2023 Vol. 21, No. 5

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Expert Forum
Research on the construction of effectiveness evaluation index system for family doctor contract service model
ZENG Weiming, SHI Jianwei, YU Wenya, CHEN Ning, CHEN Hong, GAO Ya, TAN Shuoyuan, WANG Zhaoxin, WU Zhengyi
2023, 21(5): 721-725. doi: 10.16766/j.cnki.issn.1674-4152.002968
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  Objective  Currently, various regions in China have developed family doctor contract service models fitting local characteristics, however, it still lacks scientific and feasible tools for evaluating the effectiveness. Therefore, this study aims to develop the effectiveness evaluation index system for family doctor contract service models, which would promote the high-quality development of family doctor services.  Methods  The preliminary evaluation index system and expert consultation table were formed through literature reviews and group discussions. From September 2021 to December 2021, taking the Better Together model as the theoretical basis and the "results framework" as the guidance, the final effectiveness evaluation index system for family doctor contract service models was determined through two rounds of expert consultations using the Delphi method. The weights of each index were determined through expert consultations and analytic hierarchy process.  Results  The response rates of experts in the two rounds of consultation were 100% and 75% respectively, which indicated the experts were highly motivated. The authority coefficients for the two rounds of consultation were 0.898 and 0.877 respectively; The Kendall coefficients were 0.245 (χ2=393.205, P < 0.001) and 0.252 (χ2=453.417, P < 0.001) respectively, which indicated experts ' opinions tended to be consistent. Through two rounds of expert consultation, the final effectiveness evaluation index system for family doctor contract service models was constructed, mainly focusing on population health, service quality, service efficiency, cost control, resident recognition, and intimacy. The system consisted of 5 first level indicators, 15 second level indicators, and 48 third level indicators, with weight coefficients of 0.217, 0.217, 0.196, 0.181, and 0.188, respectively.  Conclusion  The experts in this study are highly motivated, authoritative and coordinated, and the final effectiveness evaluation index system for family doctor contract service models are reliable, which can provide an objective and scientific tool of evaluating the effectiveness for the family doctor contract service models.
Expert Consensus
Expert consensus on the diagnosis and treatment of novel coronavirus infection in neonates
2023, 21(5): 726-731. doi: 10.16766/j.cnki.issn.1674-4152.002969
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Novel coronavirus infection has been raging globally for more than three years. With limited reports of neonatal cases of novel coronavirus infection at home and abroad, and little experience in clinical diagnosis and treatment, many problems will inevitably arise in the process of diagnosis and treatment, posing great challenges and pressure to medical staff in the neonatology department. In order to further standardize the diagnosis and treatment of novel coronavirus infection in neonates, the Neonatal Evidence-Based Medicine Group, Commission of Neonatal Medicine, Cross-Straits Medicine Exchange Association, based on domestic and foreign clinical evidence and combined with clinical practice experience, the expert consensus was mainly developed from the etiology, clinical manifestations, laboratory examination, diagnosis, home isolation management, fever clinic visit management, treatment, complications and prognosis of neonatal infection with novel coronavirus.
Special Topic/Respiratory Diseases in Children
Construction and validation of a risk prediction model for complications after bronchial foreign body removal in children
WANG Li, NI Chunmei, QIU Li, XU Jinmei, WANG Bei
2023, 21(5): 732-735. doi: 10.16766/j.cnki.issn.1674-4152.002970
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  Objective  To establish a predictive model for postoperative complications in children with laryngeal edema after removal of bronchial foreign bodies, so as to provide evidence for clinical prevention and treatment.  Methods  A total of 107 children with bronchial foreign bodies admitted to the Affiliated Hospital of Yangzhou University from January 2000 to December 2022 were selected as the study objects children with bronchial foreign bodies treated in the Affiliated Hospital of Yangzhou University were selected as research subjects, and were randomly divided into modeling group (74 cases) and verification group (33 cases) according to the ratio of 7:3, using the random number table method. The modeling group was divided into complication group (12 cases) and non-complication group (62 cases) according to whether complications occurred 3 months after surgery. Logistic regression was used to analyze the factors influencing complications after removal of bronchial foreign bodies. The R software was used to construct a prediction model and the model was verified.  Results  Older age (P < 0.001), longer disease duration (P < 0.001), longer length diameter of the foreign body (P < 0.001) and longer time from diagnosis to removal (P < 0.029) were independent risk factors for postoperative complications of bronchial foreign body removal in children (P < 0.05). H-L fit curve (validity) shows that modeling group χ2=6.856, P=0.427; verification group χ2=6.125, P=0.351. The ROC curve (differentiation) showed that the area under ROC curve of the modeling group was 0.901 (95% CI: 0.862-0.933), the sensitivity was 82.61% and the specificity was 86.22%. In the verification group, the area under the ROC curve was 0.852 (95% CI: 0.806-0.890), the sensitivity was 82.61% and the specificity was 73.62%.  Conclusion  Older age, longer disease duration, longer foreign body length and longer time from diagnosis to removal are independent risk factors for postoperative complications of bronchial foreign body removal in children.
The changes and clinical significance of serum Rac1 levels in children with bronchial asthma
WANG Yanan, DAI Qianqian, RU Liang
2023, 21(5): 736-739. doi: 10.16766/j.cnki.issn.1674-4152.002971
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  Objective  Through detecting the changes of serum Ras-related C3 botulinum toxin substrate 1 (Rac1) levels in children with bronchial asthma, the relationship between them and the severity and prognosis of the children ' s disease was investigated.  Methods  One hundred and fifty children with bronchial asthma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2022 were selected as the observation group and divided into mild (49 cases), moderate (59 cases) and severe (42 cases) groups according to the severity of disease. Another 80 healthy children were selected as the control group. The Rac1 mRNA of serum monocyte cells was detected by RT-PCR. The correlation between Rac1 mRNA and the airway inflammatory response and lung function of the children was analyzed by Pearson, and the risk factors for the prognosis of children with bronchial asthma were analyzed by logistic regression.  Results  The Rac1 mRNA was lower in the mild (0.14±0.03), moderate (0.07±0.02) and severe (0.06±0.03) groups than that in the control group (0.16±0.03), t=3.675, 19.990, 17.493, all P < 0.05; Rac1 mRNA was significantly negatively correlated with IL-25, IL-33, fractional exhaled nitric oxide (FeNO), IgE (r=-0.620, -0.691, -0.660, -0.634, all P < 0.01) and positively correlated with the forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), peak expiratory flow (PEF) in children with asthma (r=0.648, 0.582, 0.522, all P < 0.01). High level of Rac1 mRNA was a protective factor affecting the prognosis of children with asthma (OR=0.753, 95%CI: 0.647-0.877, P < 0.001).  Conclusion  Lower serum Rac1 levels in children with bronchial asthma are associated with airway inflammatory response and decreased lung function.
Correlation between abnormal expression of serum inflammatory factors and RNA in children with severe pneumonia and lung injury and treatment outcomes
ZHANG Guiying, HU Yang, HUANG Bo, GAO Hongliang, ZHU Mengsha
2023, 21(5): 740-743. doi: 10.16766/j.cnki.issn.1674-4152.002972
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  Objective  To investigate the abnormal expression of serum inflammatory factors and RNA in children with severe pneumonia, and explore its effect on the lungs and treatment of children.  Methods  A total of 158 children with pneumonia admitted to Hebei Children ' s Hospital from August 2020 to August 2022 were selected as the study subjects, including 72 cases of severe pneumonia (severe group) and 86 cases of common pneumonia (general group). In addition, 80 healthy children who underwent physical examination in the hospital during the same period were selected as the control group. RNA levels, LPS scores, and serum inflammatory factor levels in each group were analyzed and compared, and the predictive value of serum procalcitonin (PCT) and RNA levels on lung and adverse outcomes was analyzed.  Results  The levels of miRNA-221 and miRNA-24 in the severe group, general group, and control group increased in turn, the LPS score decreased in turn, and the serum levels of PCT, PGRN, and CRP decreased in turn (all P < 0.05). In the treatment outcome of the severe group, the serum PCT level of the surviving children was lower than that of the dead children, while the levels of miRNA-221 and miRNA-24 were higher than those of the dead children (all P < 0.05). According to Pearson correlation analysis, there was a positive correlation between lung injury and treatment outcome in children with severe illness and serum PCT, but a negative correlation between them and levels of miRNA-221 and miRNA-24 (P < 0.05). Logistic regression analysis showed that high levels of serum PCT, low levels of miRNA-221 and miRNA-24 were independent risk factors for lung injury and adverse treatment outcomes in children with severe pneumonia (all P < 0.05). ROC curve analysis showed that the level of this factor had specificity for the risk of adverse disease outcomes, with sensitivities of 0.802, 0.807, 0.814 and 0.845, 0.850, 0.858, respectively, which had high predictive value (AUC>0.70).  Conclusion  The abnormal expression of serum PCT, miRNA-221 and miRNA-24 in children with severe pneumonia is closely related to the occurrence of lung injury and adverse treatment outcomes, and is an independent risk factor and has good predictive value.
General Practice Research
Factors influencing marital status in assisted reproduction couples and its impact on pregnancy outcomes
CHENG Jingxian, WANG Chunyan, WANG Jieyu, YUAN Lanlan, WU Xuanye, WANG Yinshuang, LUO Guiying
2023, 21(5): 744-748. doi: 10.16766/j.cnki.issn.1674-4152.002973
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  Objective  To study the factors influencing the marital status of assisted reproductive technology (ART) couples and its impact on pregnancy outcomes, in order to provide a reference for improving the success rate of ART.  Methods  A total of 402 couples who entered the in vitro fertilization (IVF)cycle from March 2020 to August 2020 at the Reproductive Center of the First Affiliated Hospital of Anhui Medical University were selected as the research objects. General data, Locke Wollance marriage adjustment test (MAT) and social support rating scale (SSRS) were used to analyze the influencing factors of marital status and subsequent pregnancy outcomes, and to explore the influence of marriage on pregnancy in ART couples.  Results  Among the 402 couples, men ' s marriage score (117.34±20.40) was significantly higher than women ' s (109.80±21.90, P < 0.01). Univariate analysis showed that there were significant differences in women ' s monthly income, working status during ART, infertility duration, causes of infertility, ART stressors and living with elders (all P < 0.05). There were statistically significant differences in the male partner ' s age, education level, employment status, monthly income, infertility duration and causes of infertility (all P < 0.05). There were positive correlation between both marital status and social support (r=0.290, 0.250, both P < 0.01). The results of multiple regression analysis showed that infertility duration, cause of infertility, ART stressors, living with elders, and social support are risk factors for women ' s marital status (all P < 0.05). Age, culture level, duration of infertility and social support are risk factors for male marital status (all P < 0.05). The clinical pregnancy rate of the female marriage disorder group (57.5%) was lower than that of the good marriage group (68.4%), and the difference was statistically significant (P < 0.05).  Conclusion  The marital status of ART couples is affected by different factors, and the marital status of women is lower than that of men and has an impact on clinical pregnancy. In clinical work, couples should be treated as a whole for psychological counseling according to these risk factors in order to improve the success rate of assisted reproduction.
Correlation analysis of BRCA1/2 gene status and clinicopathological features in patients with epithelial ovarian cancer
LIU Gege, WANG Lihua, LI Yanhua
2023, 21(5): 749-752. doi: 10.16766/j.cnki.issn.1674-4152.002974
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  Objective  This study was performed to investigate the relationship between BRCA1/2 germ line mutation status and clinicopathological characteristics in epithelial ovarian cancer patients, so as to develop precise individualized treatment plan for patients.  Methods  Patients with epithelial ovarian cancer who visited the Department of Gynecologic Oncology in the First Affiliated Hospital of Bengbu Medical College from December 1, 2019 to October 31, 2021 and had germline mutation test results of breast cancer susceptibility gene (BRCA1/2) were selected for the study. According to the results of gene detection, they were divided into gBRCA1/2m (+) group (mutation group) and gBRCA1/2m (-) group (wild-type group). The clinicopathological characteristics of the two groups of patients were statistically analyzed.  Results  Compared between the two groups of patients, the initial CA125 level (P=0.016) and FIGO stage (P=0.010) of patients in the mutation group were significantly higher than those in the wild-type group, the proportion of family history was higher (P=0.026) in the mutation group, and the patients with positive ascites were more common (P=0.020) in the mutation group. The platinum interval was also longer (P=0.044) and the differences were statistically significant (all P < 0.05). There were no significant differences in the initial treatment method, satisfaction with tumour cytoreduction, recurrence, sensitivity to first-line platinum-based chemotherapy and age in advanced patients (all P>0.05).  Conclusion  Among patients with epithelial ovarian cancer, patients with BRCA1/2 gene mutations have a longer platinum-free interval, and those with a family history of ovarian cancer, higher FIGO stage, high tumor marker levels and positive ascites are more likely to have a positive germline BRCA1/2 mutation. Early genetic testing and timely aggressive intervention such as PARP inhibitors in these patients may result in a longer survival time for the patient.
Analysis of preoperative cervical MRI in the prognosis of spinal cord injury without radiological abnormalities in adults after surgery
LI Jiaran, GUO Tao
2023, 21(5): 753-756. doi: 10.16766/j.cnki.issn.1674-4152.002975
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  Objective  To investigate the correlation between recovery of spinal cord function and preoperative cervical MRI after surgery for spinal cord injury (SCI) without radiological abnormalities in adults.  Methods  Fifty-two patients with SCI without radiological abnormalities who underwent surgical treatment in the Department of Spine Surgery of Guizhou Provincial People ' s Hospital from January 2016 to September 2021 were selected, and the patients ' cervical SCI function was evaluated by JOA score and improvement rate. Single-factor logistic regression analysis and multi-factor logistic regression analysis were performed for SCI MRI type and SCI MRI range to analyze their correlation with the postoperative prognosis of adult spinal cord injury without radiological abnormality, and to identify the main influencing factors among them.  Results  There were 52 patients with SCI without radiological abnormalities. There were 41 males and 11 females, aged 36-76 years old, with a mean age of (58.50±10.46) years old. The JOA score was (5.69±2.09) at baseline and (11.84±2.79) at the last follow-up, with an improvement rate of (54.49±20.18)%. Single-factor logistic regression analysis showed that the type of MRI of SCI and the extent of MRI of SCI were associated with the prognosis after surgery for cervical SCI in adults without fracture dislocation (P < 0.05), and multi-factor logistic regression analysis showed that the type of MRI of SCI had a greater effect on recovery of spinal cord function after surgery for cervical SCI in adults without fracture dislocation than the extent of MRI of SCI.  Conclusion  The MRI type of SCI and the MRI extent of SCI were closely related to spinal cord function recovery in patients with SCI without radiological abnormalities, and the prognosis of spinal cord function recovery was worst in patients with edema and hemorrhage type and MRI extent of SCI>4 cm.
Predictive values of trends in peripheral blood inflammatory indexes for infectious abdominal complications after laparoscopic radical rectal cancer surgery
QIU Quanwei, GE Sitang, ZUO Lugen, LIU Mulin
2023, 21(5): 757-760. doi: 10.16766/j.cnki.issn.1674-4152.002976
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  Objective  To analyze the changes in peripheral blood inflammatory indicators and explore the predictive diagnostic values in predicting the occurrence of Intra-Abdominal Septic Complications (IASCs)in patients after laparoscopic rectal cancer surgery.  Methods  Patients who underwent laparoscopic radical surgery for rectal cancer in the First Affiliated Hospital of Bengbu Medical College from June 2020 to April 2022 were included as subjects in the study and were divided into IASC group and non-IASC group according to whether IASCs occurred. One hundred and fifty-six patients were included in this study, of which 19 cases (12.18%) were happened. The trend and predictive value of postoperative peripheral TNF-α, CRP and WBC for postoperative IASCs were analyzed in both groups.  Results  There was no significant difference between two groups in the levels of WBC, CRP and TNF-α in peripheral blood 1-day after surgery (P>0.05). The levels of TNF-α and CRP in peripheral blood 3-day after surgery were higher in IASC group than those in non-IASC group. ROC curve shows that the levels of TNF-α and CRP in peripheral blood 3 days after surgery predicted the occurrence of postoperative IASCs with negative predictive values above 80%, however, the positive predictive values were below 50%. Take ΔTNF-α and ΔCRP into ROC analysis. The results showed that the positive and negative predictive values of ΔTNF-α were superior to those of ΔCRP.  Conclusion  The changing trend of TNF-α in peripheral blood showed certain predictive and diagnostic values for IASCs after laparoscopic radical rectal cancer surgery.
Clinical value of scoring system of postpartum hemorrhage in predicting postpartum hemorrhage in pregnant women of different ages
ZHOU Haixian, JIN Weiwei, XU Qun, LIN Lejing, HU Yanjun
2023, 21(5): 761-764. doi: 10.16766/j.cnki.issn.1674-4152.002977
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  Objective  To analyze the predictive value of scoring system of postpartum hemorrhage (PPH) in pregnant women of different ages, and provide reference for personalized assessment of PPH risk.  Methods  A total of 3 559 pregnant women who gave birth in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022 were selected as subjects. According to age and whether the pregnant women were diagnosed with PPH, they were divided into PPH group (< 35 years old, 22 cases; ≥35 years old, 76 cases) and control group (< 35 years old, 44 cases; ≥35 years old, 152 cases). The scoring system of PPH was used to score pregnant women at admission, delivery and after delivery. The predictive value of scoring system of PPH in pregnant women aged < 35 years versus ≥35 years was analyzed.  Results  Prenatal score, postpartum score and total score all had predictive effects on PPH (P≤0.001), and area under curve (AUC) were 0.703, 0.796 and 0.806, respectively. The prenatal score, postpartum score and total score of pregnant women in PPH group (< 35 years old) were significantly higher than those in control group (< 35 years old, all P < 0.05). The prenatal score, postpartum score and total score of pregnant women in PPH group (≥35 years old) were significantly higher than those in control group (≥35 years old, all P < 0.05). In pregnant women < 35 years old, postpartum score and total score had predictive value for PPH (P < 0.001), AUC were 0.785 and 0.839, and the optimal cut-off value were 4 and 10 points, while prenatal score had no predictive value for PPH (P>0.05). In pregnant women age ≥35 years, prenatal score and total score had predictive value for PPH (P < 0.001), AUC were 0.786 and 0.881, and the optimal cut-off value were 6 and 7 points, while postpartum score had no predictive value for PPH (all P>0.05).  Conclusion  Scoring system of PPH has a good predictive effect on PPH. The cut-off values of the scores are different for pregnant women < 35 years old and ≥35 years old.
Clinical efficacy of transumbilical single-port laparoscopic treatment of inguinal hernia in children
CHEN Fangfang, FU Xiaojun, JIANG Lei, WANG Chao, WANG Yu
2023, 21(5): 765-768. doi: 10.16766/j.cnki.issn.1674-4152.002978
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  Objective  To evaluate the clinical efficacy and safety of a new threading technique in the treatment of inguinal hernia in children by transumbilical single-port laparoscopic high ligation.  Methods  This research used a retrospective cohort study. A total of 220 cases of inguinal hernia treated at the First Affiliated Hospital of Bengbu Medical College from August 2020 to August 2021 were selected, including 116 cases of inguinal hernia treated by single-port laparoscopy as the observation group, and 104 cases of inguinal hernia treated by double-port laparoscopy as the control group. The intraoperative, postoperative and perioperative adverse reactions and long-term recurrence were compared between the two groups.  Results  (1) Comparison of baseline data: there were no significant differences in gender, age, location of disease and other general data between the two groups (all P>0.05); (2) Comparison of basic conditions of surgery: there were no significant differences in surgical duration and intraoperative blood loss in the observation group (all P>0.05); length of hospital stay and surgical cost were significantly different between the two groups (all P < 0.05). (3) Perioperative adverse reactions: there were no significant differences in postoperative fever and scrotal edema between the two groups (all P>0.05). There were significant differences in postoperative incisional adverse reactions (P < 0.05). (4) Recurrence: patients in the two groups were discharged from hospital and followed up for 6 months. The results showed that there was 1 case of recurrence in the control group (0.96%). There was no recurrence case in the observation group. There was no significant difference in the recurrence rate between the two groups (P>0.05).  Conclusion  Single-port laparoscopic treatment of inguinal hernia in children using a new threading technique is clinically safe and effective and worth promoting.
Endoscopic mucosal resection and submucosal dissection for clinical treatment of non-ampullary duodenal lesions
JIANG Zhen, ZHENG Yufeng, LIU Xiaomin, ZHANG Lamei
2023, 21(5): 769-772. doi: 10.16766/j.cnki.issn.1674-4152.002979
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  Objective  To analyze the safety and efficacy of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of non-ampullary duodenal lesions (NADLs).  Methods  Seventy-eight patients with NADLs who underwent surgical treatment at the Endoscopy Center, the First Affiliated Hospital of Henan University of Science and Technology from January 2013 to December 2020 were selected, and divided into EPMR group (n=24), ESD group (n=21) and EPMR+ESD group (n=33) according to surgical modality. The clinical data of the three groups were analyzed comparatively.  Results  The differences in lesion site, lesion origin, lesion size and pathological type of NADLs were not statistically significant among the three groups (all P>0.05). The duration of surgery were (59.4±4.3) min, (71.8±10.1) min and (34.4±5.8) min, respectively, with statistically significant differences (F=264.446, P < 0.05). The complete resection rates in EPMR, ESD and EPMR+ESD groups were 87.5% (21/24), 90.5% (19/21) and 100.0% (33/33), respectively, with no significant differences among the groups (χ2=4.400, P>0.05). In the EPMR group, 2 cases (8.3%) of perioperative perforation were treated endoscopically and recovered; while in the ESD group, 3 cases (14.3%) of intraoperative perforation and 2 cases (9.5%) of bleeding were treated with bipolar electrocoagulation to stop the bleeding; in the EPMR+ESD group, 1 case (3.0%) of perioperative perforation was treated with titanium clips. No infection, duodenal stenosis or other complications occurred in any of the three groups. The average postoperative hospital stay was (6.4±0.6) d, (6.4±0.8) d and (6.2±1.2) d in the three groups, respectively, with no statistically significant difference (F=0.945, P>0.05). No recurrence was observed in any of the three groups during the follow-up.  Conclusion  Both EPMR and ESD are safe and effective for NADLs, compared to a single method, their combined use for NADLs requires a shorter operative time, which will have a wide clinical application prospect.
Correlation of white matter hyperintensity with gait abnormalities and balance disorders
ZHAO Yuehua, YIN Li, ZHANG Fan, LUO Song, QU Hongdang, XU Li
2023, 21(5): 773-775. doi: 10.16766/j.cnki.issn.1674-4152.002980
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  Objective  To assess the correlation of white matter hyperintensity (WMH) in different burdens and regions of the brain with gait abnormalities and balance disorders.  Methods  Eighty-four patients with WMH were included and divided into low burden group (45 cases), moderate burden group (17 cases) and high burden group (22 cases) by the Fazekas scale score. Gait and balance functions were comprehensively evaluated by stride length, stride width, gait speed and Tinetti performance-oriented mobility assessment (POMA) score. Pearson correlation was used to analyze the correlation of WMH in different burdens and regions of the brain with gait abnormalities and balance disorders.  Results  The high burden group had the shortest stride length, largest stride width, slowest gait speed, and lowest POMA score. The difference between groups was statistically significant (P < 0.05). Pearson correlation analysis showed that periventricular WMH had a negative correlation with stride length, gait speed, and POMA score (r=-0.787, -0.480, -0.670, -0.435, -0.600, all P < 0.01), and demonstrated a positive correlation with stride width (r=0.740, P < 0.01). Deep WMH showed a negative correlation with gait speed, total score of POMA and Tinetti balance score (r=-0.402, -0.698, -0.795, all P < 0.05).  Conclusion  WMH correlates with gait abnormalities and balance disorders. The increase of WMH burden is associated with shortened stride length, greater stride width, slower gait speed, and impaired gait and balance functions. Periventricular WMH is highly correlated with gait abnormalities, while deep WMH is strongly correlated with balance disorders.
Effects of electroacupuncture on postoperative cognitive dysfunction and peripheral inflammatory factors in elderly patients after gastrointestinal surgery
ZHAO Na, WU Xiang, WU Xiuqing, ZHANG Rui, XIE Yangyang, ZHANG Zhouyan
2023, 21(5): 776-778. doi: 10.16766/j.cnki.issn.1674-4152.002981
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  Objective  To treat elderly patients with gastrointestinal surgery with electroacupuncture, and to explore its effect on postoperative cognitive dysfunction (POCD) and the levels of peripheral inflammatory factors.  Methods  A total of 200 elderly patients who underwent gastrointestinal surgery under general anesthesia from February 2020 to March 2022 in the Affiliated Hospital of Ningbo University School of Medicine were selected, and the patients were divided into acupuncture group and control group by random number table method, with 100 cases in each group. The control group received routine basic supportive treatment such as oxygen inhalation ECG monitoring, and symptomatic supportive treatment such as infection prevention, hemostasis and fluid supplementation, and the acupuncture group received electroacupuncture on the basis of the control group. After treatment, the clinical efficacy was compared between the two groups.  Results  After treatment, the scores of auditory and verbal learning test in the acupuncture group was (58.32±1.47) points, and the score of clock drawing test was (6.08±0.35) points, which were higher than those in the control group [(57.74±1.28) points and (5.89±0.40) points] (all P < 0.05). The connection test time was (60.01±12.09)s, and the Stroop color word interference test time was (25.98±7.00)s, which was lower than those in the control group [(63.97±14.21)s and (28.79±7.35)s] (all P < 0.05). After treatment, the levels of peripheral inflammatory factors in the acupuncture group were lower than those in the control group (P < 0.05). The pain scores in the acupuncture group 1-3 d after operation were lower than those in the control group (P < 0.05), there was no significant difference between the groups 4-7 d after operation (P>0.05). After treatment, the incidence of POCD in the acupuncture group was lower than that in the control group (P < 0.05).  Conclusion  Postoperative electroacupuncture can promote the recovery of cognitive function in elderly patients after surgery, relieve the early pain of patients, reduce the level of peripheral inflammatory factors and the incidence of postoperative POCD.
General Clinical Research
Negative pressure closed drainage combined with oxygen transfusion irrigation for infectious wounds after orthopedic surgery
HU Ningning, CHEN Shufang, ZHU Ningning, ZHANG Meng, ZHU Xunbing
2023, 21(5): 779-783. doi: 10.16766/j.cnki.issn.1674-4152.002982
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  Objective  To explore the clinical effect of negative pressure closed drainage and oxygen infusion irrigation on infectious wounds after orthopedic surgery, and to provide reference for the study of infectious wounds after orthopedics and related surgery.  Methods  A total of 28 patients with infectious wounds after orthopedic surgery were selected from the Second Affiliated Hospital of Bengbu Medical College from October 2020 to June 2022. They were divided into experimental and control groups according to the random number table method, with 14 patients in each group. The control group received negative pressure closure drainage combined with saline irrigation treatment, while the experimental group received combined oxygen delivery irrigation treatment based on the control group. The two groups were measured and calculated using a sterile wound measuring scale before and 5 to 10 days after surgery, including the wound granulation tissue coverage rate, wound volume reduction rate, wound healing rate, healing time, and bacterial clearance rate. After that, depending on the condition of the wound, a second stage operation or refilling (replacing) the dressing was decided to continue sealing and drainage until it healed.  Results  Intervention after 5-10 d, the granulation tissue coverage rate, volume reduction rate and bacterial clearance rate of the experimental group [(93.03±4.05)%, (42.92±9.20)%, (95.93±4.19)%] were higher than those of the control group [(74.73±5.08)%, (35.18±9.46)%, (87.20±2.35)%]. The differences were statistically significant (t=-10.535, -2.193, -6.796; all P < 0.05); The healing rate of the experimental group was 85.71% (12/14), which was higher than 78.57%(11/14) of the control group, and the difference was not statistically significant (P=0.999). The wound healing time of the experimental group [(29.43±8.54) d] was lower than that of the control group [(32.43±9.04) d], and the difference was not statistically significant (t=0.903, P=0.375).  Conclusion  Compared with negative pressure closed drainage alone, negative pressure closed drainage combined with oxygen transfusion irrigation can promote granulation tissue growth and reduce wound volume, which is worthy of clinical application.
Analysis of lipid and lipoprotein levels of women in different reproductive aging stages
FENG Yuting, SHENG Shaoqin, YU Xiao
2023, 21(5): 784-787. doi: 10.16766/j.cnki.issn.1674-4152.002983
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  Objective  To analyse the lipid and lipoprotein levels of women in different reproductive aging stages and different age groups.  Methods  A total of 944 female patients aged from 40 to 60 years who were hospitalized in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January to December 2020 were selected and divided into three groups according to STRAW+10: reproductive period (n=352), perimenopausal period (n=127) and postmenopausal period (n=465). BMI, serum total cholesterol (TC), serum triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), apolipoprotein E (Apo E), and lipoprotein [Lp(a)] were compared in each group.  Results  (1) The TC level significantly differed among reproductive, perimenopausal and postmenopausal periods [(4.65±0.98) mmol/L vs. (4.75±1.02) mmol/L vs. (4.99±1.03) mmol/L (P < 0.05)]. The levels of TG, LDL-C and non-HDL-C were also significantly different (all P < 0.05). (2) The TC, LDL-C and non-HDL-C levels were significantly different among the three groups with ages ranging from 50 to 60 years (all P < 0.05). (3) The levels of Apo B and Apo E were significantly different among the three groups (all P < 0.05). (4) The abnormal incidence rates of TC and LDL-C were significantly higher in the postmenopausal period than in the reproductive period or perimenopausal period (all P < 0.017).  Conclusion  Some blood lipids and lipoproteins of women in different reproductive aging states have changed, especially in women aged more than 50 years.
CHAID model-based analysis of influencing factors of hypertensive patients' lifestyle on a street in Guangzhou
MA Chao, LIU Li, DENG Guangpu, XIANG Ping, WANG Yuanyuan, FANG Haoting, LIN Huang, CHEN Yiming, ZHU Hong
2023, 21(5): 788-791. doi: 10.16766/j.cnki.issn.1674-4152.002984
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  Objective  To understand the current status of lifestyle of hypertensive patients in a street in Guangzhou, and to analyze the main influencing factors to provide a reference basis for improving the lifestyle of hypertensive patients.  Methods  A total of 1 768 hypertensive patients who had been followed up in 18 communities under the jurisdiction of a street in Baiyun District, Guangzhou City, from January 1 to December 31, 2021, and who met the screening criteria of this study were randomly selected, and their basic conditions and lifestyle information were collected. Chi-squared automatic interaction detector (CHAID) model analysis was performed using SPSS 25.0 statistical software.  Results  Gender (χ2=126.030, P < 0.001), marital status (χ2=31.169, P < 0.001), and age (χ2=9.494, P=0.031) were the main influencing factors for smoking, with the 70 male patients who were unmarried, divorced, or widowed having the highest prevalence of smoking at 45.7%; signing up with a family doctor (χ2=8.289, P=0.004), gender (χ2=3.966, P=0.046) were the main influencing factors for excessive alcohol consumption, and 528 male patients who did not sign a family doctor had an excessive alcohol consumption rate of 2.8%; Educational level (χ2=12.130, P=0.003) and marital status (χ2=11.830, P=0.002) were the main influencing factors for a balanced diet of meat and vegetables, and 818 patients with high educational level who were married had the best proportion of balanced diet of meat and vegetables was 98.0%; Occupational category (χ2=62.121, P < 0.001), gender (χ2=8.937, P=0.003), and BMI (χ2=9.815, P=0.002) were the main influencing factors for physical exercise, and 201 practicing patients with BMI < 24 had the lowest proportion of physical exercise was 49.8%.  Conclusion  The overall lifestyle of hypertensive patients in a Guangzhou street is good, however, there is still a need to strengthen the management of key populations through strengthening psychological guidance, increasing education, empowering artificial intelligence, and increasing the contracting rate of family doctors.
Perceived fatigue and coping experience in elderly patients with chronic obstructive pulmonary disease: A qualitative study
XUE Jiali, LU Hongyan, YU Fang, JIANG Xirui, FENG Xiangkan
2023, 21(5): 792-796. doi: 10.16766/j.cnki.issn.1674-4152.002985
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  Objective  To understand the perceived fatigue and coping experience in older patients with chronic obstructive pulmonary disease (COPD), and give a description of the fatigue phenomenon from the perspective of patients, providing medical workers with a reference for further understanding and management of fatigue.  Methods  A phenomenological research approach was used. Semi-structured interviews were conducted with elderly COPD patients from Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University from May to October 2021, and 17 cases were finally enrolled. Nvivo 12 and Colaizzi ' s seven-step method were used for data processing and analysis.  Results  Three themes of perceived fatigue in elderly COPD patients emerged from the analysis, (1) Troubled fatigue symptoms: fatigue symptoms persisted after COPD; Fatigue symptoms were lighter in the morning and worse in the afternoon; Acute exacerbation of fatigue was an omen of acute exacerbation of COPD; Fatigue often coexisted with multiple somatic symptoms. (2) Seemingly unconquerable "constraints": limited physical activities; limited social interactions. (3) Heavy psychological burden: suffering from negative emotions; helplessness in troubling families; influence of heavy economic burden. Two themes of coping with fatigue in elderly COPD patients were summarized: (1) actively coping and seeking help; (2) passively coping and indifferently handling.  Conclusion  Fatigue symptoms persist in most elderly patients living with COPD, which can vary over time and predict the changes in condition. Fatigue impairs their quality of life crucially through negatively affecting their daily functioning and psychological state. However, due to the influence of many factors, fatigue symptoms in these patients have not been actively and effectively controlled. Therefore, it is necessary for medical workers to realize the serious adverse impact of fatigue, feel and understand fatigue from patient perspective, and take actions to develop a fatigue management scheme applicable to Chinese elderly patients with COPD as soon as possible.
Early prediction of serum 25-hydroxyvitamin D in children with Henoch-Schonlein purpura nephritis
PAN Hua, DENG Fang
2023, 21(5): 797-800. doi: 10.16766/j.cnki.issn.1674-4152.002986
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  Objective  To investigate the effect of serum 25 hydroxyvitamin D [25-(OH)D] on Henoch-Schonlein purpura nephritis (HSPN)and to determine the early diagnostic value of serum 25-(OH)D in HSPN.  Methods  A total of 102 cases of Henoch-Schonlein Purpura (HSP) children who were hospitalized in the Department of Pediatrics, Suzhou Municipal Hospital from January 2019 to December 2021 were selected as the case group, including 31 children in HSPN group and 71 children in Non Henoch-Schonlein purpura nephritis (NHSPN)group; 94 healthy children were selected as the healthy control group. The serum 25-(OH)D of children in each group was compared; The risk of serum 25-(OH)D affecting HSPN was analyzed by binary logistic regression analysis; The diagnostic value of serum 25-(OH)D for HSPN was analyzed by subject working characteristic curve.  Results  The level of serum 25-(OH)D in healthy control group was significantly higher than that in HSP group; The level of serum 25-(OH) D in HSPN group were significantly lower than that in the NHSPN group and the HSP group (both P < 0.01). When the serum 25-(OH) D of children in the healthy control group increased, the risk of HSP decreased (OR=0.302, P < 0.001); The serum 25-(OH) D of children in HSP group decreased; The risk of HSPN increased (OR=1.650, P < 0.001). In addition, the area under the ROC curve of serum 25-(OH)D was 0.814 for differentiating HSP from HSPN. Using a cut-off value was 23.34 ng/mL, the sensitivity and specificity were 68.6% and 87.1%, respectively.  Conclusion  Decreased serum 25-(OH)D level may be a risk factor for HSPN, It plays a predictive role in the early onset of HSPN.
Clinical and ultrasonic characteristics and prognosis of neonatal intrauterine volvulus
XIAO Xiuman, ZHU Libin, JIANG Na, PAN Yin, LIN Jinhan, WANG Rongyue, ZHU Jianghu, CHEN Shangqin
2023, 21(5): 801-804. doi: 10.16766/j.cnki.issn.1674-4152.002987
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  Objective  To analyse the clinical characteristics and prognosis of children with intrauterine volvulus for reducing misdiagnosis and improving prognosis.  Methods  A retrospective review was conducted with intrauterine volvulus confirmed by postnatal operation in Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University from June 2015 to April 2020.  Results  Ten children (4 males and 6 females) were included in the study. Six of them were born through caesarean section and 4 were via vaginal delivery. Among the children, 6 were preterm infants (4 cases born for caesarean section due to foetal distress) and 4 were full-term infants. Of the 10 foetuses, 7 had intestinal dilatation, 2 showed typical "vortex sign", 3 had ascites, 4 had abdominal cystic mass and 2 had polyhydramnios, which was discovered by antenatal 2D ultrasound. 5 cases had abnormal foetal heart rate before delivery. Among all the cases, 10 had abdominal distension, 4 vomited bile-like material, 8 had no foetal discharge, 2 had bloody stool immediately after birth and 7 had anaemia. Of the 10 cases, 7 had abdominal puncture, 6 had uncoagulable blood and 1 had faecal turbid liquid. All the 10 cases were operated within 48 hours, 5 cases with segmental volvulus and 5 cases with midgut volvulus. Eight cases were recovered and discharged from hospital. One neonate died because of massive necrosis of small intestine, and one baby died due to secondary infection. The survival rate was 80% (8/10).  Conclusion  Foetal intrauterine volvulus should be considered when prenatal ultrasound showed typical "vortex" sign and intestinal dilatation with ascites or progressive enlargement of abdominal cystic mass. If prenatal ultrasound showed intestinal dilatation and the patient had gastrointestinal symptoms such as abdominal distension, vomiting bile-like material or bloody stool immediately after birth, accompanied by anaemia, then intrauterine volvulus should be highly suspected. If peritoneal puncture fluid was bloody, then a definite diagnosis could be made. The key to improve the survival rate was multidisciplinary cooperation, the right time for delivery, early operation and active perioperative treatment.
Application of single nucleotide polymorphic microarray technique in prenatal diagnosis of advanced maternal age
SU Jingyu, OUYANG Luping, OU Shan, LIU Tiansheng, LI Wei, FEI Dongmei, HUANG Hongqian, GENG Guoxing, LUO Jingsi
2023, 21(5): 805-808. doi: 10.16766/j.cnki.issn.1674-4152.002988
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  Objective  To investigate the clinical value of the combination of chromosome karyotype and single nucleodide polymorphic microarray (SNP array) in the antenatal diagnosis of fetuses with advanced pregnancy and the correlation between chromosome loci and corresponding clinical phenotypes.  Methods  From January 2016 to December 2020, 2 642 pregnant women who underwent amniocentesis to extract amniotic fluid due to advanced pregnancy (≥35 years old) were enrolled in the genetic outpatient clinic of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Conventional cell culture was used for chromosome karyotype analysis and G-banding. At the same time, copy number variations (CNVs) were detected by parallel SNP array.  Results  Karyotype analysis of 2 642 amniotic fluid samples from advanced pregnant women revealed 44 aneuploidy chromosome abnormalities, among which trisomy 21-syndrome was the most common (65.9%, 29/44), followed by trisomy 18-syndrome (9.1%, 4/44), trisomy 13-syndrome (4.5%, 2/44), and sex chromosome aneuploidy chimerism (20.5%, 9/44). The SNP array also detected 20 cases of chromosomal microdeletion or microduplication abnormalities and 104 cases of unknown clinical significance. The detection rate of SNP array was significantly higher than that of karyotype analysis (P < 0.05). Comparison of karyotype analysis in age groups: the difference between the karyotype analysis in the age groups was not statistically significant (P>0.05) between the 35-37 years old and 38-40 years old age group; and between the 38-40 years old and 41-43 years old age group(P>0.05), while the difference between 41-43 years old and ≥44 years old age group was statistically significant (P < 0.05). There was no significant difference in SNP array detection rates in the four ages of advanced pregnancy (P>0.05).  Conclusion  The fetus of advanced maternal age is associated with chromosomal abnormalities, mainly chromosomal aneuploidy, but also CNVs, translocation and other chromosomal abnormalities. Simultaneous chromosome karyotype analysis and SNP array detection can provide more accurate information and basis for genetic counselling and prognostic assessment of fetus with advanced pregnancy.
Epidemiological characteristics survey of community acquired Staphylococcus aureus towards elderly in Taiyuan City
YANG Xiaowen, ZHANG Yanjun, PENG Pan, LI Xue, ZHANG Qinlian, LIU Jinping, ZHANG Jianmei, LI Linping
2023, 21(5): 809-812. doi: 10.16766/j.cnki.issn.1674-4152.002989
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  Objective  Due to the influence of underlying diseases, living habits and traditional ideas, the prevalence of community-acquired Staphylococcus aureus in elderly has certain characteristics. To investigate the epidemiological characteristics of community-acquired Staphylococcus aureus towards the elderly in Taiyuan, so as to provide evidence for health education and clinical the empirical use of antibacterial agents.  Methods  A total of 626 residents aged 60 years or older were selected from nine communities of four administrative regions in Taiyuan for face to face questionnaire survey and pathogenic detection from April 2019 to July 2020. Chi square test, Kruskal-Wallis H test and logistic regression model were used to analyze the carrying status and related risk factors of Staphylococcus aureus (SA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the elderly population in the community.  Results  Among the 626 elderly people in the community, 35 carried SA, with a carrying rate of 5.6%, of which 5 carried CA-MRSA, with a carrying rate of 0.8%. There was statistically significant difference in SA carrier rate in number of underlying diseases (χ2=9.229, P=0.026), family structure (χ2=5.746, P=0.017), whether to eat overnight meal (χ2=4.990, P=0.025), whether to use antibacterial drugs in the past 3 months (χ2=4.705, P=0.030). Multivariate logistics analysis showed that family structure (OR=2.523, 95% CI: 1.235-5.155, P=0.011), eating leftover (OR=2.496, 95% CI: 1.105-5.634, P=0.028), using of antibiotic in recently three month (OR=2.394, 95% CI: 1.019-5.620, P=0.045) were influencing factors of SA carrying.  Conclusion  The SA carrying level of the elderly population in Taiyuan is comparable to that of the elderly patients in medical institutions, and the CA-MRSA carrying level is lower than the national average. It is necessary to further strengthen the promotion of health education and antimicrobial management.
A qualitative study on training program for community chronic disease management specialist nurses under the family doctor service model
LIU Fang, GAO Yunyun, LIU Weiwei
2023, 21(5): 813-816. doi: 10.16766/j.cnki.issn.1674-4152.002990
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  Objective  To explore the views of community chronic disease management nurses and doctors on the training of community chronic disease management specialist nurses, and to provide reference for the training of community chronic disease management nurses in China.  Methods  The descriptive research method was used to interview 16 community nurses and 13 community doctors engaged in chronic disease management in the family doctor-type service team of 6 community health service centers in Beijing by purposive sampling from May to December 2020, and thematic analysis was used to analyze the interview data.  Results  The necessity of community chronic disease management specialist nurse training, training objectives, training content (including chronic disease, chronic disease management theoretical knowledge related nursing technology, rehabilitation knowledge and skills, first aid knowledge and skills, drug related knowledge, health assessment, health education ability training, psychological nursing knowledge, communication skill, scientific knowledge and public health policy, computer knowledge and skills), practice mode, training cycle, effect evaluation (completion assessment and post assessment) 6 themes and 14 sub-themes were extract through interviews.  Conclusion  The respondents have a positive attitude towards the training of community chronic disease management specialist nurses. In China, training objectives can be set based on the competency of community chronic disease management specialist nurses, and corresponding training content and modules can be formulated according to the training needs of community chronic disease management nurses. The practice model combining general hospitals and communities can be adopted, the training period can be set as 3-6 months, and a unified assessment plan for the specialized nurses of community chronic disease management should be made, so as to provide reference for the specialized training of community chronic disease management nurses in China.
HP infection in community patients with hypertension treated with aspirin for ASCVD primary prevention
ZHANG Ji, ZHANG Chenli, CHEN Ming, REN Jiahui, YAO Bilian, WANG Zhenzhen, CHEN Ying, LU Wei
2023, 21(5): 817-820. doi: 10.16766/j.cnki.issn.1674-4152.002991
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  Objective  This study aims to investigate and analyse the current situation of Helicobacter pylori (Hp) infection in community patients with hypertension treated with aspirin for ASCVD primary prevention.  Methods  A total of 100 hypertensive patients who were eligible for ASCVD primary prevention and had been taking low-dose aspirin for a long time in Dapuqiao Community from January 2020 to June 2021 were selected to investigate the previous histories of Helicobacter pylori infection and eradication before taking the medication. Helicobacter pylori testing was performed and grouped according to the results(Hp-positive and Hp-negative groups); atherosclerosis-related indexes were screened, and the test of the two groups were recorded and statistically analysed.  Results  Amongst the selected patients, 13 (13.00%) had been screened for Hp before taking aspirin; 7 cases were found to be infected with Hp through screening, and the Hp infection rate accounted for 53.85% of the screening population. All 7 cases with Hp infection had undergone eradication therapy, and 5 cases were successfully eradicated (the eradication success rate was 71.43%). In addition, 16 cases showed adverse reactions in the course of taking aspirin (the adverse reaction rate was 16.00%). All the selected cases underwent 13C-UBT breath test, and they were divided into the Hp-positive group (n=39) and Hp-negative group (n=61) based on the results. TC, TG and LDL-C in the Hp-positive group were significantly higher than those in the Hp-negative group (all P < 0.01). The comparison of the HOMA-IR index and BMI, which reflecting insulin resistance, between the two groups showed statistically significant differences (both P > 0.05). Carotid intima-media thickness (CIMT) in the Hp-positive group was significantly thicker than that in the Hp-negative group (P < 0.01).  Conclusion  The screening rate and eradication rate of Hp are low in community patients with hypertension treated with aspirin for ASCVD primary prevention. Hp infection may promote atherosclerosis by affecting glucose and lipid metabolism, increasing insulin resistance and increasing carotid intima-media thickness. Furthermore, Hp infection can aggravate the gastrointestinal damage from aspirin. Therefore, Hp should be screened and eradicated before taking medicine.
Psychological experiences during pregnancy in women of childbearing age with epilepsy: A qualitative study
KE Yanyan, LIU Ni, ZHANG Xiaofeng, PU Ping
2023, 21(5): 821-824. doi: 10.16766/j.cnki.issn.1674-4152.002992
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  Objective  To understand the actual psychological experiences during pregnancy in women of childbearing age with epilepsy, and to clarify the psychological states during pregnancy in this group of women, to provide a basis for the implementation of physical and mental health management, and to undertake targeted interventions to reduce psychological burdens of pregnancy in this population.  Methods  Female patients with epilepsy who were fertile, had offspring ≤24 months of age and were undergoing long-term follow-up treatment in Department of Neurosurgery, Second Affiliated Hospital of Army Medical University from May to December 2021 were selected for the study. Eight patients were selected by purposive sampling method, semi-structured in-depth interviews were conducted using a phenomenological approach, and Colaizzi ' s seven-step method was applied for data analysis.  Results  Four themes were obtained from the analysis: (1) Having a child due to reproductive stress caused by social and family related factors, such as deep-rooted beliefs about procreation and carrying on the family name, and the beliefs that a family without a child after marriage is an incomplete family, and choosing to have a child due to family and social pressure; (2) Stress caused by lack of knowledge about epilepsy, including antiepileptic drugs, and the impact of epilepsy on their own health and their offspring, which may be associated with an unplanned pregnancy; (3) Stress caused by the impact of pregnancy on the health of their offspring, namely the fear of passing epilepsy to their offspring, and the impact of antiepileptic drugs use on the health of their offspring; (4) Stress caused by the impact of pregnancy on their own health, namely the fear of pregnancy-related exacerbation of epileptic seizures.  Conclusion  Compared with their healthy counterparts, this group of women faces greater psychological stress during pregnancy. To ensure their safety during pregnancy, medical staffs should take steps to provide pregnancy-related health education for epilepsy patients and their families, improve social and family support for the patients, and provide antenatal care to patients according to the causes of their psychological stress during pregnancy.
Sleep characteristics and their correlation with cognitive function in patients with mild cognitive impairment
SUN Qiqi, GAO Kerun
2023, 21(5): 825-828. doi: 10.16766/j.cnki.issn.1674-4152.002993
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  Objective  To analyze the sleep characteristics of patients with mild cognitive impairment (MCI), and then analyze the relationship between MCI and cognitive function, so as to provide a basis for delaying cognitive dysfunction in MCI patients.  Methods  A total of 72 MCI patients treated in Hangzhou Seventh People ' s Hospital from February 2019 to February 2022 and 72 healthy physical examiners in the same period were selected as the observation group and control group, respectively. The sleep and cognitive function were compared between the 2 groups, and the correlation between sleep characteristics and cognitive function was also analyzed.  Results  The incidence of sleep disorders in the observation group (44.44%) was significantly higher than that in the control group (13.89%, P < 0.01). Epworth sleep scale (ESS) scores, Pittsburgh sleep quality index (PSQI) total scores, PSQI subjective sleep time, sleep duration, sleep efficiency, sleep disturbance, daytime dysfunction and other scores were significantly higher in the observation group than in the control group (all P < 0.01). The proportion of light sleep (S1+S2) % in the observation group was significantly higher than that in the control group (P < 0.01), while deep sleep period (S3+S4), rapid eye movement (REM) sleep and the proportion of REM sleep in the observation group were significantly lower than that in the control group (all P < 0.01). The total score of Montreal cognitive function assessment scale (Mo-CA) and scores of orientation, memory, visuospatial and executive function, naming, language, attention, abstract generalization and other items in Mo-CA were significantly lower in observation group than in control group (all P < 0.01). ESS score, PSQI total score, PSQI sleep quality, time to fall asleep, sleep duration, sleep efficiency, nighttime sleep disturbance, daytime dysfunction, S3+S4 (%) and the proportion of REM sleep in the PSQI scale were significantly negatively correlated with and Mo-CA scores (r was -0.329 to -0.213, P value was 0.001 to 0.036).  Conclusion  MCI patients have a higher proportion of sleep disorders, and there is a significant correlation between sleep disorders and cognitive function. The worse the sleep quality of patients, the shorter their deep sleep and REM sleep, and the worse their cognitive function.
Diagnosis value of S-Detect technique and strain elastography for C-TI-RADS 4A thyroid nodules
ZHENG Zhiyan, YE Xinhua, ZHANG Dong
2023, 21(5): 829-832. doi: 10.16766/j.cnki.issn.1674-4152.002994
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  Objective  Evaluate the reclassification of C-TI-RADS 4A thyroid nodules using S-Detect technology and strain elastography, and explore their diagnostic value for C-TI-RADS 4A thyroid nodules.  Methods  A total of 102 nodules were selected from 87 patients of C-TI-RADS 4A with clear-defined pathological results from April 2021 to April 2022 in the routine ultrasound examination of the First Affiliated Hospital of Nanjing Medical University. Samsung S-Detect technology and strain elastography were used to aid in the reclassification of nodules. The consistency between S-Detect technology, strain elastography, two methods to assist in manual reclassification diagnosis and pathological results was compared, as well as the diagnostic efficacy of the two methods for C-TI-RADS 4A type nodules.  Results  The diagnostic results of the two methods were consistent with the pathological results, the consistency between S-Detect technology and the pathological results (Kappa=0.652, P < 0.001) was higher than that of strain elastography (Kappa=0.381, P < 0.001), the consistency between the manual reclassification assisted by the two methods and the pathological results (Kappa=0.510, P < 0.001) was between the two methods. The sensitivity, specificity and accuracy of S-Detect technology and strain elastography for the benign and malignant diagnosis of C-TI-RADS 4A nodules were 93.10%, 70.45%, 83.33% and 62.07%, 77.27% and 68.63%, respectively. The sensitivity and accuracy of S-Detect technology in diagnosing C-TI-RADS 4A nodules was higher than that of strain elastography (all P < 0.05), however, the specificity of the two methods was not statistically significant (P > 0.05).  Conclusion  The S-Detect technique and strain elastography, as an assisted diagnostic method, have consistent diagnostic results of C-TI-RADS 4A type nodules with pathological results, and the S-Detect technique has high consistency.
Value of the competing risk model including sonographically estimated mid-gestation fetal weight in predicting pre-eclampsia risk
ZHU Ling, PAN Xuekui, WANG Huifeng, MEI Lina
2023, 21(5): 833-837. doi: 10.16766/j.cnki.issn.1674-4152.002995
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  Objective  To develop a competing risk model using sonographically estimated mid-gestation fetal weight for predicting pre-eclampsia risk, and to assess the effectiveness of the model.  Methods  A total of 2 234 women from 19+0 to 24+6 weeks of gestation who underwent routine antenatal checks at Huzhou Maternity and Child Health Care Hospital from March 2019 to December 2020 were selected for this study. Demographic characteristics and medical history were recorded, and fetal weight and hemodynamic parameters were estimated by sonography. The incidence of pre-eclampsia was determined by a follow-up till delivery. General data were compared between women with and without pre-eclampsia matched in a 1∶1 ratio using propensity score matching. A competing risk model was used to screen independent risk factors for pre-eclampsia, and the identified risk factors were used to construct a competing risk model for pre-eclampsia, and the predictive performance of the model was analyzed.  Results  Of the 2 234 cases, 63 were lost to follow-up and the remaining 2 171 were finally included, including 86 with pre-eclampsia (pre-eclampsia group). Sixty pairs were successfully matched. Multivariate competing risk analysis showed that the risk of pre-eclampsia was significantly increased in pregnant women with high mean arterial pressure (MAP), peripheral vascular resistance (PVR) and mean uterine artery pulsatility index (UtA-PI, SHR=1.150, 1.102 and 1.168, all P < 0.05), whereas the risk was significantly lower in those with high fetal weight estimated using sonography (SHR=0.110, P < 0.05). The nomogram constructed using risk factors identified by competing-risks regression obtained a C-index of 0.785 in predicting the risk of pre-eclampsia, showing a high concordance between prediction and reality.  Conclusion  High MAP, PVR and UtA-PI are risk factors for pre-eclampsia, whereas high fetal weight at mid-gestation stage estimated by sonography is a protective factor for pre-eclampsia. The competing risk model for predicting the risk of pre-eclampsia by including the four aforementioned factors has a high predictive value and clinical practicality, which will facilitate screening for pre-eclampsia in high-risk groups.
Advances of miR-124 in cerebral ischemia-reperfusion injury
JIN Zikai, HU Yanqi, ZHANG Lida, ZHANG Junyu, LUO Foci, HAN Wei
2023, 21(5): 838-843. doi: 10.16766/j.cnki.issn.1674-4152.002996
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MicroRNAs (miRNAs) are a class of evolutionarily highly conserved non-coding medium-stranded small molecule RNAs that can participate in regulating the pathophysiological processes of cerebral ischemia-reperfusion injury (CIRI). They are also considered as potential diagnostic biomarkers of cerebral ischemia (CI). miR-124 is a preferentially expressed miRNA in the cerebral cortex and cerebellum, which binds to multiple targets in the body after ischemic brain injury. It regulates the development of ischemic brain injury through various mechanisms such as regulation of apoptosis, autophagy, neuroinflammation, oxidative stress, promotion of neuroprotection and regeneration and inhibition of excitatory amino acid toxicity. In addition, it has a certain potential for neurorestoration by regulating the development of brain injury. Moreover, it has a negative regulatory role in regulating apoptosis and neuroinflammation. However, there is a paucity of evidence on miR-124 regulation of ischemic brain injury at the clinical level. Therefore, its potential as a diagnostic biomarker and therapeutic target for ischemic brain injury needs to be further demonstrated in extensive clinical trials.
Research progress on the risk and prevention of ovulation induction in infertile patients with polycystic ovary syndrome
CAO Jiacheng, XIAO Yang, WANG Suxia
2023, 21(5): 844-848. doi: 10.16766/j.cnki.issn.1674-4152.002997
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This study aimed to explore the risk with its mechanism and prevention measures of infertile patients with polycystic ovary syndrome (PCOS) after ovulation induction therapy. Literature was searched from several online databases, including CNKI, WanFang and PubMed, which were systematically evaluated to comprehensively understand its risks and pathogenesis, and the corresponding prevention and treatment measures were summarised to provide a basis for clinical treatment of the disease. Results are as follows, (1) Multiple pregnancy: the risk of multiple pregnancy with gonadotropin is significantly higher than that with oral ovulation stimulants, and the combination of letrozole or clomiphene with gonadotropin could not improve the outcome of multiple pregnancy. (2) Ovarian hyperstimulation syndrome (OHSS): human chorionic gonadotropin (HCG) has the highest risk of OHSS, and its dose and injection timing should be strictly controlled in clinical administration. Ovulation induction with gonadotropin releasing hormone (GnRH) is recommended for patients at high risk of OHSS, but the risk of luteal insufficiency should be monitored. (3) Luteinised unruptured follicle syndrome (LUFs): GnRH combined with HCG or clomiphene can effectively reduce this risk, but a large sample size is still lacking. (4) Empty follicle syndrome (EFS): it is commonly found in patients after ovulation induction by HCG or GnRH, and some studies suggest that prevention can be achieved by monitoring genetic markers. (5) Early abortion: metformin alone or in combination with ovulation induction drugs cannot reduce the risk of early abortion, and no significant difference in the risk of early abortion was observed between letrozole and clomiphene. (6) Diminished ovarian reserve (DOR): Anti-Müllerian hormone may be a good diagnostic indicator of PCOS infertility with DOR, however, further confirmation is needed. Based on the risk of various ovulation induction drugs, we hope that clinicians can select a more suitable treatment for infertile patients with PCOS to avoid the related risks and reduce the physiological and economic burden of infertile patients with PCOS.
Research progress of radiodermatitis assessment tools and nursing intervention in patients with cancer
PENG Qi, SUN Hongling, WU Wanying, XIE Lingnyu
2023, 21(5): 849-852. doi: 10.16766/j.cnki.issn.1674-4152.002998
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Radiation therapy is one of the most important treatment methods for patients with cancer. However, when radiation irradiates tumour cells, normal tissue cells will undergo radiation damage. Radiation dermatitis is one of the most common complications of tumour radiation therapy, with an incidence rate of about 50% to 90%, and mainly manifests as erythema, desquamation and ulcers. It seriously affects the quality of life of patients and even lead to termination of radiotherapy in some patients. Therefore, appropriate assessment tools should be used for early assessment and identification of radiation dermatitis and for carrying out active nursing interventions. Currently, many assessment tools and nursing intervention measures can be used to assess radiation dermatitis, but related review works are few. This article reviewed four radiodermatitis assessment tools: radiation therapy oncology group (RTOG), radiation-induced skin reaction assessment Scale (RISRAS), common terminology criteria for adverse events (CTCAE) and skin toxicity assessment tool (STAT). New dressings, such as skin cleansing, soft silicone dressings and silver ion dressings, topical preparations, such as cortisol and calendula, and other related care measures were also summarised. This work provided reference for the nursing and scientific research of patients with tumour and radioactive dermatitis in the future and improved their quality of life.
Research progress on T cells in aortic valve calcification
ZHANG Mingdong, LU Zhexin, GU Hongbing, FAN Yongliang, YE Yizhou
2023, 21(5): 853-856. doi: 10.16766/j.cnki.issn.1674-4152.002999
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Calcific aortic valve disease (CAVD) is the most common heart valve disease in the world. It is characterized by progressive fibrocalcification of the aortic valve, eventually leading to valve stenosis, heart failure and even death. As research has progressed, CAVD is no longer considered as a simple passive process of calcium deposition in advanced age, but a complex regulatory process involving immune and inflammatory factors. The early pathological mechanism of aortic valve calcification is very similar to the process of atherosclerosis, involving multiple signaling pathways including complex changes such as endothelial injury, lipid infiltration, chronic inflammation, matrix remodeling, cell differentiation, calcium salt deposition, and neovascularization. Recent studies have also highlighted the important regulatory effects of immune and inflammatory responses including oxidized lipids and various cytokines on aortic valve calcification. Immune and inflammatory responses are involved in osteogenesis in the cardiovascular system by regulating bone formation-related signaling pathways leading to aortic valve calcification, in which T cells play a crucial role in its pathogenesis and disease progression. In the process of aortic valve calcification, T cells are regulated by different microenvironmental signals, leading to T cell proliferation and differentiation, with different mechanisms of action. The study of T cell typing and its role in calcified aortic valve will help to explore the treatment methods and prognosis of aortic valve calcification. This article summarizes the current research progress of T cells in aortic valve calcification, and in combination with the research results of T cells in atherosclerosis, explores the potential role of T cells in aortic valve calcification, which may provide a theoretical basis for in-depth research of calcific aortic valve disease and subsequent target drug development.
A cohort study on the effect of air pollution on the risk of malignant tumor mortality in a district of Bengbu City from 2015 to 2020
CAI Jun, ZHANG Wenhao, ZHANG Peiyao, ZHAO Ke, JIA Xianjie, MI Jing
2023, 21(5): 857-860. doi: 10.16766/j.cnki.issn.1674-4152.003000
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  Objective  To explore the impact of six types of air pollution on the risk of death in patients with malignancies.  Methods  This was a retrospective cohort study using the information on incidence and mortality of malignant tumors in Yuhui District, Bengbu City, from 2015 to 2020. PM2.5, PM10, NO2, CO, SO2, and O3 concentrations were collection of using a high-resolution air pollution dataset from China (CHAP) and analyzed by Spearman' s rank correlation coefficients between the six air pollutants. Using the first tri quantile (Q1 group) of the six air pollutants as the baseline group, risk ratios (HR) and their 95% confidence intervals (95% CI) for six types of air pollution and the risk of death in patients with malignancies were estimated by Cox proportional hazards models.  Results  This study finally included 3 840 cases of malignant tumors in Yuhui District, Bengbu City, from 2015 to 2020, of which 1 443 cases died. Spearman' s correlation showed a negative correlation between O3 and the other pollutants, while the other five had a positive correlation. Cox proportional risk regression model analysis showed that air pollutants other than O3 were positively associated with the risk of death from malignancy at high concentrations, with PM2.5 having the most significant HR (4.553, 95% CI: 3.853-5.381). O3 was negatively associated with the risk of death from malignancy.  Conclusion  Air pollution can influence carcinogenic processes and significantly impact the risk of death in patients with diagnosed malignancies. Since environmental factors are not usually used as survival healing factors after diagnosis, this study provides important public health implications.
Prevention and treatment of cervical spondylosis based on the theory of "balancing body and mind, combining motion and quiescence"
GUO Fenghong, FAN Peng, LIU Dongyin, WANG Lei
2023, 21(5): 861-864. doi: 10.16766/j.cnki.issn.1674-4152.003001
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Cervical spondylosis (CS) is a common, frequently-occurring clinical disease. Due to accelerated work pace and increased life stress amid a progressing society, CS shows an increasing incidence and a trend of younger onset age. CS is considered as Bi syndrome or neck Bi in traditional Chinese medicine, and the lesion site is generally thought at the sinews and bones of the neck, and the basic pathogenesis is that there are damages in sinews and bones, and blockages in qi and blood in meridians in the neck, manifest often as adhesion, scar, contracture, sclerosis, calcification, ossification and other pathological changes. We put forward strategies relevant to the theory of "balancing body and mind, combining motion and quiescence" for the prevention and treatment of CS based on many years of clinical experiences. We think that sinew-bone imbalance is the major pathogenesis of CS, and improving physical constitution and function is the foundation of treatment. The spinal tendons are deemed as the intricate and regular lines of biological forces that maintain the balance of the spine, both statically and dynamically. Physical constitution and function can be improved by stimulating the corresponding meridians with acupuncture, moxibustion, massage and other methods to reconstruct the mechanical balance of the cervical spine, so as to achieve the purpose of softening the tendons and straightening the bones. As the physical problem often coexists with the emotional problem, importance should be attached to the use of emotion-based interventions in treating CS, which can reduce the influence of negative emotional factors on the condition and clinical efficacy. During the delivery of emotion-based interventions, attention should be given to enhancing patients' emotional state to improve their physical functions, and restoring the regulatory function of positive emotions, as well as increasing their awareness of unhealthy lifestyles, so as to reduce the occurrence and recurrence of CS. We also use the theory of "combining motion and quiescence" to guide clinical diagnosis and treatment of CS, which contributes to making an accurate diagnosis and delivering a precise treatment, resulting in better preventive and therapeutic effects. The comprehensive application of the theory of "balancing body and mind, combining motion and quiescence" has facilitated the achievement of satisfactory clinical effects.
Effect of board game on knowledge mastery and teaching satisfaction of ultrasound medical students
DI Zhixin, SUN Qinliang, FU Dong, ZHANG Yuhuan
2023, 21(5): 864-867. doi: 10.16766/j.cnki.issn.1674-4152.003002
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  Objective  To explore the effect of board game in ultrasound diagnosis.  Methods  A total of 20 students in the Department of Ultrasound Medicine of a third-class hospital in Heilongjiang Province were selected as the research objects by using the convenient sampling method from November 2021 to December 2021. The course of gastric ultrasound diagnosis was taken as the learning content. After the classroom teaching, the students were divided into four groups and played educational games according to the specified game rules. Through the way of self-comparison, the effect of board game on ultrasonic medical students' knowledge mastery and teaching satisfaction was verified.  Results  Students' pre-test scores were 4.50 (3.00, 6.00) and post-test scores were 8.50 (8.00, 9.00), and there was a significant difference between their scores before and after the test (Z=-3.951, P < 0.05). The number of students' correct and wrong questions before and after the test showed statistically significant differences in each knowledge point (Knowledge points 1-10 were respectively the forbidden time of gastric ultrasound examination; Contraindications of ultrasonic examination of stomach; Name of gastric notch; Recognition of oblique view of stomach; Gastric ulcer judgment; Judgment of gastrolithiasis; Ultrasonographic manifestations of normal gastric wall peristalsis; Ultrasonographic features of gastric leiomyosarcoma; Ultrasonographic manifestations of fasting stomach, all P < 0.05). The satisfaction of students with board games was about 90%.  Conclusion  The board game can improve the knowledge memory of ultrasonic medical students and effectively promote their learning effect. It is worth popularizing in the field of education and teaching in the future.
Application and effect evaluation of Seminar teaching method combined with flipped classroom in gastroenterology disease teaching
GU Lin, ZHAO Rui, MA Zhenzeng, ZHENG Hailun, LIU Ru, DENG Min
2023, 21(5): 868-871. doi: 10.16766/j.cnki.issn.1674-4152.003003
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  Objective  Digestive system diseases are highly professional, complicated, involving multiple systems and organs, with many professional operation skills and complex operation, so it is necessary to expand new teaching models and methods, improve clinical teaching effect and improve the quality of medical education.  Methods  A total of 120 interned medical undergraduates in the Department of Gastroenterology of the First Affiliated Hospital of Bengbu Medical College from 2022 to 2023 were selected and divided into control group (traditional lecturing teaching mode) and experimental group (Seminar teaching method combined with flipped classroom teaching mode) according to the random number table method, with 60 students in each group. The two groups had the same content. The theoretical knowledge, clinical record analysis, clinical practice comprehensive ability, teaching effect and teaching satisfaction of the two groups were compared.  Results  The scores of theoretical knowledge and clinical case analysis of the experimental group were (55.03±1.74) points and (34.98±1.58) points, which were significantly higher than those of the control group [(53.68±1.55) points, (33.37±1.46) points], both P < 0.05, respectively. The scores of all aspects of comprehensive ability of clinical practice in the experimental group were higher than those in the control group, and the differences were statistically significant (all P < 0.05). Compared with the control group, the students' satisfaction in the experimental group was higher (P < 0.05). In the experimental group, 21 students were very satisfied and 35 students were satisfied, while in the control group, 16 students were very satisfied and 29 students were satisfied.  Conclusion  Seminar teaching mode combined with flipped classroom teaching mode can achieve good teaching effect and high teaching satisfaction for clinical medical interns in the Department of Gastroenterology.
Visual analysis of research hotspots in domestic "manual treatment of ankle sprains"
ZHAO Guodong, WANG Shangquan, HAN Tao, CHEN Ming, ZHAN Jiawen, SUN Shuchun
2023, 21(5): 872-877. doi: 10.16766/j.cnki.issn.1674-4152.003004
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  Objective  To collect related literature on manual treatment of ankle sprains, use CiteSpace software for knowledge map and visual analyses, observe the research hotspots and trends and provide development suggestions and references for follow-up research.  Methods  Relevant literature of "manual treatment of ankle sprain" was collected in the CNKI database from its establishment to December 31, 2020. The annual number of articles, fund projects, research authors, research institutions, research hotspots and other aspects of the included literature were visually analysed by Citespace software.  Results  (1) A total of 306 related documents were included, of which the maximum number of documents issued at the end of 2016 was 26. (2) The National Natural Science Foundation of China (3 projects) was the most funded project in this field. (3) The top three authors were Chen Zhaojun (6 articles), Gao Jinghua (5 articles) and Gao Chunyu (5 articles). (4) The top three research institutions were Beijing University of Traditional Chinese Medicine, Third Affiliated Hospitals (9 articles), Wangjing Hospital of China Academy of Chinese Medical Sciences (8 articles) and Guangzhou University of Traditional Chinese Medicine (8 articles). (5) Keyword clustering tags included "manual massage", "ankle sprain" and "qing palace orthopedics", "activating blood and removing blood stasis agent/treatment application", "vas" and "clinical efficacy" were the mainstay.  Conclusion  Research on "manual treatment of ankle sprains" is still relatively small in terms of publication volume and large-scale national cooperation. Strengthening academic exchanges and cooperation is still an important future direction in this field. Among them, the research on the treatment of ankle sprain by shaking, pulling and poking manipulation will be a new direction and entry point for the research of ankle sprain in recent years.
Analysis of oral health status and household awareness rate of dental caries among children aged 6-11 years in Liaoning Province
GAO Qing, WU Ming, LIU Lu, YE Qianwen, ZHOU Xinlin, LIU Yiqing
2023, 21(5): 878-881. doi: 10.16766/j.cnki.issn.1674-4152.003005
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  Objective  To investigate the oral health awareness rate of children aged 6-11 years and their parents and evaluate the prevalence of dental caries in children in Liaoning Province in 2020, analyze the influencing factors and provide scientific strategies and measures for further prevention and treatment of children ' s oral caries.  Methods  A total of 7 165 children aged 6-11 years in 12 cities of Liaoning Province were selected by multi-stage stratified random cluster sampling. The children were subjected to oral examination and questionnaire survey, and the parents were investigated by questionnaire survey. Logistic regression analysis of factors influencing dental caries was also conducted.  Results  The rate of dental caries was 90.8%, the awareness rate of oral health was 64.2% and the awareness rate of parents was 78.0%. Multiple logistic regression analysis showed that brushing once a day, pit and fissure sealing, urban and rural classification, birth weight and high educational background of parents were the main factors influencing dental caries (P < 0.05). Among them, brushing teeth once a day (OR=0.461) and parents ' high education level (high school/technical secondary school OR=0.539, juniorcollege OR=0.488, undergraduate OR=0.433, master ' s degree above OR=0.367) were the protective factors for dental caries. The risk factors of dental caries were absence of pit and fissure sealing (OR=1.627) as well as rural (OR=1.438) and high birth weight (2.5-4.0 kg, OR=2.564; >4.0 kg, OR=3.253).  Conclusion  The incidence of dental caries among children aged 6-11 years in Liaoning Province is relatively high, and the situation of prevention and control is grim. The oral awareness rate of children and their parents should be raised through targeted publicity and education to form a good habit of tooth brushing. The enthusiasm of parents and children participating in the prevention and control of pit and fissure closure should be increased to prevent dental caries.
The Use of Mind Mapping in Standardized Treatment for Venomous Snake Bites
LIU Xiaoyuan, LIU Wanjuan
2023, 21(5): 882-885. doi: 10.16766/j.cnki.issn.1674-4152.003006
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  Objective  To investigate the impact of mind mapping on the treatment effect, psychological status and quality of life in patients with venomous snake bites, and to provide a theoretical basis for standardized treatment of venomous snakebite patients.  Methods  Sixty-eight patients with venomous snake bites admitted to Lishui Municipal Central Hospital from February 2020 to May 2022, all treated with antivenom. They were selected and divided into a control group (34 cases, treated with conventional therapy) and a test group (34 cases, receiving the conventional therapy combined with mind mapping-based interventions) according to the random number table method. Clinical treatment effect (swelling regression time, pain relief time, snakebite wound healing time, hospitalization time, resuscitation success rate and satisfaction rate), psychological stress indicators [symptom checklist-90 (SCL-90)] and quality of life [general quality of life inventory-74 (GQOLI-74)] were compared between the two groups.  Results  After the intervention, the test group required less time to achieve swelling reduction, pain relief, snakebite wound healing and had shorter length of hospitalization time after intervention, compared with the control group, with statistically significant differences [(5.32±1.09) d vs. (6.84±1.22) d, (3.57±0.92) d vs. (4.73±1.03) d, (16.02±2.11) d vs. (20.91±2.35) d, (7.25±1.09) d vs. (10.16±1.85) d, all P < 0.05]. Moreover, the test group had a higher treatment satisfaction rate (97.06%, 33/34) compared with 76.47% (26/34) in the control group (P < 0.05). The test group had significantly lower average factor scores for somatization, obsessive-compulsive, depression, anxiety, phobic-anxiety and total SCL-90 after treatment (all P < 0.05). In addition, the average post-treatment scores of physical function, psychological function and social function were higher in the test group (all P < 0.05). The incidence of adverse reactions was lower in the test group (14.71%, 5/34) than that in the control group (38.24%, 13/34), P < 0.05.  Conclusion  Mind mapping-based interventions may help to improve the treatment effect, reduce the psychological stress response and improve the quality of life in patients with venomous snakebites.
Construction of quality of care assessment system for critically ill neonates during interhospital ambulance transport
PENG Dongfeng, LI Feifei, QIU Ning, WANG Yun, ZHU Yefen, LU Shasha, CHEN Ren
2023, 21(5): 886-890. doi: 10.16766/j.cnki.issn.1674-4152.003007
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  Objective  To construct quality of care assessment system for critically ill neonates during interhospital ambulance transport (QCASCINIAT), to provide a basis for evaluating the nursing quality for neonates during interhospital transport.  Methods  Based on the standard system structure of nursing quality, the theoretical model of "element quality-link quality-terminal quality", combined with the relevant policies of pre hospital emergency and hospital management in China and the requirements of neonatal intensive care unit (NICU) infection control, referring to the evaluation indicators of pediatric critical care services and the 2017 version of Neonatal Transport Guidelines, through literature research, group discussions, and expert pre consultation, the QCASCINIAT were initially formulated and defined, and two rounds of expert consultation were conducted by Delphi method from July to December 2021. The score assigned to each item during the second round of consultation was used to construct a judgment matrix, and the weight of each item was calculated using the analytic hierarchy process on SPSS AU. After that, the QCASCINIAT was established.  Results  Sixteen experts from 6 grade A tertiary general hospitals or children ' s hospitals in Shanghai, Jiangsu and Anhui provinces were invited to participate in the consultation. The recovery rates of two rounds of consultation questionnaires were all 93.7%, with expert authority coefficients of 0.836 and 0.849, and Kendall cofficient of concordance of 0.134 and 0.174. According to the two rounds of consultation, the primary and secondary indicators in the initial system (totally 70 indicators, including 3 primary indicators, 13 secondary indicators and 54 tertiary indicators) were retained, but changes occurred in the tertiary indicators: 7 were deleted, 3 were merged, 4 were revised and 1 was added according to the first round of consultation, and 2 were deleted, 1 was revised and 1 was merged according to the second round of consultation. The final system includes 3 primary indicators, 13 secondary indicators and 41 tertiary indicators.  Conclusion  The QCASCINIAT is scientific, objective and reliable, which can be used as a basis for evaluating the nursing quality for critically ill neonates during interhospital transport.
The perceived climate of team Cha-xu and its influence on job satisfaction in clinical nurses: the mediating and moderating effect of organizational trust
PAN Shenshen, SU Xiangyi, LIU Qiong, DAI Xuanxuan, CHEN Chaohong
2023, 21(5): 891-895. doi: 10.16766/j.cnki.issn.1674-4152.003008
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  Objective  To explore the current status of the perceived climate of team Cha-xu in clinical nurses and its influence on job satisfaction, and to analyze the role of organizational trust between them, in order to provide a certain reference and basis for clinical nursing management.  Methods  A total of 433 clinical nurses were recruited by convenience sampling from 2 tertiary hospitals in Wenzhou, Zhejiang Province, between June and October 2021. The basic information questionnaire, perceived climate of team Cha-xu scale, the nurses ' job satisfaction scale (Chinese Version) and organizational trust scale were used in the investigation. A structural equation model was constructed using Amos 17.0 software to test for mediation effect, and hierarchical regression analysis was used to test for moderating effects.  Results  The total scores of perceived climate of team Cha-xu, job satisfaction and organizational trust were 40.31±7.45, 51.11±8.63 and 50.21±9.39 respectively, and the item mean scores were 3.67±0.68, 3.41±0.58 and 3.86±0.72 respectively. Organizational trust mediated between the perceived climate of team Cha-xu and job satisfaction, with a mediation effect of -0.14, accounting for 31.1% of the total effect. Organizational trust was also a moderator in the relationship between perceived climate of team Cha-xu and job satisfaction (ΔR2=0.067, P < 0.01).  Conclusion  Hospital managers should help nursing managers to form a good management style or leadership style, reduce the perception of team Cha-xu, pay attention to deep connection with clinical nurses, enhance nurses ' sense of organizational trust through intervention, and improve their job satisfaction and the quality of clinical nursing service.
Observation study on the efficacy of integrated traditional Chinese and Western medicine in the treatment of chest and back acne and comprehensive nursing intervention
LI Huanmei, TANG Yanli, ZHONG Hongli, SHEN Huiliang
2023, 21(5): 896-899. doi: 10.16766/j.cnki.issn.1674-4152.003009
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  Objective  To analyze the clinical effects of combining Chinese and Western medicine in the treatment of acne on the chest and back, and to explore comprehensive nursing interventions applicable to the combined treatment of Chinese and Western medicine, to improve the clinical symptoms and psychological status of patients with acne on the chest and back.  Methods  A total of 80 patients with acne on chest and back who were treated in the Department of Beauty and Physiotherapy, Zhejiang Dermatology Hospital from April 2020 to November 2021 were selected as the research samples. They were divided into control group and observation group, with 40 cases in each group according to the random number table method. The patients in the control group were treated with red and blue light and received routine nursing intervention. The patients in the observation group were treated with traditional Chinese medicine (Xiaocuo Powder) and received comprehensive nursing intervention on the basis of the control group. The clinical efficacy and incidence of adverse reactions, the global acne grading system (GAGS) score and the psychological status score before and after treatment were compared between two groups.  Results  The overall clinical effective rate of patients in the observation group was 65.0% (26/40), which was higher than that in the control group (42.5%, 17/40), and the difference was statistically significant (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant (P>0.05); after treatment, the GAGS score of the observation group was 6.13 (2.06, 10.71) points, which was significantly lower than that in the control group [8.86 (3.91, 13.25) points, P < 0.05]; The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores in the observation group were (40.73±3.89) points and (41.03±4.22) points, respectively, which were lower than those in the control group (46.38±5.41) points and (46.83±5.69) points, both P < 0.05.  Conclusion  The combination of red and blue light with Xiaocuo Powder in the treatment of chest and back acne combined with comprehensive nursing intervention has a significant clinical effect and high safety. It can effectively reduce patients ' skin damage and improve patients ' bad mood, which is worthy of clinical application.
Missed diagnosis of renal artery stenosis: a case report and literature review
LI Ni, MENG Qi
2023, 21(5): 900-902. doi: 10.16766/j.cnki.issn.1674-4152.003010
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Renal artery stenosis (RAS) is one of the independent risky factors for secondary hypertension. The incidence is relatively low and the clinical diagnosis is difficult, so the misdiagnosis rate and missed diagnosis rate is high. This study aims to conduct a retrospective analysis on one missed diagnosis case of renal artery stenosis, and review the relevant literature.

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