2021 Vol. 19, No. 12

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Expert Forum
Research on the establishment of a risk prediction model for multiple chronic diseases in the elderly based on big data
LUO Yao, DENG Xue-xue, XU Xiao-ru, FANG Rong-hua
2021, 19(12): 1979-1982. doi: 10.16766/j.cnki.issn.1674-4152.002216
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The aging of population has become a major worldwide social problem. The elderly population in China had exceeded 254 million. High morbidity and co-morbidity of chronic diseases in the elder have led to reduce quality of their life, the increase of disability rate, mortality rate and obviously increased medical expenditures, which bring heavy burden to family and society. At present, based on the application of new technologies, such as internet of things, big data and artificial intelligence in the medical industry, traditional chronic disease management will be challenged. The development of smart medicine is the strategic need of medical health reform, as well as the inevitable trend of industry innovation, and gradually becomes the source power of disease diagnosis and risk prediction. Developing accurate and effective early diagnosis and screening technology, establishing perfect disease general survey system, risk assessment and early warning system are the key points to prevent and treat chronic diseases. Foreign countries have developed disease risk assessment models for breast cancer, lung cancer, diabetes and other diseases, but these models are not fully suitable for Chinese population to carry out disease risk assessment and measurement, so it is necessary to build disease risk assessment models that are in line with the characteristics of Chinese population. How to go beyond the traditional chronic disease management system and construct the solution of precision medical decision has become a scientific problem concerned by the medical community. In the process of practicing of chronic disease management, the classification and stratification of multiple chronic disease risk factors are the core problems. Based on a large amount of collected medical data, using machine learning technology to build a prediction model for risk assessment of multiple chronic diseases in the elderly and conducts medical data mining, and to form an index evaluation system for intervention evaluation of chronic diseases in the elderly. This model will break through the difficulties and choke point of chronic disease management, and promote the prevention/intervention of chronic diseases to move forward, and achieve accurate management in the elderly.
Standard and Guideline
Functional assessment and rehabilitation service specifications for patients with chronic kidney disease
Renal Rehabilitation Committee of Chinese Association Rehabilitation Medicine, Renal Rehabilitation Committee of Zhongguancun Nephrology & Blood Purification Innovation Alliance, Renal Rehabilitation Committee of Chinese Medical Doctor Association Rehabilitation Physician Branch
2021, 19(12): 1983-1988. doi: 10.16766/j.cnki.issn.1674-4152.002217
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With the decline of renal function, patients with chronic kidney disease (CKD) will encount different degrees of dysfunction, which greatly increases the risk of poor prognosis and brings economical and nursing burden to the family and society. The main strategy is to implement the renal rehabilitation program (RRP) to enable patients with CKD to achieve the best occupational potential, functional status and quality of life. However, the RRP of CKD patients in China started relatively late, and the professional knowledge of rehabilitation treatment of medical staff in Nephrology Department is insufficient. Moreover, most CKD management centres do not provide necessary RRP for patients. Currently, unified standards for functional assessment and rehabilitation training services specification for CKD patients are lacking. This specification is conducive to guiding CKD management centres to carry out RRP, and help centres that have already conducted RRP to further standardise its implementation.
Clinical thinking of fever diagnosis and emergency treatment
WU Xiao-fei
2021, 19(12): 1989-1990.
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Dietary structure and nutritional status of 270 elderly patients with chronic kidney disease
ZHANG Jing, HUANG Pei-pei, ZHANG Lan-zhen, JIN Ling-wei
2021, 19(12): 2055-2057. doi: 10.16766/j.cnki.issn.1674-4152.002235
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  Objective  To understand the dietary structure and nutritional status of elderly patients with chronic kidney disease and provide a basis for guiding the rational diet of elderly patients with chronic kidney disease.  Methods  A total of 270 patients with CKD, who were hospitalised in our hospital from July to December 2020, were selected as study subjects, and the general data questionnaire, nutritional risk screening 2002 and semi-quantitative food frequency questionnaire were used for investigation. Anthropometric and biochemical results and dietary structure of patients at risk of malnutrition and those of patients with good nutrition were compared.  Results  A total of 65 (24.07%) were at risk of malnutrition, 205 cases had good nutrition, accounting for 75.93%. The CKD Ⅱ stage BMI, AC, TSF, ALB and PA of the patients at risk of malnutrition were lower than those of patients with good nutrition, and the differences were statistically significant (χ2=6.943, 9.360; t=4.313, 2.742, 3.458, 3.204, all P < 0.05). The proportion of insufficient intake of potatoes, fruits, vegetables, fish and shrimp in the diet of patients at risk of malnutrition were higher than those of patients with good nutrition, and the differences were statistically significant (Z=3.912, 5.750, 4.055, 4.474, all P < 0.01).  Conclusion  Elderly patients with chronic kidney disease are at high risk of malnutrition. In clinical practice, dietary guidance and health education should be strengthened for elderly patients with chronic kidney disease to improve the nutritional status of patients.
Risk factors for tuberculosis chemotherapeutic drug pyrazinamide-induced hyperuricemia
PU Qiang-hong, LI Jia-meng, LI Fan-min, YUAN Shu-sheng
2021, 19(12): 2058-2060, 2152. doi: 10.16766/j.cnki.issn.1674-4152.002236
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  Objective  To evaluate the possible risk factors for hyperuricemia induced by tuberculosis chemotherapeutic drug pyrazinamide.  Methods  Patients who were diagnosed with tuberculosis in the Department of Infection and Department of Respiratory in our hospital from July 2016 to December 2020 were enrolled. The isoniazid, rifampicin, pyrazinamide and ethambutol regimen were administrated daily in intensive period. Data of age, gender, body mass index, smoking history, drinking history and chronic disease history (diabetes, hypertension or coronary heart disease) were collected. The polymorphism of uric acid transporter URAT1 and GLUT9 gene were determined.  Results  No differences in age, sex(male/female: 50/31 vs. 8/9), BMI, smoking history, drinking history and chronic diseases (diabetes, hypertension or coronary heartdisease: 7/74 vs. 3/14) were found between two groups. There was no significant difference in ALT, albumin, total bilirubin and serum creatinine [(55.1±10.9)μmol/L vs. (58.2±12.6)μmol/L] in the two groups. There was no significant difference in the genotypes of URAT1 gene polymorphisms [rs7932775 (t1309c), rs475688, rs3825016 (c258t)] and GLUT9 gene polymorphisms [rs3733591 (r265h), rs1014290] between two groups (all P>0.05).  Conclusion  Age, sex, BMI, smoking history, drinking history, chronic diseases, hepatic and renal function, polymorphisms of URAT1 and GLUT9 gene might not be the risk factors for pyrazinamide-induced hyperuricemia.
Characteristics of intestinal flora in children with ADHD and combined with obesity
ZHOU Guo-ling, ZHANG Xun, LIAO Wen-jing, LIU Yan, YU Rong-rong
2021, 19(12): 2061-2064. doi: 10.16766/j.cnki.issn.1674-4152.002237
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  Objective  To discuss and explore the distribution characteristics of intestinal flora in children with attention deficit hyperactivity disorder (ADHD) complicated with obesity.  Methods  64 children with attention deficit hyperactivity disorder (ADHD) admitted to Hangzhou Seventh people's Hospital from August 2018 to October 2019 were divided into 32 children with normal weight ADHD (control group) and 32 obese children with ADHD (experimental observation group). The macrogenomic sequencing method of faecal flora was used to compare the α diversity of microflora, relative abundance of species classification and differences in the number of bacteria between the two groups of children.  Results  No significant difference in the α diversity of intestinal microflora was observed between the experimental group and control group (all P>0.05). With regard to bacteria genus, the abundance of Veillonella and Enterococcus in the experimental observation group was lower than that in the control group, but the abundance of Flavobacteriaceae and Enterococcus in the experimental group was higher than that in the control group (all P < 0.05). With regard to bacteria species, the abundance of Lachnospira, Prausnitzii, Veillonella and active rumen cocci in the experimental group was lower than that in the control group, whereas the abundance of Pseudomonas aeruginosa, Bacteroides faecalis and Bacteroides viscera in the experimental group was higher than that in the control group (all P < 0.05). The number of rectal true bacteria in the control group was significantly higher than that in the experimental group, whereas the number of Bacteroides polymorpha, Bifidobacterium and Lactobacillus in the control group was significantly lower than that in the experimental group (all P < 0.05).  Conclusion  The changes of intestinal flora in children with ADHD and obesity may provide reference for the treatment of children with ADHD.
Comparative observation of two different doses of caffeine citrate in apnea of preterm infants
FU Xu-ming, HUANG Lie-ping, HAN Yi-yao, WANG Ji, XU Qiao, BAI Min
2021, 19(12): 2065-2067, 2076. doi: 10.16766/j.cnki.issn.1674-4152.002238
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  Objective  To study the effects of different doses of caffeine citrate on apnea in preterm infants.  Methods  A total of 82 cases of apnea of prematurity (AOP) preterm infants were divided into high-dose groups (41 cases) and low-dose group (41 cases) according to random number table. All children were appropriately treated with anti-infection, respiratory support and other measures. Both groups were given caffeine citrate load of 20 mg/(kg·d) 24 hours before extubation, maintenance dose of 10 mg/(kg·d) in high-dose group and 5 mg/(kg·d) in low-dose group. The efficacy, adverse reaction rate, and complication rate of the two groups of children were compared.  Results  Compared to the low-dose group, the high-dose group's effective rate was higher (46.34% vs. 68.29%), and the failure rate (31.71% vs. 12.20%), apnea time [(5.02±1.44) d vs. (2.86±1.03) d], and length of hospital stay [(23.56±6.35) d vs. (20.75±5.97) d] were lower, which differences were statistically significant (all P < 0.05). There was no significant difference in hospital stay time, oxygen treatment time, and in-hospital mortality between the two groups (all P>0.05). There was no significant difference in the incidence of tachycardia, feeding intolerance, hyperglycemia, and electrolyte disturbance between the two groups (all P>0.05). There was no significant difference in the incidence of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intra-ventricular hemorrhage (IVH) and other complications in both groups (all P>0.05).  Conclusion  Compared with low-dose caffeine citrate, high-dose caffeine citrate has a higher success rate of extubation, improves the respiratory function of preterm infants with AOP, and doesn't increase significantly in adverse reactions, which have clinical application meaning.
An innovative popular science model improves bone health awareness in Shanghai community residents
JIANG Ping, XU Qing-bao, ZHOU Qiong, FAN Lin-da, DUAN Zong-shuan, WANG Xiao-ya, ZHANG Chen, WANG Tao
2021, 19(12): 2068-2071,2123. doi: 10.16766/j.cnki.issn.1674-4152.002239
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  Objective  To explore and analyze the impact of medical science talk show, an innovative popular science model on bone health awareness in Shanghai community residents.  Methods  From June 2018 to January 2019, 150 community residents were randomly selected as the research objects by convenience sampling method per communities. 450 residents were participated from 3 communities, including 150 cases were the medical science talk show group (A), 150 cases were the traditional lecture group (B), and 150 cases were the blank control group (C). At baseline and after 3-month, 6-month of popular science intervention, three groups of residents were assessed bone health awareness three times. Combined with sociodemographic data, the cognition of bone health before and after intervention was analyzed.  Results  Compared with those in baseline, the awareness ratios of bone health in 3-month, 6-month in group A and B have both improved. The awareness ratio in group A had significantly improved in all four knowledge both at 3- and 6-month intervention (all P < 0.05), while those in group B had increased significantly only in two knowledge [definition of osteoporosis (χ2=93.329, P < 0.001), main characteristics of osteoporosis (χ2=8.035, P=0.018)].  Conclusion  Medical science talk show, the innovative science popularization model has a better science popularization effect, and has a wider range of applicable knowledge. In the future, precise community health science popularization activities should take special consideration into the influence of factors such as innovative science popularization models on the effects of popular science.
Correlation between frailty and related serum factors in elderly community
QIN Li, GE Li-bin, LIANG Zhen-zhen, CHEN Liang, CHEN Chuan
2021, 19(12): 2072-2076. doi: 10.16766/j.cnki.issn.1674-4152.002240
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  Objective  To understand the situation of senile frailty in community, analyze the correlation between serum factors and senile frailty, and give corresponding suggestions to community medical staff.  Methods  A total of 375 elderly people who underwent physical examination in Huangdu Community Health Service Center, Anting Town, Jiading District, Shanghai from April to September 2018 were selected as the research subjects. The researchers made their own general data questionnaire.The indexes of blood routine and liver and kidney function were derived from the physical examination database of the elderly in this community. Interleukin-6 (IL-6), insulin growth factor 1 (IGF-1) and other indicators were measured by Shanghai Institute of Traditional Chinese Medicine. Ordered multifactor logistic regression was used to analyze the correlation between senile frailty and the levels of the above serum factors.  Results  (1) Among the 375 elderly patients, 173 were at non-frailty stage, 188 at pre-frailty stage and 14 at frailty stage. The gender, age, educational level, smoking history and drinking history of the elderly with different degrees of frailty had statistical significance (all P < 0.05). (2) Among the serum biochemical indexes of the elderly in the community with different degrees of frailty, only hemoglobin had the differences were statistically significant (P < 0.05). (3) The differences of insulin growth factor (IGF-1), follicle-stimulating hormone (FSH) and estradiol (E2) in special serum biochemical indexes of the elderly in the community with different frailty levels were statistically significant (all P < 0.05). (4)The results of logistic regression analysis showed that the levels of hemoglobin (HB), insulin growth factor (IGF-1), follicle-stimulating hormone (FSH), estradiol (E2) and other factors had no correlation with the occurrence of frailty.  Conclusion  The correlation between serum factors and community geriatric frailty is affected by many factors, so community general practitioners should conduct comprehensive assessment of community geriatric frailty in the early stage.
Study on the changes of school-age children's emotional and behavioural problems during the COVID-19 quarantine
QIU Xiao-yan, WANG Guang-hai, WANG Yu, JIANG Lian, HUO Yan-yan, CHEN Jin-jin, JIANG Fan
2021, 19(12): 2077-2080,2114. doi: 10.16766/j.cnki.issn.1674-4152.002241
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  Objective  To explore the current situation of emotional and behavioural problems among school-age children during the quarantine period of coronavirus disease 2019 (COVID-19), and to provide guidance for children's psychological intervention in public health events in the future.  Methods  Four primary schools in a district of Shanghai were selected and included in the study using simple random sampling. The general questionnaire and strength and difficulty scales were used on the parents of students. Information on the basic situation of children and families quarantined by COVID-19 during the past 6 months was collected and the results were analyzed.  Results  The emotional symptoms of children from single-parent families [2.50(1.00, 5.25)points], the behaviour problems of children from immediate families [2.00(1.00, 3.00) points] and the prosocial behaviours of children from joint families [8.00(7.00, 10.00) points] were scored higher. Emotional and behavioural problems changed in school-age children during the quarantine period. Higher scores for behavioural problems were found in girls aged 7-9 years old (all P < 0.05), and hyperactivity inactivity score decreased in boys aged 6-9 years old (all P < 0.05) compared with the Shanghai norm. Compared with SH2018, scores for behavioural problems increased in children of all ages (all P < 0.05), and the prosocial behaviour scores of children aged 7-9 years old decreased.  Conclusion  The emotional problems of children in single-parent families and lineal families and the conduct problems of children in lineal families should become the focus of research. If a similar public health event occurs in the future, then stratified and classified interventions should be carried out for children with different emotional and behavioural problems.
Analysis of related factors of treatment compliance in patients with schizophrenia
MU Xi-yuan, ZHANG Chen, WANG Xiao-rong
2021, 19(12): 2081-2083. doi: 10.16766/j.cnki.issn.1674-4152.002242
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  Objective  To investigate and analyse the related factors of treatment compliance in patients with schizophrenia and provide reference for clinical intervention.  Methods  A total of 150 cases of convalescent schizophrenic patients who were treated in our hospital from January 2019 to December 2020 were selected, and their treatment compliance was investigated by using the Morisky medication compliance questionnaire (MMAS-8). Logistic regression analysis was used to analyse the influencing factors of treatment compliance.  Results  Amongst the 150 patients, 73 cases of complete compliance, 43 cases of partial compliance, 34 cases of non-compliance, 116 cases (77.33%) of good treatment compliance and 34 cases (22.67%) of poor treatment compliance were identified. The level of education, course of disease, treatment cost, length of hospital stay, mastery of disease knowledge, return visit, treatment emergent symptom scale (TESS) score and brief psychiatric rating scale (BPRS) score were compared between the two groups, and the difference was statistically significant (χ2=4.005, P=0.045; t=3.505, P < 0.001; t=6.179, P < 0.001; t=4.165, P < 0.001; χ2=7.273, P=0.007; χ2=4.193, P=0.041; t=12.592, P < 0.001; t=20.250, P < 0.001). Multivariate logistic regression analysis showed that the level of education, low educational level, Tess score ≥ 30 and BPRS score > 35 are the risk factors affecting treatment compliance. Hospitalization time ≥ 45 days, good mastery of disease knowledge and regular follow-up are the protective factors of treatment compliance.  Conclusion  Several factors influencing the treatment compliance of schizophrenic patients are identified. The TESS and BPRS scores are inversely proportional to treatment compliance, the lower the score, the higher the treatment compliance.
Levels of plasma myelin-associated proteins and inflammatory factors in patients with major depressive disorder
HE Yi, PANG Jian-yue, LIU Yu-jia, DENG Ya-jie, LIU Yu-xia, LI Heng-fen
2021, 19(12): 2084-2087. doi: 10.16766/j.cnki.issn.1674-4152.002243
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  Objective  To compare the levels of peripheral plasma myelin-associated protein and inflammatory factors between patients with first-episode untreated and recurrent major depressive disorder and healthy people.  Methods  A total of 118 subjects in our hospital from March 2019 to May 2020 were recruited, including 40 patients with first-episode untreated major depressive disorder (first-episode group), 40 patients with recurrent major depressive disorder (recurrent group) and 38 healthy controls (control group). The levels of peripheral plasma myelin basic protein (MBP), myelin-associated glycoprotein, myelin oligodendrocyte glycoprotein, C-reactive protein, interleukin-6 and tumour necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. The 24-item Hamilton Depression scale (HAMD-24) was used to score the degree of depression in all patients.  Results  Statistically significant differences were observed in the levels of MBP amongst the three groups [recurrent group (2.32±0.95) ng/mL; first-episode group (1.92±0.91) ng/mL; control group (1.40±0.76) ng/mL] and TNF-α [recurrent group (8.49±5.45) ng/mL; first-episode group (6.30±4.71) ng/mL; control group (4.90±4.18) ng/mL, FMBP=10.824, P < 0.05; FTNF-α=5.510, P < 0.05]. The levels of MBP and TNF-α in the recurrent group were significantly higher than those in the first-episode group (tMBP=4.646, P < 0.05; tTNF-α=3.285, P < 0.05), whilst the levels of MBP and TNF-α in the recurrent group were significantly higher than those in the control group (tMBP=2.069, P < 0.05; tTNF-α=2.034, P < 0.05). The MBP of the first-episode group was significantly higher than that of the control group (tMBP=2.603, P < 0.05). No significant correlation was observed between the levels of myelin-associated protein, inflammatory factors and HAMD-24 scores.  Conclusion  The level of MBP in peripheral plasma may be an important biomarker to determine the prognosis of depression and the severity of pathological injury of the nerve myelin sheath. The level of TNF-α may be related to the recurrence of major depressive disorder.
Multi-sequence MRI-based radiomics predicting lymph-vascular space invasion in early-stage cervical cancer
WANG Hai-bo, CUI Wei, YANG Wei-li
2021, 19(12): 2088-2092. doi: 10.16766/j.cnki.issn.1674-4152.002244
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  Objective  To explore the clinical value of multi-sequence MRI-based radiomics in predicting lymph-vascular space invasion (LVSI) in early-stage cervical cancer.  Methods  A total of 134 patients (91 cases in the training group and 43 cases in the validation group) with pathological early-stage cervical cancer in the Affiliated People's Hospital of Ningbo University from January 2015 to February 2020, were retrospectively collected. All patients underwent MRI plain scan, contrast-enhanced MRI (CE-MRI) and diffusion-weighted imaging (DWI) before surgery. MRI images of each sequence were obtained, and the region of interest was drawn. Radiomic features were extracted by using the least absolute shrinkage and selection operator (LASSO) and nomogram method to construct the predictive model. The training group was used to extract feature, establish signature and construct the predictive model. The validation group was used to verify the predictive model. Receiver operating characteristic curve was used to analyse the predictive effect of each sequence MRI-based radiomic model on LVSI in early-stage cervical cancer.  Results  The predictive LVSI features were extracted from T2WI-FS, CE-MRI and DWI sequence images in patients with early-stage cervical cancer by LASSO regression. WavEnLH_s-4 and Horzl_LngREmph were all screened out. Results showed that the diagnostic efficiency of multi-sequence MRI imaging models constructed by the Logistic regression model was high for LVSI in early-stage cervical cancer. AUC of T2WI-FS, CE-MRI and DWI was 0.810, 0.803 and 0.781, respectively, in the training group and 0.785, 0.761 and 0.752, respectively, in the verification group. The AUC of multi-sequence MRI-based radiomic model constructed by nomogram was 0.893 in the training group and 0.859 in the verification group.  Conclusion  As an objective image analysis method, the nomographic model based on T2WI-FS, CE-MRI and DWI sequence has a high predictive effect and certain clinical application value in LVSI of early-stage cervical cancer.
Assessment of the effectiveness of multi-slice spiral CT multiparameter for risk stratification of acute pulmonary embolism
ZHU Lin, LU Ran, GUO Fei
2021, 19(12): 2093-2097. doi: 10.16766/j.cnki.issn.1674-4152.002245
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  Objective  To investigate the diagnostic value of multi-slice spiral CT (MSCT) multiparameter in the risk stratification of acute pulmonary embolism (APE).  Methods  Seventy-four patients diagnosed with APE by MSCT in the First Affiliated Hospital of Bengbu Medical College between January 2019 and October 2020 were included, and the patients were divided into high-risk group (18 patients), medium-high risk group (26 patients) and medium-low risk group (30 patients) according to hemodynamic status, right ventricular function and whether the myocardium was damaged, and the differences in PAOI and other imaging parameters. Clinical and laboratory indices between the groups were compared, and the subject workup characteristic curves were used to evaluate the predictive value of PAOI and cardiovascular. The predictive value of PAOI and cardiovascular parameters for patients in the high-risk and medium-high risk group was evaluated using subject work characteristic curves, and independent risk factors for APE patients in the high-risk or medium-high risk group were analyzed using multivariate ordered logistic regression.  Results  Statistically significant differences were found in LDH, PAOI, PTD, PTD/AAD, RVD/LVD and involvement of pulmonary segmental arteries in different groups of patients (all P < 0.001). The sensitivity and specificity of PAOI (> 38.8%) for assessing patients at high-risk and medium-high risk of APE were 65.9% and 80.0%, and higher PAOI values are an independent risk factor for patients at high-risk or medium-high risk of APE (P < 0.001). The sensitivity and specificity of RVD/LVD (> 1.2) and PTD/AAD (>0.9) for assessing patients at high-risk and medium-high risk of APE were 59.1% and 93.3%, 65.9% and 86.7%, respectively.  Conclusion  MSCT multiparameter may be used to assess the severity and predict the progression of APE patients and guide clinical treatment.
Value of micropure combined with superb microvascular imaging compared with X-ray molybdenum target for the diagnosis of breast diseases
FENG Shu, LI Yang, JIN Peng, TANG Xiao-min, SUN Yi-xue
2021, 19(12): 2098-2101. doi: 10.16766/j.cnki.issn.1674-4152.002246
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  Objective  To explore the value of micropure combined with superb microvascular imaging compared with X-ray mammography in the diagnosis of benign and malignant breast diseases.  Methods  A total of 160 female patients with breast diseases, who were admitted to the First Affiliated Hospital of Bengbu Medical College from December 2019 to December 2020, were selected, of which 124 were benign lesions and 36 were malignant lesions. All patients with breast diseases were single lesions, and all included patients with breast diseases received micropure combined with superb microvascular imaging examination and X-ray molybdenum target. Postoperative pathological results were used as the gold standard to compare the diagnostic efficacy of micropure combined with superb microvascular imaging and X-ray molybdenum target in breast diseases.  Results  Amongst the 160 patients with breast diseases, the diagnostic detection rate of micropure combined with superb microvascular imaging was 97.2%, whereas the diagnostic detection rate of X-ray molybdenum target was 77.8%, and the difference between the two groups was statistically significant (P < 0.05). The diagnostic specificity of 95.2% (118/124), sensitivity of 97.2% (35/36) and accuracy of 95.6% (153/160) for micropure combined with superb microvascular imaging were higher than those for X-ray molybdenum target [specificity of 78.2% (97/124), sensitivity of 77.8% (28/36) and accuracy of 78.1% (125/160)] by 15.415 (specificity), 4.571 (sensitivity) and 21.487 (accuracy), respectively, and the difference was statistically significant (all P < 0.05).  Conclusion  The efficacy of micropure combined with superb microvascular imaging for diagnosing breast diseases is higher than that of X-ray molybdenum target alone, which is conducive to improving the diagnostic accuracy of breast malignant tumours.
Research progress on the influencing factors and intervention measures of salivation in patients with trans-oral tracheal intubation
WANG Hong-mei, BOSOMTWE Samuel, DU Jin-lei, ZOU Xiao-yue, PAN Yong-liang
2021, 19(12): 2102-2105. doi: 10.16766/j.cnki.issn.1674-4152.002247
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Currently, trans-oral tracheal intubation is one of the effective treatment measures for patients with acute and critical illness, with a clinical use rate of 96%. With its widespread use, complications have become increasingly prominent, amongst which salivation is one of the more common and overlooked clinical complications in patients with trans-oral tracheal intubation. According to literature research, salivation can cause skin and/or mucosal infections, malnutrition, aggregate subglottic secretions and increased risk of unplanned extubation and ventilator-related pneumonia in patients with trans-oral tracheal intubation. It is one of the important factors that increase the length of hospital stay and medical expenses. Furthermore, studies have shown that the prevention and treatment of salivation in patients with trans-oral tracheal intubation is of great significance to the occurrence of ventilator-associated pneumonia, but clinical medical and nursing staff often ignore the relevance of salivation to ventilator-associated pneumonia. No effective management measures are available for preventing salivation, and relevant studies are also lacking. On the basis of the results of multiple studies on the influencing factors of salivation, this paper summarises the influencing factors of salivation in patients with trans-oral tracheal intubation, including salivation abnormality, neuromuscular dysfunction, sensory impairment and the relative lack of awareness of medical and nursing staff. It also provides a reasonable outlook on the prevention and treatment measures of salivation in patients with trans-oral tracheal intubation on the basis of existing intervention methods for salivation. In the future, studies on the current survey, analysis of influencing factors and intervention measures for salivation in patients with trans-oral tracheal intubation should be conducted. Relevant research in each direction provides reference for reducing and preventing salivation and its complications in patients with trans-oral tracheal intubation, so as to improve the predictability and precision of clinical prevention, treatment and nursing, as well as the comfort of patients in the hospital.
Application and research progress of near infrared spectroscopy in critically ill neonates
JIE Shuang-shuang, DAI Li-ying
2021, 19(12): 2106-2109. doi: 10.16766/j.cnki.issn.1674-4152.002248
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Near infrared spectroscopy (NIRS) is a noninvasive and reliable technique for real-time monitoring of tissue oxygen saturation. Monitoring of multi-site brain and somatic oxygen saturation in intensive care unit can evaluate local tissue oxygenation and organ perfusion in critically ill newborns. Firstly, this paper briefly introduces the development history, basic principle and monitoring position of NIRS technology. Secondly, this paper discusses the development and application of NIRS technology in neonatal critical diseases such as complex congenital heart disease, neonatal hypoxic-ischemic encephalopathy, apnea and arrhythmia, neonatal periventricular/intraventricular hemorrhage, neonatal respiratory distress syndrome, necrotizing enterocolitis, neonatal acute kidney injury, erythrocyte infusion in premature infants, etc. Finally, the future application of NIRS technology is briefly discussed. NIRS technique was initially used to monitor brain oxygen saturation after neonatal brain injury and cardiac surgery to assess brain oxygenation and perfusion, early detect neonatal brain injury and related complications after cardiac surgery thus early intervention. NIRS technology is now involved in all areas of the newborn, by monitoring oxygen saturation in different parts of the brain, kidney, intestine, liver, targeted prediction of related diseases, judging the severity of the disease and the feasibility of surgery, so as to reduce the incidence and mortality of the disease and improve the prognosis and quality of life of newborns. In the future, we need to carry out more studies in different parts and different ages of neonates, to promote the early diagnosis and treatment of other neonatal diseases, such as very low birth weight infants feeding intolerance neonatal low cardiac output syndrome after cardiopulmonary bypass, shorten the process of neonatal feeding, and protect cardiopulmonary function.
Effect of She Medicine Huoxue Xiaoji Recipe on clinical efficacy and endoplasmic reticulum stress in patients with H-type hypertension complicated left ventricular hypertrophy
PAN Quan, CHEN Li-ping, LEI Hou-xing, WANG Hua-qiang, LI Rui
2021, 19(12): 2110-2114. doi: 10.16766/j.cnki.issn.1674-4152.002249
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  Objective  To observe the effect of Sheyi Huoxue Xiaoji Recipe on clinical efficacy and endoplasmic reticulum stress-related markers in patients with H-type hypertension complicated left ventricular hypertrophy and blood stasis syndrome, and explore its mechanism of action.  Methods  A total of 80 patients with H-type hypertension complicated left ventricular hypertrophy and blood stasis syndrome in Lishui City Hospital of Traditional Chinese Medicine from April 2018 to May 2019 were selected and randomly divided into the control group and observation group according to the number table method (each with 40 cases). The control group was treated with Western medicine, whilst the observation group was treated with Western medicine plus Sheyi Huoxue Xiaoji Recipe. The changes of antihypertensive efficacy, TCM syndrome scores, blood pressure levels, homocysteine (Hcy), left ventricular hypertrophy indicators and endoplasmic reticulum stress-related markers were compared in both groups, and adverse reactions were recorded.  Results  The total effective rate of lowering blood pressure in the observation group was 90.0%, which was higher than 72.5% in the control group (χ2=4.021, P=0.045). After treatment, the TCM syndrome score, blood pressure level, Hcy, left ventricular end-diastolic diameter and left ventricular mass index in the observation group were lower than those in the control group (all P < 0.05). After treatment, the serum glucose-regulated protein 78 [(6.25±1.83) ng/mL], protein kinase R-like ER kinase [(15.74±1.75) ng/mL] and C/EBP homologous protein [(8.52±0.65) ng/mL] were lower in the observation group than in the control group [(7.35±1.07) ng/mL, (16.85±1.82) ng/mL, (9.45±0.58) ng/mL, t=3.282, 2.780, 6.751, all P < 0.05]. No adverse reactions were observed in both groups.  Conclusion  The Sheyi Huoxue Xiaoji Recipe has a significant clinical effect in treating patients with H-type hypertension complicated left ventricular hypertrophy and blood stasis syndrome, which may be related to the effective regulation of endoplasmic reticulum stress.
Efficacy of acupoint embedding thread combined with warm acupuncture in treating patients with knee osteoarthritis
HUANG Zhen, ZHANG Di, SONG Shuang-lin, BIAN Zhen-yu
2021, 19(12): 2115-2118. doi: 10.16766/j.cnki.issn.1674-4152.002250
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  Objective  To investigate the efficacy of acupoint embedding thread combined with warm acupuncture in treating patients with knee osteoarthritis and its effect on the levels of serum interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-α.  Methods  One hundred twenty patients with knee osteoarthritis admitted in our hospital from September 2017 to July 2020 were selected and divided into control group and observation group with 60 patients in each group using the random number table method. The control group was treated with diclofenac sodium sustained-release tablets, whereas the observation group was treated with acupoint embedding combined with warm acupuncture. The course of treatment of the two groups was 4 weeks. The visual analogue scale (VAS), scores of Lysholm scale (LKSS), WOMAC indexes, symptoms of traditional Chinese medicine, clinical efficacy and serum levels of IL-1, IL-6 and TNF-α were compared between the two groups.  Results  After treatment, the VAS [(1.36±0.17) points], scores of LKSS [(76.13±8.46) points] and WOMAC indexes [(2.72±0.34) points, (0.94±0.14) points, (15.40±2.22) points] in the observation group were significantly higher than those in the control group [VAS (2.81±0.43) points, scores of LKSS (62.01±7.75) points, WOMAC indexes (4.31±0.52) points, (1.65±0.22) points, (20.38±2.46) points; all P < 0.001], and symptoms of traditional Chinese medicine in the observation group were significantly higher than those in the control group (all P < 0.001). The total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, the improvement of serum IL-1 [(8.21±1.25) ng/L], IL-6 [(33.61±4.46) ng/L] and TNF-α [(12.09±1.77) ng/L] in the observation group were significantly better than those in the control group [IL-1 (12.13±1.65) ng/L, IL-6 (54.81±6.03) ng/L, TNF-α (15.40±2.51) ng/L, all P < 0.001].  Conclusion  The efficacy of acupoint embedding thread combined with warm acupuncture in treating patients with knee osteoarthritis is significant, which shows potential application in clinic.
Clinical observation of Bu Bao Decoction in improving infertility with luteal insufficiency caused by kidney yang deficiency type
XU Dao-fen, SUN Yun, HU Xin-xin, GAO Chu-chu, ZHENG Hui-jun
2021, 19(12): 2119-2123. doi: 10.16766/j.cnki.issn.1674-4152.002251
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  Objective  To investigate the clinical efficacy of Bu Bao Decoction in improving infertility with luteal insufficiency caused by kidney yang deficiency type and its effect on the endometrial haemodynamics, and analyse the safety during medication.  Methods  Eighty infertility patients with luteal insufficiency who were treated in Wenzhou Traditional Chinese Medicine Gynecology Clinic from January 2018 to March 2019 were selected and randomly divided into the observation group (40 cases) and control group (40 cases). The observation group was given Bu Bao Decoction, While the control group was given dydrogesterone tablets. The patients in both groups were treated continuously for three menstrual cycles. The clinical efficacy of the two groups, the improvement of kidney yang deficiency symptoms and the serum estradiol (E2) and progesterone (P) levels in the metaphase luteum were observed. Endometrial thickness, uterine artery blood flow resistance index (RI) and pulsatility index (PI) of patients were detected by ultrasound before and after treatment. Six-month follow-up was used to record the clinical pregnancy and adverse reactions in the two groups.  Results  The clinical effectiveness of the observation group was significantly higher than that of the control group [(35/40, 87.50%) vs. (27/40, 67.50%)], and the difference was statistically significant (Z=4.588, P=0.032). After treatment, the score of TCM kidney yang deficiency syndrome in the observation group was lower than that of the control group, and the serum E2 and P levels in the metaphase luteum were higher than those in the control group, the difference was statistically significant (t=9.046, 4.507, 5.143, all P < 0.05). The endometrial thickness of the observation group after treatment was higher than that of the control group, while RI and PI were lower than the control group, the difference was statistically significant (t=5.228, 4.005, 2.923, all P < 0.05). After follow-up for 6 months, the clinical pregnancy rate of the observation group was higher than that of the control group, and the difference was statistically significant (χ2=4.267, P=0.039). No statistically significant difference in the occurrence of adverse reactions was found between the two groups during treatment (P=0.999).  Conclusion  Bu Bao Decoction has a significant effect on treating infertility patients with luteum insufficiency caused by kidney yang deficiency. Moreover, it can significantly improve the luteum index and increase the pregnancy rate.
Application of PBL teaching method combined with endovascular simulator in clinical practice teaching of vascular surgery
TANG Wen-bo, DU Xiao-ying, GAO Yong, SONG Tao, NIE Zhong-lin, YU Chao-wen
2021, 19(12): 2124-2126, 2145. doi: 10.16766/j.cnki.issn.1674-4152.002252
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  Objective  To explore the role of problem based learning (PBL) teaching method combined with intravascular simulator teaching mode in the teaching of clinical medical interns in vascular surgery.  Methods  One hundred undergraduates majoring in clinical medicine in the First Affiliated Hospital of Bengbu Medical College were selected as the research objects and randomly divided into the experimental group and control group, with each group including 50 undergraduates in 2016. Students in the control group adopted traditional teaching mode and PPT demonstration operation mode, whilst students in the experimental group adopted PBL teaching method combined with intravascular simulator teaching mode. The two groups of students were taught by the same group of teachers with clinical teaching experience. After the teaching, this group of teachers objectively assessed the theoretical knowledge and skill operation of the two groups of students. The two groups of students evaluated the learning interest, learning ability, classroom atmosphere, mastery of theory and skills of the two teaching modes anonymously. Finally, through theoretical assessment and questionnaire, the teaching effects of the two teaching modes were compared.  Results  The scores of the experimental group were (83.15±9.45) points and (84.36±7.28) points, which were higher than those of the control group [(75.45±7.78) points and (73.38±6.96) points], respectively, and the difference was statistically significant (all P < 0.05). Students' learning interest, learning ability, classroom atmosphere, theoretical knowledge and skills were scored according to the questionnaire survey, and the results were analysed. Results showed that the evaluation of the survey contents of the experimental group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). In short, all students in the experimental group had good evaluation on the investigation of PBL teaching method combined with intravascular simulator teaching mode.  Conclusion  In clinical practice teaching of vascular surgery, PBL teaching method combined with intravascular simulator teaching mode can promote the cultivation of students' comprehensive ability more than traditional teaching and achieves good teaching effect, which is worthy of popularisation and application.
Application of a new type of whole-cycle nutrition management in cancer patients with cachexia
LIN You-yan, ZHOU Ping, ZHENG Mei-zhen, YU Xin-yan, WEN Xiao-xue
2021, 19(12): 2127-2131. doi: 10.16766/j.cnki.issn.1674-4152.002253
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  Objective  To explore the effect of a new type of whole-cycle nutrition management on the nutritional status and quality of life of cancer patients with cachexia.  Methods  A total of 100 cancer patients with cachexia were randomly divided into the control group (n=50) and treatment group (n=50). The control group received conventional anti-tumour therapy, whereas the treatment group implemented a new whole-process 'hospital Home Return' circular nutrition management mode. The main contents included the establishment of a multi-disciplinary (MDT) process management team, the intervention of fine nutrition, the establishment of cluster patient education mode, the establishment of family self-nutrition management files and the formation of multi-means hierarchical follow-up. The biochemical nutritional index, patient-generated subjective global assessment (PG-SGA) score and Barthel index (Bi) score were compared before treatment and 1, 2 and 4 weeks after treatment.  Results  The biochemical nutritional indicators, PG-SGA score and BI score of the two groups before treatment and 1, 2 and 4 weeks after treatment all improved (all P < 0.05). There was no significant difference in serum albumin between the two groups (P=0.159), and other indexes in the treatment group were better than those in the control group (all P < 0.001).  Conclusion  The new circular nutrition management mode could improve the nutritional status of patients, particularly the self-care ability of patients. Therefore, whether patients move from hospital to home, or home to hospital, the whole cycle of nutrition management should be implemented, and is worthy of reference.
Risk prediction of venous thromboembolism associated with gynaecologic cancer on the basis of the COMPASS-CAT risk assessment model
TAN Kai-yu, LIU Dan, LIU Hua-yun, TANG Xin-hui
2021, 19(12): 2132-2135, 2140. doi: 10.16766/j.cnki.issn.1674-4152.002254
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  Objective  To explore the value of the COMPASS-CAT model and new model in predicting the risk of venous thrombosis associated with gynaecological malignancies.  Methods  From January 2015 to June 2020, 161 patients with gynaecological malignancies who were hospitalised with venous thromboembolism (VTE) in Hunan Cancer Hospital were enrolled. A total of 322 patients in the control group were selected according to the time matching 1 ∶ 2. The clinical data of the two groups of patients were collected. The risk factors of VTE related to gynaecological malignancies were analysed. A new model was constructed, and the receiver operating characteristic (ROC) curve was drawn and compared with the original COMPASS-CAT assessment model.  Results  The comparison between the two groups of patients in age, tumour stage, hypertension, hyperlipidaemia, diabetes, menopausal status, history of VTE, history of blood transfusion, central venous catheter, chemotherapy, platelet count and D-dimer showed statistically significant differences (all P < 0.05). Multivariate analysis showed that menopausal status, history of blood transfusion, chemotherapy and D-dimer≥0.55 μg/mL are independent risk factors for VTE related to gynaecological malignancies (all P < 0.05). The sensitivity of the new model was 75.8%, the specificity was 67.7%, and the Youden index was 0.435. The areas under the ROC curve (AUCs) of the two models were 0.698 (95% CI: 0.647-0.750) and 0.768 (95% CI: 0.723-0.813). Compared with the COMPASS-CAT model, the AUC area of the new model increased by 0.07 (P < 0.001).  Conclusion  The newly constructed COMPASS-CAT thrombosis risk assessment model has a high level of risk prediction for the formation of VTE related to gynaecological malignancies and improves the accuracy of identifying patients at high risk of thrombosis.
Relationship between marital satisfaction and post-traumatic growth in patients with traumatic spinal cord injury
HUANG Rui-rui, LIU An-nuo, LI Lun-lan, QI Jin-mei
2021, 19(12): 2136-2140. doi: 10.16766/j.cnki.issn.1674-4152.002255
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  Objective  To explore the mediating role of self-efficacy and psychological elasticity in marital satisfaction and post-traumatic growth in patients with traumatic spinal cord injury.  Methods  Total 188 patients with traumatic spinal cord injury in the Rehabilitation Department of the First Affiliated Hospital of Anhui Medical University from August 2019 to August 2020 were selected using convenience sampling method. General Data Questionnaire, Olson Marital Quality Questionnaire, General self-efficacy scale, Connor-Davidson Resilience, Chinese version of posttraumatic growth inventory were used for questionnaire survey.  Results  Pearson correlation analysis showed that post-traumatic growth was positively correlated with marital satisfaction (r=0.667, P < 0.01), self-efficacy (r=0.658, P < 0.01) and psychological elasticity (r=0.674, P < 0.01). The results of mediating effect test showed that marital satisfaction could directly predict post-traumatic growth, and the effect value was 0.293, accounting for 35.57% of the total effect. Self-efficacy (effect value 0.220) and psychological elasticity (effect value 0.186) had independent mediating effects between marital satisfaction and post-traumatic growth, accounting for 26.77% and 22.57% of the total effects, respectively, meanwhile self-efficacy and resilience had a chain mediating effect between marital satisfaction and post-traumatic growth, the effect value was 0.124, accounting for 15.09% of the total effect.  Conclusion  The relationship between marital satisfaction and post-traumatic growth in patients with traumatic spinal cord injury is affected not only by the independent mediation, but also by the chain mediation of self-efficacy and psychological elasticity.
Six basic clinical principles of primary care practice
LI Jian, LIU Ying-ying, PIAO Hui-hong, YUAN Tong-ling, WU Jiang
2021, 19(12): 2141-2145. doi: 10.16766/j.cnki.issn.1674-4152.002256
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  Objective  Primary care is a general medical clinical service in developed countries, and its basic principles should be established. The purpose of this study is to establish the clinical service principles of primary care.  Methods  We searched literature in multiple databases using the key words 'primary care, ' 'primary care practice, ' 'primary health care, ' 'general practice' and 'family medicine' in combination with 'principle, ' 'ideal, ' 'description, ' 'characteristic' and 'feature'. A total of 54 articles were selected to summarize the basic clinical principles of primary care practice.  Results  Six basic clinical principles of primary care practice were synthesised. (1) A holistic principle included holism, whole person care, bio-psycho-social model, lateral clinical thinking and overcoming fragmented specialisation. (2) An integrative principle consisted of the combination of complementary medicine, coordinated care and practicing holistic integrated medicine. (3) A continuous principle dealed with continuous clinician-patient relationship, seamless services, life-cycle medical services and full medical care at any time and place. (4) A preventive principle contained undifferentiated disease care, health habit counselling, screening for asymptomatic diseases and immunisation. (5) A patient-centred principle referred to responses to individual patient needs and values, people-oriented care and practicing patient-centred medical home. (6) A standardised principle involved the use of evidence-based medicine, following the clinical guideline and applying the clinical pathway.  Conclusion  The six basic clinical principles might be the backbone of primary care practice, which can be used to construct the disciplinary knowledge of clinical primary care practice.
Application of preoperative nursing intervention mode based on the concept of enhanced recovery after surgery in elderly patients with lumbar spinal stenosis
ZHANG-YANG Xi-bei, BO Bin, MA Jie, ZHOU Ping-hui
2021, 19(12): 2146-2148, 2157. doi: 10.16766/j.cnki.issn.1674-4152.002257
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  Objective  To study the effects of preoperative nursing intervention based on the concept of enhanced recovery after surgery on sleep quality, anxiety and postoperative complications in elderly patients with lumbar spinal stenosis.  Methods  The clinical data of 102 patients (age>65 years) who underwent lumbar spinal surgery due to lumbar spinal stenosis from July 2017 to June 2019 in the First Affiliated Hospital of Bengbu Medical College were randomly divided into the control group (n=51) and experimental group (n=51). The control group received routine orthopaedic care in the hospital, whilst the experimental group received preoperative nursing interventions based on the concept of accelerated rehabilitation surgery. The differences in sleep quality, anxiety, postoperative complications and nursing satisfaction between the two groups before and after nursing intervention were compared.  Results  No significant differences were found in the general information, anxiety and sleep quality between the two groups before intervention (all P>0.05). After intervention, the Pittsburgh Sleep Quality Index scores in the experimental group and the control group were (6.20±1.60) points and (13.35±2.27) points, respectively, and the difference between groups was statistically significant (t=18.402, P < 0.001). The scores of the self-rating anxiety scale were (38.42±8.99) points in the experimental group and (44.63±8.92) points in the control group, with statistically significant difference between groups (t=3.505, P=0.001). The incidence of postoperative complications in the experimental group (5.88%) was significantly lower than that in the control group (19.61%), and the difference between groups was significant (χ2=4.320, P=0.038). The nursing satisfaction was 96.08% in the experimental group and 80.39% in the control group, and the difference between groups was statistically significant (χ2=15.389, P < 0.001).  Conclusion  The preoperative nursing intervention mode based on the concept of enhanced recovery after surgery can effectively improve the sleep quality of elderly patients with lumbar spinal stenosis, improve the anxiety of patients, reduce the incidence of postoperative complications and improve the satisfaction of patients with medical services and quality.
Clinical characteristics and nursing management of SCLC patients complicated with hyponatremia during radiotherapy and chemotherapy
NIU Fang, YANG Xi, SHEN Xiao-ying, GU Yu-yan, XIE Shu-ping, XIE Ling-nv
2021, 19(12): 2149-2152. doi: 10.16766/j.cnki.issn.1674-4152.002258
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  Objective  To analyze the clinical characteristics of hyponatremia in patients with small cell lung cancer (SCLC) during radiotherapy and chemotherapy, explore nursing management strategies, and provide reference for clinical practice.  Methods  A total of 87 patients with SCLC admitted in our hospital from September 2017 to December 2019 were selected as the research object. The general clinical data of patients and the serum sodium values of different treatment stages were collected retrospectively. The clinical characteristics of SCLC complicated with hyponatremia were analyzed. The strategies for nursing management was explored.  Results  Eighty-seven cases of SCLC patients complicated with hyponatremia in 35 cases (40.23%). The incidence of hyponatremia at the initial treatment, after 2 courses of chemotherapy, at the beginning and end of radiotherapy, and after the last treatment were 6.90%, 5.96%, 13.16%, 15.19% and 23.52%, respectively. The incidences of mild, moderate and severe hyponatremia were 46.99%, 11.48% and 6.26%, respectively, and the total incidence of hyponatremia was 64.73%. The clinical manifestations of 35 SCLC patients with hyponatremia were 15 cases of anorexia (42.86%), 9 cases of nausea/vomiting (25.71%), 6 cases of dizziness (17.14%), 20 cases of fatigue (57.14%), 2 cases of abnormal mental behavior (5.71%), and 7 cases of hidden symptoms (20.00%).  Conclusion  The incidence of concurrent hyponatremia in SCLC patients during radiotherapy and chemotherapy is high, and can occur in different treatment stages, and the clinical manifestations are in many forms. In the SCLC peri-chemotherapy period, attention should be paid to the observation and care of hyponatremia.
Effect analysis of preoperative experiential nursing combined with anesthesia recovery nursing to reduce emergence agitation in patients undergoing HoLEP
JIANG Xiu-juan, WANG Yu, YANG Fang-lan
2021, 19(12): 2153-2157. doi: 10.16766/j.cnki.issn.1674-4152.002259
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  Objective  To investigate clinical effect of preoperative experiential nursing combined with anesthesia recovery nursing to reduce emergence agitation in patients undergoing holmium laser enucleation of the prostate (HoLEP).  Methods  Totally 108 patients undergoing HoLEP in 363 hospital from November 2018 to November 2019 were randomized into experimental group and control group by random number method, 54 cases each group. The experimental group received preoperative experiential nursing combined with anesthesia recovery nursing, and the control group received routine nursing care. The blood pressure and heart rate 30 minute after entering anesthesia recovery room, incidence of agitation, incidence of unplanned reoperation, urethra comfort postoperative 1 d and nursing satisfaction were compared between the two groups.  Results  The blood pressure [systolic pressure (132.17±11.36) mm Hg(1 mm Hg=0.133 kPa) vs. (148.56±10.25) mm Hg, t=10.385, P=0.013; diastolic pressure (86.34±7.83) mm Hg vs. (98.62±10.16) mm Hg, t=8.352, P=0.016] and heart rate [(78.41±6.23) times/min vs. (89.35±7.91) times/min, t=7.613, P=0.018] 30 minute after entering anesthesia recovery room in the experimental group was significantly lower than the control group (all P < 0.05). The incidence of agitation was significantly less in the experimental group than that in the control group (12.96% vs. 35.19%, P=0.025). The incidence of unplanned reoperation was lower in the experimental group than the control group (1.85% vs. 5.56%, P=0.219). The urethra comfort postoperative 1 d was significantly higher in the experimental group than the control group (85.19% vs. 70.37%, P=0.031). The nursing satisfaction was significantly higher in the experimental group than the control group (96.30% vs. 87.04%, P=0.047).  Conclusion  For no-catheter history patients undergoing HoLEP, preoperative experiential nursing combined with anesthesia recovery nursing can reduce emergence agitation, relieve urethral irritation and increase nursing satisfaction, it is worth clinical spreading.
2021, 19(12): 2158-2159. doi: 10.16766/j.cnki.issn.1674-4152.002260
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2021, 19(12): 2160-2161. doi: 10.16766/j.cnki.issn.1674-4152.002261
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General Practice Research
Analysis of curative effect of 26 cases of pigmented villonodular synovitis of knee joint
WANG Wei-tao, ZHAO Jin-kang, MA Xing
2021, 19(12): 1991-1994. doi: 10.16766/j.cnki.issn.1674-4152.002218
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  Objective  To analyze and compare the joint function and the improvement of joint pain in 26 patients with knee pigmented villonodular synovitis (PVNS) before and after arthroscopic synovectomy, evaluate the therapeutic value of arthroscopic treatment in patients with PVNS, and evaluate the effect of combined local treatment on the therapeutic effect of patients.  Methods  Twenty-six PVNS of the knee joint patients underwent arthroscopic synovectomy from January 2008 to December 2019 were analyzed retrospectively. Among them, 15 patients were treated with knee arthroscopy alone, and 11 patients were treated with local radiotherapy of diseased joints after operation. All 26 patients were followed up 88.6 (3-132) months. The joint pain score VAS score and knee function score Lysholm score were recorded before arthroscopic treatment and at the last follow-up, and the changes of VAS score and Lysholm score were statistically analyzed by t-test. The recurrence was determined by the joint swelling and pain and MRI evaluation results, and compared between the two groups.  Results  All 26 patients were followed up. The postoperative pathology showed that they were consistent with PVNS. The VAS score decreased from (4.60±0.88) points before surgery to (1.35±0.82) points at the last follow-up (P < 0.001), and Lysholm score increased from (41.00±7.45) points to (80.27±4.53) points (P < 0.001). The recurrence rate was 26.67% in the group receiving arthroscopy alone, and 9.09% in the group receiving arthroscopy combined with postoperative local radiotherapy (P>0.05).  Conclusion  Arthroscopy synoviectomy can relieve the pain and improve the joint function of the PVNS, and postoperative combined with local radiotherapy has a better therapeutic effect.
Efficacy analysis of early radiotherapy versus delayed radiotherapy in 68 cases of EGFR-mutant lung adenocarcinoma with brain metastases
QIAN Jing, HE Ze-lai, TIAN Xiao-yuan, JING Qi-jun, LI Hong-wei
2021, 19(12): 1995-1998, 2027. doi: 10.16766/j.cnki.issn.1674-4152.002219
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  Objective  To investigate the efficacy and influencing factors of early radiotherapy versus delayed radiotherapy in EGFR-mutant lung adenocarcinoma patients with brain metastasis.  Methods  A total of 68 cases of EGFR-mutant lung adenocarcinoma patients with brain metastases, who were admitted in the First Affiliated Hospital of Bengbu Medical College from January 1, 2016 to December 31, 2020. The patients were divided into two groups according to the timing of brain radiotherapy. The early radiotherapy group (n=48) received brain radiotherapy and epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) simultaneously. In the delayed radiotherapy group (n=20), EGFR-TKI was performed initially, and brain radiotherapy was performed after the brain lesions progressed. Intracranial progression-free survival (iPFS) and overall survival (OS) of the two groups were evaluated, and prognostic factors were analysed.  Results  The median OS of all patients was 26 months. The iPFS of the early radiotherapy group was prolonged compared with the delayed group. The 1-year, 2-year and 3-year iPFS rates were 91.3%, 73.5%, 61.3% and 74.3%, 60.8%, 30.4%, respectively (P=0.078). The OS of the early radiotherapy group was also longer than that of the delayed radiotherapy group. The OS rates were 81.6%, 51.5%, 51.5% and 65.0%, 51.2%, 20.5%, respectively, with no significant difference (P=0.321). The OS of patients with high Lung-mol GPA score was better than the OS of patients with low score (P < 0.001). Low ECOG score indicated good iPFS (P=0.010).  Conclusion  Compared with delayed radiotherapy, early radiotherapy may prolong iPFS and OS, but no significant statistical difference is found. ECOG and Lung-mol GPA are independent prognostic factors of iPFS and OS, respectively.
Clinical study on the relationship between the changes of fractional exhaled nitric oxide and the severity of OSAHS before and after sleep
WANG Wen-juan, HUANG Li-nian, XU Qi-xia, XIA Xue-mei, RUI Yan, PANG Ying-ying, PANG Qing
2021, 19(12): 1999-2002, 2092. doi: 10.16766/j.cnki.issn.1674-4152.002220
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  Objective  To explore the clinical value of changes of fractional exhaled nitric oxide (eNO) levels before and after sleep in evaluating the disease severity of patients with obstructive sleep apnea hypopnea syndrome (OSAHS).  Methods  A total of 48 patients diagnosed with OSAHS from November 2018 to October 2019 in the First Affiliated Hospital of Bengbu Medical College were selected as OSA group, 62 healthy people were recruited as the control group. The pre-sleep and post-sleep levels of eNO [including nasal exhaled NO (FnNO), upper airway exhaled NO (FeNO) and alveolar exhaled NO (CaNO)] were compared between the two groups. The correlation between the changes of eNO and apnea hypopnea index (AHI) in OSA group was analyzed.  Results  The pre-sleep level of FnNO [(468.78±117.19) μg/L] and the post-sleep level of FnNO [(479.21±130.57) μg/L] in the OSA group were higher than that in the control group[(371.52±130.21) μg/L, (379.10±129.65) μg/L, all P < 0.05]. The pre-sleep level of FeNO [(23.10±15.19) μg/L] and the post-sleep level of FeNO [(24.92±14.94) μg/L] in the OSA group were higher than that in the control group[(17.71±7.01) μg/L, (18.03±6.63) μg/L, all P < 0.05]. The pre-sleep level of CaNO in OSA group was slightly lower than that in the control group, the difference was not statistically significant. The post-sleep level of CaNO [(2.88±1.41) μg/L] in the OSA group was lower than that in the control group [(4.07±1.86) μg/L, P < 0.05]. Compared with pre-sleep, there were no significant differences in post-sleep levels of FeNO and FnNO in both groups, while the post-sleep level of CaNO [(2.88±1.41) μg/L] in the OSA group was significantly lower than that in pre-sleep [(3.86±1.40) μg/L].Spearman correlation analysis showed that there was a significant correlation between the changes of CaNO (△CaNO) and AHI (r=0.384, P=0.008). After stratification according to AHI, the level of CaNO significantly decreased in patients with severe OSAHS after sleep.  Conclusion  Compared with pre-sleep, the post-sleep level of CaNO is slightly decreased in patients with mild and moderate OSAHS, but significantly decreased in severe patients, and the change of CaNO is significantly correlated with AHI, suggesting that CaNO can evaluate the severity of OSAHS.
MTP18 promotes oral squamous-cell carcinoma metastasis through induction of epithelial-mesenchymal transition
QI Yu-jun, LI Jie, LI Lin, CHEN Meng, LIU Jian-ping
2021, 19(12): 2003-2007. doi: 10.16766/j.cnki.issn.1674-4152.002221
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  Objective  To explore the biological functions of mitochondrial protein 18 (MTP18) in oral squamous-cell carcinoma metastasis.  Methods  (1) Bioinformatic analysis was conducted to evaluate the expression of MTP18 in 44 normal oral mucosa and 520 oral squamous-cell carcinoma tissues. (2) The silencing effect of MTP18 by siRNA was measured by qRT-PCR and Western blot analysis. In addition, the effects of MTP18 knockdown on the migration and invasion abilities of oral squamous-cell carcinoma were determined by wound-healing and Transwell invasion assays. (3) The effects of MTP18 knockdown on the expressions of markers in epithelial-mesenchymal transition (EMT) were determined by qRT-PCR analysis.  Results  (1) Bioinformatic analysis indicated that MTP18 expression was significantly increased in tumour tissues of oral squamous-cell carcinoma, especially in tumour tissues at high stages and with lymph node metastasis, compared with normal tissues (P < 0.001). (2) siRNA transfection successfully reduced the expression of MTP18 in oral squamous-cell carcinoma cells (P < 0.001). MTP18 knockdown significantly suppressed cell migration (siCtrl vs. siMTP18#1 vs. siMTP18#2: 1.00±0.07 vs. 0.43±0.04 vs. 0.44±0.03, F=102.241, P < 0.001) and invasion (siCtrl vs. siMTP18#1 vs. siMTP18#2: 1.00±0.07 vs. 0.43±0.04 vs. 0.44±0.03, F=97.017, P < 0.001). (3) MTP18 knockdown significantly increased the expressions of epithelial cell markers (P < 0.001), but suppressed the expressions of mesenchymal cell markers (P < 0.001).  Conclusion  MTP18 overexpression promotes oral squamous-cell carcinoma metastasis mainly through the induction of EMT.
Correlation analysis of SFRP1, SFRP2 and SDC-2 methylation and pathological features in patients with gastric cancer
HUANG Yi-bo, WANG Guo-ping, WANG Yi, MO Wen-kui
2021, 19(12): 2008-2011. doi: 10.16766/j.cnki.issn.1674-4152.002222
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  Objective  To analyse the correlation between secreted frizzled related protein 1(SFRP1), SFRP2 and SDC-2 gene methylation and clinicopathological characteristics of gastric cancer.  Methods  A total of 100 patients who underwent radical gastric cancer surgery from May 2017 to April 2019 in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine were collected, and the methylation status of SFRP1, SFRP2 and SDC-2 genes in gastric cancer tissues was detected. The difference of the above-mentioned gene methylation rate in gastric cancer tissues with different clinicopathological characteristics was analysed.  Results  The methylation rates of SDC-2, SFRP1 and SFRP2 genes, tumor diameter, depth of invasion, lymph node metastasis and differentiation were different in cancer tissues (all P < 0.05). Multivariate logistic regression analysis showed that SDC-2 methylation (OR=0.384) was an independent protective factor affecting cancer size (P < 0.05). SFRP2 methylation (OR=5.991) was an independent risk factor affecting the depth of tumour invasion, whilst SDC-2 methylation (OR=0.171) was an independent protective factor affecting the depth of tumour invasion (all P < 0.05). SFRP1 methylation (OR=4.614) was an independent risk factor affecting tumour lymph node metastasis, whilst SDC-2 methylation (OR=0.345) was an independent protective factor inhibiting tumour lymph node metastasis (all P < 0.05). SFRP1 methylation (OR=11.667) and SFRP2 methylation (OR=23.333) were independent risk factors affecting tumour differentiation (all P < 0.05).  Conclusion  The methylation status of SFRP1, SFRP2 and SDC-2 genes is highly correlated with the clinicopathological characteristics of gastric cancer patients. The methylation of SFRP1 and SFRP2 genes may be related factors that promote tumour growth, migration and poor differentiation.
Effects of miR-34a on proliferation and epithelial-mesenchymal transition of nasopharyngeal carcinoma cells by targeting FOXM1
GE Si-chen, JIANG Cheng-yi
2021, 19(12): 2012-2015,2023. doi: 10.16766/j.cnki.issn.1674-4152.002223
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  Objective  To investigate the effect of miR-34a on the proliferation, invasion and migration of nasopharyngeal carcinoma cells by targeting forkhead box protein M1 (FOXM1) and the mechanism of invasion and migration from the perspective of epithelial-mesenchymal transformation.  Methods  Human nasopharyngeal carcinoma cells (HNE-1 and CNE-2Z) were cultured in vitro. Each cell line was divided into three groups, namely the blank control group (control group), the negative control group (miR-34a nc group) and the overexpression of miR-34a group (miR-34a mimics group). The expression level of miR-34a in each group was detected by qRT-PCR after transfection. The targeted relationship between miR-34a and FOXM1 was predicted by bioinformatics software and then analysed by qRT-PCR and western blot. After overexpression of miR-34a, cell proliferation was detected by CCK-8 assay, cell migration and invasion were detected by Transwell test, and the relative expression levels of invasion- and migration-related proteins such as E-cadherin and Vimentin were detected by western blot.  Results  The possible targeting relationship between miR-34a and FOXM1 was predicted using bioinformatics software. In HNE-1 and CNE-2Z cells, compared with the control group and miR-34a nc group, the expression level of FOXM1 was down-regulated in the miR-34a mimics group (HNE-1: 0.570±0.041, 1.127±0.129, 1.125±0.145, F=23.672, P=0.001; CNE-2Z: 0.689±0.114, 1.966±0.164, 1.924±0.087, F=99.599, P < 0.001); proliferation, migration and invasion abilities were significantly increased (P < 0.01); E-cadherin expression was increased, and Vimentin expression was decreased (P < 0.01). No statistically significant difference was observed between the control group and miR-34a nc group (P>0.05).  Conclusion  miR-34a promotes the proliferation, invasion and migration of nasopharyngeal carcinoma cells by targeting FOXM1, which is associated with the inhibition of epithelial-mesenchymal transformation.
Analysis of influencing factors of the postoperative effect of unstable intertrochanteric fractures of PFNA-Ⅱ
JIANG Zhen, ZHENG Ming-jun, ZHAO Xiao-bo, BAO Tao, LI Cheng-nv
2021, 19(12): 2016-2019, 2101. doi: 10.16766/j.cnki.issn.1674-4152.002224
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  Objective  To explore the factors affecting the effect of PFNA-Ⅱ after unstable femoral intertrochanteric fractures.  Methods  A total of 63 patients with unstable femoral intertrochanteric fractures who underwent PFNA-Ⅱ at the Chun'an Branch of Zhejiang Provincial People's Hospital from January 2016 to January 2019 were followed up for 1 year. According to the Harris function score of the hip joint after surgery, the patients were divided into the good group (Harris score ≥ 80 points) and poor group (Harris score < 80 points). The differences in general information and surgery-related indicators between the two groups were compared, and multivariate logistic regression analysis was performed.  Results  During the follow-up, 1 patient was lost to follow-up. At the last follow-up of the remaining 62 patients, 42 patients with Harris score ≥ 80 were classified as the good group, and the remaining 20 patients with Harris score < 80 were classified as the poor group. The rate of postoperative hip dysfunction was 32.26% (20/62). There were significant differences in BMI (25.31±4.63 vs. 27.96±4.72), osteoporosis ratio (47.62% vs. 85.00%), apex distance [(24.43±1.65) mm vs. (26.84±2.18) mm], lateral wall classification (type Ⅰ-Ⅲ, fractions are 61.90%, 33.33%, 4.76% vs. 30.00%, 40.00%, 30.00%), thickness of outer wall [(2.43±0.39) mm vs. (2.05±0.31) mm] between the two groups (all P < 0.05). The results of multivariate logistic regression analysis showed that the apex distance, lateral wall type and lateral wall thickness were independent influencing factors of hip joint function after PFNA-Ⅱ operation (all P < 0.05).  Conclusion  The large apex distance, poor integrity of the lateral wall and thin lateral wall are independent risk factors for hip dysfunction after PFNA-Ⅱ operation for unstable femoral intertrochanteric fractures.
Analysis of risk factors for the pathogenesis and prognosis of patients with sepsis-associated coagulopathy
QIN Su-hui, DUN Shi-juan
2021, 19(12): 2020-2023. doi: 10.16766/j.cnki.issn.1674-4152.002225
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  Objective  To analyse the onset of sepsis-associated coagulopathy (SAC) and the risk factors affecting prognosis, provide ideas for preventing the occurrence of sepsis coagulopathy and improve prognosis.  Methods  A total of 57 patients with sepsis, who were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from January 2020 to June 2021, were included. On the basis of the diagnostic criteria for sepsis coagulopathy, the patients were divided into the control group (diagnosed sepsis; the coagulation function is normal, 36 cases), the observation group (21 cases meet the diagnosis of coagulation dysfunction in sepsis), the death group (11 cases) and the survival group (46 cases). The general information of the research subjects, serum procalcitonin (PCT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) was collected, and the pathogenesis and prognosis of sepsis coagulopathy was analysed by comparing the two groups of clinical data risk factors.  Results  No statistically significant difference in age and gender was found between the observation group and control group (P>0.05). The levels of serum PCT and APTT in the observation group were significantly higher than those in the control group [33.46(23.11, 63.25) ng/mL vs.6.85(2.35, 8.77) ng/mL; 37.40(32.15, 45.15) s vs. 29.50(25.75, 33.50) s]. In addition, the FIB level decreased significantly [(2.90±0.95) g/L vs. (5.01±1.08) g/L], and the difference was statistically significant (all P < 0.05). There was no significant difference in age、gender and APTT between the death group and the survival group (all P>0.05).The serum PCT levels in death group was significantly higher than those in the survival group [44.73(7.48, 63.90) ng/mL vs. 7.78(3.56, 14.86) ng/mL], and the FIB level decreased significantly [(3.28±1.45) g/L vs. (4.46±1.37) g/L], and the difference was statistically significant (all P < 0.05). Factor logistic regression analysis indicated that the increase in PCT (OR=1.275, 95% CI: 1.049-1.550) and the decrease in FIB (OR=0.124, 95% CI: 0.023-0.676) were considered as risk factors for SAC, and the increase in PCT (OR=0.918, 95% CI: 0.859-0.981) was considered as a risk factor for the prognosis of SAC (all P < 0.05).  Conclusion  In clinical practice, when the serum PCT level increases and the FIB level decreases, SAC may occur. The continuous increase of the PCT level in patients diagnosed with SAC may indicate a poor prognosis.
Effect of micro-implant screw combined with transverse palatal rod anchorage on the vertical orientation, arch width and posterior cheek inclination of class Ⅱ high-angle patients
MA Tao, ZHANG Rui, FENG Zhe, TIAN Bing-xin
2021, 19(12): 2024-2027. doi: 10.16766/j.cnki.issn.1674-4152.002226
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  Objective  To compare the effects of micro-implant screw anchorage system (MAS) combined with transverse palatal rod anchorage (TPA) on the angle Ⅱ high-angle patients.  Methods  Forty Class Ⅱ high-angle patients who were admitted to the Second Affiliated Hospital of Xingtai Medical College from June 2014 to June 2015 were selected. The patients were randomly divided into the MAS group and MAS combined with TPA group according to the number of entry time, with 20 cases each group. The vertical distance of molars before and after orthodontic treatment was measured by X-ray cephalometric lateral film. An electronic vernier caliper was used to measure the transverse width of the mandibular and upper dental arch before and after orthodontic treatment. The buccal inclination of the first molar was measured and analysed by CBCT before and after treatment. The changes of the vertical distance, the width of the arch and the buccal inclination of the posterior teeth were compared between the two groups.  Results  After correction, the vertical distance of the molar (L6-MP, LI-MP, U6M-SV, U6-PP and UI-PP) in the MAS combined with TPA group has no significant difference than that in the MAS group (all P>0.05), and each index of arch width (U33, U55, U66, L33, L55 and L66) in the MAS combined with TPA group the difference were statistically significant (all P < 0.05). The molar rotation angle and buccal distance in the MAS combined with TPA group were significantly higher than those in the MAS group [(2.23±0.45)° vs. (1.06±0.24)°; (1.23±0.08) mm vs. (0.15±0.01) mm], whilst the molar displacement was significantly lower in the MAS combined with TPA group than in the MAS group [(3.13±0.66) mm vs. (5.21±0.82) mm, all P < 0.05].  Conclusion  MAS combined with TPA can effectively reduce the vertical change of molars, promote the increase of the arch width and improve buccal inclination. The effect of MAS combined with TPA is better than that of MAS in the treatment of Class Ⅱ high-angle patients, which is worthy of clinical application.
Analysis of clinical short-term prognostic factors in patients with hepatitis B-related acute-on-chronic liver failure
HUANG Min, LI Dong-dong, LIU Chuan-miao
2021, 19(12): 2028-2030. doi: 10.16766/j.cnki.issn.1674-4152.002227
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  Objective  To explore the relationship between the model for end-stage liver disease (MELD) score, total bilirubin, albumin, international normalized ratio and prothrombin activity and the prognosis in patients with hepatitis B-related acute-on-chronic liver failure (ACLF).  Methods  A total of 124 patients with hepatitis B-related ACLF who were admitted from January 2018 to December 2020 were collected from the Department of Infection, the First Affiliated Hospital of Bengbu Medical University. The relevant indexes of liver function and coagulation function were collected, and whether the patients were treated with artificial liver or not, and the MELD score was also evaluated. On the basis of the clinical outcome after 90-day admission, the patients were divided into the survival group and death group. Data of MELD score, total bilirubin, albumin, international normalized ratio and prothrombin activity were compared between the two groups. Logistic regression analysis was used to study the relationship between various indexes and the prognosis of HBV-ACLF patients.  Results  The MELD score, the international normalized ratio and the total and the ages bilirubin in the survival group were (22.66±4.69) scores, 1.72±0.42 and (281.09±94.21) μmol/L and (40.54±7.39) ages, respectively, which were significantly lower than those in the death group [(31.38±5.39) scores, 2.64±0.61 and (360.54±130.97) μmol/L and (45.73±12.72) ages], all of the differences were statistically significant (all P < 0.05). The albumin and prothrombin activity in the survival group were (31.21±3.83) g/L and (35.95±11.82)%, respectively, which were significantly higher than those in the death group [(28.43±4.46) g/L and (29.54±12.10)%)], all of the differences were statistically significant (all P < 0.05). Logistic regression analysis showed that the higher MELD score, the higher level of TBIL, the higher level of INR and the elder age were considered as independent risk factors of ACLF patients, and albumin and prothrombin activity were considered as protective factors of ACLF patients.  Conclusion  The MELD score, total bilirubin, albumin, international normalized ratio and prothrombin activity can be used as prognostic predictors in sepsis patients.
Effects of the up-regulation of KLF13 on invasion, migration and p-AKT expression of osteosarcoma cells
PAN Han-song, GUO Chang-jun, LIANG Yi-min, LIANG Jian-wei, LI Xiang
2021, 19(12): 2031-2034, 2097. doi: 10.16766/j.cnki.issn.1674-4152.002228
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  Objective  To study the effects of Kruppel-like factor 13 (KLF13) on the invasion and migration of osteosarcoma cells (MG-63) and changes in p-AKT protein expression during the process.  Methods  MG-63 cells were divided into control group, NC group and LV-KLF13-OE group according to random number table method. The transfection of KLF13 recombinant lentivirus particles was observed under a microscope. The expression levels of KLF13 mRNA were detected by real-time fluorescent quantitative PCR. In addition, the protein expression levels of KLF13, serine/threonine protein kinase B (AKT) and its phosphorylation, E-cadherin and membrane palmitoylated protein 2 (MPP-2) were detected by western blot. Proliferation was detected by the Cell Counting Kit-8 (CCK-8), the migration ability was detected by a scratch test, and invasiveness was detected by the transwell method.  Results  The transfection efficiency of MG-63 cells was over 75%. Compared with those in the control group and NC group, the expression levels of KLF13 mRNA and protein and E-cadherin protein in the LV-KLF13-OE group were significantly higher (F=1 544.143, 588.000, 235.391, all P < 0.001), and the expression levels of MPP-2 protein were significantly lower (F=260.053, P < 0.001). The scratch healing rate [(20.07±8.18) %], number of invasions (89.29±15.04) and p-AKT protein expression (0.21±0.02) levels in the LV-KLF13-OE group were significantly lower than those in the control group [(71.61±6.02)%, 221.33±20.09 and 1.12±0.12] and NC group [(74.93±7.21)%, 212.69±25.47 and 1.09±0.08; F=109.781, 76.815, 226.896, all P < 0.001].  Conclusion  KLF13 overexpression may inhibit the migration and invasion of human osteosarcoma cells by down-regulating p-AKT expression.
General Clinical Research
Relationship between glycosylated haemoglobin and prognosis of patients with acute pontine infarction
ZHANG Tie-lin, LI Rui, WU Shu-mei
2021, 19(12): 2035-2037,2087. doi: 10.16766/j.cnki.issn.1674-4152.002229
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  Objective  To investigate the relationship between glycosylated haemoglobin (HbA1c) and prognosis of patients with acute pontine infarction.  Methods  The relationship between the history of diabetes, fasting blood glucose and HbA1c after admission, and the scores of modified Rankin score (mRS) and daily life self-care ability (ADL) at 90 d follow-up in 85 patients with acute pontine infarction in Hefei Eighth People's Hospital from May 2016 to April -2018 were analysed.  Results  A significant correlation between HbA1c and prognosis (mRS < 3) was observed in patients with pontine infarction at 90-day follow-up (OR=0.234, 95% CI: 0.073-0.784, P=0.014). In addition, no significant correlation amongst HbA1c ≥ 6.1% (OR=0.404, 95% CI: 0.138-1.188, P=0.100), history of diabetes (OR=0.556, 95% CI: 0.197-1.565, P=0.266), fasting blood glucose ≥ 7.0 mmol/L (OR=0.516, 95% CI: 0.179-1.488, P=0.221) and ADL>60 was observed in patients at 90-day follow-up. HbA1c had higher AUC value (mRS < 3, AUC=0.725, 95% CI: 0.615-0.835, P=0.001; ADL>60, AUC=0.682, 95% CI: 0.556-0.808, P=0.016) than diabetes history and fasting blood glucose.  Conclusion  Compared with fasting blood glucose and diabetes history, glycosylated haemoglobin may have an advantage in evaluating the prognosis of patients with acute pontine infarction.
The therapeutic effect of Spleen Aminopeptide Oral Solution on allergic rhinitis and immune balance of T lymphocyte subsets
FENG Bo, ZHANG Wei-wei, ZHENG Qi, HE Yong
2021, 19(12): 2038-2040,2044. doi: 10.16766/j.cnki.issn.1674-4152.002230
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  Objective  To explore the therapeutic effect of Spleen Aminopeptide Oral Solution on allergic rhinitis and immune balance of T lymphocyte subsets.  Methods  A total of 93 patients with allergic rhinitis admitted to our hospital were randomly divided into Spleen Aminopeptide group (n=46) and regular group (n=47) according to the random number table method. The clinical efficacy, T lymphocyte subsets, immune function and quality of life of the two groups were compared.  Results  The total effective rate of the Spleen Aminopeptide group which was higher than that of the regular group (P=0.031). After treatment, the CD3+ [(70.33±6.89)%]、CD4+ [(39.28±4.31)%] and CD4+/CD8+ (1.64±0.39) in the Spleen Aminopeptide group were higher than those in the regular group [(59.46±7.26)%、(36.04±4.76)%、1.35±0.43, all P < 0.001], and the CD8+[(24.12±2.38)%] was lower than that in the regular group [(26.34±2.11)%, P < 0.001]. After treatment, the levels of serum interleukin-2 [(75.52±10.48) pg/mL] and interferon-γ [(85.56±6.24) pg/mL] in the Spleen Aminopeptide group were higher than those in the regular group [(69.27±8.53) pg/mL, (68.81±7.07) pg/mL], the levels of serum interleukin-4 [(115.58±34.45) pg/mL] and serum interleukin-5 [(625.64±114.28) pg/mL] were lower than those in the regular group [(168.37±40.22) pg/mL, (837.57±117.49) pg/mL, all P < 0.001]. After treatment, the rhinoconjunctivitis quality of life questionnaire (RQLQ) score of the Spleen Aminopeptide group was lower than that of the regular group (P < 0.001).  Conclusion  Spleen Aminopeptide Oral Solution can improve the curative effect of allergic rhinitis, play the role of immune regulation, reduce the body allergy and clinical symptoms.
Effect of double plasma adsorption of plasma on acute paraquat poisoning
LAN wei, QIN Shu-guang, LIU Jian-fang, GUO Jing-yi, LYU Min-qing
2021, 19(12): 2041-2044. doi: 10.16766/j.cnki.issn.1674-4152.002231
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  Objective  To investigate the effect of dual plasma molecular adsorption system (DPMAS) on patients with paraquat poisoning.  Methods  A total of 79 patients with acute paraquat poisoning, who were admitted to the Twelfth People's Hospital of Guangzhou from March 2017 to August 2019, were selected and divided into the control group (32 cases) and observation group (47 cases) based on differences in treatment. The control group underwent conventional treatment, and the observation group underwent conventional treatment combined with DPMAS treatment. The clearance rate, survival rate and survival time and the levels of paraquat, bilirubin and malondialdehyde in the peripheral blood were compared between the two groups. In addition, the liver and kidney function and myocardial enzyme index levels of the patients before and after treatment were compared.  Results  The clearance rate of paraquat in the observation group was (68.45±2.56)%, which was higher than that in the control group [(52.60±2.04)%, P < 0.05], the serum paraquat level in the observation group [T2 (4.70±1.95) mg/L, T3 (3.19±1.82) mg/L and T4 (0.83±0.78) mg/L] were lower than that in the control group [T2 (6.92±1.37) mg/L, T3 (5.57±0.09) mg/L and T4 (3.52±1.22) mg/L], respectively (all P < 0.05). In addition, the survival rate of the observation group was 78.72%, and the survival time was (21.69±6.05) days, which were better than the control group [28.13%, (10.12±3.85) days, all P < 0.05]. After treatment, the concentrations of bilirubin and malondialdehyde in the peripheral blood of the two groups were significantly reduced, of which the observation group was lower than the control group (all P < 0.05). The alanine aminotransferase, aspartate aminotransferase, creatine kinase isoenzymes-MB and serum creatinine levels of the two groups and the other indicators after treatment were lower than those before treatment (all P < 0.05), and the degree of reduction in the observation group was higher than that of the control group (all P < 0.05).  Conclusion  The DPMAS can rapidly remove the paraquat content in the blood of patients with acute paraquat poisoning, educe the levels of bilirubin and malondialdehyde, reduce inflammation and myocardial damage, improve immunity, liver and kidney function, prolong the survival time of patients and improve survival rate.
The effect of sham feeding combined with early fluid diet on the recovery of gastrointestinal function after laparoscopic hepatectomy
ZHU Chun-fang, ZHENG Lu-shan, YU Shi-an
2021, 19(12): 2045-2047. doi: 10.16766/j.cnki.issn.1674-4152.002232
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  Objective  To explore the effect of sham feeding (chewing gum) combined with early liquid diet on the recovery of gastrointestinal function in patients with laparoscopic hepatectomy.  Methods  A total of 112 patients who underwent laparoscopic hepatectomy in the Department of General Surgery of Jinhua Central Hospital from June 2018 to December 2019 were selected as the study subjects. They were randomly divided into chewing group (36 cases), control group (38 cases) and blank group (38 cases). Chewing group: chewing gum (1 time/2 h, 2 ~ 3 tablets each time) combined with early liquid diet (6 hours after operation, 3 ~ 5 times/day). Control group: liquid diet was given 6 hours after operation, 3 ~ 5 times/day. Blank group: drink warm boiled water 6 hours after operation, and give liquid food after anal exhaust. The recovery of bowel sounds, first anal exhaust, defecation time, serum motilin MTL, gastrin gas levels and postoperative gastrointestinal symptoms were compared among the three groups.  Results  The recovery of bowel sounds, first exhaust and defecation time in the chewing group [(9.76±1.59) h, (20.57±2.31) and (56.82±8.27) h] were significantly earlier than those in the control group [(11.08±1.96) h, (26.64±2.77) h, and (64.33±10.39) h], the blank group [(15.26±2.09) h, (30.05±3.85) h, and (72.94±11.67) h]. The differences were statistically significant (t=3.171, 10.207, 3.428; 12.688, 12.756, 6.822, all P < 0.05). On the first day after operation, the levels of motilin MTL and gastrin gas in chewing group were higher than those in control group and blank group (all P < 0.05). The incidence of postoperative nausea and vomiting in chewing group was lower than that in control group and blank group (all P < 0.05).  Conclusion  Sham feeding combined with early liquid diet can effectively promote the recovery of gastrointestinal function after laparoscopic hepatectomy.
Expression and significance of plasma Aβ1-40, blood lipid and inflammatory indexes in Alzheimer's disease
LI Wei-ying, LIN Qing, FU Pan
2021, 19(12): 2048-2050, 2118. doi: 10.16766/j.cnki.issn.1674-4152.002233
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  Objective  To investigate the expression and clinical significance of plasma β-amyloid 1-40 (Aβ1-40), blood lipids and inflammatory indexes in elderly patients with Alzheimer's disease.  Methods  A total of 93 cases of elderly patients with Alzheimer's disease in Taizhou First People's Hospital from June 2017 to October 2019 were selected as the observation group. All patients were grouped according to the ADAS-Cog table: 53 cases were mild (ADAS-Cog score < 20 points), and 40 cases were moderate to severe (ADAS-Cog score ≥ 20 points). In addition, 50 normal elderly people who underwent health examinations in our hospital during the same period were selected as the control group. The expression of plasma Aβ1-40 and inflammatory indicators [interleukin 1β (IL-1β), IL-6, tumour necrosis factor-α (TNF-α)] were detected by enzyme-linked immunosorbent assay, and the expression of blood lipids [triacylglycerol (TG), high-density lipoprotein (HDL), cholesterol (TC), low-density lipoprotein (LDL)] were detected by a fully automatic biochemical analyser.  Results  The expressions of plasma Aβ1-40, IL-1β, IL-6 and TNF-α were higher in the observation group than in the control group [(109.37±8.52) pg/mL vs. (93.48±7.23) pg/mL, (49.53±6.09) pg/mL vs. (30.51±7.46) pg/mL, (170.87±50.71) pg/mL vs. (75.15±45.27) pg/mL, (65.93±5.72) pg/mL vs. (36.70±5.24) pg/mL, all P < 0.05]. No statistically significant difference was observed in the HDL levels between the two groups of patients (all P>0.05). The blood lipid levels of TG, TC and LDL were higher in the observation group than in the control group (all P < 0.05). The levels of plasma Aβ1-40, IL-1β, IL-6 and TNF-α were higher in the moderate to severe group than in the mild group (all P < 0.05). No significant difference were observed in the levels of serum TG, HDL, TC and LDL in the mild and moderate groups (all P>0.05).  Conclusion  The expressions of plasma Aβ1-40, blood lipids and inflammatory factors are closely related to the severity of Alzheimer's disease in the elderly, which can provide reference for the clinical evaluation of the progress of Alzheimer's disease in the elderly.
Clinical effect of platelet lysate on lumbar interbody fusion in elderly patients with lumbar disc herniation
MA Guang-xi, ZHANG Jun, YANG Yi-yu, WANG Yu
2021, 19(12): 2051-2054. doi: 10.16766/j.cnki.issn.1674-4152.002234
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Abstract:
  Objective  To evaluate the clinical efficacy of platelet lysate in the treatment of elderly patients with lumbar disc herniation after vertebral fusion.  Methods  A total of 140 elderly patients with minimally invasive transforaminal lumbar interbody fusion who were in our hospital from April 2018 to April 2020 were randomly divided into study group and control group, with 70 cases in each group. Both groups were treated with minimally invasive transforaminal lumbar interbody fusion, and the study group was treated with platelet lysate injection. The operation indexes were recorded, and the pain reaction and lumbar function of the two groups were evaluated before and after operation. The differences in lumbar imaging indexes were compared 12 months after operation, and the postoperative complications were observed.  Results  The operation time of the study group was (182.41±17.28) min, which was significantly longer than that of the control group (167.86±15.49) min, t=5.219, P < 0.001, but no significant differences in blood loss and hospital stay were found between the control group and control group [(218.64±19.53) mL vs. (221.57±19.06) mL and (6.59±0.71) days vs. (6.41±0.69) days; t=0.896, 1.514; P=0.372, 0.132]. The visual analogue scale (VAS) score and ODI score at 3, 6, 9 and 12 months after operation in the study group were significantly lower than those in the control group (all P < 0.001). In addition, no significant difference in the fusion rate was found between the two groups 12 months after operation (98.57% vs. 94.28%, χ2=0.830, P=0.362), whereas the number of fusion layers (4.68±0.52) and the height of lumbar intervertebral space [(11.62±1.12) mm] in the study group were significantly higher than those in the control group [(2.91±0.34) and (10.53±1.04) mm; t=23.873, 5.891, all P < 0.001)]. No complications in the two groups within 12 months after operation.  Conclusion  Platelet lysate injection into lumbar intervertebral space can relieve the pain reaction after lumbar fusion in elderly patients with lumbar disc herniation and improve the recovery level of lumbar function, the healing degree and stability of lumbar intervertebral tissue. This method has high safety.

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