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2024, Volume 22,  Issue 8

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General Practice Forum
Uncertainty and it's management strategies in general practice
GAO Keyin, SHI Weili, WANG Liuyi
2024, 22(8): 1267-1271. doi: 10.16766/j.cnki.issn.1674-4152.003614
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Uncertainty is pervasive within the healthcare system in medical filed nowadays. It impacts all aspects of diagnosis and treatment, affecting doctors and patients in various ways. Establishing a consensus on medical uncertainty facilitates the establishment of enduring doctor-patient relationships based on trust balance the interests of both parties, thereby influencing the efficacy of diagnosis and treatment. This poses a significant challenge in medical services. As the initial clinicians for the patients, General Practitioners are faced with challenges of managing a wide range of diseases and accommodating individual patient differences. Effectively navigating uncertainty is an integral part of their daily responsibilities, making the mastery of uncertainty management strategies particularly crucial for general practitioners. However, the current research on medical uncertainty is severely limited, with most domestic studies focusing on the application of uncertainty in specific technologies or processes. Comprehensive discussions and analysis and integration of uncertainty management strategies are lacking. Therefore, we conducted a systematic literature review to explore applicable uncertainty management strategies in general practice. This article analyzes the origins and ramifications of medical uncertainty and explores approaches to manage it during clinical judgments. We posit that medical uncertainty from various sources can negatively affect the emotions, behaviors, and reactions of both healthcare professionals and patients. However, adopting appropriate management strategies can mitigate these effects, providing a reference for clinical decision-making under the background of uncertainty.
2024, 22(8): 1272-1278. doi: 10.16766/j.cnki.issn.1674-4152.003615
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Risk factors of left ventricular hypertrophy for chronic kidney disease patients and construction of a predictive model
XIAO Zhimei, DING Chenhui, LUO Chen, QIAN Leilei
2024, 22(8): 1354-1358. doi: 10.16766/j.cnki.issn.1674-4152.003635
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  Objective  To construct a predictive model for assessing the risk of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) and evaluate its clinical application value.  Methods  The clinical data of 302 patients with stage Ⅲ-Ⅴ CKD, who were treated at Rugao Hospital Affiliated to Nantong University from January 2018 to August 2022 were collected. Patients were randomly divided into a modeling group (n=200) and a validation group (n=102) based on their ID number. Logistic regression was used to determine risk factors for LVH, and a nomogram model was constructed. The predictive ability of the model was evaluated by receiver operating characteristic curve and correction curve.  Results  The incidence of LVH in CKD patients was 37.4% (113/302). Older age (OR=1.054, 95% CI: 1.020-1.089, P=0.002), cardiovascular history (OR=5.826, 95% CI: 2.263-15.003, P < 0.001), CKD Ⅴ stage (OR=5.831, 95% CI: 2.142-15.873, P=0.009), elevated systolic blood pressure (OR=1.019, 95% CI: 1.002-1.036, P=0.025) and hyperphosphatemia (OR=1.109, 95% CI: 1.029-1.195, P=0.007) were independent risk factors for LVH. The prediction model of LVH was constructed based on the above factors, and had AUC of 0.850 (95% CI: 0.796-0.904) in the modeling group and 0.792 (95% CI: 0.707-0.877) in validation group. The calibration curve showed that the nomogram model exhibits good predictive ability for LVH.  Conclusion  The nomogram model, which is based on age, history of cardiovascular disease, CKD stage, systolic blood pressure, and blood phosphorus, provides clinicians a simple and effective tool to identify CKD patients with high risk of LVH.
5E rehabilitation program based on MDT model effect of intervention on elderly maintenance hemodialysis patients
LIU Bingyan, WANG Li, ZHANG Li, XU Shanshan, YIN Xiaoli, ZHANG Jiqiang
2024, 22(8): 1359-1363. doi: 10.16766/j.cnki.issn.1674-4152.003636
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  Objective  To explore the influence of the 5E rehabilitation program of multidisciplinary diagnosis and treatment team model on elderly maintenance hemodialysis patients, and to provide a clinical basis for the formulation of the 5E rehabilitation program.  Methods  A total of 82 elderly maintenance hemodialysis patients admitted to the Hemodialysis Department of Huaibei Miners General Hospital from January 2021 to December 2022 were selected as the study objects and were divided into a control group (40 cases) and an observation group (42 cases) by random number method. The control group received the routine nursing intervention of hemodialysis, and the observation group received a 5E rehabilitation program based on a multidisciplinary diagnosis and treatment team model on the basis of routine nursing. The differences in self-management ability, treatment compliance, and nutritional status between the two groups were compared before and after the intervention, and the changes in dialysis effect indexes in the observation group were compared before and after the intervention.  Results  Inter-group comparison showed that 3 months and 6 months after intervention, the scores of 4 dimensions of self-management behavior and total scores in the observation group were higher than those in the control group (P < 0.05), the overall improvement of treatment compliance in the observation group was better than that in the control group (P < 0.05), and the values of hemoglobin, serum albumin, prealbumin and BMI in the observation group were higher than those in the control group (P < 0.05). Intra-group comparison showed that the serum potassium, blood phosphorus, serum creatinine and blood urea nitrogen [(21.25±4.13) mmol/L, (18.86±3.92) mmol/L vs. (23.43±4.35) mmol/L] of patients at 3 and 6 months after intervention were decreased compared with those before intervention (P < 0.05).  Conclusion  The 5E rehabilitation program based on the multidisciplinary diagnosis and treatment team model can improve patients ' self-management ability and treatment compliance in the clinical application of elderly maintenance hemodialysis patients, and has a certain role in improving nutritional status and improving dialysis effects.
Clinical observation of Zixian Pills combined with azithromycin in the treatment of children with henoch-schonlein purpura complicated with Mycoplasma pneumoniae infection
XIANG Li ' e, SHANG Lili, WANG Jiejie
2024, 22(8): 1364-1366. doi: 10.16766/j.cnki.issn.1674-4152.003637
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  Objective  To investigate the efficacy and safety of Zixian Pills combined with azithromycin in the treatment of Henoch-Schönlein purpura (HSP) complicated by Mycoplasma pneumoniae infection.  Methods  One hundred cases of children with HSP complicated by Mycoplasma. pneumoniae infection who were treated in the pediatric ward of the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2021 to February 2024 were selected. They were divided into observation group (50 cases) and control group (50 cases) according to random number table method. The control group was given azithromycin and basic treatment for HSP, and the observation group was given oral Zixian Pills on the basis treatment of the control group, both of which were treated for 7-14 days. The improvement in traditional Chinese medicine (TCM) syndrome scores, clinical efficacy and adverse drug reactions were evaluated in the two groups, and the levels of urinary red blood cells, urinary microalbumin and urinary beta 2-microglobulin were measured.  Results  Before treatment, there was no significant difference in TCM syndrome scores between the two groups (P>0.05); After treatment, the scores of TCM syndromes in both groups were lower than those before treatment (P < 0.05); After treatment, the TCM syndrome score in the observation group [1.00 (1.00, 2.00)] was lower than that in the control group [2.00 (1.00, 2.00), P < 0.05]. The overall response rate (ORR) in the observation group was superior to that in the control group [92.0% (46/50) vs. 76.0% (38/50), P < 0.05]. There was no significant difference in urinary erythrocytes, urinary microalbumin and urinary beta 2-microglobulin between the two groups before treatment (P>0.05); there were significant differences in urinary erythrocytes, urinary microalbumin and urinary beta 2-microglobulin between the two groups after treatment (P < 0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).  Conclusion  The treatment of HSP complicated by Mycoplasma. pneumoniae infection in children with Zixian Pills combined with azithromycin has obvious effects on improving TCM syndrome scores and reducing renal injury, and it has good safety.
Risk prediction of placental abruption in singleton pregnancy with hypertensive disorders of pregnancy
WANG Wenxin, WANG Ruolan, FANG Yuanyuan, SHEN Qingmei, WANG Meng, YANG Kuanying, FAN Yijun
2024, 22(8): 1367-1370. doi: 10.16766/j.cnki.issn.1674-4152.003638
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  Objective  To investigate the risk factors for placental abruption in singleton pregnancy with hypertensive disorders of pregnancy (HDP).  Methods  The clinical data of 1 595 HDP patients who met the inclusion criteria and were hospitalized in the Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Anhui Medical University, from January 2014 to January 2022, were retrospectively analyzed. According to the occurrence of placental abruption, they were divided into study group (with placental abruption, 34 cases) and control group (without placental abruption, 1 561 cases). Demographic characteristics, clinical characteristics and laboratory test results were recorded. Univariate and multivariate logistic regression models were used to analyze the risk factors of HDP patients with placental abruption, and an ROC curve was constructed to evaluate the predictive efficacy.  Results  Among 1 595 HDP patients enrolled in this study, 34 were diagnosed with placental abruption (2.13%). Compared with the control group, the study group had higher levels of D-dimer (P=0.005), serum creatinine (P=0.044), blood urea nitrogen (P=0.043) and aspartate aminotransferase (P=0.014), and lower levels of platelet count (P=0.012) and fibrinogen (P=0.011). Serum D-dimer level (P=0.009), fibrinogen level (P < 0.01) and HDP types [severe preeclampsia (P=0.033), eclampsia (P=0.001)] were the influencing factors of placental abruption in HDP patients. Among them, fibrinogen had the highest predictive sensitivity (55.9%) and D-dimer had the highest specificity (84.2%). The sensitivity of the combination of D-dimer and fibrinogen was higher than that of the individual risk factors (61.8%). The AUC of HDP types was the lowest [0.617 (95% CI: 0.515-0.720)], and the AUC of D-dimer+fibrinogen+HDP types was the highest [0.735 (95% CI: 0.639-0.831)].  Conclusion  Different types of HDP have a significant impact on placental abruption in singleton pregnancy. If fibrinogen is decreased and D-dimer is increased, placental abruption should be highly suspected in singleton pregnancy with HDP.
Correlation between hypertension and sarcopenia in the community-dwelling older residents
WU Xiaoxue, CHEN Hongzhen, ZHENG Kun, YU Hongmei, XIA Li
2024, 22(8): 1371-1375. doi: 10.16766/j.cnki.issn.1674-4152.003639
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  Objective  To investigate the correlation between sarcopenia and hypertension in community-dwelling older residents in Chongqing.  Methods  A total of 615 elderly who received medical check-ups at the community health center in Chongqing from March 2023 to August 2023 were selected. General information was collected by questionnaire and skeletal muscle mass, 6-meter walking speed, grip strength, and blood pressure were also measured. Subjects were divided into sarcopenia group and non-sarcopenia group according to the guidelines of Asian Working Group for Sarcopenia 2019. The factors influencing sarcopenia were determined by binary logistic regression analysis. The correlation between blood pressure and diagnostic indices of sarcopenia was performed by Pearson correlation analysis.  Results  Among the 615 elderly from Chongqing community, 80 elderly (13.0%) were diagnosed with sarcopenia. Compared with the non-sarcopenia group, the age, prevalence of hypertension and diabetes in the sarcopenia group were significantly higher, while the BMI was significantly lower (P < 0.05). Logistic regression analysis showed that older age (OR=1.140, 95% CI: 1.098-1.183), hypertension (OR=2.058, 95% CI: 1.195-3.545) were associated with increased risk of sarcopenia (P < 0.05). Pearson correlation analysis showed that grip strength (r=-0.132, P=0.017), appendicular skeletal muscle mass (r=-0.134, P=0.016), skeletal muscle mass index (r=-0.121, P=0.030) were negatively correlated with systolic blood pressure.  Conclusion  The risk of sarcopenia was increased with and hypertension in community-dwelling older residents. SBP can effectively reflect the muscle mass and strength of the elderly with hypertension. Therefore, screening for sarcopenia elderly in community-dwelling older residents should be done as early as possible, and sarcopenia should be prevented by effective blood pressure control.
Analysis of the effectiveness of digitized management in integrated medical and preventive care for hypertension through chronic diseases outpatient services
MA Chengcheng, ZHANG Weiying, LIU Shijun, LI Bo, YE Xuhui
2024, 22(8): 1376-1380. doi: 10.16766/j.cnki.issn.1674-4152.003640
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  Objective   To enhance hypertension management in primary medical institutions by analyzing the effectiveness of digitized management of medical-preventive integration for hypertension based on integrated outpatient services for chronic diseases.   Methods   In September 2021, 772 hypertensive patients aged 35-79 were selected from the outpatient department of Kaixuan Subdistrict Community Healthcare Center. According to the random principle, 388 cases were assigned to the intervention group and 384 to the control group. The intervention group adopted digitized management of medical-preventive integration based on integrated outpatient services for chronic diseases, while the control group adopted a routine community hypertension management based on general outpatient services. After 18 months of intervention, statistical analysis assessed changes in lifestyle, blood pressure compliance rate, and combined compliance rats for blood pressure, blood glucose, and lipid levels in both groups before and after intervention. Factors influencing blood pressure compliance at the study endpoint were also analyzed.   Results   Following the intervention, the alcohol consumption, obesity, and abdominal obesity rates in the intervention group were improved [18.8% (73 cases) vs. 27.1% (104 cases), 5.4% (21 cases) vs. 11.7% (45 cases), 31.2% (121 cases) vs. 45.1% (173 cases), respectively], which were statistically significant compared to the control group (χ2=7.468, 19.627, 15.738, P < 0.05). The blood pressure compliance rate and the combined compliance rate of blood pressure, blood glucose, and lipid in the intervention group [61.9% (240 cases) and 53.4% (207 cases), respectively] were higher than those in the control group [44.3% (170 cases) and 28.1% (108 cases), respectively], with statistically significant (χ2=23.964, 50.843, P < 0.05). Multivariate logistic regression analysis showed that receiving digital integrated medical and preventive management (OR=1.587, 95% CI: 1.161-2.171), blood glucose control (OR=2.056, 95% CI: 1.294-3.266), and blood lipid control (OR=1.490, 95% CI: 1.042-2.131) were independent promoting factors for blood pressure control (P < 0.05).   Conclusion   The digitized management of medical-preventive integration based on integrated chronic disease outpatient services can improve the effectiveness of blood pressure disease management.
Efficacy of cognitive behavioral self-help therapy for depression disorder to withdraw from long-term benzodiazepine use
QIAN Guoying, CAI Lili, FEI Jinfeng, YANG Shengliang, ZHONG Hua
2024, 22(8): 1381-1384. doi: 10.16766/j.cnki.issn.1674-4152.003641
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  Objective   To evaluate the efficacy and security of tapering off long-term benzodiazepine (BZD) use for depression disorder, and to evaluate the value of additional cognitive behavioral therapy-self help (CBT-SH).   Methods   An 8-week randomized controlled trial was conducted in which 80 patients with depression who returned to the Huzhou Third Municipal Hospital from April 2020 to March 2022 and met the enrollment criteria were assigned to tapering off plus CBT-SH (intervention group, n=40), or tapering off alone (control group, n=40). The patients ' mental symptoms, sleep quality, and physical status were assessed before and after intervention, and the withdrawal symptoms were assessed after intervention. The discontinuation rate of BZD and withdrawal symptoms between the two groups were compared after intervention.   Results   At the end of 8th week, the discontinuation rate of BZD in the intervention group was higher than that in the control group [52.5% (21/40) vs. 27.5% (11/40), P=0.017]; the daily dose of BZD in the intervention group was lower than that in the control group [0.0 (0.0, 3.8) mg/d vs. 3.0 (0.0, 4.8) mg/d, P=0.035]. The withdrawal symptoms mainly showed feeling faint, noise sensitivity and dizziness. The frequency of withdrawal symptoms in the intervention group was lower than that in the control group [50.0% (20/40) vs. 77.5% (31/40), P=0.011], the scores of benzodiazepine withdrawal symptom questionnaire (BWSQ) in the intervention group were significantly lower than that in the control group (P<0.05). There were no significant differences in the scores of the 17-item Hamilton depression scale (HAMD-17), Hamilton anxiety scale (HAMA), and Pittsburgh sleep quality index (PSQI) between the two groups (P>0.05). No clinically significant changes were found in somatic indices in all patients.   Conclusion   In patients with stabilized depression disorder, the addition of CBT-SH can be used during the time of benzodiazepine withdrawal to enhance the discontinuation rate of benzodiazepine and reduce withdrawal symptoms.
The influence of multi-dimensional home rehabilitation management based on Wechat mini program on patients with schizophrenia
LIN Xuebing, JIN Hanqing, MA Lingya
2024, 22(8): 1385-1389. doi: 10.16766/j.cnki.issn.1674-4152.003642
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  Objective   To conduct multi-dimensional home rehabilitation management for discharged schizophrenic patients using the Wechat mini program to promote patient rehabilitation.   Methods   A total of 98 patients with schizophrenia discharged from Shaoxing Seventh People ' s Hospital after treatment from December 2021 to December 2022 were divided into control group (49 cases, routine home rehabilitation management) and Wechat group (49 cases, multidimensional home rehabilitation management based on Wechat mini program). Medication adherence, social functioning, psychological symptoms, stigma, neuroelectrophysiology and readmission rates were compared between the two groups.   Results   The medication adherence rating scale (MARS) score in the Wechat group was (7.88±1.36) points, which was higher than that in the control group [(6.10±1.14) points, P < 0.05]. The scale of social function in psychosis inpatients (SSPI) was higher than in the control group (P < 0.05). On the positive and negative syndrome scale (PANSS), the positive symptom score was (7.06±1.34) points, the negative symptom score was (13.56±2.10) points, the general symptom score was (18.34±3.25) points, and the total score was (38.96±5.22) points. They were lower than (9.45±1.47) points, (15.67±2.34) points, (19.56±2.47) points and (44.68±5.03) points in the control group (P < 0.05). The SSMI-C score was lower than in the control group (P < 0.05). The latency of the P300 was lower than in the control group (P < 0.05), and its amplitude was higher than in the control group (P < 0.05). The readmission rate at 6 months was slightly lower than in the control group (P>0.05).   Conclusion   Multi-dimensional home rehabilitation management based on the Wechat mini program can improve medication adherence in discharged schizophrenia patients, help control mental symptoms, improve social functioning, reduce stigma and promote cognitive function improvement.
Establishment and application of standard operation procedure for the entire process of lupus anticoagulant DRVVT detection
DAN Gang, SUN Wei, CHEN Qinghong, HU Lina, GUO Zhengbin, ZHANG Jianhua, ZHANG Rui, LIU Yuan
2024, 22(8): 1390-1394. doi: 10.16766/j.cnki.issn.1674-4152.003643
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  Objective   To investigate the standardized procedure for the entire process of lupus anticoagulant (LA) detection using the dilute Russell viper venom time (DRVVT) method to ensure the accuracy of LA test results and to aid in clinical diagnosis and treatment.   Methods   This study followed relevant industry requirements, including "Management Measures for Medical Institution Laboratory Management" and "Quality Requirements for Routine Analysis of Clinical Hematology Tests WS/T 406-2012". The entire process of LA detection using the DRVVT method, including pretest, test and posttest phases stages, was standardized. A "DRVVT Method Lupus Anticoagulant Detection Manual" was created based on standard operating procedures (SOP), and test results were tracked and monitored throughout the process to ensure the accuracy of LA test results and to aid in clinical diagnosis and treatment. The study included a total of 3 595 specimens for LA testing in General Hospital of Western Theater Command PLA, from 2021 to 2023. By analyzing aspects such as the number of specimens submitted, the distribution of submitting departments and annual growth, the study examined the degree of clinical recognition of this project and the improvement in the accuracy of disease diagnosis after establishing a standardized testing process.   Results   By establishing a set of standardized operation and detection procedures, we can effectively monitor the test results, and accurately reflect the concentration of LA in patients, to provide effective support for diagnosis and treatment. With the continuous implementation of standardized procedures, the clinical recognition of relevant items has been improved, leading to a sustained increase in the number of specimens and departments submitting specimen. The number of specimens increased from 841 in 2021 to 1 460 in 2023, with a growth rate of 73.0%. In terms of departments submitting specimen, there were 16 departments in 2021 and this number reached 29 departments in 2023, with a growth rate of 81.3%. This has fully achieved the desired effect of supporting the clinic and actively interacting with the clinical department.   Conclusion   Establishing a standard process for the detection of LA can provide accurate and truthful detection results to the clinical, deepen communication with the clinical on related diseases, and play a positive role in supporting the diagnosis and treatment of related diseases.
Analysis of screening and identification of irregular antibodies in 39 671 blood transfusion patients
LIU Kai, WU Jing, XU Xun, GUAN Zheng, XU Li, ZHANG Jun
2024, 22(8): 1395-1398. doi: 10.16766/j.cnki.issn.1674-4152.003644
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  Objective   To analyze the screening and identification results of irregular antibodies in patients with blood transfusion, and to explore the relationship between irregular antibodies and gender, blood transfusion history, and pregnancy history.   Methods   The screening and identification results of irregular antibodies in 39 671 transfusion patients from January 2021 to December 2022 were obtained from the hospital electronic medical record system. The number of positive cases for irregular antibodies was recorded, the distribution of irregular antibodies was analyzed, and the relationship between the positive rate and specificity of irregular antibodies and patient gender, transfusion history, and pregnancy history was explored.   Results   Among the 39 671 transfusion patients, a total of 365 cases tested positive for irregular antibodies, with a positivity rate of 0.92%. Among them, the highest proportion was positive antibodies in the Rh blood type system (213 cases, accounting for 58.36%). The data showed that among the 365 patients with positive irregular antibodies, females (228 cases, 62.47%) had a higher proportion than males (137 cases, 37.53%), and the positivity rate of Rh blood type system antibodies in female patients (143 cases, 62.72%) was significantly higher than that in males (70 cases, 51.09%; P=0.037). Patients with a history of transfusion and those with a history of pregnancy were more likely to have positive Rh blood type system antibodies (P < 0.05).   Conclusion   Women, blood transfusion history and pregnancy history will increase the probability of positive results on irregular antibody screening. While irregular antibody screening and identification for patients who have conventional transfusion therapy are carried out, the detection for women, patients with blood transfusion history or pregnancy history should be especially strengthened.
Analysis of prevention and treatment of obese PCOS based on "adjustable constitution"
FANG Jiamin, FENG Yahong
2024, 22(8): 1399-1402. doi: 10.16766/j.cnki.issn.1674-4152.003645
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Polycystic ovarian syndrome (PCOS) is a heterogeneous disease related to female endocrine and reproductive disorders, and it is the main cause of secondary amenorrhea, irregular menstrual cycles, and anovulatory infertility in women of childbearing age. Clinical manifestations include oligomenorrhea, hirsutism, acne, obesity, and infertility. In recent years, with the development of the social economy and the change of natural environment, the number of obese patients with PCOS gradually increased, and the psychological and physiological pressure faced by women of childbearing age also increased. These pressures have seriously impacted their physical and mental health and quality of life. Obesity not only has physiological effects on patients with PCOS, but also increases their psychological burden, causing negative emotions such as depression, anxiety, irritability, low self-esteem, and depression. Studies have shown that obese patients with PCOS not only faced the problems of weight gain and weight loss, but also more likely to have emotional problems such as anxiety, irritability, and depression. Compared with women without PCOS, women with PCOS have more serious psychological problems, weaker self-esteem, and more negative body image. Endocrine and metabolic disorders of obese patients with PCOS are more serious than those of ordinary people. At the same time, the probability of poor efficacy in treating patients with infertility increases, which may increase the risk of pregnancy complications in pregnant women. This paper discusses the prevention strategies of obese patients with PCOS by consulting the resent literature and combining with the theory of "adjustable constitution" in traditional Chinese medicine. The aim is to provide new ideas for the prevention and treatment of obese patients with PCOS.
Progress in the study of the value of systemic coagulation-inflammatory markers in predicting the prognosis of acute type A aortic dissection
SONG Xinyu, ZUO Yaqun, CHEN Zheping, JIN Yanwu
2024, 22(8): 1403-1407. doi: 10.16766/j.cnki.issn.1674-4152.003646
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Acute type A aortic dissection (ATAAD) is a complex and extremely dangerous cardiovascular disease characterized by pathological changes of aortic anatomy, systemic inflammatory response, and coagulation dysfunction, which poses a serious threat to human life and health. Currently, risk factors such as advanced age, obesity, preoperative nerve injury, massive blood transfusion, operation time, poor tissue and organ perfusion, and hemodynamic damage caused by cardiac tamponade or poor coronary perfusion are considered to be independent predictors of death in patients with ATAAD. However, these risk factors still do not meet the needs of clinical practice. In ATAAD cases, inflammation reaction and coagulation dysfunction often coexist, the complex interactions between coagulation and inflammation playing a role in the occurrence and development of ATAAD. Recent studies have shown that markers of coagulation and inflammation can aid in assessing the prognosis of ATAAD patients while enhancing predictive performance when incorporated into clinical prediction models (CPMs), surpassing traditional prediction models. Therefore, this article aims to review and summarize the relevance of systemic coagulation-inflammatory markers to the prognosis of ATAAD patients, as well as their role in establishing prediction models. This research progress provides novel insights for early clinical diagnosis, early risk stratification, and early clinical intervention.
The effect of traditional Chinese medicine inunction on negative emotions and pain in patients with acute coronary syndrome after PCI
JIN Li, TANG Xing
2024, 22(8): 1408-1411. doi: 10.16766/j.cnki.issn.1674-4152.003647
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  Objective  Negative emotions and pain are among the most important factors affecting the prognosis of patients with acute coronary syndrome. The aim of this study was to explore the value of traditional Chinese medicine (TCM) in the treatment of patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), and to provide a reference for improving negative emotions and reducing pain levels in patients with acute coronary syndrome.   Methods  From January 2020 to December 2022, 200 patients with acute coronary syndrome who were treated at the Third Affiliated Hospital of Zhejiang Chinese Medicine University were retrospectively collected. Patients were divided into two groups according to whether they received TCM or not: the TCM inunction group (n=90) and the control group (n=110). All patients received emergency percutaneous coronary intervention (PCI) and conventional therapy, while the TCM treatment group received TCM inunction. The negative emotions, pain and prognosis of the two groups of patients were compared.   Results  There was no statistically significant difference in left ventricular ejection fraction, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), pre-treatment visual analogue scale, self-rating anxiety scale and self-rating depression scale between the two groups of patients before treatment (P>0.05). After treatment, compared with the control group, the left ventricular ejection fraction in the TCM inunction group was increased (P=0.001), NT-proBNP was decreased (P < 0.001), the visual analogue scale was reduced (P < 0.001), the self-rating anxiety scale was significantly decreased (P < 0.001), and the self-rating depression scale was also decreased (P < 0.001). Compared with the control group, the incidence of major adverse cardiovascular events was significantly reduced in the TCM inunction method group [1.11% (1/90) vs. 9.09% (10/110), P=0.031].   Conclusion  TCM can improve negative emotions, reduce pain levels, and reduce the incidence of short-term major adverse cardiovascular events in patients with acute coronary syndrome after PCI.
Clinical efficacy of ear acupoint pressing combined with Modified Jianzhong Decoction in the treatment of insomnia with heart and spleen deficiency syndrome
LYU Fengjuan, LONG Yan, YANG Xiumu, WANG Yuling, YAO Weiwei, XU Zhenwei
2024, 22(8): 1412-1415. doi: 10.16766/j.cnki.issn.1674-4152.003648
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  Objective  To observe the curative effect of ear acupoint pressing combined with Modified Jianzhong Decoction in treating insomnia patients with heart and spleen deficiency and its superiority over single therapy.   Methods  A total of 45 patients with insomnia who met the enrollment criteria and were treated in our department from October 2021 to October 2023 were selected and divided into a simple auricular point treatment group (15 cases), a simple Chinese medicine decoction treatment group (15 cases), and a decoction+auricular point soy-embedding combined treatment group (15 cases) according to random number table method. The treatment was two weeks. The international SPIEGEL sleep scale score, Pittsburgh sleep quality index (PSQI) score, Assens insomnia scale (AIS) score, and traditional Chinese medicine (TCM) syndrome score, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) score of the three groups were compared before and after the treatment. The evaluation of patients ' satisfaction with the treatment was also collected.   Results  The total effective rate of Modified Jianzhong Decoction combined with ear point burying bean treatment group was 100.00%, which was higher than that of single ear point sticking (73.33%) or Modified Jianzhong Decoction (66.67%, P < 0.05). After 2 weeks of treatment, PSQI and AIS sleep quality scores in all 3 groups decreased compared with before (P < 0.05). After treatment, SAS and SDS scores of the 3 groups were decreased compared with those before treatment (P < 0.05), and the combined treatment group had the best effect, which improved anxiety and depression more significantly than the other two groups (P < 0.05). Compared with before treatment, the scores of TCM symptoms in the three groups were decreased to different degrees (P < 0.05), and the effect of the combined treatment group was the most significant (P < 0.01).   Conclusion  The combination of embedding beans in auricular points and Modified Jianzhong Decoction has a definite effect on the treatment of insomnia patients, which can effectively improve the insomnia symptoms of patients, improve the sleep quality of patients, improve the traditional Chinese medicine syndrome score, alleviate the psychological depression and anxiety of patients, and improve the clinical satisfaction of patients, and is more advantageous than the simple combination treatment or embedding beans in auricular points.
Application of SPARK image teaching case library in the clinical practice of undergraduate students in medical imaging
ZHU Jiying, LI Yangsheng, ZHU Xiangwen, XIA Qianqian, LU Chenying, HAN Zhijiang
2024, 22(8): 1416-1419. doi: 10.16766/j.cnki.issn.1674-4152.003649
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  Objective  The SPARK imaging teaching case library was applied to the internship teaching of undergraduates majoring in medical imaging, and its application effect was discussed, so as to provide a reference for the practical teaching of medical imaging in other teaching bases.  Methods  A total of 71 radiology rotation undergraduates majoring in medical imaging at Hangzhou First People ' Hospital from July 2017 to June 2023, with an 18-week rotation, were selected. They were divided into an experimental group of 34 students (July 2020-June 2023) and a control group of 37 students (July 2017-June 2020) based on rotation time. The experimental group adopted sub-specialty image diagnostic report writing and the SPARK image teaching case library learning model, while the control group adopted sub-specialty image diagnostic report writing and conventional learning methods. The image reading scores of the two groups were compared in mid-term and final assessments, and the teaching effects were also evaluated through questionnaires.  Results  The scores of image reading in the initial, mid-term, and final assessments for the experimental and the control groups were 60 (60, 70) and 70 (60, 70) (Z=0.817, P > 0.05), 80 (80, 90) and 70 (60, 80) (Z=-5.047, P < 0.001), 80 (80, 90) and 70 (70, 80) (Z=-4.811, P < 0.001), respectively. The results of the generalized estimation equation analysis showed that the mid-term assessment score increased by 11.127 points (P < 0.001), and the final assessment score increased by 14.085 points (P < 0.001) compared with the control group, and the test group increased by 7.443 points (P < 0.001). In terms of understanding and memorizing key points, enhancing self-learning ability, literature research ability, professional interest, and clinical decision-making ability, the experimental group rated the teaching methods higher than the control group (P < 0.05).  Conclusion  The SPARK image teaching case library can enhance the comprehensive learning ability of undergraduate students majoring in medical imaging and has great application value.
The application of flipped classroom combined with MDT teaching model in breast cancer teaching of residents in standardized training
YIN Faxiang, XU Rui, XIE Qiang, ZHU Chao, ZHANG Junjie, GUO Chenxu, ZHANG Ligong, JIN Xin, YU Dajun, QIAN Jun
2024, 22(8): 1420-1423. doi: 10.16766/j.cnki.issn.1674-4152.003650
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  Objective  To analyze and discuss the application of flipped classroom combined with multi-disciplinary treatment (MDT) teaching model in breast cancer teaching of standardized training for residents, and to explore a new teaching model for residential training.  Methods  A total of 70 students who received standardized resident training in the Surgery Department of the First Affiliated Hospital of Bengbu Medical University from May 2022 to May 2023 were selected and randomly divided into observation group and control group according to the numerical random table method, with 35 students in each group. The students in the control group were taught by flipped classroom combined with clinical practice. The students in the observation group were taught in the flipped classroom and MDT teaching mode. The two groups of students were compared in terms of their theoretical scores, practical scores (specialty examination, interpretation of imaging data, examination of relevant literature and guidelines), self-evaluation (enhancing learning interest, improving teamwork awareness, broadening clinical diagnosis thinking) and satisfaction with teaching mode.  Results  The theoretical achievement and practical achievement of students in the observation group were much better than those in the control group [(93.5±2.1) points vs. (91.9±1.8) points, (94.5±1.8) points vs. (92.2±2.3) points, (93.5±2.2) points vs. (86.4±2.2) points, (93.3±2.3) points vs. (85.2±3.2) points], the difference between the two groups was statistically significant (P < 0.05). The students ' self-evaluation (enhancing learning interest, improving teamwork consciousness, broadening clinical diagnosis thinking) and satisfaction with teaching mode in observation group were higher than those in control group (P < 0.05).  Conclusion  In the standardized training for residents of breast cancer teaching, the flipped classroom combined with MDT teaching mode significantly improves the students ' professional scores, enhances their learning interest, enhances their teamwork awareness, broadens their clinical diagnosis thinking, and realizes teaching and learning, and greatly improves their teaching satisfaction, which is worthy of promotion and use in clinical teaching.
Investigation and analysis of pre-exam anxiety and depression among standardized training program participants for resident physicians
SUN Ye, LIU Siyao, CHEN Shiyu, HU Ting, CHEN Yaode, NIU Hongxin, LU Lingli
2024, 22(8): 1424-1427. doi: 10.16766/j.cnki.issn.1674-4152.003651
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  Objective  The purpose of this study is to examine pre-exam anxiety and depression among participants in the standardized training program for resident physicians in Guangdong Province. The study aimed to identify the influencing factors and provide suggestions and countermeasures to reduce psychological pressure before exams.  Methods  The Zung ' s self-rating anxiety scale and the Zung ' s self-rating depression scale were released through questionnaire star to conduct a survey and analyze the anxiety and depression levels among trainees at various training bases in Guangdong Province from May 19 to August 9, 2023.  Results  A total of 205 valid questionnaires were collected. The incidence of anxiety was 16.6% (34/205), of which 11.7% (24/205) was mild anxiety and 4.9% (10/205) was moderate anxiety. The standard score for anxiety was 39.51±10.27. The incidence of depression was 20.5% (42/205), of which 16.6% (34/205) was mild depression and 3.9% (8/205) was moderate depression. The standard score for depression was 38.98±11.49, and the severity index of depression was 0.37±0.11. There were statistically significant differences in anxiety levels of students before the three major examinations (H=7.312, P=0.026). The pressure faced by participants during the medical practitioner qualification examination was significantly greater. There were significant differences in the degree of depression among students with different sources before facing the three major exams (P < 0.05). Full-time professional graduate students were more likely to experience pre-exam depression. There was a significant correlation between anxiety, depression, and exam stress (r=0.651, P < 0.01).  Conclusion  The results indicate that trainees are prone to anxiety and depression before exams. Therefore, it is crucial for standardized training bases of residents to give priority to the mental health of students while paying attention to the examination.
The value of multidisciplinary collaboration combined with Watson care intervention on cardiac function, perceived burden and complications in patients undergoing interventional coronary heart disease
ZHAN Jian, ZUO Qiang, LIU Zhixiu, ZHOU Guixiang, WANG Yating
2024, 22(8): 1428-1432. doi: 10.16766/j.cnki.issn.1674-4152.003652
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  Objective  To study the nursing effect of multi-science collaborative intervention combined with Watson care theory in interventional operation for coronary atherosclerotic heart disease (CAD), and provide guidance for clinical nursing.  Methods  The study subjects were 204 patients with coronary heart disease who underwent interventional surgery in the First Affiliated Hospital of Anhui University of Chinese Medicine from March 2021 to March 2023, who were divided into the control group (n=102, routine nursing intervention) and the observation group (n=102, multidisciplinary collaborative intervention combined with Watson Care theory intervention on the basis of the control group) by random number table method. The cardiac function indexes, compliance behavior, self-perceived burden scale, and quality of life were compared before and after intervention between the two groups, and the incidence of complications was recorded. SPSS 22.0 software was used for statistical analysis.  Results  (1) After 3 months of intervention, left ventricular ejection fraction, cardiac output per stroke, proportion of complete compliance, and quality of life score of the two groups were increased, and the observation group was higher than the control group (P < 0.05), the left ventricular end-diastolic diameter and self-perceived burden score were decreased, and the observation group was lower than the control group (P < 0.05). (2) The complication rate of the observation group (3.92%) was lower than that of the control group (12.75%, χ2=5.198, P=0.023).  Conclusion  Multidisciplinary collaborative intervention combined with Watson care theory can improve the heart function of patients with coronary heart disease after interventional surgery, improve their compliance behavior and quality of life, reduce their self-perceived burden, and reduce the occurrence of complications.
Effect of NNN-link-based care model on health knowledge and behavior and blood glucose in patients with type 2 diabetes
SU Qiaodan, WANG Jun, TU Xin
2024, 22(8): 1433-1437. doi: 10.16766/j.cnki.issn.1674-4152.003653
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  Objective  To explore the application of NNN-linking in the nursing care of patients with type 2 diabetes mellitus (T2DM), aiming to provide theoretical reference for clinical nursing.  Methods  A total of 94 T2DM patients diagnosed and treated in the Department of Endocrinology and Metabolism of Shaoxing People ' s Hospital from January to August 2023 were selected. The patients were divided into 2 groups by random number table method. The control group (47 cases) received routine care, and the observation group (47 cases) received NNN-linked care. The levels of health knowledge and behavior, blood glucose, skin and mucous tissue integrity, lower limb perfusion and anxiety self-control were compared between the two groups.  Results  The score of post-nursing diabetes management knowledge in the observation group was (89.11±7.21) points, which was higher than that in the control group [(74.22±6.12)points, P < 0.05]. Additionally, the health management behavior in the observation group was better than that in the control group except for "regular exercise" (P < 0.05). Fasting plasma glucose [FPG, (7.20±1.42)mmol/L], glycated hemoglobin A1c[HbA1c, (6.99±1.17)%], 2 h postprandial glucose [2hPG, (9.68±2.12) mmol/L] was lower than that of control group [(8.54±2.16) mmol/L, (8.10±2.13)%, (11.77±2.04) mmol/L, P < 0.05]. Furthermore, the scores of skin and mucosal tissue integrity, lower limb perfusion and anxiety self-control were higher in the observation group compared to those of control group (P < 0.05).  Conclusion  NNN-linked nursing mode in T2DM patients can improve the health knowledge and behavior level of patients, control blood glucose, maintain the integrity of skin and mucous tissue, improve lower limb perfusion, and alleviate anxiety.
The application of mindfulness-based stress reduction intervention combined with ERAS concept in PTED perioperative period for lumbar spinal stenosis patients
CHENG Jun, LI Manlin, LU Yao, BIAN Bingjie, ZHU Shangying, TONG Maoqi, GONG Chen, ZOU Ming
2024, 22(8): 1438-1442. doi: 10.16766/j.cnki.issn.1674-4152.003654
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  Objective  To investigate the effect of mind-based decompression psychological intervention combined with enhanced recovery after surgery (ERAS) in perioperative period of percutaneous transforaminal endoscopic discectomy (PTED) patients.  Methods  A total of one hundred and thirty-four patients who underwent percutaneous foraminoscopic discectomy at Bozhou People ' s Hospital from June 2021 to May 2023 were selected and divided into a control group (n=67) and an observation group (n=67) by random number table method. The control group was treated with routine perioperative nursing, while the observation group was treated with mindfulness-based decompression and rapid rehabilitation. Surgical indicators, mental state, pain levels, lumbar function recovery, and complication rates were compared between the two groups. SPSS 25.0 software was used for statistical analysis.  Results  The hospitalization time was shorter in the observation group [(1.77±0.37) d vs. (1.96±0.46) d, P < 0.05]. After the intervention, the observation group had lower negative emotion score and higher positive emotion score (P < 0.05). Pain scores was lower in the observation group one day after operation and after the intervention (P < 0.05). After intervention, lumbar function was high in the observation group (P < 0.05). After intervention, the complication rate was lower in the observation group [2 (2.99%) vs. 11 (16.42%), χ2=6.900, P < 0.05].  Conclusion  The combination of mindfulness-based decompression psychological intervention and accelerated department of surgery rehabilitation concept in the perioperative nursing of patients with percutaneous foraminoscopic discectomy can significantly improve psychological state, promote the recovery of lumbar function, relieve pain, and reduce complications.
HIV positive primary skeletal muscle Peripheral T Cell lymphoma, not otherwise specified with complex rhabdomyolysis: A case report and literature review
MA Mengxue, QIAO Shukai
2024, 22(8): 1443-1445. doi: 10.16766/j.cnki.issn.1674-4152.003655
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Peripheral T cell lymphoma, not otherwise specified (PTCL-NOS) is a highly heterogeneous and invasive subtype of non-Hodgkin ' s lymphoma (NHL), which often occurs in lymph nodes, with a small number of lesions originating from the outside of the node. Extranodal invasion is more common in the liver, spleen, and bone marrow, and soft tissue invasion is rare, especially in skeletal muscle infiltration, which is rarely reported. This study reports on the diagnosis and treatment process of one HIV-positive primary skeletal muscle PTCL-NOS case and conducts a literature review to enhance clinical physicians ' understanding of this disease.
A case report of spinal infection caused by Stenotrophomonas maltophilia following allogeneic hematopoietic stem cell transplantation
LIN Li, YE Peipei, LI Shuangyue, YU Zhuruohan
2024, 22(8): 1446-1448. doi: 10.16766/j.cnki.issn.1674-4152.003656
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We report a case of acute myeloid leukemia (AML) that developed after allogeneic hematopoietic stem cell transplantation (allo-HSCT), initially presenting as recurrent low back pain. The patient was finally diagnosed with a spinal Stenotrophomonas maltophilia infection by metagenomic next-generation sequencing (mNGS) and was successfully treated with a combination of compound sulfamethoxazole tablets and levofloxacin.
Special Topic/Aging Health Research
Analysis of the impact of intergenerational economic support on disability risk among rural elderly in China
CHEN Siwei, HUO Xinran, ZHANG Ning
2024, 22(8): 1279-1282. doi: 10.16766/j.cnki.issn.1674-4152.003616
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  Objective  This study examines the impact of intergenerational economic support and related factors on the risk of disability among rural elderly, providing a decision-making reference for improving their health.  Methods  Using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we focused on rural residents aged 60 and above with at least one child. A two-stage regression model with instrumental variables was constructed to analyze the factors affecting disability in the elderly.  Results  The number of disabled elderly was 1 384, accounting for 27.53%. Significant differences were found in the distribution of disabled population among different genders, ages, and chronic disease populations (P < 0.01). Intergenerational economic support can reduce the risk of disability in the elderly people (β=-0.111, P < 0.01). The interaction effect analysis showed that the economic support received by males, older adults, and those with chronic diseases had a diminished effect on reducing the risk of disability (P < 0.01). Heterogeneity analysis results showed the effects of drinking alcohol, and having medical insurance on disability were only significant in the male sample (P < 0.05). Smoking status has a statistically significant impact only among the oldest-old groups (P < 0.05); Age, co-residence with children, number of children, and income significantly affect only the younger elderly groups (P < 0.05). Participation in medical insurance were significant only in the elderly with chronic diseases (P < 0.05), while smoking and income were significant only in the elderly people without chronic diseases (P < 0.05).  Conclusion  The government should gradually increase economic support for rural elderly, encourage rural children to provide economic support to their parents, enhance health education, and strengthen chronic disease prevention efforts to control morbidity rates.
Correlation analysis between hyperuricemia and chronic metabolic diseases in the elderly population from the community perspective
GU Ruying, LI Juan, CHEN Yan, WANG Zhaoxin
2024, 22(8): 1283-1286. doi: 10.16766/j.cnki.issn.1674-4152.003617
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  Objective  To analyze the current status of hyperuricemia (HUA) in the elderly population in the community, explore the critical value of HUA, and the correlation between serum uric acid levels and chronic metabolic diseases.  Methods  A cross-sectional study was conducted on 1 508 elderly individuals who participated in physical examinations in two communities in Minhang District, Shanghai in 2023. The main outcome measures were serum uric acid, fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), and blood lipid detection. Height, weight, waist circumference, and blood pressure were also measured. HUA was defined as serum uric acid >420 μmol/L in males and >360 μmol/L in females.  Results  The estimated prevalence in this population was 26.8% (404/1 508, 95% CI: 24.6%-29.1%) overall, 24.7% (182/736) in males and 28.8% (222/772) in females. The prevalence of males and females increased with age, and the incidence of chronic metabolic diseases in HUA groups was significantly higher than those in non-HUA groups. There was no statistically significant difference in the proportion of chronic metabolic diseases among females with different serum uric acid levels in HUA. Multivariate regression analysis showed that hypertension (ORmale=1.847, 95% CI: 1.209-2.820; ORfemale=1.519, 95% CI: 1.009-2.288), high values of TG (ORmale=1.296, 95% CI: 1.100-1.527; ORfemale=1.619, 95% CI: 1.316-1.991) were the strong risk factors for HUA, and BMI was positively correlated with uric acid levels.  Conclusion  The prevalence of HUA among the elderly population in the Community is relatively high. Hypertension and high values of TG are strong risk factors for HUA. Females with serum uric acid > 360 μmol/L are associated with a higher proportion of chronic metabolic diseases. It is recommended to control the target level of serum uric acid in Females to be less than 360 μmol/L.
Influencing factors of dysphagia in the elderly in nursing home: a meta-analysis
XIA Yan, XIA Jieqiong, GUO Honghua, ZHAO Ziran, LI Wen, ZHANG Caihong
2024, 22(8): 1287-1291. doi: 10.16766/j.cnki.issn.1674-4152.003618
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  Objective  To systematically evaluate the influencing factors of dysphagia in the elderly in nursing home and provide reference for targeted interventions.  Methods  Studies on influencing factors of dysphagia among the elderly in nursing home were searched from PubMed, Web of Science, the Cochrane Library, Ovid, Embase, CBM, CNKI, VIP and WanFang Database. The retrieval time was from inception to March 2023. Two researchers screened literature by following the inclusion and exclusion criteria independently, extracted data and evaluated the quality of literature. The influencing factors (including OR value and 95% CI) of dysphagia in the elderly in nursing home were outcome indicators. RevMan 5.3 software was used to conduct meta-analysis.  Results  The results included a total of 12 studies, including 32890 study subjects. The meta-analysis results showed that advanced age (P=0.010), eating time (long, P < 0.001), food take (less, P=0.007), assisted eating (P < 0.001), moderate to severe cognitive dysfunction (P < 0.001), cerebrovascular disease (P=0.040), cardiovascular disease (P < 0.001), history of pneumonia (P < 0.001), tooth loss (P < 0.001), chewing difficulties (P=0.020), and severe dependence (P < 0.001) were all risk factors for dysphagia in the elderly in nursing homes.  Conclusion  There are many risk factors for dysphagia among the elderly in nursing homes, and the staff of nursing homes should comprehensively assess the risk of dysphagia among the elderly.
Research on the impact of internet use and sedentary behavior on social participation of the elderly
MA Xiaoqing, XIE Hui, ZENG Chunlu, YANG Lin, JIANG Yiyao
2024, 22(8): 1292-1295. doi: 10.16766/j.cnki.issn.1674-4152.003619
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  Objective  The correlation between elderly social participation, internet usage, and sedentary behavior has drawn significant attention. With the accelerated aging process in China, issues concerning the health and social participation of the elderly have become increasingly prominent. This study aims to shed light on the health and social participation issues of the elderly by exploring the relationship between elderly social participation, internet usage, and sedentary behavior.  Methods  Based on data from the Chinese General Social Survey (CGSS) 2021, an empirical analysis was conducted on 935 elderly individuals to investigate the impact of internet usage and sedentary behavior on their social participation.  Results  After controlling for gender, ethnicity, education level, BMI, marital status, and alcohol consumption, internet usage had a significant positive effect on elderly social participation (r=0.113, P=0.046), while sedentary behavior had a significant negative effect (r=-0.348, P < 0.001).  Conclusion  Internet usage has a positive impact on elderly social participation, while sedentary behavior has a negative impact. It is essential for families and society to support the elderly in adapting to the digital age while addressing their needs and challenges in internet usage. Efforts should be made to create a more inclusive and friendly digital environment, encourage outdoor activities and group social interactions, reduce sedentary behavior, help them establish broader social networks, improve their quality of life, and enhance their social participation.
Problems faced in the work and countermeasures of the integrated medical and elderly care in China
ZHUO Shuxiong, WU Jialin, YANG Xi, ZHOU Yingda
2024, 22(8): 1296-1299. doi: 10.16766/j.cnki.issn.1674-4152.003620
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  Objective  This paper analyzes the current situation of the integrated medical and elderly care work in China, summarizes the existing problems in the integrated medical and elderly care work and makes an in-depth analysis, and puts forward some suggestions for improvement.  Methods  The Chinese search and English search terms were "integrated medical and elderly care/integrated medical and nursing care" "development" "problems" "effect" and "current situation". Retrieve PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, WanFang Data Knowledge Service Platform and other databases, Google Scholar, Baidu Scholar, and other search engines. The retrieval time was from January 2018 to October 2023. The included literature was sorted out and analyzed, and according to the literature mention rate, the main problems existing in the current integrated medical and elderly care are sorted out. Through the Delphi expert consultation method, the problems existing in the integrated medical and elderly care mode are sorted according to importance and severity. A comprehensive ranking is obtained by adding the ranking values from low to high through the literature mention rate and the ranking values from expert interviews.  Results  Ten core problems are extracted, such as imperfect top-level design system, insufficient capacity of service subjects, the imbalance between supply and demand, the heavy burden of pension economy, insufficient construction of information platform, insufficient awareness, lack of long-term incentive mechanism, imperfect supervision mechanism, loose institutional linkage, obvious regional differences, and insufficient innovation.  Conclusion  The high-quality development of the integrated medical and elderly care model with Chinese characteristics should be supported by the establishment of a sound system guarantee, the balance between supply and demand, the deepening of information construction, and the coordination and cooperation of supply subjects, to realize the effective utilization of medical resources and achieve a healthy, orderly and stable development model.
General Practice Research
Correlation analysis of inflammation and nutritional indicators with prognosis in patients after radical cystectomy
Daniyaer Nuerdebieke, Subinuer Yizihaer, Abudureheman Zebibula, QIAO Bingzhang, Mulati Rexiati
2024, 22(8): 1300-1304. doi: 10.16766/j.cnki.issn.1674-4152.003621
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  Objective  To investigate the relationship between preoperative systematic immune-inflammation index (SII), prognostic nutritional index (PNI), and platelet to lymphocyte ratio (PLR) and the prognosis of patients undergoing radical cystoprostatectomy.  Methods  Clinical and pathological data of 179 bladder cancer patients who underwent radical cystectomy from January 2012 to December 2022 in the First Affiliated Hospital of Xinjiang Medical University and met the inclusion criteria were retrospectively analyzed. The optimal critical values of SII, PLR, and PNI before treatment were determined according to the ROC curve, the patients were divided into the high-level group and the low-level group. The Kaplan-Meier method was used to analyze the 3- and 5-year survival rates of the two groups, and univariate and multivariate Cox regressions were performed to analyze the prognostic risk factors of bladder cancer.  Results  The area under the ROC curve of SII, PNI, and PLR before treatment were 0.823, 0.739, and 0.813, respectively, as determined by the patient ' s overall survival. The results of the univariate analysis suggested that age, underlying disease, smoking history, T-stage, N-stage, whether the lymphatic vasculature was invaded, the number of tumours, whether the patients suffer from hydronephrosis, PLR, SII, and PNI were related to the OS of the patients (P < 0.05). Age, underlying disease, lymphovascular invasion, hydronephrosis, PLR, SII, and PNI were associated with the prognosis of patients with bladder cancer (P < 0.05).  Conclusion  Pre-treatment SII, PNI, and PLR are independent predictors of prognosis in patients with intermediate and advanced oesophageal cancer, and low SII, high PNI, and low PLR suggest a better prognosis.
Current status and influencing factors of sedentary behavior in patients with stable chronic heart failure
XU Jing, ZHANG Hui, ZHONG Lei, LU Yawei, XIANG Xiaoting
2024, 22(8): 1305-1309. doi: 10.16766/j.cnki.issn.1674-4152.003622
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  Objective  To understand the current status of sedentary behavior in patients with stable chronic heart failure (CHF) and analyze its influencing factors, to provide a theoretical basis for formulating targeted intervention measures in the later stage.  Methods  A total of 196 patients with chronic heart failure who visited the outpatient department of Cardiovascular Medicine in the First Affiliated Hospital of Anhui Medical University from April 2023 to October 2023 were selected by the convenient sampling method. The general information questionnaire, international physical activity questionnaire short form (IPAQ-SF), Barthel index (BI), cardiac exercise self-efficacy instrument (CESEI), social support rating scale (SSRS), and self-rating depression scale (SDS) were used to investigate, logistic regression was used to explore the influencing factors.  Results  The average daily sedentary time of the stable chronic heart failure patients was (8.19±2.71) h, and the total sedentary behavior time of 131 patients (66.84%) was more than 6 hours. Univariate results showed that there were statistically significant differences in sedentary behavior among chronic heart failure patients with different genders, age, BMI, education level, number of exacerbations in the past year, degree of dependence, cardiac function classification, depression degree, self-efficacy score of cardiac rehabilitation exercise and social support score (P < 0.05), logistic regression analysis showed that age (OR=1.964, P=0.001), BMI (OR=0.474, P=0.007), heart function grade of NYHA (OR=3.854, P=0.001), self-efficacy of cardiac rehabilitation exercise (OR=0.940, P=0.027) and depression (OR=2.863, P=0.009) were the influencing factors of sedentary behavior in patients with stable chronic heart failure.  Conclusion  The sedentary time of patients with stable chronic heart failure is longer, and sedentary behavior is common. In the future, medical staff can take effective interventions to reduce the sedentary behavior of patients and improve their prognosis.
Research on the correlation between nutritional and inflammatory indicators and prognosis of COVID-19 patients
LI Yujia, XIANG Jie, ZHANG Lijie, MENG Wenwen, ZHANG Ting
2024, 22(8): 1310-1312. doi: 10.16766/j.cnki.issn.1674-4152.003623
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  Objective  To investigate the effect of nutritional and inflammation-related composite indexes in peripheral blood on the prognosis of patients with novel coronavirus infection.  Methods  A retrospective analysis was conducted on 1 351 patients with novel coronavirus infection who attended the Affiliated Hospital of Xuzhou Medical University from November 2022 to February 2023. All patients were followed up for a 3-month-visit and categorized into a favorable prognosis group (cured or improved, n=1 091) and a poor prognosis group (died or treatment abandonment, n=260). General data, serologic nutritional index, serologic inflammatory index, and BMI were collected for all patients. The levels of independent and composite indexes related to nutrition and inflammation were calculated and compared between the two sets.  Results  Age, probability of combined diabetes mellitus, probability of combined cerebrovascular disease, neutrophil count, and systemic immune inflammation index (SII) levels were significantly higher in the poor prognosis group than in the good prognosis group (P < 0.01).The levels of BMI, lymphocyte count, albumin, platelet count, advanced lung cancer inflammation index (ALI), and prognostic nutritional index (PNI) in the poor prognosis group were significant lower than those in the good prognosis group (P < 0.05). The result of multivariate logistic regression analysis displayed that older age was an independent risk factor for poor prognosis in patients with viral pneumonia (P < 0.05), high ALI and PNI were protective indicators of poor prognosis (P < 0.05). The results of ROC curve analysis showed that the AUC for neutrophils, lymphocytes, albumin, and platelets were 0.707 (95% CI: 0.672-0.742, P < 0.001), 0.728 (95% CI: 0.694-0.762, P < 0.001), 0.720 (95% CI: 0.686-0.753, P < 0.001), 0.645 (95% CI: 0.607-0.684, P < 0.001), respectively. The AUC of composite indicators such as ALI and PNI were 0.783 (95% CI: 0.744-0.821, P < 0.001), 0.744 (95% CI: 0.705-0.782, P < 0.001), indicating that composite index have higher predictive value than the individual indicators.  Conclusion  Serological nutrition and inflammation independent indicators are associated with the prognosis of patients with novel coronavirus infection. ALI and PNI are predictive indicators for poor prognosis, offering higher predictive value.
Effect of sugammadex sodium and neostigmine on prognosis of patients with video-assisted thoracoscopic lobectomy
YUAN Yongjin, TANG Jing, FAN Zhongmin, MA Zhenjie
2024, 22(8): 1313-1316. doi: 10.16766/j.cnki.issn.1674-4152.003624
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  Objective  Postoperative muscle relaxant residue can lead to respiratory insufficiency, the aim of this study was to evaluate the antagonistic effects of sugammadex sodium and neostigmine on the muscular release of rocuronium in patients undergoing video-assisted thoracoscopic lobectomy, as well as their impact on postoperative pulmonary complications.  Methods  A total of 90 patients who planned to undergo elective video-assisted thoracoscopic lobectomy in the Affiliated Hospital of Qinghai University from September 2021 to December 2022 were selected, and they were randomly assigned to either the sugammadex sodium group (group S) or neostigmine group (group N) using a random number table method, with 45 cases in each group. Group S was intravenously injected with sugammadex sodium 2 mg/kg, while Group N received an intravenous injection with neostigmine 0.05 mg/kg (maximum dose 5 mg) and atropine 0.02 mg/kg. Extubation time, post-anesthesia cave unit (PACU) stay time, postoperative length of hospitalization, and total length of hospitalization were compared. Muscle strength in each part of the patient was assessed 15 min after admission to PACU. Postoperative pulmonary infection and other adverse reactions were compared.  Results  The extubation time and PACU residence time in group S were 8.1 (6.1, 10.9) min, 11.8 (8.9, 19.7) min, respectively, which were statistically shorter than those in group N [8.6 (6.4, 16.5) min, 13.3 (10.0, 23.9) min], and the differences were statistically significant (Z=2.089, 2.853, P < 0.05). The number of patients in group S with head raising and holding was significantly higher than that in the N group (P < 0.05). The number of patients in group S who can track object with eyes was statistically higher than that in group N (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions between 2 groups (P>0.05).  Conclusion  Compared with neostigmine, sugammadex sodium antagonized the muscle relaxation effect of rocuronium in patients with video-assisted thoracoscopic lobectomy but did not reduce the risk of postoperative pulmonary complications.
Fibulin-1 expression in tongue cancer and clinical value based on bioinformatics analysis
CHEN Xinru, HAN Rui, XU Jincheng
2024, 22(8): 1317-1320. doi: 10.16766/j.cnki.issn.1674-4152.003625
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  Objective  To explore the expression and clinical significance of Fibulin-1 (FBLN1) in tongue cancer tissue and tongue cancer cells.  Methods  The expression of FBLN1 in head and neck cancer tissues was analyzed based on the HPA database. The association between FBLN1 and MKI67 expression in head and neck cancer was analyzed using the GEPIA database. The relationship between FBLN1 expression levels and the survival time of head and neck cancer patients was examined using the Kaplan-Meier Plotter database. Gene enrichment pathway prediction was performed to investigate the potential biological functions of FBLN1 in head and neck cancer. Immunohistochemistry (IHC) and Western blotting were used to validate the expression of FBLN1 in tongue cancer tissues. Stable overexpression of FBLN1 in tongue cancer cells was established, scratch and Transwell chamber experiments were conducted to assess its impact on cell invasion ability.  Results  Analysis from the HPA database showed that FBLN1 had lower expression levels in head and neck cancer tissues compared to adjacent non-cancerous tissues. Analysis from the GEPIA database revealed no significant difference (P>0.05) in FBLN1 expression between tumor tissues and adjacent non-cancerous tissues, while MKI67 exhibited higher expression levels (P < 0.05) with no correlation between their expressions (P=0.280). Survival analysis from Kaplan-Meier Plotter indicated no association between FBLN1 expression and overall survival time for tongue cancer patients (log-rank P=0.190), but higher survival rates were observed when FBLN1 was highly expressed (log-rank P=0.007). Gene enrichment pathways suggested that FBLN1 may be involved in multiple pathways related to tongue cancer development. IHC staining demonstrated that both staining intensity and positive area for Fibulin-1 were significantly higher than those observed for tumor tissue samples (P < 0.00l). Western blotting showed that the level of FBLN1 protein was higher in adjacent cancer tissues compared to tongue cancer tissues in 10 cases (P < 0.001). Scratch and Transwell experiments demonstrated that overexpression of FBLN1 significantly inhibits the migration and invasion ability of tongue squamous cell carcinoma cells Cal-27 (P < 0.05).  Conclusion  FBLN1 is downregulated in tongue cancer tissues, and overexpression of FBLN1 can suppress the invasive capability of Cal-27 cells, suggesting its potential as a prognostic marker for tongue cancer patients.
Learning curve of the distal radial access for coronary intervention
WANG Yuntao, WANG Senhu, WANG Yujie, LI Zixuan, QI Shuyuan, WANG Guozhong, WANG Yuping, ZHANG Libin, WANG Haotian, GUO Jincheng
2024, 22(8): 1321-1324. doi: 10.16766/j.cnki.issn.1674-4152.003626
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  Objective  To determine the correlation between operator experience in distal transradial coronary intervention (dTRI) and the successful cannulation rate of the distal radial artery (DRA), as well as to identify risk factors for puncture and cannulation failures.  Methods  From January 2021 to December 2022, 1 000 patients who underwent dTRI via DRA by a single interventionist in Beijing Luhe Hospital were retrospectively enrolled. These patients were chronologically ranked and divided into ten groups (100 cases each) according to operation time and order. The primary endpoint was the successful cannulation rate of DRA for every 100 cases, while the secondary endpoints were the success rate of one-time puncture catheterization and puncture catheterization time. Logistic regression analysis was carried out to identify predictors of unsuccessful DRA.  Results  A total of 1 000 patients were enrolled, with a successful DRA cannulation rate of 92.3%. After 200 cases, this rate stabilized at 93.0% (P=0.075). The first attempt DRA puncture success rate improved from 74.0% to 96.0%, while the median sheath cannulation time decreased from 3.00 min to 2.00 min (P < 0.001). Logistic regression analysis showed that a negative association between DRA diameter (P=0.020) and cannulation failure, and a positive association with left artery access (P=0.046).  Conclusion  Achieving over 93.0% success in DRA puncture and cannulation becomes consistent after 200 cases. Small DRA diameter and left-sided access are key predictors of failure.
Correlation between peripheral inflammatory cytokines IL-10 and IL-32 and cognitive dysfunction and non-motor symptoms of Parkinson' s disease
WU Mengqi, SHI Peng, LI Qianqian, TIAN Jialing, LI Qiang
2024, 22(8): 1325-1327. doi: 10.16766/j.cnki.issn.1674-4152.003627
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  Objective  To analyze the correlation between the levels of IL-10 and IL-32 and the cognitive dysfunction and non-motor symptoms of Parkinson' s disease (PD), we measured levels of IL-10 and IL-32 in the peripheral blood of Parkinson' s disease patients and healthy controls and evaluated their cognitive function and non-motor symptoms.  Methods  Sixty patients with Parkinson' s disease in the First Affiliated Hospital of Bengbu Medical University from January 2022 to October 2023 were selected as the observation group, and 60 healthy subjects were selected as the control group. Serum concentrations of IL-10 and IL-32 in the two groups were detected by ELISA. The cognitive function and non-motor symptoms of the two groups were evaluated using the simple mental state checklist and the motor symptom assessment scale. The correlation between peripheral inflammatory factors IL-10 and IL-32 and cognitive dysfunction and non-motor symptoms of Parkinson' s disease was analyzed by hierarchical correlation method.  Results  The level of IL-10 in the peripheral blood of PD group was [136.60 (117.05, 169.70) pg/mL], which was higher than that of the control group [110.90 (92.15, 129.50) pg/mL, P < 0.01]. The level of IL-32 in the PD group was [32.35 (28.83, 37.68) pg/mL], which was higher than that in the control group [21.80 (20.60, 23.35) pg/mL, P < 0.01]. The level of IL-10 in the peripheral blood of PD patients was positively correlated with MMSE score (20.68±6.33) and NMSS score (103.17±11.25, P < 0.01). The level of IL-32 in the peripheral blood in PD patients was also positively correlated with MMSE score and NMSS score (P < 0.01).  Conclusion  The levels of inflammatory factors IL-10 and IL-32 in the peripheral blood of PD patients were higher than those of healthy controls, and were closely correlated with cognitive dysfunction and non-motor symptoms of PD.
Longitudinal study on adherence to dietary treatment and its influencing factors in patients with primary hepatic cancer
WANG Miaomiao, YU Huixi, FU Lingxue, MA Yuanjin, WANG Zhaohong, YAO Hongxiang
2024, 22(8): 1328-1331. doi: 10.16766/j.cnki.issn.1674-4152.003628
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  Objective  To explore the change track of dietary treatment adherence of primary hepatic cancer patients and its influencing factors.  Methods  A convenience sample of 243 hepatic cancer patients undergoing their first treatment in the Second Affiliated Hospital of Wenzhou Medical University between March 2021 and April 2022 was selected. The initial data collection was completed before discharge (T0), followed by collecting data on dietary treatment adherence scale at 1 month (T1), 3 months (T2) and 6 months (T3) after the first treatment.  Results  The dietary treatment adherence scores at points T0, T1, T2 and T3 were (37.62±6.53) points, (37.82±6.34) points, (37.12±6.10) points and (34.43±5.76) points. The differences between T0-T1, T0-T2 and T1-T2 were not statistically significant (P>0.05), while the differences between T0-T3, T1-T3 and T2-T3 were statistically significant (P < 0.05). Three potential trajectory categories could be identified by the potential category growth model: "closely follow group" accounted for 30.87% (75 cases), "relaxed group" accounted for 33.33% (81 cases) and "underappreciated group" accounted for 35.80% (87 cases). Religious beliefs, risk of malnutrition, living alone and health beliefs were the influencing factors in determining the potential trajectory category of dietary treatment adherence.  Conclusion  Medical staff should respect patients ' religious beliefs, assist patients at risk of severe malnutrition in developing a correct understanding of the disease, cooperate with the community to provide accurate care services for patients living alone, accurately assess their health beliefs, and improve the diet treatment adherence.
The efficacy of botulinum toxin type A combined with exfoliative fractional laser on facial acne scarring
FAN Bailu, XU Jing, TIAN Li, HAN Zhiqiang, JIA Mengna, ZHAO Shuhan, YUAN Mei
2024, 22(8): 1332-1335. doi: 10.16766/j.cnki.issn.1674-4152.003629
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  Objective  To investigate the clinical efficacy of botulinum toxin type A in combination with laser on facial atrophic acne scars.  Methods  Fifty patients with facial atrophic acne scars who visited the Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical University from October 2021 to October 2022 were selected. Patients were randomly divided into control group and observation group by random number method with 25 cases in each group. All patients received three laser treatments each, and dual-mode coverage was selected for laser treatment, with an interval of 8-10 weeks between each laser treatment. In observation group, an injection of botulinum toxin type A was given under the scar within 7-14 days after the first laser treatment. Before the treatment and three months after the end of the treatment, the efficacy of the patients ' facial acne scars was comparatively analyzed using the échelle d'évaluation clinique des cicatrices d'acné (ECCA) weighting scale and the integrated visualization system (IVS), respectively, and the patients ' satisfaction and adverse reactions were recorded.  Results  The ECCA score of observation group after treatment was 60.0 (45.0, 60.0) points, of which the mean rank was 21.96, and the ECCA score of control group after treatment was 60.0 (60.0, 60.0) points, of which the mean rank was 29.04, and the analysis of the data showed that the overall ECCA score of observation group after treatment was lower than that in control group, and the difference was statistically significant (Z=-2.014, P=0.044). The difference between the ECCA before and after treatment for the observation group was 15.0 (0.0, 15.0), compared to 0.0 (0.0, 7.5) for the control group. The change in ECCA for the observation group was significantly higher than that of the control group, with statistical significance (Z=-2.076, P=0.038). The IVS score in observation group [3.0 (2.0, 3.0) points] was higher than that in control group [2.0 (1.0, 2.0) points], and the satisfaction score of the observation group [3.0 (3.0, 4.0) points] was higher than that in control group [2.0 (2.0, 3.0) points], and the differences were statistically significant (P < 0.05).  Conclusion  Botulinum toxin type A combined with exfoliative fractional laser is effective in the treatment of facial atrophic acne scarring and can inhibit the skin ' s oil secretion situation and intervene in the development of acne and its scarring to a certain extent, which is of clinical reference.
General Clinical Research
Influence of transcutaneous electrical acupoint stimulation combined with erector spinae plane block on postoperative analgesia effect and inflammatory status in patients with posterior approach lumbar surgery
WU Xiaoxu, LUO Shujun, QIU Qiuping, WU Anshi
2024, 22(8): 1336-1339. doi: 10.16766/j.cnki.issn.1674-4152.003630
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  Objective  To explore the influence on analgesia and inflammation in patients undergoing posterior approach lumbar surgery receiving analgesia therapy of transcutaneous electric acupoint stimulation (TEAS) combined with erector spinae plane block (ESPB), so as to provide a reference for clinical optimization of anesthesia regimen for posterior approach lumbar surgery.  Methods  A total of 108 patients who were admitted to Huairou Hospital, Beijing Chaoyang Hospital Affiliated to Capital Medical University and planned to undergo posterior approach lumbar surgery were included from October 2021 to January 2023. According to the simplified randomization method (single-double number method), they were divided into an ESPB group (single number, n=54) and a TEAS group (double number, n=54). The vital signs at each time point, perioperative conditions, inflammatory indicators, pain status (VAS), and incidence rates of anesthesia complications were compared between the two groups.  Results  At T1-T2, HR, and MAP in the TEAS group were significantly higher than those in the ESPB group (P < 0.05). The awakening time, ambulation time, hospitalization time, propofol dosage, and remifentanil dosage in the TEAS group were significantly shorter or less than those in the ESPB group (P < 0.05). The levels of white Inflammatory indicators in the two groups increased significantly 1 day after surgery (P < 0.05), but the levels in the TEAS group were significantly lower than those in the ESPB group (P < 0.05). Within 24 hours after surgery, the VAS score in both groups decreased significantly (P < 0.05), and the VAS in the TEAS group at 6 h, 12 h, and 24 h after surgery were significantly lower than those in the ESPB group (P < 0.05). There was no statistical significance in the total incidence rate of complications between the TEAS group (12.96%, 7/54) and the ESPB group (24.07%, 13/54, P>0.05).  Conclusion  TEAS combined with ESPB can stabilize the vital signs of patients undergoing posterior approach lumbar surgery, and relieve the postoperative pain and inflammatory response.
Effectiveness analysis of risk model for poor prognosis of hip fracture patients based on nutrition related indicators
HUANG Yixiao, ZHOU Xuelai, WANG Yongle, ZHANG Kuixian
2024, 22(8): 1340-1343. doi: 10.16766/j.cnki.issn.1674-4152.003631
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  Objective  Based on the nutrition-related indexes of patients with hip fracture, a risk model of poor prognosis was established and its predictive efficiency was analyzed.  Methods  From February 2020 to February 2022, a total of 172 patients with hip fracture who were treated in the Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University were selected as the research objects. According to the follow-up results, they were divided into survival group and death group. The nutritional related indexes of the two groups were compared. Logistic regression analysis was used to build a risk model for predicting poor prognosis of patients with hip fracture, and ROC curve analysis was conducted to evaluate the predictive efficiency of the model.  Results  Up to the last follow-up time, 3 patients were lost, 51 patients died and were included in death group, 118 patients were included in the survival group. Multivariate logistic regression showed that increasing age and reducing hemoglobin, albumin, prealbumin levels and decreasing serum creatinine were independent risk factors for poor prognosis in patients with hip fracture (P < 0.05). The ROC curve demonstrated that the joint prediction had higher predictive efficiency (AUC=0.989, sensitivity was 94.1%, specificity was 96.6%, accuracy was 95.86%) compared to single index.  Conclusion  The risk model based on the four nutritional indicators has good diagnostic efficiency in predicting the mortality of patients with hip fracture.
Airway resistance and static lung compliance determination application offline screening for patients with severe craniocerebral injury
QI Bin, JIANG Yuhui, ZHANG He, DU Wenjie
2024, 22(8): 1344-1346. doi: 10.16766/j.cnki.issn.1674-4152.003632
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  Objective  Delayed weaning and difficult weaning of mechanical ventilation are the difficulties in the treatment of patients with severe craniocerebral injury. This paper aims to shorten the mechanical ventilation time of such patients by analyzing the application value of airway resistance and static lung compliance in ventilator offline screening.  Methods  Seventy-eight patients with severe craniocerebral injury admitted to the First Ward of ICU at Bozhou People ' s Hospital from January 2023 to November 2023 were selected and randomly divided into an experimental group (n=39) and a control group (n=39). All patients received dehydration therapy to reduce intracranial pressure, maintain cerebral perfusion, nutritional support, aerosol expectoration, sedation and analgesia, as well as other treatments. The control group underwent traditional ventilator weaning screening method while the experimental group underwent traditional ventilator weaning screening method based on airway resistance (Raw) ≤10 cmH2O·L-1·s-1 and static lung compliance ≥40 mL/cmH2O. The ICU length of stay, ventilator duration, number of spontaneous breathing trial, 48 h ventilator re-up rate, incidence of ventilator-associated pneumonia (VAP), total length of hospitalization, and total healthcare expenditure were compared between the two groups.  Results  The length of ICU stay was 11 (6, 16) days in the experimental group, which was shorter than that in the control group [13 (15, 19) days, P < 0.05]. The duration of mechanical ventilation was 141 (46, 230) hours in the experimental group, which was shorter than that in the control group [212 (151, 254) hours, P < 0.05]. The number of spontaneous breathing trials (SBT) in the experimental group was less than that in the control group [1 (1, 1) vs. 2 (1, 3), P < 0.05]. The total length of hospital stays of the experimental group was shorter than that of the control group [29 (20, 44) d vs. 41 (32, 62) d, P < 0.05]. Additionally, there were lower total medical costs as well as reduced incidence rates of VAP, and re-hospitalization within 48 hours observed among patients from the experimental group compared to those from the control group (P < 0.05).  Conclusion  Airway resistance and lung compliance measurement combined with traditional ventilator weaning screening method is more conducive to ventilator weaning in patients with severe craniocerebral injury, shortening the duration of ventilator use and ICU stay, and reducing the total length of hospital stay and medical costs, and reduce the incidence of VAP.
The correlation between the degree of depression and polysomnography parameters and fatigue level in patients with late-onset depression
ZHENG Jifeng, FENG Caiqin
2024, 22(8): 1347-1349. doi: 10.16766/j.cnki.issn.1674-4152.003633
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  Objective  The differences in polysomnography parameters and fatigue levels were compared between patients with late-onset depression and non-depressed elderly patients, and the correlation between the degree of depression and sleep quality, structure and fatigue level in patients with late-onset depression was further evaluated.  Methods  A total of 52 patients with late-onset depression admitted to Shaoxing Seventh People ' s Hospital from March 2020 to March 2023 were selected as the study group, and 67 elderly patients without depression during the same period were selected as the control group. The levels of polysomnography parameters and fatigue were compared between groups. Additionally, the correlation between the degree of depression and polysomnography parameters as well as fatigue level in patients with late-onset depression was evaluated.  Results  The sleep efficiency (SE), percentage of N2 phase (N2%) and percentage of slow wave sleep (SWS%) in the study group were lower than those in the control group (P < 0.05). The Pittsburgh sleep quality index (PSQI), sleep latency (SL), micro-arousal index (MAI), fatigue severity scale (FSS), percentage of N1 phase (N1%), percentage of rapid eye movement sleep (REM%), activity, intensity and density of rapid eye movement sleep (REM) in the study group were higher than those in the control group (P < 0.05). Correlation analysis showed that SE and N2% were negatively correlated with the degree of depression in patients, rs=-0.869 and -0.734, respectively. Other indicators were positively correlated with the degree of depression in patients, which were PQSI score (rs=0.786), SL (rs=0.649), AMI (rs=0.714), FSS score (rs=0.738), N1% (rs=0.687), SWS% (rs=0.608), REM% (rs=0.708), REM activity (rs=0.815), REM intensity (rs=0.837) and REM density (rs=0.707).  Conclusion  The sleep quality of patients with late-onset depression is decreased, accompanied by disrupted sleep structure and aggravated fatigue, exhibiting a linear correlation with the degree of depression.
Effect of preoperative erector spinae plane block on postoperative stress and opioid demand of patients undergoing thoracic surgery
WANG Xiaoyan, PAN Qin, HUANG Changjun, LI Yuhong
2024, 22(8): 1350-1353. doi: 10.16766/j.cnki.issn.1674-4152.003634
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  Objective  High-dose opioid analgesics can control severe pain after thoracic surgery, but can easily cause nausea, respiratory depression, and other side effects. In this study, erector spinae plane block (ESPB) was applied to thoracic surgery before operation to explore its influence on postoperative stress and opioid demand of patients.  Methods  From March 2021 to March 2023, 200 patients with lung cancer who underwent elective radical resection of lung cancer in the First People ' s Hospital of Linping District, Hangzhou were divided into a control group (pure intravenous anesthesia) and a compound group (ESPB combined intravenous general anesthesia) according to anesthesia methods, with 100 patients in each group. The indexes of oxidative stress, serum-related indexes, pain, and opioid use were compared between the two groups.  Results  Malondialdehyde (MDA) levels increased and super oxide dismutase (SOD) levels decreased 24 h after operation in lung cancer patients in both groups. Moreover, MDA and SOD levels in the compound group [(6.69±1.84) nmol/L, (37.30±6.42) U/mL] were lower than those in the control group [(9.03±1.35) nmol/L, (41.56±6.88) U/mL, P < 0.05]. At T1, T2, and T3, the levels of IL-6, Cor, and Ang-Ⅱ in the compound group were lower than those in the control group, and the levels of IL-10 were higher than those in the control group (P < 0.05). At T2, T3, and T4, the scores of resting and dynamic VAS in the compound group were lower than those in the control group (P < 0.05). The dosage of remifentanil in the compound group was (554.8±97.2) μg. The total amount of sufentanil infusion [(28.7±5.9) mL] and the number of supplementary infusion [(2.1±0.6) times] in 24 h were lower than those in the control group [(675.2±164.5) μg, (39.5±6.2) mL, (3.2±0.9) times, P < 0.05].  Conclusion  The application of ESPB combined with intravenous general anesthesia in radical resection of lung cancer can improve stress and inflammatory reaction, and reduce postoperative pain and the demand for opioids. It is a feasible and superior anesthesia method.

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