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2024, Volume 22,  Issue 2

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General Practice Forum
Practice and exploration of project-driven cultivation of scientific research potential of medical innovative talents
HUANG Chen, ZHANG Yuan, ZHANG Renchao, WU Weidong, LUO Zai, ZHANG Pengshan, FANG Yuan, HAN Chao, QIU Zhengjun
2024, 22(2): 175-178. doi: 10.16766/j.cnki.issn.1674-4152.003358
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  Objective  In response to the addressing current challenges in medical talent cultivation, this study aims to chart a novel strategy for developing the research potential of new medical innovators, and to furnish a theoretical foundation and practical insights for the cultivation of new medical talents.  Methods  Driven by specific research projects, the study established an innovative research team led by mentors and supported by graduate students. Guided by the flipped classroom concept and oriented towards students' concerns, the study conducted theoretical lectures and experimental training. The goal was to create an integrated and sequential medical talent cultivation mode, a normalized and sustainable collaboration mechanism in medical education, a project-based and individualized medical research innovation model, and an interactive and systematic course evaluation feedback system. Additionally, diverse and comprehensive standards for evaluating research outcomes had been implemented. The study quantitatively assessed its practical impact across three levels: talent cultivation, scientific research innovation, and pedagogical innovation.  Results  The study had successfully established an integrated and sequential talent cultivation mode for high school students, undergraduates, and postgraduates. This cultivation mode comprehensively enhanced students' foundational skills, motivation, and engagement in scientific research, thereby elevating both students' research potential and teachers' instructional proficiency. Positive outcomes had been observed in talent cultivation, scientific research innovation, and teaching innovation, evident through achievements such as thesis writing, award selection, project applications, and results transformation.  Conclusion  The proposed new medical innovation talent cultivation model, anchored in an innovative scientific research and teaching team led by mentors and postgraduates, presents a sequential cultivation system spanning high school to postgraduate levels. Emphasizing project-driven development of the scientific research potential of medical innovation talents, this model introduces a fresh perspective for nurturing innovative talents in medicine. It holds considerable practical significance and guiding value for the advancement of new medicine in China.
Special Topic/Influencing Factors of Cognitive Function in the Elderly
A study on the correlation between multimorbidity and motoric cognitive risk syndrome in rural older adults
DAI Chen, ZHANG Yan, ZHANG Jingya, WANG Qing, LOU Xu, CHEN Ren, SHEN Guodong
2024, 22(2): 179-182. doi: 10.16766/j.cnki.issn.1674-4152.003359
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  Objective  To investigate the cross-sectional relationship between multimorbidity and motoric cognitive risk syndrome (MCR) among older adults in Anhui province, China. To explore the association between the number of chronic diseases and MCR in order to provide a basis for the development of strategies and measures to prevent MCR in rural areas.  Methods  A cross-sectional study was conducted among 652 older adults in rural areas of Lu' an and Fuyang City, Anhui Province, China, participants self-reported their chronic disease status. MCR was assessed by combining slow gait with subjective cognitive decline, and logistic regression was used to analyze the relationship between multimorbidity and MCR.  Results  Older adults with chronic disease had a higher likelihood of experiencing MCR (OR=2.926, 95% CI: 1.256-6.816, P=0.013). Further, the presence of three chronic diseases in older adults was associated with the highest risk of MCR (OR=4.946, 95% CI: 1.811-13.506, P=0.002). Logistic regression analysis showed that older adults with specific multimorbidity patterns, such as hypertension+depression (OR=2.433, 95% CI: 1.294-4.573, P=0.006) and hypertension+hyperlipidemia+depression (OR=4.632, 95% CI: 1.978-10.848, P<0.001), were more prone to developing MCR.  Conclusion  MCR is associated with multimorbidity among older adults in rural Anhui province, China.
Association between age-friendliness of communities and cognitive function among older adults
YAN Fei, CHAI Qichen, LYU Jing, CHEN Jin
2024, 22(2): 183-186. doi: 10.16766/j.cnki.issn.1674-4152.003360
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  Objective  To investigate the association between age-friendliness of communities (AFC)and cognitive function in the elderly and provide scientific basis for the construction of healthy aging.  Methods  A total of 5 940 permanent residents aged 65 and over in urban and suburban/rural areas in Hangzhou, Ningbo and Lishui of Zhejiang Province were studied from April 2022 to July 2022. A cross-sectional survey was used to collect basic personal information of the subjects, and the community age-friendliness and cognitive function of the subjects were assessed using the AFC rating scale and the 8-item dementia ascertainment (AD8) scale respectively. Multivariate logistic regression was used to analyze the risk factors for cognitive dysfunction and the association between AFC and cognitive function in older people.  Results  A total of 6 000 people were screened and a total of 5 940 valid questionnaires were collected. The results of binary logistic regression analysis showed that the scores of residential environment, transport environment, community environment and social inclusion were influencing factors for cognitive dysfunction (P<0.05), OR (95% CI) were 0.924 (0.877-0.973), 0.925 (0.875-0.978), 0.946 (0.895-0.999) and 0.927 (0.876-0.982) respectively.  Conclusion  Poor residential environment, transport, community and social inclusion environments are independent risk factors for cognitive impairment. The measures to improve the degree of age-friendly community are helpful in improving cognitive function.
Exploring the correlation between serum vitamin D levels, cognitive function, and depressive mood in elderly individuals with MCI
CAI Han, ZHANG Jun, XU Hui, LI Shixia, WANG Xiaoquan
2024, 22(2): 187-190. doi: 10.16766/j.cnki.issn.1674-4152.003361
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  Objective  The objective of this study is to investigate the correlation among serum vitamin D levels, cognitive function, and depressive mood in elderly individuals with mild cognitive impairment (MCI), aiming to establish a theoretical foundation for clinical intervention.  Methods  Between February 2023 and August 2023, a total of 315 subjects with MCI were screened from the elderly community population. Blood samples were collected to measure vitamin D levels, with 155 subjects categorized as vitamin D deficient group and 160 subjects categorized as normal group. A comparative analysis was conducted to assess the general conditions of these two groups. Additionally, scores from the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the geriatric depression scale (GDS), and centre for epidemiological studies depression scale (CES-D) were compared between the two groups.  Results  Compared with the normal group, the vitamin D deficient group exhibited significantly lower scores in immediate memory (9.01±1.41 vs. 8.46±2.36), calculation (3.64±1.60 vs. 3.20±1.76), memory [2.00 (1.00, 3.00) vs. 2.00 (1.00, 2.00)], repeat [1.00 (0.00, 1.00) vs. 1.00 (0.00, 1.00)], and three-step command (2.59±0.71 vs. 2.28±0.90) of MMSE. The total score (25.10±3.05 vs. 23.56±3.90), and language score of MoCA, as well as memory and total score, were also significantly lower in the vitamin D deficient group (P<0.05). Furthermore, the total score of CES-D in the vitamin D deficient group (13.10±4.12 vs. 11.26±4.81) was significantly higher (P<0.01). Correlation analysis revealed a positive association between vitamin D levels and overall cognitive function (P<0.05), while serum vitamin D levels showed a negative correlation with depressive mood (P<0.05).  Conclusion  Vitamin D level has been found to be associated with cognition and depression in individuals with MCI.
General Practice Research
Clinical comparison of different anesthesia methods for electronic cochlear implantation in children
FANG Xiangxiang, JU Xuejun, JIANG Qiaomei, MENG Wei, HE Shuangba
2024, 22(2): 191-194. doi: 10.16766/j.cnki.issn.1674-4152.003362
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  Objective  The aim of this study was to compare the application effectiveness and safety of combined inhalation anesthesia and total intravenous anesthesia in pediatric cochlear implantation surgery.  Methods  A retrospective analysis was conducted on 100 pediatric patients who underwent cochlear implantation surgery at Nanjing Tongren Hospital from May 2018 to March 2023. They were divided into two groups based on the different anesthesia methods: combined inhalation anesthesia (control group) and total intravenous anesthesia (study group). The differences between the two groups were compared in terms of general conditions, pre-and post-operative hemodynamics and bispectral index (BIS), postoperative immediate electrical impedance, postoperative restlessness and recovery time, postoperative oxidative stress levels, and adverse reactions.  Results  There were no significant difference in age, height, weight, anesthesia time, hemodynamic indexes (SBP, DBP, HR) and BIS index between the study group and the control group (P>0.05). The immediate electrical impedance at the end of surgery in the study group was lower than that in the control group [low-frequency: (2.57±0.40) kΩ vs. (3.93±0.83) kΩ; high-frequency: (7.00±0.31) kΩ vs. (8.37±0.42) kΩ, P<0.001]. The postoperative sedation-agitation scale(RASS) and recovery time of the study group were lower than those of the control group (P<0.001). There was significant difference in postoperative oxidative stress levels between the two groups (P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).  Conclusion  Total intravenous anesthesia is a safer and more effective approach compared to combined anesthesia for cochlear implantation surgery in children. Total intravenous anesthesia offers notable benefits in terms of intraoperative hemodynamics control, recovery time, oxidative stress levels, and postoperative impedance. Therefore, total intravenous anesthesia should be considered as the primary option in clinical practice for cochlear implantation surgery in children. However, the selection of the anesthetic modality should be carefully evaluated, considering the unique needs for each patient and the experience of the anesthesia team.
Serum levels of C1q/TNF-related protein 9 and its association with insulin resistance in gestational diabetes mellitus
LIU Yuting, SHI Min, CHEN Yanna, YIN Lulu, HU Changjun
2024, 22(2): 195-197. doi: 10.16766/j.cnki.issn.1674-4152.003363
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  Objective  To investigate the relationship between serum C1q/tumor necrosis factor-related protein 9 (CTRP9) and gestational diabetes mellitus (GDM) and its clinical significance.  Methods  A total of 35 patients with GDM and 37 pregnant women without the condition were enrolled. The general characteristics, glucose metabolism indicators, serum CTRP9 levels and other adipokine levels were compared between the two groups. In addition, a Pearson correlation analysis was conducted to examine the correlation between serum CTRP9, other cytokines and clinical indexes in pregnant women with GDM.  Results  The fasting plasma glucose (FPG), OGTT 1hPG, OGTT 2hPG, fasting insulin (FINS), HOMA-IR, interleukin-6 (IL-6), leptin, tumor necrosis factor-α (TNF-α), and CTRP9 in the GDM group were higher than those in the control group (P<0.05). The results of the Pearson correlation analysis indicated that serum CTRP9 was positively correlated with FPG, 1hPG, 2hPG, FINS, HOMA-IR, IL-6 and TNF-α (P<0.05). The logistic regression analysis showed that elevated HOMA-IR (OR=14.771, P=0.046) and CTRP9 (OR=4.965, P=0.002) were independent risk factors for GDM. ROC analysis demonstrated that CTRP9 and HOMA-IR had areas under the curve of 0.914 and 0.822, respectively, for diagnosing GDM. The combined detection had an area under the curve of 0.943, indicating optimal diagnostic efficiency.  Conclusion  The serum CTRP9 level is elevated in GDM. Elevated serum CTRP9 level is an independent risk factor for GDM. Furthermore, the combination of serum CTRP9 and HOMA-IR was more efficient in screening for GDM.
Clinical study on the therapeutic effect and prognostic value of peripheral blood inflammatory indexes in the treatment of advanced gastric cancer with immune checkpoint inhibitors
ZHANG Qiao, ZHOU Xuezhi, CHENG Sai, MENG Tao, GAO Zhengjie, ZHANG Dezhong, ZHU Shaohui
2024, 22(2): 198-201. doi: 10.16766/j.cnki.issn.1674-4152.003364
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  Objective  To explore the efficacy and prognostic value of prognostic nutrition index (PNI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) in advanced gastric cancer (AGC) treated with immune checkpoint inhibitors (ICIs).  Methods  A retrospective analysis was conducted on the clinical data of 75 AGC patients who received ICIs treatment at the First Affiliated Hospital of Xinxiang Medical College from June 2019 to January 2022. The ROC curve was used to calculate the optimal cutoff values for PNI, NLR, and PLR. Kaplan-Meier curves was plotted, and cox regression analysis was used to predict the independent risk factors affecting overall survival (OS) in AGC.  Results  The best cutoff values for PNI, NLR0, PLR0, and PLR4 were 36.00, 3.45, 186.65, and 138.23, respectively. The objective response rate (ORR) of high PNI group and low PLR0 group were higher. The disease control rate (DCR) of high PNI group, low NLR0 group, low PLR0 group and low PLR4 group were higher, and the differences were statistically significant (P<0.05). Univariate analysis showed that PNI, NLR0, PLR0, PLR4, BMI and stage were correlated with OS. Multivariate analysis showed that PLR0 was an independent risk factor for OS (HR=3.539, 95% CI: 1.717-7.296, P<0.001) and PFS (HR=4.556, 95% CI: 1.955-10.617, P<0.001) except stage.  Conclusion  Detection of PNI, NLR0, PLR0, and PLR4 has clinical guiding value for the efficacy and prognosis of AGC after ICIs treatment.
Comparative study of CT features in patients with drug-resistant pulmonary tuberculosis with or without diabetes mellitus
GUO Jinlong, MIN Xuhong, SONG Biao, LI Yuan, WANG Hua
2024, 22(2): 202-205. doi: 10.16766/j.cnki.issn.1674-4152.003365
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  Objective  To explore the chest CT features of drug-resistant pulmonary tuberculosis complicated with diabetic patients, in order to improve the understanding of its imaging findings.  Methods  A retrospective study was performed between 55 cases of drug-resistant pulmonary tuberculosis with diabetes mellitus (referred to as "concurrent DM group") admitted to Anhui Chest Hospital from June 2022 to May 2023 and 80 cases of drug-resistant pulmonary tuberculosis without diabetes mellitus (referred to as "non-concurrent DM group") who met the inclusion criteria during the same period, and the chest CT features of the two groups were compared and analyzed.  Results  In the concurrent DM group, the detection rates of destroyed lung, lobar and segmental consolidation or caseous pneumonia and tuberculous pleurisy were 32.73% (18/55), 36.36% (20/55) and 41.82% (23/55), respectively, and the non-concurrent DM group were 13.75% (11/80), 20.00% (16/80) and 23.75% (19/80), respectively. The differences between the two groups were statistically significant (χ2=6.959, 4.463, 4.965, P<0.05). In the concurrent DM group, the detection rates of case of cavities and cavities without wall were 89.09%(49/55), 54.82%(108/197), respectively, and the non-concurrent DM group were 67.50% (54/80), 44.09% (82/186), respectively. The differences between the two groups were statistically significant (χ2=8.401, 4.411, P<0.05).  Conclusion  The chest CT features of drug-resistant pulmonary tuberculosis with diabetes mellitus has certain characteristics, which are more manifested as destroyed lung, lobar and segmental consolidation or caseous pneumonia, and multiple cavities without wall. Effective understanding of the imaging characteristics can provide help for early clinical diagnosis and treatment.
Analysis of the short-term efficacy and side effects of concurrent chemoradiotherapy combined with nimotuzumab in patients with locally advanced nasopharyngeal carcinoma
XU Hongbo, ZHANG Yajun, HUANG Zhifei, ZHAO Hongyu, LIU Zixuan, GAO Bo, CAI Feng, SONG Shilong, HE Zelai, JIANG Hao
2024, 22(2): 206-208. doi: 10.16766/j.cnki.issn.1674-4152.003366
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  Objective  Nasopharyngeal carcinoma has unique anatomical and biological characteristics, and radiotherapy or concurrent chemoradiotherapy is an effective treatment mode. However, many patients with locally advanced nasopharyngeal carcinoma still experience local recurrence or distant metastasis. Therefore, targeted therapy provides an additional option for nasopharyngeal carcinoma patients. This article aims to evaluate the short-term efficacy and toxicity of concurrent chemoradiotherapy combined with nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma patients, and further analyze the impact of intensity-modulated radiation therapy (IMRT) and helical tomotherapy (TOMO) on patiens' side effects.  Methods  A retrospective analysis was conducted on the clinical data of 88 patients with locally advanced nasopharyngeal carcinoma admitted to the Radiotherapy Department of the First Affiliated Hospital of Bengbu Medical University from December 2020 to June 2023. The treatment group consisted of 44 patients who received concurrent chemoradiotherapy with nimotuzumab targeted therapy, while the control group consisted of 44 patients who only received concurrent chemoradiotherapy. The short-term treatment efficacy, toxic side effects, and the impact of different radiotherapy methods on side effects were compared and analyzed.  Results  In the treatment group, the overall response rate (ORR) for the nasopharyngeal region and cervical lymph nodes were 97.8% (43/44) and 93.2% (41/44) respectively, while in the control group, the ORR were 81.8%(36/44) and 81.8% (36/44) respectively. The incidence of mucositis was higher in the treatment group compared to the control group: 84.1%(37/44) compared to 63.6%(28/44), P<0.05. Further analysis showed that the incidence of mucositis was lower in patients receiving TOMO in both the treatment and control groups than in the IMRT, but the difference was not statistically significant (P>0.05).  Conclusion  For patients with locally advanced nasopharyngeal carcinoma, concurrent chemoradiotherapy with nimotuzumab provides better short-term efficacy, while patients receiving TOMO have a decreasing trend in mucosal reactions.
Regulation mechanism of miR-206 on senescence and apoptosis of nucleus pulposus cells in lumbar intervertebral disc
ZHU Zhonglian, ZHOU Pinghui, WANG Zhaodong, GAO Xubin, XU Chen, LIU Yajun, DUAN Keyou, GUAN Jianzhong
2024, 22(2): 209-211. doi: 10.16766/j.cnki.issn.1674-4152.003367
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  Objective  To investigate the regulatory effects of miR-206 on senescence and apoptosis of nucleus pulposus cells in white rabbits with lumbar disc herniation, and to provide a reference for targeted therapy of lumbar disc herniation.  Methods  Thirty cases of New Zealand white rabbits were selected as the study subjects to construct white rabbit model of lumbar disc herniation by autologous nucleus pulposus transplantation. The rabbits were randomly divided into a model group and a control group, with 15 rabbits in each group. The rabbits in the model group were injected with miR-206 simulant, and the rabbits in the control group were injected with normal saline. The transcription level of miR-206 was detected by reverse transcription-polymerase chain reaction (qRT-PCR). Senescence of nucleus pulposus cells was detected by senescence-associated β-galactosidase (SA-β-gal). Nucleus pulposus apoptosis was detected by flow cytometry.  Results  The expression level of miR-206 in nucleus pulposus cells in the model group (1.65±0.32) was significantly higher than that in the control group (0.41±0.08), the difference was significant (P<0.05). The number of positive cells in the model group[(14.27±5.36) ×105] was higher than that in the control group [(5.08±1.13) ×105], the difference was statistically significant (P<0.05). The apoptosis rate of nucleus pulposus cells in the model group [(8.18±1.94)%] was lower than that in the control group [(42.43±6.28)%], the difference was statistically significant (P<0.05).  Conclusion  miR-206 plays an important regulatory role in nucleus pulposus cells of white rabbits with lumbar disc herniation. Overexpression of miR-206 can reduce the senescence of nucleus pulposus cells, decrease the apoptosis rate of nucleus pulposus cells in white rabbits with lumbar disc herniation, and improve the proliferation ability of nucleus pulposus cells.
The correlation between metabolic syndrome and its components with the degree of coronary artery stenosis and clinical outcomes in patients with acute myocardial infarction
WANG Kaiyang, LIU Fengshuang, LIU Yongguo, LI Guoqing, YANG Yining, YU Xiaolin
2024, 22(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.003368
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  Objective  To explore the correlation between metabolic syndrome (MS) with the degree of coronary artery stenosis and prognosis in patients with acute myocardial infarction (AMI).  Methods  There were 726 AMI patients as the subjects, from the Cardiology Department of Xinjiang Uygur Autonomous Region People's Hospital from January 2019 to December 2020. The Gensini score was used to quantitatively assess the degree of coronary artery stenosis and the clinical outcome was defined as major adverse cardiovascular events (MACEs). Multiple linear regression was used to analyze the correlation between MS and its components between Gensini score. Multivariate Cox regression was used to analyze the independent risk factors for MACEs.  Results  There were 348 patients (47.9%) in the MS group and 378 patients (52.1%) in the non-MS group. Compared with the non-MS group, patients in the MS group were older and had more combined hypertension, diabetes, abdominal obesity, dyslipidemia. Waist circumference, systolic blood pressure, fasting blood glucose, blood urea nitrogen, low density lipoprotein cholesterol and Gensini score were higher, hemoglobin levels were lower, clopidogrel utilization rate was higher and the incidence of MACEs was higher, the differences were statistically significant (P < 0.05). Internal comparison showed that Gensini scores were significantly increased in the group of abdominal obesity and elevated fasting blood glucose (P < 0.05). Multiple linear regression analysis results showed that elevated fasting blood glucose and abdominal obesity were independently correlated with Gensini score. Multivariate Cox regression analysis results showed that: diabetes and abdominal obesity were the independent risk factors for MACEs.  Conclusion  Patients with AMI complicated by MS were very common. Abnormal glucose metabolism and abdominal obesity were closely related to the degree of coronary artery stenosis, and significantly affect the prognosis of patients.
The value of ultrasonography as a guide to biopsy of peripheral lung-type lesions of different sizes
DING Yajie, SUN Yixue, LI Yang, GAO Yankun, ZHU Xiao
2024, 22(2): 217-221. doi: 10.16766/j.cnki.issn.1674-4152.003369
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  Objective  To investigate the value of conventional ultrasound versus ultrasonography as a guide in biopsy of peripheral lung-type lesions of different sizes.  Methods  A total of 361 patients with peripulmonary lesions were collected from the First Affiliated Hospital of Bengbu Medical University from January 2022 to July 2023, and all of them underwent routine ultrasound or ultrasound-guided lung puncture biopsy, and were divided into three groups of A, B, and C according to the maximum diameter of the lesions (Group A: ≤20 mm; Group B: 21-49 mm; Group C: ≥50 mm), and the lesions of the three groups were further divided into the routine group and the contrast-enhanced ultrasound (CEUS). The lesions in the three groups were further divided into the conventional group and the CEUS group. The detection rate of internal necrotic areas, the detection rate of lesions and surrounding large vessels, the success rate of puncture, the number of punctures and the complication rate were compared between the conventional group and the CEUS group at different sizes.  Results  The differences in baseline characteristics such as gender and age among the three groups were not statistically significant (P>0.05). In group A, there was no significant difference in the above biopsy indices between the conventional group and the CEUS group. In group C, the display rate of internal necrotic area (70.6%, 48/68), the display rate of lesions and peripheral vessels (47.1%, 32/68) and the success rate of puncture (97.1%, 66/68) were significantly higher in the CEUS group than in the conventional group [17.1% (14/82), 20.7% (17/82), 87.8% (72/82)], with statistically significant differences (P < 0.05).  Conclusion  Ultrasound-guided puncture biopsy is more informative when the maximum diameter of the lesion is ≥50 mm; routine ultrasound-guided puncture biopsy is more recommended for smaller peripulmonary lesions (≤20 mm) to save patient's cost and medical resources.
Analysis of the effect of low level semiconductor laser on the pain of permanent tooth caries mechanical preparation of Class Ⅰ cavities
WANG Tingting, HUANG Yongsong, XU Li, TIAN Ruixue
2024, 22(2): 222-224. doi: 10.16766/j.cnki.issn.1674-4152.003370
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  Objective  To evaluate the effectiveness of low-level laser therapy (LLLT) in the treatment of pain during mechanical cavity preparation of Class Ⅰ cavities in adult permanent teeth in adult patients with low pain tolerance.  Methods  This study selected adult patients with Class Ⅰ permanent tooth cavities (D2) who visited the Department of Stomatology at the First Affiliated Hospital of Bengbu Medical University from October 2022 to September 2023. Before the treatment, the preliminary test of pain threshold (PTPT) was initially tested by the mechanical removal method, and the pain score was evaluated by the visual analogue scale (VAS) score. Twenty patients with 7 points≤VAS < 10 points, 40 teeth were selected, laser group (20 teeth) and placebo group (20 teeth). The laser group was treated with LLLT before the cavity preparation, and the placebo group was treated with simulated laser irradiation at the same position but the laser was not in working mode. The VAS score was used to evaluate the pain intensity after the cavity preparation, and the VAS scores were compared between the two groups and before and after the treatment.  Results  The VAS score of all subjects in the laser group was lower than that in the placebo group [4.0 (4.0, 4.5) points vs. 6.0 (6.0, 6.8) points, P < 0.001]; Compared with the pain felt during PTPT, the laser group decreased by 42.9% [7.0 (7.0, 8.0) points vs. 4.0 (4.0, 4.5) points, P < 0.001] and the placebo group decreased by 14.3% [7.0 (7.0, 8.0) points vs. 6.0 (6.0, 6.8) points, P < 0.001].  Conclusion  The use of LLLT before cavity mechanical preparation can greatly reduce the pain intensity during permanent tooth treatment.
Neuroprotective effect of Bafilomycin A1 on cerebral ischaemia reperfusion injury by regulation AMPK/mTOR/ULK1 signaling pathway in mice
ZHOU Chaorui, GU Jiankun, CHEN Na, LI Mingjuan
2024, 22(2): 225-229. doi: 10.16766/j.cnki.issn.1674-4152.003371
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  Objective  To investigate the mechanism by which bafilomycin A1 (BAF-A1) attenuates cerebral ischemia-reperfusion (IR) injury in mice by regulating autophagy through the adenosine activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR)/UNC-51 like kinase 1 (ULK1) signaling pathway.  Methods  A total of 40 SPF grade male mice were select for the experiment and randomly divided into sham group (S group), model group (M group), BAF-A1 group (B group) and BAF-A1+AMPK group (B+M group) group. An IR model is prepared using the suture method and evaluated using 1.5 hours of ischaemia followed by 24 hours of reperfusion as the observation point.  Results  There was no neurological deficit in S group mice, the scores of B Group (1.47±0.28) and Group B+M (2.05±0.16) decreased compared with M Group (2.45±0.31), P < 0.05. Compared with S Group, there was significant left cerebral ischemia in M Group, B Group and B+M Group, with white infarcted areas visible. Compared with M group, the volume ratio of cerebral infarction in B group mice was significantly reduced (P < 0.05). Compared with S group mice, M group mice showed a small amount of nuclear pyknosis and fission in the neurons of the CA1 and CA3 regions of the hippocampus. Compared with M group mice, group B mice showed enhanced nuclear pyknosis, nuclear fission vacuoles, and necrosis in the CA1 and CA3 regions, but the B+M group antagonized this effect. Compared with S group, LC3 Ⅱ/Ⅰ, p-AMPK/AMPK of ischaemic brain tissue in M group rats increased (P < 0.05); compared with M group, B Group showed a decrease in LC3 Ⅱ/Ⅰ, p-AMPK/AMPK (P < 0.05). Compared with S group, the p-mTOR/mTOR and Ps757-ULK1/ULK1 ratio decreased in M group; compared with M group, the p-mTOR/mTOR and Ps757-ULK1/ULK1 ratio were significantly increased in B group (P < 0.05).  Conclusion  BAF-A1 pretreatment may exert a protective effect on neural function by inhibiting the AMPK/mTOR/ULK1 signaling pathway, thereby inhibiting excessive autophagy in the hippocampus of mice.
Prediction of prognosis in elderly nHCM patients using nomogram based on CMR and clinical characteristics
LIU Lei, LI Tianjiao, SUN Bin, REN Hongqiang
2024, 22(2): 230-234. doi: 10.16766/j.cnki.issn.1674-4152.003372
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  Objective  To investigate the survival prognosis of elderly patients with non-obstructive hypertrophic cardiomyopathy (nHCM), and to establish a nomogram based on cardiac magnetic resonance (CMR) parameters and clinical characteristics to predict the overall survival (OS) of patients with nHCM.  Methods  A total of 179 patients with nHCM admitted to the Cardiovascular Center of Suining Central Hospital and Nanchong Central Hospital from June 2015 to November 2021 were retrospectively analyzed. Multivariate Cox regression analysis was used to determine the independent prognostic factors associated with OS and nomogram was drawn. The internal validation was performed by Bootstrap.  Results  Multivariate Cox regression analysis showed that the prognostic factors were galectin-3 (Gal-3), ventricular tachycardia, apical aneurysm, late gadolinium enhancement (LGE), exercise stress test. The Bootstrap correction value of c-index was 0.908(95% CI: 0.869-0.947); The area under the curve of 1, 3, and 5-year survival rate calculated by multi time point ROC curve were 0.907, 0.935, and 0.921 for discrimination analysis. The calibration curve showed that the predicted estimated risk had good accuracy with the actual observation results.  Conclusion  The elevation of Gal-3, ventricular tachycardia, apical ventricular aneurysm, positive exercise stress test, and positive LGE based on CMR parameters are independent risk factors that affect the prognosis of elderly nHCM patients. The nomogram constructed based on the above indicators can be used to individualize the assessment of the prognosis of elderly nHCM patients.
Study on the effect of percutaneous acupoint electrical stimulation during perioperative period to prevent cognitive impairment after total knee arthroplasty in the elderly
JIN Xiaowei, ZHOU Sen, ZHOU Qitao, JIANG Yi
2024, 22(2): 235-239. doi: 10.16766/j.cnki.issn.1674-4152.003373
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  Objective  The purpose of this study is to explore the preventive effect of perioperative percutaneous acupoint electrical stimulation on postoperative cognitive dysfunction (POCD) in elderly patients undergoing total knee arthroplasty (TKA).  Methods  A total of 158 elderly patients with knee joint osteoarthritis who underwent elective unilateral TKA at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to June 2023 were randomly assigned to a control group (79 cases) and an observation group (79 cases) by random number table method. The control group received TKA under general anesthesia, and the observation group received additional perioperative percutaneous acupoint electrical stimulation intervention. The surgical and anesthesia recovery indicators were recorded, perioperative hemodynamic changes were monitored, serum cytokines and brain neurobiochemical indicators were analyzed, and POCD occurrence was followed up 5 days after surgery.  Results  There was no statistically significant difference in intraoperative bleeding volume, total intraoperative infusion volume, surgical duration, anesthesia recovery time, and tracheal intubation time between the two groups (P>0.05). The HR and MAP values of the two groups during skin resection and immediately after autologous knee joint removal were lower than those of 30 minutes before anesthesia induction (P < 0.001). The content of serum TNF-α, IL-6 and IL-1β in the observation group were lower than those in the control group 5 days after surgery (P < 0.001). The content of serum S-100β and NSE in the observation group were lower than those in the control group 5 days after surgery, while BDNF content was higher than that in the control group (P < 0.001). The incidence of POCD 5 days after surgery in the observation group (11.39%, 9/79) was lower than that in the control group (25.32%, 20/79), and the difference was statistically significant (P < 0.05).  Conclusion  Perioperative percutaneous acupoint electrical stimulation can inhibit neuroinflammatory response, alleviate brain tissue damage, regulate brain nerve metabolism function, and can prevent the occurrence of POCD.
Curative effect of cement-enhanced PFNA on the elderly with osteoporotic intertrochanteric fracture
GUO Yue, YAN Jun, HA Chengzhi, YANG Hongpeng
2024, 22(2): 240-243. doi: 10.16766/j.cnki.issn.1674-4152.003374
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  Objective  To observe the effect and postoperative recovery of cement-enhanced proximal femoral nail anti-rotation (PFNA) in the treatment of the elderly with osteoporotic intertrochanteric fractures, and to evaluate the application effect of PFNA.  Methods  A total of 80 elderly patients with osteoporotic intertrochanteric fractures admitted to Liaocheng People's Hospital were enrolled from January 2020 to January 2022. According to the random grouping method, they were divided into the PFNA group (traditional PFNA, n=40) and the cement-enhanced group (cement-enhanced PFNA, n=40). The clinical data of patients were collected. Twelve months after surgery, the Harris score was measured, and the occurrence of complications was recorded.  Results  There was no significant difference in intraoperative relevant indexes between the two groups (P>0.05). The leaving bedtime, weight-bearing time, and fracture healing time in the cement-enhanced group were (5.08±0.96) d, (3.14±0.38) weeks and (12.33±1.29) weeks, which were significantly shorter than those in PFNA group [(7.37±1.01) d, (4.92±0.56) weeks, (17.64±1.75) weeks, P < 0.05]. Twelve months after surgery, there was no significant difference in hip Harris scores (pain, function, limb deformity) between the two groups (P>0.05), but the hip Harris score (range of motion) in the cement-enhanced group was significantly higher than that in the PFNA group [(4.93±0.58) points vs. (4.61±0.52) points, P < 0.05]. The incidence of complications in the cement-enhanced group was significantly lower than that in the PFNA group (P < 0.05).  Conclusion  Cement-enhanced PFNA is an ideal operation in the treatment of the elderly with osteoporotic intertrochanteric fracture, with high safety and stability. It can realize early weight-bearing rehabilitation training and is beneficial to recover joint function.
Clinical study of transvaginal ultrasound monitoring of trazole combined with gonadotropin in the treatment of infertility in polycystic ovary syndrome
BAI Xiaohui, HONG Luxi
2024, 22(2): 244-246. doi: 10.16766/j.cnki.issn.1674-4152.003375
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  Objective  The main treatment drugs for PCOS are letrozole, but the effect of single drug treatment is not good. This study used vaginal ultrasound technology as a means to evaluate the efficacy of letrozole and gonadotropin drug combination in the treatment of infertility patients with PCOS.  Methods  A total of 86 patients with PCOS treated in Wenzhou Hospital of Integrated Chinese and Western Medicine from January to December 2022 were selected and divided into observation group (43 cases) and control group (43 cases) according to random number table method. The control group was treated with letrozole, and the observation group was treated with letrozole combined with human follicle stimulating hormone. Ovarian parameters, including ovarian volume, maximum ovarian follicle diameter, endometrial thickness and number of follicles, were evaluated by transvaginal ultrasound. Peak systolic flow rate, pulsation index and resistance index of ovarian interstitial artery were compared between the two groups. Levels of follicle-stimulating hormone, estradiol and luteinizing hormone, ovulation rate and pregnancy rate were compared between the two groups.  Results  The ovarian volume and number of follicles in observation group were smaller than those in control group, the maximum ovarian follicle diameter and endometrial thickness were larger than those in control group, and the peak systolic flow rate, pulsation index and resistance index of the ovarian interstitial artery were higher than those in control group, with statistical significance (P < 0.05). Follicle stimulating hormone and estradiol in the observation group were (7.88±1.26) mIU/mL and (162.32±20.07) pmol/L, respectively, which were significantly higher than those in the control group [(4.42±0.61) mIU/mL and (62.46±9.28) pmol/L, P < 0.05]. Luteinizing hormone in observation group was significantly lower than that in control group [(6.29±0.78) mIU/mL vs. (18.42±2.15) mIU/mL, P < 0.05]. The ovulation rate and conception rate in the observation group were significantly higher than those of control group (P < 0.05).  Conclusion  Vaginal ultrasound monitoring can provide good feedback on the treatment of PCOS patients, and gonadotropin drug treatment of PCOS can effectively improve the ovulation rate and pregnancy rate of patients, which has good clinical value.
Retrospective analysis of risk factors for stable chronic obstructive pulmonary disease combined with pulmonary hypertension
ZHANG Fen, ZHU Caixia, LIU Yufeng, XIA Yuhan, ZHANG Kedong
2024, 22(2): 247-251. doi: 10.16766/j.cnki.issn.1674-4152.003376
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  Objective  To analyze the clinical characteristics and risk factors of patients with stable chronic obstructive pulmonary disease (COPD) combined with pulmonary hypertension (PH).  Methods  A total of 199 patients with stable COPD combined with PH and 150 patients with pure stable COPD were collected from January 2020 to January 2022 at General Hospital of Ningxia Medical University as the control group. The clinical data of the two groups were compared, and the clinical characteristics and risk factors of stable COPD combined with different severity of PH were analyzed.  Results  (1) There were significant differences in several clinical indicators between the COPD group and the COPD combined with PH group. Furthermore, the COPD combined with PH patients were further divided into mild, moderate, and severe PH groups, and there were significant differences in red cell volume distribution width (RDW), N-terminal pro-brain natriuretic peptide (NT-proBNP), PCO2, HCO3-, stroke volume (SV), and right ventricular anterior-posterior diameter (RVD) among the three groups (P < 0.05). (2) Correlation analysis showed that cardiac index (CI), systemic immune-inflammation index (SII), and SV were negatively correlated with pulmonary artery pressure, while RDW, PCO2, HCO3-, and NT-proBNP were positively correlated with pulmonary artery pressure. (3) The results of multivariate logistic regression analysis showed that an elevated NT-proBNP level was an independent risk factor for severe PH in stable COPD (P < 0.05). (4) The ROC curve results showed that the AUC value of NT-proBNP was 0.827, higher than the AUC values of RDW and HCO3-.  Conclusion  An elevated NT-proBNP level is an independent risk factor for severe PH in stable COPD. In addition, there is a correlation between CI, SII, RDW, PCO2, HCO3-, NT-proBNP, SV, and RVD in stable COPD combined with PH.
Analysis of dietary patterns and influencing factors in infertile women of childbearing age
ZHANG Xueyun, WANG Jieyu, WANG Chunyan, CHENG Jingxian, WU Xuanye, LUO Guiying
2024, 22(2): 252-256. doi: 10.16766/j.cnki.issn.1674-4152.003377
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  Objective  In order to provide theoretical basis for formulating rational dietary guidance program for infertile women, this paper analyzed the current situation of dietary pattern of infertile women and explored the influencing factors of dietary pattern.  Methods  A self-designed questionnaire and a 3-day 24-hour dietary review questionnaire were used to investigate the infertile women of childbearing age who intended to undergo assisted reproductive technology in the reproductive center outpatient clinic of a top three hospital in Anhui Province from May 2021 to December 2022. The dietary patterns were established by factor analysis, and the influencing factors of dietary patterns were analyzed by disordered multiple logistic regression method.  Results  There were four dietary patterns in infertile women of childbearing age, which were high oil and salt pattern, mixed meat and vegetable pattern, traditional dietary pattern and modern dietary pattern. Multiple logistic regression analysis showed that high oil and salt pattern was negatively correlated with age (OR=0.488, 95% CI: 0.254-0.938). Meat and vegetable mixing pattern was positively correlated with in-service status and BMI [OR (95% CI) were 3.954 (2.047-7.636) and 3.392 (1.486-7.744)]. Traditional dietary patterns were positively correlated with long-term residence and infertility years, but negatively correlated with pregnance-assisted treatment [OR (95% CI) were 2.758 (1.129-6.740), 3.539 (1.113-11.250), 0.400 (0.172-0.929)]. Modern dietary pattern was positively correlated with long-term residence (OR=4.884, 95% CI: 1.892-12.603).  Conclusion  Infertile women are more inclined to traditional dietary patterns at present, and their dietary patterns are affected by many factors. Therefore, targeted dietary guidance should be provided for infertile women of childbearing age according to the characteristics of their different dietary patterns.
Analysis of clinical efficacy of photodynamic and carbon dioxide laser in the treatment of vaginal intraepithelial neoplasia
MA Xiaotuan, SHEN Qingwen, WANG Lingling
2024, 22(2): 257-260. doi: 10.16766/j.cnki.issn.1674-4152.003378
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  Objective  To retrospectively analyze the clinical characteristics of vaginal intraepithelial neoplasia (VaIN), and to evaluate the clinical effect of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the treatment of VaIN.  Methods  The clinical data of 136 patients diagnosed with VaIN by colposcopic biopsy who underwent ALA-PDT at the First Affiliated Hospital of Bengbu Medical College from January 2019 to April 2022 were selected, and the clinical data of 65 patients who underwent CO2 laser therapy were selected. HPV and TCT were regularly checked in all patients. At the same time, colposcopic biopsy was performed to retrospectively analyze the clinical characteristics of VaIN, explore the clinical efficacy of ALA-PDT treatment of VaIN, and compare with CO2 laser treatment.  Results  A 12-month follow-up was performed after the end of treatment. At the last follow-up, 85 cases (69.1%) in the ALA-PDT group and 32 cases (51.6%) in the CO2 laser group achieved complete HPV clearance. The HPV clearance rate was compared between the two groups, and the difference was statistically significant (P < 0.05). During the follow-up, 112 patients (82.4%) in the ALA-PDT group had complete clearance the lesions, 5 patients (3.7%) had persistent disease, 12 patients (8.8%) had partial remission, 3 patients (2.2%) had progression, and 4 patients (2.9%) had recurrence. In the CO2 laser group, 42 cases (64.6%) had complete remission, 3 cases (4.6%) persisted, 8 cases (12.3%)had partial remission, 2 cases (3.1%) progressed, and 10 cases (15.4%) recurred. The overall complete remission rate of lesions in ALA-PDT group was higher than that in the CO2 laser group, the difference was statistically significant (P < 0.05), and the recurrence rate in the ALA-PDT group was lower than that in the CO2 laser group, the difference was statistically significant (P < 0.05). There were 6 cases (4.4%) of adverse reactions in the ALA-PDT group and 9 cases (13.8%) in the CO2 laser group. The incidence of adverse reactions was lower in the ALA-PDT group than in the CO2 laser group, and the difference was statistically significant (P < 0.05).  Conclusion  ALA-PDT treatment of VaIN lesions has a higher complete remission rate, can effectively eradicate HPV infection, has fewer side effects, low recurrence rate, and merits further clinical promotion.
Effect of white noise combined with non-nutritive sucking in screening for pain intervention in retinopathy of prematurity
LIU Liping, WANG Dandan, WANG Hongli, GAO Feng
2024, 22(2): 261-264. doi: 10.16766/j.cnki.issn.1674-4152.003379
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  Objective  To investigate the effect of white noise combined with non-nutritive sucking in the screening of retinopathy of prematurity (ROP).  Methods  A total of 212 premature infants hospitalized in neonatal intensive care unit (NICU) of Henan Provincial People's Hospital from February 2020 to February 2021 were selected and randomly divided into white noise group (50 cases), sucking group (52 cases), white noise combined sucking group (56 cases) and control group (54 cases) according to random number table method. All the 4 groups underwent fundus screening. During the screening process, the 4 groups were given white noise intervention, non-nutritional sucking intervention, white noise combined non-nutritional sucking intervention and routine postural comfort intervention, respectively. Preterm infant pain profile (PIPP) was used to assess the degree of operational pain, and PIPP score, blood oxygen saturation and heart rate before and after screening were compared in the 4 groups.  Results  At 1 min and 5 min after screening, PIPP scores in the white noise group, the non-nutritive sucking group and the combined group were significantly lower than those in the control group (P < 0.001), while PIPP scores in the combined group were significantly lower than those in the white noise group and the non-nutritive sucking group (P < 0.01). At 1 min and 5 min after screening, the blood oxygen saturation of the white noise group, the non-nutritive sucking group and the combined group was significantly higher than that of the control group, and the heart rate was significantly lower than that of the control group (P < 0.01), while the blood oxygen saturation of the combined group was significantly higher than that of the white noise group and the non-nutritive sucking group, and the heart rate was significantly lower than that of the white noise group and the non-nutritive sucking group (P < 0.01).  Conclusion  White noise combined with non-nutritive sucking can significantly reduce the pain of ROP screening operation and stabilize the vital signs of premature infants, which is worthy of clinical promotion and application.
Analysis of the application of short-interval second ejaculation in assisted reproductive technology
HU Xu, YAO Guanying, ZHANG Lijun, HAN Zhongjiang, FENG Ke
2024, 22(2): 265-268. doi: 10.16766/j.cnki.issn.1674-4152.003380
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  Objective  To investigate the effects of short-interval second ejaculation on semen quality, final fertilization methods, fertilization rate and high-quality embryo rate.  Methods  A retrospective analysis of 32 occyte retrieval cycles of conventional in vitro fertilization at the Reproductive Medicine Department of Nanyang Central Hospital from January 2020 to December 2022. The first ejaculation (The total number of progressive motility sperm was < 1.0×106 after the optimization of the first semen extraction) and the short-interval second ejaculation (within 2 hours after the first ejaculation) were performed in all the males. Semen quality and final fertilization methods were analyzed. The above cycles were divided into three groups according to the fertilization method: in vitro fertilization (IVF, n=5), intracytoplasmic sperm injection (ICSI, n=11), IVF+early rescue ICSI (n=16), and the fertilization rate, cleavage rate and high-quality embryo rate of each group were analyzed.  Results  The semen volume of short-interval second ejaculation was significantly lower than that of the first ejaculation [(1.56±0.55) mL vs. (2.56±1.33) mL, t=5.847, P=0.038], and the sperm concentration, total motility, and percentage of progressive motility and non-progressive motility sperms were not statistically significant between short-interval second ejaculation and first ejaculation (P>0.05). According to statistics on the final fertilization methods, the proportion of IVF, ICSI, IVF+early rescue ICSI accounted for 15.6%, 34.4% and 50.0%, respectively. There were no significant differences in age, BMI, infertility years, infertility types and number of occytes obtained among the three groups (P>0.05). The normal fertilization rate and high-quality embryo rate of IVF+early rescue ICSI groups were significantly lower than those of ICSI groups (P=0.009, 0.010), and there was no significant difference in normal fertilization rate, cleavage rate and high-quality embryo rate among other groups.  Conclusion  Although short-interval second ejaculation can effectively replenish the total number of progressive motility sperm, the proportion of early rescue ICSI increases significantly during conventional in vitro fertilization, so ICSI may be a better choice when the quality of semen is poor.
Predictive value of pregestational TG/HDL-C ratio combined with cystatin C in predicting gestational diabetes in pregnant women
SHI Xiaojuan, LI Dongfeng, ZHANG Xiaowei
2024, 22(2): 269-272. doi: 10.16766/j.cnki.issn.1674-4152.003381
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  Objective  This study aims to examine the association between the triglycerides to HDL cholesterol(TG/HDL-C), cystatin C levels, and insulin resistance in pre-pregnancy women. Additionally, it seeks to investigate the correlation between TG/HDL-C and cystatin C with gestational diabetes mellitus (GDM).  Methods  A total of 198 pregnant women at the Affiliated Hospital of West Anhui Health Vocational College from January 2020 to June 2022 were selected as the research objects. They were divided into two groups: the observation group (98 cases with GDM) and the control group (100 cases without GDM). General clinical data from both groups were collected and analyzed to explore the relationship between these data and GDM.  Results  There were no significant difference in education, family economic situation, diet control, exercise, smoking history, drinking history, waist circumference, SBP, DBP, FPG, ALT, AST, Cr, UA, TC, HDL-C, and LDL-C between the two groups (P>0.05). However, but there were significant difference in age, BMI, Cys-C, and LDL-C. Logistic regression analysis showed that advanced age, elevated serum Cys-C, and increased TG/HDL-C ratio were independent risk factors for GDM (P < 0.05), with corresponding OR of 1.111, 3.190 and 3.970 respectively. ROC curve analysis demonstrated that TG/HDL-C ratio had an area under the Cys-C curve (AUC) of 0.820 (P < 0.001), while Cys-C had an AUC of 0.667 (P < 0.001). The combined detection of both parameters yielded an AUC of 0.848(P < 0.001), indicating better diagnostic efficiency compared to individual tests.  Conclusion  Pregnant women with high serum TG/HDL-C ratio and Cys-C levels prior to pregnancy are at a higher risk of GDM. These two indicators hold promise for risk assessment and prediction of GDM in pregnant women.
Study on the value of the DOSE index in assessing impaired exercise tolerance in community patients with stable chronic obstructive pulmonary disease
YANG Lulu, SHI Minghui, HE Jiaze, QUMU Shiwei, YANG Ting
2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382
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  Objective  This study aims to explorea method for primary healthcare units to assess exercise endurance impairment in patients with chronic obstructive pulmonary disease (COPD) using the DOSE index as the core indicator. Additionally, the study aims to determine the critical value of this indicator for predicting exercise endurance impairment in patients with COPD.  Methods  A total of 117 stable COPD patients who were monitored at the China-Japan Friendship Hospital from September 2019 to April 2022 were included in the retrospective analysis. Patients with a six-minute walk distance (6MWD) of less than 350 m were determined to be exercise tolerance. Information on lung function, the modified medical research council (mMRC), smoking status, and acute exacerbations in the previous year was calculate the DOSE index for each patient. Lung function, 6MWD, mMRC scores, and DOSE index were compared between the two groups divided based on 6MWD. The relationship between 6MWD and the DOSE index was investigated using Spearman's correlation analysis; Finally, the effectiveness of the DOSE index in assessing impaired exercise tolerance in COPD patients was analyzed using a receiver operating characteristic (ROC) Curve.  Results  A total of 117 patients with stable COPD were included in this study. The mean 6MWD was (416.94±117.16) m and the mean DOSE index was 3(1, 5) points. Among the participants, 29 had a 6MWD < 350 m, while 88 had a 6MWD ≥350 m. Significant differences were observed between these two groups in terms of age, FVC%pred, FEV1%pred, 6MWD, mMRC score, and DOSE index. Notably, there was a strong inverse relationship between the DOSE index and 6MWD (r=-0.456, P < 0.001). Physicians should be particularly vigilant about impaired exercise tolerance in COPD patients.  Conclusion  The DOSE index, with a predictive threshold of 5 points, exhibits a strong and negative correlation with 6MWD, making it a valuable tool in assessing impaired exercise tolerance among COPD patients. Its simplicity and ease of administration make the DOSE index suitable for implementation in primary healthcare settings.
Exploration on the current situation and development countermeasures of health room services in Beijing suburb villages under the integrated management of rural health
CHEN Jingjing, WANG Haili, PENG Yingchun
2024, 22(2): 277-280. doi: 10.16766/j.cnki.issn.1674-4152.003383
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  Objective  To understand the current situation of health room services in suburban villages in Beijing, and analyze the problems in integrated rural management from the perspectives of personnel team, service, and management, and propose solutions.  Methods  A survey and interview were conducted on 171 on-the-job rural doctors, 433 permanent residents, and 26 community health service center managers in Huairou District, Beijing, to understand the situation of service provision and performance assessment of village clinics, residents' demand for health services and their utilization of services, etc., through the information system and data reporting system of medical institutions at the village and village levels, the data such as the number of services provided by village clinics and community health service centers were collected to understand the situation of services provided by village clinics.  Results  Among on-the-job rural doctors, 155 (90.6%) hold a rural doctor practice certificate or have obtained the qualification of a rural general practitioner assistant physician, and 170 (99.4%) of rural doctors have engaged in or engaged in non-medical work such as farming and aquaculture. The total monthly outpatient volume of village clinics accounts for 4.21% (967 cases/year) of the total outpatient volume of community health service centers, of which 72.49% (701 cases/year) were simply measuring blood pressure. Diagnosis and treatment services were the service items with the highest demand rate among residents. Rural doctors did not pay enough attention to performance evaluation, the performance evaluation process was not standardized, and the incentive effect of the results was not obvious.  Conclusion  The unclear institutional responsibilities, inconsistent and non-standard service content standards of village clinics have affected the integration of rural health services. At the same time, the functions of township community health service centers in the integrated management of rural health room services need to be clarified. It is recommended to clarify the service scope and standards of village clinics, achieve homogenization of services, optimize the service methods and management models of village clinics, achieve integrated management of drugs and finance, accelerate the training of rural doctors, and promote integrated management of personnel and performance evaluation.
Effects of repeated transcranial magnetic stimulation on cognitive and social function in patients with first-episode schizophrenia
SHEN Bianhong, WANG Chengpeng, ZHANG Kaiyuan, GAO Kerun, ZHANG Zhiwen, ZHU Chunyan, FANG Ling, TANG Jianping
2024, 22(2): 281-283. doi: 10.16766/j.cnki.issn.1674-4152.003384
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  Objective  To explore the effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive and social function in patients with first-episode schizophrenia, and to provide evidence for clinical treatment.  Methods  A total of 96 patients with schizophrenia admitted to Hangzhou Seventh People's Hospital from February 2019 to February 2022 they were used the random number table method to randomly divide 48 cases into the observation group (with rTMS true stimulation) and the control group (with pseudo-stimulation), and the scores of cognitive functions [repeatable battery for the assessment of neuropsychological status (RBANS)] and social function [scale of social function in psychosis inpatients (SSPI)] and adverse reactions before and after treatment were compared between the two groups.  Results  After one month of treatment, immediate memory, delayed memory, speech function, visuospatial structure, attention and total scores of RBANS in observation group were (45.69±2.31), (46.79±3.15), (33.87±2.25), (35.81±2.91), (53.75±3.82), and (237.75±9.7) points, respectively, and in the control group were (38.62±1.29), (42.65±3.78), (27.75±2.91), (28.62±2.79), (48.85±3.95), (203.96±9.89) points, respectively. The SSPI scale scores of daily living skills, social and sexual activity skills, mobility and interaction, and total SSPI scores in the observation group were (7.84±0.63), (11.76±1.73), (12.72±1.52), and (32.95±1.87) points, respectively, and in the control group were (6.58±0.31), (9.82±1.79), (10.58 ± 1.42), (28.89 ± 1.98) points, respectively. The scores of RBANS and SSPI in the observation group were significantly higher than those in the control group (P < 0.05). There was no significant difference in adverse reactions between the observation group (31.25%, 15/48) and the control group (27.08%, 13/48), χ2=0.202, P=0.653.  Conclusion  rTMS can effectively improve cognitive and social function in patients with first-episode schizophrenia, and has high safety.
Application effects of group mindfulness cognitive therapy in patients of depression with sleep disorders
ZHANG Huiling, QIAN Chao, CHEN Ying, YANG Xiaoyan
2024, 22(2): 284-287. doi: 10.16766/j.cnki.issn.1674-4152.003385
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  Objective  To analyze the impacts of group mindfulness cognitive therapy on clinical symptoms, sleep quality, and mindfulness awareness in patients of depression with sleep disorders.  Methods  A total of 193 patients of depression with sleep disorders admitted to the Shaoxing Seventh People's Hospital from January 2023 to September 2023 were selected. They were divided into a control group (n=96) and an observation group (n=97) using the random number table method. The control group received routine psychological intervention, while the observation group received group mindfulness cognitive therapy based on the control group. The depressive symptoms [self rating depression scale (SDS) and Hamilton depression scale (HAMD)], sleep quality [Athens insomnia scale (AIS) and insomnia severity index (ISI)], and mindfulness level [five factor mindfulness questionaire (FFMQ)] were compared between the two groups of patients before and after intervention.  Results  After intervention, the observation group patients exhibited significantly lower scores in SDS (51.20±3.64), HAMD (17.46±2.52), AIS (11.05±2.33) and ISI (12.24±2.80), compared to the control group with scores of 55.64±4.71, 19.72±3.43, 14.11±3.14 and 15.91±3.17, respectively (P < 0.05). Furthermore, the FFMQ scores in all dimensions, total scores of the observation group were significantly higher than those of the control group (P < 0.05).  Conclusion  Group mindfulness cognitive therapy can significantly alleviate depressive symptoms in patients of depression with sleep disorders, and improve sleep quality and mindfulness level.
The application value of contrast-enhanced ultrasound on diagnosis and treatment of cesarean section pregnancy
YANG Chengliang, WANG Chunyan, HUANG Kai, HONG Xue, ZHANG Wei
2024, 22(2): 288-291. doi: 10.16766/j.cnki.issn.1674-4152.003386
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  Objective  To examine the use of contrast-enhanced ultrasound (CEUS) for diagnosing and treating cesarean section scar pregnancy (CSP) providing a reference for clinical diagnosis and treatment of CSP.  Methods  The study retrospectively collected data from 80 suspected patients with CSP who were admitted to the Second Hospital of Jiaxing between January 2017 and January 2021. All patients underwent transvaginal ultrasonography and CEUS examination prior to surgery. The study compared the diagnostic efficacy of vaginal ultrasound and CEUS for CSP to surgical pathology, and observed the ultrasonographic manifestations; The parameters of contrast-enhanced ultrasound time-intensity curve (TIC) were compared between CSP and non-CSP patients, and the differences of CEUS related indexes in patients with different surgical methods were analyzed.  Results  Out of 80 patients suspected of having CSP, 60 cases (75.00%) were confirmed through operation and pathology. CEUS demonstrated significantly higher diagnostic sensitivity (96.67% vs. 86.67%) and accuracy (93.75% vs. 83.75%) compared to transvaginal ultrasound, which was considered the gold standard (P < 0.05). Out of 60 patients with CSP, 18 cases exhibited extravasation, 36 cases showed rich blood grading, and 46 cases showed gestational cystic lesions; The CEUS images revealed a "bagel" sign in 55 cases. The onset and peak times of angiography in patients with cerebral small vessel disease (CSVD) were earlier than those in patients without CSVD (P < 0.05), Additionally, the peak intensity and rate of enhancement were greater in patients with CSVD (P < 0.05). The proportion of the major blood supply to the gestational sac/mass in the scar and the chorionic membrane/early placenta completely covering the scar was found to be higher in laparoscopic surgery than in ultrasound/hysteroscopy (P < 0.05), Additionally, the scar thickness was smaller in laparoscopic surgery (P < 0.05).  Conclusion  CEUS is typically characterized by the "bagel" sign in the diagnosis of CSP, which has greater diagnostic efficacy than transvaginal ultrasound, Additionally, the characteristics of the main blood supply site of CEUS pregnancy sac/mass may affect the treatment of CSP.
New progress in minimally invasive surgical treatment of thoracic spinal stenosis
YANG Fan, AN Xiaolong, ZHOU Chengpei, ZHU Kailong, QIAN Jixian, QIAN Shu
2024, 22(2): 292-295. doi: 10.16766/j.cnki.issn.1674-4152.003387
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Thoracic spinal stenosis is a group of clinical syndromes caused by a reduction in the effective cross-sectional area of the thoracic spinal canal. This reduction leads to compression of the spinal cord or nerve roots at the corresponding level due to various pathogenic factors including ossification of the ligament flavum, ossification of the posterior longitudinal ligament, thoracic disc herniation, osteophyte formation at the posterior edge of the vertebral body, and hyperplasia of the vertebral facet joint. Symptoms commonly observed in patients include lower limb numbness, weakness, and difficulty in walking. Although the incidence of thoracic spinal stenosis is lower compared with cervical and lumbar spinal stenosis, delayed diagnosis and treatment often result in a poor prognosis and significant burden on daily life. The traditional treatment method involves total laminectomy via a posterior median approach. However, this approach has drawbacks such as damage to the stability of the posterior column, increased bleeding, and a long postoperative recovery period. In recent years, chiropractors have been exploring the application and feasibility of minimally invasive techniques in the treatment of thoracic spinal stenosis, leading to significant advancements. These advancements include microendoscopic decompression technology, microscopes assisted decompression, percutaneous endoscopy, unilateral double-channel endoscopy in thoracic vertebral diseases, and the use of spinal navigation and robot assistance technologies. These techniques have improved the therapeutic efficacy of thoracic spinal stenosis, reduced trauma and complications, and enhanced the recovery of patients. Notably, percutaneous endoscopy and unilateral biportal endoscopy technologies have shown promising outcomes in the treatment of thoracic spinal stenosis. This article provides a comprehensive review of the research on minimally invasive surgical treatment for thoracic spinal stenosis.
Advances in diagnostic imaging of small cell lung cancer
JIANG Xu, MIAO Lei, YANG Lin, SUN Xujie, HU Sijie, ZHANG Li, LI Meng
2024, 22(2): 296-300. doi: 10.16766/j.cnki.issn.1674-4152.003388
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Lung cancer is the malignant tumor with the highest fatality rate in China and even the world, threatening human life and health. Small cell lung cancer (SCLC) represents about 15% of all lung cancers and is the most aggressive subtype of lung cancer. Compared with non-small cell lung cancer, SCLC is marked by an exceptionally high proliferative rate, a strong predilection for early metastasis, and a poor prognosis. Imaging has the unique advantages of simplicity and non-invasiveness and is widely used in clinical practice as the most basic examination method for lung diseases. How to detect and diagnose SCLC early through imaging examination to intervene on time has become one of the most significant and urgent problems in SCLC diagnosis and treatment strategy. In recent years, imaging examination technology has developed rapidly, in addition to traditional computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography and computed tomography (PET/CT), but also the emergence of energy spectrum CT and functional magnetic resonance imaging (fMRI). At the same time, the wide application of research methods has also provided substantial help for SCLC ' s accurate image diagnosis, such as radiomics and deep learning. Therefore, this paper reviews recent research on the imaging diagnosis of SCLC, aiming to help us better understand the routine imaging diagnosis of SCLC.
Effect of scalp acupuncture combined with rehabilitation training on serum MCP-1, ET, sICAM-1 content and nerve function rehabilitation in patients with acute cerebral infarction
XIAO Chang, YANG Dan, WEI Tianwei, ZHANG Hong
2024, 22(2): 301-303. doi: 10.16766/j.cnki.issn.1674-4152.003389
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  Objective  To explore the effects of scalp acupuncture combined with rehabilitation training on the levels of monocyte chemoattractant protein-1 (MCP-1), endothelin (ET), soluble intercellular adhesion molecule-1 (sICAM-1) in the serum of patients with acute cerebral infarction, as well as the National Institute of Health stroke scale (NIHSS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI) score, and provide a scientific basis for clinical application.  Methods  The subjects were 78 patients with acute cerebral infarction who were treated at the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from June 2021 to August 2023. They were randomly divided into a control group and an observation group using a random number table method, with 39 patients in each group, and all subjects received the same basic treatment. The control group received general rehabilitation training, while the observation group received scalp acupuncture treatment in combination with the control group for 2 weeks. The serum MCP-1 levels of the two groups before and after intervention, changes in ET, sICAM-1 levels, and NIHSS, FMA, and MBI scores were compared.  Results  Before treatment, there was no statistically significant difference in the levels of serum MCP-1, ET, sICAM-1, and NIHSS, FMA, and MBI scores between the two groups of patients (P>0.05). After 2 weeks of treatment, the levels of MCP-1, ET, and sICAM-1 in the serum of both groups significantly decreased (P < 0.05), and the observation group was lower than the control group (P < 0.05); The NIHSS score of the observation group [(5.18±1.68) points] was lower than that of the control group [(7.47±2.25) points, P < 0.001], the FMA score [(47.59±14.62) points] was higher than that of the control group [(34.69±13.34) points, P < 0.001], and the MBI score [(72.28±18.88) points] was higher than that of the control group [(62.59±17.53) points, P < 0.001].  Conclusion  Scalp acupuncture combined with rehabilitation training can significantly reduce the content of MCP-1, ET and sICAM-1 in serum of patients with acute cerebral infarction, effectively improve the symptoms of neurological impairment, improve the motor function and daily living ability of patients, and promote the rehabilitation of neurological function.
Study on the treatment of lower limb muscle spasms after stroke using botulinum toxin A injection combined with spasmodic electromyography stimulation
WANG Huanfen, LIU Wei, CHEN Saiya, CHEN Meilan
2024, 22(2): 304-307. doi: 10.16766/j.cnki.issn.1674-4152.003390
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  Objective  To enhance the treatment options for post-stroke muscle spasms and improve the quality of life of stroke patients, the clinical effect of combining botulinum toxin A injection with spasmodic electromyography stimulation for the rehabilitation of post-stroke lower limb muscle spasms were explored.  Methods  A total of 140 patients with lower limb muscle spasms after stroke who were admitted to Wenzhou Traditional Chinese Medicine Hospital between February 2020 and February 2023 were enrolled. The 70 cases in the observation group and the 70 cases in the control group were randomly divided into two groups using a random number table method. All patients underwent rehabilitation training, The control group received injection of type A botulinum toxin, while the observation group received additional treatment with spasmodic electromyographic stimulation. The study evaluated the therapeutic effect of interventions on lower limb muscle spasms in patients, comparing the levels before and after the intervention. The lower limb muscle ' s motor unit action potential (MUAP) count was measured. The study evaluated the level of motor function and living ability, as well as changes in ultrasonic indexes of gastrocnemius muscle structure.  Results  The research group achieved a significantly higher overall effective rate of lower limb muscle spasm treatment (94.29%, 66/70) compared to the control group (81.43%, 57/70), χ2=5.423, P=0.020. Following the intervention, the number of MUAP in the triceps surae of the observation group (10.92±1.74) was significantly lower than that of the control group (14.86±1.85, t=12.979, P < 0.001). Following the intervention, the scores for Fugl-Meyer assessment scale (FMA), functional ambulation category scale (FAC), and modified Barthel index (MBI) were significantly higher in the observation group than in the control group (P < 0.001). Following the intervention, the observation group exhibited lower PA and MT values of in the lower limb gastrocnemius muscle compared to the control group. Conversely, the FL and MT values were higher in the observation group than in the control group (P < 0.001).  Conclusion  The combination of spastic myoelectric stimulation and botulinum toxin A therapy can enhance the therapeutic effect of lower limb muscle spasms after stroke. It can also alleviate the severity of lower limb muscle spasms, promote the recovery of affected limb muscle structure and function, and improve patients ' motor ability and quality of life.
Application of peer combined with CBL into situational simulation teaching in standardized training of thoracic surgery residents
WANG Gaoxiang, WU Mingsheng, XU Guangwen, WU Hanran, SUN Xiaohui, LIU Changqing, XIE Mingran
2024, 22(2): 308-311. doi: 10.16766/j.cnki.issn.1674-4152.003391
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  Objective  The aimed explore the effectiveness and feasibility of introducing case-based learning (CBL) for situational simulation teaching in the standardized training of thoracic and cardiac surgery residents.  Methods  Sixty residents who underwent residential training in the Department of Thoracic Surgery at the First Affiliated Hospital of University of Science and Technology of China, from January 2021 to April 2022, were selected as participants. They were randomly divided into two groups: the group A, which received traditional teaching method group, and the group B, which received CBL-based situational simulation teaching group, according to the admission order. The teaching methods included mini-clinical evaluation exercise(mini-CEX), direct observation, and direct observation of procedural skill (DOPS). At the end of the training, theory and skill assessment, as well as teaching satisfaction survey, were conducted.  Results  There were no significant differences between the two groups in terms of age, sex, highest education, major, and time of participation in training (P>0.05). The theoretical and skill scores of the group B were significantly higher than those of the group A (t=4.977, P < 0.001; t=3.607, P=0.001). The proportion of excellent Mini-CEX rating in the group B was higher than that in the group A (P < 0.05). Additionally, the Mini-CEX score in the group B was higher than that in the group A (t=2.670, P=0.010). There were no significant difference in DOPS rating and scores between the two groups (Z=-0.869, P=0.385; t=0.405, P=0.687). The satisfaction level of the group B was significantly higher than that of the group A (P < 0.05). Similarly, the satisfaction score of the group B was significantly higher than that of the group A (t=5.007, P < 0.001).  Conclusion  The implementation of peer and CBL-based situational simulation teaching mode has the potential to creat a conductive learning atmosphere, improve the independent learning and clinical thinking skills of resident physicians, and hold significant promise for advancement.
The application of PBL combined with CBL teaching model in the training of urology clinical trainees
NING Jinzhuo, HE Kaixiang, CHENG Fan
2024, 22(2): 312-314. doi: 10.16766/j.cnki.issn.1674-4152.003392
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  Objective  The traditional teaching mode of clinical practice medicine is usually oral teaching by the instructor, and the knowledge flow is mainly one way transfer of "instructor - trainee", which has certain limitations. Based on the traditional teaching model, the problem-based teaching model (PBL) combined with case-based teaching model (CBL) was introduced to reform the teaching method, and the teaching effect was discussed.  Methods  A total of 50 interns in Urology, People ' s Hospital of Wuhan University from September 2019 to June 2022 were selected and divided into two groups according to the odd and even numbers of interns: experimental group and control group (25 persons each). The experimental group adopted the teaching mode of PBL combined with CBL for teaching urology clinical internship teaching, while the control group followed the conventional teaching mode for internship training, the experimental group adopted an innovative approach.  Results  The results demonstrated that the experimental group achieved significantly higher scores in both the clinical thinking test [(44.54±3.75) points] and the total scores [(87.80±3.25) points] than the control group scores [(34.26±2.42) points, (78.28±4.03) points, P < 0.001]; And the students of the experimental group improve the learning efficiency, consolidate the external outside professional knowledge, improve the learning interest and strengthen their learning ability and participation, cultivate clinical thinking [23(92.0%), 24(96.0%), 23(92.0%), 24(96.0%)] were better than those in the control group [17(68.0%), 15(60.0%), 16(64.0%), 16(64.0%), P < 0.05]. There was no significant difference in satisfaction with improving learning efficiency [23 (92.0%) in the experimental group and 22 (88.0%) in the control group, P>0.05].  Conclusion  The teaching mode of PBL combined with CBL in urology clerkship improved the teaching effect and quality, which is worth practicing and promoting in clinical teaching work.
Investigation on the status and demand of general practitioners transfer training in Hebei Province
ZHANG Min, REN Xiaobin, ZHANG Yali, ZHANG Jinjia, ZHAO Wenwen, WANG Rongying
2024, 22(2): 315-320. doi: 10.16766/j.cnki.issn.1674-4152.003393
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  Objective  To investigate the current situation and demand of general practitioners transfer training in Hebei Province, and provide theoretical basis for the formulation of the general practitioners transfer training program in Hebei Province.  Methods  A questionnaire survey was conducted on 801 students who participated in the general practice transfer training in Hebei Province in 2020, and relevant data were collected and analyzed statistically.  Results  The ages of the trainees in general practice transfer training were mostly distributed between 41-50 years old and 31-40 years old; tertiary education accounted for 40.18% (309/769); the trainees ' scope of practice was dominated by internal medicine (64.76%, 498/769); and the workplaces were in township and village health centers accounted for 70.35% (541/769). Most of the trainees had not participated in general practice related learning and training (69.70%, 536/769), and there were statistically significant differences in the trainees ' participation in general practice related training and understanding of general practice and its related theories at different work places (P < 0.05). Trainees thought that the abilities needed to be improved mainly included theoretical knowledge of general practice (89.34%, 687/769) and diagnosis and differential diagnosis of diseases (85.96%, 661/769). There was 38.62% (297/769) trainees believed that the theoretical training duration should be longer than 6 months, 42.26% (325/769) trainees believed that the practical training duration should be 7-12 months, and 44.21% (340/769) trainees believed that grassroots practice teaching could better exercise the clinical thinking of general practice, and there was a statistically significant difference in the needs of students of different ages, educational backgrounds, professional titles and work places for the training of clinical thinking of general practice (P < 0.05). There was 62.16% (478/769) trainees believed that the training teachers should cover general practice, junior college and community, and there was a statistically significant difference in the demand for training teachers among the trainees with different degrees (P < 0.05).  Conclusion  In 2020, the general practitioner transfer training trainees in Hebei Province are older, with relatively low academic qualifications and titles, and varying training needs. Most of the trainees have not participated in the study and training related to general practice before, and have insufficient understanding of the theories and related policies of general practice.
A study of the opinions of general practitioners in Zhejiang Province on the diagnosis and treatment of medically unspecified disease
LOU Zheng, LIU Ying, REN Jingjing
2024, 22(2): 321-325. doi: 10.16766/j.cnki.issn.1674-4152.003394
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  Objective  To understand the perspectives of general practitioners regarding the diagnosis and treatment of medically unspecified disease (MUD).  Methods  From June to August 2019, a total of 425 general practitioners from 11 prefecture level cities of Zhejiang Province were selected using stratified cluster sampling. These practitioners were investigated using a self-designed questionnaire that covered their basic information and perspectives on the diagnosis and treatment of MUD. The questionnaire utilized the "Likert Scale" scoring method for evaluation and subsequent statistical analysis.  Results  A total of 425 questionnaires were distributed, with 325 recovered and deemed valid. Among the respondents, there were 127 males (39.1%) and 198 females (60.9%), with an average age of (38.41±7.74) years. The survey found that 54.1% of general practitioners expressed pressure when treating MUD patients, while 41.6% expressed uncertainty in handing MUD cases. However, a significant majority (72.0%) of general practitioners believed it was worthwhile to assist these patients. Additionally, 70.5% of general practitioners considered MUD challenging to diagnosis, and 68.3% found MUD treatment to be challenging. Notably, male general practitioners in general hospitals demonstrated a higher willingness to treat MUD, which correlated with their years of experience. Overall, general practitioners acknowledged the significant pressure posed by MUD patients. Furthermore, age, length of service, professional title, educational background, workplace, and hospital level all affected doctors ' approach to the diagnosis and treatment of MUD.  Conclusion  Currently, general practitioners lack confidence in the diagnosis and treatment of MUD. To address this issue, it is necessary to establish a MUD diagnosis and treatment center under the leadership of the general medical department in a general hospital. This center should collaborate with multidisciplinary teams and community hospitals to develop a standardized MUD diagnosis and treatment process. Additionally, implementing an early training plan is necessary to foster general practitioners ' general practice thinking, improve their communication skills, and enhance their diagnosis and treatment ability. It is important to establish a harmonious doctor-patient relationship and promote individualized joint decision-making between doctors and patients. Finally, comprehensive management of MUD should be supported by providing recommendations and guidance.
To analyze the coping style classification and its influencing factors of breast cancer patients undergoing chemotherapy after surgery based on latent profile analysis
ZHANG Yanfang, DING Jing, YU Yuanyuan, JIANG Nannan, ZHAO Long, YANG Xiumu
2024, 22(2): 326-330. doi: 10.16766/j.cnki.issn.1674-4152.003395
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  Objective  To analyze the potential categories of coping styles among breast cancer patients and explore the factors that influence them.  Methods  A total of 601 breast cancer patients from three hospitals in Anhui Province were selected as research participants between September 2021 and May 2022. Questionnaire investigations were conducted using the simple coping questionnaire, perceived stress scale, and perceived social support scale.  Results  The coping style of breast cancer patients undergoing postoperative chemotherapy were divided into three categories: the "negative group" (C1), the "positive group" (C2) and the "high positive-high negative group" (C3). Significant differences were observed in the average monthly income, residence, perceived stress, and perceived social support scores among the different categories of breast cancer patients with postoperative chemotherapy (P < 0.05). Compared with the active group, the "negative group" was less likely to have perceived social support (OR=0.957, P < 0.001), and higher levels of perceived stress (OR=1.069, P < 0.01) were associated with a greater likelihood of being in the "negative group". Living in a rural area (OR=1.510, P < 0.05) increased the likelihood of being in the "high positive-high negative group", and higher levels of perceived stress (OR=1.097, P < 0.001) were associated with a higher likelihood of being in the "high positive-high negative group". Compared with the "negative group", higher levels of perceived social support (OR=1.043, P < 0.001) were associated with a higher likelihood of being in the "high positive-high negative group", while a monthly income less than 3 000 yuan (OR=0.431, P < 0.05) decreased the likelihood of being in the high positive-high negative group.  Conclusion  This study categorizes coping styles in breast cancer patients undergoing chemotherapy into three potential categories. Based on these findings, professional nursing staff and health educators can provide personalized psychological intervention to the specific coping styles of individuals.
Effect of specialized nursing interventions combined with short-wave ultraviolet light on oral mucosal injury in patients with nasopharyngeal carcinoma
JIANG Qingyu, WEI Jiazhang, LI Xiang, HUANG Xiaoyan, LI Yanqing
2024, 22(2): 331-334. doi: 10.16766/j.cnki.issn.1674-4152.003396
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  Objective  To explore the effect of specialized nursing interventions combined with short-wave ultraviolet therapy on the oral mucosa of nasopharyngeal carcinoma (NPC) patients who undergoing radiotherapy and chemoradiotherapy.  Methods  Sixty-three patients with NPC who received treatment for the first time from June 2021 to July 2022 were selected and divided into the control group (n=31) and the observation group (n=32) according to the random number table. The control group received conventional nursing interventions, while the observation group received specialized nursing interventions combined with short-wave ultraviolet therapy when oral mucositis appeared during radiotherapy. The severity of oral mucositis during radiotherapy, recovery time, duration of pain caused by oral mucositis, and the days of hospitalization were compared between the groups.  Results  The severity of oral mucositis in the observation group was less than that in the control group. The total days of the recovery of oral mucosal [(10.9±0.9) d vs. (12.9±3.3) d], the duration of oral pain [(9.0±0.9) d vs. (11.0±3.0) d], and the total days of hospitalization [(59.5±3.4) d vs. (65.7±9.5) d] in the observation group were reduced as compared with the control group. The differences were statistically significant (P < 0.05).  Conclusion  Specialized nursing intervention combined with short-wave ultraviolet therapy can reduce the severity of oral mucosal injury, accelerate the recovery of oral mucosal injury, reduce pain, and shorten hospitalization.
The current status and influence factors of knowledge, attitude and practice in online-hailing nurses
PAN Shenshen, SU Xiangyi, ZHENG Xiaodong, LIU Qiong, HUANG Guanli
2024, 22(2): 335-339. doi: 10.16766/j.cnki.issn.1674-4152.003397
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  Objective  This study aims to explore the current status of knowledge, attitude, and practice among online-hailing nurses, as well as identify the influencing factors. The findings will serve as a valuable reference for improving management strategies and promoting their enthusiasm in the field.  Methods  A total of 286 online-hailing nurses were recruited from 4 hospitals between January and March 2023 by convenience sampling. The basic data questionnaire, decent work perception scale, and network nursing knowledge-attitude-practice questionnaire were used in the survey.  Results  The scores for knowledge, attitude, and practice in network nursing were as follows: knowledge (62.73±12.24) points, attitude (61.87±11.96) points, and practice (29.61±4.12) points. The score for decent work perception was (48.96±8.62) points. Among the dimensions of decent work perception, the scores ranked from high to low as follows: career development, job position, working atmosphere, career recognition, and work return. In terms of influencing factors, professional title and network nursing time were found to significantly influence knowledge (P < 0.05). Family support, decent work perception, and network nursing time were identified as influencing factors for attitude (P < 0.05). Decent work perception and family support were found to be influencing factors of practice (P < 0.05).  Conclusion  Hospital managers should pay attention to the enhancement of decent work perception and actively work towards improving relevant systems. They should also conduct targeted training programs for online-hailing nurses based on their different titles. Efforts should be made to minimize the impact of network nursing on families and provide guidance to help nurses develop appropriate professional values.
Application of FMEA model prevention in cancer wound and postoperative recovery in patients with breast cancer
ZHOU Yu, TONG Zongpei, WANG Li, ZHOU Junfeng, LI Qing
2024, 22(2): 340-343. doi: 10.16766/j.cnki.issn.1674-4152.003398
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  Objective  To explore the preventive effect of failure mode and effect analysis (FMEA) model in breast cancer patients, and its impact on cancerous wounds and postoperative recovery.  Methods  A total of 86 patients with breast cancer treated at Chuzhou Integrated Traditional and Western Medicine Hospital from January 2021 to August 2023 were selected and included as study subjects. According to the random number table method, the patients were simply randomly divided into control group (n=43, routine care intervention) and FMEA group (n=43, FMEA model preventive care intervention). The two groups were compared before and after the intervention in terms of cancer wound healing, pain status, functional recovery of the affected limb, anxiety status and nursing satisfaction.  Results  After intervention, the colour normality of exudate in the FMEA group was significantly higher than that in the control group (χ2=4.674, P=0.031), while the odour of exudate was significantly lower than that in the control group [(2.14±0.67) grade vs. (2.58±0.74) grade, t=2.890, P=0.005], but the exudate volume had no significant difference (P>0.05). On the 1st, 3rd, 7th day after intervention, the VAS scores in both groups were gradually decreased (P < 0.05), and the above scores in the FMEA group at different time points were significantly lower than those in the control group (P < 0.05). After intervention, the angle of movement of the affected limb was significantly increased in both groups (P < 0.05), and the above indicators were significantly higher in the FMEA group (P < 0.05). The state anxiety inventory (SAI) score and trait anxiety inventory (TAI) score in both groups were declined significantly after intervention (P < 0.05), and the two scores were significantly lower in the FMEA group compared to control group (P < 0.05). Nursing satisfaction in the FMEA group was significantly higher than in the control group [93.02% (40/43) vs. 76.74% (33/43), χ2=4.440, P=0.035].  Conclusion  FMEA model prevention can effectively promote the recovery of post operative cancer wound and upper limb function, relieve the pain status and anxiety status of patients.
Application of diversified sleep care combined with supportive and expressive group psychological intervention in patients with schizophrenia
TAO Kewei, FU Kang, DAI Huimin, SHEN Keyan
2024, 22(2): 344-348. doi: 10.16766/j.cnki.issn.1674-4152.003399
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  Objective  To explore the effects of diversified sleep care combined with supportive and expressive group psychological intervention on patients with schizophrenia, in order to provide theoretical basis for further optimization of clinical care.  Methods  A total of 90 patients with schizophrenia admitted to Psychosomatic Disorder Department of the Seventh People ' s Hospital of Shaoxing City from June 2020 to June 2023 were randomly divided into control group and observation group using a random number table method, 45 cases in each group. The control group was given routine nursing, and the observation group was given diversified sleep nursing combined with supportive and expressive group psychological intervention on this basis. The sleep quality, emotional state [Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD)], mental resilience [Connor-Davidson resilience scale (CD-RISC)] and coping style [simplified coping style questionnaire (SCSQ)] of the two groups were compared before and after care.  Results  The sleep efficiency of the observation group [(83.23±5.22)%] was higher than that of the control group [(78.25±6.34)%]; Total sleep time [(399.45±20.34) min] and rapid eye movement sleep latency time [(129.23±15.23) min] were longer than those of control group [(369.90±35.21) min and (108.45±13.42) min]; The awakening time [(38.90±6.78) min] was shorter than that of control group [(45.77±5.09) min, t=4.068, 5.090, 6.867, 6.737, P < 0.05]. The HAMA and HAMD scores were significantly lower than those of control group (P < 0.05). The score and total score of CD-RISC were higher than those of control group (P < 0.05). The positive coping score in SCSQ was higher than that in control group (P < 0.05), and the negative coping score was lower than that in control group (P < 0.05).  Conclusion  Diversified sleep care combined with supportive and expressive group psychological intervention can effectively improve the sleep quality and reduce negative emotions, improve the level of mental resilience and improve the coping style of schizophrenia patients.
Severe pneumonia complicated with encapsulated empyema caused by Streptococcus anginosus in a child: a case report and literature review
HAN Meilin, XU Zhong, ZHU Qiujiao, ZHOU Libing, ZHANG Chunxu, HUANG Saihu, BAI Zhenjiang, WU Shuiyan
2024, 22(2): 349-351. doi: 10.16766/j.cnki.issn.1674-4152.003400
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This article reported a case of severe pneumonia and encapsulated empyema in a child caused by streptococcus anginosus infection. The patient was admitted to the hospital with fever and shortness of breath. A computed tomography scan of the chest showed bilateral pneumonia, pulmonary consolidation with partial atelectasis, and bilateral encapsulated pleural effusion. After timely antibiotic therapy combined with video-assisted thoracoscopic surgery, the child had a significant clinical improvement. The patient was followed up for 2.5 months after discharge, he was well. The chest X-ray was normal, and there were no sequelae.
Application of health management, general practice and specialty joint management mode in a patient with cerebral small vessel disease
ZHANG Guifen, TONG Yuling, GUO Yi
2024, 22(2): 352-356. doi: 10.16766/j.cnki.issn.1674-4152.003401
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Small vessel disease caused by small artery occlusion accounts for about 30% of the aetiology of ischaemic stroke in China. Many small vessel diseases are hidden, and their treatment and prognosis are different from those of large atherosclerotic stroke. In recent years, the understanding of cerebrovascular disease has become more profound. In 2021, the consensus of Chinese experts on the diagnosis and treatment of cerebrovascular disease was updated, but general practitioners still do not have enough understanding of this disease, and there are blind spots in the diagnosis, treatment and management of this disease in practice. By presenting the diagnosis, treatment and follow-up of a patient with cerebrovascular disease, we can help general practitioners improve their understanding of this disease, particularly in the treatment of cerebral microbleeds, and demonstrate the application of our "sound professional" integrated management model in the management of such patients.

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