2023 Vol. 21, No. 8

Expert Forum
Status quo and analysis of economic evaluation of integrated sports and medicine
TAN Shuoyuan, CAI Ruian, PENG Derong, SHI Jianwei
2023, 21(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.003099
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Abstract:
The initiatives that promote and shape the disease management and healthcare service models that combine sports and medicine have been put forward in the Plan of Health China 2030. Health organizations across the country have been paying increasing attention to the combination of sports and medicine, with the encouragement of national policy. However, due to the lack of economic evaluations, there is still short of supporting evidence and practical application in this area. This paper reviews the economic evaluation cases of integrated sports and medicine programs in foreign countries. We find that the programs are mainly focus on some traditional sports, such as aerobic exercise, resistance exercise and Tai Chi. Cost-effectiveness analysis is now the primary method, with quality-adjusted life years and disease-specific clinical outcomes as health output indicators. The bottlenecks in the current studies include the diverse definitions of cost accounting and health output indicators, the lack of uniformity in the length of intervention and evaluation periods, the unscientific assessment of exercise intensity and the limited use of quality-adjusted life years in this method. We suggested collecting pluralistic data in the real world and strengthening the application of the economic evaluation models based on the big data.
Special Topic/Systemic Lupus Erythematosus Research
Analysis of clinical characteristics and diagnostic and treatment of 51 cases of late-onset systemic lupus erythematosus
LIU Zhengyu, XU Liang
2023, 21(8): 1271-1274. doi: 10.16766/j.cnki.issn.1674-4152.003100
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Abstract:
  Objective  To compare the epidemiology, clinical manifestations, laboratory tests, and treatment protocols of late-onset systemic lupus erythematosus (LSLE) and adult onset systemic lupus erythematosus (ASLE), and to explore the clinical features and diagnostic and therapeutic characteristics of LSLE.  Methods  The medical records of 170 patients with systemic lupus erythematosus (SLE) who were initially diagnosed and treated in the First Affiliated Hospital of Wannan Medical College from September 2017 to June 2022 were retrospectively analyzed. According to the age of onset, patients were divided into two groups: ≥50 years old was the LSLE group (51 cases); < 50 years old was in the ASLE group (119 cases).  Results  Compared with the ASLE group, the time from onset to diagnosis was significantly longer in the LSLE group [3.0 (1.0, 12.0) months vs. 1.0 (0.5, 5.0) months, Z=-3.391, P=0.001], there was a significant increase in the percentage of patients with more than one disease at the time of diagnosis, a significant decrease in fever, rash, and photosensitivity, a significant increase in the percentage of patients with dry syndrome, a significant decrease in the incidence of leukopenia and hypocomplementemia, a significant decrease in the incidence of positive anti-d-DNA and anti-sm antibodies, and a significant decrease in the SLEDAI-2000 and BILAG-2004 scores. After the LSLE group completed the disease activity assessment, the maximum average dose of glucocorticoids and the rate of glucocorticoid use were significantly reduced. The use rate of immunosuppressants and the types of immunosuppressants used were significantly reduced, and the use of mycophenolate mofetil, cyclophosphamide and methotrexate was significantly reduced. The above differences were statistically significant (all P < 0.05).  Conclusion  Compared with ASLE, patients with LSLE have fewer typical SLE clinical manifestations, a long time from onset to diagnosis, relatively mild disease, low dose of glucocorticoids and fewer types of immunosuppressants.
Clinical study of 99Technetium-methylenediphosphonate in the treatment of systemic lupus erythematosus complicated with osteonecrosis of the femoral head
DUAN Congcong, SHEN Mengjia, HOU Chuanyun, JIANG Chao, XIE Changhao, WANG Tao
2023, 21(8): 1275-1278. doi: 10.16766/j.cnki.issn.1674-4152.003101
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Abstract:
  Objective  To investigate the efficacy and safety of 99Technetium-methylenediphosphonate (99Tc-MDP) in the treatment of systemic lupus erythematosus (SLE) complicated with osteonecrosis of the femoral head (ONFH).  Methods  A total of 60 patients diagnosed with SLE combined with ONFH (necrosis group) and SLE without ONFH (control group) were selected from June 2021 to September 2022 in the First Affiliated Hospital of Bengbu Medical College. Among them, the necrosis group (30 cases) was divided into the conventional group (15 cases) and the combined group (15 cases) according to whether 99Tc-MDP was used. The concentrations of plasma osteoprotegerin (OPG) and osteopontin (OPN) were determined by ELISA before and after a short course of treatment between the combined group and the conventional group, and the control group were compared. Follow-up was conducted after a long course of treatment between the combination group and the conventional group, and the Harris score, imaging changes and adverse reactions were compared.  Results  There was no significant difference in baseline data between the three groups before treatment. After 1 short course of treatment: compared with before treatment, plasma OPG level increased and OPN level decreased in combination group after treatment, the differences were statistically significant. After 1 course of treatment: (1) The Harris score of hip function in the combined group was increased compared with the conventional group, and was significantly increased after treatment in the combined group compared with before treatment, the difference was statistically significant; There was no significant difference in Harris score between the conventional group after treatment and before treatment. (2) There was no significant improvement in imaging evaluation after 99Tc-MDP treatment. (3) No serious adverse reactions were found in the three groups.  Conclusion  On the basis of routine medication, 99Tc-MDP has good clinical effect and high safety in the treatment of systemic lupus erythematosus complicated with osteonecrosis of the femoral head.
Concept and development of glucocorticoid application in systemic lupus erythematosus under treat-to-target strategy
GAO Dai, ZHANG Zhuoli
2023, 21(8): 1279-1283. doi: 10.16766/j.cnki.issn.1674-4152.003102
118 15
Abstract:
Glucocorticoids (hormones for short) act in two main ways: the genomic pathway, which is the main effective pathway for oral glucocorticoids, and the non-genomic pathway, which is activated at doses of up to 100 mg/day of prednisone. Hormones have been considered as a "double-edged sword" in the treatment of SLE: on the one hand, they exert rapid and powerful anti-inflammatory and immunosuppressive effects, while on the other hand, their long-term accumulation leads to the irreversible organ damage accrual. To date, glucocorticoids remain the most critical first-line drug in the management of SLE due to the lack of safer and more effective treatments. Recent studies have shown that the long-term accumulation of glucocorticoids doses and challenges in dose reduction have become the primary barrier for target achievement in SLE treat-to-target therapy. Current research evidence suggests that longer duration of disease stabilization, more stable disease activity status, and better maintenance therapeutic regimens are key to achieving successful glucocorticoids taper. Glucocorticoids pulse can activate non-genomic effect pathways that on the one hand induce rapid disease remission without significantly increasing side effects, and on the other hand create opportunities for lower initial doses of oral glucocorticoids and rapid dose reduction. Drugs such as hydroxychloroquine, immunosuppressants, small-molecule targeted agents, and biologics are also able to help glucocorticoids dose reduction. In addition, the development of new drugs including selective glucocorticoids receptor agonists may be able to play a greater role in the future. In conclusion, how to achieve successful glucocorticoids reduction and eventual discontinuation while maintaining stable disease control has become an increasingly important topic in SLE, and more high-quality evidence-based medical evidence is needed.
General Practice Research
The relationship between body mass index and waist-height ratio and hyperuricemia in patients with hypertension in Wuyuan, Jiangxi Province
CHEN Hao, WU Qian, ZHANG Rushan, ZOU Jianfei, WANG Rui, TANG Genfu
2023, 21(8): 1284-1286. doi: 10.16766/j.cnki.issn.1674-4152.003103
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Abstract:
  Objective  To investigate the effects of body mass index (BMI) and waist-height ratio (WHtR) on hyperuricemia (HUA) in hypertensive patients, and to provide a basis for the early prevention of hypertension complicated with HUA.  Methods  A total of 1 522 hypertensive patients were enrolled in 5 townships from July to August 2022 in Wuyuan County by multi-stage sampling, they were included for on-site questionnaire survey, physical examination and biochemical index detection. The subjects were divided into case group and control group according to whether they had HUA, the relationship between BMI and WHtR and HUA was analyzed by logistic regression, and the receiver operating characteristic curve was used for evaluation.  Results  The mean age of 1 522 hypertensive patients was (63.99±8.80) years, and a total of 600 HUA patients (39.4%) were detected in this study. Multivariate logistic regression results showed that overweight (24≤BMI < 28), obesity (BMI≥28), and central obesity (WHtR≥0.5) were important risk factors for HUA in hypertensive patients, with OR values of 1.828 (95% CI: 1.444-2.314), 2.955 (95% CI: 2.052-4.257), and 2.105 (95% CI: 1.629-2.720), respectively. The area under the BMI and WHtR curves were 0.599 (95% CI: 0.570-0.628) and 0.583 (95% CI: 0.554-0.612), respectively.  Conclusion  Overweight, obesity and central obesity promote the occurrence of HUA in hypertensive population, and local hypertension management agencies should pay attention to the evaluation and intervention of BMI and WHtR in hypertensive patients.
Risk stratification of clinical characteristics and correlation analysis of clinical prognosis in patients with hypertension complicated by acute coronary syndrome in northern Anhui
JIANG Nan, BAO Bingwei, DING Siyu, JI Chunfei, QIAN Shaohuan, WANG Hongju, LI Miaonan
2023, 21(8): 1287-1290. doi: 10.16766/j.cnki.issn.1674-4152.003104
142 8
Abstract:
  Objective  To analyze the clinical characteristics and risk stratification of hypertension patients with acute coronary syndrome (ACS) in northern Anhui, to discuss the high risk factors of hypertensive patients with ACS, and to guide the clinical work.  Methods  A total of 426 patients with ACS, diagnosed by coronary angiography in the First Affiliated Hospital of Bengbu Medical College from October 2018 to July 2019 in northern Anhui province. They were divided into hypertensive ACS group (HBP group, 252 cases) and non-hypertensive ACS group (NHBP group, 174 cases) according to whether they were complicated with hypertension. The average follow-up was 15 months, and major adverse cardiovascular events (MACES) were recorded in the ACS group. Multivariate logistic regression was used to analyze independent risk factors.  Results  Compared with the NHBP group, patients in the HBP group had higher age, uric acid, creatinine and triglyceride (TG) levels; The rate of early coronary heart disease was lower; the proportion of three-vessel lesions was higher; and the Gensini score was higher (P < 0.05). Binary logistic regression showed that, getting older (OR=1.163, 95% CI: 1.085-1.247, P < 0.01), Male (OR=2.615, 95% CI: 1.192-5.737, P=0.016), early-onset coronary heart disease (OR=7.775, 95% CI: 1.772-34.113, P=0.007), high TG (OR=1.337, 95% CI: 1.104-1.619, P=0.003) were independent risk factors for patients with hypertension combined with ACS (P < 0.05).  Conclusion  Getting older, male, early-onset coronary heart disease, high TG and other factors are closely related to the patients with hypertension complicated with ACS, which guide to strengthen clinical screening and intervention in clinical work.
Clinical characteristics of mild cognitive impairment in patients with hypertension and obstructive sleep apnea syndrome
XI Ting, YAO Xiaoguang, WANG Yingchun, YAO Ling, LI Nanfang
2023, 21(8): 1291-1294. doi: 10.16766/j.cnki.issn.1674-4152.003105
102 15
Abstract:
  Objective  To investigate the clinical features and associated risk factors of mild cognitive impairment (MCI) in patients with hypertension and obstructive sleep apnea syndrome (OSAS).  Methods  A total of 120 patients with hypertension who were hospitalized in the People' s Hospital of Xinjiang Uygur Autonomous Region from April to October 2021 and completed overnight polysomnographic monitoring or diagnosis of OSAS were consecutively selected. All patients were evaluated by 24-hour ambulatory blood pressure and Montreal cognitive assessment scale (MoCA), and MoCA score < 26 was defined as MCI. The characteristics of sleep parameters and ambulatory blood pressure were compared between the cognitively normal group (39 cases) and the MCI group (81 cases), and associated risk factors were discussed.  Results  The detection rate of MCI in the general population was 67.5%(81/120); Compared with the normal cognitive function group, the nighttime minimum oxygen saturation[81.0(77.0, 85.0)% vs.86.0(79.0, 88.0)%] decreased in the MCI group, while AHI[20.1(15.3, 31.6) times/h vs. 6.7(2.6, 26.1) times/h], T90[27.2(5.3, 80.4) min vs. 6.9(0.4, 79.1) min], in visual space/execution function[3(2, 3) points vs. (4(3, 5) points], attention [5(5, 6) points vs. 6(6, 6) points], delay recall [2(1, 3) points vs.3(3, 4) points], abstract thinking [1(0, 1) points vs.2(1, 2) points], cognitive domains were significantly reduced (all P < 0.05). Multivariate logistic regression showed that the lowest oxygen saturation at night was independent risk factor for MCI in this population.  Conclusion  The high prevalence of MCI in hypertensive patients with OSAS, short education and low nocturnal minimum oxygen saturation are the risk factors for the high prevalence of MCI in this population.
Effect of camrelizumab in combination with apatinib on health-related quality of life in patients with advanced liver cancer
WANG Rui, CHEN Yufuo, ZHANG Tiantian, LIU Yang, ZHANG Shanshan, LI Yumei
2023, 21(8): 1295-1298. doi: 10.16766/j.cnki.issn.1674-4152.003106
138 9
Abstract:
  Objective  To evaluate the efficacy of combination therapy with camrelizumab and apatinib as a first-line treatment for advanced hepatocellular carcinoma (HCC) and its impact on patients ' quality of life.  Methods  The advanced HCC patients who received the first-line treatment of apatinib combined with (31 cases) or without (23 cases) camrelizumab were selected in the First Affiliated Hospital of Bengbu Medical College from January 2020 to June 2022, the clinical data and patient-reported outcome (PRO) scales (EORTC QLQ-C30 and HCC18) were collected. Objective efficacy and the effect on HRQoL were evaluated.  Results  The combination group was higher in the objective response rate (22.58% vs. 8.69%, χ2=0.969, P=0.325) and disease control rate (70.97% vs. 56.52%, χ2=1.208, P=0.271) compared with the single drug group, however, the difference was not statistically significant. The mPFS in the combination group was prolonged compared to the single drug group (5.60 months vs. 3.50 months, P=0.002). Both groups had similar C30 and HCC18 scores at baseline. After 4 cycles of treatment, C30 emotional (t=2.093, P=0.041) and cognitive function (U=193.000, P=0.003) scores in combination group were higher than those in single drug group. Nausea and vomiting (U=252.500, P=0.039) and loss of appetite (U=244.000, P=0.031) were less severe than single drug group. Body change (U=250.000, P=0.044) and fever (U=237.500, P=0.026) in HCC18 were less severe than those in single drug group.  Conclusion  Camrelizumab in combination with apatinib for the first-line treatment of advanced HCC patients can improve the efficacy and health-related quality of life of patients.
Analysis of the influence factors of recovery of spontaneous circulation in in-hospital cardiac arrest patients
LIANG Shunda, FANG Fang, DING Zhiying, LI Xingxing, HE Miao, HUANG Jialin, ZHANG Hong
2023, 21(8): 1299-1303. doi: 10.16766/j.cnki.issn.1674-4152.003107
133 9
Abstract:
  Objective  To investigate the factors affecting the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation in patients with in-hospital cardiac arrest (IHCA) in order to improve the success rate of resuscitation.  Methods  Data of 423 IHCA patients admitted to the Emergency Department, Intensive Care Medicine Department, Respiratory Medicine Department and other departments of the First Affiliated Hospital of Anhui Medical University from November 2019 to November 2020 were retrospectively analyzed. They were divided into ROSC group (109 cases) and ineffective resuscitation group (314 cases) according to whether spontaneous circulation was restored. The influencing factors of ROSC in patients with IHCA were analyzed by univariate analysis. Then, the factors with P < 0.05 in the univariate analysis were included in the binary unconditional logistic regression analysis.  Results  Univariate analysis showed that compared with the non-resuscitation group, the ROSC group included long-term residence (urban/rural), occurrence season of cardiac arrest, ECG manifestations of early repolarization syndrome, history of severe trauma, history of malignancy, first in-hospital department, ICU admission during the course of disease, in-hospital department of cardiac arrest, first detection of heart rhythm, whether endotracheal intubation was performed during cardiopulmonary resuscitation, whether defibrillation was performed, duration of cardiopulmonary resuscitation, whether to use epinephrine, the application of epinephrine dose and other factors, all had statistical significance (P < 0.05). Logistic regression analysis showed that ICU admission (P < 0.001), airway opening (P=0.007), duration of cardiopulmonary resuscitation (P < 0.001) and total epinephrine dose (P < 0.001) were independent factors influencing ROSC in patients with IHCA.  Conclusion  ICU admission, airway opening before cardiac arrest, duration of cardiopulmonary resuscitation, and total epinephrine dose can affect ROSC in patients with IHCA.
Analysis of serum 25-hydroxyvitamin D levels and related factors in a population of 4 311 physical examinations in a tertiary hospital in Hefei
GAO Xiaoman, HE Jianle, XU Xihai, CHEN Yiqing, XIAO Rong, DENG Datong
2023, 21(8): 1304-1307. doi: 10.16766/j.cnki.issn.1674-4152.003108
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Abstract:
  Objective  To study the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentration and season, gender and age using data from the physical examination centre of the First Affiliated Hospital of Anhui Medical University, and to provide a reference for rational clinical vitamin D supplementation.  Methods  Data of 4 311 subjects (> 20 years old) who underwent physical examination from April 2017 to June 2022 (The data of April, May, June 2020 were missing) were selected. Spearman ' s rank correlation coefficient was used to analyze the correlation between monthly average serum 25(OH)D concentration and monthly average temperature, sunshine duration and UV intensity. The detection rates of 25(OH)D sufficiency [25(OH)D ≥75 nmol/L], 25(OH)D insufficiency [50 nmol/L ≤ 25(OH)D < 75 nmol/L] and 25(OH)D deficiency [25(OH)D < 50 nmol/L] were calculated.  Results  The mean serum 25(OH)D level was 59.7 nmol/L and the overall 25(OH)D sufficiency rate was 22.5%, insufficiency rate was 38.6% and deficiency rate was 38.9%. The median serum 25(OH)D concentration in women was lower than that in men. The serum 25(OH)D concentration showed a seasonal variation over the 5-year period and the difference was statistically significant (P < 0.05). Median 25(OH)D concentrations were lower in winter and spring than that in summer and autumn; mean 25(OH)D concentrations and sufficiency rates were higher in people over 60 years of age than in the other two age groups.  Conclusions  Serum 25(OH)D concentrations in the physical examination population are statistically significant in relation to seasonal changes, gender and age. Vitamin D should be supplemented according to different seasons and age groups to prevent osteoporosis, pathological fractures and other diseases.
Analysis of the pathogenic microorganisms and drug treatment of acute pelvic inflammatory disease
LUO Hui, YE Guoliu, JIN Maosheng
2023, 21(8): 1308-1311. doi: 10.16766/j.cnki.issn.1674-4152.003109
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Abstract:
  Objective  To investigate the types, characteristics, resistance and treatments of pathogenic microorganisms in patients with acute pelvic inflammatory disease, which will help patients to find an appropriate treatment plan.  Methods  From January 2019 to January 2021, a retrospective analysis was conducted on the data of 100 patients who visited the gynaecology department of the First Affiliated Hospital of Bengbu Medical College. Based on the results of the retrospective analysis, the drug resistance of pathogenic microorganisms was investigated.  Results  Many causes of the disease, including irregular vaginal bleeding, abortion. The main symptoms of the disease are fever, abdominal pain and increased vaginal discharge. Escherichia coli and Staphylococcus epidermidis were the most common pathogenic microorganisms detected in 100 patients. All patients were treated with intravenous antibiotics, and the temperature and white blood cell count returned to normal in a shorter time in patients treated with third-generation cephalosporins (P < 0.05). The drug sensitivity test showed that penicillin had been tested and the drug resistance rate was 56.3%. Cephalosporin had been tested and the drug resistance rate was 23.8%. There was a significant difference (P < 0.05) in the number of white blood cells in the blood when the patients were treated with susceptibility antibiotic compared to the resistant antibiotic. Moreover, the results of serial passage experiment to treat microorganisms showed that there was a clear difference in the time it took bacteria to develop resistance to different antibiotics. At the end of the passages, the concentration that inhibited the growth of 90% of the bacteria had increased 64-fold.  Conclusion  There are many pathogenic microorganisms in acute pelvic inflammatory disease, the predominant pathogens of acute pelvic inflammatory disease are Escherichia coli and Staphylococcus epidermidis. Moreover, third-generation cephalosporins are superior to second-generation cephalosporins in treating patients with antibiotics. In addition, there is less resistance to quinolones and aminoglycosides, which may be the first choice of clinical treatment. Furthermore, Pathogenic microorganism can easily develop resistance, highlighting the importance of the accuracy of empirical medication. Of course, the selection of specific antibiotics should be based on comprehensive identification of bacterial culture, drug sensitivity tests and clinician experiences.
Correlation of mild depression in patients with cerebral small vessel disease and iron content in red nucleus
LI Hua, YANG Hua, FAN Xueyi, LIANG Li, QIAN Hairong
2023, 21(8): 1312-1314. doi: 10.16766/j.cnki.issn.1674-4152.003110
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Abstract:
  Objective  To investigate the relationship between mild depression and iron content in the red nucleus in cerebral small vessel disease (CSVD) patients and evaluated the predictive value of red nucleus in mild depression CSVD patients (control group).  Methods  Forty-one patients with mildly depressed CSVD (experimental group) and 40 patients with non-depressed CSVD attending the Department of Neurology of the General Hospital of the People ' s Liberation Army (PLA) from May 1, 2021 to April 30, 2022 were collected. The depression levels were assessed by the geriatric depression scale (GDS). All subjects underwent magnetic resonance susceptibility weighted imaging scans, the iron content in red nucleus of CSVD patients were semi-quantitatively analyzed using susceptibility weighted imaging (SWI) signal intensity in the region of interest (ROI). The signal intensity in the ROI of the red nucleus was measured by 2 physicians. The iron contents in the red nucleus of the two groups were analyzed and the correlation between mild depression and iron content in the red nucleus of CSVD patients was explored.  Results  The signal intensity in the left red nucleus ROI (189.36±27.55 vs. 213.32±34.33) and the average signal intensity in the red nucleus ROI (193.06±26.33 vs. 211.64±33.53) of the mild depression CSVD group were significantly lower than those of the control group (P < 0.05), while the signal intensity of the right red nucleus ROI in the mild depression CSVD group were not different from those of the control group. Correlation analysis showed that the mean signal intensity in the red nucleus ROI was negatively correlated with depression, the left signal strength in the red nucleus ROI was negatively correlated with depression.  Conclusion  Mild depression in CSVD is significantly associated with iron content in the red nucleus, and the content of iron in the red nucleus has a certain value in predicting mild depression of CSVD.
Study on differences in target delineation methods for lung tumors using on four-dimensional CT
ZHANG Mengyu, DUAN Shimiao, WU Ye, GUO Ziwen, LI Wei, JIANG Hao
2023, 21(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.003111
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Abstract:
  Objective  Based on four dimensional CT (4DCT) images of patients with lung tumors in different parts, the study compares which target delineation method is more efficient.  Methods  A total of 130 patients with lung tumors, who underwent 4DCT simulation scans at the First Affiliated Hospital of Bengbu Medical College from October 2019 to December 2021 were selected. The doctor delineated the gross tumor volume (GTV) targets in 10 phases of 4DCT, and IGTV10 was obtained by fusion. IGTVMIP, IGTVAIP and IGTV2 were obtained based on maximum density projection (MIP), average density projection (AIP) images, 0% and 50% time-phase of 4DCT. The above delineation methods were compared in terms of volume and centroid displacement.  Results  The ratios of IGTVMIP, IGTVAIP and IGTV2 to IGTV10 in the upper lobe group were 1.00, 0.98 and 0.99, respectively (P=0.143, < 0.001, < 0.001). The ratios for the middle and lower lobe groups were 0.99, 0.96 and 0.98, respectively (P=0.603, < 0.001, < 0.001). There was no significant difference in the degree of mutual inclusion between IGTV10 and IGTVMIP in the upper lung lobe group (P>0.05), while there was a significant difference in the degree of mutual inclusion between IGTV10, IGTVAIP and IGTV2 in the upper lung lobe group (all P < 0.05). The degree of mutual inclusion of IGTV10, IGTVMIP, IGTVAIP and IGTV2 in the middle and lower lung lobe group was significantly different (all P < 0.05).  Conclusion  The motion information contained in the 10 time-fused images is significantly greater than that of the AIP images and the 0%+50% fused images, but close to that of the MIP images. The location of the tumor should also be considered when using MIP images to delineate the target area.
Clinical diagnosis and treatment of renal oncocytoma
WANG Shaochen, XUE Sheng, HUANG Xiaoyu, ZHANG Guangyu, ZHOU Wensheng
2023, 21(8): 1319-1321. doi: 10.16766/j.cnki.issn.1674-4152.003112
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Abstract:
  Objective  To improve the diagnose and treatment of renal eosinophilic adenoma, to summarize the clinical characteristics of renal eosinophilic adenoma and study the use of auxiliary examination methods to improve the diagnosis and treatment rate of renal eosinophilic adenoma.  Methods  Retrospective analysis of the clinical data of 31 patients with renal eosinophilic adenoma who were treated in the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from June 2009 to December 2021, including clinical symptoms, auxiliary examinations, imaging data, treatment methods, pathological examinations and follow-up results.  Results  Thrity-one patients accounted for 2.35% (31/1 321) of kidney tumor patients during the same period. Twenty patients were admitted to the hospital due to renal space occupancy on physical examination, while the remaining 7 patients showed lumbar discomfort, 2 patients showed intermittent gross hematuria, and 2 patients developed fever. The CT values of renal malignancy and renal oncocytoma in plain scan, cortical phase, renal pelvis phase, relative cortical phase and relative renal pelvis phase were statistically different (all P < 0.05). Seven auxiliary examination reports were considered as renal eosinophilic adenoma. Twelve patients underwent nephron-sparing surgery and 19 patients underwent radical nephrectomy for renal cell carcinoma. After surgery, all patients were diagnosed with renal eosinophilic adenoma by pathological examination, and immunohistochemical analysis showed high expression of EMA, E-cadherin, CD117. A total of 31 cases were followed up, and 21 cases had a good prognosis. All patients survived, with a maximum survival time of more than 12 years. Four patients died from non-tumor or other tumor-related causes, and 6 patients were lost to follow-up.  Conclusion  It is important to confirm the preoperative diagnosis of eosinophilic adenoma using changes in CT values, laboratory examination, puncture biopsies and immunohistochemical results. In treatment, it is recommended to reserve nephron according to the type and size of the tumor. The prognosis of this disease is good, but it still needs active follow-up.
General Clinical Research
Predictive value of eustachian tube function for endoscopic intra tympanic injection in patients with sudden sensorineural deafness
WANG Changyang, CI Jun, GUAN Hua
2023, 21(8): 1322-1325. doi: 10.16766/j.cnki.issn.1674-4152.003113
103 5
Abstract:
  Objective  To evaluate the predictive value of the eustachian tube for the effect of endoscopic intra tympanic injection through detecting the function of the eustachian tube in patients with sudden sensorineural deafness.  Methods  A total of 115 patients with sudden senineural deafness who received endoscopic tympanic injection in Zhejiang Hospital of Integrated Traditional and Western Medicine from February 2021 to August 2022 were selected. According to the pure tone hearing threshold detection results two weeks after treatment, they were divided into effective group (hearing improvement ≥15 dB) and ineffective group (hearing improvement < 15 dB). Multivariate logistic regression was used to analyze the related factors affecting the effect of endoscopic tympanic injection in patients with sudden senineural deafness, and ROC curve was drawn to analyze the predictive value of eustachian tube function on the effect of endoscopic tympanic injection.  Results  After 2 weeks of treatment, 81 cases of hearing improvement ≥15 dB compared with before treatment were effective group, and the remaining 34 cases of hearing improvement < 15 dB were ineffective group. The age, impaired frequency threshold and eustachian tube function score of ineffective group were higher than those of effective group (P < 0.05). Multivariate logistic regression analysis showed that: Age (OR=1.056, 95% CI: 1.022-1.155), impaired frequency threshold (OR=1.042, 95% CI: 1.006-1.079), eustachian tube function score (OR=4.412, 95% CI: 2.247-8.666) were the risk factors for endoscopic tympanic injection effect (P < 0.05). ROC curve showed that the prediction AUC of endoscopic tympanic injection effect was 0.812 (95% CI: 0.728-0.879), which was significantly higher than that of age (0.665, 95% CI: 0.571-0.750) and impaired frequency hearing threshold (0.667, 95% CI: 0.573-0.752), P < 0.05.  Conclusion  The function of eustachian tube is relatively valuable in predicting the effect of endoscopic tympanic injection in patients with sudden senineural deafness.
Analysis of risk factors of cognitive dysfunction after senile vertebral compression fracture surgery
ZHOU Sen, JIN Xiaowei, ZHANG Guifan, JIANG Yi
2023, 21(8): 1326-1328. doi: 10.16766/j.cnki.issn.1674-4152.003114
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Abstract:
  Objective  To analyze the influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients with vertebral compression fractures, and to provide a reference for clinical prevention strategies.  Methods  A total of 167 elderly patients with osteoporotic vertebral compression fractures, who underwent surgical treatment at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to December 2022 were selected. The clinical data of the patients were collected. Univariate and multivariate logistic regression analysis were used to investigate the risk factors for postoperative cognitive dysfunction in elderly patients with vertebral compression fractures.  Results  Among 167 patients, 39 patients developed postoperative cognitive dysfunction, with an incidence of 23.35%. Univariate analysis showed that there were significant differences in age, history of alcohol consumption, postoperative infection, perioperative analgesia, postoperative complications, type of anesthesia, operation time, intraoperative mean frontal lobe oxygen saturation, and preoperative anxiety score between patients with and without postoperative cognitive dysfunction (all P < 0.05). Logistic regression analysis showed that age≥65 years (OR=3.347, P=0.007), postoperative analgesia (OR=2.286, P=0.043), general anesthesia (OR=3.920, P=0.005), operation time ≥120 min (OR=3.418, P < 0.001) were the independent risk factors for postoperative cognitive dysfunction.  Conclusion  Older age, postoperative analgesia, general anesthesia and longer operation time are risk factors for postoperative cognitive dysfunction in elderly patients with osteoporotic vertebral compression fractures. Targeted early clinical intervention can be used to prevent and treat postoperative cognitive dysfunction in elderly patients.
Prognosis value of liquid chip detection of cytokines in patients with acute organophosphorus pesticide poisoning
YU Liting, XU Xunhong, JIANG Wenming, YU Yongmiao
2023, 21(8): 1329-1331. doi: 10.16766/j.cnki.issn.1674-4152.003115
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Abstract:
  Objective  To evaluate the prognostic value of serum cytokines in patients with acute organophosphorus pesticide poisoning (AOPP) by liquid chip technique.  Methods  A total of 80 patients with moderate to severe AOPP admitted to Chun ' an Branch of Zhejiang Provincial People ' s Hospital from April 2019 to June 2022 were selected as the study subjects. The related serum cytokines were detected by liquid chip technology. According to the prognosis, the patients were divided into survival group (61 cases) and death group (19 cases). General data and serum cytokine levels were compared between the two groups, and ROC curve was drawn to evaluate the prognostic efficacy of related influencing factors.  Results  APACHE Ⅱ score (27.89±4.00) in death group was higher than that in survival group (21.50±2.90, P < 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, salivary liquiform glycogen-6 (KL-6), transforming growth factor-β (TGF-β) and troponin I (cTnI) in death group were higher than those in survival group (P < 0.05). ROC curve showed that the AUC of cTnI, IL-6, KL-6, TNF-α and TGF-β for prognosis were 0.805 (95% CI: 0.702-0.885), 0.755 (95% CI: 0.656-0.844) and 0.682 (95% CI: 0.569-0.782), 0.751 (95% CI: 0.642-0.841), 0.716 (95% CI: 0.604-0.811), which were no statistical significance compared with the AUC predicted by APACHE Ⅱ score [(0.890, 95% CI: 0.800-0.949), P>0.05].  Conclusion  Liquid chip is an effective method to detect a variety of cytokines, and the TNF-α, IL-6, KL-6, cTnI, TGF-β1 cytokines detected by this technology have high prognostic value for AOPP.
Correlation analysis between benefit finding and abuse tendency of family caregivers of patients with Alzheimer's disease
PAN Jianbo, XIE Weigen, CHENG Lingying, TANG Zhixian, PAN Yiqun
2023, 21(8): 1332-1334. doi: 10.16766/j.cnki.issn.1674-4152.003116
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Abstract:
  Objective  To explore the correlation between the benefit finding level and abuse tendency of family caregivers of Alzheimer's disease patients.  Methods  A total of 120 family caregivers of patients with Alzheimer's disease from March 2020 to October 2021 in the Seventh People's Hospital of Shaoxing City were included, and the Chinese version of the benefit finding scale (BFS) and the Chinese version of the caregiver abuse screen for the elderly (CASE) were used to investigate the level of benefit finding and abuse tendency of family caregivers of Alzheimer's disease patients. Spearman's correlation coefficient was used to analyze the correlation between the level of benefit finding and abuse tendency of family caregivers of Alzheimer's disease patients.  Results  The total score of benefit finding of family caregivers was (36.58±3.27) points, and the total average score was (1.95±0.30) points. The scores of caregivers ' abuse tendency ranged from 0 to 8, with an average score of 4.72±1.33, there were 22 (18.33%) scored ≤2, and 98 (81.67%) scored ≥3. Spearman correlation coefficient analysis showed that there was a significant negative correlation between the benefit finding level and the abuse tendency score of family caregivers with Alzheimer's disease (r=-0.594, P < 0.05).  Conclusion  The benefit finding of family caregivers is found at a low level, and abuse tendency is widespread. The lower the level of caregiver benefit finding, the greater the likelihood of abuse. Nursing staff should take effective measures to improve the level of benefit finding of family caregivers of Alzheimer's disease, which will help improve their psychological conditions and reduce the occurrence of abuse.
Effect of programmed intermittent epidural bolus technique on burst pain suppression and the safety of maternal and infant labour analgesia in obese parturients
JIANG Yan, KE Shangao, WANG Fen, WU Yuan, WU Tao, ZHOU Qusheng, WANG Meiyun, NIE Xin, ZHOU Tao
2023, 21(8): 1335-1338. doi: 10.16766/j.cnki.issn.1674-4152.003117
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Abstract:
  Objective  To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in combined lumbar and epidural labour analgesia in obese parturients, by observing the incidence of labour pain, expulsion pain and related conditions after PIEB was applied in the analgesia of combined lumbar and epidural labour in obese parturients.  Methods  A total of 100 full-term singleton primigravida in Tongling Maternal and Child Health Hospital from April 2020 to August 2021 were randomly divided into PIEB group and continuous epidural infusion (CEI) group by random number method, with 50 cases in each group. Pain VAS scores at various time points before and after labour analgesia, pain onset, analgesic dosage, labour and delivery related conditions, adverse effects and maternal satisfaction were compared between the two groups.  Results  Finally, 44 cases in PIEB group and 42 cases in CEI group were included in the study. The comparison of pain VAS scores between groups, comparison between time points and the interaction between group and time were all statistically significant (all P < 0.05). The incidence of pain onset was lower in the PIEB group than in the CEI group [27.3% (12/44) vs. 50.0% (21/42)], the onset time was delayed [(281.27±77.88) min vs. (201.20±48.26) min], the number of PCA compressions was reduced [(1.46±0.65) times vs. (2.29±1.15) times], the proportion of PCA>1 time was lower [15.9% (7/44) vs. 38.1% (16/42)], the amount of anesthetic per unit time was lower [(8.32±1.60) mg/h vs. (9.12±2.01) mg/h], the incidence of lateral incision was lower [13.6% (6/44) vs. 33.3% (14/42)], while the use of oxytocin increased [52.3% (23/44) vs. 30.9% (13/42)], and the differences were statistically significant (all P < 0.05).  Conclusion  The application of PIEB used in obese parturients for lumbar and hard labour analgesia can reduce the outbreak of pain, delay the onset of pain, reduce the amount of anaesthesia, with high safety for mother and child.
Clinical efficacy of Jiawei Shoutai Pills in the treatment of polycystic ovary syndrome with recurrent miscarriage and its impact on pre thrombotic state
WANG Shishuai, YE Liqun, SHAN Lihua, WU Linlin
2023, 21(8): 1339-1342. doi: 10.16766/j.cnki.issn.1674-4152.003118
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Abstract:
  Objective  Analyze the clinical efficacy of Jiawei Shoutai Pills in treating patients with polycystic ovary syndrome combined with recurrent miscarriage, and its impact on the patient's pre thrombotic state, providing a basis for clinical treatment.  Methods  A total of 150 patients with polycystic ovary syndrome and recurrent miscarriage admitted to Ningbo Traditional Chinese Medicine Hospital from July 2019 to June 2021 were selected as the study subjects, They were randomly divided into A team (low molecular weight heparin calcium injection treatment), B team (modified Jiawei Shoutai Pills treatment) and C team (modified Jiawei Shoutai Pills combined with low molecular weight heparin calcium injection treatment), with 50 patients in each team.Compare the TCM syndrome score and endocrine index, coagulation- fibrinolysis index, anticardiolipin antibody.  Results  After treatment, the C team score of patients was 4.00 (1.46, 8.00) points, lower than the 10.00 (3.75, 11.25) points in the A team and the 11.21 (4.60, 12.18) points in the B team, P < 0.05; C team serum β-human chorionic gonadotropin (β-HCG), progesteroneon (P), estradiol (E2) were all higher than the B team and A team, P < 0.05; The activated partial thromboplastin time (APTT) and AntithrombinⅢ (ATⅢ) levels in the C team were higher than the traditional Chinese medicine and A team, while fibrinogen (FIB) and d-dimmer (DD) levels were lower than the B team and A team, with P < 0.05; The positive rate of anticardiolipin antibodies in the C team was 10.0% (5/50), which was lower than the LMWH and the Chinese medicine team, all were 28.0% (14/50), P < 0.05.  Conclusion  Jiawei Shoutai Pills combined with low-molecular-weight heparin calcium injection can effectively improve plasma viscosity, coagulation, fibrinolysis system and uterine artery hemodynamics in patients with polycystic ovary syndrome complicated with recurrent abortion, worthy of clinical application.
Trend analysis and prediction of anemia prevalence in children under 5 years old in Haikou
HUANG Lihong, SHI Huiling, LIN Yao, FU Liying, LIU Ying, SHI Liangsun, ZOU Binjun
2023, 21(8): 1343-1346. doi: 10.16766/j.cnki.issn.1674-4152.003119
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Abstract:
  Objective  This study aimed to analyze the current trend of anemia among children aged 0-5 years in Haikou, and to predict the prevalence of anemia in the next 5 years.  Methods  Joinpoint regression model was used to analyze the change trend of anemia prevalence among children aged 0-5 years in Haikou City and all 4 districts from 2014 to 2021; while GM (1, 1) grey prediction model was used to predict the prevalence of anemia in children aged 0-5 years in Haikou City.  Results  The prevalence rate of anemia among children aged 0-5 years in Haikou is between 3.95% (3 317/83 955) in 2015 and 9.99% (8 723/87 341) in 2019, the annual percentage change (APC) is 23.0 (95% CI: 6.9-41.6, P=0.018) from 2014 to 2019, this trend changed in 2019, and the APC of anemia is -12.3 (95% CI: - 47.4-46.2, P=0.474) from 2019 to 2021. In general, there is a clear obvious upward trend at first and then a downward trend (not significant). Specific to the situation of children in all districts, the anemia rate in Xiuying and Qiongshan districts first increased and then stabilized; while the anemia rate in Longhua district increased year by year; Meilan district showed no statistically significant change trend in the anemia rate. The prediction results of the GM (1, 1) model show that in the next 5 years from 2022 to 2026, the prevalence of anemia in children aged 0-5 years in Haikou will be about 10.28%, 11.22%, 12.21%, 13.24% and 14.32%, respectively.  Conclusion  The anemia rate of children aged 0-5 years in Haikou has increased significantly in recent years and will increase in the future, which requires the attention of relevant departments, cooperates with the government, health commission and relevant medical and health institutions and other departments jointly formulate relevant intervention measures to reduce the incidence of anemia in children.
Analysis of status quo and influencing factors of parental support of premature mothers
XIANG Dandan, CAO Xuehong, YU Haiying, ZHANG Jing, LIN Xiaoqing
2023, 21(8): 1347-1350. doi: 10.16766/j.cnki.issn.1674-4152.003120
135 4
Abstract:
  Objective  From the perspective of the mothers of premature infants, this study aims to understand the current situation of parenting support and explore the factors affecting the level of parenting support, in order to provide a reference for the development of parenting support management strategies for the mothers of premature infants.  Methods  There were 202 mothers of premature infants were selected from 2 Class A tertiary hospitals in Wenzhou city from August to December in 2022 by convenient sampling. General Situation Questionnaire, Parenting Support for Mothers of Infants, Role Adaptation Questionnaire and Self-efficacy Subscale of Parenting Sense of Competence Scale were used to conduct the questionnaire survey.  Results  The parenting support for mothers of infants were 4 points, child-raising difficulty were 5 points, the family support were 3 points, their own situation were 4 points, the husband's situation were 3 points, the baby situation were 4 points. There were differences in the number of births, family residence, and education among the parenting support scores (all P < 0.05). Parenting support for preterm mothers was negatively correlated with total self-efficacy, role adaptation, and scores for all dimensions (r was -0.169 to -0.541, all P < 0.05). Multiple stepwise regression analysis showed that self-efficacy, educational level, role-adapted infant ability to care for daily life, maternal role happiness dimensions, and birth entry into the regression equation, explaining 34.7% of the total variation.  Conclusion  The level of parenting support for mothers of premature infants needs to be improved. Medical workers should pay attention to low self-efficacy, low education, low role adaptation and parenting support level for primiparas, adopt personalized intervention measures, improve their parenting support level, and provide better home care for premature infants.
Survey on the competence of general practitioners in Xinjiang and analysis of influencing factors
Shama·Mulati, CHEN Hong, Delifia·Dilishati, XU Peilan
2023, 21(8): 1351-1355. doi: 10.16766/j.cnki.issn.1674-4152.003121
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Abstract:
  Objective  To investigate the current position competence of grassroots general practitioners (GPs) in Xinjiang and analyze the major influencing factors, so as to provide theoretical reference for strengthening the positional competence of grassroots GPs in Xinjiang.  Methods  A total of 645 in-service primary care physicians in Xinjiang were randomly selected by questionnaire survey from April to June 2022. The results of post-competence were analyzed by χ2 test, t-test and variance analysis, and the influencing factors of post-competence were explored by linear regression analysis. A total of 658 questionnaires were sent out in this survey, and 645 valid questionnaires were collected after the screening of defective papers, with a recovery rate of 98.02%.  Results  There were statistically significant differences in age, education, professional title, years of practice and institution category of general practitioners in different regions (all P < 0.05). The total post-competence self-assessment score of grassroots general practitioners in Xinjiang was (51.09±15.24) points, which was at the medium level; Changji Prefecture had the highest competency score [(55.15±16.53) points], followed by Tacheng district [(54.11±16.53) points]. There were statistically significant differences in the self-assessed post-competence scores of general practitioners between different genders (P < 0.001), different educational backgrounds (P=0.028), different working years (P=0.007) and different categories of medical institutions (P=0.027). The post-competence of grassroots general practitioners in Xinjiang was affected by gender and the category of their institutions (P < 0.01).  Conclusion  There is still much room for improvement in the skills of grassroots GPs in Xinjiang. Existing talents should be retained to expand the team of general practitioners. Grassroots medical institutions should be developed based on the homogeneity of regional conditions, the practice environment should be improved, targeted training should be carried out to enhance the humanistic practice ability of general practitioners, and the capacity of basic medical and public health services should be strengthened.
Application of 6-minute walk test in community-based cardiac rehabilitation of patients with stable coronary artery disease
YANG Ling, DU Xueping
2023, 21(8): 1356-1359. doi: 10.16766/j.cnki.issn.1674-4152.003122
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Abstract:
  Objective  To evaluate the effect of exercise rehabilitation by analyzing the 6-minute walking distance (6MWD) of patients with stable coronary artery disease before and after exercise rehabilitation.  Methods  Fifty patients in the experimental group and 50 patients in the control group were recruited from patients with stable coronary artery disease under the age of 75 years under standard management from June 2021 to June 2022 of the Yuetan Community Health Service Center. The experimental group underwent exercise rehabilitation, which consisted of exercise bicycle training. Each subject pedaled an exercise of bicycle for 30 times, 20 minutes each time, 3-5 times a week. The control group used low-intensity exercise such as walking, 3-5 times a week, 30-60 minutes each time. The observation index was 6MWD before and after intervention. The effects of the experimental group and the control group before and after intervention were evaluated by chi-square test.  Results  According to the cardiopulmonary function classification corresponding to 6MWD, "≤300 m" was "Level 1 to 2" and "≥301 m" was "Level 3 to 4". There was a statistically significant difference in cardiopulmonary function grading between the experimental group and the control group after intervention (χ2=21.951, P < 0.001). The increase of 6MWD (Δ6MWD) before and after the intervention were grouped as " < 54 m" and "≥54 m" in the experimental and control groups, and the difference was statistically significant when comparing the Δ6MWD grading in the test and control groups (χ2=96.078, P < 0.001).  Conclusion  The 6MWD and cardiopulmonary function grading of patients with stable coronary artery disease were increased after exercise rehabilitation with an exercise bicycle, which may provide an important reference for community cardiac rehabilitation of patients with coronary artery disease in the future.
Application of health education based on the Green's model in health examination of people infected with Helicobacter pylori
SHI Limiao, HU Jianhao, ZHAO Qijiang, JIANG Ying, XU Wenfang, CHEN Jing
2023, 21(8): 1360-1364. doi: 10.16766/j.cnki.issn.1674-4152.003123
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Abstract:
  Objective  This study uses the Green's model as a framework to analyze the effectiveness of health education in patients with Helicobacter pylori infection during health examinations, providing new ideas for clinical education.  Methods  A convenient sampling method was used to select 200 cases of Helicobacter pylori infection from health check-ups at the Affiliated Hospital of Shaoxing University of Arts and Sciences from June 2019 to December 2022 as the research objects. They were divided into the control group and the observation group with 100 cases each according to the random number table. The control group received routine health education, while the observation group received health education based on Green's model on the basis of the control group. The treatment rate, eradication rate, medication compliance, knowledge of Helicobacter pylori infection and health behavior score were compared between the two groups, and satisfaction of health education was counted.  Results  The treatment adherence rate in the observation group was 93.0% (93/100), while that in the control group was 78.0% (78/100). The comparison between the two groups was statistically significant (P < 0.05), and the eradication rate and good medication adherence rate of the observation group were 82.8% (77/93) and 94.6% (88/93), respectively, which were higher than 61.5% (48/78) and 82.1% (64/78) of the patients in the control group; after the intervention, the scores and total scores of knowledge mastery of patients in the observation group were higher than those in the control group (all P < 0.05); The total score of healthy behavior in the observation group was (108.32±4.12) points, which was higher than that in the control group [(100.09±5.88) points, P < 0.05]; the satisfaction with education in the observation group was higher than that in the control group (P < 0.05).  Conclusion  Health education based on Green's model can promote the treatment of people infected with Helicobacter pylori and improve the eradication rate of patients, which is conducive to improving the knowledge and health behavior of patients with Helicobacter pylori infection, and is worthy of clinical application.
The application of preoperative ultrasound-guided quadratus lumborum block for the analgesia after hepatic microwave ablation
LI Liang, FENG Xinyuan, YIN Jun, ZHOU Zhongsong, ZHANG Chaoxue
2023, 21(8): 1365-1369. doi: 10.16766/j.cnki.issn.1674-4152.003124
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Abstract:
  Objective  To investigate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block(QLB) for microwave ablation of liver tumor.  Methods  A retrospective cohort study was conducted to collect 190 patients who underwent ultrasound-guided microwave ablation (MWA) of liver tumors at the First Affiliated Hospital of Anhui Medical University from January 2017 to December 2020, 40 patients of whom underwent ultrasound-guided QLB (research group) and the remaining 150 patients underwent general anesthesia only (control group). Baseline data related to postoperative pain were scored and matched 1∶ 1 by propensity score analysis to produce a study group and a control group, then the postoperative visual analogue scale (VAS) score, the quality of recovery-40 questionnaire (QoR40) score and the treatment for postoperative pain after operation were compared between the two groups.  Results  After propensity score matching, there was no statistical difference for the baseline data between the research group (40 patients included) and the control group (40 patients included) after matching. There was no statistical difference in the baseline data between the two groups (all P>0.05). The factors related to the postoperative pain were selected by single factor regression and then included in multi-factor regression. Multi-factor regression analysis showed that OLB was negatively correlated with postoperative pain (P < 0.05). There was no significant difference in the QoR40 scores [(171.85±10.14) points vs. (167.45±10.59) points]between the two groups (t=-1.884, P=0.065). The number of cases requiring treatment was reduced in the experimental group compared with the control group, however, the difference was not statistically significant (P=0.057).  Conclusion  Compared with the general anesthesia, the combination of preoperative QLB and general anesthesia can reduce the preoperative pain for the patients underwent hepatic MWA.
The value of transvaginal two-dimensional ultrasound combined with three-dimensional energy Doppler in differentiating endometrial lesions in postmenopausal women
CHEN Xianqiu, JIN Weiwei
2023, 21(8): 1370-1373. doi: 10.16766/j.cnki.issn.1674-4152.003125
138 4
Abstract:
  Objective  To analyze the value of transvaginal two-dimensional ultrasound combined with three-dimensional energy Doppler in the differentiation of endometrial lesions in postmenopausal women.  Methods  A total of 214 postmenopausal patients with endometrial disease in the Department of Gynecology of Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected as the research objects. The patients were divided into benign lesion group (109 cases), atypical hyperplasia group (68 cases) and endometrial cancer group (37 cases) according to the pathological examination results. All subjects underwent transvaginal ultrasound to obtain endometrial thickness, two-dimensional blood flow classification, three-dimensional power Doppler blood flow.  Results  The endometrial thickness of the benign lesion group, the atypical hyperplasia group and the endometrial cancer group was gradually thickened (F=15.392, P < 0.001), the vascular index (VI), flow index (FI) and vascular flow index (VFI) were gradually increased (all P < 0.001), and the flow grade 2 and 3 was gradually increased (Z=5.994, P < 0.001). BMI, endometrial thickness, blood flow grade 3, and VFI were risk factors for the progression of endometrial lesions (OR=2.555, 1.941, 1.858, 2.450, all P < 0.05). Endometrial thickness and blood flow grade 3 had differential value between benign endometrial lesions and atypical hyperplasia (AUC=0.770, 0.811, P < 0.05). Endometrial VFI had differential value between benign endometrial lesions and atypical hyperplasia, atypical hyperplasia and endometrial cancer (AUC=0.793, 0.859, P < 0.001). In the cases of endometrial thickness > 7.6 cm, blood flow grade 3 and VFI > 11, the coincidence rates of 1, 2 and 3 with pathological diagnosis were 61.5%, 70.7% and 90.8%, respectively.  Conclusion  Endometrial thickness, blood flow grading combined with VFI has a good value in differentiating the types of endometrial lesions in postmenopausal women.
The effect of lipid metabolism on the occurrence, development and prognosis of aortic disease
WANG Yuhang, SHEN Zhenya
2023, 21(8): 1374-1378. doi: 10.16766/j.cnki.issn.1674-4152.003126
101 5
Abstract:
Aortic diseases, such as aortic aneurysm and aortic dissection, have attracted wide attention as a kind of diseases with high morbidity and high mortality, which lack effective early warning markers and have a high mortality after surgical treatment. The pathogenesis of aortic disease is not fully understood. At present, aortic disease has been proven to be associated with hypertension, atherosclerosis, gender, genetic variation, inflammation and other factors that change the force on the aortic wall. With the development of economy and society, the incidence of dyslipidemia represented by hyperlipidemia is increasing in the world. Dyslipidemia increases the risk of atherosclerosis and vascular dysfunction, and ultimately leads to coronary heart disease, stroke and other cardiovascular and cerebrovascular diseases. Currently, hyperlipidemia has been found to have adverse effects on the occurrence and development of aortic diseases. A better understanding of the relationship between lipid metabolism disorders and aortic diseases is helpful for clinical prevention, diagnosis and treatment of aortic diseases. At the same time, various lipid-regulating drugs can effectively control blood lipid through different lipid metabolic sites, and lipid-regulating drugs have played an important role in the prevention and clinical treatment of various cardiovascular and cerebrovascular diseases. Controlling blood lipids and improving atherosclerosis have better preventive effect on the occurrence of aortic diseases. This paper summarizes the relationship between clinical lipid indexes, hyperlipidemia and the occurrence, development and prognosis of aortic diseases in recent years, and probes into the cellular and molecular pathways of lipid metabolism disorders and the effects of lipid-regulating drugs on aortic diseases, as well as their potential application prospects.
Application Value of-Vascular Dementia related Biomarkers and Research Progress of Acupuncture intervention Plan
SUN Jingyan, WU Chen, YU Guoqiang, YU Xiaohong, YANG Tiansong
2023, 21(8): 1379-1382. doi: 10.16766/j.cnki.issn.1674-4152.003127
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Abstract:
Vascular dementia (VD) is a progressive cognitive disability syndrome caused by reduced blood supply to the brain caused by cerebrovascular diseases, and its incidence is second only to Alzheimer's disease (AD). The prevalence rate of VD in China ranges from 1.1%-3.0%, and the number of patients with dementia is as high as 20% of the global population. Patients suffer from memory loss, cognitive dysfunction and other symptoms, so that they lose the ability to take care of themselves, which places a great burden to their families and society. With the aging of population, the increasing number of patients and the increasing cost of treatment, how to deal with VD caused by the above factors has become a public health problem facing the world. At present, the pathogenesis is not clear, and there is no effective treatment, as the only type of dementia that can be prevented, how to prevent VD has become the focus and difficulty of clinical research. Biomarkers reflect certain characteristics in the course of disease treatment, and related biomarkers play an important role in the early diagnosis, pathogenesis, guidance of treatment strategies, prognosis assessment and other aspects of VD. Long-term use of Western medicine will produce a variety of adverse effects such as drug resistance and dependence. Therefore, many studies have combined acupuncture with Chinese herbal formulas and western drugs on the basis of traditional Chinese medicine theory, and selected acupuncture point formulas according to the patient's individual constitution and the underlying condition, all of which have achieved good clinical effects. In this paper, the literature related to VD acupuncture research in the past 5 years was retrieved from the China Journal Full-text Database (CNKI). Many biomarkers related to vascular dementia were found and classified according to their molecular categories. This paper summarized and commented on the application value of VD in the diagnosis and treatment of vascular dementia, the intervention effect of targeted acupuncture and special acupuncture methods, which provided certain ideas for the treatment and research of VD.
Progress of genetic risk scores in predicting type 2 diabetes
CAO Huiying, FENG Lei, TANG Lingtong, LIU Yanmei, BI Qianye, LUO Beibei, SHI Rui, ZHANG Yanbi
2023, 21(8): 1383-1387. doi: 10.16766/j.cnki.issn.1674-4152.003128
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Abstract:
It is reported that there are about 537 million diabetes patients aged 20-79 years around the world, and about 6.7 million adults die of diabetes or diabetes complications. China has become the country with the largest number of diabetes patients in the world. Type 2 diabetes mellitus (T2DM) is the result of environmental and genetic factors. In recent years, the incidence rate of T2DM continues to rise, so it is very important to prevent and control the occurrence and development of T2DM. To address this situation, the T2DM research team has established a T2DM risk prediction model. Currently, the mechanisms included in the T2DM prediction model are mostly lipid metabolism, pancreatic function, glucose metabolism, dietary habits, etc., which are basically traditional risk factors. This has led to the phenomenon of "homogenization" in domestic and foreign T2DM prediction models. The prediction effect of existing models in different populations is not ideal, and there is an urgent need for new ideas and methods to be added. With the completion of the Human Genome Project, more and more studies have been carried out on the establishment of T2DM prediction models based on the joint application of susceptibility genes and traditional risk factors. Therefore, this paper plans to jointly apply susceptibility genes and traditional risk factors to establish T2DM prediction models incorporating new mechanisms, integrate "congenital" genetic factors and "acquired" physiological and biochemical indicators, and aim to accurately predict T2DM. At the same time, genetic factors are represented by the genetic risk score (GRS), and exploring how GRS can be applied to prediction models is also one of the purposes of this article. This paper reviewed the calculation of genetic risk score for type 2 diabetes mellitus, the combination of genetic risk score and traditional clinical risk factors in predicting type 2 diabetes mellitus, and how to apply genetic risk score through searching domestic and foreign literature, providing ideas and basis for the improvement of prediction model for type 2 diabetes mellitus in the future.
Current status of management of cognitive function in patients with multimorbidity
HAN Yue, YANG Zhenhua, HAN Qingfeng, XIAO Weizhong
2023, 21(8): 1388-1392. doi: 10.16766/j.cnki.issn.1674-4152.003129
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Abstract:
With the increasing ageing of the population, the problem of multimorbidity is becoming more and more serious, and the multimorbidity has also become a major cause of cognitive impairment. Indeed, the two are interrelated. Without a comprehensive approach, it is easy to create a vicious circle in both directions. The mechanisms of the interaction between multimorbidity and cognitive impairment are unclear, which may be related to accelerated ageing and its chronic inflammation and oxidative stress, so more basic research is needed to clarify these views. Because of multimorbidity, problems such as polypharmacy, potentially inappropriate drug use, drug-drug interactions, and the effects of drugs on cognitive function are public health issues that general practitioners need to address. Cognitive function screening, assessment and active intervention measures in patients with multimorbidity, and comprehensive management including non-drug treatment, drug treatment, psycho-psychology and rehabilitation, will definitely prevent or reduce the occurrence of cognitive dysfunction in patients with multimorbidity. Slowing the progression of cognitive impairment. Unfortunately, the current management of cognitive function in patients with multimorbidity mainly follows the previous assessment and treatment of cognitive dysfunction without considering the impact of multimorbidity. Therefore, there is an urgent need to establish and improve guidelines for the management of the cognitive function in patients with multimorbidity. With the continuous improvement of the hierarchical diagnosis and treatment system, general practitioners will surely shoulder the burden of cognitive function management of patients with multimorbidity. While improving our own capabilities, we need to strengthen the initial screening, assessment, intervention, reassessment, and re-intervention of such patients, which truly reflects the continuous management of multimorbidity by general practitioners.
Comparison of the effects of ultrasound-guided injection of anti-inflammatory and analgesic mixture into the rotator cuff space and pain points in the treatment of rotator cuff injuries
SHAN Lingling, XU Qiong, WANG Pengfei, ZHANG Li, DU Xin, DU Fenfei
2023, 21(8): 1393-1396. doi: 10.16766/j.cnki.issn.1674-4152.003130
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Abstract:
  Objective  Shoulder joint injection therapy, as the main treatment for rotator cuff injuries, can be divided into ultrasound-guided rotator cuff space injection therapy and traditional pain point injection therapy. This study mainly compares the therapeutic differences between the two treatments.  Methods  From April 2020 to October 2022, 92 patients with rotator cuff injury who received conservative treatment with drug injection in Dongyang People ' s Hospital were divided into ultrasound-guided injection group (n=46) and traditional pain spot injection group (n=46) using the random number table method. The anti-inflammatory and analgesic mixture was injected into the rotator cuff space under ultrasound guidance and according to the traditional pain spot injection method once every 2 weeks and continuously 3 times, respectively. The visual analogue pain (VAS) score, serum C-reactive protein (CRP), Constant Murley shoulder joint score, need for oral analgesics and incidence of subcutaneous ecchymosis were compared between the two groups before and after treatment.  Results  VAS scores and serum CRP levels were lower in the two groups at 2, 4 and 6 weeks of treatment than before treatment (all P < 0.05), and VAS scores and serum CRP levels at the above-mentioned time points were significantly lower in the ultrasound guided injection group than in the traditional pain point injection group (all P < 0.05). The shoulder joint Constant-Murley score in the two groups at 2, 4, 6 weeks of treatment was higher than that before treatment (all P < 0.05), and the shoulder joint Constant-Murley score in the ultrasound-guided injection group at 4, 6 weeks of treatment was significantly higher than that in the traditional pain point injection group (all P < 0.05).In the ultrasound-guided injection group, 21.74% (10/46) of oral analgesic drugs were less than 41.30% (19/46) in the traditional pain point injection group (P < 0.05), and there was no statistically significant difference in the incidence of subcutaneous ecchymosis between groups (P>0.05).  Conclusion  Ultrasound-guided injection of an anti-inflammatory and analgesic mixture into the rotator cuff space and pain points has a good effect in the treatment of rotator cuff injuries, however, the former has significant clinical advantages in reducing rotator cuff pain, lowering serum CRP levels, promoting the recovery of shoulder joint function and reducing oral analgesic drugs.
Clinical study of relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine fumigation in the treatment of patients with shoulder-hand syndrome after stroke
ZHENG Qi, GAO Xia, CHAI Jie, HONG Feng
2023, 21(8): 1397-1401. doi: 10.16766/j.cnki.issn.1674-4152.003131
89 2
Abstract:
  Objective  Shoulder-hand syndrome (SHS) after stroke can lead to limb dysfunction, and the long-term efficacy of conventional drug therapy and functional training is not so ideal, this study investigates the clinical effects of relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine (TCM) fumigation in the treatment of SHS.  Methods  A total of 80 patients with SHS after stroke who were admitted to the People ' s Hospital of Bozhou from May 2020 to July 2021 were selected and divided into experimental group (40 cases) and control group (40 cases) by random number table method. The control group was given conventional treatments, functional exercise of shoulder and hand joints and traditional Chinese medicine fumigation. On this basis, the experimental group was treated with relaxing needling at meridian-muscle nodes. The pain visual analogue scale (VAS) scores, Fugl-Meyer assessment (FMA) scores, shoulder joint range of motion, hemodynamic indicators, TCM syndrome scores and total response rate were compared between the two groups.  Results  After treatment, the VAS score of the experimental group was 2.87±0.65, which was significantly lower than 3.51±0.84 of the control group (t=3.811, P < 0.001); The FMA score was 54.28±6.17, which was significantly higher than 49.36±7.58 of the control group (t=3.184, P=0.002); The lifting motion of shoulder joint in test group [(40.72±3.16)°] was significantly higher than that in control group [(36.85±4.73)°, t=4.303, P < 0.001]; Abductive range of motion of shoulder joint in experimental group [(70.16±4.28)°] was significantly higher than that in control group [(66.59±5.34)°, t=3.299, P=0.002]. Whole blood high-shear viscosity, whole blood low-shear viscosity, plasma viscosity and TCM syndrome scores were significantly lower than those in the control group (all P < 0.05). The total clinical response rate in the experimental group (90.00%, 36/40) was significantly higher than that in the control group (67.50%, 27/40, χ2=6.050, P=0.014).  Conclusion  The treatment of SHS after stroke with relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine fumigation can effectively relieve pain and improve limb motor function, shoulder joint range of motion and hemodynamics, with significant curative effect.
Training effect and influencing factors of job-transfer training for general practitioners in Chongqing province
XU Yang, JIA Hexun, DENG Jingzhi, YANG Wen, DENG Huisheng
2023, 21(8): 1402-1406. doi: 10.16766/j.cnki.issn.1674-4152.003132
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Abstract:
  Objective  To analyze the completion assessment results of job-transfer training of general practitioners in Chongqing General Practice Education Center, and to provide constructive suggestions for improving the transfer training program and formulating training strategies.  Methods  The research subjects were 220 general practitioners who participated in the assessment at General Medical Education Center of the First Affiliated Hospital of Chongqing Medical University in 2021. Trainees ' inquiry ability was evaluated by a standard completion assessment program. The scores of these abilities were adopts SPSS 22.0 for statistical analysis.  Results  The median score of medical history collection, physical examination, cardiopulmonary resuscitation, clinical thinking, chronic disease management, and theoretical examinations were 80.0 (71.3, 80.0), 80.0 (70.0, 90.0), 89.0 (84.0, 92.0), 67.0 (58.3, 71.0), 65.0 (60.0, 70.0) and 58.0 (55.0, 62.0), respectively; and the passing rates were 96.8%, 89.5%, 99.5%, 74.5%, 80.0%, and 40.9%, respectively, and the differences were statistically significant (all P < 0.05). Multivariate linear regression showed that gender, age, education and working years had significant influences on the total score (all P < 0.05). In terms of theoretical training, students proposed to increase theoretical training class, and hoped that the training content could better combine clinical practice and meet the actual needs of the grassroots level. In terms of clinical practice, students hoped to increase clinical practice training, department rotation time, and grass-roots practice.  Conclusion  General practitioners ' physical examination, cardiopulmonary resuscitation and interrogation skills are in good performance while their theoretical, chronic disease management and clinical thinking skills are slightly poor. There are great individual differences of trainees ' comprehensive ability.
Research on the application of PBL combined with CBL in the clinical practice teaching for lung cancer
LIU Jing, LIU Yang, LI Yumei, SHI Mohan, WANG Mingxi, ZHOU Zhengguang, YANG Yan
2023, 21(8): 1407-1410. doi: 10.16766/j.cnki.issn.1674-4152.003133
142 18
Abstract:
  Objective  To explore the application value of problem-based learning (PBL) combined with case-based learning (CBL) in lung cancer clinical practice teaching for undergraduate students.  Methods  Sixty-four undergraduate interns majoring in clinical medicine at the Department of Medical Oncology, the First Affiliated Hospital of Bengbu Medical College between March 2021 and June 2022 were selected. The random digital table method was used to divide the subjects into observation group and control group, with 32 students in each group. The observation group adopted PBL combined with CBL teaching mode, while the control group adopted lecture-based learning (LBL) teaching. At the end of the trial teaching period, teaching evaluation was performed by means of a theoretical knowledge examination, a clinical practice examination and various questionnaires.  Results  In the after-class examination, the scores for theoretical knowledge (86.81±6.01), case analysis (82.69±7.35), case writing (84.69±6.27) and overall scores (84.94±4.08) in the observation group were higher than those in the control group (82.81±6.42, 76.75±7.27, 79.34±6.25, 79.95±4.02), with significant differences (all P < 0.05). In the self-evaluation questionnaire, students in the observation group outperformed the control group in six aspects, including stimulation of learning interest, improvement of self-learning ability, theoretical knowledge mastery, clinical thinking ability, clinical practice ability, analytical and problem-solving ability (all P < 0.05). In addition, the satisfaction survey showed that students in the observation group were more satisfied with the teaching, teaching methods and teacher performance than those in the control group (all P < 0.05).  Conclusion  In the clinical practice teaching for lung cancer, PBL combined with CBL double teaching mode is more effective than the traditional LBL method and can promote the improvement of oncology teaching.
Bibliometric and visualization analysis of Chinese literature in the field of loneliness among older people
CAO Chenglin, ZHENG Xin, CAO Wenwen, QIN Xia, HU Zhi, BAI Zhongliang
2023, 21(8): 1411-1415. doi: 10.16766/j.cnki.issn.1674-4152.003134
101 9
Abstract:
  Objective  To analyze the research status and development trend of loneliness among older adults in China in order to provide valuable information for relevant research.  Methods  The literature related to loneliness among older people was screened from CNKI, CQVIP and Wanfang databases. The retrieval time was from the establishment of database to December 31, 2022. The bibliometric and visualization analysis was performed by NoteExpress and CiteSpace.  Results  A total of 403 related articles were included, and the number of published articles showed an upward trend. Among the included works of literature, 147 (36.48%) were supported by the fund. The research units were mostly medical colleges, and the cooperation network between the institutions and the authors was scattered and the density was insufficient. Current research focuses on the influencing factors and mechanisms of loneliness among older people, and the research on measuring tools was relatively lacking. The research hotspots and frontiers mainly focused on the loneliness of specific older groups, the influencing factors and interventions of loneliness among older people, the mechanism of loneliness, and the negative effects.  Conclusions  At present, the research in the field of loneliness among older people is still in the preliminary development stage. Although the research in this field has achieved results, there are still research gaps. In the future, government support should be increased, inter-institutional cooperation and exchange should be strengthened, new theories and perspectives should be introduced, and research content should be deepened, so as to promote the development of research in the field of loneliness in old age.
Analysis of adherence index of community residents using the "health record" APP based on scoping review
XIE Peijie, LIANG Xiaoqing, FAN Guanhua
2023, 21(8): 1416-1420. doi: 10.16766/j.cnki.issn.1674-4152.003135
78 1
Abstract:
  Objective  To conduct a scoping review on the relevant literatures evaluating the adherence index of community residents using the "health record" APP, and to provide a reference for further analysis of the relevant adherence index of community residents.  Methods  PubMed and CBM were used for literature retrieval and collection. Data were extracted from the included studies, including basic research information, indicators used to measure adherence and relevant grading standards, and descriptive analysis of the relevant data was performed.  Results  A total of 19 references were included. Indicators commonly used to evaluate adherence include: login times, duration of use, frequency of use, days of use, number of functions used, application retention rate, etc. They can be summarized into five categories: (1)Frequency of use (14/19, 73.7%); (2)duration of use (6/19, 31.6%); (3)width of use (9/19, 47.4%); (4)depth of use (4/19, 21.1%); (5) retention rate (9/19, 47.4%). All indicators reflect the actual usage of users in a certain dimension.  Conclusions  "Frequency of use" is the most concerned category, and further research can pay more attention to "duration of use" and "depth of use". According to the type of disease and the research design, the reasonable selection of the adherence index evaluation can objectively reflect the users ' use of the APP, and provide relevant evidence for the effectiveness of health management by using the "health record" APP. It is suggested that researchers use multiple categories of indicators to evaluate users ' adherence at the same time, in order to reduce the intervention and deviation caused by the single set of indicators or inappropriate for this study.
Research on the grass-roots employment intention and its influencing factors of order-oriented medical students after the expiration of performance in Shanxi Province
HOU Shasha, AN Yanan, LI Jing, LIU Hao, DUAN Zhaoxia
2023, 21(8): 1421-1424. doi: 10.16766/j.cnki.issn.1674-4152.003136
110 8
Abstract:
  Objective  To analyze the understanding of relevant policies of rural order-oriented medical students in Shanxi Province, the willingness to continue serving the grassroots after graduation and the expiration of the contract, and their influencing factors, in order to provide a theoretical basis for the training and deployment of order-oriented medical students in our country.  Methods  Cluster sampling method was used to conduct an online survey of 1 200 rural medical students in Shanxi Province with targeted orders, and 1 054 valid questionnaires were obtained. The data obtained were analyzed using SPSS 26.0 statistical analysis.  Results  Some of the students [45.45%(479/1 054)] are not familiar with the relevant policies of the order-oriented students, and 59.77% (630/1 054) of the students said that they will continue to serve the grassroots after the completion of the contract performance. The factors that influence the students to continue to serve the grassroots after the completion of the performance includes: the grade of the student (P=0.004), the degree of understanding of the major (P < 0.001), and whether they know the employment direction of the major (P < 0.001) etc.  Conclusion  In Shanxi Province, the awareness rate of the policy on order-oriented medical students needs to be further improved, the willingness to actively fulfil the contract after graduation is not strong, and the willingness to continue serving the grassroots after the contract is completed is not strong. Relevant administrative departments should strengthen the publicity and interpretation of relevant policies. Colleges and universities should be demand-oriented and provide medical education with general characteristics. All relevant departments should strengthen communication and cooperation.
Investigation of delirium syndrome after total hip arthroplasty for femoral head necrosis and analysis of influencing factors
XU Yunyun, LU Juan, HUANG Congcong, PAN Xiaoyun, XUE Xinghe, WANG Yi
2023, 21(8): 1425-1428. doi: 10.16766/j.cnki.issn.1674-4152.003137
114 4
Abstract:
  Objective  To explore the delirium syndrome after total hip replacement in elderly patients with femoral head necrosis and its influencing factors, and to provide theoretical reference for clinical development of targeted preventive interventions.  Methods  A total of 194 cases of elderly patients with femoral head necrosis who underwent total hip replacement in the Department of Orthopedics, the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to May 2022 were selected as the observation subjects. The clinical data of patients were collected by self-made survey scale, and the occurrence of delirium syndrome was investigated by the Fuzzy consciousness assessment method (CAM) and the incidence of delirium syndrome was investigated. Multivariate logistic regression was used to analyze the influencing factors of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis.  Results  There were 26 cases of delirium syndrome after total hip replacement in 194 elderly patients with femoral head necrosis, the incidence was 13.40%. There were differences in age, pulmonary disease, nocturnal sleep disorder, nutritional disorder, anesthesia method, operation time, intraoperative blood loss, postoperative VAS score, postoperative serum CRP level, and postoperative hypoxemia incidence between patients with and without delirium syndrome (all P < 0.05). Multivariate logistic analysis found that advanced age, pulmonary diseases, nocturnal sleep disorders, nutritional disorders, anesthesia method (general anesthesia), long operation time, large amount of intraoperative blood loss, postoperative VAS score ≥7, postoperative serum CRP level increased, and postoperative hypoxemia were the influencing factors for the occurrence of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis (all P < 0.05).  Conclusion  Elderly patients with femoral head necrosis are affected by age, lung disease, sleep disorder, nutritional level and other factors, and there is a high risk of delirium after total hip replacement. Clinical preventive interventions should be provided to reduce the risk of postoperative delirium syndrome.
Observation on the effect of self-made anti-splash oral pad in general gastroscopy
CHAI Xiandeng, YANG Guifang, DING Hao, ZOU Yang, LIU Xiaochang
2023, 21(8): 1429-1432. doi: 10.16766/j.cnki.issn.1674-4152.003138
81 7
Abstract:
  Objective  During general gastroscopy, patients ' oral secretions are prone to outflow or splashing, increasing the risk of cross infection. The purpose of this study is to explore the safety and practical effects of self-made anti-splash oral pad in clinical applications.  Methods  Sixty patients who underwent general gastroscopy in the First Affiliated Hospital of Anhui Medical University from October to December 2020 were randomly divided into observation group (using self-made anti-splash oral pad) and control group (using routine one-time oral pad) by the random digital table method. The changes of blood pressure, heart rate and blood oxygen saturation before and during the examination were observed in the two groups, as well as the outflow of oral secretions, the amount of secretions on lavatory paper and the satisfaction of patients.  Results  The systolic blood pressure, diastolic blood pressure and heart rate of the two groups were slightly increased 2 minutes after the examination compared with 5 minutes before the examination, and there was no significant change in blood oxygen saturation before and during the examination (all P>0.05). There was no significant difference in systolic blood pressure, diastolic blood pressure, heart rate and blood oxygen saturation between the two groups (all P>0.05). More than 90% of the secretions in the observation group were collected into the gloves [(16.19±2.15) g], and the amount of secretions on the lavatory paper was very little [(1.85±0.31) g]. Compared with the amount of secretions on the lavatory paper in the control group [(17.78±2.53) g], the difference was statistically significant (P < 0.01). The satisfaction of patients in the observation group was also better than that in the control group (93.33% vs. 73.33%, P=0.038).  Conclusion  In the process of general gastroscopy, the self-made anti-splash oral pad is safe and practical. It can effectively collect the outflow or splashed secretions during the inspection process and avoid cross infection caused by secretions. The clinical practice effect is significant, and it can significantly improve the patient ' s satisfaction. It is worthy of in-depth research and clinical promotion.
Effect of medical counseling on the comfort and psychological status of children with severe pneumonia
HUANG Li, SHAO Mengyun, ZHU Leiyu, ZHU Haiyan, YAO Huanying
2023, 21(8): 1433-1436. doi: 10.16766/j.cnki.issn.1674-4152.003139
151 8
Abstract:
  Objective  To analyze the application effect of pediatric medical counseling in children with severe pneumonia and its impact on their comfort and psychological state.  Methods  A total of 100 children with severe pneumonia, who admitted to Shaoxing People' s Hospital from March 2018 to September 2022, were divided into a control group and an observation group with 50 cases each according to a random number table method. The children in the control group received routine care, while the observation group received medical guidance for children based on the control group. The comfort and psychological status of the two groups of children were compared before and after intervention using the children' s comfort questionnaire and (the screen for child anxiety related emotional disorders, SCARED) and (depression self-rating scale for children, DSRSC), and the treatment compliance and parental satisfaction of the two groups of children were calculated.  Results  After intervention, the total comfort score of the observation group was (8.79±0.85) points, which was lower than that in the control group [(13.83±1.54) points], P < 0.05; after intervention, the scores of SCARED and DSRSC in the observation group were (18.72±2.41) points and (12.37±1.64) points, which were less than that in the control group [(21.35±3.91) points and (15.48±2.10) points], all P < 0.05. The compliance of the children in the observation group was higher than that in the control group (P < 0.05). The care satisfaction rate of the observation group was higher than in the control group (P < 0.05).  Conclusion  The pediatric medical guidance can effectively improve the comfort of children with severe pneumonia, alleviate their anxiety and depression, improve their treatment compliance and parents' satisfaction with their care.
Systematic evaluation of the efficacy and safety of modified prone position ventilation in the treatment of children with ARDS
CHEN Juanjuan, LI Li, SUN Qi, ZHANG Qian, LI Dongmei
2023, 21(8): 1437-1440. doi: 10.16766/j.cnki.issn.1674-4152.003140
118 4
Abstract:
  Objective  To observe the efficacy and safety of modified prone position ventilation in the treatment of children with acute respiratory distress syndrome (ARDS), to provide a standardized process for the treatment and care of clinical ARDS.  Methods  Fifty children with ARDS hospitalized in the Department of Intensive Care Medicine, the First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2021 were conveniently selected and randomly divided into control group and observation group by using a radom number table method, with 25 cases in each group. The control group was given the traditional prone position ventilation method, and the observation group was given the modified prone position ventilation method. The improvement of respiratory mechanical indexes (oxygenation index, thoracic and pulmonary compliance) and hemodynamic indexes (heart rate, mean arterial pressure) and the occurrence of complications before and after intervention were compared between the two groups.  Results  There was no significant difference in the scores of respiratory mechanics index and hemodynamic index between the two groups before intervention (P>0.05). After prone position ventilation, there were no significant changes in hemodynamic indexes between the two groups (P>0.05). The oxygenation index and chest and lung compliance monitoring scores of the observation group were better than those of the control group, and the differences were statistically significant (all P < 0.05). The incidence of complications (stress injury, vomiting, accidental extubation, facial edema) was 4.0% in the observation group and 28.0% in the control group, and the difference was statistically significant between the two groups (P < 0.05).  Conclusion  The modified prone position ventilation strategy can promote the recovery of respiratory movement, maintain the hemodynamic stability of children with ARDS, and reduce the occurrence of complications such as skin injury and vomiting caused by traditional prone position. Meanwhile, the modified prone position provides effective head and face support, alleviates the edema of face, eyelid or conjunctival caused by conventional prone position, and reduces the occurrence of complications. It is worthy of clinical promotion.
Peritoneal dialysis-related peritonitis dominated by pandrug-resistant Klebsiella pneumoniae: a case report
WANG Dan, BAO Kun, LIU Juan, MA Weizhong, WANG Rongrong, XU Xiaona, SUN Na, QIN Xindong
2023, 21(8): 1441-1443. doi: 10.16766/j.cnki.issn.1674-4152.003141
112 14
Abstract:
Carbapenem-resistant Klebsiella pneumoniae leading to peritoneal dialysis-associated peritonitis is rare, with mortality rate can be up to 50%. There is no consensus yet reached on the treatment of pandrug-resistant Klebsiella pneumonia. Here we report a case of peritoneal dialysis-related peritonitis with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infection, combing related cases based on literature. The clinical features and treatment outcomes of pandrug-resistant Klebsiella pneumoniae leading to peritoneal dialysis-associated peritonitis were elucidated, then its treatment experience was summarized.
Hyperandrogenism in postmenopausal women: a case report and literature review
ZHU Yiyi, YU Ruiqi, YUAN Tao, ZHANG Huabing, WANG Xi, WANG Linjie, WU Xueyan
2023, 21(8): 1444-1448. doi: 10.16766/j.cnki.issn.1674-4152.003142
132 12
Abstract:
A 71-year-old female complained of hirsutism, androgenetic alopecia and enlarged clitoris after 10 years of post-menopause. Laboratory examination of total testosterone level was elevated (1.55-1.79 ng/mL, reference range: 0.08-0.60 ng/mL), while dehydroepiandrosterone sulfate was within normal range. No obvious adrenal or ovarian mass was shown on imaging. Laparoscopy exploration was refused owing to advanced age and multiple comorbidities. After the 8-month trial of gonadotropin-releasing hormone analogue triptorelin, improved hirsutism and reduced androgenetic alopecia were observed, with decreased luteinizing hormone levels from 31 to 0.2 IU/L and normalized testosterone levels to 0.47 ng/mL. No signs of tumor metastasis or ovarian enlargement were found on imaging examination. At the same time, the combination of lifestyle intervention and lipid lowering treatment can improve patients ' metabolic abnormalities, alleviate psychological anxiety, and improve their quality of life.