中华全科医学

The global development of community health management and its reference to China

TENZIN Tsomo, LIU Xiang, CHEN Hong, TIAN Jiahe, CAO Zilong, CHEN Yiqi, WANG Zhaoxin, YU Wenya

2023, 21(6): 903-906. doi: 10.16766/j.cnki.issn.1674-4152.003011

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Abstract:
With the change in the spectrum of diseases and causes of death, the aggravation of population aging, the increasing prevalence rate of chronic diseases, and the particularity of the post-epidemic era, the health concept of Chinese residents has changed significantly, and the demand for healthcare is growing gradually. Traditional specialized and systematic medical services have been unable to meet people' s various needs for health.Community health management is based on the health needs of people with different health conditions, relying on a mature community health service system to collect, analyze, and evaluate residents' health data, which helps provide professional health guidance and intervention for residents. It has become a key breakthrough in dealing with the rising demand for healthcare and controlling the unreasonable growth of medical expenses in China. Although community health management in China has kept continuous development in the past decade, it is still in the very early stage and lacks a suitable model and specific proposal. However, community health management in other countries has been rising and developing for more than half a century, and there have been several mature and effective models in various countries. Therefore, through analyzing the theories, practice, and development characteristics of health management models in some representative countries (e.g., the United Kingdom, the United States, Germany, and Japan), and conducting case analysis of foreign community health management practice projects, this study aims to analyze the advantages and development characteristics of different community health management models from both theoretical and practical perspectives and analyze and evaluate the characteristics and effects of practice projects. Based on these analyses and combined with foreign community health management models, this study will deeply explore the current development status, characteristics, and existing problems of community health management models in China, which will provide theoretical evidence and direction for more accurate community health management models suitable for national conditions and practical needs in China.

Data mining-based analysis of comorbidity status and association rules of hypertensive patients in the community

PENG Derong, CHEN Chen, YU Mengzhu, FAN Feng, SHI Jianwei, WANG Zhaoxin, TAN Jun

2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012

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Abstract:
Objective To understand the comorbidity status of hypertensive patients in Shanghai community and the correlation analysis of comorbidity, and provide theoretical basis and data support for community comorbidity management of hypertension patients. Methods The diagnosis and treatment data and health records of hypertensive patients in a community in Shanghai from January 2018 to December 2020 were collected, and the coexistence of multiple diseases among hypertensive patients of different genders and ages was analyzed. The association rule analysis of comorbidity combination was performed with Apriori algorithm to find out the key diseases of hypertensive patients with multiple diseases. Results The prevalence of comorbidity among hypertensive patients in the Shanghai community was 88.1% (34 311/38 961), which was much higher than that in the general elderly population. The prevalence of comorbidity in female hypertensive patients was higher than that in male hypertensive patients, and the prevalence of comorbidity in the high age group was higher than that in the low age group (both P < 0.001). The distribution of the total number of diseases is scattered, and there are differences between different age groups. The low age group mainly had 2-4 comorbidities, and the high age group mainly had more than 4. The results of the association rule analysis showed that two comorbidities generated eight strong association rules, the first is "hypertension and chronic ischemic heart disease"; Three comorbidities generated nine strong association rules, the first is "chronic ischemic heart disease and cerebrovascular disease and hypertension"; And four comorbidities generated three strong association rules, the first is "chronic ischemic heart disease and hyperlipidemia, cerebrovascular disease and hypertension". Conclusions The coexistence of multiple diseases in Shanghai community hypertensive patients should not be ignored, and the contraindications, interactions and multiple drug use should be considered. In particular, the prevention of hypertension comorbidity in young and middle-aged people is particularly important, which requires early warning, quasi evaluation and precise intervention. Management of comorbidities should include clinical-related conditions such as chronic ischemic heart disease, cerebrovascular disease and hyperlipemia, as well as other systemic comorbidities such as chronic functional bowel disease and chronic obstructive pulmonary disease.

Potentially inappropriate medications management strategies for elderly patients with coexisting diseases based on the survey of general practitioners in Pudong New Area

HUANG Qian, XU Xin, SHAO Jie, ZHANG Fang, CAI Chengjun, HUANG Jiaoling, LIU Wei, ZHANG Shengbing

2023, 21(6): 911-915. doi: 10.16766/j.cnki.issn.1674-4152.003013

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Abstract:
Objective To investigate the causes of potentially inappropriate medications (PIM) in elderly patients with coexistent diseases and establish management strategies. Methods A field survey questionnaire was designed for 21 items of community PIM project. It is divided into three parts: (1) basic information; (2) subjective rationality evaluation of PIM in 21 coexisting diseases; (3) daily frequency of PIM in 21 coexisting diseases, which was self-assessed by using the Likert 7-point scale. From December 2021 to January 2022, a total of 236 general practitioners in 47 community health service centres in Pudong New Area of Shanghai were surveyed online by using mechanical sampling. SPSS 23.0 was used for statistical analysis, and four quadrant analyses were used to analyse the objective frequency, subjective rationality, subjective frequency and self-evaluation of each item. Results The rank sum test showed that the objective frequency of 21 PIM items were significantly different from those of subjective rationality evaluation (all P < 0.01). Linear regression analysis was established using the total score of self-assessment of daily occurrence frequency of 21 PIMs as the dependent variable. Results showed that each factor had no significant effect on the self-assessment of daily occurrence frequency of PIM (all P > 0.05). Four-quadrant analysis indicated that the PIM items related to the use of benzodiazepines and to the use of non-steroidal anti-inflammatory drugs (NSAIDs) generally belonged to the second and third quadrants (doctors paid less attention to them, or the frequency of self-evaluation was higher). Conclusion At present, general practitioners still lack the awareness of PIM management and control for elderly patients with coexisting diseases. They should strengthen training and establish a standardised management process.

Discussion on the personalized health education model for chronic diseases with multimorbidity

CAO Lin, YANG Zhenhua, XIAO Weizhong

2023, 21(6): 916-919. doi: 10.16766/j.cnki.issn.1674-4152.003014

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Abstract:
Chronic diseases with multimorbidity refers to one person concurrently suffers from two or more chronic diseases. Recent years have witnessed an increasing prevalence of multimorbidity, which results in a heavier burden and a worse patient prognosis compared with a single chronic disease, becoming a global healthcare challenge. In view of the complex medical conditions of patients with multimorbidity, the disease-centered passive care model is difficult to meet the proactive care needs of these patients, and to better their prognosis and quality of life. There is still no a unified personalized health education model for multimorbidity, but the health education model derived from simply merged health education prescriptions for single chronic diseases is not suitable for patients with multimorbidity. Thus, it is necessary to establish a scientific and feasible personalized health education model for patients with multimorbidity, which can provide the patients with personalized health education guidance involving pharmacological treatment, health behaviors and lifestyle based on a thorough assessment of their clinical data, exercise and sleep quality, nutritional status and diet, mental and psychological status and disease burden. The health education plan can be adjusted according to its effectiveness continuously evaluated during a long-term follow-up. In China, with the promotion of healthcare and pharmaceutical reform, the development of hierarchical medical system and family doctor services and other public health services has been improved basically, and general practitioners are capable to provide comprehensive health management services including personalized health education for patients with multimorbidity. Considering the common health problems in patients with multimorbidity, we reviewed studies on chronic disease health education, and discussed three aspects (health education assessment, health prescription development, effectiveness assessment) that should be focused on in the development of a personalized health education model for multimorbidity, with a view to providing a reference for the formulation of health education prescriptions for Chinese patients with multimorbidity.

Difference of Helicobacter pylori eradication rate between patients with atrophic gastritis and non-atrophic gastritis

DU Meiling, CHU Yan, ZHANG Ziqiang, WEN Zhaoyang, TAO Yiran

2023, 21(6): 920-923. doi: 10.16766/j.cnki.issn.1674-4152.003015

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Abstract:
Objective To investigate the difference of Helicobacter pylori (Hp) eradication rate between patients with atrophic gastritis and non-atrophic gastritis, and to analyze the relationship of the degree of gastric antrum atrophy, intestinal metaplasia and Hp density with Hp eradication rate. Methods A total of 505 Hp-positive patients who initially received amoxicillin combined with clarithromycin regimen in Fudan University Affiliated Shanghai Fifth People' s Hospital from January to December 2021 were enrolled and divided into two groups on the basis of pathological features in endoscopy, namely atrophic gastritis and non-atrophic gastritis. Propensity score matching (PSM) was used to reduce bias in the comparison of Hp eradication rates between two groups, followed by logistic regression analysis. Results After PSM, the failure rate of Hp eradication in atrophic gastritis group was significantly higher than that in non-atrophic gastritis group (16.3% vs. 7.8%, P=0.023), and the difference was significant in male (21.2% vs. 7.1%, P=0.008), but not in female (P > 0.05). Logistic regression analysis showed that the failure rate of Hp eradication was positively correlated with mild (pathological grade +) antral atrophy/intestinal metaplasia (OR=2.614, 95% CI: 1.227-5.571, P=0.013; OR=2.882, 95% CI: 1.310-6.338, P=0.009), but not associated with moderate to severe (pathological grade ++ to +++) antral atrophy/intestinal metaplasia (all P > 0.05). Moreover, Hp eradication failure was independent of antral Hp density (P > 0.05). Conclusion The failure rate of Hp eradication in patients with atrophic gastritis is significantly higher than that in patients with non-atrophic gastritis, and the difference is significant in males but not in females. In addition, Hp eradication failure increases only in patients with mild antral atrophy/intestinal metaplasia and doesn' t increase with the severity of antral atrophy/intestinal metaplasia. Moreover, Hp eradication failure is independent of antral Hp density.

Causal relationship between ulcerative colitis and bronchiectasis based on mendelian randomization

SHU Yuping, YU Danqi, RONG Yue, TAO Hongwu, LIU Yuedong

2023, 21(6): 924-926. doi: 10.16766/j.cnki.issn.1674-4152.003016

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Abstract:
Objective The association between ulcerative colitis and bronchiectasis can be clinically concurrent, and a two-sample mendelian randomization (MR) approach is used to investigate whether there is an association between the two and to provide recommendations for clinical management. Methods Genetic loci closely associated with ulcerative colitis were extracted as instrumental variables and bronchiectasis was the outcome variable in pooled data from the gene-wide association study (GWAS), which was derived from European ethnic groups. The ulcerative colitis data contained a total sample size of 214 620 individuals and 16 380 459 SNPs, and the bronchiectasis data contained a total sample size of 187 824 individuals and 16 380 375 SNPs. MR analysis was performed using the inverse-variance weighted (IVW), MR-Egger regression and the weighted median (WME) respectively, and the causal relationship between ulcerative colitis and bronchiectasis was evaluated by OR and 95% CI, and the Egger-intercept method was used to test for horizontal multiplicity, and the sensitivity analysis was performed using "leave-one-out method". Results A total of 123 SNPs were included as instrumental variables, with OR and 95% CI of 1.089 (1.008-1.177), 1.089 (0.909-1.305), and 1.031 (0.918-1.157) for IVW, MR-Egger, and WME results respectively, and P value of less than 0.05 for IVW, indicating that a causal relationship between ulcerative colitis and bronchiectasis was causally related. MR-Egger regression showed an intercept of 3.190×10^-5 with a standard error of 0.013 and P=0.998, there was no horizontal pleiotropy for the instrumental variable of exposure factors. Heterogeneity tests showed no heterogeneity and the results of the "leave-one-out" sensitivity analysis were stable. Conclusion There is a causal association between ulcerative colitis and bronchiectasis, which increases the risk of developing bronchiectasis.

The mechanism of rapamycin-induced autophagy to inhibit urethral fibrosis after injury in rats

CHEN Shoufeng, ZHANG Shuchao, LI Zhong, SUN Wei, LIU Beibei, YANG Xiaohuai, GUO Yuanyuan

2023, 21(6): 927-931. doi: 10.16766/j.cnki.issn.1674-4152.003017

306 6

Abstract:
Objective To investigate the effect and mechanism of rapamycin (Rapa) on the formation of urethral stricture and fibroblast in rats. Methods The rat (SD male rats, body weight 250-300 g) urethral stricture model was established and divided into negative control group, positive control group and Rapa+3-Methyladenine (3-MA) group by using the random nuber table method, with 10 rats in eah group. The urethral tissues of rats were collected at 14 d after operation, and the morphological changes of urethral tissues were observed by HE staining, and the changes of collagen were detected by Masson staining. The expression of α-SMA was observed by immunohistochemistry. HLF-1 cells were divided into control group, Rapa group and 3-MA+Rapa group. Transwell assay was applied to detect cell migration and invasion ability, flow cytometry to detect cell cycle and apoptosis, and Western blotting to detect LC3 expression. Results HE staining showed that urethral stricture degree of rats in the Rapa group was significantly reduced compared with that in the positive control group. Masson and immunohistochemical staining showed that collagen and α-SMA expression in the injured urethra tissues were increased in both the positive control group and Rapa group compared with that in the negative control group. However, the expressions of collagen and α-SMA in Rapa group were significantly lower than those in positive control group. Compared with the control group, the migration and invasion ability of HLF-1 cells in Rapa group were gradually decreased in a dose-dependent relationship (all P < 0.05), while the inhibition of Rapa on the migration, invasion ability of HLF-1 cells was decreased after the addition of 3-MA intervention (all P < 0.05). Flow cytometry and Western blotting results showed a significant increase in apoptosis in the Rapa group compared to the control group (all P < 0.05), and a dose-dependent increase in cellular LC3 expression (all P < 0.05). Conclusion Rapamycin can relieve the fibrosis after urethral tissue injury in rats, inhibit the migration and invasion of HLF-1 cells, and induce the apoptosis of HLF-1 cells, which may be achieved by inducing autophagy.

Effect of nutritional risk on physical fitness during hospitalization in elderly patients with reduced ejection fraction heart failure

KANG Yunpeng, GUO Wen, REN Aihong, LUO Fangfang, LIU Wenxian

2023, 21(6): 932-935. doi: 10.16766/j.cnki.issn.1674-4152.003018

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Abstract:
Objective To evaluate the effect of nutritional risk on physical fitness in elderly patients with reduced ejection fraction heart failure (HFrEF) during hospitalization. Methods A total of 228 elderly patients with HFrEF admitted to the Cardiac Intensive Care Center of Beijing Anzhen Hospital affiliated with Capital Medical University from January 2019 to December 2021 were included. According to the geriatric Nutritional risk index (GNRI), they were divided into 121 patients in the malnutrition risk group and 107 patients in the control group. Baseline data and physical fitness during hospitalization of the two groups were analyzed. According to short physical performance battery (SPPB), there were 185 patients with poor physical fitness and 43 patients with good physical fitness. Binary logistic regression was used to analyze the main influencing factors leading to the two groups' decline in-hospital fitness. Results The chair standing test score and total score of the simple body achievement test of HFrEF patients in the malnutrition risk group were significantly lower than those in the control group [(2.19±0.87) points vs. (2.46±0.82) points, P=0.017; (7.65±1.79) points vs. (8.23±1.79) points, P=0.039]. The grip strength level of women in the malnutrition risk group was lower than that of the control group [(17.65±4.43) kg vs. (19.89±3.74) kg, P=0.041]. Compared with patients with good physical fitness, patients with poor physical fitness were older and had higher blood B-type natriuretic peptide (BNP) levels, lower serum albumin levels, GNRI scores, and LVEF values (all P < 0.05). Binary logistic regression analysis showed that elevated BNP (OR=1.003, 95% CI: 1.001-1.005, P < 0.001) and malnutrition (OR=2.642, 95% CI: 1.248-5.591, P=0.011) were the main risk factors affecting physical fitness in elderly patients with HFrEF during hospitalization. Conclusion Malnutrition is an independent risk factor for the decline of physical fitness in elderly patients with HFrEF during hospitalization.

Protective effect of Xuesaitong capsule on myocardial cell hypoxia injury by inhibiting the expression of inflammatory factors

HAN Yong, LIU Xinwen, WANG Chaohai, YANG Xinwei, LI Wenhua, JING Jiang

2023, 21(6): 936-939. doi: 10.16766/j.cnki.issn.1674-4152.003019

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Abstract:
Objective To explore the protective effect of Xuesaitong capsule on oxidative damage of myocardial cells by establishing a mouse model of myocardial injury and treating the injured myocardial cells with Xuesaitong capsule. Methods A total of 25 SD rats were randomly divided into blank control group, myocardial cell hypoxia/reoxygenation (H/R) model group, low, medium and high dose groups of Xuesaitong capsule by rasom number table method, with 5 rats in each group. The myocardial cells of each group were cultured. The apoptosis rate of myocardial cells in each group were detected by flow cytometry. The inflammatory factors [interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α)] and oxidative stress indicators [lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD)] in each group were measured by ELISA, and NF-κB expression were detected by Western blotting. Results The apoptosis rate of myocardial cells in H/R group [(22.85±1.78)%] were higher than control group [(3.45±0.42)%] and the low, medium and high dose groups of Xuesaitong capsule [(10.25±2.02)%, (8.96±1.23)%, (5.88±1.45)%]. The serum IL-6, TNF-α, LDH, MDA and NF-κB in H/R group were significantly higher than control group and low, medium and high dose groups of Xuesaitong capsule (P < 0.05), while the activity of SOD in H/R group were significantly lower than that of control group and low, medium and high dose groups of Xuesaitong capsule (all P < 0.05). Conclusion Xuesaitong capsule has protective effect on H/R injury of myocardial cells, and its protective mechanism may be related to its inhibition of NF-κB gene overexpression.

Predictive value of HIST1H3D in lymph node metastasis of early cervical cancer

WANG Mengge, LI Man, CHANG Yuhuan, LYU Lili, YE Guoliu

2023, 21(6): 940-944. doi: 10.16766/j.cnki.issn.1674-4152.003020

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Objective To analyze the high-risk factors of lymph node metastasis in early cervical cancer, and study the predictive value of HIST1H3D in lymph node metastasis of cervical cancer. Methods A total of 40 patients with early cervical squamous cell carcinoma who underwent radical hysterectomy in Department of Obstetrics and Gynecology from January to December 2021 and 124 patients with early cervical squamous cell carcinoma from January 2016 to December 2020 were selected from the First Affiliated Hospital of Bengbu Medical College. The expression difference of HIST1H3D in lymph node metastasis group and non-metastasis group was analyzed by RT-qPCR, Western Blot and immunohistochemistry. Chi-square test and survival curve analysis were used to analyze the influence of HIST1H3D on the clinical characteristics and survival of lymph node metastasis group and non-metastasis group of early stage cervical carcinoma. The influencing factors of lymph node metastasis were analyzed by binary logistic regression. Results FIGO stage (χ²=30.491, P < 0.001), tumor size (χ²=8.362, P < 0.004), infiltration of lymphatic vascular space (P < 0.001), vaginal involvement (χ²=29.350, P < 0.001) and HIST1H3D expression (χ²=4.148, P < 0.042) were significantly related to lymph node metastasis. Overexpression of HIST1H3D gene was a high-risk factor for lymph node metastasis in early cervical cancer. The survival rate of patients with positive lymph nodes was worse (P=0.0136). There was significant difference in survival rate between the high and low expression groups of HIST1H3D, and the low expression group of HIST1H3D had a longer survival time (P=0.019). ROC curve showed that when HIST1H3D immunohistochemical score was 5, the area under the curve (AUC) was 0.704, the sensitivity was 89.29%, the specificity was 64.71%. At this time, the prediction effect of lymph node metastasis was the best (P < 0.001). Conclusion HIST1H3D has predictive value for lymph node metastasis of early stage cervical cancer.

Relationship between serum fibrinogen and albumin/globulin ratio levels and survival prognosis of patients with gastric cancer

MA Yong, CHEN Shanqin, FU Jun, HANG Qun

2023, 21(6): 945-949. doi: 10.16766/j.cnki.issn.1674-4152.003021

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Objective Studies have found that preoperative serum fibrinogen (FIB) and albumin/globulin ratio (AGR) are correlated with the prognosis of malignant tumors. Currently, there are few studies on the relationship between serum FIB and AGR and the survival prognosis of patients with gastric cancer. This study explores the relationship between preoperative serum FIB and AGR and the survival prognosis of patients with gastric cancer. Methods A total of 222 patients who underwent radical gastritis in the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2016 were included. The preoperative serum FIB and AGR levels and clinic pathological characteristics of patients with gastric cancer were analyzed retrospectively. The optimal truncation values of FIB and AGR were obtained by drawing ROC curves. According to the truncation values, patients were divided into high FIB group and low FIB group, high AGR group and low AGR group. The relationship between serum FIB, AGR grouping and clinicopathological features of patients with gastric cancer was analyzed successively. Kaplan-Meier survival curve was used for survival analysis, and Cox proportional risk model was used to study independent risk factors affecting prognosis of patients with gastric cancer. Results The optimal truncation values of FIB and AGR were 3.33 g/L and 1.46, respectively. Preoperative serum FIB was correlated with body mass index, differentiation degree, tumor size, T stage, N stage, TNM stage, CEA and CA19-9. Preoperative serum AGR was correlated with age, body mass index, degree of differentiation, tumor size, T stage, N stage, TNM stage, CEA and CA19-9. Survival analysis suggested that the OS rate and mean OS time in the low FIB group were significantly higher than those in the high FIB group (57.6% vs. 14.4%, 74.8 months vs. 32.9 months, P < 0.001). The OS rate and mean OS time in the high AGR group were also significantly higher than those in the low AGR group (56.8% vs.18.6%, 73.7 months vs.38.5 months, P < 0.001). Multivariate analysis showed that low differentiation degree, tumor size (≥5 cm), N stage, high FIB and low AGR were independent risk factors affecting the prognosis of patients with gastric cancer. Conclusion Preoperative serum FIB and AGR can be used as important blood indexes to predict the survival and prognosis of patients with gastric cancer.

Analysis of etiology and inflammatory markers in patients with biliary tract infection after choledocchojejunostomy

ZHANG Huanhuan, LUO Mingyang, WANG Xin, YAN Dong, ZENG Yanli

2023, 21(6): 950-953. doi: 10.16766/j.cnki.issn.1674-4152.003022

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Abstract:
Objective To investigate the pathogenic characteristics and drug resistance of pathogenic bacteria in biliary tract infection after cholangioenterostomy in Henan University People's Hospital and to evaluate the diagnostic value of biliary tract infection by relevant inflammatory markers. Methods A total of 351 patients who underwent choledocchojejunostomy from September 2020 to August 2022 in Henan Provincial People's Hospital were enrolled as the research objects. The characteristics of biliary tract infection pathogens and the results of drug sensitivity tests were analyzed. The levels of leukocytes, neutrophils, C-reactive protein (CRP), creactive protein-to-albumin ratio (CAR) and systemic immune-inflammation index (SII) were evaluated in diagnosing the occurrence of biliary tract infection. Results Among 351 patients, 31 had biliary tract infections (infection group, the rest were uninfected group), and the infection rate was 8.83%. A total of 36 strains of pathogenic bacteria were isolated, including 25 strains of Gram-negative bacteria (69.4%) and 8 strains of Gram-positive bacteria (22.22%) and 3 strains of fungi (8.33%). The common pathogens were Escherichia coli, Klebsiella pneumoniae and Enterococcus faecium. Among the Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae had the highest drug-resistance rates to ampicillin and the lowest drug-resistance rates to carbapenem antibiotics. There was no statistically significant difference in WBC, NEU, CAR, CRP, and SII levels between the two groups of patients before surgery. The level of NEU, CAR, WBC and CRP between the two groups on the second and third day after operation were higher than those before operation (all P < 0.05), and the infection group were higher than the uninfected group (all P < 0.05). The results of ROC curve showed that the area under the curve of combined indexes was 0.887, and its predictive value were higher than those of each individual index (all P < 0.05). Conclusion The main pathogenic bacteria of postoperative biliary tract infection in patients are Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae, and they have strong drug-resistance to commonly used antibacterial drugs which can be used to guide postoperative preventive medication for biliary tract infection. The detection of serum WBC, NEU, CAR and CRP levels in patients can predict the occurrence of biliary tract infection after surgery.

Clinical features and treatment analysis of esophageal entrance invasion in hypopharyngeal carcinoma

WU Juan, ZHOU Lanzhu, SUN Zhe, WU Jun, WANG Wenzhong

2023, 21(6): 954-957. doi: 10.16766/j.cnki.issn.1674-4152.003023

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Objective To analyze the basic clinical characteristics of esophageal entrance invasion in hypopharyngeal carcinoma, summarize the therapeutic effect and select the appropriate comprehensive treatment plan. Methods A total of 32 patients with hypopharyngeal squamous cell carcinoma invading the esophageal entrance treated by Otolaryngology Head and Neck Surgery at the First Affiliated Hospital of Bengbu Medical College from January 2014 to January 2017 were retrospectively analyzed. The basic clinical information of patients were collected, postoperative survival was followed up, and the basic clinical characteristics and treatment efficacy of hypopharyngeal cancer invading the esophageal entrance were analyzed. Results The 32 patients were all male, aged 44 to 81 (62.7±9.0) years old, including 28 piriform fossa carcinoma, 2 retropharyngeal wall carcinoma and 2 posterior annular carcinoma. Tumor TNM stage: 2 cases of T3N1M0, 5 cases of T3N2M0, 1 case of T3N3M0, 1 case of T4N1M0, 20 cases of T4N2M0, and 3 cases of T4N3M0. The tumor pathology was all squamous cell carcinoma, with pathological grade: 3 patients were highly differentiated, 14 patients were moderately differentiated, and 15 patients were poorly differentiated. The operation was successfully performed in all patients, 25 cases underwent radical neck dissection and 7 cases underwent selective neck dissection. The 3-year overall survival rate was 62.5% (20/32), and the 5-year overall survival rate was 34.4% (11/32). In 24 cases of unreserved laryngeal function, the 3-year survival rate was 66.7% (16/24), and the 5-year survival rate was 37.5% (9/24). There were 8 cases preserved laryngeal function, with a 3-year survival rate of 50.0% (4/8) and a 5-year survival rate of 25.0% (2/8). Among them, 5 cases (62.5%) had complete recovery of laryngeal function (respiratory, vocal, and swallowing protection), and 3 cases (37.5%) had recovery of vocal and swallowing protection. Conclusion Hypopharyngeal carcinoma invading esophageal entrance has high malignancy degree and poor prognosis. Preoperative examination should be actively improved, and treatment plans should be selected according to tumor stage and physical condition of patients, with comprehensive treatment based on surgery.

Risk factors and long-term prognosis of malignant arrhythmia in elderly patients with dilated cardiomyopathy

LIU Lei, LUO Guiquan, LIU Yijun, LI Xiaoping, REN Hongqiang

2023, 21(6): 958-961. doi: 10.16766/j.cnki.issn.1674-4152.003024

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Objective To investigate the risk factors and long-term prognosis of malignant arrhythmia (MA) in elderly patients with dilated cardiomyopathy. Methods A total of 199 patients with dilated cardiomyopathy over 60 years old who were hospitalized in the Cardiovascular Center of Suining Central Hospital were selected from January 2017 to April 2021. They were divided into MA group (54 cases) and non-MA group (145 cases) according to whether they were complicated with malignant arrhythmia. The risk factors of malignant arrhythmia were analyzed retrospectively. The MA group was followed up and divided into event group and non-event group according to the presence or absence of a composite endpoint event. The survival analysis was performed to clarify the factors affecting prognosis. Results Multifactorial logistic regression analysis of MA group and non-MA group showed that chronic kidney disease, NYHA class Ⅲ-Ⅳ, left ventricular ejection fration (LVEF) < 35%, and frequent premature ventricular beats were independent risk factors for complications of malignant arrhythmias in elderly patients with dilated cardiomyopathy. Kaplan-meier survival analysis of event group and non-event group showed that among elderly patients with dilated cardiomyopathy complicated by malignant arrhythmias, patients with comorbid chronic kidney disease, chronic obstructive pulmonary disease, and frequent premature ventricular beats were at higher risk of cardiac death. The independent variables that were significant for Kaplan-meier survival analysis were included in a multifactorial cox regression model correction, which showed that comorbid chronic obstructive pulmonary disease, frequent premature ventricular beats was an independent risk factor for cardiac death in elderly patients with dilated cardiomyopathy complicated by malignant arrhythmias (HR=7.593, 95% CI: 2.018-28.576, P=0.003; HR=4.090, 95% CI: 1.042-16.057, P=0.043). Conclusion Chronic kidney disease, NYHA class Ⅲ~Ⅳ, LVEF < 35%, and frequent premature ventricular beats are potential risk factors for the development of malignant arrhythmias in elderly patients with dilated cardiomyopathy. For event group, chronic obstructive pulmonary disease, and frequent premature ventricular beats are independent risk factors for prognosis and could better predict cardiac death.

Significance of HPV-E₆/E₇ mRNA examination in stratification management of non 16 and 18 high risk HPV infection patients

CHU Jicheng, HE Yu, YE Guoliu, WANG Liqun

2023, 21(6): 962-965. doi: 10.16766/j.cnki.issn.1674-4152.003025

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Objective To evaluate the application value of the human papilloma virus (HPV)-E₆/E₇mRNA examination in stratification management of patients with non-16 and 18 high-risk HPV infection and atypical squamous cell of negative for intraepithelial lesion or malign (NILM). Methods The clinical data of 383 patients with HPV-E₆/E₇ mRNA detection and colposcopy biopsy who were not at high risk of HPV infection type 16 and 18 and had negative cervical TCT at the First Affiliated Hospital of Bengbu Medical College from October 2020 to October 2021 were analyzed. The expression levels of HPV-E₆/E₇ mRNA were analyzed in different levels of cervical lesions. Results The 383 patients were divided into 252 cases of chronic cervical inflammation, 98 cases of low-grade squamous intraepithelial lesion (LSIL), and 33 cases of high-grade squamous intraepithelial lesion and above (HSIL+). The positive rate of HPV-E₆/E₇ mRNA were 40.5%, 64.3% and 66.7%, respectively (P < 0.001). There was a positive correlation between the pathological grade of cervical lesions and the expression of HPV-E₆/E₇ mRNA (r=0.254, P < 0.05). The AUC of HPV-E₆/E₇ mRNA examination was 0.623 and cut-off was 741.092 copies/mL. When cut-off was used as criteria for HSIL and above lesions, the sensitivity and specificity of HPV-E₆/E₇ mRNA were 63.6% and 64.3%, respectively, and the Youden index was 0.279. Conclusion HPV-E₆/E₇ mRNA have an important value for stratification management in patients with high-risk HPV non-16 and 18 infection and negative cervical TCT, which is hopeful to reduce the colposcopy referral rate.

Clinical study of self-made Huoxue Shubi Decoction on the treatment of ischemia reperfusion injury after PCI in acute myocardial infarction

ZHENG Xiang, WANG Shen

2023, 21(6): 966-969. doi: 10.16766/j.cnki.issn.1674-4152.003026

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Objective To explore the clinical efficacy, ventricular remodeling, and cardiovascular adverse events of self-made Huoxue Shubi Decoction on patients with ischemia-reperfusion injury (IRI) after percutaneous coronary intervention (PCI) in acute myocardial infarction. Methods A total of 96 patients with acute myocardial infarction after PCI surgery in the Department of Cardiovascular Medicine of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2019 to December 2021 were selected. According to the random number table method, they were randomly divided into a control group and an observation group, with 48 cases each group. The control group was treated with aspirin and ticagrelor, while the observation group was treated with self-made Huoxue Shubi Decoction on the basis of the control group. The clinical efficacy, traditional Chinese medicine syndromes, platelet aggregation, angina pectoris, cardiac function indicators, and cardiovascular adverse events were compared between the two groups. Results After 2 months of treatment, the effective rate of the observation group was 95.83% (46/48), while the control group was 79.17% (38/48), with statistically significant (χ²=6.095, P=0.014). After two months of treatment, the scores of chest pain, palpitations, shortness of breath, fatigue, spontaneous sweating, dark purple tongue, and weak pulse in the observation group were lower than those in the control group (all P < 0.05). After 2 months of treatment, the platelet aggregation rate and angina in the two groups were improved and the observation group were better than the control group (all P > 0.05), the left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) in the two groups were improved and the observation group were better than the control group (all P < 0.05), and there was no statistically significant difference in the incidence of cardiovascular adverse events between the two groups (P > 0.05). Conclusion On the basis of Western medicine treatment, the addition of self-made Huoxue Shubi Decoction has a significant therapeutic effect on IRI after PCI in acute myocardial infarction. It can promote the improvement of symptoms, reduce platelet aggregation, relieve myocardial remodeling, and has high safety.

Correlation analysis of serum β-actin and quantitative EEG indicators in patients with acute cerebral infarction

JIANG Feng, JIN Chunyuan, WANG Bona, HE Songbin

2023, 21(6): 970-972. doi: 10.16766/j.cnki.issn.1674-4152.003027

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Objective To explore the changes of serum β-actin and quantitative indicators EEG of acute cerebral infarction, and analyses its correlation. Methods A total of 60 patients with acute cerebral infarction from June 2021 to June 2022 in Zhoushan Hospital of Zhejiang Province were selected. There were 24 cases in mild group, 24 cases in moderate group and 12 cases in severe group; Another 50 cases of physical examination in the same period in Zhoushan Hospital of Zhejiang Province were selected as the control group. β-actin level measured by enzyme-linked immunosorbent assay. EEG was used to monitor patients ' EEG, and relative power value and power ratio index of each frequency band(DTABR) was calculated. Results The β-actin level [(1.83±0.34)μg/L] and DTABR value (7.71±0.43) in the cerebral infarction group were higher than those in the control group [(0.64±0.12)μg/L and 6.24±0.32], t=23.542, 19.991, both P < 0.05. The β-actin level [(2.29±0.41) μg/L] and DTABR value (8.54±0.47) in the severe group were higher than those in the moderate group [(1.79±0.36)μg/L and 7.68±0.42] and mild group [(1.27±0.28) μg/L and 6.63±0.34], all P < 0.05, while the β-actin level and DTABR value in the moderate group were higher than those in the mild group (all P < 0.05). The Pearson analysis showed that the level of β-actin was positively correlated with the DTABR value (r=0.584, P=0.002). Multivariate logistic regression analysis showed that β-actin and DTABR were the influencing factors for patients with cerebral infarction. Conclusion Serum β-actin level and DTABR value in patients with acute cerebral infarction significantly increase, which are closely related to the severity of the disease, and the level of β-actin is positively correlated with the value of DTABR.

Value of predicting liver failure after primary hepatocellular carcinoma resection based on two-dimensional shear wave elastography

ZHOU Tao, SUN Zhichao, CHEN Jiwen, WANG Xiaotao, CHEN Gang, LI Xinmiao

2023, 21(6): 973-976. doi: 10.16766/j.cnki.issn.1674-4152.003028

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Objective To explore the value of two-dimensional shear wave elastography (2D-SWE) in predicting liver failure after resection of primary hepatocellular carcinoma (HCC) and to help doctors judge the prognosis. Methods The clinical data of 180 patients who underwent primary hepatocellular carcinoma resection in Zhejiang Provincial Veterans ' Hospital and Zhejiang Provincial Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were analyzed retrospectively. They were divided into liver failure group (35 cases) and non-liver failure group (145 cases) according to whether there was liver failure after surgery. The patients received laboratory and 2D-SWE examination before operation. Through univariate analysis and multivariate logistic regression analysis, the risk factors for predicting liver failure after primary hepatocellular carcinoma resection were screened, and their predictive value was analyzed. Results Univariate analysis showed that there were significant differences in albumin, total bilirubin, aspartate aminotransferase, γ-glutamyltransferase, prothrombin time, international standardized ratio and Child Pugh score, model for end-stage liver disease (MELD) score, tumor size, hepatic portal occlusion, and liver hardness (all P < 0.05). Multivariate logistic regression analysis showed that international standardized ratio, tumor size and liver hardness were independent risk factors for liver failure after resection of primary hepatocellular carcinoma (OR=5.078, 4.943, 5.073, all P < 0.05). The ROC curve analysis results showed that the area under the curve for predicting liver failure after primary hepatocellular carcinoma resection using international standardized ratios, tumor size, and liver hardness values were 0.791, 0.829 and 0.994, with good prediction efficiency. Conclusion The clinical value of predicting liver failure after primary hepatocellular carcinoma resection based on 2D-SWE is high. International standardized ratios of 1.01 and above, tumor sizes of 4.82 cm and above, and liver hardness values of 10.66 kPa and above are independent risk factors for liver failure after primary hepatocellular carcinoma resection.

Effect analysis of community chronic heart failure patients managed by stages under the guidance of third-class hospitals

HUANG Yuli, YAO Huiqiang, ZHANG Xianlin, XU Qiong, ZHOU Tong, WANG Dongmei, MIAO Anqi

2023, 21(6): 977-980. doi: 10.16766/j.cnki.issn.1674-4152.003029

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Objective Under the guidance of the team of the heart failure center of the third-class hospital, community doctors and nurses implemented target management for community patients with chronic heart failure by stages, and analyzed the target effect of management. Methods A total of 760 chronic heart failure patients aged 30-92 from four community health service centers in Bengbu City were selected from June to December in 2021. Community hospitals were guided by doctors from the Heart Failure Center of the First Affiliated Hospital of Bengbu Medical College to follow up and manage chronic heart failure in stages for one year. The main observation indicators included patient awareness of heart failure, standardized drug usage rate, standardized drug compliance rate, quality of life score, and annual hospitalization rate before and after management. Results The awareness rate of heart failure among patients increased (55.45% vs. 97.63%, χ²=178.031, P=0.002). The usage rate of β receptor blockers increased in heart failure patients (22.75% vs. 92.89%, χ²=296.121, P=0.001), the usage rate of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor and neprilysin inhibitor (ARNI) increased (46.21% vs. 90.28%, χ²=186.173, P=0.002), and the usage rate of spironolactone increased (63.27% vs. 91.70%, χ²=120.312, P=0.003). The compliance rate of β receptor blockers increased (5.92% vs. 83.65%, χ²=328.231, P=0.001), the compliance rate of ACEI/ARB/ARNI increased (12.56% vs. 82.70%, χ²=296.224, P=0.001), and the compliance rate of spironolactone increased (43.36% vs. 85.55%, χ²=178.321, P=0.002). The quality of life score improved (t=95.311, P=0.003), and the annual hospitalization rate decreased (45.50% vs. 24.41%, χ²=85.252, P=0.004). Conclusion Under the guidance of tertiary hospitals, the standardized management by stages for community chronic heart failure patients has improved the control rate and quality of life of heart failure patients, reduced readmission, and improved the level of heart failure prevention and treatment by community doctors, thus promoting the continuous implementation of graded diagnosis and treatment policies.

Effect of different arteriovenous fistula puncture methods on the dialysis adequacy of hemodialysis patients

GAN Yanqun, ZHENG Zhibo

2023, 21(6): 981-984. doi: 10.16766/j.cnki.issn.1674-4152.003030

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Abstract:
Objective Arteriovenous puncture technique can significantly affect the adequacy of dialysis. This study aims to explore the differences in the impact of different puncture methods on dialysis adequacy for clinical practice reference. Methods A total of 217 patients who underwent hemodialysis at the Blood Purification Center, Zhejiang Hospital from January 2020 to October 2021 were selected as the research objects. Regional, rope ladder, and buttonhole puncture methods were used, and patient clinical information was collected. The adequacy of dialysis was compared by the average urea clearance index (Kt/V) and urea reduction rate (URR) within 6 months after dialysis. Logistic regression analysis was used to explore the related influencing factors. Results The average age of the patients was (55.6±2.8) months, and the average use time of the arteriovenous fistula was (45.3±1.6) months. Among the puncture techniques, 116 cases (53.5%) used regional puncture, 70 cases (32.2%) used rope ladder puncture, and 31 cases (14.3%) used buttonhole puncture. There was a significant correlation between Kt/V, URR values and the location of the arteriovenous fistula. Patients with brachial artery-cephalic vein fistula had better Kt/V and URR values than those with radial artery- cephalic vein fistula (P=0.002, 0.028). Puncture needle direction along the blood flow direction increased Kt/V by 0.892 times (95% CI: 0.851-0.963, P=0.033), while puncture method, arterial needle rotation, whether the arterial and venous needles were in the same vascular segment had no significant effect on Kt/V, URR values, and dialysis adequacy (all P>0.05). Conclusion When the direction of the puncture needle is consistent with the blood flow direction in arteriovenous fistula puncture, it can increase the adequacy of hemodialysis. Different puncture methods, arterial needle rotation after insertion, and whether the arterial and venous needles are in the same vascular segment do not have a significant effect on dialysis adequacy.

Clinical effect evaluation of the integrated bigatti shaver for the treatment of multiple endometrial polyps

CHEN Guo, YING Jie, TIAN Lu, ZHU Yuting, CHEN Shunxia, YAO Shun, ZHOU Shuguang

2023, 21(6): 985-988. doi: 10.16766/j.cnki.issn.1674-4152.003031

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Objective To compare the clinical effect of the integrated bigatti shaver (IBS) intrauterine shaving system and the hysteroscopic electrosurgery for the treatment of multiple endometrial polyps. Methods A total 108 patients with multiple endometrial polyps in Anhui Maternal and Child Health Hospital from January 2020 to June 2021 were retrospectively analyzed. The 48 patients with multiple endometrial polyps removed by IBS intrauterine shaving system were selected as the study group (IBS group), and 60 patients undergone hysteroscopic electrosurgery were set as the control group (electrotomy group). The clinical effect evaluation was analyzed by comparing general clinical information, intraoperative conditions, preoperative and postoperative biochemical indicators, safety, health and economic benefits, and clinical efficacy of follow-up after treatment. Results (1) Intraoperative conditions: the frequency of endoscopic insertion into the uterine cavity in the IBS group was significantly less than that in the electrotomy group, the operation time was shorter, and the amount of perfusate used was less (all P < 0.05). (2) There was no statistically significant difference in blood biochemical indicators before and after surgery (all P>0.05). (3) Comparison of security: the incidence of surgical complications in the IBS group was 2.08% (1/48), lower than that in the electrotomy group (16.67%, 10/60), the difference was statistically significant (P < 0.05), and no water poisoning and uterine perforation occurred in both groups. (4) Health and economic benefits: the hospitalization time in the IBS group was shorter than that in the electrotomy group (P < 0.05). (5) Comparison of clinical efficacy: the vaginal bleeding time of the IBS group was shorter than that of the electrotomy group, and the endometrial thickness during ovulation was higher than that of the electrotomy group, with statistical significance (all P < 0.05). Conclusion The application of IBS intrauterine shaving system in the treatment of multiple endometrial polyps has high safety and efficacy, can maximize the protection of the endometrium, and is worthy of wider clinical promotion.

Clinical analysis of 205 neonatal transfer in Huaibei area

WANG Hui, WANG Xianhe, CHEN Wenxiang, ZHOU Yi

2023, 21(6): 989-991. doi: 10.16766/j.cnki.issn.1674-4152.003032

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Objective This study aimed to investigate the status of neonatal transfer in Huaibei area to improve the efficiency of neonatal transfer. Methods From January 2017 to December 2020, the Huaibei Maternal and Child Health Hospital conducted a total of 205 cases of neonatal transfer clinical data in Huaibei City and surrounding cities and counties, including the diseases-type of transferred cases, hospitalisation time and annual transfer quantity, and the status of neonatal transfers in Huaibei area was analysed by statistical methods. Results A total of 205 cases were transferred in and 4 cases were transferred out. The cure rate was 98.05%; the transfer out rate was 1.95%, and no death was reported during transfer. Among the 205 cases of transported children, the most frequent was neonatal pneumonia in 45 cases (21.95%); followed by neonatal asphyxia in 41 cases (20.00%); then neonatal hyperbilirubinemia in 32 cases (15.61%); In addition, 25 cases (12.20%) of premature infants were identified; 13 cases (6.34%) of neonatal infections. A total of 63, 70, 26 and 46 cases were reported in 2017, 2018, 2019 and 2020, respectively. The distribution of call transfer hospitals includes 15 cases in tertiary hospitals, accounting for about 7.35%; 57 cases in secondary hospitals, accounting for 27.94% and 132 cases in primary hospitals, accounting for about 64.71%. Conclusion At present, the neonatal transfer in Huaibei Maternal and Child Health Hospital is still in its initial stage, and attention should be paid to and further strengthened, particularly the construction of neonatal transfer in primary hospital.

Analysis on influential factors of inpatient care for the elderly in a residential area in Minhang District, Shanghai based on Andersen' s healthy behavioral model

YANG Jianling, LUAN Yiming, WANG Minqin, WEI Xinping, ZHOU Liang, WANG Zhaoxin

2023, 21(6): 992-995. doi: 10.16766/j.cnki.issn.1674-4152.003033

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Objective By summarizing the investigation of the long-term care needs of the elderly in a residential area of Minhang, Shanghai, this paper aims to explore the influencing factors of the elderly ' s choice of inpatient care by selecting a scientific analysis framework and analysis method, so as to provide reference for the establishment of a demand-based inpatient care service model. Methods Based on the elderly long-term care needs questionnaire, this paper established inpatient care theoretical analysis framework with Andersen ' s Behavioral Model. And then, three different logistic regression model was proposed to analysis the characteristics set, promoting factor set and needs set step by step into those logit model, so as to explore the factors affecting inpatient care. Results (1) Logistic model goodness of fit: Model 3 > model 1 > model 2. (2) The gender (Waldχ²=7.025, P=0.007, OR=0.244), type of health insurance (Waldχ²=4.516, P=0.034, OR=0.677), end-stage cancer (Waldχ²=4.918, P=0.027, OR=0.274), and visual impairment and vision level (Waldχ²=4.687, P=0.030, OR=1.890) were significant influencing factors for inpatient care by combining the three logistic models. Conclusion In terms of inpatient care for the elderly in Shanghai, we don ' t have to overthink the economic promotion factors such as income housing condition. The segmentation health needs such as end-stage cancer and visual disability should be emphasized heavily.

Investigation on mental health status of 500 patients with essential hypertension in Bengbu City, Anhui Province

WANG Chaofan, WEI Daoxiang, ZHANG Lina, XUAN Ling

2023, 21(6): 996-999. doi: 10.16766/j.cnki.issn.1674-4152.003034

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Objective To investigate and analyze the mental health status of essential hypertension patients in Bengbu City, Anhui province, and the correlation between the course and grade of essential hypertension and mental health level, anxiety and depression, so as to provide scientific basis for the development of appropriate intervention measures for hypertension patients. Methods A total of 500 diagnosed patients with essential hypertension were investigated in Bengbu City, Anhui province from January to June 2022. The patients themselves or their families filled in the SCL-90, SAS and SDS through WeChat, QQ and browser. The prevalence of anxiety and depression in patients with essential hypertension of different genders was analyzed. SPSS 22.0 statistical software was used to compare the mental health status of hypertension patients with the national norm, and Pearson correlation analysis was used to analyze the correlation between the grade and course of essential hypertension and mental health status, anxiety and depression. Results The scores of SCL-90 factor index and SAS and SDS in patients with essential hypertension were higher than those in the national norm (both P < 0.001). The prevalence rates of anxiety and depression in male patients with essential hypertension were 38.75% (93/240) and 29.58%(71/240), respectively, while the prevalence rates of anxiety in female patients with essential hypertension were 57.69%(150/260) and 42.69%(111/260). The Pearson correlation coefficient between the grade and course of essential hypertension and the score of anxiety and depression was between 0.3 and 0.7 (both P < 0.001). The Pearson correlation coefficient between essential hypertension grade and total SCL index was 0.336 (P < 0.001). Conclusion (1) The mental health status of patients with essential hypertension is poor, and female patients with essential hypertension are more likely to suffer from anxiety and depression than male patients. (2) The grade of essential hypertension is inversely proportional to the level of mental health, and the grade and course of hypertension is proportional to the degree of anxiety and depression.

Status and influencing factors of mental health literacy of non-targeted admission residential trainees in Henan Province

ZHOU Tong, HU Qianqian, ZHENG Weikai, WANG Liuyi, WANG Yong

2023, 21(6): 1000-1003. doi: 10.16766/j.cnki.issn.1674-4152.003035

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Objective To understand the mental health literacy (MHL) status and influencing factors of the trainees who are receiving non-targeted admission trainees in Henan Province, and to provide reference for improving standardized resident training. Methods A total of 600 non-targeted admission residential trainees who entered Henan Province from September 2020 to September 2022 were selected as the research subject using cluster sampling methods, and a questionnaire survey was conducted, total 579 valid and complete questionnaires were collected. The mental health literacy of residential trainees was investigated using the multiple mental health literacy scale, and the attitudes towards seeking psychological help, social support scale and psychological help self-stigma scale were investigate using the attitude towards seeking psychological help scale, social support scale, and self stigmatization scale. Results Of 579 residential trainees 44.7% were males, and the average score of mental health literacy was 12.60±2.95, while 55.3% were females, with an average score of 12.20±3.08. The differences of MHL score were statistically significant in different majors, grades and emotional states (all P < 0.05). Spearman correlation analysis shows that the attitude of seeking professional psychological help was positively correlated with mental health literacy (r=0.337, P < 0.001), mental health literacy was negatively correlated with self-stigma of seeking professional psychological help (r=-0.349, P < 0.001), and two-way social support was positively correlated with mental health literacy (r=0.336, P < 0.001). Multiple linear regression analysis showed that grade, emotional state, attitude of seeking professional psychological help, self-stigma of seeking professional psychological help and social support were the main factors affecting the mental health literacy level of residential trainees (all P < 0.05), which could explain 36.2% of the total variation. Conclusion The scores of mental health literacy of residential trainees in Henan Province are in the middle level, and hospitals should take effective intervention measures to improve their mental health literacy.

Influence of glucose metabolism level on ovarian ultrasound characteristics in patients with polycystic ovary syndrome

DING Yanhua, ZHOU Qingxue, ZHU Xiaoling, CHENG Yan, YAO Jiqin

2023, 21(6): 1004-1007. doi: 10.16766/j.cnki.issn.1674-4152.003036

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Objective To observe the differences of ovarian ultrasound characteristics in polycystic ovary syndrome (PCOS) patients with different glucose metabolism levels, and to analyze the effect of glucose metabolism level on ovarian ultrasound characteristics in PCOS patients. Methods A total of 200 patients with PCOS who were treated in the Department of Obstetrics and Gynecology in Hangzhou Obstetrics and Gynecology Hospital from January 2019 to October 2022 were taken as the research objects. They were divided into normal blood glucose group (NBG, 44 cases), impaired fasting glucose tolerance group (IFG, 61 cases), pre diabetes group (PDM, 57 cases) and diabetes group (DM, 38 cases) according to the level of blood glucose metabolism. All the research objects were examined by transvaginal three-dimensional energy ultrasound. The age, body mass index (BMI), fasting insulin content (FINS), insulin resistance index (HOMA-IR), fasting triacylglycerol (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) of PCOS patients in each group were analyzed, and the differences of ovarian ultrasound indexes in each group were observed. Results There was no statistically significant difference in age, BMI and HDL of PCOS patients in each group (all P>0.05). HOMA-IR, TC, TG, and LDL increased with the aggravation of the abnormal degree of glucose metabolism in PCOS patients. The FINS values in IFG group, PDM group and DM group were significantly higher than that in NBG group, while the FINS values in DM group were significantly lower than those in IFG group and PDM group (all P < 0.05). The ovarian volume of NBG group, IFG group, PDM group and DM group were (11.53±1.49) cm², (13.16±1.52) cm², (14.82±1.61) cm², (16.04±1.64) cm², respectively, and the difference was statistically significant (F=14.359, P < 0.001). The values of flow index (FI), vascularity index (VI) and vascularization flow index (VFI) in each group increased with the severity of abnormal glucose metabolism in PCOS patients (all P < 0.05). Conclusion With the continuous increase of blood glucose level in PCOS patients, it will lead to lipid metabolism disorder and the intensification of insulin resistance. At the same time, it will lead to changes in ovarian ultrasound characteristics, mainly manifested as an increase in the volume of ovaries, the acceleration of ovarian blood flow, and the increase in the number of ovarian blood vessels.

Correlation between preoperative ultrasound parameters and the risk of cervical lymph node metastasis in papillary thyroid cancer

LI Dan, WU Wanbo, SHEN Siping, YAO Lili, YANG Junyu, YANG Jianjun

2023, 21(6): 1008-1011. doi: 10.16766/j.cnki.issn.1674-4152.003037

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Objective To investigate the relationship between preoperative ultrasonography parameters and the risk of cervical lymph node metastasis in papillary thyroid carcinoma (PTC), in order to provide evidence for clinical treatment and prognosis evaluation. Methods A total of 148 patients with PTC who received surgical treatment in Huzhou Central Hospital from June 2021 to June 2022 were selected as subjects, and were divided into metastatic group (59 cases) and non-metastatic group (89 cases) according to cervical lymph node metastasis. The general data and preoperative conventional ultrasound parameters (tumor maximum diameter, boundary, morphology, distance from capsule, etc.) were compared between the two groups. Pearson correlation was used to analyze the correlation between PTC ultrasound image features and cervical lymph node metastasis. Multivariate logistic regression was used to analyze the influencing factors of cervical lymph node metastasis of PTC. Results The micro-calcification, distance from the capsule < 1 mm, and the maximum diameter of the tumor >7 mm in the metastatic group were more than those in the non-metastatic group (P < 0.05). Pearson correlation analysis showed that cervical lymph node metastasis was positively correlated with micro-calcification (r=0.227, P < 0.05), distance from capsule (r=0.293, P < 0.05), and maximum tumor diameter (r=0.360, P < 0.05). Multivariate logistic regression analysis showed that micro-calcification (OR=2.601, 95% CI: 1.049-6.452), distance from capsule < 1 mm (OR=2.955, 95% CI: 1.102-7.922), and the largest tumor diameter >7 mm (OR=2.965, 95% CI: 1.095-8.031) were risk factors for cervical lymph node metastasis in PTC (all P < 0.05). Conclusion The appearance of micro-calcification, distance from the capsule < 1 mm, and maximum diameter of the tumor > 7 mm suggest that PTC may have the risk of cervical lymph node metastasis.

A review of return to work after mild traumatic brain injury

XUE Qin, MA Li, LIU Weiming, NIE Zengyao

2023, 21(6): 1012-1015. doi: 10.16766/j.cnki.issn.1674-4152.003038

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Abstract:
Mild traumatic brain injury (TBI) usually refers to the patients with Glasgow coma scale of 13-15 after the injury, and the duration of coma does not exceed 30 minutes and the duration of amnesia does not exceed 24 hours. There are a large number of TBI patients in China and around the world. Most patients can quickly return to normal work and life after the injury, but some patients still have long-term symptoms and cannot return to work, causing a heavy economic and psychological burden on the patients and their families. Although most of these patients do not show obvious structural abnormalities, they are usually accompanied by various functional disorders, and the clinical symptoms are complex and varied, including headache, dizziness, memory loss, loss of smell, hearing loss, vision loss, emotional problems, sleep problems, etc. Due to the diversity of clinical manifestations in patients, multidisciplinary therapies are often required to achieve a better prognosis. Thanks to the development of general practice in recent years, it has natural advantages in the integration of medical resources from various disciplines and the long-term follow-up of patients. Returning to work is a milestone in patients ' recovery, marking the point at which patients can begin to reintegrate into society, and returning to work as early as possible has a positive impact on patients ' recovery. Currently, some foreign studies have pointed out that the factors affecting the return to work of patients with mTBI include social demographic factors, disease factors, psychological factors, social support and so on. This paper summarizes the research in this field, hoping to identify high-risk patients who cannot return to work at an early stage, and start targeted rehabilitation treatment as soon as possible, to help patients overcome physical and psychological difficulties, so as to return to the society and work more quickly.

Effect of sodium-glucose cotransporter 2 inhibitor on sarcopenia in elderly patients with type 2 diabetes

SONG Baona, LIN Ping, WANG Qin

2023, 21(6): 1016-1020. doi: 10.16766/j.cnki.issn.1674-4152.003039

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Abstract:
Type 2 diabetes is one of the common diseases of the elderly, and the incidence increases with the increase of age. Sarcopenia, or sarcopenia, is also a clinical syndrome associated with aging. Studies have shown that the incidence of sarcopenia in elderly patients with type 2 diabetes is increasing year by year. The pathogenesis of type 2 diabetes combined with sarcopenia mainly includes insulin resistance, chronic inflammation, oxidative stress, mitochondrial dysfunction, peripheral neuropathy and injury, and the use of hypoglycemic drugs. Many hypoglycemic drugs, such as biguanides, thiazolidinediketones, dipeptidyl peptiase-4 inhibitors (DPP-Ⅳ inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and other inhibitors have influence on the occurrence of sarcopenia. With the wide application of SGLT-2i in hypoglycemic treatment and cardiovascular disease treatment, the author found that it also has an important impact on sarcopenia. When used in elderly patients with type 2 diabetes, SGLT-2i can optimize the body structure and reduce fat without affecting muscle content or increasing the incidence of fracture. It can delay the occurrence of sarcopenia through the regulation and transcription of muscle and fat, improve oxidative phosphorylation and control inflammation. By influencing the central nervous system, the active food intake of patients can be increased and the risk of sarcopenia can be reduced from the level of malnutrition. Therefore, the application of SGLT-2i in elderly patients with type 2 diabetes can not only play a role in hypoglycemia and cardiovascular protection, but also has important significance in delaying the occurrence of sarcopenia. The application of SGLT-2i may bring new ideas and targets for the treatment of elderly patients with type 2 diabetes complicated with sarcopenia.

Exercise induced cardioprotective effects and related molecular mechanisms

LIU Rui, LU Yan, JIA Yongping, MA Yichao

2023, 21(6): 1021-1025. doi: 10.16766/j.cnki.issn.1674-4152.003040

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Abstract:
Cardiovascular disease (CVD) is still the main cause of the global burden of disease at present. Physical inactivity is one of the controllable risk factors for CVD, and in clinical practice, exercise is recommended as an important means of CVD prevention and rehabilitation. Exercise is beneficial in reducing the risk of CVD and improves outcomes as well as health-related quality of life in patients with CVD such as ischemic heart disease and heart failure, and it also ameliorates anthracycline-induced cardiotoxicity. Although the mechanism of exercise-induced cardiovascular protection has not been fully elucidated, the related mechanisms have been extensively studied by animal exercise models. In research, exercise may be used as a preconditioning to render the post exercise heart resistant to pathological stimuli; Exercise intervention can also be performed after the occurrence of the disease, to a certain extent, alleviating cardiac injury and maintaining cardiac function. Mechanistically, exercise-induced cardioprotection is multifaceted and this protective effect is associated with exercise promoting physiological cardiac hypertrophy, inhibiting pathological hypertrophy, promoting cardiomyocyte proliferation, reducing cardiomyocyte apoptosis, improving cardiac fibrosis, and promoting angiogenesis in the heart. The molecular mechanisms involved in exercise-induced cardioprotection involve signaling pathways such as IGF-1/PI3K/Akt, NRG1/ErbB, and Hippo, as well as molecules such as myokines, exercise-induced peptides, sirtuin, exosomes, and miRNAs. In this review, the cardioprotective effects induced by exercise and related molecular mechanisms will be elaborated from the above aspects, in the hope of providing ideas for the prevention and treatment of cardiac diseases and exercise rehabilitation research.

Effects of Ziwu Liuzhu auricular points pressing beans on inflammatory cytokines and NT-proBNP levels in patients with chronic heart failure

WU Dongdong, YU Guoqiang, TENG Jinyan, TAN Zengde, ZHOU Yabin, ZHANG Mingming

2023, 21(6): 1026-1029. doi: 10.16766/j.cnki.issn.1674-4152.003041

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Abstract:
Objective To observe the effect of time-controlled Ziwu Liuzhu auricular points pressing beans on inflammatory cytokines and N-terminal pro-Brain natriuretic peptide (NT-proBNP) levels in patients with chronic heart failure (CHF). To investigate the mechanism of Ziwu Liuzhu auricular points pressing beans and earlobes to improve TCM symptoms, heart function and exercise tolerance in patients with CHF. Methods A total of 80 patients with CHF who admitted in the Outpatient Clinic in the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2019 to June 2020 were selected and divided into a control group and an observation group by using the random number table method, with 40 cases in each group (2 cases dropped off in the control group and 1 case dropped off in the observation group). The control group received routine basic treatment, while the observation group was treated by Ziwu Liuzhu auricular points pressing beans on the basis of the control group. Changes in serum left ventricular ejection fraction (LVEF), 6-min walking distance (6MWD), IL-6, hypersensitive C-reactive protein (hs-CRP) and NT-proBNP in both groups were observed before and after treatment. The clinical efficacy and efficacy of TCM symptoms were compared between the two groups. Results After treatment, the LVEF and 6MWD in the observation group were significantly improved compared to before treatment (P < 0.05), and the observation group was superior to the control group (P < 0.05); The serum levels of IL-6, hs-CRP, and NT-proBNP in the observation group were significantly reduced compared to before treatment (P < 0.05), and the observation group was superior to the control group (P < 0.05). The total effective rate of active TCM symptoms in the observation group was 92.3% (36/39), which was significantly better than that in the control group [34.2% (13/38), P < 0.05]. The total clinical effective rate of the observation group was 71.8% (28/39), while the control group was 44.7% (17/38), with a statistically significant difference (P < 0.05). Conclusion Ziwu Liuzhu auricular points pressing beans may significantly improve the clinical efficacy of CHF patients, improve CHF patients ' TCM symptoms, cardiac function and activity endurance, and reduce serum IL-6, hs-CRP and NT-proBNP levels in CHF patients.

Clinical observation of acupuncture nape eight points combined with manipulation therapy in the treatment of cervicogenic headache

XU Lei, TANG Yuting, CAI Lianqin, JIANG Yong

2023, 21(6): 1030-1033. doi: 10.16766/j.cnki.issn.1674-4152.003042

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Abstract:
Objective To investigate the clinical effect of acupuncture of the nape eight points combined with manipulation therapy in the treatment of cervicogenic headache by randomized controlled trial. This study provides high quality clinical evidence for the treatment of cervicogenic headache. Methods Seventy patients with cervicogenic headache who were admitted to the Department of Rehabilitation Medicine, the First Affiliated Hospital of Bengbu Medical College from June 2020 to May 2022 were randomly divided into treatment group (35 cases) and control group (35 cases) by a random table method. The treatment group received acupuncture at nape eight points combined with manipulation therapy, and the control group received oral ibuprofen. After treatment, the short-form McGill pain questionnaire (SF-MPQ) score and the neck dDisability index (NDI) score were observed before and after treatment in the two groups. Clinical efficacy was also compared between the two groups. Results There were no significant differences in the PRI, VAS, PPI and NDI scores of the SF-MPQ scores between the two groups before treatment (all P>0.05). The post-treatment PRI, VAS, PPI and NDI scores of the SF-MPQ were significantly different from the pre-treatment scores (all P < 0.05). The PRI, VAS, PPI and NDI scores in the SF-MPQ score in the treatment group [(5.46±0.95) points, (3.26±0.74) points, (1.34±0.48) points, (14.89±1.60) points] were better than those in the control group [(6.43±1.01) points, (4.51±0.92) points, (2.37±0.73) points, (18.74±3.11) points, t=4.148, 6.297, 6.951, 6.522, all P < 0.05], the differences were statistically significant. The total effective rate was 97.1% in the treatment group and 77.14% in the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion The acupuncture nape eight points combined with manipulation therapy can significantly improve the clinical symptoms of cervicogenic headache, improve the function of the cervical spine, and alleviate the patient ' s emotional disturbance of boredom and anxiety.

Rehabilitation efficacy analysis of the body weight supported treadmill training combined with knee joint controlling on knee hyperextension in patients after stroke

YIN Qiyong, XU Qingqin, CHEN Desheng, WANG Min, CHEN Hemu

2023, 21(6): 1034-1038. doi: 10.16766/j.cnki.issn.1674-4152.003043

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Abstract:
Objective To explore the rehabilitation efficacy of body weight supported treadmill training (BWSTT) combined with knee joint controlling (KJC) on lower limb motor function in patients with knee hyperextension (KH) after stroke, so as to improve the motor function of lower limbs and enhance walking stability and safety. Methods Thirty stroke patients admitted to Department of Rehabilitation Medicine of the First Affiliated Hospital of Anhui Medical University from June 2021 to June 2022 were selected. They were divided into a control group and an experimental group by using the random number table method, with 15 cases in each group. In order to collect plantar pressure data, 15 aging and gender-matched healthy subjects were recruited as the normal controls. The control group was treated with conventional rehabilitation therapy, while the experimental group received BWSTT and KJC on the basis therapy. The Berg balance scale (BBS), Fugl-Meyer assessment of lower extremity (FMA-LE), 10-meter walking test (10MWT), KH measurements and plantar pressure analysis [bilateral plantar pressure percentage, symmetry index (SI) and center of pressure (COP)] were compared between the two groups before and after 4 weeks of treatment. Results The BBS, FMA-LE, 10MWT and KH measurements improved in both groups after 4 weeks of treatment (P < 0.05), and the experimental group had better results than the control group except for 10MWT [BBS score: (22.87±1.96) points vs. (20.93±2.23) points; FMA-LE: (22.07±2.64) points vs. (19.67±2.61) points; 10MWT: (27.13±8.20) seconds vs. (30.73±10.95) seconds; KH measurements: (14.00±2.95) times vs. (17.40±3.91) times, all P < 0.05]. The SI and COP improved in both groups compared to pre-admission and were better in the experimental group than those in the control group (P < 0.05), but had difference with normal subjects (P < 0.001). Conclusion BWSTT combined with KJC can effectively improve walking and balance in stroke patients with KH.

Investigation on the current situation and need of continuing education training for general practitioners in Sichuan Province

WANG Yanan, CHEN Hong, ZHAO Guangbin, LIN Min, WANG Junkang, WANG Jia, LI Yang

2023, 21(6): 1039-1043. doi: 10.16766/j.cnki.issn.1674-4152.003044

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Abstract:
Objective To analyze the current situation and need of continuing education for general practitioners in Sichuan Province, and provide reference and basis for organizing and carrying out continuing education training for general practitioners more effectively. Methods The general practitioners who joined the "online training for improving the diagnosis and treatment ability of General Practitioners in Sichuan Province" in 2021 were surveyed online. The self-made questionnaire "General Practitioners Continuing Education training Status and Demand" was used. The survey included basic information, previous training, clinical skills, auxiliary examination, systematic knowledge, scientific research, training methods needs. Whether there were differences in the need for continuing education training among general practitioners with different educational backgrounds, professional titles, and work locations were analyzed. A total of 1 804 questionnaires were sent out, 1 463 were effectively received with effective recovery of 81.10%. Results Total 1 407 people (96.17%) had joined the continuing education training, most of them chose network teaching (1 008, 68.70%) and combination of network and alive (889, 60.76%). General practitioners had a great demand for training in clinical skills, auxiliary examination, systematic knowledge, scientific research. General practitioners with different degree, titles and working place had different needs, and the differences were statistically significant (P < 0.05). Conclusion At present, the general practitioners has great demand of continuing medical education training, and a strong willingness to do so. There are differences in the needs of general practitioners from different backgrounds for continuing education training content. It is recommended to adjust the training content, establish targeted thinking, implement precise training, meet the needs of general practitioners with different educational backgrounds, professional titles, and work locations, in order to improve the efficiency of training. It is recommended to strengthen the innovation of training models and increase the implementation of online training.

Construction of evaluation index system of nursing undergraduate clinical practice teaching quality

WANG Xi, WANG Jie, XU Guixia, MA Mengwei, PAN Qianwen, XU Dong

2023, 21(6): 1044-1047. doi: 10.16766/j.cnki.issn.1674-4152.003045

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Abstract:
Objective To construct a scientific and feasible evaluation index system of nursing undergraduate clinical practice teaching quality, and to provide a comprehensive and quantifiable reference basis for the evaluation of clinical nursing practice teaching quality. Methods The index system was preliminarily constructed by literature research and questionnaire survey from teachers and students. From June to September 2021, the purpose sampling method was adopted to select 20 consulting experts from nursing education management, clinical nursing and nursing professional teaching for two rounds of expert letter consultation. The evaluation index system of nursing undergraduate clinical practice teaching quality was constructed, and the analytic hierarchy process (AHP) was used to determine the index weight. Results The recovery rate and effective rate of the two rounds of expert correspondence questionnaires were 100%, and the expert authority coefficient value was 0.857. The Kendall ' s coefficients of concordance (Kendall ' s W) for the first, second and third indexes after two rounds of letter consultation were 0.328, 0.364 and 0.425, respectively. The final evaluation index system of nursing undergraduate clinical practice teaching quality included 5 first-level indexes, 18 second-level indexes and 37 third-level indexes. The five first-level indexes included guiding ideology of teaching work, practical teaching management, practical teaching resources, practical teaching implementation and practical teaching effect, with weights of 0.196, 0.172, 0.236, 0.206 and 0.190, respectively. Conclusion The evaluation index system of nursing undergraduate clinical practice teaching quality has good scientific and reliable, the index weight is reasonable, and can be used as a tool to objectively evaluate the quality of nursing undergraduate clinical practice teaching, and also can provide decision-making basis for the clinical practice teaching base to comprehensively improve the quality of nursing undergraduate clinical practice teaching.

Actual effect of electronic health records combined with new media carriers on health promotion of community residents: a scoping review

ZHENG Yingwei, HUANG Bin, FAN Guanhua

2023, 21(6): 1048-1052. doi: 10.16766/j.cnki.issn.1674-4152.003046

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Abstract:
Objective Based on the present situation of literature research on the application of electronic health records to improve community residents ' health literacy, this paper systematically analyses the effects of electronic health records combined with new media carriers on the health promotion of community residents, as well as the information utilization situation of electronic health records, and clarifies the progress of the application of electronic health records in clinical activities. Methods Based on the general evaluation framework method of Arksey and O ' Mallry, the domestic and foreign literature about the application ways and effects of electronic health records in PubMed and China National Knowledge Infrastructure (CNKI) database were searched. Descriptive analysis and data collection were used to show the distribution of the included studies, and suggestions were put forward based on the scoping review. Results A total of 1 167 literature related to the research topic were retrieved, and 9 core literature were finally included in the overview evaluation after the selection of titles, abstracts, and full text reading. According to the research methods, it could be divided into three categories: APP and (or) wearable devices, Wechat, and disease and health related websites (or systems). The mode of these new media carriers and electronic health records could promote the self-health management of patients with chronic diseases. Conclusions Electronic health records can improve patients ' health literacy, but its promotion and application are affected by accesses, information security, user ages. It still has a lot to be improved in China. At the current stage, the inevitable requirements of promoting electronic health records are actively encouraging and guiding residents to understand and actively apply electronic health records, improving the relevant legal system.

Research on the monitoring of pathogens and the prediction model of risk factors for hospital-acquired pneumonia in intensive care unit

ZHANG Xiangjun, ZHU Jingrui, WANG Li, LI Jing

2023, 21(6): 1053-1055. doi: 10.16766/j.cnki.issn.1674-4152.003047

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Abstract:
Objective To study the risk factors of hospital-acquired pneumonia (HAP) in intensive care unit (ICU) and the composition of HAP pathogens. To construct and evaluate the risk prediction model of HAP, so as to facilitate the screening of risk population and prevent and control the occurrence of HAP. Methods Data of hospitalized patients in the comprehensive ICU of a general hospital from January 2020 to March 2021 were collected, and pathogenic bacteria were isolated and monitored. Logistic regression analysis was used to construct the risk factor prediction model and evaluate it. Results A total of 570 cases were included in this study, including 34 cases of HAP. The pathogens isolated from sputum specimens of HAP patients were mainly gram-negative bacteria. Multivariate analysis showed that malnutrition, invasive operation, length of stay in ICU>10 days and chronic pulmonary disease were independent risk factors for HAP (P < 0.05). Regression model was established: logit (P)=-7.870+2.496×alnutrition+2.173×nvasive operation+1.440×ength of stay in ICU>10 days+1.054×hronic pulmonary disease. Hosmer and Lemeshow goodness-of-fit test: χ²=3.022, P=0.933. The area under the ROC curve was 0.895, 95% CI was 0.847-0.943. Conclusion The bacteria isolated from HAP sputum specimens are mainly gram-negative bacteria. Malnutrition, invasive operation, length of stay in ICU>10 days and chronic pulmonary disease are independent risk factors for HAP in ICU patients. The risk factor prediction model constructed by logistic regression analysis can achieve better prediction effect.

Analysis of the clinical characteristics and hospitalization costs of IgG4-related diseases

LYU Zhijie, WU Li, ZHANG Hongxia, DU Ping

2023, 21(6): 1056-1059. doi: 10.16766/j.cnki.issn.1674-4152.003048

368 8

Abstract:
Objective To analyze the clinical characteristics and hospitalization costs of 42 IgG4-related diseases (IgG4-RD) patients, so as to provide reference for improving early diagnosis and reasonable cost control. Methods Clinical data of 42 IgG4-RD patients admitted to Sir Run Run Shaw Hospital Zhejiang University School of Medicine from October 2016 to October 2021 were retrospectively collected for statistical analysis. Results Among the 42 patients, the number of involved organ was 1 to 5, and the most common organs were pancreas (42.86%), biliary (26.19%), lymphatic (30.95%), the interquartile range of IgG4-RD responder index was 5.5(3.0, 7.0) and the number of involved organ was positively associated with serum of IgG4 and IgG4-RD responder index (IgG4-RD RI). There were 28 patients treated with glucocorticoids alone, 10 patients treated with glucocorticoids combined with immunosuppressant, 2 patients were not given drug treatment, 2 patients refused glucocorticoids treatment, 33 patients responded well to drug treatment, and serum of IgG4, erythrocyte sedimentation rate (ESR) and IgG4-RD RI decreased compared with previous treatment. The median hospitalization cost of IgG4-RD patients was 13 808.15 (6 968.50, 24 652.09) yuan. Drug treatment factors, surgical material factors, and co-examination factors were the three public factors affecting the hospitalization cost of patients with IgG4-RD. Conclusion IgG4-RD is a group of systemic diseases that occurs well in middle-aged and elderly men, with multiple organ involved and is highly treatable. Serum of IgG4 and IgG4-RD RI can be used as important reference indicators for clinical diagnosis and therapeutic evaluation. The hospitalization costs of IgG4-RD patients can be reasonably controlled from western medicine costs, surgical materials costs and examination costs.

Analyze the core gene of renal clear cell carcinoma based on bioinformatics and verify the expression of AURKB

LI Jun, TAO Run, WANG Weijie, ZHANG Jiajun

2023, 21(6): 1060-1063. doi: 10.16766/j.cnki.issn.1674-4152.003049

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Abstract:
Objective The target gene AURKB was screened in renal clear cell carcinoma by bioinformatics method, and its clinical significance in renal clear cell carcinoma was analyzed. Methods The GSE66271 dataset was downloaded from GEO database and the differential genes were screened. Hub genes were selected based on STRING database and Cytoscape software. The expression and prognostic relationship of AURKB gene in renal clear cell carcinoma were verified by GEPIA online database. The difference of AURKB expression in clear cell carcinoma and adjacent normal tissue was verified by immunohistochemistry. Results A total of 517 differential genes were obtained after analysis of GSE66271 data set, including 155 up-regulated genes and 362 down-regulated genes. AURKB was selected from 10 hub genes in the differential gene network for verification. GEPIA database analysis showed that AURKB high expression significantly reduced the overall survival (OS) and disease-free survival (DFS) in KIRC patients (P < 0.05), indicating that AURKB may be a KIRC oncogenic gene. In addition, AURKB expression was positively correlated with different disease stages in KIRC patients (P < 0.05). Immunohistochemical test showed that AURKB protein was mainly expressed in the nucleus, and the positive expression in cancer tissues (58.00%, 29/50) was higher than that in adjacent normal tissues (24.00%, 12/50), the difference was statistically significant (χ²=11.947, P=0.001). Conclusion AURKB is highly expressed in renal clear cell carcinoma and leads to poor prognosis, suggesting that AURKB may be an oncogenic genes for KIRC, and is expected to be a new therapeutic target for KIRC.

Whole-process management based on pre-habilitation concept in patients of the gasless transoral endoscopic thyroidectomy

LU Tianya, CHEN Jiaolong, LIU Jianjun, HU Chengwen

2023, 21(6): 1064-1068. doi: 10.16766/j.cnki.issn.1674-4152.003050

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Abstract:
Objective To study the effects of whole-process management based on the concept of pre-habilitation on pain, self-efficacy, anxiety, depression and postoperative rehabilitation in patients undergoing gasless transoral endoscopic thyroidectomy. Methods A total of 60 patients who were pre-hospitalized in the First Affiliated Hospital of USTC from January 2021 to June 2021 and received gasless transoral endoscopic thyroidectomy were selected as the control group and received routine care. A total of 60 patients who were pre-hospitalized in the First Affiliated Hospital of USTC from July 2021 to December 2021 and received gasless transoral endoscopic thyroidectomy were selected as the observation group and received the whole-process management based on pre-habilitation concept. Numeric rating scale digital was used to evaluate the pain of 3 days after operation of the 2 groups. General self-efficacy scale was used to evaluate the general self-efficacy of the two groups at discharge. Anxiety and depression of all patients were assessed by the hospital anxiety and depression scale at 3 times of admission, discharge and 1 month after discharge. Results After intervention, the Numeric rating scale in the observation group were lower than that in the control group at 3 days after operation (all P < 0.05); The self-efficacy score of patients in the observation group [(29.2?.7) points] was higher than that in the control group [(24.6?.8) points, t=5.009, P < 0.001]; The scores of anxiety and depression in the control group were higher than those in the observation group at discharge and 1 month after discharge (all P < 0.05); With the prolongation of postoperative time, anxiety and depression scores in each group decreased gradually, and there were time interaction and intergroup interaction between the two groups (all P < 0.05). The incidence of submandibular edema and skin congestion after operation in the observation group (17.2% and 5.2%) were significantly lower than those in the control group (35.2% and 16.7%, all P < 0.05). Conclusion The whole-process management based on the concept of pre-rehabilitation can effectively reduce the postoperative pain degree of patients with transendoscopic thyroid cancer, improve their self-efficacy, improve their negative mood, reduce their postoperative complications and promote the rapid recovery of patients.

Influence of FTS concept based on Chinese medicine characteristics on comfort and postoperative recovery of patients undergoing laparoscopic cholecystectomy

FENG Minli, TAO Fuzheng, ZHU Zhe, WU Liya, SHEN Haiping

2023, 21(6): 1069-1072. doi: 10.16766/j.cnki.issn.1674-4152.003051

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Abstract:
Objective To investigate the nursing effect of laparoscopic cholecystectomy patients guided by fast track surgery (FTS) concept with traditional chinese medicine (TCM) characteristics and its influence on patients ' comfort level and postoperative recovery. Methods A total of 180 patients who underwent laparoscopic cholecystectomy at Taizhou Integrated Traditional Chinese and Western Medicine Hospital from July 2020 to October 2022 were selected as the research subjects, and were divided into control group (90 cases) and observation group (90 cases) according to random number table method. Rapid rehabilitation surgical nursing and rapid rehabilitation surgical nursing based on the characteristics of TCM were respectively adopted. Clinical indicators, negative emotions, sleep quality, activities of daily living and complication rates were compared between the two groups. Results The time of first activity out of bed, exhaust time, defecation time and hospitalization time in the observation group were all shorter than those in the control group [(6.51?.25) h vs. (7.86?.92) h, (23.33?.46) h vs. (27.22?.55) h, (1.89?.54) d vs. (2.91?.92) d, (2.32?.04) d vs. (2.87?.25) d, all P < 0.05]. After the intervention, scores on the self-rating anxiety scale, the self-rating depression scale and Pittsburgh sleep quality index in the observation group were lower than those in the control group (all P < 0.05), and the score of daily living ability was higher than that in the control group [(82.54?.15) points vs. (78.45?.26) points]. The incidence of complications in the observation group was 5.56% (5/90), which was lower than 15.56% (14/90) in the control group (P < 0.05). Conclusion Based on the concept of TCM characteristics, it can effectively promote the postoperative rehabilitation of patients with laparoscopic cholecystectomy, relieve negative emotions, improve sleep quality, improve daily living ability, reduce the risk of complications, and significantly improve the comfort level of patients after surgery.

Effects of resistance-endurance exercise combined with cognitive-behavioral group psychotherapy on postoperative efficacy and lipid metabolism in patients with coronary heart disease

MAYIRE·Maimaiti, REYILA·Awuti, NIJATI·Abudureheman, PAREDANMU·Tuohuti, GUO Ju

2023, 21(6): 1073-1076. doi: 10.16766/j.cnki.issn.1674-4152.003052

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Abstract:
Objective To explore the effect of resistance-endurance exercise combined with cognitive-behavioral group psychotherapy on postoperative efficacy and lipid metabolism in patients with coronary heart disease, and to provide reference for clinical intervention. Methods A total of 100 patients with coronary heart disease admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2020 were selected and randomly divided into control group (50 cases) and observation group (50 cases) according to the random number table method. Routine intervention was given to the control group, while the observation group was given resistance-endurance exercise + cognitive-behavioral group psychotherapy. The curative effect, lipid metabolism, postoperative inflammatory cytokines [hypersensitive C-reactive protein (hs-CRP) and interleukin (IL-6), endothelin-1 (ET-1)], cardiac function index [left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), 6 min walking distance (6MWT)] and negative emotion [self-rating anxiety scale (SAS) and self-rating depression scale (SDS)] of the two groups were compared. Results The total effective rate of the observation group was significantly higher than that of the control group (88.00% vs. 70.00%, P < 0.05). After the intervention, triglyceride, total cholesterol, low density lipoprotein cholesterol and serum hs-CRP, IL-6 and ET-1 levels in the observation group were significantly lower than those in the control group (P < 0.05), and high density lipoprotein cholesterol was significantly higher than that in the control group (P < 0.05); NT-proBNP in the observation group was significantly lower than that in the control group (P < 0.05), and LVEF and 6MWT were significantly higher than those in the control group (P < 0.05); SAS and SDS scores of the observation group decreased compared with those of the control group (P < 0.05). Conclusion For patients with coronary heart disease, resistance-endurance exercise and cognitive-behavioral group psychotherapy can effectively improve postoperative efficacy, improve lipid metabolism, reduce the level of inflammatory cytokines, improve cardiac function, and reduce negative emotions in patients.

Effect of ladder nursing mode on medication compliance and social function of patients with bipolar disorder

CHEN Xinxia, HE Fei, CHEN Mengyi, FENG Hong

2023, 21(6): 1077-1080. doi: 10.16766/j.cnki.issn.1674-4152.003053

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Abstract:
Objective To analyze the application effect of ladder nursing mode in patients with bipolar disorder, as well as its impact on medication compliance and social function, providing new ideas for clinical nursing. Methods A total of 110 patients with bipolar disorder admitted in Shaoxing Seventh People ' s Hospital from January 2020 to January 2022 were selected as the study subjects. According to random number table method, they were divided into control group and observation group with 55 cases each. The patients in the control group were treated with routine nursing, while the patients in the observation group were treated with ladder nursing mode on the basis of the control group. The clinical symptoms, medication compliance and social function of patients in the two groups were compared using Hamilton depression scale (HAMD), hypomania self-rating scale (HCL-32), Morisky drug compliance scale and social function deficiency screening scale (SDSS) before and after intervention. Results After intervention, the HAMD and HCL-32 scores of the observation group patients were (14.04?.54) points and (5.02?.16) points, respectively, which were lower than the (16.81?.21) and (6.88?.83) points of the control group (P < 0.05). The compliance rate of patients in the observation group was 90.9% (50/55), higher than 76.4% (42/55) in the control group (P < 0.05). The total score of the SDSS scale in the observation group was (8.18?.20) points, which was lower than the control group [(9.71?.34) points], P < 0.05. Conclusion The ladder nursing model can improve the psychological status of patients with bipolar disorder, improve the compliance of patients with medication, and promote the recovery of social function.

Diagnosis and Treatment of Anemia Caused by Ancylostomiasis with Clinical Diagnostic and Therapeutic Thinking in General Practice: A Case Report

LI Jie, QING Di, SHI Tingting, ZHOU Fangming, LIU Shiping

2023, 21(6): 1081-1084. doi: 10.16766/j.cnki.issn.1674-4152.003054

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The incidence of ancylostomiasis has been significantly reduced. Anemia caused by ancylostomiasis is easy to be missed and misdiagnosed because of its lack of specificity in clinical manifestations. This article reports on the diagnosis and treatment process of a case of anemia caused by ancylostomiasis, discusses in detail the holistic clinical diagnosis and treatment thinking of general practitioners focusing on patients from the biological, psychological and social levels, and reviews the relevant knowledge of hookworm disease and anemia in combination with the literature, aiming to provide ideas and references for the diagnosis and treatment of such diseases by general practitioners at the grass-roots level, so as to achieve early detection and treatment, and reduce misdiagnosis and mistreatment.

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2023 Vol. 21, No. 6

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