2023 Vol. 21, No. 7

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Expert Forum
Practice of family physician contracted service under the whole process health management model in tertiary a-level hospital
MU Xingyu, ZHANG Lin, AN Kang, SHI Yi, LI Caizheng, SHE Yi, LI Shuangqing, SU Qiaoli
2023, 21(7): 1085-1088. doi: 10.16766/j.cnki.issn.1674-4152.003055
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  Objective  The family physician contracted service has carried out beneficial practices in China's community health service centers. Most of the tertiary A-level hospitals take community health service centers as the main body, and cooperate with community units to provide technical guidance and knowledge training for medical staff, and provide support for two-way referrals. The family physician contracted service model independently carried out in tertiary A-level hospitals needs to be explored.  Methods  We analyzed the family physician contract service based on the whole process health management conducted by the General Medicine Department of West China Hospital of Sichuan University in the past three years, summarized its operation mechanism, outlined the service model, and analyzed the possible problems in the implementation in the tertiary A-level hospitals.  Results  We have established the management organization structure, the management system of the contracted medical team, formulated the work process of each job posting, and improved the health management process of the contracted personnel. The family doctor team provides all-round medical care and whole process health management for family contract patients at different time nodes, and forms an up-down linkage mechanism with the community center to promote hierarchical diagnosis and treatment. With the family doctor team as the link, the family doctor contract service mode of whole process health management in tertiary A-level hospital has been established, forming a whole process health management service platform. How to better provide the contracted individuals with high-quality diagnosis and treatment technology of tertiary A-level hospitals, and how to implement the community link and connect with Healthy China 2030 needs further consideration.  Conclusion  The tertiary A-level hospital can also carry out the contracted service mode of family doctor based on the whole process health management, so as to provide beneficial exploration for the rational and optimal utilization of medical resources, promote hierarchical diagnosis and treatment, and improve the quality of medical service.
Special Topic/Cerebral Infarction Research
The effect and significance of cerebral infarction location on cognitive function
ZHAO Jianhua, ZHANG Jing, CAI Mengmeng, CHAO Linlin, SHI Jingjing, BAO Jieyu
2023, 21(7): 1089-1092. doi: 10.16766/j.cnki.issn.1674-4152.003056
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  Objective  To analyze the changes of clinical data and cognitive impairment in patients with cerebral infarction, and to evaluate the effect and significance of infarction location on cognitive function.  Methods  A total of 316 patients with acute cerebral infarction admitted to People's Hospital of Zhengzhou University from January 2020 to January 2021 were enrolled in this prospective observational study. Cognitive function was evaluated at 2 weeks, 6 months, and 12 months after the onset of stroke. According to the evaluation, the patients were divided into a post-stroke cognitive decline group (PSCI group, 44 cases) and a non-decline group (NPSCI group, 272 cases), and the changes of cognitive function were evaluated.  Results  The proportion of infarction sites involving frontal lobe (15.91%, 7/44), basal ganglia (13.64%, 6/44) and thalamus (18.18%, 8/44) in PSCI group were higher than those in NPSCI group [frontal lobe (4.78%, 13/272), basal ganglia (5.51%, 15/272) and thalamus (6.62%, 18/272)], the differences between the two groups were statistically significant (all P < 0.05). Repeated measures analysis of variance showed that the cognitive function scores of the two groups were significantly different (P < 0.001). Pairwise comparison showed that there were statistically significant differences between 2 weeks after onset and 6 and 12 months after onset (P < 0.001). Further generalized estimating equation showed that there were significant differences in the frontal lobe, basal ganglia and thalamus when the infarction was involved (P < 0.05). At the same time, it was found that the difference of cognitive function between 12 months and 2 weeks, 6 months after onset was statistically significant (P < 0.05), that was, time was also an influencing factor of cognitive function.  Conclusion  Long-term cognitive impairment is more likely to occur in patients with infarcts located in frontal lobe, basal ganglia and thalamus.
Study on the correlation between miR-184 expression levels and disease severity, inflammatory factors in patients with acute cerebral infarction
SU Yan, LIU Kai, DU Yuanyuan, XIONG Bochao, LIANG Lei, LUO Song, QU Hongdang
2023, 21(7): 1093-1096. doi: 10.16766/j.cnki.issn.1674-4152.003057
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  Objective  To investigate the correlation between serum miR-184 levels and severity of disease and with inflammatory factors in patients with acute cerebral infarction (ACI).  Methods  A total of 74 ACI patients and 41 healthy individuals were included in the Neurology Department of the First Affiliated Hospital of Bengbu Medical College from January to December 2021. The expression levels of miR-184, IL-6, TNF-α and CRP in the serum of the two groups were detected using qPCR and ELISA methods; the levels between two groups were compared, and Pearson correlation analysis was applied to study the correlation between miR-184 levels and inflammatory factors in ACI patients.  Results  Compared with the control group, the levels of miR-184 in the ACI group decreased (P < 0.001), while the levels of IL-6, TNF-α, and CRP increased (all P < 0.05). The larger the infarct size, the higher the NHISS score, and the lower the miR-184 level. Spearman correlation analysis showed that the level of serum miR-184 in ACI patients was negatively correlated with disease severity and infarct volume (rs=-0.641, -0.620, both P < 0.05). The level of serum miR-184 in ACI patients was also correlated with the levels of inflammatory factors IL-6, TNF-α and CRP levels (rs=-0.560, -0.389, -0.565, all P < 0.05).  Conclusion  miR-184 can be used as a serological marker for diagnosing ACI and evaluating the severity of the condition, and is a promising target for the treatment of ACI.
Effects of edaravone dexborneol combined with tirofiban on cerebral hemodynamics and oxidative stress in patients with acute cerebral infarction
HUANG Liangtong, XU Lingyan
2023, 21(7): 1097-1100. doi: 10.16766/j.cnki.issn.1674-4152.003058
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  Objective  In recent years, the incidence of acute cerebral infarction has been increased year by year. In order to find more effective methods for the treatment of acute cerebral infarction, this study used edaravone dexborneol combined with tirofiban in the treatment of patients with acute cerebral infarction, to investigate its effect on cerebral hemodynamics and oxidative stress.  Methods  A total of 220 patients with acute cerebral infarction who admitted to Lishui Central Hospital from January 2021 to March 2022 were selected as research objects, and they were divided into group A (n=108) and group B (n=112) by therapeutic method. Group A was treated with tirofiban, i.e. conventional treatment, and group B was treated with edaravone dexborneol on the basis of the group A. The clinical efficacy, adverse effects, cerebral hemodynamics, oxidative stress and serum inflammatory factors were compared between the two groups.  Results  After treatment, the national institutes of health stroke scale (NIHSS) of the two groups was significantly lower than that before treatment, and the NIHSS of group B was significantly lower than that of group A [(3.44±0.53) points vs. (3.67±0.77) points, t=2.589, P=0.010]. After treatment, the levels of resistance index, malondialdehyde, norepinephrine, tumor necrosis factor-α, interleukin-6 and hypersensitive C-reactive protein in the two groups were significantly lower than those before treatment, and those in the group B were significantly lower than those in the group A (all P < 0.05); The levels of maximum blood flow velocity, average blood flow velocity, and superoxide dismutase in the two groups were significantly higher than those before treatment, and those in the group B were significantly higher than those in the group A (all P < 0.05). There was no statistically significant difference in the occurrence of gingival bleeding, gastrointestinal reactions, dizziness, headache and intracranial hemorrhage between the two groups (P>0.05).  Conclusion  Edaravone dexborneol in combination with tirofiban showed better efficacy in patients with acute cerebral infarction, which may improve the effects of cerebral hemodynamics, oxidative stress and inflammation, however, had no significant effect on adverse reactions.
General Practice Research
Analysis of circRNA and mRNA expression profiles in Alzheimer's disease mice treated with islet amyloid polypeptide
LI Xiaoxiong, LI Jinping, HUANG Jie, MA Jingjing, HOU Mingliang, MA Linqiu, WANG Congguo, ZHOU Huadong
2023, 21(7): 1101-1104. doi: 10.16766/j.cnki.issn.1674-4152.003059
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  Objective  To investigate the changes of circulating RNA (circRNA) and messenger RNA (mRNA) expression profiles in brain tissue of mice with Alzheimer's disease (AD) treated with islet amyloid polypeptide (IAPP) and the molecular mechanisms.  Methods  According to the number table method, 6 APP/PS1 mice were randomly divided into IAPP intervention group and reference group, 3 mice in each group. The intervention group mice were injected intraperitoneally with 0.5 μmol/L of IAPP (200 μg/kg), the reference group mice were injected with the same dose of phosphate buffer saline. Differentially expressed circRNAs and mRNAs between the two groups of mice were detected using gene chip technology. Chip results were validated by qRT-PCR. Differentially expressed mRNAs were analyzed by GO and KEGG pathways.  Results  According to the screening criteria of difference fold change (|FC|) ≥1.5 and P < 0.05, there were 899 differentially expressed circRNAs, 343 up-regulated and 556 down-regulated, and 2 257 differentially expressed mRNAs, 1 310 up-regulated and 947 down-regulated, between the IAPP intervention group and the reference group. qRT-PCR validation results were consistent with the gene chip results. GO analysis showed that the differentially expressed mRNAs were mainly enriched in G protein-coupled receptor, cell metabolism and other biological functions. KEGG pathway analysis showed that they were mainly involved in citrate cycle, proteasome, IL-17 and chemokine signaling pathway, etc.  Conclusion  The expression profiles of circRNAs and mRNAs in the brain tissue of AD mice were significantly changed after intraperitoneal injection of IAPP, suggesting that these differentially expressed circRNAs and mRNAs may be the key mechanisms of IAPP treatment in AD mice.
Efficacy of cyclophosphamide combined with glucocorticoids therapy with different degrees of hematuria IgA nephropathy
SU Jili, ZHOU Xiaoshuang, FAN Xiuzhao, HAO Huiqiang, TIAN Shuangshuang, HUI Dongna, HAN Xiutao
2023, 21(7): 1105-1108. doi: 10.16766/j.cnki.issn.1674-4152.003060
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  Objective  To evaluate the effect of cyclophosphamide (CTX) combined with glucocorticoids (GS) in the treatment of primary IgA nephropathy (IgAN) with different degrees of hematuria, and provide reference for therapy of IgAN.  Methods  The clinical data of the primary IgAN patients treated with CTX and GS at the Shanxi Provincial People's Hospital from January 2015 to December 2021 were retrospectively collected. According to the degree of baseline hematuria, they were divided into mild hematuria group [urinary red blood cell count (URBC) < 30/high-power field (HPF)] and severe hematuria group (URBC≥30/HPF). The changes of renal function before therapy and 1st, 3rd and 6th month after therapy were compared between the two groups. The main outcomes were proteinuria remission rate, estimated glomerular filtration rate (eGFR) slope. The secondary outcomes were serum creatinine (Scr), blood urea nitrogen (BUN), eGFR and adverse reactions.  Results  A total of 132 IgAN patients were included, 95 cases in the mild hematuria group and 37 cases in the severe hematuria group. After therapy, proteinuria remission rate and eGFR slope in the severe hematuria group were higher than those in the mild hematuria group, and the difference between the two groups was statistically significant (all P < 0.05). Scr in the severe hematuria group showed a downward trend, while that in the mild hematuria group showed an upward trend, and the difference between the groups was statistically significant (P < 0.05). eGFR in both groups showed a trend of decreasing first and then increasing. The change of eGFR in the severe hematuria group was more obvious than that in the mild hematuria group (P < 0.05). BUN in both groups showed a trend of increasing first and then decreasing. The level of BUN in the severe hematuria group was lower than that in the mild hematuria group at all time points (P < 0.05).  Conclusion  The combination of CTX and GS has a good therapeutic effect on IgAN patients with severe hematuria. The level of hematuria before therapy may be latent basis for the selection of therapy decisions for IgAN.
Expression of KLHL7 in non-small cell lung cancer and its clinical significance
HUANG Ting, GONG Huiyuan, TANG Zhen, LI Wei, ZHANG Lei, LI Xiaojun, GAO Xiong
2023, 21(7): 1109-1112. doi: 10.16766/j.cnki.issn.1674-4152.003061
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  Objective  To investigate the correlation between the expression of Kelch-like family member 7 (KLHL7) in non-small cell lung cancer (NSCLC) tissue and paracancerous tissue and the prognosis of NSCLC patients.  Methods  The difference of KLHL7 expression in NSCLC tissue and paracancerous tissue was analyzed by using TIMER and UALCAN database respectively. The Kaplan-Meier plotter website was used to analyze the effects of KLHL7 expression levels on the prognosis of patients with NSCLC. A total of 96 patients with NSCLC who received surgical treatment in the First Affiliated Hospital of Bengbu Medical College from January 2014 to December 2016 were selected. Immunohistochemistry was used to detect the expression levels of KLHL7 in NSCLC tissue and paracancerous tissue.  Results  Bioinformatics analysis found that the expression of KLHL7 in NSCLC tissue was significantly increased and the prognosis was poor. Immunohistochemistry staining showed that the positive rate of KLHL7 protein expression in NSCLC tissue was significantly higher than that in paracancerous tissue (57.3% vs. 3.1%, P < 0.001). High KLHL7 expression was significantly correlated with diameter of tumor >3 cm, low tumor cell differentiation, lymph node metastasis and high TNM stage (all P < 0.05). The results of K-M survival analysis showed that tumor diameter, tumor cell differentiation, lymph node metastasis, TNM stage and KLHL7 expression level were all prognostic factors of NSCLC patients (all P < 0.05). Multivariate analysis showed that low tumor cell differentiation, lymph node metastasis, high TNM stage and high KLHL7 expression were independent risk factors affecting postoperative survival time of NSCLC patients (all P < 0.05).  Conclusion  KLHL7 is highly expressed in NSCLC tissue and correlated with tumor progression, which is an independent risk factor affecting prognosis of patients with NSCLC and has certain clinical value for prognosis assessment.
Study on the changes of cortical excitability in patients with postherpetic neuralgia evaluated by transcranial magnetic stimulation
YANG Yiling, LI Yuee, ZHANG Junfeng, ZHANG Yun
2023, 21(7): 1113-1116. doi: 10.16766/j.cnki.issn.1674-4152.003062
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  Objective  To explore differences of cortical excitability assessed by transcranial magnetic stimulation (TMS) between patients with postherpetic neuralgia (PHN) and healthy controls, and to examine their relationships with pain symptoms severity.  Methods  A total of 30 PHN patients and 30 age-and sex-matched healthy controls underwent single- and paired-pulse TMS applied to the left and right motor cortex in Outpatient Department of the First Affiliated Guangdong Pharmaceutical University from August 2022 to March 2023. The test indexes included resting motor threshold (RMT), mean wave amplitude of motor evoked potentials (MEPs) at the optimal stimulation point, and cortical resting period (SP). Three different stimulation intensities (CS=70%/80%/90% AMT) with an interval of 2 ms were used to observe the intracortical inhibition (SICI) and the stimulation interval of 12 ms intracortical ease (SICF) index. The extent of PHN disease was assessed using the disease course, visual analog scoring scale (VAS).  Results  Compared with healthy controls (55.25±5.05), patients with PHN demonstrated significantly increased RMT values (60.91±5.52) in contralateral hemisphere (P < 0.05), while average MEPs, SP and SICF showed no significant differences between PHN patients and healthy controls (P>0.05). SICI measurements in the motor cortex of the affected dominant area were higher in the PHN group (0.81±0.09) than that in the healthy control group (0.73±0.08, P < 0.05) under the stimulation intensity of 70% AMT. Correlation analysis revealed a positive correlation between SICI measurements in the affected dominant cortical area and disease duration in the PHN group (r=0.323, P < 0.05).  Conclusion  Patients with PHN have diminished motor cortical excitability in the affected dominant area and impaired cortical inhibition in the affected dominant area, and the degree of impairment correlates with the duration of the disease.
Knockdown of EPHA2 regulates autophagy and biological behavior of bladder cancer cell through mTOR phosphorylation
ZHANG Yongqi, ZOU Zhenhai, WU Mengqi, LIU Beibei, GUO Yuanyuan, LIU Jianmin
2023, 21(7): 1117-1120. doi: 10.16766/j.cnki.issn.1674-4152.003063
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  Objective  To explore the molecular mechanism by which Si-EPHA2 interferes with the biological behaviour of bladder cancer cells by targeting mTOR autophagy pathways.  Methods  The expression levels of EPHA2 in bladder cancer tissues and paracancerous tissues, as well as bladder cancer cells (T24) and normal urinary tract epithelial cells (SV-HUC-1) were examined by Western blotting assay and qRT-PCR assay. The expression of EPHA2 was knocked down in bladder cancer T24 cells by siRNA transfection to constitute an experimental model of bladder cancer cells with inhibited EPHA2 expression, and the cells were divided into si-NC blank for control group, and si-EPHA2 for experimental group. Changes in bladder cancer cell proliferation were detected by CCK 8 assay, changes in bladder cancer cell migration and invasion by Transwell assay, and changes in bladder cancer cell apoptosis by flow cytometry assay; the level of bladder cancer mTOR phosphorylation level and the expression of autophagy marker LC3 were detected by Western blotting assay after knockdown of EPHA2 expression; Knockdown of TSC1 was continued on top of knockdown of EPHA2-expressing T24 cells to detect changes in bladder cancer cell biology.  Results  EPHA2 showed higher expression levels in bladder cancer tissues and cells (P < 0.05); knockdown of EPHA2 decreased mTOR phosphorylation levels and increased autophagy levels (P < 0.05); knockdown of EPHA2 significantly inhibited the proliferation, migration and invasion ability of bladder cancer cells (P < 0.05) and promoted apoptosis (P < 0.05); on the basis of knockdown of EPHA2 expression, knockdown of TSC1 to promote mTOR phosphorylation partially reversed the effect of Si-EPHA2 on the biological behavior of bladder cancer cells (P < 0.05).  Conclusion  Knockdown of EPHA2 can target and inhibit mTOR phosphorylation in bladder cancer cells, enhance autophagy, inhibit the proliferation, migration and invasion ability of bladder cancer cell.
Predictive value of NRS2002 and PNI nutritional screening methods in the prognosis of patients with gastric cancer
BA Minqing, CHEN Liu, ZHU Xiaoqiong, HU Kongwang, ZHAO Cunxi
2023, 21(7): 1121-1124. doi: 10.16766/j.cnki.issn.1674-4152.003064
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  Objective  To compare the predictive value of nutritional risk screening 2002 (NRS2002) and prognostic nutritional index (PNI) in the short-term prognosis of gastric cancer.  Methods  A total of 381 gastric cancer patients who attended Anhui Cancer Hospital and underwent surgery from April 2021 to May 2022 were selected for preoperative nutritional assessment using NRS2002 and PNI to analyze the relationship with general clinical information and prognosis of gastric cancer patients. Binary logistic regression was used to analyze the influencing factors of malnutrition. The predictive value of two methods was compared using the area under the receiver operating characteristic (ROC) curve (AUC).  Results  Preoperative nutritional assessment by NRS2002 found that age, TNM stage, and degree of differentiation were independent prognostic factors. Preoperative nutritional assessment by PNI revealed that the patient's nutritional status, age, TNM stage, and degree of differentiation were independent prognostic factors. Both nutritional screening methods showed that the postoperative hospitalization time [(11.57±3.73) days vs. (10.19±2.66) days; (11.63±3.65) days vs. (10.16±2.68) days)], hospitalization costs[(51 078±9 204) ￥ vs. (45 574±2 406)￥; (50 796±8 992)￥ vs. (45 635±8 234)￥, and postoperative complication rate in the group with nutritional risk were higher than those in the group without nutritional risk, and the difference was statistically significant (all P < 0.05). The prediction effect of NRS2002 (AUC=0.73) was slightly better than that of PNI (AUC=0.68).  Conclusion  NRS2002 and PNI nutritional evaluation methods have clinical value in predicting short-term prognosis of gastric cancer patients, and NRS2002 has higher specificity and sensitivity than PNI.
Application of ultrasound measurement of inferior vena cava collapse index in evaluating pre-anesthesia blood volume in critically ill pregnant women
GAO Jiaojiao, LI Xiaohong, TAO Jing, DAI Wentao
2023, 21(7): 1125-1129. doi: 10.16766/j.cnki.issn.1674-4152.003065
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  Objective  To explore the clinical value of ultrasound measurement of inferior vena cava collapse index (IVC-CI) in critically ill pregnant women for evaluating their pre-anesthesia blood volume.  Methods  A total of 90 critically ill pregnant women who underwent elective cesarean section at the First Affiliated Hospital of Bengbu Medical College from September 2021 to July 2022 were selected and randomly divided into a routine fluid replacement group (C group), a central venous pressure fluid replacement group (CVP group), and an ultrasound measured inferior vena cava fluid replacement group (IVC group), with 30 cases in each group. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), lactate value (Lac), surgical time, bleeding volume, total fluid intake, vasoactive drug use rate, and incidence of postoperative hypotension among three groups of patients at different time points were record and compared. The central venous pressure (CVP), maximum inferior vena cava diameter (dIVCmax), and minimum inferior vena cava diameter (dIVCmin) before and after fluid replacement in the IVC group were record, the IVC-CI was calculated and analyzed its correlation with CVP.  Results  At 5 minutes after anesthesia (T1), after fetal removal (T2), and at the end of surgery (T3), the SBP, DBP, and MAP values in Group C were lower than those in the CVP and IVC groups (P<0.05). At time point T1, the HR and lactate values in Group C were higher than those in the CVP and IVC groups (F=11.650, 7.860, P<0.05). The total liquid intake in Group C [(740.00±156.01)mL] was lower than that in the CVP [(975.00±198.54)mL] and IVC groups [(967.33±179.60)mL, F=16.711, P<0.001]. In the IVC group, dIVCmax and dIVCmin were positively correlated with CVP (r=0.937, 0.873, P<0.05), while IVC-CI was negatively correlated with CVP (r=-0.688, P<0.05).  Conclusion  The inferior vena cava collapse index can be used to evaluate the pre-anesthesia blood volume of critically ill pregnant women and guide fluid replacement.
Clinical experience of intravenous removal of lead electrodes in middle-aged and elderly patients with delayed infection of cardiac implantable electronic device
WU Mengwei, HU Yidong, YANG Liu, HU Kai, SU Hao
2023, 21(7): 1130-1133. doi: 10.16766/j.cnki.issn.1674-4152.003066
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  Objective  To retrospectively analyze the safety and feasibility of transvenous lead extraction (TLE) in middle-aged and elderly with delayed infection of cardiac implantable electronic device (CIED).  Methods  A total of 60 TLE patients with delayed infection of CIED hospitalized at the First Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from May 2015 to May 2021 were collected. The patients were divided into the younger group (< 70 years old, n=32) and the middle-aged and elderly group (≥70 years old, n=28) according to the age. The baseline data, surgical data and postoperative complications of the patients were collected to analyze the efficacy and safety of transvenous electrode removal in the two groups.  Results  Among the 60 patients enrolled, the age of the middle-aged and elderly group was (77.5±4.7) years old with 18 male patients (64.3%, 18/28), the age of the younger group was (57.1±8.7) years old with 23 male patients (71.9%, 23/32). The differences of two groups on complications for patients such as atrial fibrillation [9.4% (3/32) vs. 35.7% (10/28)], hypertension [3.1% (1/32) vs. 53.6% (15/28)], coronary heart disease [3.1% (1/32) vs. 25.0% (7/28)] were statistically significant (all P<0.05). There was no significant difference in complication rate [3.1% (1/32) vs. 7.1% (2/28), P=0.476] and complete surgical success rate [96.9% (31/32) vs. 96.4% (27/28), P=0.923] between the two groups.  Conclusion  The safety and feasibility of TLE in middle-aged and elderly patients with delayed infection of CIED is safe and feasible.
Clinical features, treatment and prognosis of vaginal intraepithelial neoplasia
WANG Yafei, WANG Liqun, YE Guoliu
2023, 21(7): 1134-1137. doi: 10.16766/j.cnki.issn.1674-4152.003067
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  Objective  To study the general clinical characteristics, treatment and prognosis of vaginal intraepithelial neoplasia (VAIN).  Methods  The clinical data of 168 patients with histologically confirmed VAIN admitted to the First Affiliated Hospital of Bengbu Medical College from January 2019 to February 2022 were retrospectively collected. The sensitivity of different screening methods to the diagnosis of VAIN and the regression of lesions after treatment were compared.  Results  The average age of the patients was (49.52±11.63) years old, of which 115 cases (68.5%) were 45 years old and above, and 57.1% of the patients were postmenopausal. The screening sensitivity of cytology, HPV, colposcopy, and cytology combined with HPV were 61.5%, 92.4%, 84.6% and 95.0%, respectively. The overall sensitivity of HPV screening was significantly higher than that of cytology (P=0.001). There was no significant difference in the sensitivity of cytological screening between patients after hysterectomy and those without hysterectomy (P=0.718). The pathological coincidence rate of colposcopy was higher than that of cytology (P=0.001). There was a positive correlation between the grade of VAIN and the grade of cervical lesions (r=0.162, P=0.036). HPV16 was the most common genotype of VAIN. Among the 97 patients who were followed up after treatment, 83 patients (85.6%) had lesion degradation and regression, of which 2 patients relapsed again after regression and improved after re-treatment. Five patients (5.2%) had lesion progression, of which 1 patient with VAIN3 progressed to vaginal cancer. The prognosis of VAIN patients may be related to age.  Conclusion  Cytology, HPV and colposcopy can still be used as a diagnostic procedure for VAIN. After active treatment and follow-up, most patients have a good prognosis.
Clinical efficacy of sacubitril/valsartan in the treatment of hypertension with left ventricular hypertrophy research
ZHANG Tingting, GE Huijuan, ZHUANG Xiaosai, REN Lei, NING Bin
2023, 21(7): 1138-1142. doi: 10.16766/j.cnki.issn.1674-4152.003068
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  Objective  To explore the role of sacubitril/valsartan in reversing hypertension with left ventricular hypertrophy.  Methods  Ninety patients with hypertension and left ventricular hypertrophy who visited the Department of Cardiology of Fuyang People's Hospital from February to August 2021 were selected as the research objects, including 56 males and 34 females. They were divided into sacubitril/valsartan (A) group, benazepril (B) group and valsartan (C) group according to random numerical table, with 30 cases in each group, and followed up for 12 months. The degree of left ventricular hypertrophy index interventricular septal thickness (IVST), left ventricular posterior wall thickness in diastole (LVPWd), left ventricular mass index (LVMI), left ventricular remodeling and functional indexes such as left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), the blood pressure compliance rate, clinical efficacy, occurrence of adverse reactions and complications were compared between the three groups.  Results  After treatment, the left ventricular hypertrophy index (IVST, LVPWd and LVMI) and the left ventricular remodeling and functional index (LVEDD and LVEF) of the three groups were significantly improved than those before treatment, all the difference was statistically significant (all P<0.05), and the IVST, LVPWd, LVMI, LVEDD, LVEF of the A group were 10.00 (10.00, 11.00) mm, 10.00 (9.25, 10.75) mm, 81.38 (71.03, 99.34) g/m2, 43.00 (41.00, 47.75) mm and 64.00%(60.00%, 67.00%), which were better than the other two groups, the difference in amplitude of change was statistically significant (P<0.05). The blood pressure compliance rate were 86.67% of the group A, 56.67% of the group B, and 53.33% of the group C. The blood pressure compliance rate in Group A significantly increased, with a statistically significant difference (all P<0.05). There was no significant difference in the incidence of adverse reactions and complications during treatment among the three groups (P>0.05).  Conclusion  Sacubitril/valsartan can relieve the degree of left ventricular hypertrophy in the treatment of hypertension complicated with left ventricular hypertrophy, improve ventricular remodeling and patient prognosis, the effect of reducing pressure is obvious, and the safety is good.
Changes of peripheral blood miR-145 level and its effect on PAI-1 in patients with repeated implantation failure
DU Dan, YANG Fan, HE Ping, CHEN Hui, ZHAO Yan, WANG Jing, LIU Haipeng, PENG Shuming
2023, 21(7): 1143-1146. doi: 10.16766/j.cnki.issn.1674-4152.003069
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  Objective  To investigate the changes of serum miR-145 levels and their impact on plasminogen activator inhibitor 1 (PAI-1) in patients with repeated implantation failure before egg retrieval and embryo transfer.  Methods  A total of 71 cases of repeated implantation failure (RIF) in the Reproductive Medicine Center of the First People's Hospital of chenzhou were included in the observation group, and 551 cases of successful pregnancy were included in the control group. The correlation between miR-145 and PAI-1, the independent relationship between miR-145 and RIF, and the evaluation value of miR-145 on RIF were analyzed.  Results  The levels of miR-145 [(1.09±0.13)ng/mL vs. (0.98±0.14) ng/mL, F=8.419, P=0.004; (1.19±0.16) ng/mL vs. (1.01±0.18) ng/mL, F=58.184, P<0.001] and PAI-1 [(21.36±6.28) ng/mL vs. (15.09±7.16) ng/mL, F=6.463, P=0.017; (25.36±6.18) ng/mL vs.(17.32±6.99) ng/mL, F=78.536, P<0.001] in the observation group were higher than those in the control group before egg retrieval and embryo transfer. There was a positive correlation between miR-145 and PAI-1 in the observation group before egg retrieval and embryo transfer (r=0.725, P<0.001; r=0.671, P<0.001). miR-145 was independently correlated with RIF before egg retrieval and embryo transfer (P<0.05). The AUC values of RIF evaluated by miR-145 before egg retrieval and embryo transfer were 0.690 and 0.774, respectively.  Conclusion  Patients with RIF infertility have abnormally high expression of miR-145, and it may reduce endometrial receptivity by targeting PAI-1 expression, thus participating in the process of RIF.
Correlation between frailty and self-efficacy in patients with type 2 diabetes and its influencing factors
ZHANG Ying, ZHENG Jing, GUAN Yuxiang, XU Juan, WANG Chao
2023, 21(7): 1153-1156. doi: 10.16766/j.cnki.issn.1674-4152.003072
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  Objective  To investigate the current status of frailty in patients with type 2 diabetes mellitus (T2DM) and analyze the related factors of frailty, and explore the relationship between frailty and self-efficacy in patients with T2DM.  Methods  This study was a cross-sectional study. Patients with T2DM hospitalized in a tertiary A-level hospital in Anhui Province from March to October 2021 were selected as the research object. General data of patients, scores of Tilburg Weakness Scale and diabetes Management Self efficacy Scale were collected and statistically analyzed with SPSS 26.0.  Results  (1) A total of 296 hospitalized patients with T2DM were included in the study, including 120 frailty patients (frailty group) and 176 no frailty patients (no-frailty group). The frailty score of the frailty group was (7.00±1.76) points, the score of the no-frailty group was (3.16±0.96) points. There were significant differences between the two groups (P<0.05). (2) The score of Chinese-diabetes management self-efficacy scale (C-DMSES) was (124.81±28.42) points in the frailty group and (140.71±22.11) points in the no-frailty group, the difference between the two groups was statistically significant (P<0.05). (3) Logistic regression analysis showed that women, low education level, more chronic diseases, and low self-efficacy score were independent risk factors for type 2 diabetes patients' weakness (all P<0.05). (4) Spearman correlation analysis showed that the weakness of T2DM patients was negatively correlated with self-efficacy scores (r=-0.460, P<0.01).  Conclusion  The frailty is negatively significantly associated with self-efficacy. Medical staff needs to pay attention to self-efficacy and frailty of patients with T2DM at the same time, carry out comprehensive intervention, and improve self-efficacy, and delay the development of frailty.
Study on the variability curve of family mode pulmonary rehabilitation compliance in patients with chronic obstructive pulmonary disease
ZHAI Wenshuang, CAI Hanjiong, QIAN Jia, GUO Liqin
2023, 21(7): 1157-1160. doi: 10.16766/j.cnki.issn.1674-4152.003073
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  Objective  To study the variety rule of family mode pulmonary rehabilitation compliance in patients with chronic obstructive pulmonary disease (COPD), find influencing factors, and identify intervention nodes.  Methods  Eighty-two COPD patients who were hospitalized in the Department of Respiratory and Critical Care Medicine, Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January to December 2021 were selected as the research subjects, and a prospective observational study was conducted. For the patients included in the study, they filled out the rehabilitation manual during hospitalization, established rehabilitation files, teach pulmonary rehabilitation methods, and issued pulmonary rehabilitation prescriptions. During the 0-12 weeks after the patients were discharged from the hospital, telephone or on-site follow-up was conducted every 2 weeks, and the adherence level score of each follow-up was recorded according to the "COPD Patient Pulmonary Function Exercise Adherence Scale". SPSS 25.0 was used to analyze the date, and MATLAB 2020 software was used to fit the data, draw variation curves, and search for compliance influencing factors and change time nodes.  Results  The compliance level of COPD patients with family mode pulmonary rehabilitation was generally low, increased from 0 to 4 weeks, and gradually decreased after 4 weeks. The compliance level was the highest in the fourth week, with an average of (34.46±5.99) points. There were significant differences in the level of compliance of patients with different education levels, ages and medical payment methods (P<0.01). Multivariate regression analysis showed that medical payment methods were the main factors affecting patient compliance.  Conclusion  The compliance level of family mode pulmonary rehabilitation in COPD patients is generally low, and the compliance variation curve first increases and then decreases with time. Full medical insurance payment, choosing equipment suitable for family mode pulmonary rehabilitation and respiratory function exercise, and providing correct intervention in the stagnant and wandering area at the time when the compliance level gradually decreases in 4 to 6 weeks after discharge, are conducive to improving the family model of COPD patients rehabilitation compliance.
Predictive role of peripheral blood cell parameters in the cancer development of hydatidiform moles
LI Mingwei, WU Fang, CHENG Jin, ZHOU Ping
2023, 21(7): 1161-1164. doi: 10.16766/j.cnki.issn.1674-4152.003074
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  Objective  To investigate the clinical value of red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet count (PLT) and absolute neutrophil count (N) in predicting malignant transformation of hydatidiform mole prior to the initial curettage.  Methods  A total of 88 hydatidiform moles patients with curettage and follow-up in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Anhui University of Science and Technology from January 2011 to May 2021 were selected. Patients were divided into malignant group (76 cases) and non-malignant group (12 cases) according to the serum β-HCG results after curettage.The platelet count(PLT), neutrophil(N), neutrophil to lymphocyte ratio(NLR) and red blood cell distribution width (RDW) before the first curettage in the 2 groups were analyzed. The critical value of those markers was calculated by the area under the curve (AUC) statistic derived from the ROC curves.  Results  (1) Age, gestational weeks, Logβ-HCG, RDW, PDW, N and NLR in patients with malignant group were higher than that in non-malignant group, while absolute lymphocyte values (L) and PLT in the malignant group was significantly lower than that in non-malignant group(P<0.05). (2) Multivariate logistic regression analysis revealed that RDW, NLR and N increase as well as PLT decreased were independent risk factors for hydatidiform mole canceration. (3) ROC curve analysis that among the clinical markers measured before first curettage, for RDW= 14.95, NLR=3.84, N=7.12×109/L and PLT=182.00×109/L, the AUC was estimated as 0.925, 0.946, 0.893 and 0.713, respectively. (4)According to the threshold grouping of RDW, NLR, N and PLT, the malignant transformation rate of high RDW, NLR and N group were higher than patients in the low RDW, NLR and N group, while the malignant transformation rate of low PLT was higher than patients in the high PLT group (P<0.05).  Conclusion  RDW, NLR, PLT and N with hydatidiform mole patients before the first curettage have certain clinical guiding significance in predicting the malignant transformation of hydatidiform moles.
Genotypic characteristics and clinical significance of cytomegalovirus infection in children with thrombocytopenia under 12 months old
LIU Hui, SANG Xu, WANG Lei, ZHOU Rui, DONG Huaifu
2023, 21(7): 1165-1168. doi: 10.16766/j.cnki.issn.1674-4152.003075
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  Objective  To collect clinical cases of cytomegalovirus (CMV) related thrombocytopenia in infants and study the relationship between glycoprotein B, H (gB, gH) genotypes and CMV related thrombocytopenia.  Methods  A total of 697 CMV-positive cases treated at the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2021 were selected, including 29 children with hypoplastic platelets (age < 1 year), all of whom were newly first diagnosed children without persistent thrombocytopenia for >3 months. The genotypes of gB and gH were analyzed by nested polymerase chain reaction (nPCR) and restriction length polymorphism (RFLP).  Results  Among 697 children with CMV infection, 76 cases were congenital infection, 378 cases were perinatal infection and 243 cases were postpartum infection. Twenty-nine CMV-patients with good immune function were analyzed for related thrombocytopenia, including 7 (9.2%) congenital infection, 14 (3.7%) perinatal infection and 8 (3.3%) postpartum infection. Platelet count at diagnosis < 20×109/L was a common manifestation of CMV-related thrombocytopenia in perinatal infection. Among them, the incidence of hepatobiliary symptoms found in the congenital and perinatal infection groups was significantly higher. Immunoglobulin was used in 24 cases, and antiviral drugs were used in 9 cases. The most common CMV genotypes in this study were gB1 (60.7%) and gH2 (57.1%).  Conclusion  Thrombocytopenia is a common clinical manifestation of congenital CMV infection. The gB1 genotype has strong virulence. The gH2 genotype is closely related to thrombocytopenia.
The necessity for a prenatal diagnosis of isolated fetal choroid plexus cyst
SUN Yuxiu, TANG Junxiang, WANG Chaohong, WANG Yaqun, WANG Senlin, ZHU Jiansheng
2023, 21(7): 1169-1171. doi: 10.16766/j.cnki.issn.1674-4152.003076
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  Objective  Karyotype analysis and chromosomal microarray analysis were used to explore the necessity of prenatal diagnosis of choroid plexus cyst (CPC), to provide a basis for prenatal consultation.  Methods  A total of 276 pregnant women who were diagnosed as fetal choroid plexus cysts by ultrasound and voluntarily underwent amniotic fluid puncture after prenatal consultation in Anhui Maternal and Child Health Hospital were selected from January 2017 to January 2022. All pregnant women were divided into 5 groups based on whether they incorporate high-risk factors. G-band chromosome karyotype analysis and chromosome microarray analysis (CMA) were performed to analyze the incidence of chromosomal abnormalities in choroid plexus cysts in each group.  Results  Total 18 cases of chromosomal abnormalities were detected in 276 cases. There were 105 cases of isolated choroid plexus cyst, including 5 cases of chromosomal abnormalities; 45 elderly patients with choroid plexus cyst (the age of pregnant women was older than 35 years old), including 4 cases of chromosomal abnormalities; 84 cases of high risk of choroid plexus cyst combined with serological screening, including 6 cases of chromosomal abnormalities; 35 cases of choroid plexus cyst with other ultrasonic soft indexes, including 2 cases of chromosomal abnormalities; 7 cases of complex choroid plexus cysts (combined with advanced age, high risk of serological screening and other ultrasound soft indicators, more than two of the three), including 1 case of chromosomal abnormalities. There was no significant difference between the 5 groups. In addition, there were 60 cases of unilateral choroid plexus cysts, including 2 cases of chromosomal abnormalities, and 45 bilateral cases, including 3 cases of chromosomal abnormalities, an there were no statistical difference between the two groups.  Conclusion  Isolated choroid plexus cyst also needs prenatal diagnosis as choroid plexus cyst with other high-risk factors.
Study on the effect of self-made traditional Chinese medicine formula combined with far infrared therapeutic instrument in the treatment of drug exudation or extravasation in children
LI Na, LI Nan, WEI Xueyan, SHI Junran, WANG Jingjun, ZHOU Xiumin, LIU Yanxia
2023, 21(7): 1172-1174. doi: 10.16766/j.cnki.issn.1674-4152.003077
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  Objective  To explore the clinical efficacy of self-made traditional Chinese medicine prescription combined with far infrared therapeutic instrument in the treatment of drug exudation in children and its impact on the levels of serum superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in patients.  Methods  A total of 126 children with local drug exudation or extravasation during infusion in the Pediatric and Traditional Chinese Medicine Pediatric Departments of Shijiazhuang Maternal and Child Health Hospital from January 2020 to June 2022 were selected as study subjects, and randomly divided into a control group and an observation group using a random number table method, with 63 patients in each group. The control group was treated with 50% magnesium sulfate wet compress combined with far infrared therapeutic instrument. The children in the observation group were treated with self-made traditional Chinese medicine prescription combined with combined with far infrared therapeutic instrument. The treatment effect was observed and the visual analog scale (VAS) score, skin symptom recovery time, SOD and GSH-Px levels between the two groups were compared.  Results  The observation group had 36 cases of significant effect, 27 cases of effective treatment, and 0 cases of ineffective treatment, while the control group had 22 cases, 28 cases and 13 cases, respectively. The treatment effect in the observation group was better than that in the control group (Z=-3.325, P=0.001). After 24 hours of treatment, the VSA score in the observation group were lower than those in the control group (P < 0.05). The regression time of pain, inflammation, and redness in the observation group was shorter than that in the control group (P < 0.05). After 24 hours of treatment, the levels of SOD and GSH-Px in the observation group were higher than those in the control group (P < 0.05).  Conclusion  Self-made traditional Chinese medicine prescription combined with far infrared therapeutic instrument has good effect on exudation or exudation, and its mechanism may be related to improving serum SOD and GSH-Px.
Study on the correlation between micronutrient intake during pregnancy and glycemic control outcomes in patients with gestational diabetes
ZHANG Changying, CHEN Xueli, FENG Yunren, SHI Liang, HE Yuan
2023, 21(7): 1175-1178. doi: 10.16766/j.cnki.issn.1674-4152.003078
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  Objective  To analyze the correlation between micronutrients intake during pregnancy and the effect of blood glucose control in patients with gestational diabetes (GDM), and to provide a basis for clinical supplementation of micronutrients.  Methods  From May 2020 to January 2023, 100 GDM patients who underwent regular prenatal examinations at Xinchang People ' s Hospital and 100 pregnant women with normal blood glucose levels during the same period of prenatal examination were selected as the GDM group and the control group for the study (all were 27 to 35 weeks of gestation). Basic information and dietary intake status of the study subjects were obtained through questionnaire surveys and 24-hour dietary review methods. Binary logistic regression analysis was used to investigate the effect of micronutrient intake on blood glucose control in GDM pregnant women.  Results  Compared with the control group, the total dietary energy, protein, and fat intake of the GDM group were (2 217.65±156.09) kcal, (97.24±11.42) g, and (66.23±7.83) g, respectively, which were higher than those in the control group [(2 163.44±113.24) kcal, (86.43±9.82) g, (61.77±6.33) g, all P < 0.05]; Binary logistic regression showed that high protein, high fat and low carbohydrate energy supply ratio were risk factors for blood glucose control in GDM pregnant women (OR=2.462, 2.533, 2.126, P < 0.05); Vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin D, vitamin E, zinc, iron, copper, and selenium were protective factors for glycemic control in pregnant women with GDM (OR=0.451, 0.237, 0.184, 0.760, 0.228, 0.081, 0.871, 0.311, 0.073, 0.105, P < 0.05).  Conclusion  The diet structure of GDM pregnant women is unreasonable, the intake of protein and fat is too high, and the intake of carbohydrate is too low. Increased micronutrient intake is associated with better control of blood glucose in GDM pregnant women. clinical emphasis should be placed on micronutrient supplementation to reduce the incidence of gestational diabetes.
Analysis of the demand and influencing factors of community home combined medical and health care services in the elderly based on the Anderson model
TAN Mei, ZHANG Yuting, ZHANG Yan, BAI Simin, ZHANG Min, CHEN Yu
2023, 21(7): 1179-1183. doi: 10.16766/j.cnki.issn.1674-4152.003079
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  Objective  To understand the current situation of the demand for community home combined medical and health care services for the elderly in Shaanxi Province and analyze its influencing factors, in order to provide a theoretical basis for the construction of a multi-level combined medical and health care service system for the elderly at home.  Methods  A total of 1 531 elderly people were surveyed by stratified random sampling in 36 counties (districts) of Shaanxi Province. Based on the Anderson model, Chi-square test was used to analyze the differences among propensity factors, enabling factors and demand factors in the demand for community home combined medical and health care for the elderly. The factors influencing of their demand was studied using binary logistic regression.  Results  The results of the analysis of influencing factors showed that among the propensity factors, the type of residence (OR=1.328, 95% CI: 1.059 to 1.667) and the presence of hobbies (OR=1.360, 95% CI: 1.083 to 1.708); among the enabling factors, the presence of health insurance (OR=1.436, 95% CI: 1.014 to 2.034), the presence of having pension insurance (OR=1.442, 95% CI: 1.012 to 2.055) and type of social support (general support OR=1.320, 95% CI: 1.036 to 1.681); high social support OR=2.086, 95% CI: 1.406 to 3.096); among the need factors, the perception of health care integration (OR=1.485, 95% CI: 1.093 to 2.018) and the number of chronic diseases (2 chronic diseases OR=1.398, 95% CI: 1.021 to 1.914; 4 or more chronic diseases OR=4.173, 95% CI: 1.526 to 11.415) influenced the demand for community home combined medical and health care for the elderly.  Conclusion  The elderly in rural areas, those who have social security and high social support, suffer from multiple chronic diseases and have high awareness of the combination of medical care and care have high demand for community home combined medical care and health services. Community home medical care and health services should meet the principle of providing appropriate service place, content and form, and on this basis, establish a diversified and sustainable multi-level health and elderly care service system.
Prevalence and associated factors of chronic orthostatic intolerance in communities
LI Guanfei, ZHANG Xunjuan, PANG Meng, LI Song
2023, 21(7): 1184-1187. doi: 10.16766/j.cnki.issn.1674-4152.003080
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  Objective  To investigate the prevalence and associated factors of chronic orthostatic intolerance (OI) in community-dwelling middle-aged and elderly people.  Methods  From January to September 2021, a random cluster sample of 546 registered residents aged ≥40 years in three community health services in Changchun was conducted. Data included medical history, questionnaire and blood pressure in supine and standing positions. SPSS 26.0 software was used for descriptive statistical analysis. Factors associated with OI were analyzed by multivariate logistic regression models.  Results  The overall prevalence of OI was 15.8%(86/546), and among the subtypes, the prevalence of orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS) and orthostatic hypertension (OHT) were 10.6%(58/546), 0.7%(4/546) and 4.4%(24/546), respectively. The prevalence of OH was significantly higher than the other two subtypes(χ2=56.840, P < 0.001). Stratified by age, the prevalence of OI tended to increase with age(χ2=7.919, P=0.048), with the highest prevalence in those aged ≥70 years old(20.6%, 28/136). Multi-factor logistic regression analysis showed that age≥60 years, hypertension, and supine systolic blood pressure ≥140 mmHg (1 mmHg=0.133 kPa) in the prone position were independent risk factors for chronic OI.  Conclusion  There is a high prevalence of chronic OI in the middle-aged and elderly population in communities. OH is the main clinical type. Elderly people, hypertension and supine systolic hypertension are at high risk of developing chronic OI. Therefore, prevention and control of OI should be strengthened in key populations.
Construction and application of health management program based on HAPA for elderly patients with sarcopenia
SHA Wenna, CHEN Meihong, NING Li, JIN Jianfen, FU Qiuyan, ZHANG Qixiu
2023, 21(7): 1188-1191. doi: 10.16766/j.cnki.issn.1674-4152.003081
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  Objective  To construct health management program based on health action process approach (HAPA) for elderly patients with sarcopenia, and explore its application effects through prospective and randomized studies.  Methods  A total of 100 participants were recruited in the Geriatric Department of Hangzhou First People ' s Hospital using a convenient sampling method from October 2021 to July 2022. According to the admission time, they were divided into control group and observation group, 50 cases in each group. After intervention, 45 cases were included in the observation group and 47 cases were included in the control group, eventually. The patients in the control group were provided normal care and the patients in the observation group were provided health management program based on HAPA. The outcomes were evaluated by the self-rated abilities for health practices scale (SRAHP), electronic grip, short physical performance battery (SPPB), hemoglobin (Hb) and serum albumin (ALB).  Results  After intervention, scores for muscle strength and physical function, as well as Hb and ALB were (23.79±2.02) points, (9.00±0.97) points, (126.06±3.82) g/L, (34.64±2.85) g/L in the observation group and (21.14±1.49) points, (7.47±1.39) points, (123.12±2.88) g/L, (33.12±2.88) g/L in the control group, the difference was statistically significant (all P < 0.05). The total score of health behavior self-efficacy and the score of exercise, health responsibility were (63.80±5.05) points, (18.42±2.18) points, (15.66±2.45) points in the observation group and (60.38±6.52) points, (16.91±3.36) points, (13.85±2.83) points in the control group, the difference was statistically significant (all P < 0.05).  Conclusion  The health management program based on HAPA for elderly patients with sarcopenia has a positive effect on self-efficacy of health behavior, muscle strength, physical function and Hb and ALB among elderly patients with sarcopenia.
Survey on mobile phone dependency among medical students and analysis of its influencing factors
ZHANG Ziyao, LU Qiao, LIU Weihao, CHEN Zeliang, CHENG Chi, ANG Shaojia, JIANG Yuzhou, PAN Mengdie
2023, 21(7): 1192-1196. doi: 10.16766/j.cnki.issn.1674-4152.003082
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  Objective  To investigate the current situation of mobile phone use among medical students at universities, to explore the relationship between medical students ' sense of purpose in life, coping styles and mobile phone addiction, and to analyze the mental health problems of mobile phone addicts.  Methods  General data questionnaire, Mobile phone addiction index (MPAI), Simplified coping style questionnaire (SCSS), Chinese meaning in life questionnaire (C-MLQ), Academic delay of gratification, Patient health questionnaire-9 (PHQ-9) and Generalized anxiety disorder-7 (GAD-7) were used to survey 598 students from Bengbu Medical College, and 559 valid questionnaires were returned.  Results  Medical students ' scores on the mobile phone addiction scale showed significant differences in grade and all were statistically significant(all P < 0.01);the number of mobile phones, years of mobile phone use, hours of daily mobile phone use, mobile phone data traffic use, and monthly mobile phone payment showed significant differences on the mobile phone addiction index scale (all P < 0.001); the results of correlation analysis showed that occupational (r=-0.115), total score of the purpose of life scale (r=-0.160), experiencing meaning in life (r=-0.176), and seeking meaning in life (r=-0.109) were significantly negatively correlated (all P < 0.05); the results of multi-factor regression showed that negative coping (B=6.437, P < 0.001) and depression (B=0.568, P=0.003) could significantly affect the scores on the mobile phone addiction scale.  Conclusion  The phenomenon of mobile phone addiction among medical students is influenced by a variety of factors. Seniority may be a risk factor for mobile phone addiction among medical students, and negative, anxious and depressive emotions, and a low level of life meaning may contribute to the development of mobile phone addiction among medical students.
CT imaging diagnosis of primary pulmonary mucinous adenocarcinoma
CHEN Wu, SONG Biao, WANG Bin, LI Yuan, SONG Qilong, WANG Zhaohua, MIN Xuhong
2023, 21(7): 1197-1201. doi: 10.16766/j.cnki.issn.1674-4152.003083
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  Objective  To investigate and summarize the CT imaging characteristics of primary pulmonary mucinous adenocarcinoma, diagnose the disease early through its imaging characteristics, and select appropriate treatment methods, so as to improve survival.  Methods  A total of 62 cases of pathologically confirmed primary pulmonary mucinous adenocarcinoma from August 2019 to August 2022 in Anhui Provincial Chest Hospital were selected, their clinical, imaging features and pathological results were retrospectively analyzed, and the imaging features of nodular/mass type and consolidation type of primary pulmonary mucinous adenocarcinoma were compared, and the imaging manifestations combined with pathological features were summarized.  Results  The age of onset of 62 patients was 14-80 years old, and the average age was (60.5±10.5) years. The main complaint was cough white phlegm. The imaging results showed that there were 46 cases of nodular/mass type in 62 patients, including 2 cases (4.3%) of pure ground-glass nodules, 22 cases (47.8%) of mixed ground-glass nodules, 22 cases (47.8%) of solid nodules and masses, 31 cases (67.4%) of subpleural (gravity-heavy parts) of the lower lobes of both lungs, 2 cases occurred in airway dissemination (4.3%), and other common signs included vascular cluster sign, vacuole/cavitation sign, etc. There were 16 cases of consolidation type, with 14 cases (87.5%) occurring under the pleura in the lower lobes of both lungs, 9 cases (56.3%) experiencing airway spread, and other common signs including vacuole/cavity sign, vascular floating sign, and dead tree branch sign. The pathological results showed that abundant mucus could be seen under the microscope, scattered in the heterotypic cell mass, and the immunohistochemistry showed: CK7(+) 43 cases, TTF-1(+) 51 cases, Napsin-A (+) 36 cases, Ki-67 (≤ 50%) 53 cases, and CDX-2 (+) 18 cases.  Conclusion  Primary pulmonary mucinous adenocarcinoma is generally divided into nodular/mass type and consolidation type, mainly distributed in the large position of gravity of lung lobes, light to moderate reinforcement after enhancement, pathological scattered around the heterotypic cell mass filled with mucus components, and immunohistochemical diagnosis commonly involves CK7(+) and TTF-1(+).
Application value of superb microvascular imaging-based vascular index to quantitatively assess liver fibrosis
HE Yadong, SUN Yixue, PANG Qing, LI Dongdong, LI Yang
2023, 21(7): 1202-1205. doi: 10.16766/j.cnki.issn.1674-4152.003084
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  Objective  The Superb microvascular imaging (SMI) -based vascular index (SMI-VI) technique was applied to evaluate neovascularization in patients with hepatic fibrosis, to provide a new repeatable and quantitative assessment of the extent of liver fibrosis.  Methods  The SMI technique was used to measure the subcapsular vascular index of 93 patients with liver fibrosis and 25 healthy normal subjects who were treated in the First Affiliated Hospital of Bengbu Medical College from September 2020 to August 2021, to investigate the relationship between vascular index and the degree of liver fibrosis, and to compare the difference of the vascular index between patients with mild liver fibrosis and healthy normal subjects. The ROC curve of the vascular index was plotted to determine the optimal cut-off value for each stage of hepatic fibrosis.  Results  SMI-VI was positively correlated with the level of liver fibrosis (r= 0.754, P < 0.001). SMI-VI in patients with mild liver fibrosis was 10.40 (8.28, 13.63), which was higher than that in healthy normal subjects [8.60 (6.85, 10.10)], and the difference was statistically significant (P < 0.05). The cut-off values of SMI-VI for the diagnosis of significant liver fibrosis, progressive liver fibrosis, and cirrhosis were 10.65, 12.25 and 14.55, with corresponding areas under the curve of 0.86, 0.89 and 0.95, sensitivity of 88%, 86% and 85% and specificity of 70%, 72% and 90%, respectively.  Conclusion  The vascular index based on SMI technology has important clinical applications as it can quantitatively assess the degree of liver fibrosis non-invasively and easily by analyzing the number of vessels under the liver capsule.
Research progress on correlations between CD36 and type 2 diabetes mellitus
HUANG Qian, LIU Deliang, LI Huilin
2023, 21(7): 1206-1210. doi: 10.16766/j.cnki.issn.1674-4152.003085
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With the rapid development of the global economy, the improvement of people's living standards and the changes of their life style, diabetes has become one of the most severe noncommunicable diseases threatening the life and health of the whole of humanity, among which type 2 diabetes mellitus (T2DM) accounts for the vast majority of cases. Although there are many kinds of drugs targeting different targets of T2DM, their efficacy is not satisfactory, and may be accompanied by some side-effects, such as abdominal bloating, nausea and vomiting, weight gain, urinary tract infection and so on. Therefore, it is urgent and significant to find new therapeutic targets and develop new therapeutic drugs for T2DM. T2DM is primarily caused by insufficient insulin secretion by the pancreatic β cells and/or insulin resistance (IR) in peripheral tissues. Thus, it is important to find new ways to improve IR and regulate insulin secretion of pancreatic β cells for the treatment of T2DM. Cluster of differentiation 36 (CD36) is a multifunctional membrane protein receptor, which is widely expressed in various cells of the body. It participates in the occurrence and progression of T2DM through recognizing and binding different ligands to regulate lipid metabolism, adhesion, apoptosis, inflammatory response and immune response and other physiological and pathological processes. An increased expression of CD36 induced by hyperglycemia in the main insulin target tissues, including liver, fat and skeletal muscle, is involved in IR through various mechanisms. In addition, CD36 also participates in the process of insulin secretion and pancreatic β cell death by mediating oxidative stress, endoplasmic reticulum stress, inflammation and other pathological processes. Furthermore, CD36 also regulates fat preference and feeding behavior by mediating fat perception signal transduction, participating in the occurrence and progression of T2DM. Therefore, regulation of the expression level of CD36 in various tissues and organs may become an important approach for the treatment of T2DM and related metabolic diseases in the future.
Research progress of alternative splicing in autoimmune diseases
CHU Yiran, XU Shengqian
2023, 21(7): 1211-1214. doi: 10.16766/j.cnki.issn.1674-4152.003086
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Alternative splicing (AS) is a general mechanism for regulating gene expression, and up to 95% of human genes experience AS, meaning that this post-transcriptional regulatory mechanism is critical for almost all cellular processes. The general function of AS is to increase the diversity of mRNA expressed from the genome. AS alters the protein encoded by mRNA, which can have profound functional effects. AS is also observed in gene products of metazoan immune systems that have evolved to effectively recognize pathogens and distinguish between "self" and "non-self", possibly thanks to the diversity and flexibility that AS provides. Human immune response is a complex process that responds to many exogenous antigens, prevents microbial infections, and monitors endogenous components of tumors and autoimmune diseases, and requires a large number of molecules to support functional complex immune activities. Alternative splicing of pre-mRNA plays an important role in immune cell development and regulation of immune activity by generating multiple transcription subtypes to supplement the function of limited genes associated with immune response. In addition, multiple factors have been identified to be involved in the control of alternative splicing, where abnormal splicing of RNA can lead to infections, immune diseases, abnormalities in immune activity, and tumors. In this review, we focus on the regulation of AS in immune system cells, their impact on immunobiology and AS and autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. We summarize some of the recent findings that AS is associated with autoimmune diseases, and try to find common patterns of splicing regulation that may advance our understanding of autoimmune diseases and open up new therapeutic approaches.
Reliability and validity test and application value of hierarchical diagnosis and treatment rating scale in rehabilitation medicine in stroke patients
XUE Kaiwen, LYU Xing, WANG Yulong
2023, 21(7): 1215-1219. doi: 10.16766/j.cnki.issn.1674-4152.003087
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  Objective  To evaluate the reliability, validity and cut-off points of version A and B of the hierarchical diagnosis and treatment rating scale, and to determine a more applicable version.  Methods  The study was conducted in four rehabilitation facilities in Shenzhen in April 2022, and the scales were tested using Cronbach′s α coefficient, interclass correlotion coefficient (ICC), Kaiser-Meyer-Olkin (KMO) and Bartlett's spherical test, Spearman correlation coefficient and ROC curves.  Results  The Cronbach's α coefficients for version A and B were 0.740 and 0.694, respectively, with ICC greater than 0.75. The KMO values for version A and B were 0.659 and 0.660, respectively, with Bartlett spherical test P < 0.01. The correlation between the scale (version A and B) and the National Institute of Health Stroke Scale (NIHSS) was greater than 0.75, while the correlation between the scale (version A and B) and modified Rankin scale (mRS) were -0.101 and -0.063 respectively. NIHSS>20 points corresponded to disease item scores of 2.5 and 7.5 points in the A and B version of the scale, with AUCs=0.775 (95% CI: 0.677-0.855) and 0.840 (95% CI: 0.750 -0.908). The functional items of version A corresponded to the scores of 7.5 and 5 for bedridden group and community group of Longshi scale (LS), with AUC=0.541 (95% CI: 0.435-0.645) and 0.575 (95% CI: 0.469-0.677); The functional items in version B corresponded to the scores of 10 and 5 for bedridden group and community group of LS, with AUCs=0.500 (95% CI: 0.395-0.606) and 0.555 (95% CI: 0.448-0.658).  Conclusion  Both hierarchical diagnosis and treatment rating scale A and B have good reliability and validity for application with stroke patients. However, the functional components of the scale need further adjustment. Items in version B are more appropriate for assessing patients' rehabilitation needs and referral directions.
Epidemiological investigation and correlation analysis of enuresis in children and adolescents aged 5-18 years in Pudong New District of Shanghai
WANG Zhangjuan, SHEN Xiaoyu, YIN Lei, SHA Sha, ZHOU Wei, ZHAO Li, GONG Lixia
2023, 21(7): 1220-1223. doi: 10.16766/j.cnki.issn.1674-4152.003088
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  Objective  To investigate the prevalence and related factors of nocturnal enuresis in children and adolescents aged 5-18 years in Pudong New Area of Shanghai, and to provide evidence for clinical prevention and treatment.  Methods  Using a cross-sectional survey research method, a questionnaire survey was conducted among the parents of children and adolescents aged 5-18 years in 12 schools in Pudong New Area by random cluster sampling. According to the severity of enuresis, the children were divided into two groups: the enuresis group and the group who had bed wetting within 3 months.  Results  A total of 2 711 questionnaires were distributed and 2 627 cases of enuresis were collected, the questionnaire response rate was 96.90%. In this study, the prevalence of enuresis in children and adolescents aged 5-18 was 1.26% (33/2 627), 1.77% (24/1 358) in males, and 0.71% (9/1 269) in females. The prevalence of enuresis in males was higher than that in females (P=0.015). Enuresis improves gradually with age; 33.3% (11/33) of the children and adolescents with enuresis had a family history, 25.7% (29/113) of the children with bed wetting within 3 months had a family history, and enuresis was obviously correlated with inheritance. Enuresis affected the mood and quality of life of children and family members, and the difference was statistically significant with the severity of enuresis (P < 0.05). The incidence of parents blaming and abusing children for enuresis was high. Excessive bedtime drinking was common in children with enuresis.  Conclusion  Clinicians should pay attention to the emotion disclosure of children with enuresis and their parents. Prevention and treatment should be carried out from many aspects, such as psychological guidance and behavioral therapy.
Exploration the optimization of the special interests training program for general practitioners based on grounded theory
MENG Jia, GUO Meng, WANG Junying, JIANG Lihong
2023, 21(7): 1224-1228. doi: 10.16766/j.cnki.issn.1674-4152.003089
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  Objective  To comprehensively explore the factors influencing the special interests training program for general practitioners from a grounded theory perspective, and to provide empirical support for optimizing the implementation of the special interests training program.  Methods  The semi-structured interviews were conducted with 14 students who had completed the special interests training program at the standardized training base for general practice residents of the Second Affiliated Hospital of Harbin Medical University, Based on the procedural grounded theory research method, the open coding, axial coding, and selective coding were conducted on the raw interview data, and the relevant theoretical model was finally constructed.  Results  In the open coding process, 171 coding numbers, 17 initial concepts and 6 categories were formed. Three primary categories were summarized by axial coding. The final selection coding resulted in the core category "the optimization of the special interests training program for general practitioners" and the theoretical model was constructed from three dimensions.  Conclusion  To enhance the internal driving force of special interest straining of general practitioners, to meet the rigid demand for comprehensive quality improvement of "full" and " specialisation", and to focus on the interest-driven elements in the training process, so as to provide a solid foundation for optimizing the implementation of the program. A collaborative management mode should be established with specialized teachers as the leaders, general practice teachers as the bridge, and active cooperation from all departments. Strict assessment criteria should be formulated so as to provide a strong guarantee for the efficient implementation of the special interests training program. The core factors for the implementation of the program optimization are to constantly improve the teaching consciousness of teachers, pay attention to the selection of teachers and staff, and gradually improve the teaching level.
Analysis of the application effect in teaching introduction to general practice by teaching mode through integration of Face-to-face Learning and E-learning into Five-steps
WANG Changhong, BAI Zhifeng, CHEN Liqiao, SONG Xiangquan, FU Hua, WEI Shuangping, LI Weiming
2023, 21(7): 1229-1233. doi: 10.16766/j.cnki.issn.1674-4152.003090
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  Objective  To explore the application effect in the teaching of Introduction to General Practice by the teaching mode of integrating face-to-face learning and e-learning into five-step (learning, speaking, doing, using and thinking). To provide references for the teaching of Introduction to General Practice in higher vocational colleges.  Methods  Students in class 1 Jia (61) and class 1 Yi (60) of 2020 clinical specialty were selected as research objects by cluster sampling method. Students in class 1 Jia (control group) were taught by the traditional teaching mode. Students in class 1 Yi (research group) were taught by teaching mode of integrating face-to-face learning and e-learning into five-step. After the course, the evaluation of teaching effect, process evaluation and examination evaluation of the two groups were compared by questionnaire, process data of intelligent cloud on vocational education platform and final examination.  Results  Students in the research group liked the teaching method of Introduction to General Practice than students in the control group. They thought that the teaching mode was better than that of the control group in training autonomous learning ability, stimulating learning interest and training teamwork ability (all P < 0.05), 71.7% (43/60) students thought the teaching method of integrating face-to-face learning and e-learning into five steps could promote students' learning. The intelligent cloud on vocational education platform showed that the average rate of students watching videos in the research group was 91.7%. It was higher than that in the control group (77.0%, χ2=4.883, P=0.027). The average completion rate of students doing after-school exercises in the research group was 98.3%. It was also higher than that in the control group (86.9%, χ2=4.215, P=0.040). The final examination scores of the students in the research group were better than those in the control group (all P < 0.05).  Conclusion  The teaching method of integrating face-to-face learning and e-learning into five-step can train students' autonomous learning ability, stimulate students' learning interest, enhance students' teamwork ability, promote students' learning, and improve students' theoretical knowledge and application ability. It is an effective in teaching Introduction to General Practice for students of higher vocational college.
The study on the structural characteristics of spatial association network of hospital knowledge collaborative innovation in Henan Province
JI Ruirui, LYU Benyan, REN Wenjie
2023, 21(7): 1234-1237. doi: 10.16766/j.cnki.issn.1674-4152.003091
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  Objective  To study the spatial association network of knowledge collaborative innovation of hospitals in urban agglomeration of Henan Province, and to provide decision-making reference for promoting hospital innovation collaboration, medical and health technology innovation and high-quality development of medical industry in Henan Province.  Methods  Construct the regional network of knowledge collaborative innovation of hospitals in urban agglomeration of Henan Province by using social network analysis, and analyse the structural characteristics of the network and the position and change of each city in the regional network of innovation collaboration.  Results  From 2010 to 2020, the frequency of hospital paper cooperation in Henan Province increased gradually, and Zhengzhou ranked first. Among the overall characteristics of the collaborative innovation network of hospitals in Henan urban agglomeration, the number of network relations increased from 162 to 204, and the network size showed an expanding trend, indicating that the regional network of collaborative innovation of hospital in Henan city cluster was gradually improved. The network density was low, around 0.12, and the network efficiency was around 0.5, which was low in the past three years. The results indicated that the stability of network structure and the innovation linkages among node cities should be strengthened. The results of core edge structure analysis from 2010 to 2020 show that the core degree of Zhengzhou is the highest, all above 0.9, the core degree of Xinxiang is higher, around 0.1, and the core degree of other cities is basically less than 0.1. Zhengzhou and Xinxiang belong to the core area, while other cities belong to the edge area. The core-edge structure of the regional network of hospital knowledge collaborative innovation in Henan urban agglomeration was obvious, and there was polarization. The Gini coefficient was around 0.7, indicating that the gap between the regional network of innovation collaboration was large. It is highly unbalanced.  Conclusion  The level of collaborative innovation in the medical field in Henan Province needs to be improved, and the balance of innovation in medical and health science and technology among cities needs to be strengthened.
Norm construction of scores for patient reported outcomes of hypertension
WANG Han, TANG Shunding, DENG Li, ZHANG Wen, ZHANG Xiaoqing
2023, 21(7): 1238-1242. doi: 10.16766/j.cnki.issn.1674-4152.003092
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  Objective  To establish the demarcation norm of the patient-reported outcomes of hypertension, and provide evidence for clinical treatment.  Methods  Patients with hypertension diagnosed in 4 counties of 2 cities in Yunnan Province who were single-drug patients were randomly selected from April to June 2020. The questionnaire of hypertension patient-reported outcomes was completed, and the scores of the scale (PROISCD-HY) were calculated. After clustering analysis of the population, the clustering results were used as the basis for population division to establish a cut-off norm for the reported outcome scores of hypertension patients.  Results  The survey eventually collected 487 single-drug hypertension patients reported outcome questionnaires. The two-step cluster method was used to cluster analysis, and the respondents were divided into 4 categories by age and gender: 114 males aged ≥65, 89 males aged 18-64, 160 females aged ≥65, and 124 females aged 18-64. In the 4 groups, there were all statistical differences in other fields except the field of "Spirit/Belief" (P < 0.05), and the clustering was reasonable. A demarcation norm for patients reported outcomes of hypertension was construct with intervals of 0.5s and boundary points of (x±s) and (x± 0.5s), and determined as 5 states: [0, x-s) very poor, [x-s, x-0.5s) poor, [x-0.5s, x+0.5s) average, [x+0.5s, x+s) good, [x+s, 100) very good. The demarcation norm for the final total scores of the scale were: [0, 66.23), [66.23, 70.01), [70.01, 77.56), [77.56, 81.33), [81.33, 100). Among them, the scores of demarcation norm of the 18-64-year-old male were: [0, 70.08), [70.08, 73.50), [73.50, 80.34), [80.34, 83.76), [83.76, 100); the 18-64-year-old female were: [0, 68.19), [68.19, 72.08), [72.08, 79.85), [79.85, 83.73), [83.73, 100); the norm of ≥65-year-old male were: [0, 65.73), [65.73, 69.43), [69.43, 76.81), [76.81, 80.51), [80.51, 100); ≥65-year-old female were: [0, 64.15), [64.15, 67.49), [67.49, 74.17), [74.17, 77.51), [77.51, 100).  Conclusion  This study constructs a demarcation norm for patient reported outcomes and provides data support and evaluation reference standard for related hypertension research.
Expression and clinical significance of CPT2 in renal clear cell carcinoma
GAO Xingfu, GUAN Han, YAN Ruilian, LING Nengyong, LUO Wenhao, WANG Sheng
2023, 21(7): 1243-1247. doi: 10.16766/j.cnki.issn.1674-4152.003093
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  Objective  To investigate the differential expression of carnitine palmitoyltransferase 2 (CPT2) in renal clear cell carcinoma (ccRCC) and its correlation with clinical prognosis, in order to provide a new biological therapy target and theoretical basis for the diagnosis and treatment of ccRCC.  Methods  The tumor genome atlas (TCGA) data were first screened to obtain the target gene CPT2. Subsequently, R software was used to analyze the differential expression results of the gene. The clinical data and prognosis downloaded from TCGA was analyzed by R software and visual charts was draw. Immunohistochemistry was used to study the differential expression of this gene in ccRCC tissues and paraneoplastic tissues. Immunohistochemistry was used to study the differential expression of gene in ccRCC tissues and paraneoplastic tissues, and the correlation with clinical data was analyzed.  Results  Using R software to analyze the TCGA database samples, it was found that the expression of CPT2 in paracancerous tissues was higher than that in cancerous tissues (P < 0.05). There was no statistically significant difference in CPT2 expression among patients of different ages and N stages (all P>0.05). There were significant differences in CPT2 expression among patients with different gender, T stage, M stage, clinical stage, pathological grade and overall survival (all P < 0.05). Immunohistochemical results showed that the expression rate of CPT2 in paracancerous tissues (100.0%, 16/16) was higher than that in ccRCC tissues (39.7%, 23/58, P < 0.001). There was a statistically significant difference in CPT2 comparison among patients with different clinical stages (P < 0.05), and there was no statistically significant difference in CPT2 comparison among patients with different gender, T stage, pathological grade, M stage, and age (all P>0.05). The KEGG pathway of CPT2 mainly included adipocyte factor signaling pathway, glucagon signaling pathway, fatty acid degradation, fatty acid metabolism, and PPAR signaling pathway, etc.  Conclusion  CPT2 may be a tumor suppressor gene in renal clear cell carcinoma, which may serve as a potential biological target for early screening and treatment, bringing new programs and directions for the prevention and treatment of renal clear cell carcinoma.
Effect of video based finger exercises on postoperative limb symptoms and sleep quality in patients undergoing coronary intervention therapy
ZHOU Jing, LI Miaonan, ZHAO Na, WANG Dongmei, XIE Ying, WANG Jiaoshu, CAO Jiayu
2023, 21(7): 1248-1250. doi: 10.16766/j.cnki.issn.1674-4152.003094
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  Objective  To explore the effect of video based finger exercises on patients after coronary intervention therapy.  Methods  A total of 83 patients with coronary heart disease who were hospitalized in the Department of Cardiovascular, the First Affiliated Hospital of Bengbu Medical College from June 2020 to December 2020 and underwent coronary intervention therapy were selected as the study subjects. They were randomly divided into an observation group (42 cases) and a control group (41 cases) using a random number table method. The control group patients were given routine limb rehabilitation exercise guidance after coronary intervention therapy, guiding them to perform hand clenching and relaxation movements on the surgical side. The observation group patients were given a nursing model of video based rehabilitation exercise guidance for finger exercises after coronary intervention therapy. One day before the surgery, the responsible nurse pushed the recorded finger exercises to the patient or family members through the 317 nursing network platform, and then provided one-on-one finger exercise guidance. The patient was instructed to practice finger exercises one day before the surgery, and 30 minutes after returning to the ward on the day of surgery, the patient was instructed to start performing seven step finger exercises, did it every hour during non-sleep time, with 10-20 cycles in each of the seven steps, for 3-5 minutes each time, until the hemostat was removed.  Results  The degree of palm swelling on the surgical side was (20.70±1.74) cm in the observation group 2 hours after surgery, while it was (21.49±1.73) cm in the control group. After 4 hours of surgery, the palm swelling in the observation group was (20.63±1.67) cm, while it was (21.37±1.71) cm in the control group, with a statistically significant difference (P < 0.05). The observation group patients had lower limb pain on the surgical side at 1, 2, 4 and 12 hours after surgery compared to the control group, and there was significant statistical significance in limb pain on the surgical side at 2 hours after surgery (P < 0.05). There was no statistically significant difference in sleep quality between the two groups at 24 and 48 hours after surgery (P>0.05).  Conclusion  Video based finger exercises can reduce the degree of palm swelling on the surgical side and limb pain in patients undergoing coronary intervention via the radial artery route, which is conducive to the recovery of limbs after surgery.
Effects of Manchester pain management model on postoperative pain and negative emotions of patients with thoracic tumor
HU Xiaoqing, YING Huajuan, REN Jiawei, RUAN Guodong
2023, 21(7): 1251-1254. doi: 10.16766/j.cnki.issn.1674-4152.003095
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  Objective  To analyze the influence of Manchester pain management mode on the pain degree of patients with chest tumor, and provide a basis for clinical pain management.  Methods  Using the convenient sampling method, 120 patients with thoracic tumor who were treated in Hospital from February 2021 to October 2022 were selected, and divided into the control group (60 cases) and the observation group (60 cases) according to the random number table. The patients in the control group applied routine pain management, while the patients in the observation group applied Manchester pain management mode on the basis of the control group. The pain degree and psychological status, the first time out of bed activity time, average hospitalization time, average sleep time during hospitalization and pain control were compared between the two groups before and after surgery.  Results  On the 1st, 3rd, and 7th day after surgery, the pain scores of patients in the observation group [(6.03±0.37) points, (4.53±0.34) points, and (3.19 ±0.16) points, respectively] were lower than those in the control group [(6.82±0.42) points, (5.45±0.33) points, and (4.20±0.28) points, all P < 0.05]. On the 7th day after operation, the scores of anxiety, depression and fear of patients in the observation group were lower than those in the control group (all P < 0.05). The first activity time [(28.17±3.42) h] and average hospitalization time [(11.73±1.26) d] were shorter than those in the control group [(31.13±4.16) h, (13.12±2.14) d, both P < 0.05], and the average sleep time during hospitalization [7.07±0.83) h] was longer than those in the control group [(6.31±1.24) h, P < 0.05]. The satisfaction with pain control in the observation group [(8.44±0.47) points] was higher than that in the control group [(7.15±0.62) points, P < 0.05].  Conclusion  The Manchester Pain Management Model can reduce the postoperative pain of patients with thoracic tumor, alleviate the negative emotions, shorten the length of hospital stay, and improve the satisfaction with pain control, which is worthy of clinical application.
Analysis of influencing factors of self-perceived burden in children with Henoch-Schoenlein purpura
NIAN Hongyan, YANG Congyan, XU Bing
2023, 21(7): 1255-1258. doi: 10.16766/j.cnki.issn.1674-4152.003096
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  Objective  To investigate the status of self-perceived burden in children with Henoch-Schoenlein purpura, analyze the relationship with family care, mental toughness and self-perceived burden, and explore the influencing factors of self-perceived burden.  Methods  A total of 133 children with Henoch-Schoenlein purpura treated in the Pediatrics Department of the First People' s Hospital of Bengbu from July 2018 to Jun 2021 were selected as the research objects. The children and their families were investigated with family care scale (APGAR), chronic illness children' s resilience scale (CICRS) and self-perceived burden scale (SPBS). Two-sample t-test and ANOVA were used for univariate analysis of self-perceived burden. Pearson correlation analysis was used for correlation analysis of family care, psychological resilience and self-perceived burden. Multiple linear regression was used for influencing factors of self-perceived burden.  Results  The total SPBS score of patients was (31.06±8.18) points, and the self-perceived burden was at the moderate level. There were statistically significant differences in SPBS scores among children with different ages, personality characteristics, family income, main caregiver role, course of disease, number of hospitalizations and whether by kidney injury (P < 0.05). There was negative correlation between family care, mental toughness and self-perceived burden of each dimension and total score (all P < 0.01). The number of hospitalizations, kidney injury, family care aall nd mental toughness were the influencing factors of the self-perceived burden of children with Henoch-Schoenlein purpura (all P < 0.05).  Conclusion  Children with Henoch-Schoenlein purpura have different degrees of self-perceived burden, and family care, mental toughness are related to the self-perceived burden to a certain extent. Nursing staff should pay attention to family emotional intervention, carry out psychological behavior counseling, and improve children' s self-perceived burden.
Stanford type A aortic dissection complicated with acute ST-segment elevation myocardial infarction: A case report
WANG Baoguo, WANG Lin, LIU Yuan, LIU Jingwei, ZHANG Weihua
2023, 21(7): 1259-1262. doi: 10.16766/j.cnki.issn.1674-4152.003097
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Stanford type A aortic dissection is a severe cardiovascular emergency with the hematoma forming in the media layer due to the rupture of the ascending aortic intima. When the dissection involves the coronary ostium, it may be complicated by acute myocardial infarction, which significantly increases the risk of death in the acute phase. This paper reported an elderly female patient received drug-eluting stents implantation, with acute inferior and posterior wall myocardial infarction on electrocardiogram (ECG), and right coronary artery lesion on coronary angiography. The patient still had persistent back pain after percutaneous coronary intervention (PCI), and CT angiography of the thoracic and abdominal aorta showed Stanford type A aortic dissection, and was diagnosed as Stanford type A aortic dissection involving the right coronary artery, complicated by acute inferior and posterior wall myocardial infarction. This paper combines the previous literature to analyze the imaging characteristics of coronary artery involvement by aortic dissection, in order to improve clinicians ' awareness of the diagnosis of acute myocardial infarction due to this particular type of coronary lesion.
A case study of squamous cell carcinoma of the vulva in complete remission after radical radiotherapy
YANG Xiaoting, CAI Mei, LI Nan
2023, 21(7): 1263-1266. doi: 10.16766/j.cnki.issn.1674-4152.003098
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The patient is a female, 80-year old, with vulvar discomfort for 2 years, with bilateral labia majora plaques and ulcers for more than 3 months. Histopathological examination of tissue biopsies showed irregular epidermal hyperplasia with infiltration into the dermis, formation of squamous cell masses with visible nuclear heterogeneity, and lymphocytic infiltration in the superficial dermis. Immunohistochemistry demonstrated that the combined positive score (CPS) of programmed death-ligand 1 (PD-L1) was 80. Nucleic acid testing for high-risk HPV typing suggested HPV16 positive (+). The woman was diagnosed with vulvar hypofractionated keratinized squamous cell carcinoma based on the aforementioned evidence. The patient was greatly improved after radical radiotherapy, with manifestations of complete regression of the original large skin lesion and basic relief of symptoms, and required no further surgery or targeted immunotherapy, since the treatment effect met the criteria for radical tumor treatment. No significant radiotherapy-related side effects or tumor recurrence were observed during the follow-up period.
General Clinical Research
Efficacy of self-designed Shufeng Jiedu formula combined with calcipotriol on psoriasis and its influence on immune function
DING Rong, HUANG Qiaoling, CHEN Zhiwei, PAN Qianxiong
2023, 21(7): 1147-1149. doi: 10.16766/j.cnki.issn.1674-4152.003070
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  Objective  To observe the efficacy of self-designed Shufeng Jiedu formula combined with calcipotriol on psoriasis and its influence on immune function, and provide theoretical reference for clinical treatment of psoriasis.  Methods  A total of 60 patients with psoriasis treated in Ruian Hospital of Traditional Chinese Medicine from February 2019 to November 2022 were selected and randomly divided into two groups by random table method, with 30 cases in each group. The control group were treated with calcipotriol ointment combined with NB-UVB, and the observation group were treated with self-designed Shufeng Jiedu formula on the basis of the control group. Both groups had a treatment course of 8 weeks. The clinical efficacy was evaluated by the psoriasis skin lesion area and severity index (PASI), and the changes in traditional Chinese medicine syndrome scores, immune function (CD3+, CD4+, CD8+, CD4+/CD8+) levels, and safety between two groups of patients before and after treatment were compared.  Results  After treatment, the total effective rate of the observation group was 96.67% (29/30), which was significantly higher than 73.33% (22/30) of the control group (χ2=4.706, P=0.030); the score of severe itching, punctate bleeding and rash increase in the observation group were lower than those in the control group (all P<0.01); the PASI score index of the observation group were lower than that of the control group (all P<0.01); the levels of peripheral blood CD3+, CD4+ and CD4+/CD8+in the observation group were higher than those in the control group [(52.86±6.13)% vs. (45.48±5.57)%, (53.42±5.76)% vs. (48.19±5.24)%, 1.90±0.35 vs. 1.62±0.39, t=4.880, 3.679, 2.927, all P<0.01], however, CD8+ was lower than the control group [(28.25±5.35)% vs. (31.43±5.07)%, t=2.363, P=0.011].  Conclusion  Self-designed Shufeng Jiedu formula combined with calcipotriol exert certain effect in treating of psoriasis, which can significantly improve the PASI score index and the main syndrome score. Its mechanism may be related to the regulation of immune function, and the safety is good.
Efficacy of anlotinib in the third-line treatment of advanced ovarian cancer
LI Chengbiao, GU Gangshou
2023, 21(7): 1150-1152. doi: 10.16766/j.cnki.issn.1674-4152.003071
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  Objective  To observe the clinical efficacy and toxicity of anlotinib as a third-line treatment for advanced ovarian cancer, and to evaluate the clinical value of this treatment.  Methods  A total of 60 patients with advanced ovarian cancer who were treated in Wuwei People's Hospital from May 1, 2020 to April 30, 2022 were selected. The patients were divided into control group (n=30) and treatment group (n=30) by random number table method. The treatment group was treated with anlotinib as third-line treatment, and the control group was only given best supportive treatment. The objective response rate (ORR), disease control rate (DCR), quality of life (KPS score) and progression-free survival (PFS) of the two groups were compared. The side effects of anlotinib treatment were observed to evaluate the efficacy and safety of anlotinib.  Results  The ORR and DCR of the treatment group were 26.7% (8/30) and 86.7% (26/30), respectively. The ORR and DCR of the control group were 0 and 23.3% (7/30), respectively. There were significant differences in ORR and DCR between the two groups (both P<0.05). After treatment, the KPS score of the treatment group was (82.17±9.56) points, which was significantly higher than (75.18±9.15) points of the control group, and the difference was statistically significant (t=2.893, P=0.005). Some patients in the treatment group had nausea and vomiting, flatulence, diarrhea, fatigue, hypertension and loss of appetite during the treatment, but they could be tolerated and did not affect the treatment.  Conclusion  Anlotinib as a third-line treatment for advanced ovarian cancer has good short-term clinical efficacy and high safety.

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