中华全科医学

Construction of the post competency model of rural doctors in Beijing

LI Min, DONG Yu-qi, LI Na, MA Li, WANG Chen, LIU Yan-li, SUN Chen, WANG Fei, WANG Zhong

2023, 21(1): 1-5. doi: 10.16766/j.cnki.issn.1674-4152.002798

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Abstract:
Objective To construct a model of rural doctors' post competency in Beijing, and provide a reference for the improvement of Beijing rural doctors' ability, performance evaluation and training. Methods Competency framework and model draft were build using a literature research method and expert group discussion method. A total of 18 experts who were either engaged in Beijing rural doctor research or directly engaged in rural doctor management were selected. From May to September 2019, the improved Delphi expert consultation method was used to send two rounds of consultation forms via email to score the importance, applicability and operability of the indicators. The post competency model of rural doctors in Beijing was modified according to the scores and expert opinions, and the weight of each indicator of the post competency model was calculated using the analytic hierarchy process. Results After two rounds of Delphi consultation, the positive coefficient of the two rounds was 100%, the expert' s familiarity with the topic was 0.87, their confidence of judgment was 0.91, making the average authority coefficient 0.89. The final establishment included four main areas, clinical medical service ability, public health service ability, medical humanities ability, education and other skills, with eight second-level indicators and 35 third-level indicators. The weight of each indicator was then calculated. In the first-level indicators, the highest scores were in clinical medical service capacity (0.374) and public health service capacity (0.374). Among the second-level indicators, the national basic public health service (0.091) had the highest weight. In the third-level indicators, urgent and severe on-site treatment (0.021) and chronic disease management (0.018) were the highest scoring. Conclusion The post competency model of rural doctors in Beijing is constructed through the improved Delphi method. The positive coefficient and authority coefficient of experts are high, and the selection of evaluation indicators is scientific and reasonable, which can be used as an important reference for evaluating the competency of rural doctors in Beijing. However, the competency model still needs to be constantly revised and improved according to the development of the current situation of rural doctors.

CT-derived model for the diagnosis of pulmonary invasive mucinous adenocarcinoma by machine learning

ZHANG Jun-jie, HAO Li-gang, XU Qian, FENG Hui, ZHANG Ning, SHI Gao-feng

2023, 21(1): 6-9. doi: 10.16766/j.cnki.issn.1674-4152.002799

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Abstract:
Objective Lung mucinous adenocarcinoma is a rare subtype of lung cancer with unique molecular biology characteristics. It influences the choice of treatment options. We explore a machine learning model based on clinical and CT features in the diagnosis of lung invasive mucinous adenocarcinoma, propose to improve the diagnostic accuracy of pre-treatment mucinous adenocarcinoma. Methods A retrospective analysis of 620 cases with pulmonary invasive adenocarcinoma confirmed by needle biopsy or surgical pathology in the Fourth Hospital of Hebei Medical University from January 2017 to May 2022 was performed. After matching by using the propensity score matching (PSM) with a matching ratio 1 : 1, the patients were randomly divided into the training set and the test set based on the 7 : 3 ratio. Three machine learning models, namely, support vector machine (SVM), random forest (RF) and logistic regression (LR), were constructed using the variables with statistical differences, and the optimal model was selected by AUC values. The AUC value of the optimal machine learning model was analysed by 5-fold cross-validation method, the DCA curve was drawn to evaluate the diagnostic efficiency of the constructed model, and a Nomogram is constructed. Results Analysis showed that lesion location in the lower lobe, cystic lumen, bronchial truncation and ΔCT_V value were independent predictive factors for invasive mucinous adenocarcinoma. The 4 above mentioned features were constructed by machine learning, and the prediction model was compared. Finally, the logistic regression model (AUC=0.801) was shown to be the optimal model. 30% of 285 cases were randomly selected as the test set (n=85 cases), and the remaining samples were used as the training set for 5-fold cross-validation. The logistic regression model obtained AUC of 0.777 in the validation set, AUC of 0.785 in the test set, accuracy of 0.682, AUC of 0.803 in the training set and accuracy of 0.749. Finally, the Nomogram of the logistic regression model was constructed. The Briser Score in the calibration curve of the model was 0.149, and the DCA curve also showed that the model had good predictive ability and stability in potential clinic application. Conclusion By using machine learning models based on clinical and CT features, a clinical prediction model for primary pulmonary invasive mucinous adenocarcinoma was constructed, which has a potential role in guiding clinical diagnosis.

Value of analysis of coal workers' pneumoconiosis nodules based on radiomics combined with clinical factors in predicting the occurrence of lung cancer

MENG Shan, HUI Dong-ming, WANG Kun, LI Zhi-chao

2023, 21(1): 10-14. doi: 10.16766/j.cnki.issn.1674-4152.002800

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Abstract:
Objective To investigate the relationship between radiomics, clinical factors and malignant transformation of coal workers' pneumoconiosis nodules, establishing the best prediction model for malignant transformation of coal workers' pneumoconiosis nodules. Methods The clinical data of 425 cases of coal workers' pneumoconiosis treated in the Second People ' s Hospital of Jiulongpo district from January 2015 to June 2019 and CT imaging data of 628 pneumoconiosis nodules were collected. They were randomly divided into training set and verification cohorts at a ratio of 7 : 3. Each group of data was divided into malignant group and non-malignant group. The basic image features of the nodule were interpreted and the region of interest (ROI) was delineated. The Radscore calculation formula was constructed using the key features of radiomics. The predictive models were established base on clinical features, radiomics features, and clinical features combined with Radscore through logistic regression, and AUC and Delong were used to compare the prediction efficiency of models. Results During the 3-year follow-up, 54 malignant nodules were confirmed by pathology, with a diameter of (1.70±0.63) cm, 574 nodules without malignant change, with a diameter of (1.68±0.76) cm. There was no significant difference in the diameter between the two groups (t=0.468, P=0.642). Statistically significant differences were existed between the two groups in terms of length of service exposed to coal dust, family history, smoking history, drinking history and image features of spicule sign and air sign (all P < 0.05). There was no significant difference in age, tuberculosis history and chronic obstructive pulmonary disease (COPD) history (all P>0.05). LASSO screened 11 imaging features. The mixed model had the best effect in the validation set, with an AUC of 0.895. AUC of radiomics model and clinical model were 0.671 and 0.654 respectively. Delong test showed that the model difference was statistically significant (P < 0.05). Conclusion There is a certain correlation between the length of service exposed to coal dust, family history, smoking history, drinking history, burr sign, air sign, radiomics features and the malignant change of coal worker pneumoconiosis nodule, which can be used to build a model to predict the malignant change of coal worker pneumoconiosis nodule.

The value of establishing a model in the differentiation of solid pulmonary nodules based on CT radiomics

SUN Xin-ran, ZHAO Hong, ZHAO Da-hai, QI Wen, WU Jiang-fen

2023, 21(1): 15-18. doi: 10.16766/j.cnki.issn.1674-4152.002801

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Abstract:
Objective To explore the diagnostic efficacy of CT radiomics model for benign and malignant solid pulmonary nodules. Methods CT imaging data of 231 cases of solid pulmonary nodules confirmed by surgery, puncture or clinical diagnosis in our hospital from March 2019 to November 2022 were retrospectively analyzed, select 231 typical pulmonary nodules, and they were divided into benign group (98 cases) and malignant group (133 cases) according to pathological types. Infer Scholar software was used to outline the lesion contour from two and three dimensions respectively. The radiomics features were extracted by software, and the enrolled cases were divided into the training set and the test set in a ratio of 7∶ 3. Features were screened by Pearson correlation coefficient, significance test and LASSO regression analysis. Two dimensional and three dimensional radiomics feature models (model Ⅰ and model Ⅱ) were constructed respectively in the training set, and verified by test set. The area under receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency of the model. Results Total 919 and 1 746 radiomics features were extracted from two dimensions and three dimensions respectively. After screening, 12 and 20 optimal radiomics features were obtained, which were used to construct radiomics model Ⅰ and Ⅱ by machine algorithms. The AUC value of model Ⅰ in the training set was 0.97. The AUC value of model Ⅱ in the training set was 0.98. The AUC value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of model Ⅰ in the test set were 0.94 (95% CI: 0.87-0.98), 83.9%, 89.5%, 86.7%, 87.2%, 87.0%, respectively. The AUC value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of model Ⅱ were 0.97 (95% CI: 0.94-0.99), 75.9%, 97.5%, 95.7%, 84.8%, 88.4%, respectively. Conclusion The model based on CT radiomics features can well predict the benign and malignant of solid pulmonary nodules. The diagnostic efficacy of model Ⅱ constructed from three-dimensional perspective is better than that of model Ⅰ constructed from two-dimensional perspective.

IL-33/ST2 pathway in atherosclerosis: the IL-33 paradox

TUERSUNAYI·Yisimitila, ALIMIJIANG·Abulimiti, MAIHEFURETI·Wufuer, YUAN Yu-juan, PATIGULI·Kadierjiang, MUYESAI·Nijati

2023, 21(1): 19-23. doi: 10.16766/j.cnki.issn.1674-4152.002802

377 15

Abstract:
Objective This study aimed to investigate the relationship between the IL-33/soluble growth stimulation expressed gene 2 (ST2) pathway and coronary arteriosclerosis in human and animal models. Methods The clinical trial included patients with a clear diagnosis of acute myocardial infarction (AMI group, n=50) and stable coronary artery disease (CAD group, n=50) who visited the Department of Cardiology, People ' s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to December 2019. Coronary blood specimens were collected from the study subjects, and IL-33 levels were detected by ELISA. In the animal experimental model, blood was collected from inferior vena cava of ApoE knockout mice, TG and cholesterol (CHOL) concentrations were measured. In addition, the thrombin-antithrombin complex (TAT) levels of the samples were calculated by ELISA. Results IL-33 and Gensini scores in AMI group were significantly higher than those in CAD group (all P < 0.05). Pearson correlation analysis showed a positive correlation between Gensini score and IL-33 level expression (P < 0.05). Multiple linear regression analysis showed that Gensini score levels were independently correlated with IL-33 (β=0.295, P=0.001) levels. The area under the curve (AUC) of the Gensini score, the AUC for IL-33, Gensini score and joint predictors were 0.716, 0.820 and 0.864, respectively. In the animal experimental model, the TAT concentration, TG and CHOL concentrations in ApoE knockout mice decreased with the increase of intervention time after different concentrations of IL-33 intervention (all P < 0.05). Conclusion Coronary blood IL-33 in patients with AMI accelerates the progression of atherosclerosis through the IL-33/ST2 pathway and induces thrombosis. IL-33 reduces lipids in atherosclerotic ApoE mice to inhibit the progression of atherosclerosis.

Changes in bone mineral density, bone metabolism and its influencing factors in early-onset type 2 diabetes mellitus

GAO Jing-jing, LI Cong, GAO Lei, BAO Peng, FEI Ai-hua, GAO Yan-hong

2023, 21(1): 24-27. doi: 10.16766/j.cnki.issn.1674-4152.002803

326 14

Abstract:
Objective To analyse the changes in bone mineral density, bone metabolism and its influencing factors in early-onset type 2 diabetes mellitus (T2DM). Methods We performed a retrospective analysis of 201 patients with T2DM who were diagnosed with diabetes aged ≤ 40 years old in the Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2018 to December 2021. These subjects were classified as the early-onset group. In addition, we selected 107 non-diabetic patients matched with the early-onset group with regard to age and sex ratio as the control group. The general clinical data, biochemical indexes, mean bone mineral density (BMD) of lumbar spine L_1-4 and bone metabolism markers were compared between the two groups. Results (1) After correcting the BMI, no statistically significant difference in BMD was observed between the early-onset group and control group (F=1.004, P>0.05). The levels of type Ⅰ procollagen amino-terminal peptide, osteocalcin, 25(OH)D₃ and parathyroid hormone of the early-onset group were lower than those in the control group (t=3.941, 6.556, 7.123, 4.620, all P < 0.05), whereas no significant difference in β-carboxyl terminal peptide (β-CTX) was found between the two groups (t=1.684, P>0.05). (2) Correlation analysis results showed that BMD was independently and negatively correlated with age (95% CI: -0.007 to -0.001, P=0.012) but was independently and positively correlated with BMI (95% CI: 0.004 to 0.014, P=0.001) and HbA1c (95% CI: 0.002 to 0.021, P=0.014). β-CTX was independently and negatively correlated with age (95% CI: -0.013 to -0.003, P=0.001) and TC (95% CI: -0.079 to -0.015, P=0.004). In addition, the female gender was an independent risk factor for decreased β-CTX (95% CI: -0.177 to -0.020, P=0.014). P1NP was independently and negatively correlated with age (95% CI: -0.831 to -0.137, P=0.007), FPG (95% CI: -1.815 to -0.333, P=0.005) and TG (95% CI: -0.635 to -0.508, P=0.004). Conclusion There is no significant difference in BMD amongst patients with early-onset type 2 diabetes compared with non-diabetic people, but the markers of bone formation decrease. The age, gender, BMI, blood glucose and blood lipid levels are independent influencing factors of changes in BMD and bone metabolism in patients.

Comparison of clinical efficacy of implant-supported fixed denture and implant-supported overdenture in middle-aged and elderly edentulous patients 1-3 years after final restoration

ZHOU Zi-qian, LI Shu-yuan, NI Can

2023, 21(1): 28-32. doi: 10.16766/j.cnki.issn.1674-4152.002804

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Abstract:
Objective To compare the soft and hard tissues around implants, patient satisfaction and denture complications of middle-aged and elderly edentulous patients after completing the implant supported fixed denture (ISFP) or implant supported overdenture (IOD) for 1-3 years respectively. Methods This study selected 43 middle-aged to elderly complete or partial edentulous jaws patients (between 50 and 80 years old) who were admitted in Nanjing Stomatological Hospital from March 2019 to March 2021. They were divided into two groups according to the clinical method of prosthesis. One group received implant supported fixed prosthesis (ISFP group, 28 cases), another group was treated with implant supported overdenture (IOD group, 15 cases), and the patients were followed up for 1-3 years after final restoration. The soft and hard tissue changes after repair were evaluated and compared between the two groups. Results There was no significant difference in the soft and hard tissue changes around the implants between the ISFP and IOD groups after treatment for 1-3 years. The ISFP group patients had achieved better denture retention, masticatory function, voice function and patients ' satisfaction compared to the IOD group 1-3 years after the treatments, the ISFP group was (9.179±0.700) points, (8.464±0.793) points, (8.179±0.772) points, while IOD group was only (6.733±0.961) points, (6.467±0.915) points, (6.800±1.265) points, and the difference was statistically significant (all P < 0.05), but there was no significant difference in the evaluation of the aesthetics and comfort level of dentures between the two groups. There was no significant difference in the incidence of mechanical complications between the two groups. However, in terms of mechanical complications, the incidence of parts shedding or wear in IOD group was higher than that in ISFP group, and the difference between the two groups was statistically significant, while the incidence of biological complications between the two groups was not statistically significant. Conclusion The application of implant-supported fixed prosthesis and implant-supported overdenture fit for edentulous patients in some certain circumstances. Clinically, we should choose the appropriate method according to the patients ' previous treatment conditions and willingness. The result that implant-supported overdentures may have more long-term complications should also be considered.

Clinical application of preoperative autologous blood donation in selective cardiac surgery under extracorporeal circulation

LIU Yan-yi, ZHU Hai-juan, DONG Wen-peng, ZHU Bang-qiang, LI Xiang-yun, LI Feng

2023, 21(1): 33-36. doi: 10.16766/j.cnki.issn.1674-4152.002805

287 6

Abstract:
Objective This study aimed to investigate the clinical values of preoperative autologous blood donation (PABD) in selective cardiac surgeries under extracorporeal circulation (SCSUEC) and to discuss the safety and feasibility of PABD. Methods A total of 81 patients who consecutively received SCSUEC combined with PABD in the First Affiliated Hospital of Anhui Medical University from January 2015 to July 2021 were enrolled as the experimental group. Another 81 patients from the same hospital were matched by gender and baseline haemoglobin level (±1.5 g/dL), and they received SCSUEC at a ratio of 1 :1, which were determined as the case control. Comprehensive comparisons in the transfusion amount of allogenic RBC and plasma, the cost of transfusion, the postoperative recovery parameters and postoperative complications were conducted between the two groups. Results Compared with the case control, participants in the experimental group have significantly less allogenic RBC transfusion [2.00 (0.00, 4.00) U vs. 5.50 (4.00, 8.00) U], less allogenic plasma transfusion [600.00 (400.00, 800.00) mL vs. 800.00 (600.00, 1 325.00) mL], less first 24 h drainage [445.00 (310.00, 567.50) mL vs. 575.00 (433.50, 860.00) mL], shorter mechanical ventilation time [16.00 (8.00, 18.00) h vs. 18.00 (11.00, 26.00) h] and shorter ICU stay [43.00 (36.00, 65.00) h vs. 58.00 (41.00, 94.00) h] were significantly decreased (all P < 0.05). Furthermore, less incidence of acute renal failure, haemoglobinuria and prolonged mechanical ventilation were observed in the experimental group (all P < 0.05). The difference in costs related to blood transfusion was statistically significant between two groups (P < 0.05). Conclusion PABD can reduce the demand for allogenic RBC and plasma transfusion in SCSUEC. It can also be used to avoid postoperative complications and promote postoperative recovery.

Relationship between hearing aid discontinuance and auditory and social factors in patients with senile deafness

WANG Chang-yang, CI Jun, GUAN Hua

2023, 21(1): 37-40. doi: 10.16766/j.cnki.issn.1674-4152.002806

193 8

Abstract:
Objective This study aimed to improve the utilisation rate of hearing aids, the disuse and normal use of hearing aids in patients with senile deafness were compared to analyse its correlation with auditory and social factors. Methods From January 2018 to January 2020, 186 cases of patients with senile deafness equipped with hearing aids in the Department of Otolaryngology of Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine were analysed. According to the discontinuation of hearing aids after 1 year, the patients were divided into discontinuation group and normal group. The clinical data of hearing and social factors were compared between the two groups. Multivariate Logistic regression was used to analyse the related factors of hearing aid discontinuance in patients with senile deafness. Results Amongst the patients included in the study, 69 with hearing aid discontinuance were classified as the discontinuance group, and the remaining 117 patients with continuous normal use of hearing aids were classified as the normal group. In addition, the hearing aid discontinuation rate was 37.10%. The proportion of hearing aids costing < 15 000 yuan, the Hearing Impairment in Elderly Inventory Screening version (HHIE-S) score and the mean of pure tone hearing threshold in the discontinuance group were higher than those in the normal group (all P < 0.05). The speech recognition rate, times of daily socialisation, proportion of retirees and times of annual traveling in the discontinuance group were lower than those in the normal group (all P < 0.05). Multivariate logistic linear regression analysis showed that the increase of HHIE-S score (OR=1.625), the increase of hearing aids price < 15 000 yuan (OR=3.112) and the increase of pure tone threshold (OR=1.166) were independent risk factors influencing hearing aid withdrawal in patients with senile deafness. Increased speech recognition rate (OR=0.820) and increased daily social interaction (OR=0.277) were the protective factors influencing hearing aid withdrawal in patients with senile deafness. As seen in the contour plot, with the number of daily social interactions increases and the language recognition rate increases, the risk of hearing aid deactivation gradually decreases. Conclusion Daily social contact frequency and language recognition rate are the most important factors affecting hearing aid withdrawal in patients with senile deafness. Early monitoring helps to adjust the treatment plan in time and improve the application rate of hearing aid.

Mechanism of JAK/STAT signaling pathway in the early stage severe acute pancreatitis rats

CHENG Feng, QIU Zhao-lei, ZHENG Chuan-ming, XIA Ya-qin, LI Lei, DU Zhao-hui, JIANG Hai, WANG Zhen-jie, XIE Fu-chen

2023, 21(1): 41-44. doi: 10.16766/j.cnki.issn.1674-4152.002807

258 6

Abstract:
Objective To investigate the effect of inhibiting JAK/STAT signaling pathway on relevant disease indicators in rats with early stage severe acute pancreatitis (SAP), so as to speculate the possible mechanism of this signaling pathway in SAP rats. Methods Fifty-four adult SD rats were divided into control group, SAP group and AG490 group according to random number table, 18 rats in each group. AG490 group was given AG490 application before modeling, other groups were given equal amount of saline. SAP model was made by retrograde intra-biliary pancreatic duct injection with 5% sodium taurocholate, and the rats were executed at 6 h, 12 h and 24 h after modeling, and atrial blood was taken to measure serum amylase, calcium, TNF-α and calcium. The pancreatic tissues were examined by HE staining. Western blotting was used to detect the expression level of STAT3 protein in pancreatic tissues. Results The amylase values in the AG490 group at 6 h, 12 h and 24 h were (2 049.17±257.00) U/L, (2 915.00±188.42) U/L and (3 746.50±181.05) U/L, respectively, which were higher than those in the control group and lower than those in the SAP group, and SAP group was higher than the control group (all P < 0.05). The blood calcium concentrations at 6 h, 12 h and 24 h in the AG490 group were higher than those in the SAP group, both groups were lower than the control group (all P < 0.05). The TNF-α, IL-6 and IL-1 at 6 h, 12 h and 24 h in the AG490 group were lower than those in the SAP group, and both groups were higher than the control group. STAT3 expression in SAPgrouppancreatic tissue increased with time between groups, and the 24 h point was significantly higher than the AG490 group, with insignificant differences at other points. AG490 group, pancreatic cell edema and inflammatory cell infiltration were seen in pathological sections, no significant difference. Conclusion The early stage of severe acute pancreatitis may induce multiple inflammatory factors through the JAK/STAT signaling pathway and promote the progression of pancreatitis.

Relationship between time of intravenous thrombolysis and early cognitive function in patients with acute mild ischemic stroke and transient ischemic attack

WANG Hong, WANG Liu-qing, ZHANG Wan-li, WANG Zhen, YE Zu-sen, CHENG Yi-fan, HUANG Huan-jie, SHAO Bei

2023, 21(1): 45-49. doi: 10.16766/j.cnki.issn.1674-4152.002808

208 14

Abstract:
Objective To investigate the influence of intravenous thrombolytic time on early cognitive function in patients with acute mild ischemic stroke (MIS), and transient ischemic attack (TIA). Methods A total of 173 MIS and TIA patients (The National Institutes of Health Stroke, NIHSS ≤6) who were admitted to the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2019 were collected. These patients received intravenous thrombolytic therapy within 4.5 hours of onset. A total of 156 cases were finally included in the study. According to whether the patients had cognitive dysfunction 30 days after the onset of the disease, they were divided into cognitive impairment group (n=100) and non-cognitive impairment group (n=56). The baseline characteristics, intravenous thrombolytic time and the occurrence of cognitive impairment of the two groups were summarized, and the impact of intravenous thrombolytic time on the occurrence of early cognitive impairment was analyzed. Results The age of cognitive impairment group was significantly higher than that of non-cognitive impairment group (P=0.037); the educational time was significantly shorter than that of non-cognitive impairment group (P=0.011); the course of hypertension and diabetes, intravenous thrombolysis time was significantly longer than the non-cognitive impairment group (P=0.036, 0.003, 0.017); the cognitive impairment group had significantly higher total cholesterol than the non-cognitive impairment group (P=0.040). Logistic regression showed that older age (OR=1.092, 95% CI: 1.031-1.157, P=0.002), longer duration of hypertension (OR=1.238, 95% CI: 1.002-1.193, P=0.021), longer duration of diabetes (OR=1.265, 95% CI: 1.116-1.384, P=0.016), and longer duration of intravenous thrombolysis(OR=1.105, 95% CI: 1.067-1.356, P=0.010) were associated with cognitive impairment 30 days after intravenous thrombolysis independent risk factors. Conclusion Shortening the time of intravenous thrombolysis after onset may help reduce patient' early cognitive impairment in patients with acute mild ischemic stroke, and transient ischemic attack.

Clinical and radiological analysis of subacute combined degeneration caused by different etiologies

CHENG Chen, YU Wen-ke, CHEN Yong, YU Xin-feng, LU Xiao-dong

2023, 21(1): 50-53. doi: 10.16766/j.cnki.issn.1674-4152.002809

262 7

Abstract:
Objective This study aims to compare the clinical, radiological features and outcomes between patients with subacute combined degeneration (SCD) induced by recreational nitrous oxide (N₂O) abuse and patients with N₂O-unrelated SCD. Methods From January 2017 to April 2021, the clinical data of 43 patients with SCD diagnosed at Affiliated Hospital of Hangzhou Normal University, Sir Run Run Shaw Hospital Zhejiang University and Zhejiang Second Hospital were retrospectively analysed. According to the etiology, case data were divided into 23 patients with recreational N₂O-induced SCD and 20 patients with N₂O-unrelated SCD. The clinical and MRI features, laboratory tests and prognosis were compared between the two groups. Results Of the 23 patients with recreational N₂O-induced SCD, the mean age of onset was lower than those with N₂O-unrelated SCD [21 (19, 25) vs. 69 (62, 74) years, P < 0.001]]. The incidence of urinary and stool dysfunction was lower in the N₂O-induced SCD group (34.78%, 8/23) than in the N₂O-unrelated SCD group (65.00%, 13/20, P=0.048). MRI examinations indicated the N₂O-induced SCD cases presented a higher incidence of cord swelling [56.52% (13/23) vs. 20.00% (4/20), P=0.015]. The mRS scores for patients with N₂O-induced SCD [3.0 (2.5, 4.0)] were lower than those with N₂O-unrelated SCD [4.0 (3.5, 4.0), P=0.033] at admission. Moreover, patients with N₂O-induced SCD presented significantly lower mRS [2.0 (1.0, 2.0)] scores than those with N₂O-unrelated SCD [3.0 (3.0, 4.0), P < 0.001] at the last follow-up visit 3 months later. Conclusion These findings indicated that patients with N₂O-induced SCD have less severe neurological function deficit, an increased incidence of cord swelling and better prognosis.

Influence of paediatric snoring combined with posterior inferior distribution of the ventilation function on nasal ventilation

GONG Ling-ling, WANG Wei, JIANG Cheng-yi, ZHAN Xiao-dong

2023, 21(1): 54-56. doi: 10.16766/j.cnki.issn.1674-4152.002810

151 6

Abstract:
Objective The causes of snoring in children are multiple and complex, and the effect of routine flat gland resection in some children is poor. This study will combine snoring surgery with posterior end ablation of inferior turbinate in children to explore its application value in improving nasal ventilation function. Methods A total of 60 children with severe snoring [obstructive sleep apnea (OSA)] diagnosed by polysomnography (PSG) in the Department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2021 to December 2021 were selected and randomly divided into control group (30 cases, thermic tonsils under a nasal endoscopy and adenoid ablation) and experimental group (30 cases, underwent endoscopic low oil into nasal and adenoidectomy combined with ablation of the posterior end of the inferior tribute). Before and after treatment, PSG and nasal resistance were measured, and disease specific quality of life survey (OSA-18) for children with obstructive sleep apnea hypopnea syndrome (OSAHS) were completed. The AHI, LSaO₂ levels, OSA-18 scale scores, and nasal resistance values at 1, 2 and 3 weeks after surgery of children with abnormal nasal resistance value were compared between the two groups before surgery and 6 months after surgery. Results The AHI [(3.60±1.63) times/min], LSaO₂ indexes (96.07%±2.29%) and OSA-18 total score [(22.57±2.79) points] of the experimental group were better than those of the control group [(8.63±1.30) times/min, 91.23%±1.22% and (25.57±4.71) points], and the differences were statistically significant (all P < 0.05). No significant improvement in nasal resistance was observed in the first week after surgery (P>0.05), and the nasal resistance in the second and third weeks after surgery was significantly improved (all P < 0.05) compared with before surgery. In addition, the nasal resistance in the experimental group was significantly better than that in the control group (all P < 0.05). Conclusion Endoscopic low-temperature plasma tonsillectomy and adenoid ablation combined with posterior and inferior distribution of ablation in children with abnormal resistance are more conducive to improving post-operative function and quality of life.

Therapeutic efficacy of gelatin sponge to block bone cement leakage during percutaneous vertebroplasty

HUANG Zhen, ZHAO Chun, YANG Zhi-yong, XU Gang, WANG Kai-ming

2023, 21(1): 57-61. doi: 10.16766/j.cnki.issn.1674-4152.002811

320 7

Abstract:
Objective To investigate the therapeutic efficacy of bone cement leakage after gelatin sponge plugging in percutaneous vertebroplasty in osteoporotic vertebral compression fracture. Methods The study retrospectively enrolled 46 patients with osteoporotic vertebral compression fracture, who were admitted to the Department of Orthopedics of Third People ' s Hospital of Bengbu City from February 2020 to February 2022. All patients were randomly divided into gelatin sponge group and control group, with 23 patients in each group. Patients were followed up for 1 months after surgery. The operation time, bone cement injection volume, Cobb angle, Beck index, Oswestry disability index (ODI), and bone cement diffusion coefficient were recorded and analyzed before operation, 1 day after operation, and 1 month after operation. The therapeutic efficacy of gelatin sponge application on bone cement leakage during percutaneous vertebroplasty was evaluated, and the pain relief effect of postoperative patients was evaluated by visual analog scale. Results The gelatin sponge group had one case of cement leakage (4.35%), while 8 patients (34.78%) had cement penetration in the control group, the difference between the two groups was statistically significant (χ²=4.973, P=0.026). The cement diffusion coefficient of gelatin sponge group and control group were (77.57±0.72)% and (58.20±0.85)%, respectively, with a statistically significant difference (t=83.392, P < 0.001). Before operation, 1 day after operation, and 1 month after operation, there were no significant differences in ODI, VAS score, Cobb angle, and Beck index between groups (all P>0.05). However, there were statistically significant differences in each index group 1 day after operation, 1 month after operation and before operation (all P < 0.05). Conclusion Gelatin sponge plugging can significantly reduce the incidence of leakage caused by cement diffusion during percutaneous vertebroplasty, and improve the diffusion effect of bone cement in diseased vertebrae. Gelatin sponge has a series of advantages such as easy material acquisition, low price, and easy operation, and has certain promotion value in clinical work.

Implementation of ERAS anaesthesia management measures in elderly patients undergoing total hip replacement

ZHANG Jia, YANG Bao-zhong, GUAN Xiao-dong

2023, 21(1): 62-65. doi: 10.16766/j.cnki.issn.1674-4152.002812

233 7

Abstract:
Objective This study aimed to observe the clinical effect of enhanced recovery after surgery (ERAS) anaesthesia management in the perioperative period of total hip arthroplasty in the elderly patients. Methods A total of 120 elderly patients who underwent elective total hip arthroplasty in Yuncheng Central Hospital from October 2019 to October 2021 were selected as the study subjects. They were randomly divided into the control group (60 cases) and study group (60 cases). The control group performed total hip arthroplasty under general anaesthesia, and the study group performed ERAS anaesthesia management measures. The control group received total hip arthroplasty under general anaesthesia, and the study group received ERAS anaesthesia management measures. The recovery indexes after operation and anaesthesia was recorded. The changes in VAS score and contents of serum inflammatory and stress factors such as tumor necrosis factor-α (TNF-α), inflammatory factors interleukin-6 (IL-6), norepinephrine (NE) and cortisol (Cor) were compared within 48 h after operation. The number of remedial analgesia and adverse reactions of analgesic drugs within 48 h after operation were counted, and the complications during hospitalisation were observed. Results The intraoperative bleeding volume in the study group [(1 022.86±26.74) mL] was less than that in control group [(1 350.41±28.29) mL, t=65.177, P < 0.001]. The recovery time of postoperative spontaneous breathing, anaesthesia awakening time, extubation time, postoperative first exhaust time, postoperative ambulation time and hospitalization time of the study group were shorter than those of the control group (all P < 0.05). The VAS scores of the study group were lower than those of the control group at 12, 24, 36 and 48 h after operation (all P < 0.05). At 24 and 48 h after operation, the content of serum TNF-α, IL-6, NE and Cor in the study group was lower than that in the control group (all P < 0.05). The rate of remedial analgesia, adverse reaction of analgesic drugs and postoperative complications in the study group was significantly lower than that in the control group (all P < 0.05). Conclusion ERAS anaesthesia management mode can effectively reduce the surgical trauma of total hip replacement in the elderly, inhibit stress and inflammatory reaction, alleviate postoperative pain reaction, shorten the rehabilitation cycle and reduce the risk of adverse drug reactions and complications.

Risk factors and clinical significance of pancreatic cancer

BAO Xue-qing, HUANG Fen, WANG Li-juan, XIA Jie, WANG Zhao-hong

2023, 21(1): 66-69. doi: 10.16766/j.cnki.issn.1674-4152.002813

297 12

Abstract:
Objective To collect the data on pancreatic cancer (PC), and to analyze the risk factors for pancreatic cancer, and to develop preventive measures. Methods A total of 256 cases of patients with PC treated in our hospital from January 2019 to December 2020 were selected as the observation group, and a total of 256 cases of patients without PC who were hospitalised in the Second Affiliated Hospital of Wenzhou Medical University during the same period were selected as the control group. Relevant clinical data of the two groups were collected, and the risk factors affecting the incidence of PC were analysed by univariate analysis and multivariate logistic regression. The clinical significance of such data was also explored. Results Univariate analysis showed that the proportion of men, patients with diabetes mellitus (DM), family history of PC, history of pancreatitis, family history of DM and obesity in the observation group were significantly higher than those in the control group (all P < 0.05). But the proportion of patients with DM treated with metformin in the observation group was significantly lower than that in the control group (28.77% vs. 58.97%, P < 0.05). Multivariate logistic regression analysis showed that DM, family history of DM, family history of PC, history of pancreatitis and obesity were independent risk factors for PC (OR were 2.251, 2.208, 2.252, 3.373, 3.257, respectively). 95%CI were 1.383 to 7.640, 1.016 to 4.797, 1.067 to 4.752, 1.279 to 8.899, 1.257 to 8.443, respectively. Metformin was a protective factor for PC in diabetic patients (OR was 0.451, 95%CI was 0.239 to 0.853). Conclusion DM, family history of DM, family history of PC, history of pancreatitis, and obesity are independent risk factors for the development of PC. Patients with these risk factors should be vigilant about the occurrence of PC, especially those with family history of DM, family history of PC, and obesity should take active prevention and treatment measures. Metformin can effectively reduce the risk of PC in DM patients, which is a protective factor for PC in DM patients.

Readmission and influencing factors of patients with chronic obstructive pulmonary disease within 1 year after discharge in a Class Ⅲ Grade A hospital

LIU Ying, XU Lei, BI Wei, MENG Nan-nan

2023, 21(1): 70-72. doi: 10.16766/j.cnki.issn.1674-4152.002814

262 12

Abstract:
Objective To investigate the readmission status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) within 1 year after discharge and analyse its influencing factors. Methods A total of 208 patients with acute exacerbation of COPD who were admitted to our hospital from February 2019 to August 2020 were selected as the research objects. The patients were followed up within 1 year after discharge to investigate whether they were readmitted. Based on whether the patients were readmitted, they were divided into readmitted group (82 cases) and non-readmitted group (126 cases). Results A total of 82 patients (39.42%) were readmitted within 1 year after discharge, of which 58 (27.88%) were readmitted once and 24 patients (11.54%) were readmitted two times or more. The two groups had statistically significant differences in age, smoking index, hypertension, coronary heart disease, average daily activity time of medium and low intensity, the number of acute exacerbations in the previous year, home oxygen therapy, regular medication, percentage of the volume of forced breathing in the first second predicted (FEV₁%Pred) and family care ability (all P < 0.05). Multivariate logistic regression analysis showed that moderate-to-low intensity daily activity time (< 2 h), FEV₁%Pred (< 50%), number of acute exacerbations in the previous year (≥2 times) and decreased family care ability were independent risk factors for readmission of COPD patients with acute exacerbations. There were statistically significant differences in age, average daily activity time of medium and low intensity, number of acute exacerbations in the previous year, FEV₁%Pred, and family care ability between the patients who were readmitted once in a year and those who were readmitted more than twice in a year (all P < 0.05). Conclusion The readmission rate of patients with acute exacerbation of COPD within 1 year after discharge is high. Moderate-to-low-intensity daily activity time, FEV₁%Pred, the number of acute exacerbations in the previous year and family care ability are independent risk factors for readmission.

Prevalence and risk factors of metabolic syndrome among pre-menopausal and post-menopausal women of Uygur in Tianshan District of Urumqi

ZHANG Jing, ADILA· alimu, GUO Yan-ying, LUO Yun-zhi, JIMILANMU· maimaitiming, WANG Xin-ling

2023, 21(1): 73-76. doi: 10.16766/j.cnki.issn.1674-4152.002815

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Abstract:
Objective To investigate the prevalence of metabolic syndrome (MS) among pre-menopausal and post-menopausal women of Uygur in Tianshan District of Urumqi and analyze the risk factors. Methods A cross-sectional survey was carried out in Tianshan District, Urumqi City in May 2017. A cluster random sampling method was used to conduct a questionnaire survey, physical examination and laboratory examination in four communities. Results The number of observation cases of this study was 822. The mean age of the subjects was (50.44±9.16) years old, 439 cases of pre-menopausal, 383 cases of post-menopause. The prevalence of MS in women over 40 years old was 32.8%, 19.1% in perimenopause and 48.6% in post-menopause. The prevalence difference in pre-menopausal and post-menopausal women was statistically significant (P < 0.01). The prevalence of central obesity, blood pressure, blood glucose, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were 76.6%, 40.3%, 31.1%, 32.7% and 7.8%, respectively. Abnormal waist circumference, abnormal blood pressure, abnormal blood glucose, abnormal TG and MS levels were significantly increased with increasing age, with a statistically significant difference (all P < 0.05). There was no significant difference in HDL-C abnormalities among different age groups (P>0.05). The logistic regression analysis of relative risk factors for MS showed that the MS was associated with menopause significantly (OR=4.972, 95% CI: 2.607-9.482, P < 0.001), and the other risk factors for MS were high BMI, family history of diabetes, heavy physical activity, smoking, and snoring. Conclusion Post-menopausal women are at high-risk of MS, significant upward trend with age. We should strengthen the education of perimenopausal and postmenopausal women, take early prevention and intervention measures, reasonably diet, control weight, reduce the risk of postmenopausal MS and cardiovascular disease, and improve quality of life.

Effect of cluster feeding intervention mode on growth and development of infants with very low/ultra-low birth weight

ZHU Wen-juan, WANG Xiao-hui, GUO Li-ping, WEI Hong-qing, TANG Xiao-ying

2023, 21(1): 77-80. doi: 10.16766/j.cnki.issn.1674-4152.002816

327 6

Abstract:
Objective The cluster feeding interventions mode for infants with very low/ultra-low birth weight was explored to investigate the effect of its application on growth and development and to provide reference for clinical practice. Methods A total of 105 infants with very low/ultra-low birth weight who were born in the Obstetrics Department of Nanxishan Hospital of Guangxi Zhuang Autonomous Region and external hospital admission from October 2019 to October 2020 were selected. They were divided into the observation group (55 cases) and the control group (50 cases) by using the random number table. The control group was given routine intervention mode, whereas the observation group was given cluster feeding intervention mode. Breast feeding, formula feeding, feeding intolerance, incidence of complications and changes in growth and development were compared between the two groups. Results The rate of pure breast-feeding in the observation group was 52.73%, which was higher than that in the control group (32.00%). The rate of pure formula feeding was 21.82%, which was lower than that in the control group (40.00%). In addition, the incidence rate of feeding intolerance, necrotising enterocolitis, infection, hypoglycaemia and anaemia in the observation group were 9.09%, 3.64%, 3.64%, 1.82% and 3.64%, respectively, which were lower than those in the control group (24.00%, 16.00%, 16.00%, 12.00% and 16.00%, respectively), and the difference was statistically significant (P < 0.05). The weight, height and head circumference of the observation group were (2 581.12±273.03) g, (47.22±2.78) cm and (32.37±2.05) cm, respectively, which were higher than those of the control group (2 217.34±240.71) g, (42.01±2.50) cm and (31.40±2.10) cm, respectively, and the differences were statistically significant (all P < 0.05). Conclusion The cluster feeding intervention model has a significant effect on infants with very low/ultra-low birth weight, which can improve the breastfeeding rate, reduce the incidence of feeding intolerance and complications and promote the growth and development of newborns.

Clinical features of neonatal severe enterovirus infection

LI Bin, QIU Li-ling, DU Kun, ZHAO Mei, GAO Jin, ZHAO Pei-li

2023, 21(1): 81-83. doi: 10.16766/j.cnki.issn.1674-4152.002817

280 6

Abstract:
Objective To analyze the clinical characteristics and influencing factors of neonatal severe enterovirus infection. Methods A retrospective analysis of neonatal enterovirus infection cases admitted to Children' s Hospital Affiliated of Kunming Medical University from December 2019 to December 2020 was performed. Based on the severity of infection, they were divided into the common infection group (n=63) and severe infection group (n=13). The clinical characteristics of the two groups were compared, and the risk factors of severe enterovirus infection were analysed by Logistic regression. Results Compared with the common infection group, the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants and a significantly earlier onset time (P < 0.05). The abnormal white blood cells (< 5×10⁹/L or >15×10⁹/L), thrombocytopenia, pH decrease, C-reactive protein increase, procalcitonin and lactic acid increase were higher than those in the common infection group (all P < 0.05). The incidence of combined liver function abnormality, coagulation function abnormality and myocardial injury was also higher than that of common infection group (all P < 0.05). The mortality of children in severe infection group was higher than that in common infection group (P < 0.05). Multivariate logistic regression analysis showed that preterm birth (OR=7.125, 95% CI: 2.275-29.021), coagulation dysfunction (OR=22.452, 95% CI: 2.948-268.656) and pH ≤ 7.25 (OR=14.569, 95% CI: 2.675-40.590) were the risk factors for severe enterovirus infection. Conclusion Significant differences in clinical manifestations, complications and laboratory tests are observed between the neonates with common and severe enterovirus infection. Neonatal enterovirus infection is accompanied by premature delivery, early onset, acidosis, elevated lactic acid, abnormal liver function, and abnormal blood coagulation function, and it is necessary to be alert to severe infection.

Relationship between TBX21 gene polymorphism and susceptibility to asthma in Han children

LI Hui-juan, ZHEN Xing-gang, ZHANG man

2023, 21(1): 84-87. doi: 10.16766/j.cnki.issn.1674-4152.002818

203 5

Abstract:
Objective To explore the polymorphism of T-box transcription factor 21 (TBX21) in children of Han nationality and analyze its association with asthma susceptibility. Methods A total of 190 Han asthma patients admitted to the paediatrics department of Henan Children' s Hospital from January 2019 to January 2021 were selected as the asthma group, and 135 Han children who underwent physical examination in our hospital during the same period were selected as the control group. Oral mucosa specimens were collected; single nucleotide polymorphisms (SNP) were analysed at rs9910408, rs16947078 and rs2240017 gene loci, and the genotype distribution and allele frequencies of the 3 loci, including the TBX21 gene, were compared between the two groups. The relationship between rs2240017 locus polymorphism and asthma susceptibility was analysed by logistic regression. Results The Hardy-Weinberg balance test showed that the distribution frequencies of rs9910408, rs16947078 and rs2240017 genotypes in the two groups of children did not shift, and the research subjects were well represented. The difference in rs2240017 genotype distribution between the asthma group and control group was statistically significant (P < 0.05), and the frequency of the C allele in the asthma group was significantly higher than that of the control group (89.47% vs. 40.37%, P < 0.05). Moreover, the frequency of the G allele was significantly lower than that of the control group (10.53% vs. 59.63%, P < 0.05). No statistically significant difference in the rs9910408 and rs16947078 genotypes distribution was observed between the two groups (P>0.05). Logistic regression analysis showed that the decrease of G/G, C/G, C/C genotypes and G allele frequencies, as well as the increase of C allele frequency of TBX21 gene rs2240017 may be the influencing factor of asthma susceptibility (P < 0.05). Conclusion The rs2240017 polymorphism of the TBX21 gene is closely related to asthma susceptibility.

Clinical effect of Yunpi Buxue Decoction in the treatment of children with iron deficiency anaemia

QIAN Xiong, ZHANG Yin-min, CHEN Kai

2023, 21(1): 88-91. doi: 10.16766/j.cnki.issn.1674-4152.002819

198 3

Abstract:
Objective This study aims to investigate the short-term and long-term curative effect of Yunpi Buxue Decoction in the treatment of children with iron deficiency anaemia and its influence on iron metabolism indexes to provide reference for their clinical treatment. Methods Eighty children with nutritional iron deficiency anaemia of spleen-stomach weakness syndrome who were admitted to Jiaxing Hospital of Traditional Chinese Medicine from September 2019 to June 2020 were selected and divided into the control group (n=40) and observation group (n=40) using the random number table method. The control group was treated with vitamin C combined with iron dextran oral liquid, and the observation group was treated with Yunpi Buxue Decoction based on the control group. The short-term and long-term efficacy, adverse reactions, iron metabolism indexes and laboratory index levels were compared between the 2 groups of children. Results The total clinical effective rate of the observation group (92.50%) was apparently higher in comparison with that of the control group (75.00%, χ²=4.501, P < 0.05). After treatment, the mean corpuscular haemoglobin concentration, mean corpuscular volume, haemoglobin, serum iron and transferrin saturation in the observation group [(328.45±32.84) g/L, (85.74±9.20) fL, (130.88±15.66) g/L, (16.65±3.12) μmol/L, and (35.74±6.20) %] were apparently higher compared with those in the control group [(304.74±30.22) g/L, (75.33±8.82) fL, (118.30±17.26) g/L, (13.84±3.05) μmol/L, and (30.55±6.84) %], all P < 0.05. Six months after treatment, the recurrence rate of the observation group (7.50%) was significantly lower in comparison with that of the control group (27.50%; χ²=5.541, P < 0.05). The incidence of adverse reactions in the observation group (17.50%) was not statistically significant compared with that in the control group (12.50%; χ²=0.392, P>0.05). Conclusion Yunpi Buxue Decoction combined with vitamin C and iron dextran oral liquid has a significant short-term and long-term curative effect on children with iron deficiency anaemia, which can effectively regulate the body' s blood cells and iron metabolism, and it has a better safety.

A research on human resource management problems and countermeasures of J Community Health Service Center in Shanghai

LIU Mei, WANG Zhao-xin, JI Chang, SUN Jin, TANG Chen, ZHANG Tong, YUAN Min-jian

2023, 21(1): 92-96. doi: 10.16766/j.cnki.issn.1674-4152.002820

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Abstract:
Objective To provide decision-making basis for health personnel planning through analysing the main problems of human resource management in J community health service centre (hereinafter referred to as the "Center") and identifying the key issues that need to be addressed. Methods Firstly, we clarified the problems of human resource management in Center by interviewing some key insider and a detailed description of human resource status. In addition, we condensed and categorised human resource management issues systematically by the guidance of the "macro model of health system". Secondly, we performed expert consultation demonstration from two dimensions of importance and severity to clarify the importance and seriousness of the problem. Finally, such issues were divided into four categories with cluster analysis: "important and serious", "important but not serious", "serious but not important" and "relatively unimportant and not serious". Results (1) A total of 18 human resource management problems of eight categories were determined from the two dimensions of "structure resource" and "structure organisation" through systematic classification and demonstration. (2) Through the judgment of importance and severity, this study found that the "important and serious" key problems faced by the Center human resource management were "problem 1: insufficient number of core health technicians", "problem 2: lack of talent reserve mechanism, and talent reserve is difficult to meet future business needs" and "problem 4: relatively low personnel post matching". Conclusion Based on the three key issues, the Center human resource management system should be optimized from three aspects: first, the number of core health technicians should be increased through multiple construction or optimization of multi-source flexible employment mechanism; the second aspect is to improve the on-duty service ability of professional health technicians and enhance the personnel post matching degree; third, it should be optimize the access evaluation mechanism, adjust the supply structure of human resources, and establish a long-term development mechanism for the talent team.

Using Organisational Communication Theory to Solve the Problem of Family Doctors Signing Contract

TANG Zhi-hong, WANG Zhao-xin, CAI Li-qiang

2023, 21(1): 97-99. doi: 10.16766/j.cnki.issn.1674-4152.002821

315 4

Abstract:
Objective This study aims to analyse the problems existing in the current signing communication of family doctors by using the theory of organisational communication and conducts strategic research. Methods This paper expounds the main ways of signing communication between family doctors and residents, analyses the advantages and disadvantages and proposes solutions to the problems of signing communication by using the theories of organisational communication, focusing on theory and interaction amongst groups. Results Contract signing is performed in two ways: internal communication and external communication. Internal communication primarily refers to the formal communication between the administrative department and family doctor on the signing work. Formal communication refers to the transmission and exchange of information in accordance with the express provisions of the organisation, relying on the official institutions and authority relationships of the administrative system as channels for information transmission and exchange, however, problems such as rigidity and monotony in the type of communication are observed. Communication outside the organisation is primarily informal oral communication between family doctors and residents with regard to contract signing. Thus, this study aims to change the attitude and behaviour of the person being communicated through communication, and the two parties can reach a consensus. However, the communication method is too simple, and it lacks effective communication skills. The contract only stays at the level of "propaganda". Conclusion Facing such a new thing as family doctor contracting, communication channels must be expanded, and the two-way communication mechanism between administrative departments and family doctors must be implemented. In addition, a consensus between the two sides must be achieved. Multiple communication channels must be established, and the interaction amongst the groups must be used. Moreover, a good atmosphere for signing a contract within the community must be established to deepen communication from publicity to communication, and the "focus theory" must be used to adopt diversified communication methods for different groups. Family doctors should improve their communication skills to achieve the premise of signing a contract and provide valuable services, such as signing services and solving the health problems of contracted residents.

Effects of health education based on action research method on the postoperative rehabilitation of patients with total hip replacement

DENG Ying, PAN Wei-yu, ZUO Shan-shan, SHAN Dan-dan

2023, 21(1): 100-103. doi: 10.16766/j.cnki.issn.1674-4152.002822

287 9

Abstract:
Objective To explore the effect of health education based on action research method on mental resilience, rehabilitation compliance, self-care ability and postoperative hip functional rehabilitation of patients with total hip replacement (THR). Methods A total of 100 patients who received THR in Henan Provincial People' s Hospital from January 2019 to January 2022 were divided into study group (n=50) and control group (n=50) by the random number table method. They received action research method-based health education and routine health education respectively, and the intervention lasted for 3 months after discharge. Mental resilience and hip recovery of patients in the two groups were evaluated by using the Conner Davidson resilience scale (CD-RISC) and Harris hip rating scale before the intervention and after 3 months of intervention. The rehabilitation compliance of the two groups at different postoperative time points and complications after 1 month of intervention were analysed, and exercise self-care agency (ESCA) was performed after 3 months of intervention. Results The CD-RISC and ESCA scores of the study group were significantly higher than those of the control group after 3 months of intervention, as well as Harris scores after 1 and 3 months of intervention (all P < 0.05). The complete compliance rates of the study group at 1 week, 1 month and 3 months after surgery were 88.00%, 68.00% and 54.00%, respectively, which were significantly higher than those of the control group at 50.00%, 40.00% and 28.00% (all P < 0.05). The total incidence of complications after 1 month of intervention in the study group was 4.00%, which was lower than that in the control group (22.00%, P < 0.05). Conclusion Health education based on the action research method can improve the postoperative mental resilience and self-care ability of patients with THR, enhance their rehabilitation compliance, reduce complications and promote the recovery of hip joint.

Low-dose contrast-enhanced ultrasound combined with serum microRNA-1469 level in the diagnosis of benign and malignant liver tumours

YU Hui-juan, XING Li-li, YANG Fan, LI Guang-ming

2023, 21(1): 104-107. doi: 10.16766/j.cnki.issn.1674-4152.002823

227 3

Abstract:
Objective To analyze the value of low dose contrast-enhanced ultrasound combined with serum microRNA-1469 in the diagnosis of benign and malignant neoplasms in liver. Methods A retrospective analysis of the clinical data of 103 patients with liver tumours who were admitted from January 2017 to January 2020 in Seventh People' s Hospital of Zhengzhou was conducted. According to benign and malignant tumors, they were divided into benign tumor group (50 cases) and malignant tumor group (53 cases). Low-dose contrast-enhanced ultrasonography was performed at admission, and the level of serum miR-1469 was detected. The value of low-dose contrast-enhanced ultrasound combined with serum miR-1469 in the diagnosis of benign and malignant liver tumours was evaluated. Results The peak intensity of contrast-enhanced ultrasound in the benign tumour group [(127.84±14.59) dB] was lower than that in the malignant tumour group [(186.36±18.14) dB, P < 0.05]. In the benign tumour group, the peak time of contrast-enhanced ultrasound [(60.28±6.52) s] was higher than that in the malignant tumour group [(40.75±4.87) s, P < 0.05], and the expression level of miR-1469 (5.74±0.62) was higher than that of the malignant tumour group (0.82±0.08, P < 0.05). ROC analysis showed that the peak intensity and peak time of contrast-enhanced ultrasound were 155.32 dB and 42.34 s, respectively. The area under the curve (AUC) of liver malignant tumours was 0.791 and 0.801, respectively, and the AUC of peak time was high. The best cut-off point of miR-1469 in the diagnosis of liver malignant tumours was 0.88. The sensitivity, AUC and Youden index of combined diagnosis of contrast-enhanced ultrasound combined with mir-1469 were 74.46%, 0.912 and 0.640, respectively. Conclusion Low-dose contrast-enhanced ultrasound combined with serum miR-1469 can be used to diagnose benign and malignant liver tumours. The diagnostic efficiency is better than that of single diagnosis, and the clinical application value is higher.

Multi-sequence MRI image data-based machine learning model in the diagnosis of benign and malignant parotid gland tumours

XU Zu-liang, SHENG Liang, HE Xia-xia, WANG Yan-na, WANG Guo-yu

2023, 21(1): 108-111. doi: 10.16766/j.cnki.issn.1674-4152.002824

339 5

Abstract:
Objective The clinical value of multi-sequence MRI image data-based radiomics in the diagnosed of benign and malignant parotid gland tumors. Methods A total of 97 patients with parotid gland tumours diagnosed by pathological examination in Taizhou Central Hospital from January 1, 2021 to May 30, 2022 were selected, including 64 benign tumours and 33 malignant tumours. Meantime, patients' clinical data and MRI images were extracted. ITK-SNAP was used to segment regions of interest. In addition, PyRadiomics plugin of 3D-Slicer was used to extract 120 image features from T₁-weighted contrast enhancement images (T₁Wce), T₂-weighted images (T₂WI) and apparent diffusion coefficient (ADC) images that were constructed on the basis of diffusion-weighted imaging (DWI) sequence. Then, Lasso regression was used for the reduction of image features. Finally, a support vector machine model (SVM) was constructed using the selected image features. Then, the ROC curve was drawn to evaluate the diagnostic efficiency of each model. Results No significant differences in age and gender ratio was observed between the two groups. Four imaging models were constructed, including the models based on T₁Wce, T₂WI, ADC images and the combination of the three sequences. The AUC was as follows: T₁Wce model 0.752, T₂WI model 0.776, ADC model 0.810, T₁Wce+T₂WI+ADC model 0.897. The AUC of the three-sequence combination model was significantly higher than that of the single-sequence model. Conclusion The radiomics model based on MRI image data can be effectively used for assisting the diagnosis of benign and malignant parotid gland tumours. Moreover, the model based on the combination of T₁Wce, T₂WI and ADC images has the best diagnostic efficiency.

Effect of machine learning in the auxiliary diagnosis model of cardiovascular disease

LU Wen-ting, YAO Yuan, XIONG Jing, LIU Xiang-ping, LI Shuang-qing

2023, 21(1): 112-117. doi: 10.16766/j.cnki.issn.1674-4152.002825

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Abstract:
Based on the survey, cardiovascular disease mortality ranks first in the total mortality rate of urban and rural residents in China. The incidence of cardiovascular diseases is still increasing. In the past decade, China has effectively promoted the construction of cardiovascular health. The state has called for shifting the main battlefield of cardiovascular disease from hospitals to communities. Therefore, improving the quality of primary care services are necessary to meet the growing health demand of the people. With the advent of the digital information age, machine learning is widely used in image recognition, speech recognition and natural language processing. Artificial intelligence (AI) is widely used in e-commerce, home, logistics and transportation, however, its impact on medical care has just begun. With the improvement of medical data availability and the rapid development of big data analysis methods, the successful application of artificial intelligence in medical field becomes possible. Under the guidance of relevant clinical problems, powerful AI technology can extract the clinical information hidden in massive data and then assist doctors in clinical decision-making. In recent years, with the national and social attention to primary medical care and the development of Internet information technology, the application of machine learning technology in the diagnosis and prediction of cardiovascular diseases has become a hot topic. Machine learning is gradually changing the way doctors diagnose diseases and their clinical decision-making, but the diagnosis and decision-making of each cardiovascular disease requires a certain degree of analysis with regard to disease and statistics, and the selection of the optimal machine learning algorithm can better solve clinical problems. By comparing the area under the curve, sensitivity, specificity, accuracy, F1 value, C statistical value and other quantitative indicators of the auxiliary diagnosis model of cardiovascular diseases in recent 5 years, this paper evaluates the advantages of machine learning under different disease classifications, systematically summarises the application of different AI methods in the diagnosis and prediction of cardiovascular diseases and evaluates related auxiliary diagnosis models.

Significance and prospect of preoperative inspiratory muscle training in abdominal surgery

MU Yan-xi, YAO Ya-long, LI Jin-zhou, WANG Wen-jie, HUANG Ze-ping, CHEN Kang, DONG Peng, CHEN Xiao

2023, 21(1): 118-122. doi: 10.16766/j.cnki.issn.1674-4152.002826

264 11

Abstract:
Pulmonary complications, as one of the most common complications after abdominal surgery, not only increase the length of hospital stay and hospital costs but also seriously affect the prognosis and quality of life of patients. With the development of minimally invasive surgical techniques and anaesthetic techniques, the incidence of postoperative pulmonary complications (PPCs) has decreased. However, PPCs are still considered common complications after abdominal surgery. The commonly used clinical methods to prevent PPCs include balloon blowing, abdominal breathing and lip reduction breathing. However, the implementation and efficacy of these methods cannot be guaranteed because they cannot be set at a specific training intensity, and healthcare professionals cannot effectively assess the patient' s mastery of these methods. Several studies have shown that preoperative inspiratory muscle training (IMT) can improve the muscle strength and endurance of inspiratory muscles, improve the lung function of patients and reduce the incidence of PPCs in abdominal surgery patients. The advantage is that the specific training intensity can be set according to the patient' s condition, and the training intensity can be gradually increased from low to high according to the patient' s condition to achieve individualised training. However, IMT for abdominal surgery patients in China is still in the initial exploration stage, which deprives the preoperative IMT of unified and standardised exercise prescription. In addition, whether IMT is effective in reducing PPCs in abdominal surgery patients is still controversial. Therefore, in this paper, we searched the literature on the effects of preoperative IMT on PPCs in abdominal surgery patients in Chinese and English databases and the grey literature of major clinical registries and reviewed the value of preoperative IMT in abdominal surgery in combination with relevant clinical trials being conducted by our research team. Our purpose is to present different research perspectives and viewpoints from various aspects, so as to provide reference for clinical work and future clinical research and benefit more patients.

Clinical effect of Tougucao Cebaiye Decoction on androgenic alopecia and on the level of anxiety and depression

XIA Ji-ning, XIANG Jing

2023, 21(1): 123-126. doi: 10.16766/j.cnki.issn.1674-4152.002827

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Abstract:
Objective This study aimed to observe the therapeutic effect of Tougucao Cebaiye Decoction combined with western medicine on androgenic alopecia (AGA) and its relief effect on anxiety and depression level of patients. Methods A total of 124 patients with AGA admitted to Jiaxing Hospital of Traditional Chinese Medicine from June 2019 to June 2021 were selected and divided into the treatment group and control group by using the random number table method, with 62 cases in each group. Both groups were given finasteride tablets and minoxidil tincture orally. On this basis, the treatment group was given Tougucao Cebaiye Decoction for 6 months. The objective indexes (total number of hair stems, variation of hair stem diameter), TCM syndrome score (alopecia, pruritus, greasy, scaly) and clinical efficacy were compared before and after treatment in two fixed observation areas (frontal horn and head). The anxiety and depression of AGA patients were analysed, and the effects of Tougucao Cebaiye Decoction on the mood of patients with AGA after treatment were compared. Results After treatment, the variation in vertical hair stem diameter was lower in the treatment group than in the control group (17.31±3.16 vs. 23.67±3.78, t=10.164, P < 0.001). The total number of hair stem count was higher than that in the control group (55.18±4.32 vs. 53.09±4.95, t=2.505, P=0.014), and the total number of hair stems in frontal horn was higher than that in the control group (48.83±3.24 vs. 46.66±3.37, t=3.681, P < 0.001). After treatment, the scores of alopecia, pruritus, greasy and scaly were lower in the treatment group than in the control group (all P < 0.001). The total effective rate of the treatment group was 88.71%, which was higher than that of the control group (74.19%, χ²=4.324, P=0.038). After treatment, the GAD-7 and PHQ-9 scores were lower in the treatment group than those in the control group (all P < 0.05), and the WHOQOL-BREF scores of physiology, psychology, independence and environmental domains in the treatment group were higher than those in the control group (all P < 0.001). Conclusion Tougucao Cebaiye Decoction combined with western medicine can effectively inhibit hair loss symptoms in patients with damp heat type AGA, improve TCM syndromes, improve therapeutic effect, alleviate anxiety and depression and improve quality of life.

Effects of biofeedback electrical combined with pelvic floor muscle rehabilitation training on pelvic floor function in patients with hysterectomy

WANG Ting-ting, WANG Jia-ying, ZHOU Xiao-ming, ZHANG Zhou-yan

2023, 21(1): 127-130. doi: 10.16766/j.cnki.issn.1674-4152.002828

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Abstract:
Objective This study aimed to analyse the effect of biofeedback electrical stimulation combined with pelvic floor muscle rehabilitation training on pelvic floor function in patients undergoing laparoscopic extrafascial hysterectomy and provide theoretical reference for the formulation of postoperative rehabilitation programs for patients undergoing hysterectomy. Methods A total of 120 cases of patients who underwent laparoscopic extrafascial hysterectomy in the Affiliated Hospital of Ningbo University School of Medicine from May 2020 to May 2022 were selected as the research subjects. All patients were divided into the control group and observation group by the random number table method, with 60 cases in each group. The patients in the control group received conventional pelvic floor muscle rehabilitation training after operation. The patients in the observation group received pelvic floor muscle rehabilitation training combined with biofeedback electrical stimulation after operation. The clinical efficacy of the two groups was observed, and the scores of pelvic floor muscle tone, pelvic floor function, sexual function and quality of life were compared between the two groups before treatment and after 3 months of treatment. Results The total effective rate of clinical treatment in the observation group was 96.67% (58/60), which was higher than 81.67% (49/60) in the control group (χ²=6.988, P=0.008). The rehabilitation of pelvic floor muscle tension in the observation group was better than that in the control group after three months of treatment(P < 0.001). Compared with the control group, three months after treatment, the PFIQ-7 and PFDI-20 scores of pelvic floor function in the two groups were lower than those before treatment (all P < 0.05), and the observation group was lower than the control group (all P < 0.05). In the observation group, the scores of sexual desire, sexual psychology, orgasm and other sexual functions of the patients were significantly higher than those of the control group (all P < 0.05). After 3 months of treatment, the quality of life GQOLI-74 scores was significantly improved in both groups, and the score in observation group was higher than that in control group (all P < 0.05). Conclusion Biofeedback electrical stimulation combined with pelvic floor muscle rehabilitation training can improve the pelvic floor muscle tension in patients with laparoscopic extrafascial hysterectomy, promote the recovery of pelvic floor function and improve the quality of sexual life of patients, which is worthy of active clinical application and promotion.

Discussion and practice on the training scheme of professional degree masters of general medicine

ZHAO Pei, GAO Ya, WU Dan, YUAN Xiao-chen, SHEN Hui

2023, 21(1): 131-134. doi: 10.16766/j.cnki.issn.1674-4152.002829

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Abstract:
To meet the increasing demands for health care by the public, the modern medical model changed from the specialised medical-oriented biomedical model to the general medical-oriented and bio-psycho-social medical models, it promoted the rapid development of general medicine. General medicine is a comprehensive medical specialty that integrates clinical, preventive, rehabilitation and health management disciplines. General practitioners are important practitioners of general medicine. How to train high-quality general practitioners has become an important part of promoting healthy China in medical education. The major responsibility of general practitioners is to provide comprehensive, coordinated and continuous essential health care services for individuals, families and communities. As an important supporting force for the construction, development and maintenance of general medicine, professional degree masters of general medicine should be oriented to the needs of communities, especially for diseases of patients from elderly communities typically involve multiple organs and systems. Therefore, it leads to great challenges in the training of professional degree masters of general medicine. A capable professional degree master of general medicine is not only a provider but also an educator and researcher. The training system for the professional degree masters of general medicine in China is still in the development stage, and a comprehensive training program is lacking. Based on the author's own teaching experience for a number of years, this paper analysed and discussed several issues in the training program of professional degree masters of general medicine in our hospital, particularly the problems exposed in the pandemic. We have also raised suggestions and strategies regarding these issues in terms of clinical diagnosis and treatment ability, teaching ability, scientific research ability, infectious disease prevention and control ability and doctor-patient and interpersonal communication ability of professional during the pandemic. This work may provide theoretical support and practical references for the continuous optimisation and improvement of the training mode of professional degree masters of general medicine. The training of professional degree masters of general medicine can continuously supply high-level general practitioners for the society, making them the main force of general medicine. Such training will not only meet the health needs of the population but also promote the sustainable development of general medicine.

Status and influencing factors of career attractiveness and quality of life of general practitioner training doctors in Jiangsu Province

YUE Na, CAO Jing-min, CHEN Wen-ji, TAO Zhao, YUAN Pan, JIN Hui, QIU Shan-hu, XIE Bo

2023, 21(1): 135-138. doi: 10.16766/j.cnki.issn.1674-4152.002830

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Abstract:
Objective To understand the current situation and influencing factors of career attractiveness and quality of life of grass-roots general practitioners in Jiangsu Province, and focus on teacher training, so as to provide basis for improving professional attractiveness and quality of life of general practitioners in Jiangsu Province. Methods A total of 368 general practitioners from various parts of Jiangsu Province were investigated by the method of simple random sampling in 2020. The basic situation questionnaire was used to investigate job satisfaction, job burnout, turnover intention and quality of life. Univariate analysis (χ² test, rank sum test) and multivariate analysis (linear regression, ordered logistic regression) were used to analyze the relationship between projects. Results The average score of job satisfaction was (74.35±12.59) points, which was in the state of basic satisfaction. The average score of turnover intention was (14.54±3.40) points, and the score of personal achievement was 16.00 (10.00, 24.00) points, with mild job burnout and high turnover intention. Univariate analysis showed that age, major, position, working years, educational background, professional title, working area, training times and teaching were the influencing factors of professional attractiveness (all P < 0.05). Multivariate analysis showed that whether teaching, training frequency, income, education background, professional title and major were the influencing factors of occupational attractiveness (all P < 0.05). The quality of life was positively correlated with job satisfaction and turnover intention, and negatively correlated with job burnout (all P < 0.01). Emotional exhaustion affected the quality of life of general practitioners (P < 0.01). Conclusion At present, the career attractiveness of general practice in Jiangsu Province needs to be improved, and reducing job burnout is helpful to improve the quality of life of general practitioners. Increasing the number of high-quality teacher training, promoting the construction of job transfer teams, optimizing the structure of talent introduction, and improving the salary package are expected to enhance the career attraction.

Research status and visualization analysis of pain-fatigue-sleep disturbance symptom clusters in tumour patients

YANG Li-ping, DUAN Pei-bei, YANG Ling, XIA Chao, HAN Si-xuan, FEI Chao-nan

2023, 21(1): 139-143. doi: 10.16766/j.cnki.issn.1674-4152.002831

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Abstract:
Objective To systematically analysed the research status, hotspots and trends of "pain-fatigue-sleep disorder symptom clusters", the most frequent and stable symptom group in tumour patients, and to provide reference for further research in this field in China. Methods International literatures related to pain-fatigue-sleep disturbance symptom clusters from 2001 to 2021 were retrieved from the core collection of Web of Science database and analysed and visualised with CiteSpace software. Results A total of 379 articles, including the works of 113 authors, were included, and the number of articles showed an overall upward trend since 2001. The United States ranked first in terms of the number of publications and cooperated closely with other countries. Although China ranked second, its centrality was relatively low. Around the world, symptom cluster research mainly centred on adult cancer chemotherapy patients, and the research focus was mainly the symptom cluster recognition methods, symptom cluster-related symptoms, symptom cluster-related mechanism research, and intervention measures. Conclusion This study provides valuable information for researchers to identify potential collaborators and institutions, core journals, hot topics and research frontiers. Research in this field in China can concentrate on in-depth research of influencing factors, adopt multidisciplinary intervention with the help of mobile medical platform and build evidence-based practice programs of intervention care with Chinese characteristics based on the background of Chinese traditional medicine therapy.

Meta-analysis of the intervention effect of self-compassion training on depressive symptoms and its influencing factors

WANG Xiao-hang, LIU Qu-zhi

2023, 21(1): 144-148. doi: 10.16766/j.cnki.issn.1674-4152.002832

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Abstract:
Objective To retrieve recently published randomised controlled trials of self-compassion training on depressive symptoms and explore the effect of self-compassion training on depressive symptoms and its influencing factors using meta-analysis. Methods Databases, such as Web of Science, Embase, the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and VIP, were searched. The retrieval time limit was from the establishment of the database to May 2021. All randomised controlled trials with self-compassion training intervening with depressive symptoms were collected. Two independent investigators screened the literature in accordance with the inclusion and exclusion criteria and CMA V3.3 software was used to combine the effect size and moderate effect analysis. Results A total of 28 articles (n=3 312) were included. Meta-analysis showed that the combined effect size was g=0.423 (95%CI: 0.291-0.555, P < 0.001), and after the publication bias was filled, g=0.296 (95%CI: 0.143-0.449, P < 0.001). Moderating effect analysis showed that when considering only the moderating effect of a single variable, the intervention effect was affected by country and region, proportion of female participants and dropout rate (all P < 0.05). In the multiple regression model, the type of control group and research quality showed significant moderating influence on the intervention effect (all P < 0.05), whereas the other moderating variables were not significant. Conclusion The self-compassion training program has a good intervention effect on depressive symptoms. In the future, we can expand the scope of the population to continue the exploration of the intervention effect of self-compassion training in the context of Chinese culture.

Construction of auricular point sticking program for patients with primary dysmenorrhea

HUANG Jing-jing, YE Ran, CHEN Hao, WANG Qiu-qin, GE Ying-ying, CHENG Yan-fei

2023, 21(1): 149-153. doi: 10.16766/j.cnki.issn.1674-4152.002833

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Abstract:
Objective To develop auricular point sticking program for patients with primary dysmenorrhea, and to provide reference for the nursing of patients with primary dysmenorrhea. Methods Based on the concept and method of evidence-based research, randomised controlled trials, guidelines and textbooks were used as evidence sources to formulate the program. An expert group meeting was held to develop the questionnaire. Questionnaires were sent to 13 experts on site and via e-mail from July 2021 to September 2021. After two rounds of consultation, the auricular point sticking program for patients with primary dysmenorrhea was constructed. Results In the two rounds of consultation, the positive coefficients of experts were 86.67% and 100.00%, and the authority coefficients were 0.85 and 0.81. In the first round of consultation, Kendall ' s concordance coefficient of auricular acupoint prescription was 0.386, and that of the operation method part was 0.555 (all P < 0.001). In the second round of consultation, Kendall ' s concordance coefficient of auricular acupoint prescription was 0.398, and that of the operation method part was 0.709 (all P < 0.001). The final program was divided into two parts, the auricular acupoint prescription and operation method, and included 8 dimensions, such as main acupoints, matching acupoints, pressing time, pressing frequency, intervention time, intervention course, selection of the side of the ear and replacement frequency. The main acupoints were internal genitalia, endocrine, shenmen, sympathetic, pelvic cavity and ovary. In point matching, cold blood stasis syndrome matched kidney, Qi stagnation with blood stasis syndrome matched liver, liver and kidney deficiency syndrome matched liver and kidney, Qi and blood deficiency matched spleen, lung and liver, and damp heat stasis syndrome matched ear tip, spleen and triple energizer. Conclusion The constructed program improves the main acupoints, adds matching acupoints and standardises the operation methods and thus can provide guidance for clinical care.

Relationship between forgiveness and general well-being in patients with thyroid cancer: multiple mediating effects of hope and positive coping

XIE Chang-hua, DAI Yu, ZHOU Li-hua, WANG Xin-yan

2023, 21(1): 154-158. doi: 10.16766/j.cnki.issn.1674-4152.002834

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Abstract:
Objective To explore the relationship among hope, positive coping, forgiveness and subjective well-being of thyroid cancer patients, and to test the multiple mediating effect of hope and positive coping between forgiveness and general well-being, so as to provide scientific basis for formulating intervention programs to improve the level of general well-being of thyroid cancer patients. Methods A total of 177 patients with thyroid cancer in the Third Department of Gneral Surgery of Suzhou Hospital Affiliated to Anhui Medical University from May 2019 to March 2021 were selected. They were surveyed by simple coping style scale (SCSS), general well-being scale (GWB), Herth hope index (HHI), and Heartland forgiveness scale (HFS). The structural equation model was established, and the mediation effect test was performed by Bootstrapping method. Results (1) The scores of forgiveness, hope, positive coping and general well-being of patients with thyroid cancer were (103.97±20.45), (34.76±3.78), (15.38±5.78) and (57.50±10.10) points respectively. (2) Forgiveness was positively correlated with hope, positive coping and general well-being (r=0.229, 0.513, 0.480, all P < 0.01); hope was positively correlated with positive coping and general well-being (r=0.278, 0.390, all P < 0.01); positive coping was positively correlated with general well-being (r=0.508, P < 0.01). (3) Multiple mediation effect model analysis showed that the level of forgiveness had a significant direct effect on the general well-being of patients with thyroid cancer. Hope and positive coping style had concurrent multiple mediating effect between forgiveness and general well-being (95% CI: 0.132-0.409). The total effect was 0.62; the direct effect was 0.35, and the total mediation effect was 0.27. The mediating effect accounts for 43.5% of the total effect. Conclusion Forgiveness can directly affect the general well-being. It can also influence the general well-being through hope and positive coping style indirectly. Results of this study can provide a theoretical basis for the formulation of mental health intervention programs for patients with thyroid cancer.

Application of child life program intervened in children' s intravenous indwelling needle puncture

JIANG Hui-zhen, REN Chun-xia, ZHAN Ying-zhu, XIA Ling-ling, WANG Xiao-qing, DAI Jing, ZHANG Ting-ting, CHEN Ling

2023, 21(1): 159-162. doi: 10.16766/j.cnki.issn.1674-4152.002835

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Abstract:
Objective Child Life Program intervened the use of various measures to reduce children' s stress during medical processes. This study aimed to investigate the application effect of child life program intervened in children' s intravenous indwelling needle puncture. Methods From February 25, 2019 to June 12, 2021, 120 newly admitted children aged 3 to 10 years who underwent intravenous indwelling needle puncture from the First Affiliated Hospital of Anhui Medical University were collected and randomly divided into two groups by the radom number table method, with 61 cases in the intervention group and 59 cases in the control group. The control group used conventional children' s indwelling needle pre-puncture care and health education methods, whereas the intervention group used child life program intervention with routine education. Using the FLACC (face, legs, activity, cry, and consolability) pain behaviour assessment scale and the Wong-Baker faces pain rating scale, the degree of children' s pain during indwelling needle puncture was scored. The pain scores, compliance and one-time puncture success rate was compared. Results In children with good venous conditions at the puncture site, the FLACC scale scores [2(1, 3)] points and the Wong-Baker FACES scale scores [2(2, 3)] points of the intervention group were significantly lower than those of the control group [5(2, 8) points, 6(4, 8) points, Z=-4.335, -5.802, all P < 0.001]; Among the children who were operated by nurses with 6 to 10 years or more of experience, the FLACC scale scores and were significantly lower than those of the control group [2(1, 3) points vs. 4(2, 8) points, Z=-3.022, P=0.003; 2(1, 3) points vs. 5(2, 7) points, Z=-2.975, P=0.003]; And Wong-Baker faces scale scores and of the intervention group were significantly lower than those of the control group [2(2, 4) points vs. 6(3.5, 10) points, Z=-4.760, P < 0. 001; 2(2, 2) points vs. 6(4, 10) points, Z=-4.431, P < 0.001]. Moreover, the compliance of intravenous indwelling needle puncture and the one-time puncture success rate in the intervention group were significantly higher than those in the control group. Conclusion The application of child life program can reduce the pain response of children' s intravenous indwelling needle puncture, improve compliance and increase the primary puncture success rate.

Correlation between the status of nurses' information literacy and critical thinking ability

WANG Le-jie, QIU Xiao-dan, JIANG Le-ping, YAN Lei-lei

2023, 21(1): 163-166. doi: 10.16766/j.cnki.issn.1674-4152.002836

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Abstract:
Objective To investigate the status quo of information literacy and critical thinking ability of nurses and analyse the correlation between them. Methods In April 2022, 470 clinical nurses from two Class Ⅲ Grade A general hospitals in Wenzhou were investigated with regard to information literacy and critical thinking ability by using the general information questionnaire, information literacy questionnaire and critical thinking scale. In addition, the Spearman method and hierarchical regression method were used to analyse the correlation between information literacy and critical thinking ability. Results The total score of nurses' information literacy was (73.25±6.35) points, and the total average score was (3.67±1.31) points. Among them, the average score of the dimension of information awareness (4.23±0.98) was the highest, and the average score of the dimension of the information ability (3.31±0.78) was the lowest. The total score of the critical thinking ability of nurses was (271.37±23.28) points. The proportion of strong critical thinking ability was 15.11% (71/470), in which the presence of positive critical thinking ability accounted for 29.57% (139/470) and the absence of positive critical thinking ability accounted for 55.32% (260/470). The total score of clinical nurses' information literacy was significantly different in educational background, professional title and position (all P < 0.05). Pearson correlation analysis showed that the total score of nurses' information literacy and all dimensions were positively correlated with the total score of critical thinking and all dimensions. Regression analysis showed that educational background, professional title and position could account for 11.3% of the total variation of nurses' information literacy. After controlling for general data, open-mindedness, analytical ability, systematisation ability and intellectual curiosity could account for 27.5% of the variance in nurses' information literacy. Conclusion The information literacy of clinical nurses is at a medium level, and their critical thinking ability is relatively weak, which needs to be improved. Moreover, the information literacy of clinical nurses is affected by educational background, professional title, position and critical thinking ability. Therefore, nursing managers should attach great importance to the role of critical thinking in promoting nurses' information literacy and strengthen the cultivation of nurses' critical thinking and information literacy.

Construction of VTE nursing training system based on post competence and its application in the prevention of PICC-related venous thrombosis in patients with lung cancer

ZHENG Xia, MOU Jing, LIAO Lei

2023, 21(1): 167-171. doi: 10.16766/j.cnki.issn.1674-4152.002837

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Objective This study aims to explore the construction of post competency-based VET nursing training system and its application effect on nursing team construction and PICC-associated venous thrombosis in patients with lung cancer. Methods A total of 132 patients with lung cancer and 36 nursing staff admitted to the Department of Surgery in the Third People' s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University from April 2019 to April 2020 were selected as the research objects. All patients and nursing staff were divided into the control group and observation group using the random number table method. Nursing staff in the control group received routine VTE training. The nursing staff in the observation group received VTE training based on post competency. The clinical symptoms in the two groups of patients were observed; the blood indexes were recorded, and the VTE awareness rate of the nursing staff and VTE monitoring indexes of the hospital were evaluated. Results After training and nursing, the incidence of deep vein thrombosis, pulmonary thromboembolism and PICC-related venous thrombosis in the observation group was significantly lower than that in the control group (all P < 0.05). The levels of D-dimer, fibrinogen degradation products and endogenous creatinine clearance in the observation group were significantly lower than those in the control group, whereas the levels of albumin were significantly higher than those in the control group, with statistical significance (all P < 0.05). The assessment accuracy, prevention accuracy, basic prevention rate, physical prevention rate and drug prevention rate of VTE in the observation group were higher than those in the control group (all P < 0.05). The assessment score and knowledge score of nursing staff in the observation group were significantly higher than those in the control group [(83.48±7.39) points, (82.48±7.42) points vs. (67.92±5.03) points, (67.46±6.38) points, t=7.385, 6.512, both P < 0.001]. Conclusion The construction of the VTE nursing training system based on post competency is conducive to improving the risk quality management ability of hospitals, reducing the incidence of PICC-associated VTE events, improving the comprehensive quality of medical staff, broadening their scope of knowledge and bringing favourable conditions for the improvement of clinical symptoms and the recovery of blood function in patients with lung cancer.

Congenital afibrinogenemia caused by homozygous frame-shift mutation of FGA gene c.1368delC: a case report and literature review

HE Li-ting, PAN Jia-hua

2023, 21(1): 172-175. doi: 10.16766/j.cnki.issn.1674-4152.002838

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Abstract:
Congenital afibrinogenemia is mainly manifested by repeated bleeding, including umbilical cord bleeding, cyanogenesis, nose bleeding, gingival bleeding, spleen bleeding, liver bleeding, gastrointestinal or urogenital tract bleeding, etc. In this case, the patient suffered from recurrent bleeding and repeated hypofibrinogenemia after birth. Genetic screening and family verification of congenital afibrinogenemia suggested that the patient had nucleic acid mutation of FGA gene, c.1368delC homozygous frame-shift mutation and amino acid mutation p.T457Rfs*27. Both parents carried the heterozygous frame-shifting mutation. The patient developed pulmonary hemorrhage, but there were no related clinical symptoms and signs. After atomizing inhalation of budesonide formoterol powder twice in the morning and evening for 1 month, the pulmonary hemorrhage lesions were obviously absorbed.

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2023 Vol. 21, No. 1

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