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2024 Vol. 22, No. 9

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General Practice Forum
Discussion on clinical philosophical thinking of general practitioners
MA Wanrui, REN Jingjing, ANG Zhizhong
2024, 22(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.003657
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General practice is an integrative medical discipline that amalgamates clinical medicine, preventive medicine, rehabilitative medicine, and disciplines within the humanities and social sciences. The main diagnosis and treatment scope of general practice has particularity and complexity, which requires general practitioners to learn to consciously establish and scientifically apply philosophical thinking methods in addition to having a high sense of responsibility, comprehensive professional knowledge, rich life experience, persistent scientific spirit, and excellent management skills. More than 2 400 years ago, Hippocrates put it this way: "A physician must be a philosopher at the same time." In the Geneva Declaration, the World Medical Association also advocated that doctors should possess all the best qualities of philosophers. This is especially true for general practitioners. Philosophical thinking can help general practitioners change the subjectivity, one-sidedness, externality, and stillness of their thinking in clinical practices. It is also the embodiment of the current bio-psycho-social medical model, which enables general practitioners to maintain a good humanistic culture and have the ability and art to deal with various problems. Therefore, the cultivation of clinical philosophical thinking of general practitioners is of great significance to the clinical practice and theoretical study of general practitioners. This paper intends to make a preliminary discussion on the clinical thinking method of general medicine and the philosophy of medicine, and theoretically discuss the role that the clinical philosophical thinking of general practitioners may play in medical practice and education, to provide certain references for further improving the clinical practice ability and teaching skills of general practitioners.
2024, 22(9): 1453-1462. doi: 10.16766/j.cnki.issn.1674-4152.003658
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Effects of emotional state, metacognition, and serum miRNAs on disease fear in depressed patients
FENG Caiqin, ZHENG Jifeng
2024, 22(9): 1522-1525. doi: 10.16766/j.cnki.issn.1674-4152.003673
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  Objective  To explore the relationship between emotional state, metacognition, and serum levels of miRNA-134 and miRNA-16 with disease fear in patients with depression.  Methods  A total of 142 patients with first-episode, medication-free depression treated at Shaoxing Seventh People's Hospital from September 2022 to January 2024 were selected. According to the fear of progression questionnaire-short form (FoP-Q-SF) score, the patients were divided into a high fear group (79 cases) and a low fear group (63 cases). The baseline data, emotional state, metacognition, and serum levels of miRNA-134 and miRNA-16 were compared between the two groups. Logistic regression analysis was used to evaluate the factors affecting the fear of disease in patients with depression.  Results  The scores of Hamilton depression scale-17 (HAMD-17), Hamilton anxiety scale-14 (HAMA-14), and the metacognitions questionnaire-30 (MCQ-30) in the high fear group were significantly higher than those in the low fear group (P < 0.05). The serum levels of miRNA-134 and miRNA-16 were significantly lower than those in the low fear group (P < 0.05). Additionally, there were significant differences in gender, age, employment status, living alone, family history of depression, and sleep duration between the two groups (P < 0.05). Logistic regression analysis identified living alone, MCQ-30 score, serum levels of miRNA-134 and miRNA-16 as significant factors affecting disease fear, with OR values of 8.149, 1.094, < 0.001, and < 0.001, respectively.  Conclusion  Metacognition levels and serum expression of miRNA-134 and miRNA-16 significantly impact the fear of disease in patients with depression.
The application of electrical stimulation of Neiguan acupoint in age-related cataract surgery
ZHANG Lixiang, WANG Lifang, DONG Ping, LI Fang
2024, 22(9): 1526-1529. doi: 10.16766/j.cnki.issn.1674-4152.003674
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  Objective  To explore the application of electrical stimulation on Neiguan acupoint in age-related cataract (ARC) surgery to provide more options for preventing postoperative nausea and vomiting (PONV) in clinical settings.  Methods  A total of 103 ARC patients who underwent phacoemulsification (Phaco) combined with intraocular lens implantation (IOL) surgery at the Ophthalmology Hospital of Hebei Province and the First Rongjun Youfu Hospital of Hebei Province from August 2021 to October 2023 were selected. The patients were randomly divided into an experimental group (n=52) and a baseline group (n=51) using a random number table method. All patients were given promecaine surface anesthesia, the baseline group received routine education and drug intervention, and the experimental group received the intervention of electrical stimulation of Neiguan acupoint on the basis of the baseline group. The incidence of PONV was analyzed in the two groups. Index of nausea and vomiting and retching (INVR) score, intraocular pressure, levels of serum motilin (MTL) and gastrin (GAS) before and after surgery, and patient satisfaction were compared between the two groups.  Results  The incidence of nausea and the total incidence of nausea and vomiting in the experimental group were lower than those in the baseline group within 6 hour and 6-24 hour after surgery (P < 0.05). At 6 hours and 24 hours after surgery, the intraocular pressure of the experimental group was lower than that of the baseline group (P < 0.05). The INVR score of the experimental group was found to be significantly lower compared to the baseline group at the 6 hour, 12 hour, and 24 hour time points following the operation (P < 0.05). The levels of MTL and GAS at 12 hour after the operation showed a decrease in both groups compared to pre-operation levels. However, the experimental group exhibited higher levels compared to the baseline group (P < 0.05). The level of satisfaction in the experimental group was 98.08% (51/52), which was significantly higher than the 84.31% (43/51) satisfaction level in the baseline group (P < 0.05).  Conclusion  The electrical stimulation of Neiguan acupoint can help stabilize intraocular pressure and gastrointestinal function in ARC patients, reduce the risk of PONV occurrence, and improve patient satisfaction.
Effect of Shexiang Tongxin Dripping Pills on coronary flow reserve in patients with coronary slow flow phenomenon
HAN Yong, TIE Chunmiao, SHEN Nannan
2024, 22(9): 1530-1532. doi: 10.16766/j.cnki.issn.1674-4152.003675
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  Objective  To investigate the clinical efficacy of Shexiang Tongxin Dripping Pills in treating coronary slow flow phenomenon (CSFP), and to explore its effect on improving coronary flow reserve (CFR) in patients.  Methods  Eighty-eight patients with coronary slow flow who were admitted to Affiliated Hospital of Shaoxing University from January to December 2023 were selected and randomly divided into the control group (n=44) and the observation group (n=44). The control group was given conventional treatment, and the observation group was treated with Shexiang Tongxin Dripping Pills in addition to the conventional treatment. The blood coagulation function, corrected TIMI frame count (CTFC), CFR and inflammatory factors before and after treatment were compared, as well as the adverse reactions after medication.  Results  After 4 weeks of treatment, the thrombin time (TT) in the observation group [(22.56±1.31) s] was higher than that in the control group [(19.53±1.94) s], and the difference was statistically significant (P < 0.05). Similarly, the prothrombin time (PT) in the observation group [(13.41±1.16) s] was higher than that in the control group [(12.19±0.99) s] with a statistically significant difference as well (P < 0.05). Additionally, the activated partial thromboplastin time (APTT) in the observation group [(42.80±3.83) s] was also higher compared to APTT [(38.74±4.17) s] in the control group (P < 0.05). On contrary, fibrinogen (Fib) in the observation group [(2.03±0.43) g/L] was lower than the control group [(2.38±0.49) g/L] with statistically significant difference (F=56.916, P < 0.05). The levels of CTFC and basal flow velocity (BFV) in the observation group were lower than those in the control group, while the maximal flow velocity (MFV) and CFR levels were higher than those in the control group (P < 0.05). The levels of hypersensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the observation group were lower than those in the control group (P < 0.05). There was no statistically significant difference in adverse reactions between two groups (P > 0.05).  Conclusion  Shexiang Tongxin Dripping Pills have better effect in the treatment of patients with coronary slow flow, it can relieve the clinical symptoms of patients, improve the coagulation function and inflammatory factors significantly, and can increase CFR, while having fewer adverse reactions.
Significance of nutritional status evaluation of BMI combined with hematological indexes in chemotherapy tolerance of patients with advanced digestive tract tumor after operation
YE Zhongwei, WU Xuelian, HE Yi
2024, 22(9): 1533-1537. doi: 10.16766/j.cnki.issn.1674-4152.003676
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  Objective  The nutritional status of patients with advanced digestive tract tumours has been demonstrated to affect their tolerance to chemotherapy. Consequently, an accurate evaluation of the nutritional status of patients with advanced digestive tract tumours is conducive to the early identification of high-risk groups with chemotherapy intolerance of advanced digestive tract tumours. Accordingly, the evaluation of nutritional status included the measurement of BMI and hematological indices, with a view to analyzing their value in identifying chemotherapy tolerance in patients with advanced digestive tract tumours was analyzed.  Methods  A total of 255 patients with advanced digestive tract tumours who received chemotherapy at Lishui Central Hospital from August 2021 to January 2023 were divided into a tolerance group and an intolerance group according to their chemotherapy tolerance. Logistic regression was employed to analyze the factors influencing the chemotherapy tolerance of patients with advanced digestive tract tumours, and the receiver operating characteristic (ROC) was constructed to analyze the value of nutritional evaluation of BMI combined with hematological nutritional indicators in predicting chemotherapy tolerance.  Results  A total of 255 patients with advanced digestive tract tumours were included in the study. Of these, 58 patients were intolerant to chemotherapy, while 197 patients were also intolerant to chemotherapy. The results of the logistic regression analysis indicated that age (OR=1.098), BMI (OR=0.550), ALB (OR=0.593), PAB (OR=0.885) and TRF (OR=0.779) were the influencing factors of postoperative chemotherapy tolerance in patients with advanced digestive tract tumours (P < 0.05). Following age adjustment, BMI, ALB, PAB and TRF remain significant influencing factors of chemotherapy tolerance in patients with advanced digestive tract tumours (P < 0.05). The combined use of BMI, ALB, PAB and TRF yielded a C-index of 0.952 for predicting chemotherapy tolerance in patients with advanced digestive tract tumours.  Conclusion  The combination of BMI with hematological nutritional indexes ALB, PAB and TRF can be employed to predict the chemotherapy tolerance of patients with advanced digestive tract tumours following surgical intervention.
The current situation of sibling relationship quality in preschool children and its correlation with emotional and behavioral problems
GAO Hongqiong, FANG Hongying, CAO Yueting, CHENG Yan, MENG Fanyue
2024, 22(9): 1538-1541. doi: 10.16766/j.cnki.issn.1674-4152.003677
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  Objective  To understand the current status of sibling relationships among preschool children, analyze its impact on emotional and behavioral problems, so as to provide references for the early development of children's mental health.  Methods  Using the method of stratified cluster sampling, 1 448 children aged 3-6 years old were selected from 11 kindergartens and families with multiple children in three districts and one county of Tongling City from April to June 2022. The early childhood sibling's quality questionnaire (parent version) and the strengths and difficulties questionnaire (SDQ, parent version) were completed by the children's guardians.  Results  The average sibling warmth score was 3.725±0.658, the average sibling conflict score was 3.453 ± 0.675, and the average sibling jealousy score was 3.770±0.796. The biggest child of multi-child families and children with an age difference of less than 5 years were more prone to occur sibling conflict and sibling jealousy. Logistic regression analysis showed that children in the sibling warmth low score group (OR=2.015, 95% CI: 1.263-3.885), sibling conflict middle score group (OR=0.424, 95% CI: 0.258-0.697) and sibling jealousy low score group (OR=0.387, 95% CI: 0.197-0.760) were prone to emotional and behavioral problems (P < 0.05).  Conclusion  The sibling relationships among preschool children in Tongling are good, and sibling relationships have an impact on the occurrence of emotional and behavioral problems in preschool children. Early intervention is necessary.
Effect of fresh embryo transfer on clinical pregnancy outcomes in patients with GnRH antagonist
PAN Xiaoqin, SHEN Liwen, ZHU Mengyi
2024, 22(9): 1542-1545. doi: 10.16766/j.cnki.issn.1674-4152.003678
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  Objective  To compare of clinical outcomes between fresh cycle transfer and first frozen embryo transfer (FET) in patients during controlled ovarian hyperstimulation (COH) with GnRH antagonist protocol, to explore embryo transfer strategies for GnRH antagonist protocol.  Methods  A retrospective analysis was performed for patients using GnRH antagonist protocol at the Reproductive Medicine Center of Huzhou Maternal and Child Health Hospital, from 2017 to 2022. The patients were divided into two groups based on whether fresh embryos were transferred. Patients in the study group were treated with fresh embryo transfer (n=197), while patients in the control group were those whose whole embryos freezing and completed the first FET (n=136). The differences in pregnancy outcomes between the two groups were compared.  Results  There were no significant differences in clinical pregnancy rate (CPR, 50.8% vs. 54.4%, P=0.512), and live birth rate (LBR, 41.1% vs. 46.3%, P=0.346)between the fresh embryo transfer group and the frozen embryo transfer group in patients using GnRH antagonist protocol through univariate analysis, and also in the implantation rate of cleavage embryo and blastocyst (P > 0.05). The age of patients undergoing COH with GnRH antagonist protocol was the only factor predicted both CPR (RR=0.989, 95% CI: 0.981-0.997, P=0.007) and LBR (RR=0.992, 95% CI: 0.983-0.999, P=0.048) through modified Poisson regression. The fresh embryo transfer was not a factor influencing CPR (RR=1.016, 95% CI: 0.924-1.118, P=0.742) and LPR (RR=1.020, 95% CI: 0.922-1.128, P=0.700).  Conclusion  The age of patients is the only significant predictor of both CPR and LBR using COH with GnRH antagonist protocol, whereas fresh embryo transplantation doses not affect clinical pregnancy outcome.
Impact of pelvic floor therapeutic instrument assisted with traditional Chinese medicine on inflammation and hormone levels in patients with pelvic inflammatory disease
YANG Liqing, ZHAN Hong
2024, 22(9): 1546-1549. doi: 10.16766/j.cnki.issn.1674-4152.003679
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  Objective  To analyze the effects of pelvic floor therapeutic instrument assisted with traditional Chinese medicine in vagina on inflammation and hormone level of patients with chronic pelvic inflammatory disease (CPID), so as to provide more sufficient theoretical basis for the treatment of CPID.  Methods  Ninety patients with CPID admitted to Hangzhou Third People's Hospital from March 2020 to October 2023 were divided into two groups according to different treatment methods: the enema group with traditional Chinese medicine and the vaginal treatment group, with 45 patients in each group. Both groups were treated with pelvic floor therapeutic instrument, with the enema group also receiving traditional Chinese medicine via enema and the intravaginal group receiving it vaginally. The clinical efficacy, inflammation levels, hormone levels, and incidence of adverse reactions were compared between the two groups.  Results  After treatment, the total effective rate in the vaginal treatment group (91.11%, 41/45) was higher than that in the enema group (75.56%, 34/45, P < 0.05). Tumor necrosis factor-α and CRP levels in the vaginal treatment group were lower than those in the traditional Chinese medicine enema group (P < 0.05), while the levels of interleukin-2 and interleukin-4 were higher (P < 0.05). Follicle-stimulating hormone levels in the vaginal treatment group was lower than that in the traditional Chinese medicine enema group, and estradiol was higher (P < 0.05). Additionally, proteasome inhibitor levels of ovarian artery and uterine artery in the vaginal treatment group were higher than that in the traditional Chinese medicine enema group, and resistance index was lower compared to the enema group.  Conclusion  Pelvic floor therapeutic instrument assisted with vaginal Chinese medicine can reduce the level of inflammatory factors, regulate hormones levels, improve the level of hemodynamics, and enhance the clinical efficacy in the treatment of CPID.
Study on community type 2 diabetes mellitus management model based on intelligent medical care under the background of normalization of anti-epidemic
SHI Junjing, CHEN Shirong, DING Chunmei, JIANG Hua
2024, 22(9): 1550-1554. doi: 10.16766/j.cnki.issn.1674-4152.003680
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  Objective  To explore the advantages of a community type 2 diabetes mellitus management model based on smart medical treatment under the background of anti-epidemic normalization.  Methods  Patients with type 2 diabetes treated in Yingbo Community Health Service Center, Pudong New Area, Shanghai during 2020 were selected as the study objects and divided into intervention group and control group by random number table. A total of 137 diabetic patients (72 in the control group and 65 in the study group) were included. The control group adopted the simple 1+1+1 contract management mode, and the research group added smart medical management on the basis of the control group. Blood glucose control indexes, metabolic indexes, diabetes related knowledge questionnaire (DRKQ), improvement of diabetic specific quality of life (DSQL) scale, changes in summary of diabetes self care activities (SDSCA) scale, and Morisky medication adherence scale 8 (MMAS-8) scale were observed in the two groups after 6 months of intervention.  Results  After six months of intervention, compared with the control group, the blood glucose index (fasting blood glucose decreased by about 0.7 mmol/L, and blood glucose decreased by about 1.3 mmol/L two hours after meals), blood lipid index (TC decreased by about 0.3 mmol/L, LDL-C decreased by about 0.3 mmol/L), and blood pressure index (SBP value decreased by about 4 mmHg) in the study group were significantly improved (P < 0.05). The DRKQ scale showed that the knowledge about diabetes was improved in both groups (P < 0.001). The DSQL scale showed that the total scores of physiological, psychological, social adjustment, treatment, and quality of life in the study group were significantly lower than those in the control group (P < 0.001). SDSCA scale showed that after the intervention, self-diet management, exercise, blood glucose monitoring, self-foot care, and medication on time in the study group were significantly better than those in the control group (P < 0.05). The MMAS-8 scale showed that the medication compliance score of the study group was significantly improved under the guidance of smart medicine (P < 0.001).  Conclusion  The management model based on smart medicine can better improve the clinical indicators of patients with diabetes, and improve patients' self-management ability, diabetes knowledge, quality of life, and medication compliance.
Changes in inflammatory factors in children with allergic rhinitis before and after allergen-specific immunotherapy: expression spectrum and clinical significance
SHANG Hong, SHAO Lei, HU Chongwei
2024, 22(9): 1555-1558. doi: 10.16766/j.cnki.issn.1674-4152.003681
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  Objective  To detect the expression levels of inflammatory factors in children with allergic rhinitis before and after subcutaneous specific immunotherapy (SCIT) and to analyze the application value of these inflammatory factors in evaluating the efficacy of SCIT.  Methods  Eighty children with allergic rhinitis (AR) who received standard SCIT at the pediatric department of Chun'an Branch of Zhejiang Provincial People's Hospital from February 2021 to July 2023 were divided into a response group (n=48) and a non-response group (n=32) according to the curative effect. The baseline levels of inflammatory factors were compared between the two groups. The variables with P < 0.05 were selected for univariate logistic regression model, and the ROC curves were drawn to analyze the predictive effect of SCIT on AR children.  Results  After treatment, the levels of C-reactive protein (CRP), interleukin (IL)-1β, IL-6, and IL-13 decreased, while the levels of tumor necrosis factor-β (TNF-β), IL-10, and IL-33 increased (P < 0.05).The baseline levels of IL-10 and IL-33 in children in the response group were lower than those in the non-response group (P < 0.05). Univariate logistic regression analysis showed that IL-10 (OR=0.344) and IL-33 (OR=0.963) significantly affected SCIT outcomes (P < 0.05). ROC curve showed that IL-10 (AUC=0.836) and IL-33 (AUC=0.833) have good predictive value for SCIT efficacy.  Conclusion  After SCIT treatment, the levels of TNF-β, IL-10, and IL-33 increased, while the levels of CRP, IL-1β, IL-6, and IL-13 decreased. Baseline levels of IL-10 and IL-33 are valuable predictors of efficacy.
Effect of Teach-back oral health education on oral health behavior and periodontal status of patients with oral implantation
SHAO Xiawa, YIN Min, XUAN Guihong, ZHOU Yeqing, DAI Ying
2024, 22(9): 1559-1562. doi: 10.16766/j.cnki.issn.1674-4152.003682
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  Objective  To construct an oral health education program based on Teach-back and explore its application effect in patients with oral implantation.  Methods  From January 2020 to January 2023, 104 patients with chronic periodontitis who underwent implant repair treatment in the stomatology department of the outpatient department of Shaoxing People's Hospital were divided into a control group (52 cases) and a Teach-back group (52 cases) by random number table method. The control group received traditional oral health education, and the Teach-back group implemented Teach-back oral health education and continued intervention for 6 months. The oral health behavior, periodontal status [modified sulcus bleeding index (mSBI), modified plaque index (mPLI), probing depth (PD)], the incidence of periimplantitis and the score of oral health impact profile-14 (OHIP-14) were compared between the two groups.  Results  In the Teach-back group, 48 patients completed the study, 49 cases completed the study in the cotrol group. In the Teach-back group, the behavioral score of "gargling after eating, using dental floss or flush device, regular tooth cleaning and pasteurized brushing method" was higher than that of the control group (P < 0.05); mSBI, mPLI and PD were (0.82±0.14) points, (0.80±0.21) points and (2.01±0.66) mm, respectively, which were lower than the control group (1.03±0.24) points, (0.91±0.23) points and (2.40±0.77) mm (P < 0.05). The incidence of peri-implant inflammation was 2.08% (1/48), which was lower than 16.33% (8/49) of the control group (P < 0.05). The score of OHIP-14 was lower than that of the control group (P < 0.05).  Conclusion  Teaching back oral health education has great significance for improving oral health behavior and periodontal health, and preventing peri-implant inflammation.
Metabolite level of intestinal flora in patients with major depression and its correlation with inflammatory factors
WANG Liying, CHEN Jing
2024, 22(9): 1563-1566. doi: 10.16766/j.cnki.issn.1674-4152.003683
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  Objective  To analyze the characteristics of intestinal flora and the level of its metabolites in patients with major depressive disorder (MDD), and to explore its relationship with inflammatory factors.  Methods  A total of 98 MDD patients who were treated in Shaoxing Seventh People ' s Hospital from May 2020 to May 2023 were selected as the research object and 50 healthy people who received health examination in the same period were selected as the control group. The levels of intestinal flora metabolites and inflammatory factors between MDD patients and healthy people were compared, and the relationship between intestinal flora metabolites and inflammatory factors was analyzed by Pearson correlation.  Results  The levels of IL-1β[(55.48±12.08) ng/L] and other inflammatory factors in the MDD group were higher than those in the control group [(42.15±10.03) ng/L, t=7.124, P < 0.001]. The trimetlylamine oxide (TMAO) level in the MDD group [(3.25±0.71) μmol/L] was higher than that in the control group [(1.37±0.24) μmol/L, t=23.694, P < 0.001]. The total amount of short chain fatty acids (SCFAs) in the MDD group [(18.26±2.94) μg/g] was lower than that in the control group [(22.03±3.25) μg/g, t=6.889, P < 0.001]. In the MDD group, the TMAO level was positively correlated with the level of IL-1β (r=0.404), IL-6 (r=0.503), and CRP (r=0.454), and negatively correlated with TNF-αlevel (r=-0.348). The levels of SCFAs and IL-1β (r=-0.478), IL-6 (r=-0.378), and CRP (r=-0.416) were negatively correlated (P < 0.05).  Conclusion  The levels of TMAO and SCFAs in the intestinal flora of MDD patients are closely related to the levels of inflammatory factors, and restoring the balance of intestinal flora metabolites plays an important role in the treatment of MDD.
Study on the characteristics and diagnostic value of 1H-MRS on the frontal lobe in patients with first-episode depressive disorder
SONG Hongtao, MEI Anchang, LIU Xian, TAO Qing, LI Jingya, JIAO Dongliang
2024, 22(9): 1567-1570. doi: 10.16766/j.cnki.issn.1674-4152.003684
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  Objective  To analyze the characteristics of prefrontal lobe proton MR spectroscopy (1H-MRS) in patients with first-episode depressive disorder and evaluate its diagnostic value.  Methods  From January 2021 to December 2022, 40 patients with first-episode depressive disorder who met the criteria and exclusion criteria were randomly selected as the study group according to the medical record number in the Bengbu First People ' s Hospital, while 40 healthy persons were randomly selected in Bengbu First People ' s Hospital Physical Examination Center as the control group. The 1H-MRS indexes of the subjects were collected by superconducting magnetic resonance imaging system. The general information of the study subjects was collected using a self-made general situation questionnaire. The collected data was organized and entered into the database. The chi square test, independent sample t-test and construct ROC curve on the data were analyzed by SPSS 20.0.  Results  (1) There was no significant difference in the distribution of sex, education, marriage, only child status, or age between the study group and the control group (P > 0.05). (2) The value of N-acetyl-based aspartate acid (NAA) / creatine (Cr) (1.74±0.73) in the study group was significantly lower than that in the control group (2.03±0.48, P < 0.05), while there was no significant difference in choline complex (Cho)/Cr between the study group (1.07±0.53) and the control group (1.11±0.31, P > 0.05). (3) Using NAA/Cr value as the test variable, and the study group and control group as state variables (study group=1, control group=0), ROC curves were constructed. NAA/Cr value demonstrated a certain predictive effect for first-episode depressive disorder (AUC=0.664, P=0.012).  Conclusion  Patients with first-onset depression show significantly reduced NAA/Cr values and decreased neuronal function in the frontal lobe. NAA/Cr is a valuable objective indicator for diagnosing first-onset depression.
Research progress of dupilumab in the treatment of moderate to severe bronchial asthma
WANG Congyao, TIAN Chunyan, LI Zhuying
2024, 22(9): 1571-1575. doi: 10.16766/j.cnki.issn.1674-4152.003685
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Bronchial asthma is a common chronic respiratory disease, which is characterized by chronic airway inflammation and airway hyperresponsiveness. The clinical manifestations are often recurrent wheezing, shortness of breath, chest tightness, cough, and other symptoms. Patients with moderate to severe asthma have recurrent symptoms, which often lead to decreased lung function if they cannot be effectively controlled. In recent years, as a new biological preparation for treating severe asthma, biologically targeted drugs have provided more treatment options for asthma patients. At present, the main clinical applications include anti IgE monoclonal antibodies, anti IL-4 receptor monoclonal antibodies, and anti IL-5 receptor monoclonal antibodies. Dupilumab, as a targeted biological drug, has a significant effect in the treatment of moderate to severe bronchial asthma. It can bind to IL-4Rα with high affinity and block the signal transduction of IL-4 and IL-13, thereby inhibiting type 2 airway inflammation, improving pulmonary symptoms, and controlling asthma attacks. Asthma patients treated with dupilumab not only improve their quality of life, but also reduce the dosage of glucocorticoids and alleviate a series of side effects caused by long-term use of glucocorticoids. Moreover, the safety of dupilumab in the treatment of asthma is good, with few serious adverse reactions. The common adverse reactions are mild and short-lived, and often can be relieved by themselves. Dupilumab provides a new strategy for the treatment of patients with asthma, and is the recommended drug for severe asthma in domestic and foreign guidelines. However, at present, the domestic market was launched relatively late, there are few research reports, the clinical research cycle is short, the sample size data is limited, and long-term research and observation are still needed. This article will review the clinical treatment progress of dupilumab in the treatment of moderate to severe bronchial asthma, providing a basis for further research.
The curative effect of traditional Chinese medicine aromatherapy combined with emotional release technology in insomnia patients
GONG Liying, FAN Mingna, ZHANG Xiuhong, ZHANG Jinxia
2024, 22(9): 1576-1579. doi: 10.16766/j.cnki.issn.1674-4152.003686
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  Objective  To explore the effects of traditional Chinese medicine aromatherapy combined with emotional freedom techniques (EFT) on traditional Chinese medicine symptoms, sleep quality, and negative emotions in patients with insomnia.  Methods  A total of 120 insomnia patients were selected in Hangzhou Hospital of Traditional Chinese Medicine from January to December 2022, and divided patients into group A (implementing routine intervention and psychological support), group B (combining aromatherapy pillow therapy on a routine basis), group C (adding emotional release therapy on a routine basis), and group D (combining Ningxin Anshen aromatherapy pillow therapy and emotional release therapy) using a random number table method, with 30 patients in each group. The treatment cycle was 14 days. The traditional Chinese medicine syndrome evaluation scale, Pittsburgh sleep quality index (PSQI), and hospital anxiety and depression scale (HADS) were used to evaluate the traditional Chinese medicine symptoms, sleep, and negative emotions of patients 24 hours after enrollment and 2 weeks after treatment.  Results  After intervention, the traditional Chinese medicine syndrome scores, PSQI scale scores, anxiety, and depression scores of group B, C, and D were significantly improved (P < 0.05). The traditional Chinese medicine syndrome scores (9.92±3.04), PSQI scale scores (10.27±2.59), anxiety (8.26±1.59), and depression scores (8.14±1.71) of Group D were all lower than those of group B (19.15±3.72, 12.50±2.61, 11.55±2.05, 11.62±2.11), and group C (18.96±3.50, 12.14±2.78, 11.90±2.18, 11.39±2.07), the differences were statistically significant (P < 0.05).  Conclusion  The combination of Ningxin Anshen Aromatic Pillow and EFT therapy can effectively improve the sleep quality of insomnia patients with liver depression and heat dissipation, alleviate their depression and anxiety, and improve their traditional Chinese medicine symptoms.
Application of communication standard education combined with acupressure in patients with opioid constipation
SUN Hong, FANG Liya, BU Yamei, ZHENG Yunxia, CAI Jianli
2024, 22(9): 1580-1583. doi: 10.16766/j.cnki.issn.1674-4152.003687
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  Objective  To explore the effects of communication standard education intervention combined with acupressure on disease cognition, gastrointestinal activity and constipation in patients with opioid-induced constipation (OIC).  Methods  A total of 120 OIC patients admitted to the Oncology Department of Huzhou First People ' s Hospital from December 2020 to November 2023 were selected as the study objects. They were divided into control groups and experimental group by random number table method, with 60 cases in each group. The control group was given routine nursing intervention, and the experimental group was given communication standard education combined with acupressure intervention. The changes of disease cognition, gastroenterogram parameters and constipation symptoms before and after nursing intervention were compared between the two groups.  Results  One case in the control group was lost to follow-up, and two cases in the experimental group withdrew due to transfer to another hospital. Finally, 59 cases in the control group and 58 cases in the experimental group completed the study. The disease recognition rate of experimental group was higher than that of control group after intervention (P < 0.05). Ascending colon amplitude and peristalsis frequency were (139.45±20.34) μV, (7.90±1.56) times/min, transverse colon amplitude and peristalsis frequency were (140.77±17.21) μV, (7.90±1.44) times /min. Those were higher than control group [(120.34±15.27) μV, (6.77±1.24) times/min, (129.45±15.23) μV, (6.88±1.27) times/min, P < 0.05]. The score of Cleveland constipation rating scale was (8.11±1.01) points, which was lower than that of control group [(11.34±2.14) points, P < 0.05]. Bristol stool quality grade was better than control group (P < 0.05).  Conclusion  Communication standard education intervention combined with acupoint massage can improve disease cognition, accelerate gastrointestinal activity and relieve constipation in OIC patients.
Effect of self-efficacy gas station combined with ACBT training on pulmonary rehabilitation of patients with non-small cell lung cancer after thoracoscopic surgery
DAI Feifei, MAO Shuzhen, ZHANG Yongmei
2024, 22(9): 1584-1587. doi: 10.16766/j.cnki.issn.1674-4152.003688
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  Objective  To explore the application effect of self-efficacy gas station combined with active cycle of breathing techniques (ACBT) training in thoracoscopic postoperative pulmonary rehabilitation of patients with non-small cell lung cancer (NSCLC), in order to provide theoretical guidance for rapid pulmonary rehabilitation of patients with lung cancer.  Methods  A total of 119 patients with NSCLC who underwent thoracoscopic lobotomy in Hangzhou Hospital of Traditional Chinese Medicine from April 2022 to January 2024 were selected and divided into two groups by random excel method: 60 patients in control group received routine pulmonary rehabilitation training, and 59 cases in observation group received self-efficacy gas station combined with ACBT training on the basis of control group. Until 3 months after surgery, self-efficacy, training compliance, sputum output, lung function and complication rate of the two groups were compared.  Results  Fifty-eight patients in the control group and 57 patients in the observation group completed the study. The score of general self-efficacy scale (GSES) in observation group was higher than that in control group (P < 0.05). The scores of training compliance, help seeking compliance and precautions compliance were higher than those of control group (P < 0.05). The sputum output on the 3rd day after operation was higher than that of control group (P < 0.05). Forced expiratory volume/forced vital capacity [FEV1/FVC, (62.11±7.13) % vs. (58.09±6.09) %], vital capacity [VC, (3.40±0.91) L vs. (2.86±0.77) L] and peak expiratory flow rate [PEF, (461.37±17.85) L/min vs. (422.34±20.09) L/min] parameters were higher than those in control group (P < 0.05). The complication rate (3.51% vs.15.52%) was lower than that of the control group (P < 0.05).  Conclusion  Self-efficacy gas station combined with ACBT training can improve the self-efficacy and postoperative exercise compliance of NSCLC patients, promote sputum excretion and postoperative lung function recovery, and reduce the occurrence of complications.
Application effect of flipped classroom teaching model based on deep learning theory in gastrointestinal surgery clinical teaching
HAO Bo, ZHANG Zongbing, LE Zhenghong, GAO Zhenyuan, LIU Mulin
2024, 22(9): 1588-1591. doi: 10.16766/j.cnki.issn.1674-4152.003689
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  Objective  To investigate the application effect of the flipped classroom teaching model based on deep learning theory in clinical teaching of professional master ' s degree students in gastrointestinal surgery, and to provide a reference for improving the clinical quality and resilience of master ' s degree students in gastrointestinal surgery.  Methods  A total of 60 master ' s degree students in surgery who received clinical teaching in Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical University from January 2022 to December 2022 were randomly divided into an observation group (30 students) and a control group (30 students). The observation group used the teaching model based on deep learning theory to carry out teaching training, and the control group used the traditional teaching model for training. After 3 months, the evaluation of the clinical teaching effect and the satisfaction survey of the teaching effect were conducted for all master ' s degree students in surgery.  Results  The scores of theoretical examination [(90.5±3.6) points] and skill assessment [(88.1±3.5) points] in the observation group were higher than those in the control group [(83.1±5.8) points, (76.0±4.8) points]. The skill examination of specialty interrogation history collection, physical examination, medical record writing, and surgical dressing technique scores in the observation group were higher than those in the control group (P < 0.05). The students in the observation group had significantly higher learning enthusiasm, clinical analysis ability, thinking expansion ability, clinical operation ability, independent learning ability, teamwork ability, and satisfaction than those of the control group.  Conclusion  The flipped classroom teaching model based on deep learning theory can significantly improve students ' clinical practice ability, effectively cultivate the clinical thinking of master ' s degree students in surgery, and increase teaching satisfaction.
Research on the training of primary medical care personnel based on CBL data model in Jiangsu Province
JIA Jian, GAO Wen, CHENG Hongyan, XU Zhiyang, ZHAN Yiyang
2024, 22(9): 1592-1595. doi: 10.16766/j.cnki.issn.1674-4152.003690
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  Objective  To explore a new way to improve the training effect of primary medical care personnel (PMCP) in Jiangsu Province based on the application of a case based learning (CBL) data model.  Methods  A total of 123 PMCP from 5 cities (including Nanjing, Suzhou, Wuxi, Suqian and Yancheng) in Jiangsu Province were selected as subjects from January to June in 2022. The clinical case database based on the CBL data model was used for online training, and the test of clinical knowledge structure was conducted before and after the training. T-test and one-way ANOVA were used to analyze the difference in PMCP ability. Multiple linear regression was used to analyze the factors affecting the training effect.  Results  The mean scores of 123 PMCP were (73.4±16.7) points. The score of Suzhou was the lowest, while Yancheng was the highest. After 3 months of online CBL case training, the mean scores of 123 PMCP significantly improved (86.3±24.7) points, the difference was statistically significant (P < 0.001). The correct rate of core knowledge of circulatory system, skin, emergency, eye, ear, nose and throat, and rehabilitation in the post-training test was lower than that of the pre-training test, and other aspects were higher than that of the bottom test. The accuracy rate of all knowledge points of evidence-based medical thinking improved compared with the thorough test. The results of multiple linear regression analysis showed that the standardized training and online learning time of general practice residents were the main influencing factors affecting the training effect. The overall mean score of the training satisfaction survey was (67.58±12.30) points. Among them, the highest-scoring parameters were training schedule with a score of (4.38±0.84) and mastery of the new coronavirus infection diagnosis standards (4.38±0.81). The lowest-scoring parameters was the difficulty of the training questions with a score of (3.88±1.15). There were significant differences in satisfaction scores in four dimensions: training content, training organization, training effect and training method (P=0.014). Most of the research subjects believed that online training is conducive to saving training time and improving training efficiency, but the difficulty of the topic is slightly high.  Conclusion  Training based on CBL data model is conducive to improving the clinical ability of general practitioners and helping to homogenize the management of training process.
Risk factors and predictive model construction of postoperative delirium in elderly patients with hip fracture
YANG Jing, LIU Mei, YANG Lei, GU Zejuan
2024, 22(9): 1596-1600. doi: 10.16766/j.cnki.issn.1674-4152.003691
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  Objective  The main treatment of hip fracture in the elderly is surgery, and postoperative delirium (POD) often occurs after surgery, increasing the risk of mortality. Therefore, this study mainly discusses the risk factors of POD and establishes a prediction model to take targeted interventions to reduce the occurrence of POD and improve the quality of life of patients.  Methods  The data of 137 patients with hip fractures admitted to the First Affiliated Hospital of Nanjing Medical University from June 2022 to December 2023 were selected. According to the diagnosis results of POD, the patients were divided into POD group (39 cases) and non-POD group (98 cases). The baseline data of the two groups were compared. Logistic regression was used to analyze the risk factors of POD in elderly patients with hip fracture and construct a nomogram model. The receiver operating characteristic (ROC) curve was drawn to test the predictive value of the nomogram model for POD.  Results  The age, preoperative waiting time, intraoperative blood loss and postoperative pain score of patients in the POD group were higher than those in the non-POD group, the preoperative albumin was lower than that in the non-POD group, and the proportion of patients with postoperative hypoxemia, diabetes and preoperative weakness was higher than that in the non-POD group (P<0.05). Logistic regression analysis showed that older age, long preoperative waiting time, postoperative hypoxemia, diabetes, preoperative weakness, and high postoperative pain score were risk factors for POD (OR>1, P<0.05). High preoperative albumin is a protective factor for POD (OR<1, P<0.05). The results showed that the C-index value was 0.972. The ROC results showed that the AUC was 0.986 (95% CI: 0.970-1.000, P<0.05), and the specificity, sensitivity, and Youden index were 0.959, 0.949, and 0.908, respectively.  Conclusion  Older age, long preoperative waiting time, postoperative hypoxemia, diabetes, preoperative frailty, high postoperative pain score and low preoperative albumin level are risk factors for POD in elderly patients with hip fracture. Based on this, a nomogram model is constructed to predict the occurrence of POD.
Effects of multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept on elderly patients undergoing general anesthesia for hip fracture
SHI Chunjuan, ZHONG Baoying, BAO Yingxue
2024, 22(9): 1601-1604. doi: 10.16766/j.cnki.issn.1674-4152.003692
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  Objective  Based on the ERAS concept, a multi-mode thermal insulation combined with multi-sensory awakening stimulation program was constructed to explore its influence on elderly patients undergoing general anesthesia for hip fracture, aiming to provide theoretical reference for optimizing perioperative nursing.  Methods  A total of 102 elderly patients undergoing general anesthesia for hip fracture at Tongde Hospital of Zhejiang Province from September 2019 to September 2023 were selected and divided into two groups by random number table method. The control group (n=51) were given traditional heat preservation measures and language awakening program, while the observation group (n=51) was treated with a multi-mode thermal insulation combined with multi-sensory awakening stimulation program guided by ERAS concept. Differences in body temperature, stress levels, quality of anesthesia recovery, and incidence of adverse reactions were compared between the two groups.  Results  The body temperature of the observation group was higher than that in the control group after anesthesia induction (T1), the beginning of surgery (T2), 40 min after surgery (T3), and at the end of surgery (T4, P<0.05). Levels of cortisol (Cor) and norepinephrine (NE) at T1-T4 were lower in the observation group than those in the control group (P<0.05). Recovery times of spontaneous respiration [(5.21±1.09) min vs. (7.09±1.32) min], consciousness [(16.23±3.12) min vs. (25.90±4.77) min], and retention in the anesthesia recovery room [(33.22±5.67) min vs. (50.09±8.23) min] were shorter than those in the control group (P<0.05). The incidence of adverse reactions in the observation (9.80% vs. 29.41%) was lower than that in the control group (χ2=6.220, P=0.013).  Conclusion  The multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept can maintain the stability of body temperature during operation, relieve stress response, improve the quality of anesthesia recovery, and reduce the incidence of adverse reactions in elderly patients undergoing general anesthesia for hip fracture.
The mediating effect of hope level between posttraumatic growth and quality of life in patients with lung cancer after thoracoscopic surgery
LU Hong, WANG An, SHI Yanjuan, PAN Hui
2024, 22(9): 1605-1608. doi: 10.16766/j.cnki.issn.1674-4152.003693
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  Objective  To analyze the influencing factors of posttraumatic growth and quality of life of lung cancer patients after thoracoscopic surgery, and the mediating effect of hope level in the traumatic process.  Methods  A total of 350 lung cancer patients who underwent thoracoscopic surgery at Yixing People's Hospital between January 2021 and December 2022 were selected as the study subjects. The World Health Organization Quality of Life-BREF was used to assess the patients' quality of life. The posttraumatic growth inventory was employed to evaluate the patients' posttraumatic growth. The Herth hope index was used to measure the patients' level of hope. The patients were divided into hope low level group (89 cases), hope medium level group (132 cases) and hope high level group (129 cases) according to the HHI score. Spearman's correlation test was performed to analyze the relationship between hope levels and posttraumatic growth and quality of life in lung cancer patients after thoracoscopic surgery. Furthermore, the mediating effect of hope levels on the relationship between posttraumatic growth and quality of life in these patients was examined.  Results  The overall quality of life scores for patients with low, medium, and high levels of hope were 80.32±6.54, 86.87±7.59, and 94.88±8.94, respectively, with statistically significant differences (F=4.872, P=0.008). The total posttraumatic growth scores for patients with low, medium, and high levels of hope were 66.51±8.43, 75.64±7.28, and 87.45±7.15, respectively, showing significant differences (F=4.814, P=0.009). Hope levels partially mediated the relationship between posttraumatic growth and quality of life, with a mediation effect ratio of 46.39% (0.374×0.351/0.283×100%).  Conclusion  Hope level plays an important mediating effect between posttraumatic growth and quality of life in patients with lung cancer after thoracoscopic surgery. Improving hope level can improve patients' quality of life and posttraumatic growth in clinical practice.
Qualitative study on family support care needs of very low birth weight infant parents based on timing it right theory
XIAO Juan, LING Ya, HUANG Jinhua
2024, 22(9): 1609-1613. doi: 10.16766/j.cnki.issn.1674-4152.003694
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  Objective  Recognizing the significance of parental family support in promoting the recovery and development of very low birth weight infants, this study applies the timing it right theory to analyze the nursing needs for family support among parents of very low birth weight infants at different stages in NICU. The aim is to gain insights into the current status of family support requirements for these infants and provide valuable guidance for developing effective family support nursing programs.  Methods  Based on timing it right theory, the disease course of very low birth weight infants was divided into three periods: NICU hospitalization period, discharge transition period and discharge home period. Using the phenomenological research method, the parents of very low birth weight Infants in three different periods who were hospitalized in the neonatal department of the First Affiliated Hospital of Anhui Medical University parents of very low birth weight infants in these three different periods were selected as research objects from October 2021 to April 2022, and semi-structured interviews were conducted on them. A total of 42 fathers/mothers of very low birth weight infants were finally interviewed. Colaizzi phenomenological method was used to sort out and analyze the interview data.  Results  Combining different periods of timing it right theory to extract themes, three themes can be summarized: (1) NICU hospitalization, feeling worried and in need of more information support; (2) Discharge transition, feeling nervous and hoping for technical support; (3) Discharge home period, feeling calm and hoping to obtain discharge support.  Conclusion  Providing supportive care for parents of very low birth weight infant in NICU is a complex and dynamic process. As premature babies progress through different stages of their illness, the support needs of their family also change. Medical professionals should provide professional and specific guidance and assistance based on these changing demands to enhance the parenting confidence and ability of parents with very low birth weight infants, thereby promoting healthy growth.
Effect of comprehensive nutrition nursing intervention program based on attribution theory on nutritional status of elderly patients with chronic obstructive pulmonary disease
CHE Liping, TANG Qi, JIANG Yanhong, ZHOU Daina, HU Lingqin, FENG Li, YU Jianhong
2024, 22(9): 1614-1618. doi: 10.16766/j.cnki.issn.1674-4152.003695
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  Objective  The nutritional status of elderly patients with chronic obstructive pulmonary disease (COPD) is a significant predictor of prognosis. The objective of this study is to investigate the potential benefits of a comprehensive nutritional intervention based on attribution theory for elderly patients with COPD.  Methods  A total of 108 elderly patients with COPD treated at the Affiliated Hospital of Shaoxing University of Arts and Sciences from August 2021 to August 2023 were randomly assigned to either a control group (54 cases with traditional nutritional intervention) or an experimental group (54 cases with comprehensive nutritional intervention based on attribution theory). Ultimately, 51 cases were enrolled in each group. A comparison was made of the nutritional status, serum nutritional indexes, immune function and incidence of malnutrition of the two groups.  Results  The BMI[(22.09±4.67) vs. (20.31±4.12)]. Similarly, the upper arm muscle circumference [(21.95±5.13) cm vs. (19.90±4.01) cm] of the experimental group after 6 months of nursing and triceps skin fold thickness [(12.05±2.05) mm vs. (10.45±2.11) mm] were higher than those in the control group (P<0.05). The albumin (proportionate) [(39.95±5.01) g/L vs. (37.88±4.79) g/L] and prealbumin (PA) [(0.30±0.06)g/L vs. (0.27±0.05)g/L] and total protein (TP)[(61.60±6.44)g/L vs. (59.16±5.23)g/L] were higher than those in control group (P<0.05). CD3+, CD4+ and CD4+/CD8+ were higher than those in the control group (P<0.05). Additionally, the incidence of malnutrition was lower in the experimental group (3.92% vs. 15.69%) than in the control group (P<0.05).  Conclusion  A comprehensive nutrition nursing intervention based on attribution theory has been demonstrated to improve the nutritional status of elderly patients with COPD, promote the recovery of serum nutritional indexes, and enhance immune function and prevent malnutrition.
Analysis of special nursing effect and postoperative function after total knee arthroplasty
YAN Nan, FAN Yun
2024, 22(9): 1619-1622. doi: 10.16766/j.cnki.issn.1674-4152.003696
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  Objective  Despite the presence of patient dissatisfaction following total knee arthroplasty (TKA), some individuals exhibit suboptimal postoperative functional recovery. Through an assessment of the impact of specialized nursing care on postoperative recuperation and an analysis of key factors influencing postoperative functional recovery, it is possible to enhance postoperative care strategies aimed at facilitating the restoration of knee joint function and enhancing patient satisfaction.  Methods  A retrospective analysis was conducted on 110 patients with knee osteoarthritis admitted to our hospital from February 2022 to July 2022. The patients were divided into a specialized nursing group (52 cases) and a routine nursing group (58 cases) based on different nursing methods. At the last follow-up, comparisons were made between the two groups in terms of visual analogue scale (VAS), hospital for special surgery knee score (HSS score), range of motion (ROM), complication rate, and nursing satisfaction. Patients were further categorized into an excellent group (HSS≥70) or poor group (HSS<70) according to their HSS scores. Multivariate logistic regression analysis was performed to identify risk factors affecting knee joint function after TKA.  Results  (1) Clinical effect: The VAS score in the specialized nursing group was significantly lower than that in the routine nursing group (2.08±0.97 vs. 3.49±1.10). Additionally, HSS scores and knee ROM showed significant improvement in the specialized nursing group compared to the routine nursing group (90.24±9.06 vs. 84.34±7.36; 108.80±8.67 vs. 90.45±6.30, P<0.05). (2) Nursing effect: The anxiety score, patient compliance, and overall satisfaction with care were better in the specialized nursing group compared to those in the routine nursing group (P<0.05). (3) Multivariate logistic regression results: nursing style age, preoperative HSS score, postoperative patient compliance, and postoperative SAS score all emerged as influential factors for functional recovery after TKA (P<0.05).  Conclusion  Specialized nursing can alleviate knee pain after TKA surgery and promote knee function recovery. The postoperative nursing method, age, preoperative HSS score, and patient compliance after surgery are independent influencing factors affecting the efficacy of TKA.
Application of comprehensive nursing plan based on timing theory in patients with total knee arthroplasty
ZHU Xuefeng, WENG Huiying
2024, 22(9): 1623-1627. doi: 10.16766/j.cnki.issn.1674-4152.003697
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  Objective  Under the guidance of timing theory, according to the needs of total knee replacement patients in different periods, a comprehensive nursing intervention plan is developed to optimize the quality of nursing and promote the early recovery of patients.  Methods  A total of 108 patients who were to undergo total knee arthroplasty in Huzhou First People' s Hospital from June 2022 to June 2023 were selected and divided into control group and experimental group by random number table method, with 54 patients in each group. The control group was given routine nursing and follow-up, and the experimental group was given comprehensive nursing intervention based on timing theory for 6 months. The rehabilitation exercise compliance, exercise of self-care agency scale (ESCA) and hospital for special surgery (HSS) scores of the two groups were compared.  Results  The scores of rehabilitation exercise compliance (active learning compliance, psychological compliance and physical compliance) of experimental group were higher than those of control group at 6 months after operation (P < 0.05). The dimension scores and total scores of self-care skills and health knowledge level in ESCA were higher than those in control group (P < 0.05). The scores of function, muscle strength, mobility and stability in HSS were (18.98±3.70) points, (9.44±2.11) points, (17.45±3.09) points, (9.34±2.07) points and (85.78±5.67) points, respectively, which were higher than those in the control group [(14.23±2.45) points, (7.37±1.56)points, (15.23±3.44) points, (7.90±1.43) points, (74.29±5.62) points, t=17.866, 19.091, 16.789, 23.451, 19.231, P < 0.05].  Conclusion  Comprehensive nursing based on timing theory plays a positive role in improving postoperative rehabilitation exercise compliance, enhancing self-care ability and improving knee function of total knee replacement patients.
Hypothyroidism caused by roxadustat: a case report
YANG Yunjiao, WANG Xi, YAN Xuelian, XIE Haiyan
2024, 22(9): 1628-1630. doi: 10.16766/j.cnki.issn.1674-4152.003698
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This article reports a case of hypothyroidism caused by roxadustat, a prolyl-hydroxylase inhibitor, used to treat renal anemia. An 86-year-old male with a 10-year history of chronic renal insufficiency with reduced speech and food intake for 3 weeks. After 4 months of medication, symptoms of hypothyroidism and abnormal laboratory tests appeared. After discontinuing roxadustat for one week, his thyroid function gradually normalized. For patients receiving roxadustat treatment, regular thyroid function monitoring is essential, and discontinuation or thyroid hormone replacement therapy should be considered if necessary.
Special Topic/Type 2 Diabetes Mellitus
Impact of fluctuating and persistent hyperglycemia on vascular complications in patients with type 2 diabetes mellitus
ZHU Chenxi, LI Liyan, ZHAO Xudong, HAO Jingbo, LI Lei
2024, 22(9): 1463-1466. doi: 10.16766/j.cnki.issn.1674-4152.003659
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  Objective  To observe the effects of fluctuating hyperglycemia and persistent hyperglycemia on macrovascular and microvascular complications in patients with type 2 diabetes and explore the possible mechanisms.  Methods  A total of 112 patients with newly diagnosed type 2 diabetes mellitus who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from November 2022 to May 2023 were selected and divided into two groups, 52 patients in the persistent hyperglycemia group and 60 patients in the fluctuating hyperglycemia group according to the mean amplitude of glycemic excursions (MAGE). Macrovascular and microvascular complications were assessed.  Results  The fluctuating hyperglycemia group had higher 2 h blood glucose, 2 h insulin, carotid intima-media thickness (IMT) than the sustained hyperglycemia group (P < 0.05), while high-sensitivity C-reactive protein (hs-CRP), urinary albumin urine creatinine (UACR), brachial endothelium-dependent diastolic function (EDD), and ankle brachial index (ABI) were significantly lower (P < 0.05). Rates of coronary heart disease [30.0% (18 cases) vs. 13.5% (7 cases), χ2=4.394, P=0.036] and rates of cerebral infarction [26.7% (16 cases) vs. 11.5% (6 cases), χ2=4.039, P=0.044] increased, peripheral arteriosclerosis worsened, and diabetic nephropathy [10.0% (6 cases) vs. 25.0% (13 cases), χ2=4.450, P=0.035] and diabetic retinopathy [8.3% (5 cases) vs. 23.1% (12 cases), χ2=4.703, P=0.030] decreased. Multivariate logistic regression analysis showed that the influencing factors of macrovascular complications were 2 h blood glucose, 2 h insulin, MAGE>3.9 mmol/L, and brachial EDD (P < 0.05). The contributing factors for microvascular complications were fasting glucose, glycated hemoglobin, MAGE≤3.9 mmol/L, and hs-CRP (P < 0.05).  Conclusion  Fluctuating hyperglycemia has a greater influence on macrovascular complications in patients with type 2 diabetes, possibly due to impaired endothelial function, whereas sustained hyperglycemia has a stronger impact on microvascular complications, which could be linked to inflammatory responses.
Mediating effect of social participation on self-management and social isolation in elderly patients with type 2 diabetes mellitus
WANG Jing, LIN Keke, SUN Chao, WU Quanying, BAI Xiaoyan, WEI Yiwen, LIU Yu
2024, 22(9): 1467-1470. doi: 10.16766/j.cnki.issn.1674-4152.003660
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  Objective  To analyze the influence pathway of self-management on social isolation in elderly patients with type 2 diabetes mellitus (T2DM) and the mediating role of social participation.  Methods  The social isolation status of er adults with T2DM treated in hospitals or community health service centers in Beijing from May to November 2023 was investigated with the Lubben social network scale-6, the summary of diabetes self-care activities and impact on participation and autonomy questionnaire. Structural equation model of social isolation and self-management and social participation were constructed to analyze the mediating effects of social participation.  Results  Among 496 er adults with T2DM, 227 experienced social isolation, and the incidence was 45.77%. The er adults experienced social isolation in family dimension and friend dimension were 74 (14.92%) and 239 (48.19%), respectively. The structural equation model parameter estimated converge well, while the posterior predicted P-value of the model was 0.371>0.05, which meant a good fit. The model showed that exercise management and smoking had a negative direct effect on social isolation (-0.136 and -0.132), and also indirect effected through social participation (-0.201 and -0.079), with a mediation effect ratio of 59.47% and 37.44%.  Conclusion  Self-management (exercise and smoking) and social participation in elderly patients with type 2 diabetes can predict the occurrence of social isolation. Social participation plays a mediating role in the relationship between diabetes self-management (exercise and smoking) and social isolation.
A two-sample Mendelian randomization study of type 2 diabetes mellitus and colorectal cancer risk
ZHANG Qiao, ZHOU Xuezhi, CHEN Binghe, HOU Dong, WU Xinjun, ZHU Shaohui
2024, 22(9): 1471-1474. doi: 10.16766/j.cnki.issn.1674-4152.003661
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  Objective  This study aims to explore the potential causal relationship between type 2 diabetes mellitus (T2DM) and colorectal cancer (CRC) using a two-sample Mendelian randomization (MR) method.  Methods  Summary data were obtained from genome-wide association studies (GWAS) datasets, including 490 089 cases for the exposure (T2DM) and 383 348 cases for the outcome (CRC). To minimize linkage disequilibrium and confounding factors, and to ensure strong association, 47 single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs) for the study. The inverse variance weighted (IVW) method was used as the primary analysis, with supplementary analysis by the weighted median method, MR-Egger method, simple mode method, and weighted mode method to assess the causal relationship. Sensitivity analysis was conducted using the leave-one-out method, and visual tools were employed to further evaluate the reliability and robustness of the MR results. Heterogeneity was assessed using Cochran ' s Q test for both the IVW method and MR-Egger method, while pleiotropy was evaluated using the MR-Egger intercept method.  Results  The IVW method indicated no significant causal relationship between T2DM and CRC (OR=1.000, 95% CI: 0.999-1.001, P=0.790). These results were consistent across the weighted median method (P=0.386), MR-Egger method (P=0.137), simple mode method (P=0.275), and weighted mode method (P=0.479). The leave-one-out analysis did not identify any individual SNPs that significantly influenced the overall results. Both heterogeneity tests (P>0.05) and pleiotropy tests (P>0.05) supported the reliability and robustness of the MR conclusions.  Conclusion  There is no evident genetic causal relationship between T2DM and colorectal cancer.
General Practice Research
Application value of apolipoprotein E in predicting acute ischemic death and evaluating functional outcomes
WANG Peng, YIN Dawei, HE Ye, HU Chong, SUN Wen, ZHU Yuyou
2024, 22(9): 1475-1478. doi: 10.16766/j.cnki.issn.1674-4152.003662
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  Objective  In recent years, many studies have shown that many diseases are associated with apolipoprotein E (APOE) gene diversity. The aim of this study is to investigate the predictive value of the APOE gene in acute ischemic stroke (AIS) caused by intracranial vascular stenosis and its role in evaluating its prognosis.  Methods  A total of 511 patients with acute ischemic stroke admitted to the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to December 2023 were collected. According to the presence or absence of intracranial artery stenosis, they were divided into the intracranial artery stenosis (ICAS) group (317 cases) and the non-intracranial artery stenosis (NCAS) group (194 cases). At the 6-month follow-up, According to whether they carried the APOE-ε4 gene or not, they were further divided into ε4 carrier group (213 cases) and non-ε4 carrier group (298 cases). Variable such as age, gender, comorbidities, blood lipids, lipoprotein, apolipoprotein E (including allele typing), and lipoprotein A were analyzed, along with high-resolution magnetic resonance imaging of the vessel wall. Followed up evaluations were conducted 6 months after the operation, with results tracked via high-definition vessel wall imaging.  Results  The plasma APOE concentration in the ICAS group was significantly lower than that in the non-intracranial artery stenosis group (r=0.481, P < 0.01). Among the ε4 carriers, 97/213 (45.54%) had a poor prognosis, while 48/298 (16.11%) of non-ε4 carriers experienced poor prognosis at the end of treatment and after 6 months of follow-up, with a significant difference (OR=4.622, 95% CI: 3.512-6.091, P < 0.01).  Conclusion  Low plasma APOE levels are a risk factor for acute ischemic stroke caused by ICAS, and the APOE-ε4 gene is associated with poor functional prognosis in AIS patients. Combining the APOE-ε4 genotype with high-resolution vessel wall imaging may be valuable in predicting acute ischemic stroke and evaluating functional outcomes.
The correlation between BRAFV600E gene mutations and clinical pathological characteristics of papillary thyroid carcinoma
WANG Yanyan, ZHANG Chao, WANG Lin, PENG Defeng, SUN Siyu, JIANG Fangqian, YANG Qingqing, YAO Tingjing
2024, 22(9): 1479-1482. doi: 10.16766/j.cnki.issn.1674-4152.003663
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  Objective  Papillary thyroid carcinoma (PTC) is a common malignant tumor. The incidence rate is increasing year by year, and its pathogenesis and clinical characteristics are still not very clear. This article intends to explore the relationship between the BRAFV600E gene mutation detection results and the clinicopathological characteristics of PTC patients, so as to provide a basis for treatment decisions of PTC patients.  Methods  According to strict inclusion criteria, eligible case data were collected from patients with papillary thyroid carcinoma admitted to the First Affiliated Hospital of Bengbu Medical University from January 2022 to September 2022. Chi-square test and logistic analysis were used to analyze the BRAFV600E gene mutation and its relationship with clinical and pathological characteristics in PTC patients. All clinical data were statistically analyzed using SPSS 26.0 software.  Results  This study included 108 patients with papillary thyroid carcinoma, with a BRAFV600E gene mutation rate of 70.37% (76/108). The results of univariate analysis showed that the presence of Hashimoto's thyroiditis, central lymph node metastasis, capsule invasion, and maximum diameter of tumor ≥0.5 cm were associated with BRAFV600E gene mutations, and the difference was statistically significant (P < 0.05). The logistic analysis results showed that age ≥55 years and maximum diameter of tumor ≥0.5 cm were risk factors for BRAFV600E mutation, while Hashimoto's thyroiditis was a protective factor for BRAFV600E mutation.  Conclusion  BRAFV600E detection has a certain diagnostic value in papillary thyroid carcinoma. The results of BRAFV600E detection are correlated with some clinical and pathological features of papillary thyroid carcinoma. The results of BRAFV600E detection have good guiding significance for clinical treatment decision-making and prognosis judgment.
Relationship between peripheral blood IL-17A levels and severity of acne vulgaris and its predictive value for acute acne scars
FANG Jing, WANG Liwen, WANG Jing, GAN Zhihui, WANG Juan
2024, 22(9): 1483-1486. doi: 10.16766/j.cnki.issn.1674-4152.003664
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  Objective  To investigate the correlation between interleukin 17A (IL-17A) in peripheral blood and the severity of acne vulgaris, and its predictive value for acne scars.  Methods  From October 2022 to October 2023, a total of 130 patients with acne vulgaris who were treated at the Department of Dermatology of Anhui Provincial Hospital were divided into mild-to-moderate group (45 cases), severe group (40 cases), and extremely severe group (45 cases). Forty healthy examinees were selected as the control group. According to the severity of scar, the observation group was divided into non-scar group (25 cases), mild scar group (25 cases), moderate scar group (40 cases) and severe scar group (40 cases). IL-17A levels of peripheral blood were detected by Enzyme linked immunosorbent assay.  Results  The peripheral blood IL-17A of mild and moderate group, severe group, and severe and extreme group in acne vulgaris patients were significantly higher than that of the healthy control group (P < 0.05). The severity of acne was positively correlated with the level of IL-17A in peripheral blood (r=0.724, P < 0.001). The levels of IL-17A in peripheral blood of patients with mild, moderate, and severe acne scars gradually increased and were significantly higher than the non-scar group (P < 0.05). Spearman analysis showed that the severity of acne scars was positively correlated with the level of IL-17A in peripheral blood (r=0.591, P < 0.001). The sensitivity of peripheral blood IL-17A level in predicting the occurrence of acne scars was 84.00%, and the specificity was 83.80%.  Conclusion  Peripheral blood IL-17A level is closely related to the severity of acne vulgaris and acne scars, and has good predictive value for acne scars.
Correlation analysis of the inflammatory burden index with the severity of Guillain-Barré syndrome
QI Xingyue, ZHAO Xudong, LI Lei
2024, 22(9): 1487-1490. doi: 10.16766/j.cnki.issn.1674-4152.003665
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  Objective  To explore the relationship and predictive value of the novel inflammatory biomarker, inflammatory burden index (IBI) with the severity of Guillain-Barré syndrome (GBS).  Methods  Retrospective analysis was used to select 160 patients with GBS who were first diagnosed at the Affiliated Hospital of Xuzhou Medical University from January 2014 to September 2022. They were divided into the mild group (n=52) and the severe group (n=108) according to the Hughes functional grading scale (HFGS) score. Clinical data and inflammatory indicators, including IBI, were collected, and statistical analysis was conducted. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of IBI for severe GBS, while multivariate logistic regression analysis was employed to explore the factors influencing the severity of GBS.  Results  The IBI of patients in the severe group at admission was 13.15 (4.06, 56.78), which was significantly higher than that of patients in the mild group at 3.32 (1.93, 8.87), P < 0.001. The ROC analysis results show that the maximum area under the ROC curve predicted by IBI for the severe group was 0.737 (95% CI: 0.660-0.815). There were statistically significant differences in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), IBI, systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) between the two groups (P < 0.05). The results of multivariate logistic analysis showed that IBI≥11.00 (OR=3.803, 95% CI: 1.631-8.868) and MLR≥0.42 (OR=5.697, 95% CI: 1.109-29.272) were independent risk factors for the occurrence of severe GBS.  Conclusion  The elevated level of IBI is correlated with the severity of GBS patients and possesses a high predictive value for identifying severe GBS cases.
Clinical efficacy of afatinib in second-line treatment of advanced squamous cell carcinoma of the lung
LIU Yun, LIU Ying, LIU Jiahui, WANG Lu, HOU Wenrui, LI Dianming
2024, 22(9): 1491-1495. doi: 10.16766/j.cnki.issn.1674-4152.003666
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  Objective  To observe the efficacy and adverse reactions of afatinib in the second-line treatment of patients with advanced lung squamous cell carcinoma, and to explore the clinical value.  Methods  A total of 58 patients with advanced lung squamoma with negative driver genes were collected from the First Affiliated Hospital of Bengbu Medical University from March 2020 to October 2022 and afatinib was given orally at 40 mg/d according to the guidelines. When grade 3 or more side reactions occurred, the drug was stopped until the patients recovered, and the dose of re-administration was reduced by 10 mg/time to the lowest 20 mg/d. The patients were evaluated every 6 weeks according to response evaluation criteria in solid tumor 1.1 until the disease progressed, and the therapeutic efficacy and adverse effects were observed.  Results  (1) Clinical efficacy: 0 cases of complete remission, 20 cases of partial remission (34.48%), 18 cases of stable disease (31.04%), 20 cases of progressive disease (34.48%), objective response rate (ORR) was 34.48%, disease control rate (DCR) 65.52%; The median progression-free survival (mPFS) was 4.20 months (95% CI: 3.62-4.78) and the median overall survival (mOS) was 11.60 months (95% CI: 7.99-15.21). (2) Univariate results showed that PS score and underlying diseases were correlated with DCR, mPFS, and mOS, while non-sensitive gene mutation and distant metastasis were correlated with mPFS and mOS, and the differences were statistically significant (P < 0.05). (3) Multiple factors showed that PS score and underlying disease were risk factors for mPFS and mOS, and the differences were statistically significant (P < 0.05). (4) Adverse reactions: diarrhea in 58 cases (100.00%), skin rash in 44 cases (75.86%), and grade 3 adverse reactions, diarrhea in 7 cases (12.07%), skin rash in 5 cases (8.62%), no grade 3 or above adverse events.  Conclusion  Afatinib is an alternative second-line treatment for patients with advanced lung squamous cell carcinoma, with good efficacy and controllable side effects.
The predictive value of uric acid to albumin ratio for medium and long-term all-cause mortality in patients with CTO
ZHANG Jingjing, ZHAO Yufei, ZHU Hualiang, ZHU Xiaoxia, LIU Zeyan, HUANG Zheng
2024, 22(9): 1496-1499. doi: 10.16766/j.cnki.issn.1674-4152.003667
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  Objective  Uric acid to albumin ratio (UAR) can reflect the inflammation and oxidation status, this study was to analyze its expression level in patients with chronic coronary artery occlusion (coronary chronic total occlusion, CTO), and evaluate its prediction value for long-term death in patients.  Methods  A total of 259 CTO patients undergoing coronary angiography in the Second Affiliated Hospital of Anhui Medical University from January 2019 to March 2023 were selected, and the patients were divided into survival group and death group according to their prognosis. Univariate regression analysis and multivariate logistic regression analysis were used to evaluate the effect of UAR on mortality adverse events in CTO patients.  Results  Among the 259 CTO patients, 39 (15.06%) died and 220 (84.94%) survived during the follow-up period of approximately of (39.9±12.3) months. Compared with the survival group, patients in the death group exhibited a older age, higher proportion of dual -vessel lesions of CTO, higher levels of blood urea nitrogen, creatinine, uric acid, UAR, and neutrophil-to-lymphocyte ratio (NLR), fewer cases of complete revascularization, and lower levels of albumin and triglycerides (P < 0.05). Multivariate logistic regression analysis showed that the risk factors for poor prognosis in CTO patients include increasing age, increased number of CTO lesions and elevated UAR. The area under the ROC curve for UAR predicting mid to long-term all-cause mortality in CTO patients was 0.648 (95% CI: 0.547-0.748, P=0.003), with a sensitivity of 53.8% and a specificity of 72.7%.  Conclusion  The UAR of the deceased is significantly higher compared to survivors, indicating that UAR holds certain predictive value for mid to long-term all-cause mortality in patients with chronic total occlusion of the coronary arteries.
Relationship between the changes of ER, PR, Her-2 and Ki-67 before and after neoadjuvant chemotherapy and chemotherapy efficacy in breast cancer
LI Yang, LI Yumei, DENG Jun
2024, 22(9): 1500-1503. doi: 10.16766/j.cnki.issn.1674-4152.003668
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  Objective  To investigate the relationship between the changes of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2(Her-2) and proliferation-associated antigen (Ki-67) in breast cancer patients before and after neoadjuvant chemotherapy (NAC).  Methods  The data of 100 patients with breast cancer who received neoadjuvant chemotherapy in the First Affiliated Hospital of Bengbu Medical University from January 1, 2020 to December 31, 2021 were collected. Finally, 80 patients were included in the study. The NAC regimen used anthracycline combined with taxoid regimen, and the NAC regimen for Her-2 positive patients was docetaxel+carboplatin+trastuzumab+pertuzumab (TCbHP). After NAC, all patients underwent surgery for breast cancer. Immunohistochemical tests were performed on postoperative tumor residual samples, and the expression changes of related indicators were recorded. According to the grading of Miller-Payne system and postoperative pathological results, the patients were divided into pathologically complete response group (pCR) and non-pathologically complete response group (non-pCR). χ2 test and multiple logistic regression model were used to analyze the differences in the expression of ER, PR, Her-2 and Ki-67 before and after chemotherapy in the non-PCR group, and to analyze whether the expression changes of these molecules were correlated with the disease control rate of patients.  Results  The change rates of ER, PR, Her-2 and Ki-67 before and after NAC were 2.50%, 7.50%, 10.00% and 40.00%, respectively. There were statistically significant differences in the expression changes of Ki-67 (P=0.011) before and after NAC, while there were no statistically significant differences in the expression changes of ER (P=0.737), PR (P=0.581) and Her-2 (P=0.108). In addition, multiple logistic regression analysis showed that Ki-67 high expression was an independent predictor of clinical disease control rate of neoadjuvant chemotherapy (P < 0.05).  Conclusion  NAC treatment may affect Ki-67 expression, while ER, PR and Her-2 do not change significantly. Patients with reduced Ki-67 expression levels after NAC may have a higher rate of disease control.
Histopathology and changes in CXCL9 expression levels in patients with missed miscarriage
SU Shiyue, WEI Zhaolian
2024, 22(9): 1504-1507. doi: 10.16766/j.cnki.issn.1674-4152.003669
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  Objective  To analyze the histopathological and gene expression changes of villus in patients with missed miscarriage, and explore the mechanism of missed miscarriage.  Methods  Patients with induced abortion from December 2020 to February 2023 from the First Affiliated Hospital of Anhui Medical University were selected to participate in the study, including 35 cases of missed abortion in the study group and 35 cases in the control group. The pathological changes of villus tissue were observed by HE staining and transmission electron microscopy, and the sequencing results and CXCL9 gene expression changes were verified by RNA sequencing and qRT-PCR.  Results  In the study group, the number of HE chromatozytial trophoblasts decreased and inflammatory cells infiltrated, and fluoroscopy electron microscopy showed that the endoplasmic reticulum of cytotrophoblasts expanded, the number of mitochondria in syncytial trophoblast decreased and the number of Hofbauer cells increased. The most significant up-regulated genes were KRT34 (FDR=0.008), MRGPGR (FDR=0.048), CUZD1 (FDR=0.002), CXCL9 (FDR < 0.001), CD72 (FDR=0.043), FGF14 (FDR=0.042), TMEM176A (FDR < 0.001), and GAPT (FDR=0.026). qRT-PCR showed that the expression of KRT34, MRGPGR, CUZD1, CXCL9, CD72, FGF14, TMEM176A and GAPT genes was up-regulated, and the all P < 0.05, while the mRNA expression of CXCL9 in the study group (28.66±0.38) and the control group (27.46±0.75) were significantly different (P < 0.001).  Conclusion  Inflammatory cell infiltration and up-regulation of CXCL9 expression may play an important role in the development of missed miscarriage.
Efficacy of arthroscopic reconstruction of anterior cruciate ligament and simultaneous meniscus inside-out suture in the treatment of meniscus bucket handle tear
LI Xiang, CHANG Wenjyu, WANG Jinzi, SUN Zhenyue, DING Hai
2024, 22(9): 1508-1511. doi: 10.16766/j.cnki.issn.1674-4152.003670
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  Objective  To analyze the application effect of inside-out meniscus suture in the arthroscopic reconstruction of anterior cruciate ligament in patients with meniscus bucket handle tear and compare with total internal suture in order to promote rapid postoperative recovery and protect joint function.  Methods  The data of 120 patients with cruciate ligament rupture combined with barrel handle tear of medial meniscus treated in the First Affiliated Hospital of Bengbu Medical University from May 2018 to May 2023 were retrospectively analyzed. All patients underwent anterior cruciate ligament reconstruction under arthroscopy. Patients with total internal suture and inside-out suture were included in total internal suture group (n=51) and inside-out suture group (n=69) according to the simultaneous meniscus suture method. Meniscus healing rate, operation time, hospital stay and surgical treatment cost, three-dimensional gait parameters before and after operation, and incidence of complications were compared between the two groups.  Results  There was no statistically significance difference in meniscus healing rate (90.20% vs. 94.20%, P>0.05), operation time, hospital stay and surgical treatment cost between the two groups. The pre-post displacement, up-down displacement, inside-out displacement, inside eversion displacement, inside-out inversion and inside-out rotation decreased in both groups, while the flexus-extension increased (P < 0.05). There was no statistically significant difference in the three-dimensional gait parameters between the two groups (P>0.05). There was no statistically significance difference in the incidence of joint space tenderness and joint effusion between the two groups (P>0.05). The incidence of numbness in the lower knee area in the internal external suture group was higher than that in the total internal suture group (13.04% vs. 0, P < 0.05).  Conclusion  Arthroscopic anterior cruciate ligament reconstruction combined with simultaneous meniscus suture from the inside out has the same efficacy as total internal suture, but the incidence of postoperative numbness in the lower knee area is relatively high.
General Clinical Research
Clinical research of Lucentis combined with fortify spleen for fluid retention removement recipe in the treatment of retinal vein occlusion macular edema
YU Jiexin, LIU Yanli, LI Xingyu
2024, 22(9): 1512-1517. doi: 10.16766/j.cnki.issn.1674-4152.003671
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  Objective  To explore the clinical effects of Lucentis combined with fortify spleen for fluid retention removement recipe and its prognostic indicators in the treatment of retinal vein occlusion macular edema (RVO-ME).  Methods  A total of 60 patients with RVO-ME visiting the First Affiliated Hospital of Zhejiang Chinese Medical University from October 2021 to October 2022 were randomly divided into a combination treatment group and a conventional treatment group. Each included 30 cases. All patients were given intravitreal injection of Ranibizumab for three months. The combined treatment group was given oral granules administration of self-prepared Chinese medicine recipe for fortifying spleen to remove fluid retention, while the control group was treated with placebo granules. The inflammatory markers of peripheral blood, best corrected visual acuity (BCVA), high reflection signal (HRF) in OCT images, macular central thickness (CMT), sub-retinal fluid (SRF), and cystoid macular edema (CME) before and after the treatment in the two groups were compared. Those indexes were also compared between patients with and without recurrent ME, The group with recurrent ME included 20 patients, while the group without recurrent ME included 40 patients.  Results  After 3 months of treatment, the systemic immune inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), HRF, and CMT in the combined treatment group were significantly lower than those in the conventional treatment group (P < 0.05). The combined treatment group has significantly higher resolution rates of SRF (88.9% vs. 50.0%) and CME (63.0% vs. 25.0%, P < 0.05). The RVO-ME recurrence rate in the combined treatment group was 20.0%, significantly lower than the conventional group (46.7%, P < 0.05). HRF and CMT descended more significantly in patients without recurrent ME than those with recurrent ME (P < 0.05). The ROC curve indicates patients with baseline CMT < 497.50 μm (P=0.010) and HRF < 15.5 (P=0.021) had a lower probability of edema recurrence and better BCVA.  Conclusion  Combined treatment of Lucentis with self-prepared Chinese medicine granules improves the efficacy and reduces recurrence in the treatment of RVO-ME. Patients with CMT < 497.50 μm and HRF≤15 before treatment have a better prognosis.
Influence of blood glucose fluctuation, inflammation and immune factors on recurrence of condyloma acuminatum in patients with diabetes
WANG Ying, TU Sheng
2024, 22(9): 1518-1521. doi: 10.16766/j.cnki.issn.1674-4152.003672
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  Objective  This study aimed to investigate the correlation between blood glucose fluctuations, interleukin-6 (IL-6), and serum tumor necrosis factor-alpha (TNF-α) levels following CO2 laser and imiquimod treatment (CO2-Ⅰ) in patients with diabetes mellitus complicated by anogenital (DMCA), and their association with recurrence rates.  Methods  A prospective cohort study was conducted on 136 DMCA patients treated with CO2-Ⅰ at the People's Hospital of Bozhou, from August 2020 to December 2022. Post-treatment, all patients underwent continuous blood glucose monitoring for 72 hours to calculate the mean amplitude of glycemic excursion (MAGE). After discharge, patients were followed up for six months to evaluate short-term recurrence. Patients were divided into a recurrence group and a non-recurrence group based on their post-treatment recurrence status. The impact of blood glucose fluctuations on short-term recurrence in diabetic patients with condyloma acuminatum (DMCA) following CO2 laser treatment (CO2-Ⅰ) was analyzed.  Results  Among the 136 DMCA patients, 34 (25.00%) experienced recurrence, while 102 (75.00%) did not. The recurrence group exhibited significantly higher levels of MAGE, IL-6, and TNF-α compared to the non-recurrence group, with these differences being statistically significant (P < 0.05). Multivariate logistic regression analysis indicated that higher MAGE values (≥3.9 mmol/L, OR=1.527, P < 0.001), higher incidence of anorectal and/or genital erosion (OR=2.786, P=0.016), elevated TNF-α levels (≥6.39 μg/L, OR=1.746, P=0.001), and decreased IL-6 levels (< 5.26 pg/mL, OR=1.725, P=0.001) were risk factors for the recurrence.  Conclusion  In DMCA patients treated with CO2-Ⅰ, high MAGE values, increased expression of TNF-α and lower IL-6, and the presence of anorectal and/or genital erosion significantly increase the risk of short-term recurrence. These findings hold certain clinical implications and may provide a basis for prognosis assessment.

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