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2025, Volume 23,  Issue 3

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General Practice Forum
Development status and future demand projections of general practitioners in China
HU Bingzhi, ZHANG Tao, CHEN Xiaoling, CHEN Xiaodong, SHI Shuyin
2025, 23(3): 357-361. doi: 10.16766/j.cnki.issn.1674-4152.003903
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  Objective  To analyze the development trends of general practitioners (GPs) in China from 2012 to 2021 and predict the number of general practitioners from 2022 to 2026.  Methods  A database was established using Excel 2010. The gray GM (1, 1) model and the exponential smoothing model were used to predict and analyze the number of general practitioners in China, respectively.  Results  During the observation period, the total number of general practitioners, the number of registered general practitioners, and the number of general practitioners per 10 000 population all showed an increasing traend. The total number of general practitioners increased from 109 794 in 2012 to 434 868 in 2021, with an average annual growth rate of 18.77%. The number of registered general practitioners under the general practice specialty increased from 37 173 in 2012 to 314 297 in 2021, with an average annual growth rate of 30.58%. The number of general practitioners per 10 000 population increased from 0.81 in 2012 to 3.08 in 2021, with an average annual growth rate of 18.17%. The grey GM (1, 1) model for GPs has a grade 1 fit, with an average relative error of 3.341%. The best exponential smoothing model for general practitioners was the Brown linear trend model, with an average relative error of 3.338%.  Conclusion  The accuracy of the exponential smoothing model for predicting general practitioners in China from 2012 to 2021 is better than that of the grey GM (1, 1) model. However, the problem of the total shortage of general practitioners in China is expected to persist in the future. It is necessary to further increase the allocation of the total number of general practitioners and optimize the cultivation and incentive mechanism of general practitioners.
Special Topic/Gestational Diabetes Mellitus
Expression of serum asprosin in patients with gestational diabetes mellitus and its correlation with glucose and lipid metabolism
LI Siman, CHEN Juan, ZHANG Wenjie
2025, 23(3): 362-364. doi: 10.16766/j.cnki.issn.1674-4152.003904
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  Objective  To investigate whether there is abnormal expression of serum asprosin in patients with gestational diabetes mellitus (GDM), and to analyze its relationship with glycolipid metabolism indexes, so as to provide new ideas for the pathogenesis of GDM.  Methods  A total of 86 GDM patients (GDM group) and 50 healthy pregnant women (control group) were selected from Northwest Women and Children's Hospital from April 2020 to April 2021. GDM patients were divided into a high-expression group (n=44) and a low-expression group (n=42). Glucose and lipid metabolism indexes and serum asprosin level were detected, the correlation between serum asprosin and other indexes was analyzed, and the risk factors of GDM were analyzed by multi-factor logistic regression.  Results  The level of serum asprosin in the GDM group [(2.56±0.61) ng/mL] was higher than that in the control group [(1.12±0.43) ng/mL, P < 0.05]. Serum asprosin were positively correlated with triacylglycerol, total cholesterol, fasting blood glucose (FBG), fasting insulin (FINS), and insulin resistance index (HOMA-IR) in GDM patients (r=0.312, 0.327, 0.403, 0.462, 0.518, all P < 0.05). High levels of FBG (OR=3.216, 95% CI: 1.434-7.210), FINS (OR=2.869, 95% CI: 1.395-5.902), HOMA-IR (OR=3.511, 95% CI: 1.456-8.466), serum asprosin (OR=2.659, 95% CI: 1.295-7.003) were risk factors for GDM (P < 0.05).  Conclusion  The high expression of serum asprosin in patients with GDM is closely related to the level of glucose and lipid metabolism.
Research on the clinical application of flash glucose monitoring system in blood glucose management during pregnancy
AN Yan, ZU Fei, DONG Xuejie, YU Ping, ZHU Wei
2025, 23(3): 365-368. doi: 10.16766/j.cnki.issn.1674-4152.003905
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  Objective  To apply the 28-day flash glucose monitoring (FGM) system to gestational diabetes mellitus (GDM) patients undergoing insulin therapy, observe the impact of FGM on blood glucose management and pregnancy outcomes, and provide evidence for the selection of better blood glucose monitoring methods in clinical practice.  Methods  The study subjects were 98 patients diagnosed with GDM and receiving insulin therapy at Beijing Aerospace General Hospital from April to October 2022. They were divided into the FGM group (49 cases) and the self-monitoring of blood glucose (SMBG) group (49 cases) using a random number table method. The fasting blood glucose (FBG), 2-hour plasma glucose (2hPG), mean blood glucose (MBG), estimated glycated hemoglobin (eHbA1c), time to target blood glucose (TIR), incidence of hypoglycemia, weight compliance and pregnancy outcome were compared between the two groups.  Results  The levels of MBG and eHbA1c in FGM group were significantly lower than those in SMBG group (P < 0.05), but there was no statistical significance in FBG, 2hPG and TIR (P > 0.05). The weight control rate during pregnancy in the FGM group was significantly higher than that in the SMBG group [61.22% (30/49) vs. 40.82% (20/49), P < 0.05]. The incidence of cesarean section, premature birth, prelabor rupture of membranes, and macrosomia among pregnant women in the FGM group were significantly lower than those in the SMBG group (P < 0.05). Logistic regression analysis revealed that underweight during pregnancy was an independent risk factor for adverse pregnancy outcomes, including cesarean section and preterm birth (OR=14.639, 95% CI: 1.747-122.655, P=0.013).  Conclusion  The application of FGM system can help achieve ideal blood glucose control and weight control, reducing the risk of adverse pregnancy outcomes.
Construction and preliminary validation of a nomogram model for predicting the risk of postpartum depression in gestational diabetes mellitus patients
ZHU Dan, ZHANG Liqin, ZHANG Haibo, ZHU Lingling, CHEN Qianya
2025, 23(3): 369-373. doi: 10.16766/j.cnki.issn.1674-4152.003906
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  Objective  To construct a nomogram model for predicting the risk of postpartum depression (PPD) in women with gestational diabetes mellitus (GDM) and to preliminarily validate its predictive efficacy.  Methods  A total of 318 GDM patients admitted to Nantong Maternal and Child Health Care Hospital from January 2021 to December 2023 were retrospectively enrolled in this study. Six weeks after delivery, the Edinburgh postnatal depression scale (EPDS) was used to assess PPD, and the patients were divided into a PPD group (n=76, 23.9%) and a non-PPD group (n=242, 76.1%). Demographic characteristics, gestational clinical features, blood glucose levels, and complications were collected. Independent risk factors for PPD were screened by multivariate logistic regression analysis, and a nomogram model was constructed based on the regression results. The discrimination and calibration of the model were evaluated using the receiver operating characteristic (ROC) curve and calibration curve, respectively. A clinical decision curve was also plotted.  Results  Multivariate logistic regression analysis showed that pre-pregnancy BMI, gestational weight gain, being an only child, average monthly family income, fasting blood glucose, 2-hour postprandial blood glucose, and the occurrence of gestational complications were independent risk factors for PPD in GDM patients (P < 0.05). The nomogram model based on these variables had an area under the ROC curve of 0.958 (95% CI: 0.893-0.989), indicating good discrimination. The model also showed good calibration, with the predicted values being consistent with the actual observed values (Hosmer & Lemeshow χ2=5.399, P=0.714). The clinical decision curve showed that when the risk of PPD in GDM patients predicted by this model was >0.3, timely intervention based on the patient's clinical characteristics could achieve higher net benefits.  Conclusion  The nomogram model for predicting the risk of PPD in GDM patients constructed in this study is simple, easy to use, and has good predictive efficacy. It can provide a reference for the early identification and intervention of PPD in GDM patients in clinical practice.
General Practice Research
Current status and influencing factors of return-to-work readiness in middle-aged and young patients after cardiac pacemaker implantation
KANG Sitan, GAO Min, WEN Gaoqin, ZHONG Weinan, SUN Guozhen
2025, 23(3): 374-378. doi: 10.16766/j.cnki.issn.1674-4152.003907
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  Objective  Return-to-work is one of the important indicators of recovery for middle-aged and young patients after cardiac pacemaker implantation. However, research on their readiness to return to work remains limited. This study aims to investigate the current status of return-to-work readiness among middle-aged and young patients after cardiac pacemaker implantation and analyze its influencing factors.  Methods  Using a convenience sampling method, this study selected 158 patients who successfully underwent pacemaker implantation at the First Affiliated Hospital of Nanjing Medical University from January 2021 to October 2023. Data were collected using the general demographic questionnaire, the readiness for return-to-work scale, the simple coping style questionnaire, and the HALFT (help, participation, loneliness, financial, talk) scale.  Results  The return-to-work rate among middle-aged and young patients post-pacemaker implantation was 61.39%. Among the 97 patients who returned to work, 12.37% (12 cases) were in the indeterminate maintenance phase, while 87.63% (85 cases) were in the active maintenance phase. Among the 61 patients who had not yet returned to work, 57.38% (35 cases) were in the pre-contemplation stage, 32.79% (20 cases) were in the contemplation stage, 3.28% (2 cases) were in the action preparation-self-assessment stage, and 6.56% (4 cases) were in the action preparation-behavior stage. Age, gender, education level, preoperative ejection fraction, positive coping style, and social frailty were significant influencing factors of the return-to-work status for middle-aged and young patients after cardiac pacemaker implantation.  Conclusion  The current status of return-to-work among middle-aged and young patients following cardiac pacemaker implantation requires improvement. Healthcare professionals should implement multidimensional, personalized intervention strategies to help patients actively cope with their illness and life challenges. These strategies should also focus on expanding social support networks to prevent social frailty, thereby accelerating patients ' return to normal family life and work and promoting comprehensive social rehabilitation.
Prediction value of Caprini score combined with serology for lower extremity deep vein thrombosis in patients with gynecological malignant tumor
WEI Xinyuan, WANG Caizhi, WANG Lingling
2025, 23(3): 379-382. doi: 10.16766/j.cnki.issn.1674-4152.003908
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  Objective  The clinical characteristics and serological indexes of patients with lower extremity deep vein thrombosis (DVT) after surgery for gynecologic malignant tumor are retrospectively analyzed, and the predictive value of Caprini score combined with preoperative D-D and FIB for postoperative DVT in patients with gynecologic malignant tumor is discussed.  Methods  Ninety-five patients with postoperative DVT of lower limbs who were treated in the Department of Gynecology and Gynecologic Oncology of the First Affiliated Hospital of Bengbu Medical University from October 2018 to October 2022 were selected as the thrombus group, and 190 patients who were admitted for surgical treatment during the same period but did not develop DVT were included as the non-thrombotic group at a ratio of 1∶2. The general data of the two groups were compared, and the relationship between Caprini score and preoperative D-D, FIB was analyzed, and the predictive value of the combined application of the three on postoperative DVT of gynecological malignant tumor was discussed.  Results  Postoperative Caprini score was positively correlated with preoperative D-D and FIB in thrombus group (r=0.375, 0.426, both P < 0.05). The AUC of postoperative DVT in patients diagnosed with gynecological malignant tumor by Caprini score, D-D and FIB were 0.832, 0.811 and 0.782, respectively. The optimal critical values were 8.50 points, 0.54 mg/L and 3.26 g/L, respectively. The sensitivity were 62.10%, 76.80% and 69.50%, respectively. The specificity were 90.50%, 74.70% and 77.90%, respectively. The sensitivity and specificity of Caprini score combined with D-D and FIB in the diagnosis of postoperative DVT in patients with gynecological malignant tumor were 78.90%, 79.50% and 0.859 (P < 0.05).  Conclusion  In patients with gynecological malignant tumors, postoperative Caprini score is positively correlated with preoperative D-D and FIB. When postoperative Caprini score is ≥8.50 points, preoperative D-D is ≥0.54 mg/L and preoperative FIB is ≥3.26 g/L, DVT should be highly suspected.
Differential expression of circular RNAs in the plasma of premature infants with retinopathy
ZHANG Liya, ZHU Pan, JIN Xiamin, JIE Qingqing, CUI Yingbo, CHEN Lili
2025, 23(3): 383-387. doi: 10.16766/j.cnki.issn.1674-4152.003909
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  Objective  This study aims to analyze the expression profile changes of circular RNA (circRNA) in the plasma of children with retinopathy of prematurity (ROP).  Methods  Three children with ROP hospitalized at Women and Children's Hospital of Ningbo University from January 2023 to August 2023 were selected as the ROP group, while three children without ROP during the same period were selected as the control group. High-throughput sequencing technology was used to detect and screen for differentially expressed circRNAs in hemorrhagic plasma, followed by bioinformatic analysis including gene ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Online databases were employed to predict the potential target microRNAs (miRNAs) of circRNA.  Results  Compared with the control group, a total of 108 circRNAs were significantly differentially expressed in the plasma of patients in the ROP group (P<0.05, fold change≥1), with 41 upregulated and 67 downregulated circRNAs. Bioinformatics analysis revealed that pathways such as proton-transporting ATP synthase and cellular metabolism play important roles in the occurrence and development of ROP. The relationship between differentially expressed circRNA and miRNA was predicted using miRanda and psRobot software, and a circRNA-miRNA regulatory network diagram was constructed.  Conclusion  Differential expression of circRNA exists between the ROP group and the control group, suggesting their potential involvement in the occurrence and development of ROP, or as novel molecular markers for diagnosis and treatment of ROP.
Clinical study on preoperative non-retention of double J-tube in the treatment of upper renal and ureteric calculi with flexible ureteroscope
WU Yu, FENG Feiming, XU Weiqiang, GU Mingli
2025, 23(3): 388-391. doi: 10.16766/j.cnki.issn.1674-4152.003910
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  Objective  To explore the application prospects of preoperative non-retention of double J-tube in the treatment of upper renal and ureteric calculi with flexible ureteroscope.  Methods  A retrospective analysis was conducted on the clinical data of 100 patients with renal calculi or upper ureteric calculi treated with flexible ureteroscope in the Urology Department of the Second Affiliated Hospital of Bengbu Medical University from September 2020 to September 2022. The patients were divided into two groups based on whether a double-J stent was indwelled preoperatively. In the experimental group, 50 patients underwent flexible ureteroscope holmium laser lithotripsy in the first stage without preoperative retention of double J-tube, while the control group of 50 patients received preoperative double-J tube placement and second-stage surgical treatment. The indicators such as one-time success rate of access sheath, operation time, postoperative hospital stay, complication rate, hospitalization costs, and stone residue rate were compared between the two groups of patients.  Results  There were no statistically significant differences between the two groups in terms of the one-time success rate of the access sheath, operation time, postoperative hospital stay, and residual stone rate (P>0.05). There were also no statistically significant differences between the two groups in postoperative C-reactive protein, procalcitonin, incidence of hematuria, infection, urinary system injury, and overall complication rates (P>0.05). The hospitalization cost of the experimental group was [(14 190±148) yuan], which was lower than that of the control group [(16 770±161) yuan], and the difference was statistically significant (t=8.364, P<0.001).  Conclusion  Preoperative non-retention of double J-tube has no significant impact on the surgical success rate, operation time, postoperative hospital stay, complication rate, and stone residue rate in the treatment of upper renal and ureteric calculi with flexible ureteroscope. However, it can significantly reduce the hospitalization costs for patients, and is worth promoting clinically.
Expression and clinical significance of miR-330-3p and AXIN1295aa in gastric cancer
LI Yang*, WANG Kai, SONG Zonggong
2025, 23(3): 392-396. doi: 10.16766/j.cnki.issn.1674-4152.003911
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  Objective  miRNA and the Wnt/β-catenin signaling pathway play important roles in the occurrence and development of tumors. This study aims to explore the effects of miRNA-330-3p (miR-330-3p) and axis suppressor protein 1295aa (AXIN1295aa) expression on gastric cancer.  Methods  A total of 130 patients with gastric cancer admitted to Nanyang Second General Hospital from January to October 2020 were selected. The mRNA expression of miR-330-3p and AXIN1295aa in gastric cancer tissues was detected by qRT-PCR. The expression level of AXIN1295aa protein was detected by immunohistochemistry.  Results  The expression levels of miR-330-3p and AXIN1295aa mRNA in gastric cancer tissue were significantly higher (1.79±0.24 and 0.52±0.10) than those in normal gastric mucosal tissue (1.05±0.14 and 0.11±0.03, t=30.382, 40.575, P < 0.05). The positivity rate of AXIN1295aa protein in gastric cancer tissue was 70.77%, significantly higher than that in normal gastric mucosal tissue 37.69% (x2=16.426, P < 0.001). There were statistically significant differences in the expression levels of miR-330-3p and AXIN1295aa among patients with different tumor diameter, differentiation degree, TNM staging, lymph node metastasis, and invasion of the serosal layer (P < 0.05). There was a statistically significant difference in the 3-year survival rate of gastric cancer patients with different levels of miR-330-3p and AXIN1295aa expression (P < 0.01). The combination of miR-330-3p and AXIN1295aa had a high predictive value for 3-year mortality risk in gastric cancer patients (AUC=0.846). There was a positive correlation between miR-330-3p and AXIN1295aa mRNA expression levels in gastric cancer tissue.  Conclusion  The high expression of miR-330-3p and AXIN1295aa in gastric cancer tissues is closely related to postoperative survival of patients, and can be used as a potential prognostic indicator.
Evaluation and application of rational drug use for fat emulsion, amino acids (17) and glucose (11%) injection based on AHP-TOPSIS method
WANG Cong*, FAN Kaikai, LIU Hongfeng, WANG Xiyong
2025, 23(3): 397-400. doi: 10.16766/j.cnki.issn.1674-4152.003912
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  Objective  To by constructing the drug utilisation evaluation (DUE) standard of fat emulsion, amino acids (17) and glucose (11%) injection, it provides a reference basis for the rational use of medication in the clinic.  Methods  A total of 255 medical records of fat emulsion, amino acids (17) and glucose (11%) injection from January to December 2023 in Suzhou Hospital of Anhui Medical University were selected by simple random sampling, and the evidence-based medical data, guidelines, expert consensus and drug instructions related to fat emulsion, amino acids (17) and glucose (11%) injection were used as the theoretical basis to establish DUE criteria for our hospital. The weight coefficients of each index were calculated by the hierarchical analysis (AHP) method, and the data of the patients who applied fat emulsion, amino acids (17) and glucose (11%) injection were retrospectively analysed and evaluated by the method of technique for order preference by similarity to an ideal solution (TOPSIS), and the evaluation results were classified into three levels of irrationality of the medication, basic rationality of the medication, and reasonableness of the medication according to the distribution of the relative proximity (Ci).  Results  The evaluation results of 255 patients applying fat emulsion, amino acids (17) and glucose (11%) injection by the AHP method combined with the TOPSIS method showed a low rate of rationality in the prescription of fat emulsion, amino acids (17) and glucose (11%) injection, of which 67 cases (Ci≥0.8, 26.27%) were reasonably medicated, 37 cases (0.6 ≤Ci < 0.8, 14.51%) medication was basically reasonable, and 151 cases (Ci < 0.6, 59.22%) were unreasonably medicated; the main problems of unreasonable medication were focused on indications for medication, timing of medication, nutritional assessment, monitoring of medication, combination of medication and contraindications.  Conclusion  The AHP-TOPSIS method was used to establish the DUE criteria for the clinical application of fat emulsion, amino acids (17) and glucose (11%) injection, which is presented in the form of quantifiable data, and its evaluation results are scientific, reasonable, intuitive and credible, which can objectively reflect the use of fat emulsion, amino acids (17) and glucose (11%) injection. The study found that there are still many unreasonable phenomena in the clinical application of this drug, and it is necessary to formulate effective measures to intervene and strengthen the management, so as to find out the problems and make improvements.
Comprehensive analysis between ferroptosis-related gene signatures and neuroblastoma prognosis
DUAN Jinjiang*, LIU Xingyu, ZHAO Xu, ZHOU Kai, SHEN Qiyang
2025, 23(3): 401-405. doi: 10.16766/j.cnki.issn.1674-4152.003913
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  Objective  Neuroblastoma (NB) is a neoplasm that originates from the neural crest cells of the developing embryo. It is one of the most prevalent extracranial malignancies affecting the central nervous system, manifesting as a solid tumor in the pediatric population these tumors typically develop in the adrenal glands or the sympathetic ganglia. The clinical presentation of NB can vary significantly ranging from asymptomatic incidental tumors to widespread metastases accompanied by systemic manifestations. While children diagnosed with clinically stable NB can be successfully treated, those with high-risk NB often have a poor prognosis, even with combination therapy strategies. In order to assess the prognosis of patients with neuroblastoma (NB), there is a need for in-depth study of sensitive biomarkers.  Methods  Gene sequencing and clinicopathological raw data of 126 and 498 cases were obtained from the TARGET and GEO database. We engaged in a discourse on the role of ferroptosis death-related genes (FRGs) as a prognostic biomarker for NB patients. Lasso-Cox regression analysis was utilized to select FRGs related to prognosis. The experiment involved DRD4 gene knockdown in neuroblastoma, and detected the migration and proliferation ability of tumor cells after DRD4 gene knockdown.  Results  In the TARGET cohort, a prognostic prediction model was constructed using a selection of five genes. The risk score was calculated based on the five selected FRGs. Patients were divided into low-risk and high-risk groups according to the median risk score. The high-risk group exhibited a higher relative abundance of immune cells, and the expression of immuno-oncology targets was found to be up-regulated in patients with high-risk scores. Furthermore, the high-risk group exhibited a heightened association with oxidative phosphorylation and MTORC1 signaling. Knockdown of DRD4 significantly reduced the number of surviving cells and inhibited the migration and proliferation of NB.  Conclusion  FRGs have been identified as sensitive biomarkers with the potential to predict the prognosis of patients with NB. These findings underscore the significance of FRGs in the fields of clinical immunotherapy and targeted therapy.
Application of common carotid artery blood flow monitoring in fluid resuscitation of adult patients with septic shock
YU Zhe*, ZU Chenchen, SHENG Shizheng, LI Gang
2025, 23(3): 406-409. doi: 10.16766/j.cnki.issn.1674-4152.003914
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  Objective  To monitor the velocity of common carotid artery in septic shock patients, and analyze the correlation between the variability of common carotid artery blood flow and the effect of fluid resuscitation.  Methods  A total of 107 patients with septic shock admitted to Chun ' an Branch of Zhejiang Provincial People ' s Hospital from August 2020 to June 2023 were taken as the research object. Before and after fluid resuscitation, they were divided into two groups according to the rising rate (ΔSVI) of cardiac stroke index (SVI). ΔSVI < 10% was non-response group (42 cases) and ΔSVI≥10% was response group (65 cases). The general data and ultrasonic parameters of the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the effect of liquid resuscitation. The value of ROC and AUC analysis of common carotid artery blood flow variability was used to evaluate the effect of fluid resuscitation.  Results  ΔASVI, velocity-time integral difference before and after passive leg raising test (ΔVTI), corrected blood flow time difference (ΔFTc), variation rate of common carotid artery peak flow velocity (ΔVpeakCA), respiratory variation rate of inferior vena cava (ΔIVC) and respiratory variation rate of aortic peak flow velocity (ΔVpeakAo) in the occurrence group were lower than those in the non-occurrence group, and the difference was statistically significant (P<0.05). Multivariate logistic regression results showed that ΔVTI (OR=1.087, 95% CI: 0.009-0.876), ΔFTc (OR=1.499, 95% CI: 1.013-2.219), ΔVpeakCA (OR=1.555, 95% CI: 1.071-2.256) and ΔIVC(OR=2.427, 95% CI: 1.060-5.554) were factors influencing the effectiveness of fluid resuscitation (P<0.05). ROC curve showed that the AUC of the combination of ΔVTI, ΔFTc, ΔVpeakCA and ΔIVC (0.969) was significantly higher than that of ΔVTI (0.833), ΔFTc (0.648), ΔVpeakCA (0.886) and ΔIVC (0.596).  Conclusion  The variability of common carotid artery blood flow is a factor affecting fluid resuscitation in patients with septic shock, and ΔVpeakCA has high evaluation value for patients.
General Clinical Research
Analgesic effect of paraneural injection of Esketamine on patients undergoing modified radical mastectomy for breast cancer
PANG Xiyou*, LIAO Junfeng, XU Chaoyang
2025, 23(3): 410-413. doi: 10.16766/j.cnki.issn.1674-4152.003915
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  Objective  To explore the postoperative analgesic effect of paraneural injection of Esketamine in patients undergoing modified radical mastectomy modified radical mastectomy for breast cancer, and to provide reference for clinical formulation of postoperative analgesia program.  Methods  A total of 115 modified radical mastectomy patients admitted to Jinhua Central Hospital from January 2022 to July 2024 were randomly divided into group A (n=57) and group B (n=58) using a random number table method. Group A did not receive perineural injections, while group B received perineural injections of ketamine and ropivacaine. The postoperative recovery quality [15-item quality of recovery (QoR-15)], inflammatory factor levels [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], postoperative analgesic effect (VAS score), sleep quality [Pittsburgh sleep quality index (PSQI)], and adverse reactions (nausea, vomiting, dizziness, delirium) of two groups were observed.  Results  The QoR-15 score in group B [(107.42±7.46) points] was higher than that in group A [(102.17±6.95) points] 72 hours after surgery (P<0.05). The postoperative levels of IL-6 and TNF-α in both groups showed a decreasing trend, with group B showing a greater decrease (P<0.05). The static and dynamic VAS scores of both groups showed an increasing trend after surgery, but the increase in group B was smaller (P<0.05). The PSQI score of group B at 72 hours after surgery [(7.15 ±1.24) points] was lower than that of group A [(8.23±1.41) points, P<0.05]. The incidence of adverse reactions was 8.62% (5/58) in group B and 12.28% (7/57) in group A, and there was no significant difference between the two groups (χ2=0.408, P=0.523).  Conclusion  Paraneural injection of Esketamine can improve the quality of postoperative recovery, reduce inflammatory reactions, alleviate postoperative pain, and improve sleep quality in modified radical mastectomy patients, which is worthy of application.
Construction of risk prediction model of enteral feeding intolerance in severe neurosurgical patients based on machine learning algorithm
YU Shanzhao*, BAO Yiping, ZHAO Ling, YOU Hui
2025, 23(3): 414-416. doi: 10.16766/j.cnki.issn.1674-4152.003916
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  Objective  Severe patients are prone to gastrointestinal motor dysfunction when experiencing stress. Among the various clinical manifestations of this condition, feeding intolerance (FI) is a common occurrence. Prolonged FI increases the risk of a poor prognosis. The objective of this study is to develop a risk prediction tool for FI in adult neurosurgical patients with severe symptoms. The tool will be constructed using a machine learning algorithm to predict enteral nutrition feeding intolerance. The tool will help to reduce the incidence of FI and improve the prognosis of patients.  Methods  A retrospective analysis of the clinical data of 396 patients with severe neurological conditions in the intensive care unit of the Affiliated Hospital of Shaoxing University of Arts and Sciences from January 2018 to May 2024 was conducted. The study aimed to identify the risk factors for FI in neurosurgical critical patients Three machine learning algorithms were employed to construct an FI risk prediction model. The 396 neonatal intensive care unit (NICU) patients were randomly divided into a training set (n=272) and a validation set (n=124) according to a 7∶3 ratio. Machine learning algorithms were used to construct a prediction model in the training set, and the sensitivity and accuracy of the model were evaluated using the validation set.  Results  The incidence of FI in NICU patients was 35.86% (142/396). A subsequent analysis of the influencing factors revealed that a history of diabetes, the use of mechanical ventilation, the use of vasoactive drugs, an albumin level of < 35 g/L, and low blood potassium concentration were independent risk factors for FI in NICU patients. All three models demonstrated good accuracy and sensitivity. The Kappa values of all three models exceeded 0.80, and their negative and positive predictive values were greater than 0.90. The logistic regression analysis model exhibited superior predictive power.  Conclusion  The FI prediction performance of the three models is satisfactory, and the FI prediction model of the logistic regression analysis model has more advantages, which can effectively identify the risk of FI in neurosurgical critical patients. This is conducive for predicting and identifying patients with high risk of FI.
Application of "EndoAngel"-assisted colonoscopy in the detection rate of colorectal polyps
LI Qiongxia, LI Xiumei, YE Yingjian, LI Min, LI Jiazi
2025, 23(3): 417-420. doi: 10.16766/j.cnki.issn.1674-4152.003917
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  Objective  To explore the application value of "EndoAngel" assisted colonoscopy in the examination of colon polyps, and to provide some reference for medical workers in the diagnosis and screening of colon polyps.  Methods  A total of 1 080 patients undergoing colonoscopy at the Endoscopy Center of Xiangyang No.1 People ' s Hospital from August 2023 to March 2024 were randomly assigned into the control group (n=540) and the experimental group (n=540) using a random number table. The control group underwent conventional colonoscopy with observations jointly performed by endoscopy nurses and endoscopists, while the experimental group utilized real-time monitoring with "EndoAngelⓇ" assisted colonoscopy. The primary outcome measure was the polyp detection rate (PDR), while secondary outcomes included polyp size, single or multiple polyps, bowel preparation quality, as well as the sensitivity and specificity for detecting colorectal adenomas.  Results  The PDR of the experimental group [24.07% (130/540) vs. 15.56% (84/540)] was higher than that of the control group (χ2=12.331, P<0.001). There was no statistically significant difference in the quality of intestinal preparation between the two groups (P>0.05). The difference in polyp size detection between the two groups was statistically significant (P<0.05). Compared with the control group, the experimental group had an advantage in detecting small and micro polyps; The difference in the number of polyps detected between the two groups was statistically significant (P<0.05). Among 180 patients who underwent pathological examination, the experimental group had higher specificity and sensitivity than the control group (P<0.05).  Conclusion  Real-time monitoring by "EndoAngelⓇ" assisted colonoscopy has significant advantages in improving the detection rate of colonic polyps, especially small polyps, and multiple polyps, which can prevent and treat colorectal cancer earlier.
Impact of patellar treatment methods on clinical outcomes in artificial knee replacement surgery
LIU Dong, SHAO Long
2025, 23(3): 421-424. doi: 10.16766/j.cnki.issn.1674-4152.003918
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  Objective  This study aimed to evaluate the effects of simultaneous patellar replacement versus patelloplasty during total knee arthroplasty (TKA) on postoperative patellar mechanical characteristics, knee joint function, and complications in patients.  Methods  A total of 80 patients with knee osteoarthritis and admitted to Anji County Second People ' s Hospital from September 2021 to September 2023 were included. They were randomly divided into a patelloplasty group (40 cases) and a replacement group (40 cases) using a computer random number table method. The patelloplasty group underwent patellar reshaping surgery simultaneously during the TKA process, while the replacement group underwent patellar replacement surgery simultaneously during the TKA process. The biomechanical characteristics of the patient ' s patella after surgery were simulated and analyzed, and the changes in knee joint and patellar function before and after surgery were evaluated. Complications were monitored for one year after surgery.  Results  The maximum structural stress of the patella in the extended, 45° flexed and 90° flexed states after replacement surgery were significantly lower than those in the patelloplasty group (P < 0.001). The knee society score (KSS) score, hospital for special surgery (HSS) score, and Lysholm score of the replacement group were significantly higher than those of the patelloplasty group at 1 year after surgery [(84.63±6.68) points, (87.92±7.18) points, and (92.46±6.91) points, respectively, P < 0.001]. The Kujala score and Feller score of the replacement group [(86.47±6.54) points and (27.95±2.36) points, respectively] were significantly higher than those of the patelloplasty group [(80.35±6.21) points and (25.42±2.14) points, respectively] at one year after surgery (P < 0.001). The complication rates showed no statistically significant difference in both groups of patients (P>0.05).  Conclusion  While both patelloplasty and patellar replacement in TKA can effectively prevent complications, patellar replacement is more helpful in reducing postoperative patellar stress and improving knee joint and patellar function.
The value of serum Cys-C, β2MG and SCr in the diagnosis of chronic renal failure complicated with heart failure and their relationship with cardiac function grading
SHANG Chuanbo, CHEN Xin, CHEN Jianguo
2025, 23(3): 425-429. doi: 10.16766/j.cnki.issn.1674-4152.003919
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  Objective  To analyze the value of serum cystatin C (Cys-C), β2 microglobulin (β2MG) and creatinine (SCr) in the diagnosis of chronic renal failure (CRF) complicated with heart failure, and to analyze their relationship with cardiac function, so as to provide reference for clinical diagnosis of this disease.  Methods  A total of 60 patients with CRF complicated with heart failure admitted to Wuhu First People ' s Hospital from January 2020 to July 2023 were selected as the observation group, another 60 patients with CRF during the same period were selected as the simple CRF group, and 60 healthy subjects during the same period were selected as the control group. Serum levels of Cys-C, β2MG and SCr were compared between the three groups of subjects and those in the observation group with different cardiac function grades. The value of serum Cys-C, β2MG and SCr alone or combined in the diagnosis of CRF complicated with heart failure was analyzed by ROC curve, and the relationship between serum Cys-C, β2MG and SCr and cardiac function grades was analyzed.  Results  The serum levels of Cys-C, β2MG and SCr in observation group were higher than those in simple CRF group and control group, and those in simple CRF group were higher than those in control group (P < 0.05). The levels of Cys-C, β2MG and SCr in grade Ⅳ patients were higher than those in grade Ⅰ, grade Ⅱ and grade Ⅲ patients (P < 0.05). The AUC value of serum Cys-C, β2MG and SCr combined detection in the diagnosis of CRF complicated with heart failure was higher than that of single detection (Z=4.303, 3.843, 5.867, all P < 0.05). Logistic regression analysis showed that serum Cys-C, β2MG and SCr levels were the influencing factors of cardiac function classification in patients with CRF complicated with heart failure (P < 0.05).  Conclusion  Serum Cys-C, β2MG and SCr are the influencing factors of cardiac function classification in patients with CRF complicated with heart failure, and the combined detection of CRF and heart failure has higher diagnostic value.
The value of demography, blood routine and serum biochemical indexes in predicting hypertensive disorder complicating pregnancy
CHEN Yuanyuan, MA Jianting
2025, 23(3): 430-433. doi: 10.16766/j.cnki.issn.1674-4152.003920
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  Objective  The purpose of this study was to investigate the predictive value of demographic characteristics, blood routine, and biochemical parameters in early pregnancy for hypertensive disorders of pregnancy (HDP).  Methods  A total of 16 112 pregnant women who underwent regular prenatal check-ups and delivered in the Affiliated Yangming Hospital of Ningbo University from May 1, 2018 to April 30, 2022 were selected, and 12 889 cases from May 1, 2018 to April 30, 2021 were selected as the observation group for the construction of the prediction model. A total of 3 223 cases from May 1, 2021 to April 30, 2022 were used as validation groups for external validation of the prediction model. The demographic characteristics, blood routine, and biochemical examination data of all research subjects were investigated in the first trimester (8-12+6 weeks), and the prediction model of HDP for the observation group was established by logistics regression statistical method, and the model was verified by the validation group, and the ROC curve was obtained and the area under the ROC curve was calculated, and the clinical prediction performance of the prediction model was evaluated.  Results  A total of 12 889 patients were in the observation group, of which 1 196 were HDP patients, accounting for 9.28%. Multivariate regression model analysis showed that age, medical history, BMI, hematocrit (HCT), HB, TG, HDL, LDL, TC, and ALB were influencing factors of HDP. Based on these factors, a combined prediction model for HDP was constructed, and when the scoring threshold was 1.5, the AUC for predicting the occurrence of HDP was 0.766.  Conclusion  Clinical models based on demographic, blood routine, and biochemical indicators have certain predictive value for hypertensive diseases in pregnancy.
Correlation of delayed onset of lactogenesis Ⅱ with feeding in preterm infants and maternal breastfeeding psychology based on propensity score matching
LI Lingyan, LI Jianying, HUANG Zitian, XIANG Dandan, LIN Xiaoqing
2025, 23(3): 434-438. doi: 10.16766/j.cnki.issn.1674-4152.003921
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  Objective  To explore the incidence of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) in premature mothers and its relationship with feeding status in preterm infants and breastfeeding psychology in mothers, and provide some reference for the management.  Methods  A total of 804 premature mothers were selected between January 2022 and June 2023 in the 2nd Affiliated Hospital of Wenzhou Medical University. After propensity score matching, there are 267 cases each in the DOL Ⅱ and non-DOL Ⅱ groups. The differences between the DOL Ⅱ and non-DOL Ⅱ groups in preterm hospital feeding, maternal feeding attitude, breastfeeding self-efficacy and breastfeeding duration were analyzed.  Results  The incidence of DOL Ⅱ in premature mothers was 36.3% (292/804). The duration of gastric tube, started oral feeding time and breastfeeding rates at discharge were (7.85±1.98) d, (6.65±1.53) d and 39.7% (106/267) respectively in DOL Ⅱ group, with (7.19±1.67) d, (5.89±1.21) d and 45.3% (121/267) in non-DOL Ⅱ group, which were all had significantly differences (P < 0.05). The average daily lactation, infant feeding attitude score and breastfeeding self-efficacy scale were (28.65±7.85) mL, (61.44±13.13) points and (48.17±12.41) points respectively in DOL Ⅱ group, with (30.75±7.94) mL, (68.43±14.52) points and (52.27±13.74) points in non-DOL Ⅱ group, which were all had significantly differences (P < 0.05). The breastfeeding rate was 22.8% (61/267) in DOL Ⅱ group and 36.3% (97/267) in non-DOL Ⅱ group in the corrected age of 12 months. The difference in breastfeeding duration time between the two groups was statistically significant (P < 0.05).  Conclusion  Preterm infants whose mothers have DOL Ⅱ have longer started oral feeding time, and lower breastfeeding rates at discharge. DOL Ⅱ mothers have lower infant feeding attitudes, breastfeeding self-efficacy and shorter breastfeeding duration.
Effects of serum vitamin D levels on neonatal outcomes in pregnant women with preeclampsia
XIAO Jiali, LUO Jing, JIANG Yuming, CAO Fang, ZHANG Yinying, YANG Rongwei
2025, 23(3): 439-442. doi: 10.16766/j.cnki.issn.1674-4152.003922
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  Objective  Pregnant women with preeclampsia (PE) have an increased risk of adverse pregnancy outcomes. This study analyzed the relationship between the severity of serum vitamin D (VD) deficiency and gestational age, newborn birth weight, and neonatal adverse outcomes, and provided new ideas for reducing adverse pregnancy outcomes in women with PE.  Methods  A total of 280 PE patients treated in Jiaxing Maternal and Child Health Hospital from January 2023 to December 2023 were selected as the PE group and 280 normal pregnant women as the control group, and the difference of serum 25 (OH) D level between PE patients and control group was compared. PE patients were divided into severe VD deficiency group, mild VD deficiency group, and normal VD group according to serum 25(OH) D level. The binary logistic regression equation was used to investigate the relationship between serum VD deficiency and adverse pregnancy outcomes.  Results  The serum 25(OH)D level in the PE group [(48.29±12.88)nmol/L] was significantly lower than that in the control group [(57.75±11.92)nmol/L], and the difference was statistically significant (P < 0.05). The incidence of severe PE in the severe VD deficiency group was significantly higher than that in the normal VD group and the mild VD deficiency group (P < 0.05), but there was no statistical significance between the normal VD group and the mild VD deficiency group (P>0.05). Gestational age, neonatal birth weight, and Apgar score in severe VD deficiency group were lower than those in normal VD group and mild VD deficiency group, and the incidence of neonatal asphyxia was higher than that in normal VD group and mild VD deficiency group, with statistical significance (P < 0.05), while there was no statistical significance between normal VD group and mild VD deficiency group (P>0.05). There was no significant difference in perinatal mortality among the three groups (P>0.05). Multivariate logistic regression results showed that age >35 years old, BMI>25, severe PE, and VD deficiency were independent risk factors for neonatal adverse outcomes.  Conclusion  Serious deficiency of serum VD increases the risk of adverse neonatal outcomes in PE patients.
The impact of family doctor contracting on the utilization of community health services for functional building population
CAI Chengjun, XU Xin, SHAO Jie, ZHOU Lulu, ZHANG Shengbing, HUANG Jiaoling, SHI Jianwei, HUANG Qian
2025, 23(3): 443-447. doi: 10.16766/j.cnki.issn.1674-4152.003923
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  Objective  To analyze the influencing factors of community health service utilization among functional building populations, and explore the impact mechanism of family doctor contract services on community health service utilization.  Methods  From March to April 2024, three functional buildings in the district of Weifang Community Health Service Center in Pudong New Area of Shanghai were selected by typical sampling method, and 396 people in functional buildings were selected by cluster random sampling method for investigation. The questionnaire included sociodemographic variables, medical security and health status, utilization of community health services in the last 6 months, and utilization of contracted services by family doctors. Univariate analysis and logistic regression model were used to analyze the influencing factors of community health service utilization, and a structural equation model was established to analyze the mechanism of family doctor contract service to improve the utilization of community health service.  Results  The utilization level of community health services in functional buildings within 6 months was 32.83% (130/396), the utilization rate of contracted services by conventional family doctors was 20.71% (82/396), and the utilization rate of contracted services by family doctors in functional buildings was 18.69% (74/396). Marital status, perceived health level, chronic disease, understanding of family doctor system, understanding of family doctor team composition, trust in family doctor and use of regular family doctor contract service were all influencing factors on community health consumption level (P < 0.05). The structural equation model indicated that the utilization of contracted services by conventional family doctors in functional buildings had a driving effect on both the utilization of contracted services by family doctors in functional buildings and the utilization of community health services, and the utilization of contracted services by family doctors in functional buildings had a driving effect on the utilization of contracted services by conventional family doctors (P < 0.05).  Conclusion  The utilization of contracted services by family doctors has a direct driving effect on the utilization of community health services. Improving the awareness rate of family doctors and improving residents ' trust in family doctors is the cornerstone of further improving the utilization of services.
Anxiety and influencing factors of common chronic disease patients in the community based on the perspective of psychosomatic medicine
LIU Huailei, PENG Yangyang, ZHANG Hanzhi, ZHOU Cong, MIAO Sibo
2025, 23(3): 448-452. doi: 10.16766/j.cnki.issn.1674-4152.003924
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  Objective  To provide a reference for the comprehensive management of chronic disease patients in the community, based on the perspective of psychosomatic medicine. To this end, the study investigates the anxiety levels of patients with hypertension, coronary heart disease (CHD), and knee osteoarthritis.  Methods  A stratified multi-stage random sampling method was employed to collect relevant information on patients with hypertension and/or coronary heart disease and/or knee osteoarthritis who visited three community health service centers in Pudong, Jing ' an and Baoshan District of Shanghai. The study period was from June 2022 to April 2023. The Hamilton anxiety scale (HAMA) was used to evaluate the patients. Multivariate binary multiple model logistic regression was used to analyze the influencing factors of anxiety.  Results  Among the 415 patients, 155 cases (37.3%) had normal HAMA scores, while 260 cases (62.7%) had abnormal HAMA scores. Of these, 153 cases (36.9%) had probable anxiety and 107 cases (25.8%) had certain anxiety. The incidence of abnormal anxiety scores in the hypertension group was lower than that in the hypertension combined with CHD group, the hypertension combined with arthritis group and the hypertension combined with CHD combined with arthritis group. The mediation effect analysis revealed that chronic disease symptoms had a mediating effect on the impact of the number of diseases on abnormal anxiety scores, accounting for 16.564%. Multivariate binary multiple model logistic regression analysis demonstrated that the number of illnesses was an independent factor of abnormal anxiety score in all three models (OR=2.544, 95% CI: 1.750-3.698; OR=2.426, 95% CI: 1.501-3.921; OR=2.266, 95% CI: 1.341-3.828, all P < 0.05).  Conclusion  Patients with multiple coexisting diseases and accompanying symptoms in the community should be evaluated for anxiety and receive targeted intervention measures.
Associations between depression symptoms and motor cognitive risk syndrome among older rural community dwellers in Anhui
WANG Qing, ZHANG Jingya, DAI Chen, ZHAO Wenzheng, LOU Xu, CHEN Ren, ZHANG Yan
2025, 23(3): 453-456. doi: 10.16766/j.cnki.issn.1674-4152.003925
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  Objective  The purpose of this study was to explore the correlation between depressive symptoms and motoric cognitive risk syndrome (MCR) and its sub-components in rural elderly, in order to provide evidence for the development of MCR prevention strategies in rural settings.  Methods  A cross-sectional study was conducted in rural areas of Huoshan County and Linquan County, Anhui Province, from July to August 2022, enrolling 623 elderly people through convenience sampling. Depressive symptoms were assessed by patient health questionnaire-9 (PHQ-9), and MCR syndrome was defined as the presence of slow gait speed and subjective cognitive complaints. Binary and ordered logistic regression models were used to analyze the associations between depression status and MCR and its sub-components.  Results  Every 1-unit PHQ-9 score increase was significantly associated with a higher risk of subjective cognitive decline (OR=1.081, 95% CI: 1.034-1.129) and MCR (OR=1.086, 95% CI: 1.033-1.141). Having depressive symptoms was significantly associated with a higher risk of slow gait (OR=1.533, 95% CI: 1.042-2.254) and subjective cognitive decline (OR=1.797, 95% CI: 1.163-2.776), and MCR (OR=1.965, 95% CI: 1.165-3.316).  Conclusion  Depressive symptoms are associated with MCR and its sub-components in rural elderly residents in Anhui. Attention should be paid to the management of depressive symptoms in rural elderly, and the early prevention of MCR should be actively carried out in rural elderly to delay the progression to dementia and reduce the disease burden of dementia in the future.
Analysis of influencing factors and pathway of post-traumatic growth in parents of children with acute leukemia
YANG Xiaoyu, JIANG Shanshan, ZHANG Lu, YAO Pin, YU Xinying
2025, 23(3): 457-460. doi: 10.16766/j.cnki.issn.1674-4152.003926
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  Objective  To investigate the influencing factors and pathways of post-traumatic growth in parents of children with acute leukemia, and to provide the theoretical basis for improving their post-traumatic growth level.  Methods  Convenience sampling was employed in this study. A total of 244 parents of children with acute leukemia from the Department of Pediatrics at Shengjing Hospital of China Medical University were enrolled as research subjects between December 2021 and September 2023. The general demographic questionnaire, the PTSD checklist-civilian version, the 14-item resilience scale, the trait coping style questionnaire, and the post-traumatic growth Inventory were utilized for data collection. Statistical analysis was performed using univariate analysis, multiple linear regression, Pearson correlation, and path analysis.  Results  The total post-traumatic growth score of parents of children with acute leukemia was (53.80±14.87) points. The results of multiple linear regression analysis showed that family type, resilience and active coping style were the influencing factors of post-traumatic growth (P < 0.05). Pathway analysis showed that resilience and active coping style could positively predict post-traumatic growth (β=0.535, 0.259, all P < 0.001), post-traumatic stress disorder also affected post-traumatic growth through the independent mediating effect of resilience and active coping style, and the chain mediating effect of resilience and active coping style (β=-0.189, P=0.001).  Conclusion  The post-traumatic growth level of parents of children with acute leukemia needs to be improved. Medical staff can formulate intervention plans targeting influencing factors (resilience and active coping style) to help parents achieve high levels of post-traumatic growth.
The best evidence study on the prevention and management of bad mood in depressed patients
YU Xiaowei, LI Songtao, XUAN Yuehong, YAO Qiunyu
2025, 23(3): 461-463. doi: 10.16766/j.cnki.issn.1674-4152.003927
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  Objective  To retrieve and analyze relevant evidence on the management of anxiety and depression management in patients with depression, and to summarize the best evidence.  Methods  In this study, "Depression, Bad mood, Management, Prevention" was selected as the Chinese keyword, and the corresponding English keyword was "depression, bad mood, management, prevention". The guidelines, expert consensus, recommended practice, and systematic review on the prevention and management of bad mood in patients with depression were searched by computer from the National Institute of Clinical Medicine Guideline database, US guide.com, UptoDate, PubMed and other databases. The search period was from the establishment of the database to March 20, 2022. The corresponding evaluation criteria were selected according to the type of original literature (guidelines, expert consensus and systematic review), the included literature was integrated by content analysis method, and the literature meeting the quality standards was extracted and summarized.  Results  In this study, 12 literatures were finally included from 664 literatures, including 3 guidelines, 3 expert consensus, and 6 systematic reviews, and the quality assessment results were all qualified. The evidence from five aspects of screening, prevention, risk factors, treatment and health education for the prevention and management of negative emotions in depressed patients was summarized, and 15 pieces of best evidence were obtained after final screening.  Conclusion  The best evidence on the prevention and management of bad mood in patients with depression can provide evidence-based evidence for medical staff. Medical staff should formulate prevention and management measures according to the specific clinical situation and characteristics of patients, and apply the best evidence to manage the bad mood of patients with depression in a more systematic and scientific way, so as to improve the quality of nursing.
The value of multimodal ultrasound in the diagnosis of C-TIRADS4 fine needle aspiration cytology for TBSRTC Type Ⅲ thyroid nodules
SHAO Chunhui, LI Peiying, ZHAO Junzhi, LUO Yongke, LYU Pin, ZHANG Yi
2025, 23(3): 464-467. doi: 10.16766/j.cnki.issn.1674-4152.003928
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  Objective  Exploring the diagnostic value of multimodal ultrasound quantitative parameters in the classification of thyroid C-TIRADS4 nodules FNAC as TBSRTC Ⅲ nodules.  Methods  A total of 126 thyroid C-TIRADS4 type FNAC specimens confirmed by surgical pathology in Baoji People ' s Hospital from January 2023 to January 2024 were selected as TBSRTC type Ⅲ nodules by contrast ultrasonography and elastic imaging, FNAC cytological images and postoperative pathological results. Postoperative pathological results were used as grouping criteria, including 83 nodules in the malignant group and 43 nodules in the benign group. CEUS parameters (PI, TIC-AUC), SE parameters (SEmean, SR), and SWE parameters (Emean, ER) were used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each parameter and the diagnostic efficiency of multi-mode ultrasound combined application.  Results  The mean values of PI, TIC-AUC, and SEmean in the benign group were higher than those in the malignant group (P < 0.05), while SR, Emean, and ER were lower than those in the malignant group (P < 0.05). The AUC (95% CI), sensitivity, specificity, and Youden index of multimodal ultrasound diagnosis were 0.912 (0.849-0.955), 96.39%, 86.05%, and 0.824, respectively, which were significantly higher than that of single ultrasound diagnosis mode. PI and TIC-AUC were pairwise compared with ROC curves of multi-mode ultrasound, and there were statistically significant differences between multi-mode ultrasound vs. PI and multi-mode ultrasound vs. TIC-AUC (Z=2.750, 2.293, P < 0.05).  Conclusion  The quantitative parameters of multimodal ultrasound can improve the diagnostic value of C-TIRADS4 type FNAC examination and pathological diagnosis of TBSRTC type Ⅲ thyroid nodules.
Study on transvaginal ultrasound characteristics of incomplete abortion caused by different types of residual drugs
DING Yanhua, LI Yinghua, ZHAO Liyan, YAO Jiqin
2025, 23(3): 468-471. doi: 10.16766/j.cnki.issn.1674-4152.003929
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  Objective  To investigate the differences in transvaginal ultrasound characteristics among different types of residues in patients with incomplete medical abortion, and to evaluate their clinical value in guiding the development of individualized treatment strategies.  Methods  A total of 150 patients with incomplete medical abortion who received treatment at Hangzhou Obstetrics and Gynecology Hospital from January 2022 to June 2024 were selected as the research subjects. Based on pathological examination results, the residual materials were divided into two groups: the chorionic decidua group (109 cases) and the non-chorionic decidua group (41 cases). Transvaginal ultrasound examination was performed on all study subjects to assess the differences in ultrasound characteristics, including morphology, echo signal, blood flow distribution, and hemodynamics between the two groups.  Results  The proportion of patients with increased uterine volume in the chorionic and decidua group was significantly higher than that in the non-chorionic decidua group (P<0.05). The residual of chorionic decidua group mainly presented as the form of lumps, while the residual of non-chorionic decidua mainly appeared as the form of patches. The ultrasound signals of residual chorionic decidual tissue were mainly hypoechoic and mixed echogenic, while the ultrasound signals of non-residual chorionic-decidual tissue were mainly hyperechoic signals (P<0.001). The proportion of residual blood flow signals in the chorionic decidua group (89.91%, 98/109) was significantly higher than that in the non-chorionic decidua group (9.76%, 4/41), with a statistically significant difference (χ2=87.961, P<0.001). The pulsatility index (PI) and resistance index (RI) of residual blood flow after medical abortion in the chorionic decidua group were 0.86±0.13 and 0.61±0.09, respectively, which were significantly lower than those in the non-chorionic decidua group (1.47±0.21 and 0.74±0.11, P<0.001).  Conclusion  Significant differences were observed in ultrasound characteristics, including morphology, echo signal, blood flow distribution, and hemodynamics, among different types of residues in incomplete medical abortion. Transvaginal ultrasound demonstrates high clinical value in guiding the selection of treatment methods for incomplete medical abortion.
Acute traumatic coagulopathy: mechanisms and diagnosis
ZHANG Yongxiao, LIU Shanshou, DAI Zheng, FU Chuanqing, YIN Wen
2025, 23(3): 472-476. doi: 10.16766/j.cnki.issn.1674-4152.003930
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Trauma induced coagulopathy (TIC) is defined as an abnormal coagulation process caused by trauma. The condition initially presents as insufficient coagulation, leading to bleeding; a state that is later characterized by hypercoagulability, with associated venous thromboembolism (VTE) and multiple organ failure (MOF). TIC ' s complex pathophysiology involves endothelial dysfunction, immune system activation, which are platelet dysfunction, and coagulation activation, exacerbated by the "lethal triad" (coagulopathy, hypothermia, acidosis). The primary focus of laboratory diagnosis is on conventional coagulation tests and viscoelastic hemostatic assays. However, recent emphasis on cell-mediated hemostasis models has underscored the pivotal roles of platelets and endothelial cells. Moreover, it is noteworthy that metabolicit is noteworthy that metabolic abnormalities induced by tissue damage and hemorrhagic shock are closely associated with TIC. Imbalanced fibrinolytic systems have been demonstrated to engender heightened risks of both bleeding and thrombosis. The management of TIC is predicated on two fundamental objectives: the primary one being the cessation of bleeding, and the secondary one being the restoration of blood volume. Goal-directed transfusion strategies of blood products, in conjunction with antifibrinolytic drugs such as tranexamic acid, have been shown to yield encouraging results. Emerging research areas include microRNA regulation, the relationship between endothelial glycocalyx damage and TIC, and the development of individualized precision treatment strategies. This review summarizes the mechanisms of tissue injury (TIC), the diagnosis and treatment advances, and provides insights for understanding and managing acute traumatic coagulopathy.
The influence of non-genetic factors on gout
ZHANG Xiaowei, WANG Guihong
2025, 23(3): 477-480. doi: 10.16766/j.cnki.issn.1674-4152.003931
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The accumulation of urate in the blood and the precipitation formed when the concentration of uric acid in the extracellular fluid is saturated contribute to the deposition of uric acid in the synovium, bursa, cartilage, and other joint tissues, which results in abnormally high levels of uric acid, deriving from a recurring inflammatory disease that can be characterized by recurrent episodes, which is known as gout. Gout may develop as a result of increased purine biosynthesis, leading to excessive production of uric acid, or because of inadequate excretion of uric acid. Uric acid is an intermediate product of purine metabolism that is excreted through the kidneys and feces. When uric acid is either over-produced or under-excreted, the increase in uric acid concentration causes hyperuricemia. In the absence of symptoms such as acute arthritis, hyperuricemia cannot be called gout. It can only be defined as gout when symptoms are present. Gout often coexists with hyperuricemia and is often comorbid with a variety of chronic diseases such as hyperlipidemia, diabetes mellitus, hypertensive disorders, obesity, and coronary artery disease. According to the results of some regional epidemiological surveys, the prevalence of gout in China is estimated to be between 1.0% and 3.0%; the prevalence of hyperuricemia is between 5.5% and 19.3%, and continues to rise. And the impact of gout on the social labor force should not be underestimated, so it is necessary to study the impact of related factors on gout to reduce the incidence and disability rate. In addition to genetic factors, non-genetic factors also play a very important role, so the main focus of this study is to explore the non-genetic factors that may be associated with gout, which include age, gender, diet, alcohol consumption, smoking, medications, comorbidities, seasonality, air pollution, etc. The study will also consider the combined effects of different factors on the onset or exacerbation of gout and provide feasible recommendations for the management of high-risk factors for gout.
Research progress of infection-related thyroid injury in COVID-19
XU Lujia, ZHANG Yujian, SONG Xuenan, ZHANG Jianbo, CONG Riping, TANG Kuanxiao
2025, 23(3): 481-484. doi: 10.16766/j.cnki.issn.1674-4152.003932
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As a significant increase in the incidence of related acute respiratory infections and pneumonia, highlighting the continued need for vigilance against coronavirus disease 2019 (COVID-19) infection. COVID-19 can induce multiple organ dysfunction, including effects on the thyroid. Thyroid diseases associated with COVID-19 include autoimmune thyroiditis, subacute thyroiditis (SAT), painless thyroiditis, and non-thyroidal illness syndrome (NTIS), etc. However, the mechanisms underlying the abnormal thyroid function caused by COVID-19 remain unclear. Further research is needed to clarify the effects of COVID-19 vaccine and specific therapeutic drugs on thyroid function. This paper summarizes the current research of COVID-19-related thyroid diseases. It covers the spectrum of thyroid diseases associated with COVID-19, the potential pathophysiological mechanisms driving thyroid axis function, and the impact of vaccines and therapeutic drugs on thyroid health. This paper aims to optimize diagnostic and treatment strategies for COVID-19-related thyroid diseases, improve patient prognosis, and reduce the incidence of thyroid disorders induced by COVID-19.
The application of wax therapy combined with Chinese herbal acupuncture point wet hot compress for patients with hemiplegia after stroke
ZHOU Yibo, ZHANG Jie, MEI Na, HUANG Changyu, YAO Yao
2025, 23(3): 485-489. doi: 10.16766/j.cnki.issn.1674-4152.003933
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  Objective  Appropriate techniques of traditional Chinese medicine (TCM) have received much attention in the rehabilitation treatment of hemiplegia after stroke. The purpose of this study was to investigate the intervention effect of wax therapy combined with wet and hot compress of traditional Chinese medicine on such patients.  Methods  A total of 130 patients with hemiplegia after stroke admitted to the Rehabilitation Medical Center of Tongde Hospital of Zhejiang Province from June 2022 to May 2024 were strictly included and divided into control group and intervention group with 65 cases in each group by random number table method. Under the premise of conventional treatment and nursing, the control group was given traditional Chinese medicine acupoint wet and hot compress, and the intervention group was given wax therapy combined with traditional Chinese medicine acupoint wet and hot compress. Both groups were intervened and observed for 9 weeks The modified Ashworth scale, simplified Fuel-Meyer assessment (FMA), visual analogue scale (VAS), modified Barthel index (MBI), and hemorheological indicators [high cut whole blood viscosity, plasma viscosity, and fibrinogen (FIB)] were compared between groups.  Results  Compared with before intervention, the modified Ashworth scale, VAS score, and hemorheology indexes of the affected limb were decreased in both groups after intervention (P<0.05), while the FMA score and MBI score of the affected limb were increased (P<0.05). Compared with the control group, the modified Ashworth grade, VAS score of the affected limb and hemorheology indexes in the intervention group were lower after intervention (P<0.05). The FMA score [(59.46±5.23) points vs.(50.62±4.91) points] and MBI score of the affected limb [(56.06±4.21) points vs. (50.21±4.03) points] were higher, and the difference was statistically significant (F=3.372, P=0.018; F=10.238, P<0.001).  Conclusion  Wax therapy combined with hot and wet compress of Chinese herbal acupuncture points can obviously reduce the muscle tension and pain of the affected limbs of hemiplegia patients after stroke, improve the hemorheology and limb motor function, and improve the self-care ability, which is an effective technical rehabilitation program of traditional Chinese medicine
Effect of modified round sharp needle therapy on pain mediators and lumbar function in the treatment of lumbar myofascial pain syndrome
QIN Xiaoyi, YAN Sisi, HONG Tao
2025, 23(3): 490-493. doi: 10.16766/j.cnki.issn.1674-4152.003934
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  Objective  To explore the efficacy of modified round needle therapy in the treatment of lumbar myofascial pain syndrome (LMPS) and its impact on pain mediators and lumbar function, providing evidence for optimizing clinical treatment strategies.  Methods  A total of 112 LMPS patients admitted to the outpatient department of the First People's Hospital of Linping District, Hangzhou, from January 2021 to December 2023, were randomly divided into group A and group B. Group A (56 patients) received conventional Western medicine treatment, while group B (56 patients) received modified round needle therapy. Clinical efficacy, pain severity (VAS score), levels of pain mediators [prostaglandin E2 (PGE2) and 5-hydroxytryptamine (5-HT)], inflammatory factors [interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α)], and lumbar function [Oswestry disability index (ODI) score] were compared between the two groups.  Results  The total effective rate in the group B was 96.43% (54/56), significantly higher than the 82.14% (46/56) in the group A (χ2=5.973, P=0.015). The VAS scores of the two groups after treatment were decreased (P<0.05), with group B exhibiting significantly lower scores than group A (P<0.05). The levels of PGE2 and 5-HT of the two groups after treatment were decreased (P<0.05), with group B showing greater reductions compared to group A (P<0.05). The IL-1β and TNF-αlevels of the two groups after treatment were both decreased (P<0.05), with group B demonstrating lower levels than group A (P<0.05). The ODI scores of the two groups after treatment were also decreased (P<0.05), with group B showing lower scores than group A (P<0.05).  Conclusion  Modified round needle therapy is an effective treatment for LMPS, significantly alleviating pain symptoms, improving their lumbar mobility, and promoting the recovery of lumbosacral muscle tension. It also accelerates the repair process of damaged tissues and is highly beneficial for application.
A survey study on the current research capabilities and training needs of clinical postgraduates in affiliated hospitals of reginal colleges
LIU Yanchang, CHEN Bo, CHENG Jinhao, HE Fenglian
2025, 23(3): 494-496. doi: 10.16766/j.cnki.issn.1674-4152.003935
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  Objective  To analyze the current situation of scientific research ability and training needs of clinical medical professional degree postgraduates. The findings were used to explore corresponding countermeasures to provide reference for improving their research ability and training quality.  Methods  In this study, a questionnaire was administered to full-time enrolled clinical masters between 2019 and 2021 at the Second Affiliated Hospital of Anhui Medical University. The survey evaluated research awareness, attitude and motivation, current participation in research, and training needs. Data were collected and statistically analyzed.  Results  Awareness, attitude and motivation of scientific research: (1) In terms of research awareness and attitude, 70.24% (203/289) of the students recognized the importance of research and actively participated in it. (2) As for the motivation of scientific research, "improving research ability", "enhancing job prospects after graduation", and "advancing development of medical career" were the primary motivations of students, accounting for 76.47% (221/289), 68.17% (197/289), and 67.47% (195/289), respectively. (3) Key barriers to conducting research included objective factors such as "lack of research ideas", "lack of research skills", as well as subjective barriers like "difficulty in formulating questions related to clinical research". The current status of participation in scientific research: (1) Participation in "subject research" and "thesis/publication writing" was reported by 73.01% (211/289) and 60.21% (174/289), respectively. (2) Types of published papers included "SCI-indexed articles", "Chinese core journal articles", and "science and technology core journal paper" accounted for 21.45% (62/289), 23.88% (69/289), and 13.49% (39/289), respectively. The main needs for training to improve research ability were "participating in clinical research", "topic selection and design of clinical topics", "writing and submission skills of scientific research papers", and "research project application".  Conclusion  By fostering an academic environment, optimizing the training courses, strengthening the mentorship system, and improving the overall training system, collaboration among students, supervisors, and hospital administration can enhance the research skills of clinical masters and improve the quality of talent development.
Exploration of teaching practices to promote deep learning in Regional Anatomy using mind mapping based on the BOPPPS model
ZENG Minjuan, LIU Yanquan, HUANG Tong, CHEN Xiaojia, LI Linke, LI Wenman, ZHANG Jiankai
2025, 23(3): 497-501. doi: 10.16766/j.cnki.issn.1674-4152.003936
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  Objective  This study aims to explore the effectiveness of using mind mapping to promote deep learning in Regional Anatomy based on the BOPPPS model and to explore a new approach to teaching reform in basic medical courses.  Methods  A total of 265 undergraduates majoring in clinical medicine in Guangdong Medical University were selected as subjects and divided into a control group (n=131) and an observation group (n=134) by random number table method. The control group adopted the lecturing and demonstration teaching method, while the observation group adopted the combined mind mapping method with the BOPPPS model. The teaching practice effects of the two groups were assessed and compared. The study process questionnaire (SPQ) and critical thinking ability scale were used to evaluate the student ' s learning motivation and critical thing skills, respectively. The teaching satisfaction was measured using the basic medical course teaching effect evaluation and satisfaction questionnaire.  Results  The observation group demonstrated significantly better performance in theoretical knowledge, anatomical thinking, and practical skills than the control group [(75.86±7.34) points vs. (72.20±6.47) points, t=4.302, P<0.001; (87.26±7.74) points vs. (83.78±8.15) points, t=3.565, P<0.001]. The scores of surface motivation, deep motivation, and SPQ in the observation group were higher than those in the control group (P<0.05). The scores of seeking true knowledge, open mind, systemic literacy, critical thinking self-confidence, intellectual curiosity and cognitive maturity, and the total score of the observation group were better than those of the control group (P<0.05). The students in the observation group were better than those in the control group in areas like training objectives, learning interests, learning atmosphere, humanistic care, and communication ability, teamwork ability, and teaching satisfaction (P<0.05).  Conclusion  Integrating mind mapping into the BOPPPS model effectively promotes deep learning in Regional Anatomy. It enhances learning motivation, cultivates critical thinking in medical students, and improves teaching quality and satisfaction in basic medical courses.
Application of formative evaluation based on intelligent high-fidelity simulation and DOPS in the standardized training of ophthalmology residents
LI Ning, LI Juan, BU Jingli, GAO Ziqing
2025, 23(3): 502-505. doi: 10.16766/j.cnki.issn.1674-4152.003937
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  Objective  To explore the application effect of formative evaluation based on intelligent high-fidelity simulation and direct observation of procedural skills (DOPS) in the standardized training of ophthalmology residential, providing reference for improving ophthalmology education.  Methods  Thirty-eight residents who received training at the First Affiliated Hospital of Bengbu Medical University from July 2015 to July 2024 were studied. They were divided into the study group (formative evaluation based on intelligent high simulation and DOPS) and the control group (final evaluation) according to training batches. The two groups had the same training hours and training content. The DOPS evaluation form was used for formative evaluation of the study group, while both groups assessed for theoretical knowledge and clinical practice ability.  Results  DOPS scores in the study group at the end of training were higher than that at the middle of training (P < 0.05). The test scores of theoretical knowledge and clinical practice ability in the study group were higher than those in the control group [(91.49±3.10) points and (90.85±2.41) points vs. (87.92±3.25) points and (86.89±3.47) points, t=3.465, P=0.001 and t=4.086, P < 0.001, respectively]. The satisfaction scores of residents in the study group regarding all aspects of the training effectiveness were also higher than those in the control group (P < 0.05). The satisfaction scores of the instructors toward the residents in the study group were also higher than those in the control group (P < 0.05).  Conclusion  The integration of intelligent high-fidelity simulation and DOPS formative evaluation in ophthalmology residential training demonstrates significant effectiveness. This approach enhances the clinical comprehensive abilities of physicians and improve the quality of training.
Evidence map of causal associations between hypertension and its influencing factors based on Mendelian randomization studies
ZHU Xianshang, MAO Huabo, ZENG Hongyu, LYU Fengli, WANG Jiancheng
2025, 23(3): 506-510. doi: 10.16766/j.cnki.issn.1674-4152.003938
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  Objective  To systematically identify, describe, and evaluate research evidence on the causal association between hypertension and its influencing factors through an evidence mapping system.  Methods  A comprehensive search was conducted across CNKI, Wanfang Data, PubMed, and Web of Science databases up to October 18, 2023 to obtain Mendelian randomization studies exploring causal associations between hypertension and influencing factors. Excel was used to extract and organize data incorporated into research, and to conduct the properties of the studies based on the three major assumptions of MR research. An evidence map was constructed to summarize the number of studies, exposures or outcomes, and research results.  Results  A total of 108 documents were included in this study, encompassing 182 Mendelian randomization studies. The research focused on exploring the causal relationship between hypertension, either as an exposure or an outcome, and various influencing factors. Nine categories of exposures and seven categories of outcomes related hypertension were identified. The majority (97.80%) of the studies utilized the inverse variance weighting method, and 95.05% utilized a two-sample MR design, primarily involving European populations. Approximately 80.77% of the studies met the three major assumptions of MR research, with statistically significant findings reported in most cases.  Conclusion  This study systematically summarizes the causal relationships between hypertension and its influencing factors. Current Mendelian randomization research primarily examines the causal links between hypertension and anthropometric characteristics, common diseases, and cardiovascular or cerebrovascular diseases. Furthermore, exploration is needed to clarify the specific effects of exposure factors on blood pressure levels and to establish quality control standards for MR studies. Improving the reliability and generalizability of evidence will provide more precise reference for the prevention and treatment of hypertension.
Construction and application of integrated endoscopic anesthesia risk chain management scheme for medical care
SHAO Xiaoduo, JIN Jianwei, CHEN Ying, ZHOU Chunchun, YOU Xi, ZHANG Yibing
2025, 23(3): 511-515. doi: 10.16766/j.cnki.issn.1674-4152.003939
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  Objective  A risk chain management scheme for integrated medical and nursing endoscopic diagnosis and treatment of anesthesia is constructed and clinically applied, and its influence on patients ' anesthesia adverse reactions, anxiety state and satisfaction is discussed.  Methods  A total of 300 patients treated at the Endoscopy Center of Wenzhou Central Hospital from April to June 2023 were selected as the control group, and 300 patients treated from July to September 2023 were selected as the intervention group. Patients in the control group underwent routine anesthesia management by anesthesiologists, while the intervention group implemented an integrated anesthesia risk chain management scheme based on the control group, including the establishment of an endoscopic anesthesia risk chain management team, the construction of the management scheme and the implementation of the scheme, and compared the incidence of anesthesia adverse reactions, anxiety scores and satisfaction with endoscopic anesthesia in the two groups.  Results  In terms of adverse reactions, the incidence of hypoxia, nausea and vomiting, cough and reflux aspiration in the intervention group was significantly lower than that in the control group, with statistical significance (P < 0.05). However, there was no significant difference in the incidence of arrhythmia and respiratory depression between the two groups (P > 0.05). In terms of anxiety scores, there was no statistically significant difference between the two groups before treatment (P > 0.05). After treatment, the anxiety scores of the two groups were significantly decreased (P < 0.01), however, the anxiety score of the intervention group (33.45±4.78) was lower than that of the control group (38.90±6.09), with statistical significance (F=15.290, P < 0.001). In terms of satisfaction, the satisfaction of patients in the intervention group was higher than that in the control group, and the difference was statistically significant (P < 0.01).  Conclusion  The integrated chain management scheme of medical care is conducive to reducing the occurrence of adverse anesthesia events in endoscopic diagnosis and treatment, reducing patients ' anxiety about endoscopic diagnosis and treatment, and improving their satisfaction.
Effectiveness of internet-based hospital-community-family linkage nursing on non-small cell lung cancer patients undergoing chemotherapy
SHEN Yanping, XU Guoying, ZHANG Xiaohua
2025, 23(3): 516-520. doi: 10.16766/j.cnki.issn.1674-4152.003940
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  Objective  To develop an internet-based tripartite linkage nursing intervention model involving hospital, community, and family, and to analyze its impacts on cancer pain, mental state, and quality of life in non-small cell lung cancer patients undergoing chemotherapy. This study aims to provide new nursing ideas for lung cancer patients undergoing chemotherapy.  Methods  A total of 156 non-small cell lung cancer chemotherapy patients admitted at Shaoxing Second Hospital from January 2022 to June 2023 were conveniently selected and divided into two groups according to their condition and willingness to participate. A total of 67 cases were given routine care (control group), while another 89 cases were given internet-based care integration nursing intervention (observation group). The cancer pain grading, psychological distress, and quality of life were compared between two groups of patients before the nursing intervention (before admission and treatment) and after the intervention (at the end of the second month of follow-up after treatment).  Results  After the intervention, the cancer pain grade of the observation group was lower than that of the control group. The cancer pain score of the observation group was (3.67±0.56) points, which was significantly lower than that of the control group (5.34±0.87) points, P < 0.05. After intervention, the SDS and SAS scores of the observation group were (48.74±2.77) points and (47.28±2.85) points, respectively, which were lower than those of the control group (52.60±1.13) points and (51.05±1.11) points (P < 0.05). After intervention, all dimensions of the MOS item short from health survey (SF-36) scale in the observation group were higher than those in the control group (P < 0.05).  Conclusion  Internet-based hospital community family linkage nursing for non-small cell lung cancer patients undergoing chemotherapy can effectively alleviate the degree of cancer pain, reduce anxiety and depression, and improve quality of life. This nursing model is worthy of clinical promotion.
Application of nursing intervention based on KANO model in home care of pacemaker implants
WU Xiuhua, ZHU Xialing, YE Li, WANG Lili
2025, 23(3): 521-524. doi: 10.16766/j.cnki.issn.1674-4152.003941
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  Objective  To develop and implement personalized nursing plans through KANO model demand analysis, and to develop ideas for clinical nursing work.  Methods  A total of 151 patients who received pacemaker implantation surgery in Lishui Central Hospital from January 2022 to March 2023 were selected and divided into a control group (76 cases) and a KANO group (75 cases) by random number table method, and were given conventional continuous nursing intervention or nursing intervention based on KANO model, respectively. Finally, 73 and 74 cases were enrolled in each group, and the mastery of disease-related knowledge, compliance, complication rate, and quality of life score were compared between the two groups.  Results  The awareness rates of "self-disease knowledge, self-care knowledge, pacemaker specific knowledge, and pacemaker implantation knowledge" in the KANO group after nursing were 89.19%, 87.84%, 79.73%, and 85.14%, respectively, which were higher than 64.38%, 64.38%, 57.53%, and 63.01% in the control group (P < 0.05). Medical compliance score: daily pulse measurement [(3.09±0.56) points], regular medication [(3.01±0.47) points], exercise [(2.88±0.45) points], postoperative precautions [(2.90±0.34) points] in the KANO group were higher than (2.53±0.41) points, (2.44±0.36) points, (2.19±0.37) points, (2.23±0.46) points in control group (P < 0.05). The incidence of complications (6.76% vs. 20.55%) in the KANO group was lower than that of the control group (χ2=5.946, P=0.015). The quality of life score in the KANO group was higher than that of the control group (P < 0.05).  Conclusion  Nursing intervention based on the KANO model has obvious advantages in improving disease-related knowledge and compliance behavior of home patients with cardiac pacemaker implantation, reducing the occurrence of complications, and improving the quality of life.
Application of continuing nursing based on the concept of nursing goal implementation in children with Kawasaki disease and coronary artery injury
QIU Jinlyu, CHEN Miaoyue, ZHANG Hongmei, ZHANG Li
2025, 23(3): 525-529. doi: 10.16766/j.cnki.issn.1674-4152.003942
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  Objective  To establish a continuity of care plan based on the concept of nursing goal implementation and evaluate its effectiveness in children with Kawasaki disease and coronary artery damage, with the aim of improving medication compliance and reducing family burden.  Methods  A total of 156 children with Kawasaki disease and concomitant coronary artery damage, admitted to Hangzhou Children ' s Hospital from January 2021 to June 2024, were randomly divided into two teams using a random number table: the control group (n=78) received routine continuing care, while the observation group (n=78) received continuing care based on the concept of nursing goal implementation in addition to routine care. Medication adherence, parental disease management ability, disease knowledge mastery, and family caregiving burden of two groups were compared.  Results  The medication compliance rate in the observation group was 97.4% (76/78), which was significantly higher than the control group of 88.5% (69/78, P < 0.05). After the intervention, the scores for parental disease management ability and disease knowledge in the observation group were (51.33±3.28) points and (82.52±6.44) points, respectively, which were significantly higher than the control group of (44.52±6.73) points and (74.46±7.08) points (P < 0.05). Furthermore, the total score on the family care burden scale for the observation group was (48.62±4.90) points, which was significantly lower than the control group of (61.74±7.07) points (P < 0.05).  Conclusion  Continuing nursing based on the concept of nursing goal implementation effective improves medication compliance in children with Kawasaki disease and coronary artery damage, enhances parental disease management ability and knowledge, reduces family burden.
The impact of integrated preventive nursing interventions based on causal analysis on pregnancy outcomes and postpartum efficacy in patients with severe preeclampsia
HUANG Xuexia, GU Huifeng, SHEN Pinghua, QIAN Lu, ZHANG Weifeng, FEI Anping, CHEN Yan
2025, 23(3): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.003943
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  Objective  Severe preeclampsia (PE) is one of the more severe types of gestational hypertension, posing a great threat to both pregnant women and infants. This study attempts to use a causal analysis-based integrated intervention for prevention and care in patients with severe PE, aiming to explore whether this intervention program can reduce adverse pregnancy outcomes and improve postpartum self-efficacy.  Methods  Eighty patients with severe PE admitted to the Maternity and Child Health Hospital of Huzhou were prospectively selected as the research subjects. Among them, 40 patients admitted from January 2021 to May 2022 were included in the control group and received routine nursing care. Another 40 patients admitted from June 2022 to April 2023 were assigned to the observation group, which received an integrated intervention of preventive nursing based on causal analysis in addition to the routine nursing provided to the control group. The mental state (self-rating anxiety scale, SAS, and self-rating depression scale, SDS), occurrence of adverse pregnancy outcomes (postpartum hemorrhage, abnormal amniotic fluid, and premature rupture of membranes), and postpartum self-efficacy were compared between the two groups.  Results  Following the intervention, the observation group exhibited lower SAS and SDS scores compared to the control group [(31.13±4.15) points, (24.40±4.40) points vs. (35.60±4.07) points, (28.28±4.42) points], with the differences being statistically significant (P < 0.05); The observation group had a lower total incidence of adverse pregnancy outcomes at 10.00% (4/40) compared to the control group at 22.50% (9/40), though this difference was not statistically significant (P>0.05); The postpartum self-efficacy in the observation group was superior to that in the control group, the difference being statistically significant (P < 0.05).  Conclusion  For patients with severe PE, an intervention plan based on causal analysis in integrated preventive nursing can effectively enhance their psychological well-being, boost postpartum self-efficacy, and show a trend in reducing adverse pregnancy outcomes.
Diagnosis and treatment of MUPS: a general practice perspective on involuntary weight loss
YAO Dingye, LUO Guiping, SUN Junsheng, MA Fanghui, REN Jingjing
2025, 23(3): 534-538. doi: 10.16766/j.cnki.issn.1674-4152.003944
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Involuntary weight loss is one of the common medically unexplained physical symptoms (MUPS) in general practice clinic, and it ' s aetiology is complex, with various system diseases leading to involuntary weight loss. Patients are often referred to many departments without diagnosis and management, which not only wastes a lot of medical resources, but also causes physical and mental distress to patients. This article analyses the case of a patient who was not diagnosed and treated in several departments, but was finally diagnosed with smile-type depression in general practice clinic: using general practice diagnostic tools such as John Murtagh ' s safe diagnostic strategy and RICE inquiring. The aim of this article is to raise general practitioners ' understanding of involuntary weight loss and to make good use of the unique diagnostic tools of general practice in analysing and assessing patients in general practice clinic.

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