis (KOA). Methods A total of 120 patients admitted in the First Affiliated Hospital of Henan University of Science and Technology from June 2018 to February 2020 was selected. The random number table was used to group patients: 60 patients with foundation treatment + knee joint injection of sodium hyaluronate (conventional group) comprised one group, and 60 patients with use of platelet rich plasma treatment on the basis of routine treatment group (study group) comprised the other group. The changes in regulatory complex factor 1α mRNA and silencing information regulator 1 in chondrocytes mRNA in knee joint fluid and other factors were compared before and after treatment. Results After treatment, the knee swelling score of the study group was (1.83±0.51) points and the pain score of the study group was (2.87±0.98) points, which were lower than those of the conventional group (2.28±0.65) points and (3.31±1.20) points; the differences were statistically significant (all P < 0.05). After treatment, the mRNA expression intensity of ASF1α in the study group was 0.58±0.17, which was lower than that in the conventional group (0.71±0.21, P < 0.05). The mRNA expression levels of SIRT1 and superoxide dismutase in the study group were 1.41±0.30 and (124.9±28.0) U/L, respectively, which were higher than those in the conventional group [1.22±0.28 and (113.8±24.1) U/L, all P < 0.05]. After treatment, the Lysholm score of the study group was (69.84±11.03) points, which was higher than that of the conventional group [(65.28±12.26) points, P < 0.05]. The total effective rate of the study group was 98.33%, which was higher than 85.00% of the conventional group (P < 0.05). Conclusion Injection of platelet-rich plasma and sodium hyaluronate in KOA patients can effectively regulate the levels of ASF1α mRNA, SIRT1 mRNA and SOD in the joint fluid, and it has a significant effect on the recovery of joint function and relief of clinical symptoms.

Incidence and risk factors of atherosclerotic renal artery stenosis in elderly patients with refractory hypertension

LI Jing, ZHE Jian-qing, WANG Jing, LIU Mei-li

2022, 20(9): 1513-1516. doi: 10.16766/j.cnki.issn.1674-4152.002637

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Objective To investigate the incidence of atherosclerotic renal artery stenosis (ARAS) in elderly patients with refractory hypertension and to analyse its risk factors, to provide evidence for the early clinical diagnosis and treatment of ARAS. Methods The clinical data of 216 elderly patients with refractory hypertension treated in the Cardiology Department of the First Affiliated Hospital of Xi ' an Jiaotong University from February 2016 to February 2021 were retrospectively analysed. According to the results of renal artery color Doppler ultrasonography and angiography, they were divided into ARAS (n=48) and non-ARAS (n=168) groups. The clinical data of the two groups were compared, and the risk factors for ARAS were analysed. Results In 216 patients, 62 cases (28.70%) were diagnosed as ARAS by renal arterial ultrasonography, and 48 cases (22.22%) were confirmed as ARAS by renal arteriography. The proportions of diabetes mellitus, hyperlipidemia, peripheral vascular disease, coronary heart disease, renal insufficiency in the ARAS group were 47.92% (23/48), 68.75% (33/48), 39.58% (19/48), 54.17% (26/48) and 52.08% (25/48), respectively, significantly higher than those in the non-ASAR group [30.36% (51/168), 51.19% (86/168), 18.45% (31/168), 34.52% (58/168) and 26.79% (45/168), respectively, all P < 0.05]. Multivariate logistic-regression analysis showed that peripheral vascular disease (OR=2.651, 95% CI: 1.039-6.764) and renal insufficiency (OR=2.713, 95% CI: 1.106-6.656) were independent risk factors for ARAS in elderly patients with refractory hypertension. Conclusion Elderly patients with refractory hypertension have a higher incidence of ARAS, and peripheral vascular disease and renal insufficiency are independent risk factors affecting ARAS occurrence.

Incidence and influencing factors of perineotomy

ZHANG Han-mei, ZHOU Li-hua, MA Hong, CHENG Yu-ting

2022, 20(9): 1517-1520. doi: 10.16766/j.cnki.issn.1674-4152.002638

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Objective To investigate and analyse the situation of episiotomy in vaginal delivery to provide intervention direction for improving the quality of midwifery and reducing the rate of episiotomy. Methods The convenience sampling method was used to conduct a cross-sectional survey of vaginal delivery patients in the Gaoxin Branch of the First Affiliated Hospital of Anhui Medical University from January 1 to December 31, 2019, including their age, times of delivery, course of delivery, gestational weeks, pregnancy complications or/and complications, perineum incision and its indications. The perineum incision rate and its influencing factors were statistically analyzed. Results A total of 1 992 cases of vaginal delivery were included, of which 700 cases underwent episiotomy. The annual average rate of episiotomy was 35.14%. The top three indications for perineotomy were poor perineal condition (356 cases, 50.86%), abnormal foetal heart rate (190 cases, 27.14%) and amniotic fluid Ⅲ degree contamination (75 cases, 10.71%). Univariate analysis showed that age (Z=4.586, P < 0.001), education level(Z=2.414, P=0.016) of pregnant women, working years of midwives (Z=2.398, P=0.016), parity (Z=14.307, P < 0.001), the second stage of labour time (χ²=300.016, P < 0.001), gestational weeks (Z=3.104, P=0.002), with or without pregnancy complications or complications (χ²=60.435, P < 0.001) and scar uterus (χ²=6.591, P=0.010) were the influencing factors of episiotomy. Multivariate logistic regression analysis based on the results of univariate analysis showed that the age of pregnant women >35 years, midwife working experience >10 years, the second stage of labour time >120 minutes and scar uterus were independent risk factors of episiotomy (all P < 0.05). Conclusion At present, the rate of episiotomy remains high, and the training of midwives needs to be further strengthened. This work can be used to enhance the quality of midwifery, reduce the rate of episiotomy and improve the quality of postpartum life by improving the midwife ' s comprehensive assessment of perineal conditions, labour process and maternal and foetal conditions.

Effect of child interest induction intervention model in preschool children undergoing general anaesthesia

YE Jian-fang, WANG Shang-li, ZHOU Gen-zhi, DING Lei-ming

2022, 20(9): 1521-1525. doi: 10.16766/j.cnki.issn.1674-4152.002639

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Objective To explore the application effect of child interest induction intervention model in general anaesthesia for preschool children. The intervention model provides a guiding basis for the popularisation and application of general anaesthesia in preschool children. Methods A total of 468 preschool children undergoing general anaesthesia in Lishui Central Hospital from July 2019 to June 2020 were selected as the research objects. Amongst them, 439 cases that met the requirements of the study were screened in accordance with the inclusion and exclusion criteria. On the basis of the order of admission time, 218 children undergoing general anaesthesia from July 2019 to December 2019 were taken as the routine group and 221 children undergoing general anaesthesia from January to June 2020 under the management of child interest induction intervention model were taken as the intervention group. The preoperative anxiety, the cooperation degree of anaesthesia induction and the degree of agitation in the awakening period between the two groups were compared. Results During preoperative visit, no significant difference was found in the anxiety score between the intervention group [(29.96±3.25) points] and the routine group [(30.18±3.37) points, P > 0.05]. The anxiety scores during preoperative waiting [(26.16±4.15) points] and before anaesthesia induction [(44.47±5.38) points] in the intervention group were significantly lower than those in the routine group [(34.92±4.32) points and (52.48±5.52) points, respectively]. The scores of cooperation degree of anaesthesia induction [(1.51±0.84) points] and agitation degree of awakening [(6.79±3.27) points] in the intervention group were significantly lower than those in the routine group [(2.87±1.13) points and (8.51±3.48) points, respectively] and the difference were statistically significant (all P < 0.05). Conclusion The implementation and application of child interest induction intervention model in general anaesthesia for preschool children could effectively improve the preoperative anxiety of preschool children undergoing general anaesthesia, improve the coordination of anaesthesia induction and reduce the degree of agitation in postoperative recovery period.

Cognitive status and influencing factors of hypertension amongst residents in a community in Chengdu

DUAN Li, HE Juan, LI Miao-jing

2022, 20(9): 1526-1530. doi: 10.16766/j.cnki.issn.1674-4152.002640

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Objective To understand the cognitive status of hypertension amongst residents in a community in Chengdu and analyse its main influencing factors to provide some reference for the prevention and control of hypertension in the community. Methods From January to March 2021, 400 residents over the age of 18 in a community were randomly selected from 12 districts of Chengdu through multistage cluster random sampling. Face-to-face interviews and questionnaires were conducted with self-designed questionnaires, including personal basic information, hypertension-related knowledge, and access to hypertension-related knowledge. Chi-square test was used for intergroup comparison, and the influencing factors were analyzed by binary logistic regression. A total of 400 questionnaires were distributed, and 387 valid questionnaires were recovered, with an effective recovery rate of 96.75%. Results The overall awareness rate of hypertension-related knowledge of residents in a community in Chengdu was 57.67%, including 54.99% of basic knowledge, 58.36% of risk factors, 50.71% of complications, and 66.80% of prevention knowledge. The overall pass rate of hypertension-related knowledge was 50.13%. Significant differences existed in the pass rate of hypertension-related knowledge amongst residents of different gender, age group, education level, occupation, monthly average income, marital status, medical insurance type, and family history (all P < 0.05). Amongst them, education level, occupation, medical insurance type, and family history were the main factors influencing the pass rate of hypertension-related knowledge (all P < 0.05). Relatives, friends and close neighbors (66.93%), medical personnel (51.42%), radio and television (51.16%), newspapers and magazines (44.70%), and Internet (35.66%) were the main ways to obtain hypertension-related knowledge, whereas community publicity and education (24.29%), health lectures (14.99%), and expert consultation (11.37%) were obviously insufficient. Conclusion The overall cognition level of hypertension in the studied community in Chengdu is poor, and the knowledge of hypertension is not sufficiently comprehensive. The publicity and education of hypertension prevention and control knowledge in the community must be further strengthened.

Investigation and analysis of drug use status of patients with type 2 diabetes in the Haidian community of Beijing

CUI Fang-nan, TANG Xin, NIU Hong-li, JIANG Yue, ZHAO Fu-ying

2022, 20(9): 1531-1534. doi: 10.16766/j.cnki.issn.1674-4152.002641

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Objective To investigate the drug use status of type 2 diabetes (T2DM) patients in the Haidian District of Beijing, to analyse the reasons for the concomitant medication and the problem of polypharmacy, and to provide the basis for clinical rational drug use. Methods Patients who established the chronic disease file of T2DM in the community health service of the People ' s University of China and had been regularly visited for 6 months or longer between January 1, 2020 and December 31, 2020 were selected. The basic information of patients, the time of diagnosis of T2DM, comorbid diseases, and current medication were recorded. Results A total of 467 patients with T2DM were included in this study. The ratio of male to female was 1∶ 1.02, the age was 37 - 98 years, the course of disease was 0.5-37.5 years, and the medication was 5 (4, 7) species. Amongst them, 419 patients used drug intervention to control blood glucose, and 41.77% (175/419) patients used single-drug hypoglycaemic therapy. A total of 72.55% (304/419) patients used metformin containing hypoglycaemic regimen, 50.84% (213/419) patients were treated with α-glucosidase inhibitor, 23.40% (98/419) patients used sulphonylurea, 22.91% (96/419) patients used insulin, and 5.73% (24/419) patients used dipeptidyl peptidase 4 inhibitor. A total of 70.45% (329/467) patients used lipid-lowering therapy, 54.39% (254/467) patients continued to use antiplatelet aggregation drugs therapy, and 74.73% (349/467) patients used a combination of antihypertensive drugs. A total of 281 patients (60.17%) took five or more drugs at the same time for a long time. With prolonged disease course, the number of combined medications increased gradually, and the number of concomitant medications was positively correlated with the duration of diabetes (r=0.177, P < 0.001). Conclusion In the Haidian community of Beijing, T2DM patients with multiple-drug use are common, and hidden medical risks exist. Doctors should strengthen the management of patients, optimise the medication plan, and ensure medical safety.

Authorised educational diet combined with psychological intervention in viral post-hepatitis cirrhosis

CHEN Xiu, YU Jian-ping, WENG Fang-fang, PAN Xiao-ben

2022, 20(9): 1535-1537. doi: 10.16766/j.cnki.issn.1674-4152.002642

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Objective To examine the effect of authorised educational diet combined with psychological intervention in viral post-hepatitic cirrhosis. Methods We selected a total of 120 patients with viral post-hepatitis cirrhosis who were admitted to the Department of Infectious Diseases, Linping Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to January 2021. They were randomly divided into a study group and a control group with 60 cases each through random-number-table method. The control group followed the routine nursing care, and the research group performed authorised education diet combined with psychological intervention for 3 months on the basis of routine nursing. Before and after the intervention, the relevant health knowledge and compliance behaviour of patients were scored, and liver-function index and nutritional-status index of patients were observed. Results After the intervention, the health knowledge score of the two groups was higher than that before the intervention, and the study group was higher than that of the control group, at the same time, the compliance behavior score of the two groups was higher than that before the intervention, and the study group was higher than that of the control group (all P < 0.05). After intervention, ALT and TBIL in the study group were lower than those in the control group [(51.03±6.62) U/L vs. (55.27±6.71) U/L, (54.87±8.54) μmol/L vs. (60.33±8.61) μmol/L, all P < 0.05]; The levels of Alb, Hb and BMI in the study group were higher than those in the control group [(31.02±5.08) g/L vs. (21.56±4.78) g/L, (114.07±11.09) g/L vs. (101.95±10.87) g/L, 21.25±2.04 vs. 20.07±2.01, all P < 0.05]. Conclusion Authorised education diet combined with psychological intervention for patients with viral post-hepatitis cirrhosis can improve their cognition of disease health knowledge and compliance behaviour, nutritional status, and liver function.

Application and satisfaction analysis of new humanised health education in orthopaedic nursing

HUANG Jun-mei, ZHAO Zhi, SONG Zi-wei, ZHOU Xin-she

2022, 20(9): 1538-1540. doi: 10.16766/j.cnki.issn.1674-4152.002643

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Objective To analyse the application effect of new humanised health education in orthopaedic nursing and its impact on improving patient satisfaction. Methods A total of 82 patients treated in the Department of Orthopaedics of the First Affiliated Hospital of Bengbu Medical College from March 2020 to November 2021 were included in this study. The patients were randomly divided into experimental and control groups with 41 cases each. The experimental group received new humanised health education and the control group received routine health education. Patient compliance of the two groups with different health-education modes was compared. Moreover, self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to evaluate the psychological status of the patients in the two groups before and after health education. The satisfaction of patients treated with different health-education modes was compared using a health-education nursing satisfaction evaluation form. Results Before health-education intervention, no significant differences existed in the SAS and the SDS between the two groups (all P>0.05). After health-education intervention, SAS and the SDS in the experimental group were lower than those in the control group, and the differences were significant (all P < 0.05). The compliance rate of health education in the experimental group (97.56%, 40/41) was significantly higher than that in the control group (80.49%, 33/41, P < 0.05). The score of health-education nursing satisfaction in the experimental group [(92.53±3.62) points] was higher than that in the control group [(80.46±4.57) points], and the difference was statistically significant (P < 0.05). Conclusion The application of the new humanised health-education model for orthopaedic patients can improve their cognition of nursing, compliance rate, and satisfaction.

The application value of magnetic resonance MRS, DWI and SWI sequences in the grading diagnosis of glioma

LI Xin, XIE Ji-cheng, WANG Jing, PANG Jian-xin, WU Ling, JI Wen-bin

2022, 20(9): 1541-1544. doi: 10.16766/j.cnki.issn.1674-4152.002644

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Objective To investigate the application value of ¹H-magnetic resonance spectroscopy (¹H-MRS), diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) in the grading diagnosis of glioma. Methods Seventy-six cases of glioma confirmed by surgery or biopsy in our hospital were collected. According to the 2016 Edition of the WHO classification standard of the central nervous system tumors, the cases were divided into low-level group of glioma (Ⅰ-Ⅱ, 31 cases) and the high-level group of glioma (Ⅲ-Ⅳ, 45 cases). The original data were processed with the Functool software of GE ADW 4.5 workstation. MRS, DWI and SWI mapping software were selected to measure the main metabolites including choline (CHO), creatine (CR) and N-acetylaspartate (NAA) in the tumor parenchymal area of MRS and calculated the ratio, apparent diffusion coefficient (ADC) and intertumoral susceptibility signal (ITSS). Statistical analysis was performed on the results of the two groups with Mann-Whitney U Test. Results In the low-grade glioma group and high-grade glioma group, the Cho/NAA ratios were 1.780 and 4.390, the Cho/Cr ratios were 1.920 and 3.560, and the NAA/Cr ratios were 0.930 and 0.780, respectively. ADC values were 1.730 ×10^-3mm²/s and 1.030×10^-3mm²/s, ITSS scores were 1.0 and 2.0, respectively. The differences of Cho/NAA, Cho/Cr, NAA/Cr, ADC and ITSS scores were statistically significant between two groups (all P < 0.001). Conclusion MR multimodal imagings (MRS, DWI and SWI) show important application value in the grading diagnosis of glioma.

The correlation between the dynamic analysis of uterine artery ultrasound parameters during pregnancy and the risk of preeclampsia

CHU Hua, LU Yan, LIU Ming-song

2022, 20(9): 1545-1547. doi: 10.16766/j.cnki.issn.1674-4152.002645

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Objective To dynamically analyse the ultrasound parameters of uterine arteries and their correlation with the risk of preeclampsia in pregnant patients. Methods A total of 60 cases of preeclampsia patients who received uterine artery ultrasonography in Huzhou Maternity and Children ' s Health Hospital from January 2020 to October 2021 were included in the preeclampsia group, and 60 patients who received uterine artery ultrasonography during the same period without preeclampsia were included as the control group. The ultrasound parameters of the uterine artery during pregnancy and their correlation with preeclampsia during pregnancy were dynamically analysed. Results The RI value, PI value and S/D value of pregnant women in both groups decreased with the prolongation of pregnancy, and the RI value, PI value and S/D value of the control group were lower than those of the preeclampsia group (all P < 0.05). Pearson correlation coefficient analysis showed that the RI value, PI value and S/D value at 11-16 weeks of pregnancy and 20-24 weeks of pregnancy were positively correlated with the risk of preeclampsia (r=0.602, 0.774, 0.638; r=0.809, 0.833, 0.608, all P < 0.05). Multivariate logistic regression analysis showed that high RI value, high PI value and high S/D value at 11-16 weeks of pregnancy and 20-24 weeks of pregnancy were the risk factors of preeclampsia in pregnant women (OR=2.463, 1.239, 1.599; OR=1.643, 1.568, 1.741, all P < 0.05). ROC curve analysis showed that the predictive value of uterine artery ultrasound parameters at 11-16 weeks of gestation (AUC was 0.965) was higher than the uterine artery ultrasound parameters at 20-24 weeks of gestation (AUC was 0.885, P < 0.05). Conclusion The RI, PI and S/D index of the uterine artery in pregnant women decrease with the prolongation of pregnancy, which is positively correlated with the risk of preeclampsia in pregnant women, and can be used as a predictor of the risk of preeclampsia in pregnant women.

Identification of nontuberculous mycobacteria by matrix-assisted laser desorption ionization time-of-flight mass spectrometry and analysis of drug-sensitivity test

ZHOU Ya-di, JIN Fa-xiang

2022, 20(9): 1548-1550. doi: 10.16766/j.cnki.issn.1674-4152.002646

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Objective To study the typing results of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) of nontuberculous mycobacteria (NTM), compare the drug resistance of different NTM strains, and provide a basis for clinical rational drug use. Methods The data on NTM strains in Shaoxing City Tuberculosis Designated Hospital (Affiliated Hospital of Shaoxing College of Arts and Sciences) from March 2019 to June 2021 were retrospectively analyzed. After excluding the strain data from the same patient, the remaining 128 NTM strains were classified by MALDI-TOF MS technology. Genotyping was performed at the same time, and the results of genotyping were used as the gold standard. The accuracy of MALDI-TOF MS typing results was calculated, and drug susceptibility tests were performed on the top three NTMs after typing. Results The accuracy of NTM typing by MALDI-TOF MS was 98.4%. The sensitivity rates of mycobacterium intracellular to amikacin (AK), clarithromycin (CLA), linezolid (LZD), moxifloxacin (MXF) and rifampicin (RFP) were 98.5%, 89.4%, 86.4%, 83.3% and 62.1%, respectively. The sensitivity rates of mycobacterium avium to AK, CLA, LZD, MXF and RFP were 100.0%, 92.9%, 100.0%, 82.1% and 89.3%, respectively. The drug resistance rates of the above strains to minocycline (MH) were 90.9% and 82.1%, respectively. The sensitivity rates of mycobacterium Kansas to AK, CLA and RFP were 100.0%, 100.0% and 95.2%, respectively. Conclusion MALDI-TOF MS has high accuracy in NTM typing, and mycobacterium intracellular, Mycobacterium avium and Mycobacterium Kansas are highly sensitive to AK and CLA. AK and CLA can be used as the first choice for clinical treatment of NTM.

Role of long noncoding RNA on signaling pathways related to acute gout arthritis

BAO Yan-yuan, XI Yu-jiang, GAO Jia-mei, ZHANG Li-ping, XIE Zhao-hu, LI Zhao-fu

2022, 20(9): 1551-1554. doi: 10.16766/j.cnki.issn.1674-4152.002647

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Long non-conding RNA (lncRNA) is a kind of noncoding RNA more than 200 nucleotides long. It plays a role in regulating the expression of neighboring genes. It has no protein-coding function but can bind to multiple sites of protein. Specific interaction with DNA and RNA occurs through the principle of base complementary pairing. In recent years, with the rapid development of gene-detection technology, the relationship between lncRNA and various immune-system diseases has been gradually recognised. Gout belongs to the category of immune-system diseases. Owing to abnormal purine metabolism and uric acid production and excretion in the human body, urate crystals deposit in tissues or organs and trigger inflammatory reactions, thereby causing severe pain on the affected site and difficulty toleration. With the improvement in living standard and the change of diet structure, the incidence of gout is increasing, thereby seriously affecting people ' s life quality. Studies have pointed out that lncRNA is closely related to the onset of gout, and the inflammatory signaling pathways involved in gout attack are primarily the toll-like receptor signaling pathway, nod-like receptor protein 3 inflammasome signaling pathway, and Purinergic 2X7 receptor signaling pathway. In addition to regulating immune cells to participate in the onset of gout, lncRNA also plays a role by affecting the above signal pathways. This article primarily discusses the relationship between lncRNA and signal pathways and factors related to acute gout arthritis, further revealing the pathogenesis of gout, to provide a new direction for the prevention and treatment of gout.

Characteristics and predictive factors of chronic critical illness

XIE Shuo, LI Jia-xin, LIU Xin-min, JIAO Hong-mei

2022, 20(9): 1555-1559. doi: 10.16766/j.cnki.issn.1674-4152.002648

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With the development of modern evidence-based medicine and the improvement in intensive-care technology, some critically ill patients who survive from the initial acute critical state after treatment are bound to have persistent organ dysfunctions. Accordingly, they need to rely on intensive care and organ support for a long time. These patients experience persistent organ damage and even chronically persistent inflammation, immunosuppression, and catabolic syndrome that progress to chronic critical illness. Chronic critical illness is prone to physical, psychological, and cognitive-related dysfunction, with high mortality and morbidity. The health of these patients is not protected, but the time to death is prolonged by technology. They are often hospitalised for longer periods of time, suffer permanent disability and severe distress, reduce their quality of life, and affect their entire family. At present, the definition of chronic critical illness has not been unified, but the standard is based on a certain length of hospitalisation plus severe organ damage. Epidemiological surveys in many countries have shown that the incidence of chronic critical illness increases yearly. With the aging of the population, it has become an increasingly serious global problem. Many studies have been performed to explore the pathogenesis and risk factors of chronic critical illness, predict the development of chronic critical illness, and reduce the impact of chronic critical illness on patients and their families. This review aims to summarise the progress of research on the definition, epidemiology, pathogenesis, and predictive factors of chronic critical illness to improve clinicians ' understanding and ability to prevent chronic critical illness. We provide a reference for the diagnosis and treatment of chronic critical illness, as well as enrich the knowledge of diagnosis and treatment strategies to further improve the quality of life of chronic critical-illness patients.

Willingness and influencing factors of HIV pre-exposure prophylaxis for 295 men who have sex with men in Changsha

YAN Xing, CHEN Huai-jing, LIU Hui, DUAN Dan, GONG Zhuo

2022, 20(9): 1560-1564. doi: 10.16766/j.cnki.issn.1674-4152.002649

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Abstract:
Objective To understand the needs and influencing factors of men who have sex with men (MSM) for HIV pre-exposure prophylaxis (PrEP) in Changsha. Methods A cross-sectional study was conducted using the on-site questionnaire survey method in MSM Sentinel of Changsha from January to December 2020. MSM with different characteristics was used to test the difference in PrEP service demand. Single-factor analysis was performed, and an unconditional two-category logistic regression model was used for multivariate analysis. Results Approximately 54.20% of MSM had heard of PrEP, and 30.80% expressed their willingness to accept PrEP. The awareness rate was higher than the willingness to use it. Monthly income level (χ²=17.037, P < 0.05), perception of local MSM infection with AIDS (χ²=8.449, P < 0.05), dangerous sexual behaviours such as condom rupture and slippage (χ²=9.916, P < 0.05) and same-sex commercial sex in the last 6 months (χ²=6.717, P < 0.05) were determined. The differences were statistically significant between the PrEP service demand and above factors. MSM with high monthly income, having dangerous sexual behaviours such as condom rupture or slippage, and believing that the local MSM AIDS epidemic was serious were more willing to use prep services, the corresponding OR values were 3.339, 3.710 and 2.517, respectively. Conclusion The MSM in Changsha City is dominated by young and highly educated singles. The awareness rate of PrEP services is relatively high, and the willingness to use it is lower than the awareness rate. There is a phenomenon of separation of awareness and action. Monthly income level, perception of local MSM infection with HIV and history of dangerous sexual behaviours such as condom rupture and slippage are related to the demand for PrEP services.

Application of multimodal fusion technique in clinical practice teaching of neurosurgery

HONG Wen-ming, ZHANG Fang, WANG Bin, HU Yang-chun

2022, 20(9): 1565-1568. doi: 10.16766/j.cnki.issn.1674-4152.002650

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Abstract:
Objective In the clinical practice of neurosurgery, multi-modal fusion technology is used to conduct clinical teaching for medical undergraduates. Its teaching application effect was explored and analysed in this study. Methods A total of 126 medical undergraduates were selected for clinical practice in the Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from January 2018 to October 2021. The students were randomly divided into the multimodal fusion technology teaching group (63 students) and the traditional teaching group (63 students) via the random number table method. The teaching test was conducted by in-class test, clinical practice operation and theoretical examination. The results of the student satisfaction questionnaire were statistically analysed to evaluate the teaching effect. Results The results of the questionnaire on students'teaching satisfaction showed that students in the multi-modal fusion technology group gave scores of 95.2%, 96.8%, 93.7%, 95.2% and 96.8%, respectively, for the teaching form, teaching content, knowledge structure, training process and learning efficiency; these scores were higher than those in the traditional teaching group (55.6%, 88.9%, 90.5%, 42.9% and 49.2%). Statistically significant differences were found in teaching form, training process and learning efficiency satisfaction (all P < 0.05). There was no significant difference in teaching content and knowledge structure satisfaction (all P>0.05). The results showed that the average score of the students in the multi-modal fusion technology group was (92.8±4.9) points in the in-class test, (90.6±5.8) points in the theory test, (88.8±5.2) points in the clinical practice skill operation and (90.7±5.3) points in the comprehensive test; these scores were significantly better than those in the traditional teaching group [(83.6±5.2) points, (81.8±4.6) points, (81.2±4.8) points, (82.2±4.9) points, all P < 0.05]. Conclusion In neurosurgery clinical practice teaching of medical undergraduates, multi-modal fusion technology can significantly improve the efficiency of clinical practice teaching and student training effect, providing a new strategy for teaching the clinical practice of neurosurgery.

Application of teaching mode based on CDIO concept in cardiovascular nursing practice teaching

ZHOU Tong, XUAN Ling, WANG Dong-mei, ZHANG Jing, ZHANG Na-na

2022, 20(9): 1569-1572. doi: 10.16766/j.cnki.issn.1674-4152.002651

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Objective To explore the application effect of Conception-Design-Implementation-Operation (CDIO) teaching mode in clinical practice teaching of cardiovascular specialty nursing. Methods Based on the CDIO concept, a teaching team and teaching cases were established in the course practice teaching of cardiovascular nursing and applied to clinical practice. Seventy-nine nursing interns enrolled in Cardiovascular Medicine Department of the First Affiliated Hospital of Bengbu Medical College from January to December 2021 were randomly divided into experimental group and control group by simple grouping. In the experimental group, 38 people adopted CDIO clinical practice teaching method, and 41 people in the control group adopted conventional teaching method. The two groups of students completed the assessment of theory and operation skills after finishing the department internship task, and completed the evaluation of clinical practice ability of 8 dimensions, including four processes of nursing procedure and humanistic care ability. The clinical teaching quality of the two groups of teachers was evaluated. Results The test scores of theory and operation skills in the experimental group [(95.61±1.59) points and (95.12±1.22) points] were higher than those in the control group [(76.07±8.91) points and (94.34±1.61) points], and the differences were statistically significant (all P < 0.05). In the assessment of clinical practice ability, the students in the experimental group were significantly better than those in the control group in 8 dimensions including nursing procedures, humanistic care ability and overall, and the differences were statistically significant (all P < 0.001). The scores of teaching quality assessment in the experimental group [(96.89±1.31) points] were higher than those in the control group [(90.46±1.46) points], and the difference was statistically significant (P < 0.001). Conclusion The teaching mode based on CDIO concept can stimulate nursing students'independent learning ability, promote the organic combination of theory and practice, improve nursing students'ability to comprehensively use theoretical knowledge to analyze and solve practical problems, and improve the teaching effect.

Requirements of standardised residency training in the department of pathology in Anhui Province

XU Hong-hai, WANG Wei, WU Shi-wu, FENG Zhen-zhong, LIU Yin-hua, WANG Ji-nian

2022, 20(9): 1573-1578. doi: 10.16766/j.cnki.issn.1674-4152.002652

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Abstract:
Objective To assess the content mastery and investigate the training needs of standardised residency training (SRT) residents in the department of pathology in Anhui Province, and provide suggestions for establishment of the SRT system for the department of pathology. Methods Questionnaires for the content mastery and training needs were distributed to trainees who were recruited in the SRT program in the department of pathology in five comprehensive teaching hospitals in Anhui Province in 2021. Results A total of 124 questionnaires were sent out and 122 were included, with an effective inclusion rate of 98.39%. Results showed that less than 30% of the non-pathology specialty trainees mastered the sampling of small biopsy specimens (10 cases) and routine postoperative specimens (11 cases), in contrast, more than 85.00% of the trainees mastered these two pathology techniques (74 cases, 76 cases). The diagnosis of common diseases of postoperative specimens and intraoperative frozen sections in non-pathology specialty trainees were 32.43% (12 cases) and 18.92% (7 cases), respectively, whereas those in the trainees majoring in pathology were 82.35% (70 cases) and 54.12% (46 cases), respectively. The mastery of cervical exfoliative cytology in the trainees who were not majoring in pathology and the trainees majoring in pathology was 10.81% (4 cases) and 44.71% (38 cases), respectively, and the differences were significant (all P < 0.001). For the training needs, pathology specialty trainees prefer to learn the pathology diagnosis ideas of common diseases and difficult and rare diseases, whereas non-pathology specialty trainees prefer to learn the analysis of the key points of the interpretation of pathological reports. In addition, more than 60.00% (57 cases) of pathology specialty trainees tend to the actual operation of pathology technology process of HE staining operation training and special staining and immunohistochemistry training, whereas more than half of non-pathology specialty trainees tend to the theoretical introduction of pathology technology process. Conclusion Classification and stratification of precise training according to the different specialization and education backgrounds of the trainees are needed in the SRT program in the department of pathology.

Application of PBL combined with CBL and situational teaching in practice teaching of obstetrics and gynecology

LIN Lu, HU Xiao-wen, HE Yu

2022, 20(9): 1579-1582. doi: 10.16766/j.cnki.issn.1674-4152.002653

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Abstract:
Objective To apply problem-based learning (PBL) combined with case-based learning (CBL) and situational teaching in clinical practice teaching of obstetrics and gynecology, and analyze the teaching effect. Methods A total of 62 undergraduate interns of grade 2020 who were practicing in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Bengbu Medical College were used as the control group, and the traditional teaching mode was adopted in the practice teaching. A total of 62 undergraduate interns from grade 2021 who were also practicing in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Bengbu Medical College were selected as the observation group. PBL combined with CBL and situational teaching methods was adopted. The results of comprehensive assessment and teaching satisfaction of interns in the two groups were statistically compared and analyzed. Results The interns in the observation group were significantly higher than those in the control group in terms of comprehensive evaluation results and comprehensive satisfaction with teaching methods (all P < 0.05). The theoretical knowledge and practical skills of interns in the observation group [(90.62±3.75) points and (89.88±5.13) points] were significantly higher than those in the control group [(81.44±6.93) points and (76.41±5.80) points], the difference was statistically significant (all P < 0.05). Conclusion Breaking the routine, innovating thinking, keeping up with the pace of the times and reasonably integrating and applying a variety of teaching modes such as problem-based learning, case-based learning and situational simulation teaching in the teaching of clinical practice of obstetrics and gynecology can improve the examination results of interns'theoretical knowledge and practical knowledge, improve the interns'comprehensive satisfaction with teaching and improve the teaching quality of clinical practice of obstetrics and gynecology, so as to lay a solid foundation for cultivating high-quality comprehensive skilled medical talents.

Effect of translational medicine concept on the clinical teaching of surgery

SONG Pei-jun, XU Jing, WANG Huai-gu, HUO Ji-wu, LI Xu-wen, LI Jian-cheng

2022, 20(9): 1583-1586. doi: 10.16766/j.cnki.issn.1674-4152.002654

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Abstract:
Objective To explore the effect of translational medicine concept on the clinical teaching of surgery to provide new ideas and new directions. Methods Ninety undergraduate clinical medicine students of the class of 2018 who were on internship in the Plastic and Burn Surgery Department of the First Affiliated Hospital of Bengbu Medical College from August 2020 to September 2020 were selected as the study subjects. They were divided into a control group and an experimental group using the random-number generator of a computer, with 45 students each. The control group used traditional teaching methods. The experimental group used the concept of translational medicine as the guiding ideology for the clinical teaching of surgery, and case-based learning and simulated clinical teaching methods were adopted. After teaching, the theoretical-knowledge level, clinical skill-operation ability, and innovation ability of the students were determined, to evaluate the teaching effect. Results After teaching, the theoretical score [(88.21±4.43) points] and passing rate (93.33%) of the experimental group were higher than those of the control group [(79.73±1.80) points] and passing rate (82.22%). The theoretical scores of the experimental group was significantly higher than those of the control group (P < 0.001). The skill-operation ability [(71.22±9.84) points] and passing rate (91.11%) of the experimental group were higher than those of the control group [(66.21±9.71) points] and passing rate (80.00%). The difference between the skill-operation abilities of the experimental and control groups were statistically significant (all P < 0.001). The number of applicants in scientific research projects and the number of successful bidders in the experimental group were higher than those in the control group, and the difference was statistically significant (all P < 0.05). Conclusion The application of translational medicine concept to the beneficial exploration of the clinical teaching of surgery can help improve the quality of clinical teaching in surgery and help create a new type of composite medical talent that integrates basic research and clinical practice for a healthy China. The future reform of clinical medicine teaching has laid a solid foundation.

Effect of EEN and PN scheme on the nutrition indicators, immunological function and rehabilitation in patients undergoing laparoscopic colorectal surgery

ZHAO Min, SANG Chang-ye, YAN Chang-hong

2022, 20(9): 1587-1589. doi: 10.16766/j.cnki.issn.1674-4152.002655

496 0

Abstract:
Objective To explore the effect of early enteral nutrition (EEN) + parenteral nutrition (PN) schemes on the nutritional indicators, immunological function and postoperative rehabilitation in patients undergoing laparoscopic colorectal surgery. Methods A total of 90 patients who were admitted in our hospital for laparoscopic colorectal surgery were included in the study and divided into the observation group (45 cases) and the control group (45 cases) according to different nutrition support schemes. The patients in the observation group were given EEN + PN scheme, whereas the patients in the control group were given total parenteral nutrition (TPN) support. The nutritional indicators, immunological function and postoperative rehabilitation in the two groups were compared. Results ALB, total protein (TP) and prealbumin (PAB) levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 3.640, 4.529 and 3.207, respectively, all P < 0.05; t value 1 week after operation were 2.047, 2.550 and 4.079, respectively, all P < 0.05). IgG, IgA and complement C4 levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 2.058, 3.649 and 10.680, respectively, all P < 0.05; t value 1 week after operation were 2.897, 2.154 and 6.012, respectively, all P < 0.05). Exhaustion, defecation and hospitalization time after operation in the observation group were significantly lower than those in the control group (t=6.010, 5.784 and 4.851, respectively, all P < 0.05). The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant (22.2% vs. 24.4%, χ²=0.104, P>0.05). Conclusion EEN + PN support scheme for patients undergoing laparoscopic colorectal surgery can effectively improve the nutritional status and promote postoperative rehabilitation.

Under the background of "Mountain and Sea" promotion project, the investigation of county doctors'common ultrasound practice and the preliminary exploration of PBL ultrasonic training mode

WANG Ceng, WANG Jing, ZHENG Yi, SHEN Hao-neng, CHEN Qi

2022, 20(9): 1590-1592. doi: 10.16766/j.cnki.issn.1674-4152.002656

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Abstract:
Objective To investigate the ultrasound-practice ability of county doctors and explore the effectiveness of ultrasonic problem-based learning-training mode through the "Mountain and Sea" project, which improved the cooperative assistance mode between provincial hospitals and county-level hospitals. Methods Experts were assisted in Xianju County People's Hospital from April to October 2021. Problem-based learning (PBL) was adopted for ultrasound medical specialists. The teaching method was problem-based, with 127 ultrasound doctors in basic hospitals as the main body, in the form of group discussion and the expert as the guidance. Taking cardiac ultrasound as a key training content, the relevant data of experts during and after Xianju assistance were analysed and compared with the cardiac ultrasound data of the same period in 2020 and 2021. Results Grassroots clinicians had a high recognition of ultrasound to solve the practical work. About 94.49% (120/127) of clinicians believed that ultrasound can basically solve clinical problems. Doctors had different interests in scientific research to different degrees. In the training mode based on PBL, during the period of expert assistance, the number of cases of cardiac ultrasound examination and the diagnosis of complex heart disease increased compared with the same period in 2020. The growth rate of the total cases was 7.40%, and the growth rate of complex positive cases was 162.86%. After the end of expert assistance (November 2021 to February 2022), the number of cases of cardiac ultrasound examination and the diagnosis of complex heart disease increased compared with the same period of 2020-2021. The growth rate of the total number of cases examined was 10.63%, and that of complex positive cases was 10.18%. Conclusion The medical and health "Mountain and Sea" promotion project is a project to help the people and put the work into practice. It gives full play to the superior disciplines of provincial hospitals, thereby constantly improving the medical, teaching, and research level of grassroot doctors and also enabling grassroot people to avail of the "homogenised" medical resources of provincial hospitals.

Efficacy of massage for the treatment of post-stroke constipation: A meta-analysis

LIU Gen-li, TANG Yi-zhou, SHI Shuai, LIU Shuang, HAN Meng-meng, LIU Ya

2022, 20(9): 1593-1597. doi: 10.16766/j.cnki.issn.1674-4152.002657

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Abstract:
Objective To evaluate the clinical efficacy and safety of massage in the treatment of constipation after stroke. Methods According to the reporting standards of system evaluation and meta-analysis, Chinese and English literature from the establishment of the database to December 2020 was searched by a computer. Foreign language databases: Cochrane Library, PubMed, Embase, Web of Science, and Chinese databases: China Biomedical Literature Database, Wanfang Data, VIP database and China Journal Full text Database were used to search relevant literature on massage treatment of constipation after stroke. Rev Man 5.3 software was used for data analysis. Results Eleven RCTs with a total of 1 045 patients were included for the meta-analysis. The overall response rate (RR=1.43, 95% CI: 1.11-1.83), incidence of constipation (RR=0.36, 95% CI: 0.25-0.53), frequency of defecation on day 2 (RR=1.98, 95% CI: 1.30-3.70), and frequency of defecation on the third day (RR=2.27, 95% CI: 1.49-3.47) in the intervention group were better than in the control group. Conclusion Massage therapy can effectively improve the clinical efficacy of post-stroke constipation and reduce the incidence of post-stroke constipation, but multi-centre, high quality, long-term randomised clinical studies are needed for further verification.

Pharmaceutical intervention based on weighted TOPSIS method on the rationality rate of apatinib prescription

XU Jian, KONG Ling-ti

2022, 20(9): 1598-1602. doi: 10.16766/j.cnki.issn.1674-4152.002658

210 1

Abstract:
Objective To establish the evaluation criteria for apatinib drug utilisation and to promote the rational use of apatinib in clinical practice through appropriate pharmaceutical interventions. Methods Referring to the instructions of apatinib and related clinical guidelines, the evaluation criteria for the drug utilisation of apatinib were formulated, and the weighted technique for order preference by similarity to an ideal solution (TOPSIS) was used to objectively evaluate the drug use of apatinib. Pharmaceutical intervention measures and continuous intervention were given, and finally the use of apatinib after intervention was evaluated by the weighted TOPSIS method. Results The baseline survey revealed that the reasonable rate of apatinib prescription was low, the relative closeness of 79 medical records was between 0.9 and 1.0, and the relative closeness of 57 medical records was between 0.6 and 0.9. The scores of dose and dose adjustment, indications and combination regimen recommended by clinical guidelines were low, with mean values of 5.00, 8.10, and 8.10 points. The researchers combined baseline investigations to formulate targeted interventions, including the utilization of hospital rational-drug-use software to formulate apatinib diagnostic-restriction rules, mobilising clinical pharmacists to go deep into clinical departments to conduct special training on apatinib rational use, and continuing to conduct apatinib special prescription reviews. The prescription rationality rate greatly improved after pharmaceutical intervention, the relative closeness of 146 medical records was between 0.9 and 1.0, and the relative closeness of 21 medical records was between 0.6 and 0.9. The scores of the "combination regimen recommended by clinical guidelines" index improved, and the mean value increased to 9.32 points. Conclusion The weighted TOPSIS method can objectively and comprehensively evaluate the use of apatinib, which is convenient for problem detection and timely intervention.

Impact of continuous improvement in the construction of the chest-pain centre on the rescue time of acute ST segment elevated myocardial infarction and cardiovascular adverse events

HE Wen-jun, ZHANG Xiao-fang, JIN Yu, MAO Ying

2022, 20(9): 1603-1607. doi: 10.16766/j.cnki.issn.1674-4152.002659

258 3

Abstract:
Objective To analyse the effect of continuous improvement in chest-pain centre on the treatment effect and adverse events of acute ST segment elevation myocardial infarction (STEMI). Methods A total of 186 patients with STEMI within 12 h before and after the establishment of chest-pain centre of Quzhou Hospital Affiliated to Wenzhou Medical University from November 2020 to August 2021 were compared. Patients treated from November 2020 to March 2021 (before the continuous improvement in chest-pain centre construction) served as the control group. Patients treated from April 2021 to August 2021 (after the continuous improvement in chest-pain centre construction) served as the observation group. There were 93 patients in both groups. Treatment time, incidence of major adverse cardiovascular events, and cardiac function at 1 month after discharge were compared between the two groups. Results The treatment time of patients in the observation group was shorter than that in the control group (all P < 0.05). The incidence of major adverse cardiovascular events in the observation group was 6.6%, lower than 16.1% in the control group (P < 0.05). One month after discharge, the left ventricular ejection fraction (LVEF), plasma brain natriuretic peptide (BNP), and 6 min walking distance in the observation group were (52.45±6.02) %, (50.91±4.23) pg/mL, (422.07±20.59) m, respectively, which were better than those in the control group [(47.62±5.22) %, (68.77±6.81) pg/mL, (391.41±19.45) m, all P < 0.05]. Conclusion The continuous improvement in the construction of chest-pain centre can shorten the rescue time of STEMI patients, reduce the occurrence of cardiovascular adverse events, and improve the prognosis of patients, which is worthy of clinical application.

Evaluation of drug-related problems in clinical application of rivaroxaban based on Granada-Ⅱ classification

WANG Xiao-ling, LI Xiao-hui, LIANG Hai, LI Miao-nan

2022, 20(9): 1608-1611. doi: 10.16766/j.cnki.issn.1674-4152.002660

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Abstract:
Objective Based on the data analysis of inpatients using rivaroxaban, this study aimed to explore the drug-related problems (DRPs) of rivaroxaban in clinical application and to promote its rational use. Methods Through the hospital HIS system, 247 cases of rivaroxaban admitted to Bozhou People's Hospital from January 2020 to December 2021 were selected. The use of rivaroxaban, combination medication, and adverse reactions during hospitalisation of anticoagulant patients were retrospectively analysed using the international Spanish drug-related research method, the Granada-Ⅱ classification method. DRPs included necessity issues (DRP1, not getting the required drug treatment; DRP2, off-label use), safety issues (DRP3, wrong drug use; DRP4, low single dose of drug, less frequent administration, and insufficient course of treatment), effectiveness analysis issues (DRP5, contraindication drug use, bridging between anticoagulants, and adverse reactions; DRP6, overdose). Results A total of 247 cases of hospitalised patients receiving rivaroxaban were collected, and the total number of DRPs was 177, accounting for 71.66%. Rivaroxaban accumulated generating 204 DRPs, including 61 DRP2, 100 DRP4, 39 DRP5, and 4 DRP6. Conclusion The use of rivaroxaban in this hospital has the problems of no indication for use, unreasonable usage and dosage, and insufficient treatment. It needs to strengthen the intervention in DRPs of rivaroxaban to promote the reasonability of clinical application.

Application and effect evaluation of airtight shallow ventilator lung dilated suction in postoperative cardiac patients

ZHU Ji-rong, LIU Dan-dan, GE Jian-jun

2022, 20(9): 1612-1614. doi: 10.16766/j.cnki.issn.1674-4152.002661

170 2

Abstract:
Objective During cardiac surgery, the lung is inevitably affected by cardiac surgery because the surgery requires incision of the sternum and disrupts the continuity of the sternum. Cardiac surgery is time-consuming, resulting in longer alveolar collapse time during surgery, which requires higher requirements for postoperative airway care. This study investigates the application and effect of airtight shallow ventilator lung dilated suction in postoperative cardiac patients, aiming to provide reference for the selection of suction method for postoperative cardiac patients. Methods A total of 221 postoperative cardiac patients admitted to the First Hospital of the University of Science and Technology of China from February 2020 to August 2020 were taken as the study subjects. They were divided into control group (110 cases) and observation group (111 cases) using random number table method. The patients in the control group were given conventional lung dilated suction and patients in the observation group were given airtight shallow ventilator lung dilated suction. The mechanical assisted ventilation time, heart rate recovery time after suctioning, terminal oxygen saturation recovery time and sputum sound improvement scores of the patients in the two groups were compared. Results The time of mechanical ventilation was (11.93±5.83) h in the control group and (9.92±3.61) h in the observation group, and the difference was statistically significant (t=3.083, P < 0.05). The heart rate recovery time and oxygen saturation recovery time after the end of sputum aspiration in patients in the observation group after cardiac surgery were significantly lower than those in the control group (t=2.707, 4.591, all P < 0.05). The sputum sound improvement score was (2.69±0.55) points in the control group and (2.86±0.35) points in the observation group, and the difference was statistically significant (t=2.641, P < 0.05). Conclusion Compared with conventional manual lung dilated suction, airtight shallow ventilator lung dilated suction can shorten the duration of mechanical ventilation in adult postoperative cardiac patients, stabilize the patients'vital signs and improve the sputum sound in postoperative patients. Airtight shallow ventilator lung dilated suctioning is recommended as the preferred method of endotracheal suctioning in these patients.

The influence of mind mapping schema health education on postoperative self-care ability of patients with enterostomy

LIU Quan-li, ZHANG Jie, ZHANG Jing, HUO Rui

2022, 20(9): 1615-1619. doi: 10.16766/j.cnki.issn.1674-4152.002662

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Abstract:
Objective To investigate the effect of mind map schema health education on postoperative self-care ability and skin complications of patients undergoing enterostomy after rectal cancer operation, so as to improve the ability of self-care at home and reduce the occurrence of complications. Methods Patients undergoing radical colorectal cancer surgery with enterostomy in the Gastrointestinal Surgery Department of First Affiliated Hospital of Bengbu Medical College from January to September 2021 were prospectively enrolled. They were divided into control group (39 cases) and observation group (40 cases) using random numbers method. The control group received routine ostomy health education, including ostomy-related nursing knowledge, life guidance, complication management and discharge guidance, while the observation group received routine health education combined with mind map education. The patients'ability of self-care for ostomy was evaluated by the ostomy self-care ability scale at discharge day, one month and three months. The occurrence of skin complications around ostomy after discharge was recorded. Results There was no significant difference in the ostomy self-care ability score between the two groups on discharge day (P>0.05). The self-care ability scores of the observation group and the control group were statistically significant after discharge for one month [(53.13±2.65) points vs. (47.77±2.44) points] and three months [(58.80±2.60) points vs. (54.92±2.66) points, all P < 0.01]. In terms of ostomy complications, there were statistically significant differences between the control group and the observation group in the number of cases of complications after discharge for one month (21 vs. 12, χ²=4.617, P=0.032) and three months (15 vs. 7, χ²=4.318, P=0.038). The hospitalization satisfaction of the observation group and the control group was 95.0% (38/40) and 76.9% (30/39), respectively, with statistical significance (χ²=5.384, P=0.020). Conclusion Mind mapping schema health education can improve the ability of patients with enterostomy to take care of their stoma at home, reduce the occurrence of stoma complications, and improve satisfaction during hospitalization.

Effect of pathway nursing program on mechanical thrombectomy in patients with acute ischaemic stroke

TIAN Min, XIE Jing, LUO Song, YE Bin

2022, 20(9): 1620-1623. doi: 10.16766/j.cnki.issn.1674-4152.002663

130 1

Abstract:
Objective To explore the therapeutic effect of pathway nursing program on mechanical thrombectomy of acute ischaemic stroke patients. Methods A total of 60 patients with mechanical thrombectomy for acute ischaemic stroke from January 2020 to December 2021 in the Third People's Hospital of Bengbu were selected. Amongst them, patients admitted from January 2020 to December 2020 were the control group (30 cases), and patients admitted from January 2021 to December 2021 were the observation group (30 cases). The control group was given a routine nursing program, and the observation group was given a pathway nursing program. The treatment efficiency of patients in the two groups were compared. The rate of vascular recanalisation, incidence of complications, nursing satisfaction, and improved ranking scale (MRS) score 90 d after surgery were compared. Results After giving pathway nursing program treatment, the observation group patients'door-to-needle time, door-to-puncture time and door-to-revascularisation time were 43.00 (30.75, 49.00), 88.00 (82.50, 88.25), and 115.50 (109.50, 118.00) min. These values were shorter than those of the control group with 45.50 (41.00, 51.25), 90.50 (85.00, 98.50), and 122.50 (111.50, 128.25) min, respectively, and the difference were statistically significant (all P < 0.05). The vascular recanalisation rate in the observation group was 90.0%, which was higher than that in the control group (66.7%), and the difference was statistically significant (χ²=4.812, P=0.028). The incidence of complications was 30.0% in the observation group and 56.7% in the control group, and the difference was statistically significant (χ²=4.344, P=0.037). Nursing satisfaction was 96.7% in the observation group and 73.3% in the control group, and the difference was statistically significant (χ²=4.706, P=0.030). The MRS score of the observation group was 2.0 (1.0, 2.0) points at 90 days, lower than that of the control group's 2.0 (2.0, 3.0) points, and the difference was statistically significant (Z=-2.512, P=0.012). Conclusion Pathway nursing program can improve the treatment effect and nursing satisfaction of patients with mechanical thrombectomy.

Analysis of the application of dynamic alternating air cushion bed combined with nutritional support to prevent pressure injury in critically ill patients

XU Huan, HUO Rui, XU Wan-hong, LI Hui

2022, 20(9): 1624-1627. doi: 10.16766/j.cnki.issn.1674-4152.002664

238 3

Abstract:
Objective To investigate the preventive effect of dynamic alternating air cushion bed combined with nutritional support on pressure injury in critically ill trauma patients. Methods A total of 130 critically ill trauma patients who were treated in our department from January 2019 to December 2021 were selected and randomly divided into observation and control groups according to the number-table method, with 65 cases in each group. Patients in the observation group received nutrition support combined with dynamic alternating air cushion bed care, whereas those in the control group received nutrition support combined with jet cushion care. The incidence of pre- pressure injury manifestations, pressure injury incidence, coma and health status, length of stay and hospitalisation expenses were observed and compared between the two groups. Results After 7 d of treatment, no patients in the observation group had developed pressure injury, and 3 patients in the control group had developed pressure injury stage 1. No significant difference existed in the incidence of pressure injury between the two groups (P=0.244). From 7 d of treatment, patients in the observation group had a lower incidence of the stress-injury prophase than those in the control group (P=0.020). Significant differences existed in the Braden score between the two groups in time, group, and interaction between time and group. Patients in the observation group had higher Braden scores than those in the control group at 5 and 7 days of treatment [(13.87±1.18) points vs. (13.11±1.38) points, (14.79±1.80) points vs. (13.73±1.86) points, all P < 0.05]. After 7 days of treatment, the GCS scores [(8.11±1.74) points vs. (6.83±1.43) points] and APACHE Ⅱ scores [(16.68±3.01) points vs. (19.16±3.26) points] in the observation group were significantly better than those in the control group (all P < 0.05). This finding suggested that nutritional support combined with dynamic alternating air cushion bed had a good rehabilitation effect on critically ill traumatic patients. Conclusion Nutritional support combined with a dynamic alternating air cushion bed are more effective for stress-injury prevention in critically ill trauma patients and warrants clinical promotion.

Metagenomics next generation sequencing assisted diagnosis of visceral leishmaniasis: A case report and literature review

WU Zeng-xiang, AN Kang, LI Shuang-qing

2022, 20(9): 1628-1630. doi: 10.16766/j.cnki.issn.1674-4152.002665

231 17

Abstract:
Metagenomics next generation sequencing (mNGS) has the advantage of rapid detection of a wide range of pathogens. A case of visceral leishmaniasis (VL) was reported. The patient, a 47-year-old male, started with recurrent fever and went to several hospitals without definite diagnosis. He was treated with antibacterial agents and symptomatic treatment, but his condition was not relieved. After that, the Leishmania sequences were found by mNGS, and rK39 immunochromatographic rapid detection (rK39 test) was further performed. The result was positive, and the final diagnosis was visceral leishmaniasis. It is suggested that mNGS is expected to be used in the diagnosis of visceral leishmaniasis, and it has important reference value in the diagnosis of infectious diseases.

Characteristics of emotional behaviour and social life ability in children with cerebral Wilson's disease

JIN Shan, FANG Xiang, YANG Wen-ming, XIE Dao-jun

2022, 20(9): 1455-1457. doi: 10.16766/j.cnki.issn.1674-4152.002621

226 4

Abstract:
Objective To clarify the characteristics of emotional behaviour and social life ability of children with cerebral Wilson's disease (WD), to find concealed neuropsychological damage in time, to adopt more targeted individualised intervention programs and correct abnormal emotional behaviour, and to improve the social life ability of children. Methods Thirty children with cerebral WD in the Encephalopathy Center of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2019 to December 2020 served as the observation group. Thirty healthy school-age children served as the control group in the same period. The characteristics of emotional behaviour and social life ability of 30 WD children and 30 normal children were assessed by Achenbach children's behaviour scale and infant junior middle school students' social life ability scale. The differences between WD children and normal children were analysed. Results The scores of aggression, poor communication, social withdrawal, and violation of discipline in the cerebral WD group were 8.0(7.0, 9.0) points, 4.0(3.0, 5.0) points, 3.0(3.0, 4.0) points, 4.0(3.0, 5.0) points and the control group were 6.0(4.0, 7.0) points, 3.0(1.8, 3.0) points, 1.0(1.0, 2.0) points, 1.0(1.0, 2.0) points, respectively. A significant difference existed between the two groups (all P < 0.05). In the assessment of social ability, no significant difference existed between the two groups (P>0.05). A significant difference existed in the scores of independent life, sports, communication, collective activities, and self-management (all P < 0.05). Conclusion Significant personality changes, irritability, decreased social ability and other emotional behaviour, and living ability abnormalities exist in children with cerebral WD. In addition to the improvement in clinical symptoms, the treatment of such patients should also pay attention to mental and psychological rehabilitation so that they can have more complete spiritual and psychological functions and good social adaptability.

Effect of NLR and PLR from pre-radiotherapy on prognosis of locally advanced nasopharyngeal carcinoma patients

YANG Li-ping, WU Ai-lin, ZHOU Yan, TAO Zhen-chao, HE Jian, YANG Jing, ZHANG Yang-yang, QIAN Li-ting, GAO Jin

2022, 20(9): 1458-1461. doi: 10.16766/j.cnki.issn.1674-4152.002622

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Abstract:
Objective To explore the correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and the prognosis of patients with locally advanced nasopharyngeal carcinoma undergoing radiotherapy. Methods We retrospectively analysed the clinical data and follow-up data of 60 patients with locally advanced nasopharyngeal carcinoma who underwent radiotherapy and chemotherapy from January 2016 to December 2018. An ROC curve was used to determine NLR and PLR. According to the best cutoff value, patients were divided into high-and low-level groups. Chi-square or Fisher exact test was used to compare the differences between groups. Kaplan-Meier method was used to draw survival curve. Cox regression model was used for univariate and multivariate analysis. Results According to the ROC curve, the best cutoff values of NLR and PLR before radiotherapy were 1.99 and 154.94, respectively. In univariate analysis, N stage, clinical stage, pre-radiotherapy NLR and PLR were related to patient prognosis (all P < 0.05). The average survival time of the low pre-radiotherapy NLR group was (62.26±1.88) months, which was better than that of the high NLR group of (51.17±3.94) months (P=0.048). Compared with the high pre-radiotherapy PLR group, the average survival time of the low PLR group was longer (P=0.014). Cox multivariate analysis showed that clinical stage, N stage, and pre-radiotherapy PLR level were independent prognostic factors for patient survival (all P < 0.05). Conclusion PLR before radiotherapy could be used as an independent prognostic predictor for patients with locally advanced nasopharyngeal carcinoma undergoing radiotherapy. It is recommended as an auxiliary method for evaluating the prognosis of patients.

Study on the relationship between lymphocyte subsets, cytokines and immune efficacy in advanced non-small cell lung cancer

GUO Ying, GAO Tian-hui, ZHAO Meng-yang, ZHOU Li-qin, LIU Shan-shan

2022, 20(9): 1462-1465. doi: 10.16766/j.cnki.issn.1674-4152.002623

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Abstract:
Objective Immuno-checkpoint inhibitors significantly change the treatment prospects for non-small cell lung cancer. PD-L1, as a biomarker of immunotherapy, is extensively used in clinical settings, but some defects remain in its application. This study aimed to further explore the predictive effect of serum-related markers in clinical practice. Methods We retrospectively collected 48 cases of advanced non-small cell lung cancer patients receiving immunotherapy in Henan Provincial People's Hospital from 2019 to June 2021. Fasting peripheral blood was taken before treatment and after 4 cycles of treatment to detect the levels of cytokines and lymphocyte subsets. After four cycles, according to the efficacy (complete response, CR; partial response, PR; stable disease, SD; progressive disease, PD), it was divided into a control group (CR+PR+SD) for a total of 36 cases and an ineffective group (PD) for 12 cases. The changes in level after treatment between the two groups and the relationship with efficacy were compared. Results After the four cycles of immunotherapy treatment, lymphocyte levels, total T lymphocyte levels, and CD4⁺ T lymphocyte levels in the control group were significantly higher than those in the ineffective group [(1 648±564) μL vs. (1 098±581) μL; (1 121±388) μL vs. (651±368) μL; 540(367, 799) μL vs. 245(125, 411) μL, all P < 0.05]. The count level of T cells was significantly negatively correlated with tumor progression, and a higher T cell expression level corresponded with better progression-free survival (PFS). Conversely, the high expression of IL-4 and IL-6 was significantly positively correlated with tumor progression, and PFS was worse. Conclusion The lymphocyte subgroups and expression levels of cytokines are closely related to the efficacy of patients with advanced non-small cell lung cancer. They can be used as predictors of the efficacy of immunotherapy for advanced non-small cell lung cancer.

Effects of ultrasonic pulsed conductance therapy combined with auricular point pressing with beans on the quality of life of patients with liver cancer undergoing arterial perfusion chemotherapy

FU Ling-xue, YU Hui-qian, WANG Yi-ying, HE Ying, CHEN Shui-bing, YAO Hong-xiang

2022, 20(9): 1466-1468. doi: 10.16766/j.cnki.issn.1674-4152.002624

218 0

Abstract:
Objective To investigate the intervention effect of ultrasonic pulsed conductance therapy combined with auricular point pressing with beans on the quality of life of patients with liver cancer undergoing arterial perfusion chemotherapy. Methods The clinical data of 92 patients with liver cancer undergoing arterial infusion chemotherapy in the Second Affiliated Hospital of Wenzhou Medical University from September 2020 to February 2021 were retrospectively selected. According to the different treatment methods, they were divided into the control group (42 cases, general routine treatment) and experimental group (50 cases, ultrasonic pulse conductance therapy combined with auricular point pressing with beans). At 2 months after the intervention, the nutritional status [total protein (TP), albumin (ALB) and haemoglobin (HGB)], liver function [alanine aminotransferase (ALT) and glutamic-oxaloacetic aminotransferase (AST)] before and after the intervention were analysed and compared between the two groups, and Karnofsky functional status scale (KPS) and quality of life (QOL) scale were used to evaluate patients' quality of life. Results Compared with the control group after the intervention, the serum TP [(76.53±9.79) g/L], [ALB (49.08±5.56) g/L], [HGB (126.56±18.17) g/L], [KPS (81.91±8.07) points] and QOL [(47.84±6.75) points] in the experimental group were significantly higher than those in the control group [(70.10±9.32) g/L, (45.79±5.70) g/L, (118.20±18.09) g/L, (75.46±8.32) points and (40.30±6.96) points, t=3.207, 2.795, 2.203, 3.765 and 5.262, all P < 0.05]. Compared with the control group after the intervention, ALT [(42.68±9.71) U/L] and AST [(43.29±9.48) U/L] in the experimental group were significantly lower than those in the control group [(47.15±9.20) U/L and (49.03±9.42) U/L; t=2.253, 2.901, all P < 0.05]. Conclusion Ultrasonic pulsed conductance therapy combined with auricular point pressing with beans can significantly improve the nutritional status and liver function of patients with liver cancer undergoing arterial perfusion chemotherapy, which also can improve the quality of life of patients.

Application of metal endocrown in the restoration of residual crown of low occlusal gingival distance molar

XIE Xiao-fei, LIU Fang, TIAN Rui-xue, YIN Xiao-xuan, GAN Hong-qin, ZHANG Kai

2022, 20(9): 1469-1472. doi: 10.16766/j.cnki.issn.1674-4152.002625

240 2

Abstract:
Objective To explore the effect of metal endocrown in the preservation and restoration of molar with insufficient gingival distance. Methods Patients from the Department of Stomatology of the First Affiliated Hospital of the Bengbu Medical College were selected for the study. The main criteria included 50 molars with 1-3 mm gingival distance, 50 molars with 50 teeth, including 28 males with 28 teeth and 22 females with 22 teeth (age range=18-60 years; average=42 years). After complete root-canal treatment, the tooth was prepared, a pure titanium inlay crown was prepared using the pulp cavity, and re-examination was conducted 1, 6, 12, and 18 months after the restoration was bonded (in reference to the United States Public Health Service evaluation criteria for dental restorations). The loosening and falling off of the prosthesis, fracture of the prosthesis or tooth, marginal tightness, secondary caries, gingival condition, and food impaction were observed and recorded. Results All 50 patients did not lose the follow-up, and all observation indices were normal during 1 month follow-up. During the follow-up period, no tooth or prosthesis fracture occurred, and the inlay crown fell off at the 5th, 9th, and 16th months, respectively. We found one case of marginal misfit, two cases of gingivitis, and one case of gingivitis with food impaction in 6 months. At 12 months, we found 2 cases of marginal misfit, 1 of marginal misfit with secondary caries, 3 of gingivitis, and 2 of gingivitis with food impaction. At 18 months, we found 3 cases of marginal misfit, 3 of marginal misfit with secondary caries, 4 of gingivitis, and 2 of gingivitis with food impaction. Conclusion The application of metal endocrown in the restoration of molars with insufficient gingival distance is satisfactory.

Preventive effects of Galli gigerii endothelium corneum on renal calculus in rats

SHA Cong-wei, CHEN Wen-zheng, ZENG Mu-da, ZHOU Shi-guang, CHEN Jun-hu

2022, 20(9): 1473-1476. doi: 10.16766/j.cnki.issn.1674-4152.002626

428 7

Abstract:
Objective To study the effect of Galli gigerii endothelium corneum on kidney calcium oxalate stone in rat model, and to explore the preventive and therapeutic effect of Galli gigerii endothelium corneum on kidney calcium oxalate stone in rats. Methods Forty SPF male rats were randomly divided into normal group, model group, high-dose, medium-dose and low-dose groups. The normal group rats were given normal drinking water and feed, and the model group rats were given modeling agent (1% glycol water+0.2 mL / only 2% ammonium chloride to fill the stomach in the morning). The rats in high-dose (5.00 g/kg BW), medium-dose (2.50 g/kg BW), and low-dose (1.25 g/kg BW) GGEC groups fill the stomach with 0.2 mL/100 g BW at the same time in the afternoon for four weeks. The 24 h urine output, urinary calcium (Ca), urinary phosphorus content (P), and renal catalase (CAT), malondialdehyde content (MDA), serum CAT, MDA, Ca, P, creatinine (Cr), BUN contents were analyzed, and renal histopathological changes were observed at the end of the experiment. Results Compared with the model group, renal CAT [(6.1±1.3) U/mg vs. (4.1±1.2) U/mg, P < 0.05] and serum CAT [(29.8±1.5) U/mL vs. (26.6±1.3) U/mL, P < 0.01] significantly increased in the high-dose group, whereas renal MDA significantly decreased in the high-, medium-, and low-dose groups [(15.71±0.21) nmol/mg, (16.84±0.18) nmol/mg, (17.29±0.11) nmol/mg vs. (17.59±0.19) nmol/mg, all P < 0.01], respectively. Serum Cr [(46.5±3.3) mmol/mL vs. (52.1±2.7) mmol/mL, P < 0.01] significantly decreased in the high-dose group. Compared with the model group, the pathological damage of renal tissue in each dose group of GGEC was reduced. Conclusion The GGEC can effectively prevent calcium oxalate calculi and protect renal function in rats.

Effectiveness of Transcranial Direct Current Stimulation Therapy Combined with Vortioxetine for patients with anhedonia depression

ZHU Chun-yan, HU Xi-wen, JU Xuan, SUN Ji-jun

2022, 20(9): 1477-1480. doi: 10.16766/j.cnki.issn.1674-4152.002627

355 10

Abstract:
Objective To investigate the therapeutic effect of transcranial direct current stimulation (tDCS) therapy targeting left dorsolateral prefrontal lobe on major depressive disorder (MDD) patients with anhedonic features. Methods A total of 61 patients with depression treated in Hangzhou Seventh People's Hospital from June 2020 to June 2021 were selected and randomly assigned to real tDCS group (30 cases) and sham tDCS group (31 cases). The real tDCS group was treated with 2 mA tDCS, the sham tDCS group was treated with the same parameter settings. All patients were treated with vortioxetine at 10 mg/d at the same time, and both groups were treated for 2 weeks. The Hamilton Depression Scale (HAMD-17), Snaith-Hamilton Pleasure Scale (SHAPS), Dimensional Anhedonia Rating Scale (DARS) were evaluated at baseline, 1 week and 2 weeks after treatment, respectively. Results Before treatment, there were no significant differences in age, gender, years of education, total disease course and episodes of disease between 2 groups (all P>0.05). After treatment, SHAPS score and HAMD-17 score in the real tDCS group were lower than those before treatment (all P < 0.05), and the DARS score was higher than that before treatment (P < 0.05). After 2 weeks of treatment, the SHAPS score in the real tDCS group [(17.71±3.11) points] was lower than that in the sham tDCS group [(19.45±3.42) points], and the HAMD-17 score in the real tDCS group [(16.70±5.36) points] was also lower than that in the sham tDCS group [(20.22±4.84) points]. the DARS score in the real tDCS group [(46.27±8.75) points] was higher than that in the sham tDCS group [(39.84±9.69) points], and the difference was all statistically significant (all P < 0.05). Conclusion tDCS therapy targeting the left dorsolateral prefrontal cortex can effectively treat MDD patients with anhedonic features.

Clinical value of serum VCAM-1 combined with Fazekas score in evaluating the prognosis of acute cerebral infarction with leukoaraiosis

LIU Shi-hua, ZHANG Chao, CHEN Lei, WANG Qun-feng, ZHONG Ping

2022, 20(9): 1481-1483. doi: 10.16766/j.cnki.issn.1674-4152.002628

393 5

Abstract:
Objective To explore the predictive value of serum vascular cell adhesion molecule 1 (VCAM-1) level combined with Fazekas score in the clinical outcome of acute cerebral infarction with leukoaraiosis (ACIL) patients after 90 days. Methods A total of 96 acute cerebral infarction patients with an National Institutes of Health Stroke Scale (NIHSS) score of 8 who were admitted to the Suzhou Hospital Affiliated to Anhui Medical University from August 2020 to October 2021 were selected as the research objects. Enzyme-linked immunosorbent assay was used to detect serum VCAM-1 levels, and Fazekas score was determined for all patients according to brain magnetic resonance. Based on the modified Rankin scale (mRS), the prognosis of patients at 90 days was evaluated. mRS≤2 was regarded as good prognosis (70 cases), and mRS≥3 was regarded as poor prognosis (26 cases). The receiver operating characteristic (ROC) curve was used to analyse the value of serum VCAM-1 level combined with Fazekas score in evaluating the prognosis of ACIL patients. Results Compared with the good-prognosis group, the age [(71.23±3.66) years vs. (64.57±5.24) years], serum VCAM-1 level [2.66 (2.48, 2.78) ng/mL vs. 2.10 (1.40, 2.23) ng/mL], and Fazekas score [4 (4, 5) points vs. 3 (2, 3) points] of the poor-prognosis group were significantly higher than those in the good-prognosis group (all P < 0.05). Multivariate logistic-regression analysis showed that age, VCAM-1 level and Fazekas score were independent risk factors for poor prognosis. ROC curve analysis results revealed that the sensitivity and specificity of poor prognosis assessment were 92.31% and 94.29%, respectively. Conclusion Serum VCAM-1 combined with Fazekas score has a high predictive value for the 90-day outcome of acute cerebral infarction patients.

Clinical value of serum amyloid A and interleukin-6 in the diagnosis and severity evaluation of sepsis

NIU Kai-xuan, WU Shu-lu, LIU Cheng, DENG Xi-ming

2022, 20(9): 1484-1487. doi: 10.16766/j.cnki.issn.1674-4152.002629

344 10

Abstract:
Objective To explore the significance of serum amyloid A (SAA) and interleukin-6 (IL-6) in the diagnosis and severity evaluation of sepsis. Methods A total of 80 patients in the Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from October 1, 2020 to May 31, 2021 were selected, and scores of SAA, IL-6, procalcitonin (PCT), C-reactive protein (CRP), APACHE Ⅱ and SOFA were collected within 24 hours from admission. According to the diagnostic criteria of sepsis, 25 cases were divided into the non-sepsis group and 55 cases were divided into the sepsis group. The diagnostic efficacy of SAA and IL-6 in sepsis was evaluated by ROC curve, while the correlation between SAA, IL-6 and APACHE Ⅱ score, SOFA score was explored by Spearman analysis. According to the diagnostic criteria of septic shock, patients with sepsis were divided into the common sepsis group (n=25) and the septic shock group (n=30), and the judgment value of SAA and IL-6 on the severity of the disease was evaluated. Results The ROC curve for the diagnosis of sepsis showed high sensitivity and specificity of IL-6 (94.4%, 63.4%). SAA combined with PCT had the highest specificity (95.8%). IL-6 combined with CRP had the highest sensitivity (100.0%). SAA and IL-6 were positively correlated with APACHE Ⅱ score and SOFA score. The ROC results to assess the severity of the disease showed that the specificity of SAA alone and IL-6 combined with PCT was the highest (both 80.0%), and the sensitivity of SAA combined with PCT was the highest (96.0%). Conclusion SAA and IL-6 can be used as effective markers to evaluate the severity of sepsis, and IL-6 can also assist in the early diagnosis of sepsis. The combination of SAA and IL-6 with PCT and CRP can improve the clinical value.

Effects of vertebral osteotomy on spinal-cord function in rabbits

ZHU Zhong-lian, ZHAO Zhi, WANG Zhao-dong, GAO Xu-bin, WANG Xu-yi, GUAN Jian-zhong

2022, 20(9): 1488-1490. doi: 10.16766/j.cnki.issn.1674-4152.002630

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Abstract:
Objective To explore the effect of vertebral osteotomy on the function of the spinal cord and to provide a theoretical basis for the clinical application of vertebral osteotomy. Methods By random-number table method, 40 rabbits were randomly divided into a control group, a low osteotomy group (compression 25% after osteotomy), a middle osteotomy group (compression 50% after osteotomy), and a high osteotomy group (compression 100% after osteotomy), with 10 animals each. They were given corresponding surgical treatment. Dural shrinkage, motor function (Reuter score), spinal-cord blood flow, and other indicators were determined. Results The dural sac transverse diameter and spinal cord of the middle and high osteotomy groups were (5.74±0.29) mm, (14.46±0.77)° and (7.65±0.36) mm, (85.62±2.95)°, which were higher than those of the low osteotomy[(4.85±0.32) mm, 0°] and control group [(4.39±0.11) mm, 0°], all P < 0.05. The blood flow of the middle and high osteotomy groups were (27.66±0.85) μL/100 μm³ and (10.53±0.24) μL/100 μm³, which were lower than those of the low osteotomy [(34.28±0.94) μL/100 μm³] and control group [(33.81±1.06) μL/100 μm³], all P < 0.05. The Reuter score of the low, middle, and high osteotomy groups [(2.38±0.34) points, (7.25±0.42) points, (9.56±0.73) points] were significantly higher than those of the control group[(1.39±0.25) points, all P < 0.05]. Conclusion Vertebral osteotomy has a good clinical effect. Shorter spine shortening has little effect on spinal-cord function. In clinical practice, attention should be paid to the critical value of safe osteotomy.

Early effects and impacts on cold executive function of repetitive transcranial magnetic stimulation combined with sertraline in first-episode adolescent depression

CHEN Hai-si, GAO Jing-fang, WANG Xiao-le, HU Xi-wen

2022, 20(9): 1491-1494. doi: 10.16766/j.cnki.issn.1674-4152.002631

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Abstract:
Objective To explore the early effects and impacts on cold executive function of repetitive transcranial magnetic stimulation (rTMS) combined with sertraline in adolescents with first-episode major depressive disorder. Methods A total of 77 adolescent patients with first-episode depression from Hangzhou 7th Hospital were divided into study group (38 cases) and control group (39 cases) by random number method. The control group was treated with sertraline (25 mg/d in first week, up to 100 mg/ d in 2 weeks). The study group was given sertraline combined with rTMS (1 time/d, 5 times/ week). Depressive symptoms and cold executive function before and after treatment were evaluated using Hamilton Depression Scale (HAMD-17), children's Depression Rating Scale (CDRS-R), audiovisual integration continuous operation test (IVA-CPT) and THINC-it. Results The early improvement rate in the study group was 92.11% (35/38), higher than 71.79% (28/39) in the control group (P < 0.05). After 2 and 4 weeks of treatment, the HAMD-17 and CDRs-R scores of the two groups decreased compared with those before treatment, and the scores of the study group were lower than those of the control group after treatment (all P < 0.05). After 4 weeks of treatment, the attention quotient (listening, visual and full-scale) in the study group [(98.24±20.72) points, (90.00±21.97) points, (94.24±21.43) points] was higher than that in the control group [(82.62±27.71) points, (78.10±27.85) points, (80.21±24.47) points], and the difference was statistically significant (all P < 0.05). Both two groups improved statistically significant in Spotter, Symbol Check, Codebreake, and Trails (all P < 0.05). The study group showed significantly higher score in PDQ5 in THINC-it after treatment (P < 0.05). Conclusion Sertraline combined with rTMS can early improve the clinical symptoms and cold executive function of first-episode adolescent depression patients.

Prognostic factors of transarterial chemoembolization combined with radiofrequency ablation for advanced Barcelona clinic liver cancer

HU Zhou-chao, WANG He-ping, YAN Jin-gang, ZHANG Guo-qiang

2022, 20(9): 1495-1497. doi: 10.16766/j.cnki.issn.1674-4152.002632

261 1

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Objective To investigate the prognostic factors of the arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in the treatment of patients with advanced hepatocellular carcinoma (HCC) at Barcelona Clinic stage (BCLC). Methods The clinical data of 76 patients with advanced HCC with BCLC who received TACE combined with RFA treatment in our hospital from February 2013 to February 2015 were retrospectively analysed. Kaplan-Meier univariate analysis and Cox multivariate regression were used to analyse the factors affecting overall survival (OS) and progression-free survival (PFS) of patients. Results The median OS was 27 months (11 - 68 months), and the median PFS was 15 months (4 - 63 months) in the 76 patients. Kaplan-Meier univariate analysis showed that physical status (PS) score, Child-Pugh grade of liver function, tumour number, tumour diameter, portal vein tumour thrombus, alpha foetal protein, Teggio treatment and times of RFA treatment were closely correlated with median OS (all P < 0.05). Liver function Child-Pugh grade, tumour number, tumour diameter, portal vein tumour thrombus, Teggio treatment and the frequency of RFA treatment were significantly correlated with median PFS (all P < 0.05). Cox multivariate analysis showed that enlargement of tumour diameter and portal vein tumour emboli were independent risk factors for OS and PFS (all P < 0.05), and multiple RFA treatment and Teggio treatment were independent protective factors for PFS (all P < 0.05). Conclusion Oral administration of Teggio and increasing the number of RFA treatments are of great help to control the tumour progression in BCLC patients with middle and advanced HCC treated with TACE combined with RFA. However, increase in tumour diameter and portal venous cancer thromboembolism are independent risk factors affecting the prognosis of patients, and corresponding measures should be adopted for clinical prevention and treatment.

Current situation and influencing factors of postoperative explosive pain in patients with femoral neck fracture

ZHAO Feng, YAN Feng, MENG Li-feng, WU Ju-sheng, GE Ke-liang, WANG Peng-yu, FENG Zhi-ying

2022, 20(9): 1498-1501. doi: 10.16766/j.cnki.issn.1674-4152.002633

424 3

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Objective To analyse the current situation and influencing factors of postoperative explosive pain in patients with femoral neck fracture. Methods A total of 200 patients with femoral neck fracture treated in the Department of Orthopaedics of Zhuji People's Hospital from February 2019 to September 2021 were selected. All patients underwent surgery under ultrasound-guided lumbar plexus sciatic nerve block anaesthesia (73 cases of compression cannulated screw fixation, 65 cases of artificial femoral head replacement, and 62 cases of artificial total hip arthroplasty). Pain was evaluated by digital pain score (NRS) 12 - 24 h after operation, and the incidence of explosive pain was counted. According to the occurrence of explosive pain, the patients were divided into explosive and non-explosive-pain groups. The differences in relevant data (gender, age, nationality, educational level, body mass index, preoperative NRS score, operation time, anaesthesia time, ASA grade, operation mode, anaesthesia mode, osteoporosis, and postoperative complications) between the two groups were compared. The risk factors of the incidence of explosive pain were analysed by logistic analysis. Results The NRS score of 200 patients 12 - 24 h after operation was (6.22±1.63) points, and 131 patients had explosive pain. The incidence of explosive pain was 65.50%. The explosive and non-explosive-pain group had 131 and 69 cases, respectively. The age, preoperative NRS score, operation time, anaesthesia time, anaesthesia mode, osteoporosis, and postoperative complications of the two groups were compared (all P < 0.05). Multivariate logistic analysis showed that age (≥60 years old) was the protective factor of the incidence of explosive pain. Preoperative NRS score (≥6 points), operation time (≥126 min), anaesthesia time (≥135 min), anaesthesia mode (simple nerve block), and osteoporosis (yes) and postoperative complications (yes) were the risk factors. Conclusion The incidence of postoperative explosive pain in patients with femoral neck fracture is high. Preoperative pain, long operation time, long anaesthesia time, simple nerve block, osteoporosis, and postoperative complications are the influencing factors. Preventive intervention measures should be actively taken to reduce the risk of postoperative explosive pain.

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2022 Vol. 20, No. 9

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