2021 Vol. 19, No. 7

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Expert Forum
Deepen the reform of the medical and health system: Optimize new progress in the allocation of medical resources under sudden public health incidents
XU Ting, XU Jie, ZHANG Lu-fa, WANG Tao, DONG En-hong
2021, 19(7): 1069-1072. doi: 10.16766/j.cnki.issn.1674-4152.001987
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This article briefly describes the connotation and allocation elements of medical resources, and reviews the current status and progress of medical resource allocation researches in public health emergency at home and abroad. The review is mainly from the resource allocation rules, emergency management process and evaluation, measurement of medical resources demand, medical human resource, institutions, equipment, supplies and internal and external management, then addresses the limitations of existing researches are as follows: (1) The research on the design of emergency management laws, rules and systems, emergency management normalization process and other institutional mechanisms of public health emergencies is not fully combined with the actual health system of various countries. (2) There are few researches on the connection between specific emergency scenarios and medical resource allocation. (3) The research methods of emergency medical resource allocation in China are relatively limited, most of which focus on the location of medical institutions and the optimal allocation of emergency materials by quantitative research methods. However, there is little discussion on how to determine the types of medical resources in the case of public health emergencies. Based on the above analysis, further research directions are proposed: (1) The formulation of emergency laws, regulations and procedures on medical resource allocation in public health emergency with full consideration of specified health system features for every country. (2) Combined with the existing health system reform, the related research of medical resource allocation strategy was carried out. (3) The determination of the types and prioritization of medical resources, and more uses of methods to compute medical human resource, material resources, financial resources, equipment and other resources needed in public health emergency.
2021, 19(7): 1073-1074.
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Anxiety and depression in patients with type 2 diabetes mellitus and their influencing factors
LI Meng-fan, LI Xue-yan, LIANG Bing
2021, 19(7): 1135-1137,1146. doi: 10.16766/j.cnki.issn.1674-4152.002004
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  Objective  The Hospital Anxiety and Depression Scale (HADS) was used to investigate the prevalence of anxiety and depression in patients with type 2 diabetes mellitus (T2DM), and the factors affecting anxiety and depression in T2DM were analysed.  Methods  A total of 287 patients with T2DM who were admitted at Bengbu Community Hospital and the Department of Endocrinology of the First Affiliated Hospital of Bengbu Medical College from November 2019 to January 2020 were selected. Their medical records were reviewed, and the patients were surveyed using a structured questionnaire to collect sociodemographic and health data. The HADS was used to evaluate the anxiety and depression status of the patients. A total of 201 patients, including 93 in the anxiety and depression group and 108 in the non-anxiety and depression group. The influencing factors of the occurrence of anxiety and depression, such as gender, age, course of disease, education, marriage, glycosylated hemoglobin (HbA1c) and complications were analysed.  Results  Amongst 201 patients with T2DM, the incidence rate of anxiety and depression was 46.3%. Age, course of disease, HbA1c, number of complications and complications were significantly correlated with the incidence of anxiety and depression (all P < 0.05). In multiple logistic regression analysis, the course of disease, HbA1c, diabetic nephropathy and other factors were the risk factors associated with the occurrence of anxiety and depression.  Conclusion  Patients with T2DM have a high incidence of anxiety and depression and a poor psychological state, which is affected by age, course of disease, number of diabetic complications, HbA1c and other related factors.
Clinical efficacy of fiberoptic bronchoscopy alveolar lavage in the treatment of Mycoplasma pneumoniae lobar pneumonia in children
LU Bao-xia, CHEN Rong-shou, WANG Shan, PENG Wan-sheng, ZHOU Rui
2021, 19(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.002005
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  Objective  To observe the clinical curative effect, inflammatory index and immunity changes of Mycoplasma pneumoniae (MP) lobar pneumonia in children after treatment with fiberoptic bronchoscope alveolar lavage.  Methods  Total 60 children with lobar pneumonia caused by MP infection in the Department of Pediatrics of Lu'an people's Hospital from April 2019 to September 2020 were selected and randomly divided into observation group and control group with 30 cases in each group. The control group was given conventional treatment of Mycoplasma pneumoniae, and the observation group was given bronchoalveolar lavage under fiberoptic bronchoscope on the basis of conventional treatment. The clinical efficacy (including hospitalization time, cough disappearance time, body temperature recovery time), inflammatory factor levels, cellular immunity and humoral immunity indexes were compared between the two groups.  Results  (1) After treatment, the results of chest CT reexamination in the observation group showed that the lung shadow completely disappeared in 18 cases, partially disappeared in 10 cases, no change in 2 cases, the observation group was significantly better than the control group, the difference was statistically significant (P < 0.05). (2) In the observation group, cough disappearance time[(4.89±1.74) d], fever time[(2.63±0.56) d] and hospitalization days[(7.45±1.68) d] were less than those in the control group[(6.33±1.33) d, (3.85±1.29) d, (9.90±1.32) d, P < 0.05]. (3) Two sets of laboratory indexes after treatment, the levels of WBC, PCT, IL-6, TNF -α, CD3+, CD4+, CD4+/CD8+, IgA、IgM、IgG in the observation group were significantly better than those in the control group (all P < 0.05).  Conclusion  Bronchoalveolar lavage under fiberoptic bronchoscopy in the treatment of Mycoplasma pneumoniae lobar pneumonia can significantly improve the clinical efficacy, reduce inflammatory reaction, and accelerate the recovery of children's immunity.
Analysis of mortality and related factors in neonates with congenital diaphragmatic hernia undergoing thoracoscopic minimally invasive surgery
PAN Shou-dong, DAI Ting, JI Ying-tong, CHEN Gang, MA Li-shuang, YAN Fu-xia
2021, 19(7): 1142-1146. doi: 10.16766/j.cnki.issn.1674-4152.002006
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  Objective  To analyze the mortality and related factors of neonatal congenital diaphragmatic hernia (CDH) in the era of minimally invasive surgery. Minimally invasive surgery, represented by thoracoscopy, has been increasingly used for repair in neonates.  Methods  All neonates with CDH undergoing surgical repair in children's Hospital affiliated to Capital Institute of Pediatrics from January 2016 to December 2019, were retrospectively reviewed, and the mortality within 30 days after surgery was analyzed. The neonates were divided into survival group and death group according to whether they were survived within 30 days after surgery. The general information, preoperative, intraoperative and postoperative predictors of mortality were compared between the two groups.  Results  During the data collection period, a total of 50 cases of neonates with CDH underwent surgical repair in our hospital, of which 32 (64.0%) were completed with thoracoscopy. Fifteen neonates died within 30 days after surgery, and the mortality rate was 30.0%. There were significant differences in 9 factors between survival group and death group, including prenatal diagnosis before 25 weeks gestational age (P=0.006), low birth weight (< 2 500 g, P=0.029), combined with simple congenital heart disease (P=0.037), preoperative use of high-frequency oscillatory ventilation (HFOV, P < 0.001), preoperative oxygenation index (OI, P=0.007), American Society of Anesthesiologists (ASA) physical states (P=0.014), age at surgery after birth (P=0.045), open laparotomy (P < 0.001) and postoperative OI (P < 0.001).  Conclusion  In an era of minimally invasive surgery, neonates with CDH has a mortality rate of 30% within 30 days after surgery, mainly related to the severity of the disease itself. The potential of minimally invasive surgery on improving the outcome of neonatal diaphragmatic hernia should be further studied.
Analysis of serum 25 hydroxyvitamin D3 and blood lipid levels in patients with gestational diabetes mellitus
WANG Nan, QUAN Li-mei, ZHANG Gen-qin, DAI Xi-wang, CHEN Qian, JIN Yan, WU Lin-lin
2021, 19(7): 1147-1149. doi: 10.16766/j.cnki.issn.1674-4152.002007
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  Objective  To view the 25-hydroxyvitamin D3[25(OH)D3] in patients with gestational diabetes mellitus (GDM), and view the influences of this level change on the pregnant woman blood sugar and lipid metabolism.  Methods  Total 306 pregnant women admitted to the Department of Obstetrics, Jinhua people's Hospital of Zhejiang Province from May 2018 to December 2019 were selected as the research objects, and their serum 25 (OH) D3 levels, blood glucose and lipid related indicators were detected. According to the results of OGTT test, pregnant women were divided into gestational diabetes mellitus group (n=74) and normal pregnancy group (n=232). The pregnancy outcomes of different subgroups of gestational diabetes mellitus were compared.  Results  The serum 25 (OH) D3 level in GDM group was (55.20±0.06) nmol/L, lower than that in the normal pregnancy group[(64.92±1.10) nmol/L, P < 0.05]. The levels of blood glucose and blood lipid in GDM group were higher than those in the normal pregnancy group. The serum 25 (OH) D3 level was negatively correlated with FPG, TC and TG (all P < 0.05). The gestational age of GDM patients with normal serum 25 (OH) D3 level was (39.20±0.16) weeks, which was higher than that in patients with 25 (OH) D3 deficiency[(36.67±0.51) weeks], and the neonatal weight was greater than that of the patients with 25 (OH) D3 deficiency[(3.72±0.15) kg vs. (3.07±0.12) kg, P < 0.05].  Conclusion  The level of 25 (OH) D3 in patients with gestational diabetes mellitus was lower than that in normal pregnant women, and it was significantly associated with FPG, TC, TG and other glucose and lipid metabolism parameters. If it was lack in the body, it would affect the pregnancy outcome.
Clinical effects of infantile massage combined with modified Maxing Yinqiao Powder on the treatment of children with pneumonia during remission
LI Lin-ping, LI Wei-lin, SUN Bo, LING Ying-pei, CHEN Qian
2021, 19(7): 1150-1154. doi: 10.16766/j.cnki.issn.1674-4152.002008
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  Objective  To explore the curative effect of infantile massage combined with modified Maxing Yinqiao Powder on the treatment of infantile pneumonia with dyspnoeic cough of "wind-heat blocking the lung syndrome".  Methods  From January 2016 to January 2019, 80 children with pneumonia of "wind- heat blocking the lung syndrome" during remission treated in Taizhou Hospital of Traditional Chinese Medicine (TCM) were enrolled in this study. They were randomly divided into two groups: the control group was treated with routine Western medicines, whereas the observation group was treated with infantile massage combined with modified Maxing Yinqiao Powder based on Western medicines treatment. Levels of T lymphocyte subsets and inflammatory factors were determined.  Results  The total effective rate in the observation and the control groups was 100.00% and 95.00%, respectively, and the markedly effective rate was 95.00% and 77.50%, respectively (P < 0.05). After the treatment, the scores of clinical signs and TCM syndromes of the observation group[(4.71±1.41) points and (2.85±0.56) points, respectively] were significantly lower than those of the control group[(6.85±1.90) points and (3.41±0.37) points, respectively, all P < 0.05]. After the treatment, the proportions of CD3+ and CD4+ and levels of CD4+/CD8+ and interleukin-2 in the observation group were higher than those in the control group (all P < 0.05). The levels of interleukin-6 and tumour necrosis factor-α were lower in the observation group than those in the control group (P < 0.05). (4) The time for the shortness of breath and lung rales and cough to disappear, and the length of hospital stay in the observation group were (8.01±1.04), (1.56±0.27), (6.96±1.37) and (9.11±1.74) days, respectively of in the control group were (9.66±2.01), (2.85±0.63), (8.56±1.74) and (11.22±1.63) days, the difference was statistically significant (all P < 0.05).  Conclusion  Infantile massage combined with modified Maxing Yinqiao Powder is effective in the treatment of infantile pneumonia with dyspnoeic cough of "wind-heat blocking the lung syndrome".
Satisfaction analysis of community health service utilization among young and middle-aged building crowds
HUANG Jiao-ling, SU Zhong-xin, CUI Ya-qi, LIU Tie-xin, LIN Jie, GONG Wei-hua, ZHOU Liang, WANG Zhao-xin, LU Wei, YANG Yong-hua
2021, 19(7): 1155-1157, 1185. doi: 10.16766/j.cnki.issn.1674-4152.002009
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  Objective  To explore the service utilization of Shanghai community health services and the satisfaction of incumbent workers and the influencing factors.  Methods  Questionnaire survey was conducted on the building employees in Beiwaitan Street of Shanghai with a typical sampling method. A total of 1 040 questionnaires were distributed, and 993 valid questionnaires were recovered. The effective recovery rate was 95.5%.  Results  The overall satisfaction score of building crowds for community health service was 7.24, with a higher evaluation of the community health service attitude, medical environment, medical expenses, effective communication, reasonable inspection, reasonable dispensing, service efficiency, effective treatment, etc, the first three of which scoring 7.90, 7.89, and 7.88. The satisfaction on long prescriptions, referral services, family beds, extended prescriptions, quality of medical staff and other aspects were lower, the first three of which scoring 7.38, 7.43 and 7.43. Marital status, household registration, self-rated health status, and cognition of family doctor were the main influencing factors of community health service satisfaction. The satisfaction score of Shanghai household members (7.54) was significantly higher than that of non-Shanghai household members (6.27), and the satisfaction score for the very clear cognition of family doctor was 8.33, which was significantly higher than the very unclear (5.60), relatively unclear (6.51) and general cognitive status groups (7.44).  Conclusion  The policy of introducing community health service into buildings through family doctor has been recognized by building staff. Publicity efforts should be strengthened to raise the level of awareness of family doctor system; education and training should be used to strengthen the building of talent teams and improve the technical level of community medical staff; the government should promptly modify the prescription policy and the three-level referral system, and to improve the quality of services for home beds.
Analysis of health status and differences among white-collar workers in one street in Shanghai city
HAO Yu, CUI Ya-qi, YANG Yong-hua, LIN Jie, GONG Wei-hua, WANG Zhao-xin, YU Wen-ya, GONG Xin, LU Wei, HUANG Jiao-ling
2021, 19(7): 1158-1162. doi: 10.16766/j.cnki.issn.1674-4152.002010
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  Objective  To learn the general health status of white-collar workers and its affecting factors.  Methods  A survey was conducted using questionnaire among the White-collar workers who works in work building in Beiwaitan Street in Shanghai city. A total of 1 040 questionnaires were distributed, and overall 993 valid questionnaires were returned. Based on the results, this article examined the effect of different population characteristics on the health status of white-collar workers, including the prevalence of chronic disease, anxiety status and self-rated health.  Results  Prevalence of chronic disease among the surveyed subjects was 13.71%, and the prevalence of people with anxiety disorder accounted for 33.55% of the total. As for the results of self-rated health, the majority of the subjects noted average condition, which made up 48.43% of the total, and those who noted relatively good made up 32.73%, taking the second place. According to the results, the prevalence rate of chronic disease seemed to increase gradually with age (P < 0.05), and the subjects who worked as service personnel and professional technicians were more likely to suffer from chronic diseases (P < 0.05). The higher the level of education of white-collar workers, the better the status of mental health (P < 0.05), and the anxiety disorders appeared less for workers who had social medical insurance. Furthermore, the results showed that women's self-rated health was better than men's (P < 0.05), and those with a higher education level seemed to have better results for this part (P < 0.05). Married workers and those who had social medical insurance were more likely to have better results of self-rated health (P < 0.05).  Conclusion  The health status of white-collar workers has occupational specificity.The age, gender, professional type, education level received, marriage status and whether or not the workers have social medical insurance can all be regarded as the important factors affecting their health status. A basic medical system which is especially suitable for the white-collar workers should be established or improved to promote their general physiological and mental health statuses.
Young and middle-aged people's awareness of family doctor building services and influencing factor analysis
ZHOU Liang, HAO Yu, YANG Yong-hua, MA Xiao-jun, WANG Zhao-xin, SHI Jian-wei, HUANG Jiao-ling
2021, 19(7): 1163-1166. doi: 10.16766/j.cnki.issn.1674-4152.002011
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  Objective  To provide a policy reference that can fully implement the system of contracted family doctor services by investigating a survey to the new mode of family doctor building service.  Methods  A self-designed questionnaire was used to survey the white-collar workers from the eight buildings in Beiwaitan Street in Shanghai which were selected randomly. Among 1 040 questionnaires which were distributed, 993 valid questionnaires were recovered. The influencing factors of building services were analysed by maximum likelihood estimation.  Results  The sample in this survey was good and in line with the current overall situation of young and middle-aged people in Shanghai. The cognition of building services was poor, only four interviewees (response rate was 0.04%) fully understood this new service pattern and only three interviewees (response rate was 0.03%) were acquainted with the service content entirely. Regarding awareness of building services, statistical differences were observed (P < 0.05) among different groups in family doctor contract, household registration, degree of understanding of their own health status and frequency of physical examination. In terms of building service content, statistically significant differences were noted among different groups of people in family doctor contract, gender, age, household register, education level, income, understanding of their own health status, self-health perception and frequency of physical examination.  Conclusion  The surveyed people with relatively lower health demand and lower utilisation rate of health service have a lower awareness of family doctor building service pattern and the service content. The higher the understanding of their own health status, the more likely they are to accept more health service information and the higher is their awareness of family doctor building service pattern.
A survey on services for abortion and reproductive health management for women of childbearing age in Shanghai
DU Xue-li, BAO Yong, XU Ting
2021, 19(7): 1167-1170. doi: 10.16766/j.cnki.issn.1674-4152.002012
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  Objective  To investigate and analyse the status of services for induced abortion and reproductive health management in Shanghai, explore approaches to improve reproductive health management services and provide a reference for improving the quality of women's reproductive health management in China.  Methods  In July 2018, a self-designed questionnaire was used to conduct an anonymous survey among 3 013 women who underwent abortion in 20 medical institutions for termination pregnancy in three districts of Shanghai. Data were analysed using SPSS 22.0.  Results  The main group who sought abortion consisted of women aged 20 to 30 years. Nearly half (50.3%) of them had repeated (65.9%) or multiple miscarriages (81.1%). Moreover, 39.7% of them did 'not use any form of contraception', and 43.1% of them'did not psychologically prepare to get pregnant'. The Internet (51.4%) was their main source of knowledge on contraception. Among them, 17.6% believed that abortion did not have an impact on their health. Furthermore, 90.0% received reproductive health guidance from medical staff after the abortion, and 86.7% received reproductive health follow-up services from medical institutions.  Conclusion  The majority of the respondents had insufficient knowledge on reproductive health. Therefore, reproductive health education for women who have married or given birth must be enhanced. By improving medical care and health education, social public health service institutions and medical institutions can gradually change and improve the knowledge of women of childbearing age on healthy pregnancy and safe sex. The present contents and forms of abortion interventions for this group require innovation.
Psychological experience of patients with respiratory diseases in the context of COVID-19
WEI Zeng-zeng, WU De-quan, WANG Tong
2021, 19(7): 1171-1174,1231. doi: 10.16766/j.cnki.issn.1674-4152.002013
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  Objective  The psychological feelings of patients with respiratory diseases in the context of COVID-19 were discussed in depth from a microlevel to provide a reference for further clarifying the psychological needs of these patients and formulating psychological crisis intervention measures.  Methods  On the basis of the inclusion and exclusion criteria, 11 patients with respiratory diseases who were treated in the Second Affiliated Hospital of Anhui Medical University from January 2020 to February 2020 were selected for in-depth interviews using phenomenological research methods. The data were analysed by using Giorgi's method of data analysis.  Results  Four themes about patients with respiratory diseases were extracted: heavy psychological load, lack of knowledge related to diseases, difficult medical treatment process and weakened social support.  Conclusion  Affected by the COVID-19 pandemic, patients with respiratory diseases suffer from heavy psychological load, lack of knowledge related to diseases, difficult medical treatment process and weakened social support. In terms of the medical treatment environment, medical staff should fully mobilise internet resources, expand the field of medical services, clearly inform patients and their families about hospital isolation and the distribution of diagnosed areas, and eliminate patients' concerns for medical treatment. In terms of guidance of the medical treatment process, medical staff should inform the changes of medical treatment process caused by the COVID-19 pandemic and explain the reasons and effects of process changes to obtain the support and understanding of patients and their families. In terms of disease knowledge education, medical staff should strengthen knowledge education of the novel coronavirus pneumonia, elaborate the differences and connections between the novel coronavirus pneumonia and other respiratory diseases, reduce the public's speculation and discrimination against patients with common respiratory diseases and improve the positive psychological feelings of patients.
The risk factors and correlation with cognitive function for relapse of alcohol dependence
SHI Jie, HU Yin-tian, CHENG Wei
2021, 19(7): 1175-1178. doi: 10.16766/j.cnki.issn.1674-4152.002014
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  Objective  To investigate the risk factors of alcohol dependence and to evaluate the cognitive function of patients with alcohol dependence and to explore the relationship between cognitive function impairment and rehydration.  Methods  Total 85 patients with alcohol dependence who were given abstinence treatment in Hangzhou Seventh People's Hospital from June 2018 to June 2019 were selected as the research objects. According to whether alcohol dependence occurred again within one year after abstinence, they were divided into the relapse group (52 cases) and the non-relapse group (33 cases). The executive function, memory function and attention ability of the two groups were compared to analyze the risk factors of alcohol dependence relapse.  Results  There were statistically significant differences between the relapse group and the non-relapse group in terms of alcohol consumption, marital status and emotional symptoms before treatment (all P < 0.05). The emotional expression, intimacy, independence, organization, control and entertainment of the patients in the relapse group were significantly lower than those in the non- relapse group (all P < 0.05). The total number of executive forces WCST responses, the number of completed classification and the number of correct responses in the relapse group were significantly lower than those in the non-relapse group (all P < 0.05). The scores of memory S/VM, SS and DS in the relapse group were significantly lower than those in the non- relapse group (all P < 0.01), while there was no significant difference between the VM scores and those in the non- relapse group (P>0.05). The scores of attention DST and CPT-IP were significantly lower in the rehydration group than those in the non-rehydration group (all P < 0.01). Non-conditional logistic regression analysis showed that higher alcohol consumption, associated emotional symptoms, lower independence and affinity density, poor control and organization, and poor attention and executive ability were risk factors for alcohol dependence.  Conclusion  Heavy drinking, emotional symptoms, lack of organization in family environment, independence and affinity, lack of executive ability and attention are risk factors affecting patients' relapse, which should be paid attention to clinically.
Depression and its influencing factors in second child pregnant women with cicatricial uterus
ZHOU Jin-ying, SUN Yang-fang, LIU Bei, HU Chun-xian
2021, 19(7): 1179-1181, 1235. doi: 10.16766/j.cnki.issn.1674-4152.002015
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  Objective  To investigate the depression status of second child pregnant women with cicatricial uterus and analyse its influencing factors, so as to provide reference for improving the mental health of pregnant women during pregnancy.  Methods  Total 206 cases of pregnant women with cicatricial uterus who received prenatal examination in Hangzhou Obstetrics and Gynecology Hospital and Hangzhou Maternal and Child Health Care Hospital and planned to deliver in our hospital were selected as the research objects from January 2019 to December 2019. The general information questionnaire, self-rating depression scale, self-rating sleep quality scale and social support scale were used to investigate the subjects. The related influencing factors of depression in pregnant women (second child) with cicatricial uterus were analysed by single-factor and multiple linear regression.  Results  The total average score of depression in pregnant women with cicatricial uterus was (49.35±13.62) points. Univariate analysis showed that the depression scores of pregnant women with different age, family per capita monthly income, mother-in-law and daughter-in-law relationship, pregnancy complications, sleep quality, expectation of foetal gender and worry about postpartum recovery were statistically significant (all P < 0.05). Multiple linear regression analysis showed that family per capita monthly income, pregnancy complications, relationship between mother-in-law and daughter-in-law, sleep quality, expectation of foetal gender, worry about postpartum recovery and social support level were the influencing factors of depression in pregnant women (second child) with cicatricial uterus (all P < 0.05).  Conclusion  Pregnant women with cicatricial uterus have depression during pregnancy. Medical staff should strengthen psychological counselling and personalised education and guidance for pregnant women with pregnancy complications, low family income and sleep disorder during pregnancy, and encourage family members to provide material, information and emotional support to pregnant women to improve their depression during pregnancy.
Effect of the four-linkage health education model on the self-management efficacy of pregnant women
SUN Xiao-jun, HE Gui-juan, FANG Pei-di
2021, 19(7): 1182-1185. doi: 10.16766/j.cnki.issn.1674-4152.002016
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  Objective  To explore the effect of the the new health education model of ' hospital-community-family-pregnant ' four linkages' on improving the efficacy of self-management of pregnant women.  Methods  A total of 130 pregnant women in Yinzhou People's Hospital of Ningbo City were enrolled in this study from November 2018 to August 2019. They were divided into observation group and control group via the random number table method, with 65 cases in each group. For the control group, the traditional community education in the form of large class and the one-way communication model of preaching was adopted. For the observation group, a new health education model of ' hospital-community-family-pregnant ' four linkages was established. In this new model, the pregnant women underwent a training course according to the designed training plan. The efficacy of self-management of the pregnant women in the two groups in both delivery and breastfeeding were compared at the time of enrolment and after training. The delivery outcomes of primiparas in the two groups were compared.  Results  In the control group, no significant difference was observed in the efficacy of self-management before and after training (t=1.954, P>0.05). However, a statistically significant difference was found in the efficacy of breastfeeding before and after the training (t=135.630, P < 0.001). The difference in the efficacy of self-management of childbirth and breastfeeding before and after the training between the two groups was statistically significant (all P < 0.001). The total labour duration and caesarean section rate in the observation group were significantly lower than those in the control group (all P < 0.05).  Conclusion  The The new health education model of ' hospital-community-family-pregnant ' four linkages can provide pregnant women a more comprehensive professional health education knowledge during pregnancy than the traditional health education mode. This new model can enhance the initiative of pregnant women to participate in learning and improve the efficacy of their self-management during childbirth and breastfeeding.
A comparison of diagnosis of benign and malignant breast diseases between digital breast tomosynthesis and MRI
WANG Xiang-zhi, TANG Xiao-min, YANG Ju-ping, GAO Zhi-zhen, XIE Zong-yu, SHEN Jun-jie
2021, 19(7): 1186-1190. doi: 10.16766/j.cnki.issn.1674-4152.002017
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  Objective  To explore the diagnostic of benign and malignant breast diseases between digital mammography (DM), digital breast tomosynthesis (DBT) and MRI.  Methods  During the period from January 2019 to October 2020, 116 patients with suspected lesions by palpation underwent further imaging exam in the First Affiliated Hospital of Bengbu Medical College. The DM, DBT and MRI were performed on all the patients. All breast lesions were analyzed according to BI-RADS. The pathological results were "gold standard" to evaluate the diagnostic efficacy of the DM+DBT and MRI in benign and malignant breast diseases. The ability of the DM+DBT and MRI to evaluate the actual lesion size and malignant signs. The difference of average glandular dose between DM and DBT.  Results  Among the 116 lesions, 86 were malignant and 30 were benign. The sensitivity of DM+DBT was 88.4%, specificity 86.7%, and accuracy 87.9%. The sensitivity of MRI was 96.5%, specificity 73.3%, and accuracy 90.5%. The ROC area under the curve of DM+DBT and MRI for diagnosis of breast diseases were 0.911 and 0.948. There was no significant difference in AUC value between DM+DBT and MRI (Z=1.084, P=0.278). The DM+DBT and MRI were slightly overestimated the size of malignant tumor, but both of them were positively correlated with the pathological measurements (all P>0.05). The calcification was significantly higher for DM+DBT detection than for MRI (χ2=22.114, P < 0.05). The infiltration of pectoralis major and axillary lymph nodes were significantly higher for MRI than that for DM+DBT detection (χ2=4.900, 21.333, all P < 0.05). The average glandular dose (AGD) of DM and DBT was (1.574±0.422) mGy and (2.534±0.521) mGy, respectively. The AGD of DBT was significantly higher than DM (t=-29.213, P < 0.001).  Conclusion  DM+DBT can effectively diagnose benign and malignant breast lesions, providing a comparable efficiency to MRI. It is easy for patients and does not need contrast injections. DM+DBT is recommend for patients with dense gland type breast.
The value of a novel automatic nucleic acid system in detecting Epstein-Barr virus for the rapid diagnosis of infectious mononucleosis in children
LIU Xiu-jing, CHEN Hua-le, YU Jian, CHEN Zhan-guo
2021, 19(7): 1191-1195. doi: 10.16766/j.cnki.issn.1674-4152.002018
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  Objective  To verify the performance of a novel automatic nucleic acid system in detecting Epstein-Barr virus (EBV) and evaluate its value in the rapid diagnosis of infectious mononucleosis (IM) in children.  Methods  The automatic EBV quantitative detection system involves nucleic acid extraction and quantitative detection via real-time fluorescence PCR. Whole blood samples were extracted using a PANA9600S automatic rotating nucleic acid workstation and amplified using an ABI7500 real-time fluorescence PCR. The main performance indexes of the EBV quantitative detection system, such as accuracy, precision, linear range, detection limit, antipollution ability, cross reaction and anti-interference ability, were evaluated. Finally, the detection system was used for nucleic acid quantitative detection of 50 children suspected with IM. The results of EBV nucleic acid detection were compared with those of other existing indicators.  Results  The EBV automatic quantitative detection system had good accuracy, and its high, medium and low levels of quantitative standards were within the range of fixed value. Its detection precision was high, and both CV values within and between batches were < 5%. The detection system was within the linear range of 1.0×103-1.0×108 copies/mL. The linear correlation coefficient was above 0.980, and the detection limit was 5.0×102 copies/mL. Moreover, the detection system had good antipollution ability, no cross reaction and had a strong anti-interference ability. EBV nucleic acid test was conducted on the peripheral blood of 50 children with suspected EBV infection. The positive detection rate was 80.0%, and the quantitative value of EBV ranged from 5.45×102 copies/mL to 1.46×108 copies/mL, which was significantly higher than the detection of serum EBV IgM antibody (P=0.031) and blood routine detection of abnormal lymphocyte ratio (P < 0.01).  Conclusion  The novel EBV automatic quantitative nucleic acid detection system described herein has good performance indexes and thus can meet the requirements of clinical detection. Therefore, it can be utilised for the rapid diagnosis of children with suspected IM. Thus, its clinical application must be promoted.
Review of transanal total mesorectal excision in the treatment of rectal cancer
YU Da-jun
2021, 19(7): 1196-1198, 1205. doi: 10.16766/j.cnki.issn.1674-4152.002019
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For a long time, colorectal surgeons have been continuously exploring the treatment of rectal cancer and improving the quality of life of patients and the therapeutic effect of rectal cancer. Low and median rectal cancer is common in Chinese patients. The current surgical operations used in the treatment of low and median rectal cancer include transanal total mesorectal excision (TaTME), ISR, Miles, APR, Hartmann, Parks, ELAPE and Dixon. Different surgical procedures are used in rectal cancer with different symptoms. For low rectal cancer patients with "difficult pelvis" such as huge tumor, mesangial hypertrophy and pelvic stenosis, TaTME can accurately locate the margin of the lesion, internal sphincter space in the anal canal and middle and low rectal membrane space. It can effectively reduce the risk of surgical complications, control the recurrence rate and improve the survival rate, which has been favoured and recognised by colorectal surgeons. However, TaTME requires doctors to have sufficient experience in laparoscopic and transanal surgery and is limited by the current development of laparoscopic equipment and instruments. In this paper, the developmental origin, application, advantages and disadvantages of TaTME and its future prospects are reviewed to provide some theoretical basis and empirical evidence for this research and practice.
Fire-needle therapy combined with halometasone and Bailing prescription the treatment of resistant vitiligo
DAI Ting, LIU Jin-fen, LI Da-ning, LIU Jia, LI Hong-min
2021, 19(7): 1199-1201,1223. doi: 10.16766/j.cnki.issn.1674-4152.002020
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  Objective  To evaluate the add-on effect of fire-needle therapy combined with Bailing prescription and halomethasone in the treatment of resistant vitiligo.  Methods  Patients with refractory vitiligo who had received vitiligo treatment for more than one year in the Department of Dermatology of Xuhui Hospital were selected to carry out a randomized, self controlled clinical study. The control group was treated with halometasone combined with Bailing prescription once a day, while the study group was treated with fire-needle therapy on the basis of the control group, once every two weeks, with a course of 12 weeks. According to the efficacy standard of vitiligo formulated by pigmented dermatology group of national society of integrated traditional Chinese and western medicine dermatology and Venereology, the efficacy was determined. The curative effect (significant efficiency, effective rate) and the incidence of adverse reactions were compared between the two groups.  Results  A total of 64 target lesions in 42 patients were included in the analysis. The significant efficiency of the combination group was 40.6%, and that of the basic treatment group was 21.9%. The effective rate of the combination group was 71.8%, and the basic treatment group was 48.4%. The combination group showed significantly superior efficacy than that of the basic treatment group (P < 0.05). There were 3 cases and 2 cases of adverse reactions in the combination group and the basic treatment group respectively, and there was no significant difference in the incidence of adverse reactions (P>0.05).  Conclusion  The fire-needle therapy combined with Bailing prescription and halomethasone can significantly increase the treatment effect of refractory vitiligo, and does not increase the adverse reactions. It shows the advantage of milli fire acupuncture in the treatment of refractory vitiligo.
Clinical effect of massage combined with early rehabilitation training after arthroscopic meniscus arthroplasty of the knee
LIU Yao, ZHOU Liu-xiao, XU Huan
2021, 19(7): 1202-1205. doi: 10.16766/j.cnki.issn.1674-4152.002021
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  Objective  To investigate the clinical effect of massage combined with early rehabilitation training after arthroscopic meniscus arthroplasty of the knee.  Methods  A total of 96 patients who underwent meniscus arthroplasty in our hospital from April 2019 to May 2020 were selected and randomly divided into the observation and control groups (48 cases each group) according to the random number table method. The patients in the control group received early rehabilitation training after operation, whereas those in the observation group received manipulation massage combined with early rehabilitation training after operation. The clinical therapeutic effects of the two groups were compared.  Results  Before treatment, the VAS scores of patients in the two groups were not statistically significant (P>0.05). The VAS scores of patients in the two groups at 1 day, 3 days and 1 week after surgery were significantly lower than those before treatment (all P < 0.05). The VAS scores of patients in the observation group at each time point after surgery were significantly lower than those in the control group (all P < 0.01). Before treatment, no significant difference was observed in the Lysholm scores between the two groups (P>0.05). The Lysholm scores were significantly increased in the two groups 1 day, 3 days and 1 week after surgery compared with those before treatment (all P < 0.05). The Lysholm scores in the observation group 3 days and 1 week after surgery were significantly higher than those in the control group (all P < 0.05). In terms of the efficacy of knee joint function, the excellent and good rate of knee joint function in the observation group (89.68%) was significantly higher than that in the control group (64.58%, χ2=8.491, P=0.004).  Conclusion  After arthroscopic meniscus arthroplasty of the knee, massage combined with early rehabilitation training can effectively reduce the pain of patients, promote the recovery of knee joint function and improve the excellent and good rate of knee joint function, which has a high clinical value.
Effect of Chinese Herbal Decoction combined with dydrogesterone in the treatment of early threatened abortion
SHANG Xin-tong, HUANG Nan, QIU Ya-fen
2021, 19(7): 1206-1209. doi: 10.16766/j.cnki.issn.1674-4152.002022
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  Objective  To explore the effect of self-made Gushen Antai Decoction combined with dydrogesterone in the treatment of early threatened abortion in order to provide a reference for the clinical treatment of early threatened abortion.  Methods  Eighty cases of early threatened abortion at the Affiliated Hospital of Hangzhou Normal University from January 2017 to December 2019 were selected and randomly divided into observation group and control group (40 cases in each group). The control group was treated with dydrogesterone, whereas the observation group was treated with Gushen Antai Decoction on the basis of the control group. The clinical efficacy, improvement of clinical indicators, progesterone level, nuchal translucency thickness (NT) and crown hip length (CRL) of foetuses, success rate of foetal preservation and incidence of adverse reactions at 12-14 weeks of gestation were compared between the two groups.  Results  After treatment, the total effective rate and the success rate of foetal preservation in the observation group were 92.5% (37/40), which were significantly higher than those in the control group [75.0% (30/40) and 72.5% (29/40), respectively. P < 0.05]. After treatment, the relief time of waist pain, abdominal pain and haemostasis in the observation group were significantly shorter than those in the control group (all P < 0.05). The levels of β-human chorionic gonadotropin, progesterone and estradiol in the observation group were significantly higher than those in the control group (all P < 0.05). No significant difference was observed in foetal NT and CRL levels and the incidence of adverse reactions between the two groups of patients at 12-14 weeks of gestation (P>0.05).  Conclusion  Gushen Antai Decoction has a significant effect on the treatment of early threatened abortion. It can effectively stabilise the patient's progesterone level, relieve the symptoms of abdominal pain and back pain, increase the efficiency of foetal preservation and is safe and reliable.
Application of shock wave-induced diclofenac diethylamine emulsion in rehabilitation after hip arthroplasty on the basis of the concept of enhanced recovery after surgery
XIE Wei, ZHANG Chi, YANG Xing-hua, ZHANG Xin, LIU Yong-fei, CHENG Biao
2021, 19(7): 1210-1213. doi: 10.16766/j.cnki.issn.1674-4152.002023
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  Objective  To explore the application of shock wave-induced diclofenac diethylamine emulsion in rehabilitation after knee arthroplasty on the basis of the concept of enhanced recovery after surgery.  Methods  A total of 80 patients who were admitted to the Orthopaedic Department of Shanghai First Rehabilitation Hospital from January 2018 to June 2020 and had pain after knee arthroplasty were included in the study. The patients were randomly divided into the control group (40 patients) and treatment group (40 patients) with a random number matrix. The control group received routine rehabilitation. In addition to rehabilitation treatment, the treatment group received shock wave diclofenac diethylamine emulgel every 6 days for a total of three times. The pain VAS, SAS, Berg Balance and Lysholm knee function scores of the two groups were evaluated 1, 6 and 12 days after treatment.  Results  No significant differences in age and gender were found between the groups (all P>0.05). The most significant effect of shock wave-induced diclofenac diethylamine emulsion was observed 12 days after treatment. The VAS scores of the treatment group were significantly lower than those of the control group (2.62±1.26 vs. 3.65±2.58, P < 0.05). The SAS scores of the treatment group were significantly lower than those of the control group (42.08±2.16 vs. 47.76±2.69, P < 0.05). The Berg Balance Scale scores of the treatment group were significantly higher than those of the control group (46.83±4.67 vs. 41.39±3.52, P < 0.05). The Lysholm scale scores of the treatment group were significantly higher than those of the control group (82.98±8.86 vs. 74.52±6.48, P < 0.05).  Conclusion  Based on the concept of accelerated rehabilitation, shock wave-induced diclofenac diethylamine emulsion can effectively reduce the level of pain and anxiety in patients who underwent knee arthroplasty and promote the recovery of knee joint function.
Effect of training on infection prevention and control skills of primary medical staff in Jiangsu Province
ZANG Feng, GE Zi-jun, LIU Juan, AN Hai-yan, LIU Bo, HU Xia, YANG Yue, HUANG Hua, CHEN Wen-sen, YU Rong-bin, ZHANG Xiang
2021, 19(7): 1214-1217. doi: 10.16766/j.cnki.issn.1674-4152.002024
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  Objective  To improve the infection prevention and control level of primary medical staff through the three-stage special training for primary medical staff.  Methods  The Jiangsu provincial grassroots health personnel training guidance centre selected teachers to conduct offline training on infection prevention and control for key personnel of township health centres and community health service centres in Jiangsu Province in five bases from November 5 to November 19, 2020. The training content mainly includes the following parts: (1) Basic knowledge of hospital infection prevention and control, including standard prevention, occupational protection, hand hygiene and infection prevention and control, aseptic operation, disinfection and sterilization, medical waste management, infectious disease management, etc. (2) On site demonstration, including hand hygiene, occupational exposure disposal, disinfectant configuration and use, personal protective equipment wearing and taking off, environmental sampling, etc. (3) Case analysis and sharing, including diagnosis of nosocomial infection cases, disposal of different types of nosocomial infection outbreaks, sharing of infection control measures, etc. (4) On site questions and answers. (5) The on-site assessment, including three parts: the assessment of basic knowledge of sensing and control, the assessment of wearing and taking off protective clothing and the assessment of emergency response ability.  Results  A total of 120 general practitioners participated in the training, including 76 male and 44 female trainees. The age distribution range was 26-58 years old, mainly 30-39 years old (40.83%). The distribution of professional titles was mainly primary and intermediate. The final average score of trainees (89.44±11.06) was higher than the average score in the stage of investigation (54.85±12.74), and the score increased by 45 points (P < 0.001). In the assessment of personal protective equipment, the score of wearing and taking off medical protective clothing is relatively low. No significant difference was observed in gender, age, professional title, medical institution grade and base (P>0.05).  Conclusion  The ability of infection prevention and control has been greatly improved, and the training has achieved good results.
Mechanism of San'ao Decoction in treatment of cough variant asthma on the basis of network pharmacology
JIAO Rui, PANG Li-jian, LYU Xiao-dong
2021, 19(7): 1218-1223. doi: 10.16766/j.cnki.issn.1674-4152.002025
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  Objective  To explore the mechanism of San'ao Decoction in the treatment of cough variant asthma (CVA).  Methods  The TCMSP database was used to screen the effective components and predict the target of San'ao Decoction. GeneCards and OMIM database were searched to screen the CVA disease target. CytoNCA was used to screen the core target of San'ao Decoction in the treatment of CVA. Cytoscape 3.7.1 was used to establish a compound disease target regulatory network. On the basis of DAVID database, GO and KEGG pathway enrichment analyses were conducted to determine the core targets of San'ao Decoction.  Results  On the basis of TCMSP, 114 effective components and 254 potential targets of San'ao Decoction were obtained. A total of 2 257 targets related to the occurrence and development of CVA were screened. Twenty-eight core targets of San'ao Decoction for CVA treatment were screened by using the network topology analysis plug-in CytoNCA. Total 328 entries were obtained by GO function enrichment analysis, including 264 entries of biological process and 46 entries of molecular function and 18 orders of cell composition, mainly including apoptosis, lipopolysaccharide reaction, mitogen activated protein kinase (MAPK) activity, nitric oxide synthetase activity and other functional pathways. A total of 115 entries were obtained from KEGG pathway enrichment analysis, mainly including MAPK signalling pathway, tumour necrosis factor signalling pathway, Th17 cell differentiation and other pathways.  Conclusion  On the basis of network pharmacology, the overall regulatory characteristics of San'ao Decoction in the treatment of CVA, including multi-component, multi-target and multi-channel, are preliminarily discussed and verified, and the potential mechanism of San'ao Decoction in the treatment of CVA is predicted so as to provide scientific basis for the research of its active components.
Investigation and research on the current situation of the combination of medical care and maintenance for the aged cared by home in Hangzhou
WANG Jie-sheng, XU Xiao-fang, LI Hong-chun, JIN Dong
2021, 19(7): 1224-1227,1247. doi: 10.16766/j.cnki.issn.1674-4152.002026
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  Objective  To investigate the current situation of medical care for the aged at home in Hangzhou and find out the mismatch between supply and demand, so as to put forward suggestions for carrying out targeted pension service and pension supply-side reform.  Methods  In order to understand the current situation of demand and supply of medical care combined with maintenance, a questionnaire survey and an actual interview survey were conducted among the elderly in five communities in Xihu District and Jianggan District of Hangzhou in 2019. According to the scoring results of the activity of daily living (ADL), the elderly population was divided into self-care group and disabled group.  Results  The disabled group was older than the self-care group (P < 0.05). There was no significant difference in the sex ratio between the two groups (P=0.273). Major of them were female. There was a significant difference between the two groups of caregivers (P < 0.05). The main caregivers of the elderly were partners. The proportion of disabled elderly living alone decreased while the proportion of depend on children and nannies increased. Except chronic disease management, establishment of electronic archives and health knowledge education, the proportion of elderly people receiving public health services for other projects was less than 50%. The proportion of disabled elderly people receiving on-site services, family sickbeds and medical assistance services was less than 50%, suggesting poor accessibility of basic medical care. The proportion of patients receiving pipeline care and pressure sore care service was less than 50%, which indicated the lack of special medical care for the elderly. Except for acute and chronic neck, shoulder, waist and leg pain, the proportion of receiving other rehabilitation services was less than 50%, suggesting a lack of professional rehabilitation.  Conclusion  Based on the investigation of the current situation of medical care for the aged at home in Hangzhou, it is found that there is a mismatch between supply and demand. It is suggested that the government encourage single persons to marry as much as possible to deal with the problem of life care for the aged in the future. It is also suggested that community service centers for the aged increase home service and short-term care services to enhance the living ability of the aged at home. It is suggested that community health service institutions improve the quality of public health services for the elderly, improve the accessibility of basic medical care, train specialized nurses for the elderly, and build professional rehabilitation departments.
Investigation of bacterial contamination and disinfection level in oral dental chair waterway and application of flushing method in reducing bacterial contamination
WANG Gui-qin, ZHANG Jie, LOU Jing, JIANG Man, XU Guo-chao
2021, 19(7): 1228-1231. doi: 10.16766/j.cnki.issn.1674-4152.002027
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  Objective  To investigate and analyse the current status of bacterial contamination in oral dental chair waterway, disinfection levels and the effectiveness of water flushing methods in reducing bacterial contamination.  Methods  A total of 112 dental chairs from 23 dental institutions in Hangzhou from April 2016 to January 2020 were selected as the subjects of this study. They were divided into three groups according to the scale of medical institutions: A (52 units), B (34 units) and C (26 units). The oral dental chair waterway was sampled for bacterial culture, and the current situation of bacterial contamination in the waterway was investigated. The flushing method was used to disinfect the dental chair waterway, and then a second waterway sampling test was performed to compare the changes in the number of bacteria in the waterway between the two samples.  Results  The overall over-standard rate of dental water for dental chairs was 39.13% (9/23), with group A having no water pollution, and the over-standard rate of group C was 60.00% (6/10), which was higher than that of group B (37.50%, 3/8), χ2=8.005, P=0.012. The overall rate of high-speed mobile phone water pollution was 56.25% (63/112). The rate of water pollution in group C was 92.31% (24/26), which was significantly higher than that in group B (73.53%, 25/34) and group A (26.92%, 14/52). The difference was statistically significant (χ2=14.927, 29.661, all P < 0.001). The overall rate of water pollution exceeding three-use guns was 68.75% (77/112), amongst which the rate of water pollution in group C (96.15%, 25/26) was significantly higher than that in group B (82.35%, 28/34) and group A (46.15%, 24/52, all P < 0.001). After the water washing method was implemented, the total number of oral dental chair waterway bacteria in the three groups was significantly reduced to within the standard range, and the total oral dental chair waterway bacteria in group A were significantly lower than those in groups B and C (all P < 0.05).  Conclusion  Bacterial contamination of dental waterways is a serious matter, and the smaller the size of the medical institution, the more serious the pollution of the dental chair waterway, which should be paid enough attention. Flushing can effectively clean the bacteria and microorganisms in the dental chair waterway, significantly reduce the degree of bacterial pollution in the waterway and improve the quality of the waterway, which is worthy of active application and promotion.
A co-word clustering analysis based on the current state of research on kinesiophobia
LU Guan-zhen, WU Ting-ting, SU Yan-guang, WU Zhe
2021, 19(7): 1232-1235. doi: 10.16766/j.cnki.issn.1674-4152.002028
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  Objective  To comprehensively analyze the current status and mainstream direction of research on kinesiophobia by cluster analysis and bibliographic cooccurrence system, so as to provide a reference for solving clinical problems brought about by patients with kinesiophobia.  Methods  The topic and abstract retrieval, subject word retrieval, keyword retrieval and full text retrieval were combined. The Pubmed literature database was used as the data source to retrieve the documents related to kinesiophobia from January 1995 to February 2020, and the bibliographic information was used. The database mining system (BICOMB) and graphic clustering tool (gCLUTO) software extracted key fields such as document subject headings and subtopics, document years, periodical distribution, national and regional distribution, and perform data processing. The co-word cluster analysis was carried out from the aspects of literature growth law, annual distribution, country distribution and subject words.  Results  A total of 804 articles related to kinesiophobia were retrieved, showing that the population of kinesiophobia research was wide and involved in all ages. The annual number of articles published in kinesiophobia showed a slight upward trend, and some years lacked continuity, published between countries and regions. There was a large gap between the numbers of articles. The research tools and intervention methods were relatively single, the research content was relatively narrow, and the discipline direction was relatively limited.  Conclusion  Cluster analysis of high-frequency subject words related to acrophobia by introducing gCLUTO software shows that the research field of phobia is relatively concentrated and the subject theme is prominent. Most of them benefit from bone and joint surgical diseases such as knee replacement, chronic Low back pain, etc. Through cluster analysis, we have grasped the mainstream direction and hot issues of current research on phobia, the clinical can combine the domestic culture and development status to formulate a series of intervention measures in line with patients with kinesiophobia, in order to solve the clinical problems caused by patients with acrophobia, and provide a reference for further in-depth clinical exploration in the future.
Application of self-service lower limb therapeutic footwear in prevention of deep vein thrombosis after lower limb fracture surgery
PAN Xuan-xuan, LIANG Ping-ping, HONG Jing
2021, 19(7): 1236-1238,1242. doi: 10.16766/j.cnki.issn.1674-4152.002029
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  Objective  Staying in bed for a long time due to lower limb fractures can cause postoperative deep vein thrombosis of lower limb, affecting limb function recovery. The conventional way of functional exercise should be carried out by patients after the fracture is stable, However, by this means the recovery of limb function is slow, and a scientific and standardized exercise method is needed. In this study self-service lower limb functional therapeutic footwear were made from soft bottom shoes and two bandage to analyse the role of self-service lower limb functional therapeutic footwear on the recovery of lower limb fracture.  Methods  A total of 120 patients with lower extremity fracture from August 2016 to August 2012 were studied and divided into groups according to the lottery method. Sixty patients in the control group received regular exercise, and 60 patients in the observation group used self-service lower limb therapeutic footwear during functional exercise. The incidence of deep vein thrombosis, inner diameter of lower leg, swelling degree of lower limb, ankle joint function and lower limb function in the two groups were compared.  Results  The incidence of lower extremity deep vein thrombosis in the observation group was lower than that in the control group (P < 0.05). In the observation group, the circumference of calf and thigh were (28.16±1.96) cm and (53.24±2.56) cm, respectively. The score of swelling degree was (0.78±0.12) points, which was lower than that of the control group. The score of ankle function, lower limb movement and balance function of the observation group were (81.54±1.69) points, (30.12±1.27) points and (42.78±1.98) points, respectively, which were higher than that of the control group (all P < 0.05).  Conclusion  For patients with lower limb fracture surgery, using self-service lower limb therapeutic footwear can prevent deep vein thrombosis of lower limb and relieve swelling in the lower extremities. Patients with obvious discomfort can achieve improved ankle and lower limb function. The number of samples can be increased to extend this study. The application value of self-service in lower limb functional exercise shoes on the lower limb fracture can be deeply explored.
Application effect of individualised nursing combined with cluster nursing in edaravone treatment of acute paraquat poisoning
LI Rui-yun, LI Qiong
2021, 19(7): 1239-1242. doi: 10.16766/j.cnki.issn.1674-4152.002030
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  Objective  To explore the application effect of individualised nursing combined with cluster nursing in the treatment of acute paraquat poisoning with edaravone.  Methods  Fifty-four patients with acute paraquat poisoning admitted at the Third Affiliated Hospital of Xinxiang Medical College from January 2015 to January 2020 were selected and treated with edaravone. They were randomly divided into the control group (27 cases, using personalised nursing) and observation group (27 cases, using personalised nursing combined with cluster nursing). The levels of tumour necrosis factor (TNF)-α, ALT, Cr and serum interleukin (IL)-18 were compared between the two groups before and after nursing. The 28-day survival rate and mortality of the two groups were observed and recorded.  Results  Compared with the control group, the levels of TNF-α and IL-18 in the observation group were lower after nursing, and the difference was statistically significant [(74.75±8.58) ng/L vs. (112.42±12.39) ng/L, (145.42±13.85) ng/L vs. (164.57±15.34) ng/L, t=12.988, 4.815, all P < 0.05]. No significant difference was observed in ALT and Cr levels between the two groups before nursing (all P>0.05); compared with the control group, the levels of ALT and Cr in the observation group were lower after nursing, and the difference was statistically significant [(122.82±15.65) U/mL vs. (236.15±28.58) U/mL, (138.56±15.77) μmol/L vs. (181.36±19.34) μmol/L, t=18.073, 8.912, all P < 0.05]. The 28-day survival rate of patients in the observation group was 48.15%, and that of patients in the control group was 22.22%. Compared with the control group, the 28-day survival rate of patients in the observation group was higher, and the difference was statistically significant (χ2=3.979, P=0.046).  Conclusion  Edaravone treatment and combined nursing (individualised nursing+cluster nursing) can effectively improve the related biochemical indexes such as TNF-α, serum IL-18, ALT and Cr and increase the survival rate and prognosis of patients with acute paraquat poisoning.
Effects of early systematic care on patients with esophageal cancer undergoing radiotherapy
LU Hong, GENG Chun-hua, XIAO Bin, WANG Yi, XU Yang
2021, 19(7): 1243-1247. doi: 10.16766/j.cnki.issn.1674-4152.002031
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  Objective  To investigate the effects of early systematic nursing care on patients suffering from esophageal carcinoma and receiving radiotherapy.  Methods  From January 2018 to April 2020, we enrolled 46 patients with esophageal carcinoma and divided into two groups of 23 individuals at random. Usual care or early systematic nursing care was adopted for the control or study group.The nutrition index, quality of life, serum inflammatory factors, occurrence of radiation esophagitis (RE) and pneumonia (RP) were the indicators we used for comparison.  Results  All pieces of baseline information showed no obvious distinction between the two groups (all P>0.05). The incidence of RE was 8.70% and dramatically attenuated in patients who received early systematic nursing, as compared with that in the control group (39.13%, P < 0.05). As for RP, the incident rate was 4.35% in the study group and lower than that in the control (17.39%), but no distinct difference was observed (P>0.05). Patients who received early systematic nursing had remarkably lower serum IL-6, TGF-β, S100A8 and IL-10 levels than patients who received usual nursing (all P < 0.05). Quality of life with SF-36 showed that the total score of the study group [(598.30±143.20) points] was considerably improved when compared with that of the control group [(417.00±200.58) points]. Meanwhile, BMI, Hb, ALB and Lym in patients who received early systematic nursing were higher than those in the control group (all P < 0.05).  Conclusion  During radio therapy of patients with esophageal cancer, the early systematic nursing can improve nutritional status and inhibit the release of inflammatory cytokines and may thus be paramount in the suppression of radiation-induced esophagitis and improvement of patients' quality of life.
Effect of personalised nursing quality index evaluation system based on information on the nursing quality in outpatient and emergency infusion room
YAN Yun, SHEN Guo-di
2021, 19(7): 1248-1250. doi: 10.16766/j.cnki.issn.1674-4152.002032
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  Objective  To analyse the influence of personalised nursing quality index evaluation system based on information on the nursing quality in outpatient and emergency infusion room.  Methods  A total of 200 patients who were treated in the infusion room of the Outpatient and Emergency Department of Huzhou Central Hospital of Zhejiang Province from January 2018 to December 2019 were selected by random sampling. A total of 100 patients from January 2018 to December 2018 were set as the control group, and 100 patients from January 2019 to December 2019 were set as the intervention group. The control group implement the outpatient transfusion room in patients with routine nursing care. On the basis of the control group, the intervention group reviewed the literature, communicated with clinical experts, consulted them and adopted useful suggestions. Referring to the relevant nursing system, the intervention group formulated personalized nursing quality indicators based on informatization, studied and constructed personalized nursing quality indicators evaluation system based on informatization, so as to excavate, analyze and improve the nursing quality, and to achieve the purpose of improving outpatient nursing treatment. The waiting time for infusion, the incidence of adverse events, the success rate of puncture and the satisfaction of patients' nursing were analysed and compared between the two groups.  Results  The waiting time in the intervention group was (31.16±10.23) min, and the incidence of adverse events was 2.00%, which were significantly lower than those in the control group [(45.17±9.26) min and 11.00%, respectively, all P < 0.05]. In addition, the puncture success rate and nursing satisfaction of patients in the intervention group were 97.00% and 98.00%, respectively, which were significantly higher than those in the control group (81.00% and 84.00%, all P < 0.05).  Conclusion  The personalised nursing quality index evaluation system based on information can effectively improve the nursing quality of outpatient and emergency infusion rooms and improve the occurrence of adverse events.
General Practice Research
A five-year analysis of disease spectrum and clinical features of rheumatic inpatients in a new general hospital
LIANG Dong-bin, TAO Li-hua, XU Jing, GUO Qian, LI Ji, SHI Lian-jie
2021, 19(7): 1075-1078. doi: 10.16766/j.cnki.issn.1674-4152.001988
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  Objective  To understand the disease spectrum distribution and general characteristics of inpatients in the Department of Rheumatology and immunology in China.  Methods  The clinical data of inpatients in the Department of Rheumatology and Immunology of Peking University International Hospital from January 2015 to December 2019, including gender, age, diagnosis and length of stay, were collected for statistical description and analysis.  Results  There were 22 beds, 229 patients discharged in total, and 1 236 non-repeat inpatients. The mean age was (51.14±16.74) years. Of all the patients, 947 patients were no more than 65 years (76.62%). The ratio of female to male was 1.81 ∶ 1. The most frequent rheumatic diseases inpatient was following, RA 25.29%, SS 11.30%, SLE 8.59%, Gout 8.43%, OA 7.65%, SpA 5.70%, and each of the other rheumatic diseases was less than 3%. The number of discharged patients increased year by year, with 56, 282, 542, 595 and 752 cases in each year, respectively. However, the number of repetitive inpatients increased. Different rheumatic diseases showed different hospital days, and patients with IIM need the longest hospital days [(19.79±11.86) d], and the average length of hospital stay of SSc was (16.54±8.48) days. The proportion of RA patients who were admitted to hospital repeatedly was 8.64%, but this proportion of IIM patients and SSc patients was 32.14% and 34.60%, respectively (all P < 0.001).  Conclusion  Most of the rheumatic inpatients were female and less than 65 years. Arthritis disease was still the main type of hospitalization in rheumatic disease. Patients with IIM or SSc need longer hospital stay and show a higher proportion of repeated hospitalization than patients with other rheumatic diseases.
Effect of intermittent θ pulse stimulation on frequency spectrum and frequency ratio of EEG in patients with type 2 diabetes mellitus and mild cognitive impairment
XIE Jing, WANG Dan, YUAN Xu, CHEN Shang-jie, JIANG Yong, WANG Min
2021, 19(7): 1079-1083. doi: 10.16766/j.cnki.issn.1674-4152.001989
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  Objective  To investigate the effect of single intermittent θ pulse stimulation on the frequency spectrum and frequency ratio of resting EEG in patients with type 2 diabetes mellitus and mild cognitive impairment.  Methods  From July to November 2020, 40 patients with type 2 diabetes mellitus complicated with mild cognitive impairment were recruited in the community health service center affiliated to Shenzhen Bao 'an Hospital. They were randomly divided into true stimulation group (n=20) and sham stimulation group (n=20). Each patient received a 5 min resting EEG collection first, with a single pulse measurement resting movement threshold, an intermittent θ pulse was stimulated at 80% intensity, and EEG was collected at rest for 5min immediately after stimulation.  Results  After the intervention of intermittent θ pulse stimulation, there was no significant difference in the absolute power of each electrode channel and each frequency band before and after the intervention of sham stimulation group. There was no significant difference in the absolute power of each frequency band of the electrode channel between the sham stimulus group and the true stimulus group. However, in the true stimulation group, the absolute β-band power of T7 and CP6 channels increased significantly after intervention compared with before stimulation, respectively (45.83±8.28) μV2, (39.84±11.10) μV2, the difference was statistically significant (P=0.042, P=0.040). Compared with before stimulation, the (δ+θ)/(α+β) frequency ratio of T7 channel in the true stimulation group decreased significantly after stimulation, the difference was statistically significant (P=0.041). Multivariate regression analysis showed that gender, age, body mass index, disease course and absolute power of the subjects had no statistical significance (all P>0.05).  Conclusion  After a single intervention of intermittent θ pulse stimulation, the absolute power of β-band of T7 and CP6 channels in the temporal region of type 2 diabetes mellitus patients with mild cognitive impairment was increased, and reduce the frequency ratio of the T7 channel. iTBS improves cognitive function by affecting cognitive processing in patients with type 2 diabetes with mild cognitive impairment.
Analysis of the related factors of the invasion depth of gastric cancer in middle-aged and elderly patients
LIANG Song, JIANG Pin, LI Jing, FANG Xin-an, YANG Li
2021, 19(7): 1084-1086, 1149. doi: 10.16766/j.cnki.issn.1674-4152.001990
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  Objective  To analyze the correlation between the depth of infiltration of early gastric cancer (EGC) and clinicopathological features in middle-aged and elderly patients, and to explore the risk factors for the depth of infiltration of EGC and its relationship with lymph node metastasis (LNM).  Methods  The clinicopathological data of 110 patients with EGC admitted to the General Surgery Department of Lu'An Affiliated Hospital of Anhui Medical University from January 2013 to December 2019 were retrospectively collected. The relationship between the infiltration depth, LNM and clinicopathological features were analyzed. A logistic regression model was used to analyze the independent risk factors for the infiltration depth and LNM.  Results  Of the 110 patients, 54 had tumors confined to the mucosal layer, of which 53 patients had no LNMs and 1 had LNMs, and 56 had tumors invading the submucosal layer, of which 44 patients had no LNMs and 12 patients had LNMs. Univariate analysis showed no statistically significant differences between the two groups with different depth of infiltration in terms of gender (P=0.739), age (P=0.336), gross type classification (P=0.815), tumor location (P=0.410), differentiation (P=0.519), vascular invasion (P=0.057) and perineural invasion (P=0.243). Patients with tumor size ≥2 cm (P=0.005) and LNM (P=0.001) had a higher proportion of tumors invading the submucosa than those confined to the mucosal layer. Multivariate logistic regression analysis showed that tumor size (P=0.016) was an independent influence on the depth of infiltration of EGC, and further analysis revealed that the depth of infiltration (P=0.044) was an independent influence on LNM of EGC.  Conclusion  Tumor size was the independent risk factor of the tumor invasive depth. EGC with a tumor size of ≥2 cm may be more likely to have tumor invasion of the submucosal layer and a greater risk of LNM. It is recommended that the middle-aged and elderly patients with EGC whose tumor diameter is ≥2 cm and invades the submucosal layer should be careful when choosing endoscopic submucosal dissection or radical gastrectomy with inadequate lymph node dissection.
Significance of nutritional risk screening before transcatheter arterial chemoembolization for primary liver cancer and the effect of individualised nutritional intervention
LI Ping, LIU Wen-hong, ZHAO Meng, SU Guang-ming
2021, 19(7): 1087-1090. doi: 10.16766/j.cnki.issn.1674-4152.001991
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  Objective  To understand the preoperative nutritional needs and quality of life of patients with primary liver cancer treated with interventional therapy and to analyse the effect of individual nutritional interventions.  Methods  A total of 120 primary liver cancer patients undergoing transcatheter arterial chemoembolization (TACE) from December 2018 to December 2019 were included in the study. They were divided into the observation group and control group according to the random number table method with 60 cases in each group. All patients were screened using the preoperative Nutritional Risk Screening 2002 (NRS2002) scale and Quality of Life Scale (EORTC QLQ-C30) before operation. The patients in the control group were provided perioperative regular diet guidance, whereas those in the observation group were given individualised nutritional intervention. The patients were followed up for 3 months. The NRS2002 score, EORTC QLQ-C30 score, liver function index (ALT, AST, GGT) and nutritional index (BMI, ALB) between the two groups were observed and compared.  Results  (1) A total of 120 patients with primary liver cancer had poor preoperative nutritional status and low quality of life. (2) No statistically significant difference was observed in the NRS2002 score, EORTC QLQ-C30 score, liver function and nutritional index between the two groups before intervention (all P > 0.05). (3) After three months of follow-up, the observation group had improved NRS2002 and EORTC QLQ-C30 scores compared with the control group (all P < 0.05). Moreover, the observation group had lower liver function indexes (tALT=-7.623, tAST=-8.816, tGGT=-12.476) and higher nutritional indexes (tBMI=6.578, tALB=3.593) compared with the control group (all P < 0.001).  Conclusion  Patients with primary liver cancer have poor preoperative nutritional status and low quality of life. Individualised nutritional intervention can effectively improve patients' nutritional status, quality of life and liver function, indicating that it has a good clinical application prospect.
Relationship between serum lipoprotein (a) level and CISS classification and severity of ischemic stroke in youth
LUO Wen-ping, LI Xiao-yu, LUO Song, LIU Xiao-lin
2021, 19(7): 1091-1094, 1102. doi: 10.16766/j.cnki.issn.1674-4152.001992
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  Objective  To explore the relationship between serum lipoprotein (a) [Lp(a)] and ischemic stroke in young people with different Chinese ischemic stroke subtypes (CISS classification), and provide evidence for its prevention and treatment.  Methods  The clinical data of 122 young patients with ischemic stroke treated in the First Affiliated Hospital of Bengbu Medical College from April 2017 to December 2019 were collected and included in the young stroke group, and 122 cases of ischemic stroke patients aged ≥ 45 years who were hospitalised during the same period were randomly admitted as the middle-aged and elderly stroke group. The traditional risk factors and serum Lp(a) levels between the two groups were compared. According to the CISS classification, pathogenesis and NIHSS scores at the time of admission, young patients with ischemic stroke were divided into different groups. The serum Lp(a) levels were compared between the groups. Multivariate logistic regression was used to analyse the independent influencing factors of ischemic stroke in young people.  Results  The serum Lp(a) level in the young stroke group was significantly higher than that in the middle-aged and elderly stroke group (t=7.317, P < 0.001). In different CISS classifications, serum Lp(a) levels in LAA, PAD, CS, OE, and UE groups were (381.38±62.46) mg/L, (297.94±43.97) mg/L, (283.00±39.33) mg/L, (279.25±38.22) mg/L, (292.92±34.93) mg/L, the difference between the groups was statistically significant (F=22.272, P < 0.001). The serum Lp(a) level of the LAA group was significantly higher than that of the PAD group, CS group, OE group and UE group(all P < 0.05), but there was no significant difference among the other four subtypes (all P > 0.05). Moreover, no significant difference was observed in the serum Lp(a) levels amongst patients with different pathogenesis of LAA (F=0.264, P=0.851), but a significant difference was noted in the serum Lp(a) levels amongst patients with different NIHSS scores (F=8.579, P < 0.001). Hyperlipidaemia, smoking and Lp(a)>300 mg/L were independent influencing factors of LAA subtypes in young patients with ischemic stroke.  Conclusion  Elevated serum Lp(a) level is one of the independent risk factors for ischemic stroke in young people. It plays an important role in patients with large atherosclerosis and can be used to assess the severity of the disease. Attention should be paid to monitoring and intervention.
Relationship between preoperative NLR and PLR and clinicopathological characteristics and T stage after laparoscopic radical resection of hilar cholangiocarcinoma
LI Chuan-tao, ZHOU Chi, WANG Zhao-ying, LU Zheng, CUI Pei-yuan
2021, 19(7): 1095-1098. doi: 10.16766/j.cnki.issn.1674-4152.001993
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  Objective  To study the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with the clinicopathological characteristics and T staging of hilar cholangiocarcinoma (HC).  Methods  The data of patients with HC were analyzed retrospectively. The receiver operating characteristic (ROC) curve was used to determine the best cut-off values of NLR and PLR. Statistical analysis of preoperative NLR and PLR and HC pathological characteristics and the relationship between T staging and the predictive value of T staging.  Results  The ROC curve was used to determine the best cut-off value: high-NLR group (NLR>4.12, 56 cases), low-NLR group (NLR≤4.12, 44 cases), high-PLR group (>184.56, 48 cases) and low-PLR group (≤184.56, 52 cases). Univariate analysis showed that preoperative NLR was correlated with tumour location and T stage (all P < 0.05) and had no correlation with gender, age, degree of differentiation and tumour size (all P > 0.05). Preoperative PLR was correlated with T stage, tumour size and lymph node metastasis (all P < 0.05) and had no correlation with gender, age, degree of differentiation and tumour location (all P > 0.05). Multivariate analysis showed that preoperative NLR was associated with T staging (OR=2.999, P=0.026) and tumour location (OR=0.346, P=0.032). Preoperative PLR was related to T stage (OR=3.635, P=0.007) and tumour size (OR=1.728, P=0.031), but not to lymph node metastasis (P > 0.05). The ROC curve areas of NLR and PLR before surgery were 0.811 and 0.794, respectively, which have predictive value for T staging.  Conclusion  Preoperative NLR and PLR are simple and practical detection indicators that can be used to evaluate the pathological characteristics of HC before surgery and have predictive value for T staging.
The application of hand-assisted laparoscopic D2 radical gastrectomy
GUO Ai-jun, LU Ming-dian, ZHOU Bo
2021, 19(7): 1099-1102. doi: 10.16766/j.cnki.issn.1674-4152.001994
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  Objective  To explore the clinical application of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer.  Methods  We retrospectively analyzed the clinical data of 60 patients with gastric cancer who were treated in the Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University from January 2018 to December 2020, among which 20 patients underwent hand-assisted laparoscopic surgery, 20 underwent traditional open surgery, and 20 underwent laparoscopic assisted surgery. The differences in operative time, blood loss, incision length, postoperative discharge time, duration of first time to get out of bed after surgery, length of hospital stay, number of dissected lymph nodes and other indicators among the three groups were analyzed.  Results  All of the 60 operations were completed successfully. Results of the three groups showed that the operation time of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly longer than that of the traditional group [(239.7±22.2)min, (251.9±33.2)min, (184.1±37.2)min, F=26.309, P < 0.001], but there was no significant difference in the operation time between the hand-assisted laparoscopic group and laparoscopic assisted group (P > 0.05). The blood loss of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly less than that of the traditional group (F=68.984, P < 0.001), and the blood loss of the hand-assisted laparoscopic group was shorter than that of the laparoscopic assisted group (P < 0.05). The incision length of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly smaller than that of the traditional group (F=675.937, P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (P > 0.05). Postoperative exhaust time, length of hospital stay and duration of first time to get out of bed after surgery of the hand-assisted laparoscopic group and the laparoscopic assisted group longer than that of the traditional group (all P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (all P > 0.05). There was no significant difference in numbers of lymph nodes dissected among the 3 groups (F=0.582, P=0.562).  Conclusion  Hand-assisted laparoscopic D2 radical gastrectomy (HALG) combines the advantages of both open and laparoscopic-assisted radical gastrectomy. Compared with OG and LAG, HALG shows great advantages in lower requirements for assistants, less manpower, smaller incision, less intraoperation blood loss, quicker postoperative recovery and fewer complications. In conclusion, the HALG is a safe and feasible surgery.
Clinical study on endoscopic diagnosis and treatment of laterally spreading tumor
HU Hong-na, ZHANG Li-jiu, SONG Sha-sha
2021, 19(7): 1103-1106, 1195. doi: 10.16766/j.cnki.issn.1674-4152.001995
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  Objective  To study the endoscopic pathological features and endoscopic treatment method of laterally spreading tumor (LST).  Methods  The clinic pathological data of 48 LST patients diagnosed and treated with endoscopy in the Second Affiliated Hospital of Anhui Medical University from January 2014 to December 2019 were retrospectively analyzed. According to the lesion site, the patients were divided into the rectal group (27 cases) and the colon group (21 cases), and their diameters, lesion subtypes and postoperative pathological Results were recorded respectively. Twenty-seven cases underwent endoscopic mucosal dissection (ESD), 19 cases underwent endoscopic mucosal resection (EMR/EPMR), and 2 cases underwent expected mucosal resection (pre-cut-off EMR). The residual rate, bleeding rate, perforation rate and recurrence rate of endoscopic treatment were observed.  Results  There was no significant difference in age and gender between the two groups (all P > 0.05). In the rectal group, the diameter of the lesions was (3.27±1.29) cm, and the nodules were mainly of mixed type, while in the colon group the diameter was (2.61±0.78) cm, and the main particles were all of the homogeneous type, with statistically significant differences (all P < 0.05). Compared with the colon group, the proportion of high-grade intraepithelial neoplasia and cancerization in the rectal group was significantly increased (P < 0.05). Rectal LST was mainly treated with ESD (74.1%), while colon LST was mainly treated with EMR/EPMR (61.9%). One case of colon LST was unable to receive effective complete resection with ESD due to excessive length of lesion length, and was transferred to surgical operation. The remaining 47 cases were all completely removed. Postoperative hemorrhage in 1 case (2.1%) was improved by endoscopic hemostasis therapy again. One patient recurred 4 years after operation and underwent complete endoscopic resection again. None of the patients in this group had residual or perforation complications.  Conclusion  Rectal LST lesions have a large range, mainly nodular mixed type, with relatively high malignant potential, mainly ESD therapy. Colonic LST is commonly treated with granular homogeneous type, and EMR/EPMR treatment is more common. Pre-cut-EMR treatment may be considered in some cases.
Short-term efficacy of Xiangsha Pingwei Granule in the treatment of Helicobacter pylori gastritis with dyspepsia
ZHU Xin-ying, ZHAO Li-wei, MENG Xia, YANG Liang, JIAO Li, MA Huan
2021, 19(7): 1107-1110, 1178. doi: 10.16766/j.cnki.issn.1674-4152.001996
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  Objective  To evaluate the efficacy and safety of Xiangsha Pingwei Granule in the treatment of Helicobacter pylori (H. pylori) gastritis with dyspepsia.  Methods  Total 240 H. pylori gastritis patients with dyspepsia were randomly divided into control group and observation group, 120 cases each. Control group received 220 mg Bismuth Potassium Citrate+Rabeprazole 10 mg+Amoxicillin 1 000 mg+Clarithromycin 500 mg, oral twice a day for 14 days; observation group received Xiangsha Pingwei Granule 10 g twice a day for 14 days based on the control group. H. pylori eradication rate, TCM clinical symptom score, serum pepsinogen (PG)Ⅰ, PGⅡ, pepsinogen ratio (PGR) levels and adverse reactions were compared between the two groups.  Results  There was no significant difference in the eradication rate of H. pylori between the two groups (90.4% vs. 93.8%, χ2=0.890, P=0.345). The total effective rate of observation group was 89.5%, which was significantly higher than 79.5% of the control group (χ2=4.325, P=0.038). The scores of TCM symptoms of the two groups decreased with time. The decrease of the above symptom scores in the observation group was significantly higher than control group. The overall level of the above symptom scores in the observation group was significantly lower than control group. The serum levels of PGⅠ, PGⅡ and PGR in the two groups decreased with time. The decrease of the above indexes in the observation group was significantly greater than control group. The overall level of the above indexes in the observation group was significantly lower than that in the control group. There were 20 cases (17.5%) of adverse reactions in observation group, which was significantly lower than 32 cases (28.6%) in the control group (χ2=3.878, P=0.049).  Conclusion  Xiangsha Pingwei Granule combined with quadruple therapy in the treatment of H. pylori gastritis complicated with dyspepsia has good clinical efficacy and safety, which is worthy of clinical promotion.
Effect of different binders on bond strength and durability of fibre post
YANG Fan, LU Xiao-miao, LIU Fang, LIAO Sheng-kai
2021, 19(7): 1111-1113,1209. doi: 10.16766/j.cnki.issn.1674-4152.001997
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  Objective  To discuss the influence of different resin binders on bond strength of fibre pile under different conditions.  Methods  Total 160 single-canal premolars that needed to be extracted for orthodontic treatment in the Department of Stomatology of the First Affiliated Hospital of Bengbu Medical College from July 2018 to December 2019 were selected as the research objects. After completing root canal therapy, root canal preparation was followed by cold pressure filling. Then, post-canal preparation was conducted and then divided into four A, B, C, D groups according to the random number table method (with 40 pieces in each group). Each group was treated with different binder. Group A was bonded with the sixth generation of Kelloli binder, group B was bonded with the eighth generation of 3M binder, group C was bonded with the eighth generation of BISCO binder, and group D was bonded with the eighth generation of Kerr binder. A 1-mm-thick segment of each tooth was cut in the root neck with a low-speed diamond cutting machine perpendicular to the tooth's long axis, which was used as the experimental specimen. Each group was divided into two groups, namely, the experimental group and the hot and cold cycle experimental group (with 20 pieces in each group). Under different conditions, the influence of different binders on the bond strength was tested and recorded. Finally, the fracture of the specimen was observed under a microscope.  Results  Statistically significant differences were observed in the bond degree of the four kinds of binders in the sheet pull-out test (F=110.854, P < 0.001). Amongst them, the bond degree of group D [(28.04±3.18) MPa] was the largest, and that of group A [(15.15±2.62) MPa] was the lowest. Statistically significant differences were observed amongst the four kinds of adhesive bonding degree in the hot and cold cycle experiments (F=82.630, P < 0.001). Amongst them, the bond strength of group D was the highest [(24.12±2.47) MPa], and group A had the lowest bond strength [(14. 29±2.11) MPa], and there was no significant difference in the distribution of fracture mode among the four groups (χ2=2.906, 3.593, P=0.820, 0.731).  Conclusion  The bond strength of fibre piles varies significantly amongst different binders, and the eighth generation of Kerr binder has the highest bond strength.
Bioinformatics analysis of lncRNA DLEU2 transcriptional regulatory factors
ZENG Wei, LIU Yi, LI Wen-ting, LI Yi, ZHU Jin-feng
2021, 19(7): 1114-1116,1120. doi: 10.16766/j.cnki.issn.1674-4152.001998
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  Objective  To investigate the structural characteristics of lncRNA DLEU2 transcription factor and its transcriptional binding sites with lncRNA DLEU2.  Methods  Bioinformatics tools were used to analyse the physical and chemical properties, structure, transmembrane region, signal peptide and subcellular localisation of lncRNA DLEU2 transcriptional regulatory factors and to predict the transcriptional binding sites between transcriptional factors and lncRNA DLEU2.  Results  Isoelectric point analysis showed that the isoelectric points of transcriptional regulatory factors CTCF, MAX, ELF1, YY1 and USF1 were less than 7.0. The isoelectric points of POLR2A, FOXA1, BHLHE40, CEBPB and ATF3 were more than 7.0. Lipolysis index analysis showed that the liposolubility index of the above 10 transcriptional regulatory factors were less than 100, indicating that they were hydrophobic proteins. The results of instability index analysis showed that the instability index of 10 transcriptional regulatory factors in this study were greater than 40, indicating that they were unstable proteins. All the secondary structures of the above transcriptional regulatory factors were composed of α-helix, irregular coiling and extended chain structure, and no transmembrane protein and signal peptide structures were found in the above transcriptional factors. Subcellular localisation analysis showed that YY1 was located in the cytoplasm, and other transcription factors were located in the nucleus. At the same time, the 10 transcriptional regulatory factors and lncRNA DLEU2 transcriptional binding sites were predicted.  Conclusion  The diversity of lncRNA DLEU2 transcriptional regulatory factors may contribute to the further study of the regulation of lncRNA DLEU2 transcriptional expression, and the results will be helpful for the screening of lncRNA DLEU2 related cancer therapeutic drugs.
Clinical analysis of modified laparoscopic extensive hysterectomy in the treatment of stage ⅠA2 - ⅠB1 cervical cancer
LIU Jian, DENG Zhao-ya, XU Jie, GAO Long-fei, SUN Yi-lin, LI Yan
2021, 19(7): 1117-1120. doi: 10.16766/j.cnki.issn.1674-4152.001999
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  Objective  To compare the perioperative conditions of modified laparoscopic and complete laparoscopic extensive hysterectomy in patients with stage ⅠA2 - ⅠB1 cervical cancer.  Methods  Patients who were admitted at the Department of Gynecology and Oncology of the First Affiliated Hospital of Bengbu Medical College from February 2017 to June 2020 were recruited. The patients were graded as clinical stage ⅠA2 - ⅠB1 according to the International Federation of Gynecology and Obstetrics (FIGO) and received laparoscopic extensive hysterectomy for cervical cancer. The clinical pathology, surgery and postoperative recovery of patients were retrospectively analysed. A total of 30 patients were included in this study, including 15 cases of modified laparoscopic (no lifting cup and closed vaginal resection sample) and complete laparoscopic (with lifting cup) extensive hysterectomy. The operation time, blood loss, length of parauterine resection, length of vaginal wall resection, perioperative complications and postoperative recovery were compared between the two groups.  Results  No statistically significant differences were observed in the age[(50.13±7.35) years vs. (44.80±7.46) years], body mass index (24.26±3.57 vs. 23.48±3.01), FIGO staging (ⅠA2/ⅠB1: 4/11 vs. 1/14) and pathological type (squamous carcinoma/adenocarcinoma: 13/2 vs. 10/5) of the two groups of patients (all P>0.05). Moreover, no statistically significant differences were observed in the operation time[223 (204, 248) min vs. 100 (80, 300) min], intraoperative blood loss[216 (179, 251) mL vs.100 (76, 300) mL], length of vaginal wall resected[(3.32±0.20) cm vs. (3.49±0.29) cm] and length of parauterine wall[(3.25±0.27) cm vs. (3.41±0.32) cm] between the two groups (all P>0.05). In addition, no significant differences were observed in urinary retention (yes/no: 4/11 vs. 2/13), deep vein thrombosis (yes/no: 3/12 vs. 1/14), lymphatic cyst (yes/no: 6/9 vs. 8/7), postoperative supplementary treatment (yes/no: 8/7 vs. 8/7), postoperative exhaust time[(2.80±0.41) d vs. (2.79±0.43) d] and postoperative hospital stay[(5.13±1.64) d vs. (5.60±0.99) d] between the two groups of patients (all P>0.05).  Conclusion  Modified laparoscopic extensive hysterectomy has the same safety as complete laparoscopic hysterectomy and is worthy of further promotion.
General Clinical Research
Application of ICG fluorescence imaging in laparoscopic hepatectomy for primary liver cancer
YAO Chao, ZHANG Deng-yong, SUN Wan-liang, LU Zheng
2021, 19(7): 1121-1124. doi: 10.16766/j.cnki.issn.1674-4152.002000
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  Objective  To study the application value of indocyanine green (ICG) molecular fluorescence imaging in laparoscopic hepatectomy for primary liver cancer.  Methods  The clinical and pathological data of 56 patients with primary liver cancer who underwent ICG fluorescence laparoscopic hepatectomy in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College from December 2018 to September 2020 were analysed retrospectively. The operative methods, the methods of preoperative staining, the characteristics of intraoperative fluorescence tumour development, the detection of new lesions and the pathological results of tumour after operation were statistically analysed.  Results  All patients successfully completed hepatectomy under ICG fluorescence laparoscopy without conversion to laparotomy. New suspicious lesions were found in 9 patients under fluorescence imaging. Pathological examination of intraoperative rapid frozen section showed 4 cases of hepatocellular carcinoma, 1 case of inflammatory changes and 4 cases of sclerotic nodules. Amongst the 9 patients, eight cases were complicated with liver cirrhosis. During the operation, staining failed in 10 patients due to severe liver cirrhosis or the presence of communicating branches. Staining failed in 8 patients who were injected with ICG before operation and 2 patients who received anti-staining during operation. The patients of Child-Pugh grade A could obtain a good development effect 2 or 3 days before operation, whereas those of grade B had the best tumour development under fluorescence 5 days before operation. All patients had no serious complications and recovered well.  Conclusion  The development of ICG fluorescence imaging technology provides surgeons with a simple and effective navigation method that can accurately locate the tumour and resection boundary and help to find superficial small lesions. However, how to define the degree of liver cirrhosis and injection time still need to be discussed.
Clinical effect and imaging analysis of disc anchor surgery for anterior disc displacement without reduction
WANG Yan, WANG Jing-xiao, GUO Qian-qian, CHEN Bin, LUO Jia, LYU Yi-min, ZHOU Chang-long
2021, 19(7): 1125-1127,1154. doi: 10.16766/j.cnki.issn.1674-4152.002001
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  Objective  To investigate the clinical effect and imaging analysis of disc anchor surgery (DA) in the treatment of anterior disc displacement without reduction (ADDWR).  Methods  Total 195 patients (220 lateral joints) with ADDWR were selected in our hospital from January 2014 to December 2018. Opening degree, visual analogue scale (VAS) and MRI findings were analyzed, and performed a long-term follow-up. MRI was reviewed regularly to assess the location of the joint disc and changes in the condylar bone.  Results  The average opening degree before surgery was (17.63±3.31) mm and (37.63±2.30) mm one month after surgery, 3 months post-surgery mean opening degree was (38.03±2.65) mm and 6 months was (38.23±2.20) mm. VAS before surgery was 31.26(12.91, 49.61), and 7.72(0.81, 14.63) one month after surgery, 6.69(1.08, 12.31) three months after surgery, and 5.65(0.13, 11.17) in six months post-surgery, there was significant difference of opening degree and the VAS between preoperative and post treatment (all P < 0.05). One month after surgery, MRI showed all displaced discs were reset, and after a follow-up of 12-72 months (30.12 months on average), MRI showed that 95.91% (211/220) of the discs were in good position, compared with 4.09% (9/220) of the anterior discs. Some condyles bone had new bone formation[76.82% (169/220)], 20.00% (44/220) had no bone changes, and 3.18% (7/220) had bone resorption.  Conclusion  DA can effectively treat the ADDWR and the articular disc position after surgery set stable, can significantly improve the opening degree, relieve pain and stimulate condylar bone regeneration.
Clinical analysis of endoscopic ablation electrode in the treatment of epistaxis
HUANG Fang-ming, LI Zhong-wen, LI Dong-hai
2021, 19(7): 1128-1130,1213. doi: 10.16766/j.cnki.issn.1674-4152.002002
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Abstract:
  Objective  To explore the new treatment of epistaxis, and to understand the effect of endoscopic ablation electrode haemostasis in clinical treatment, so as to provide basis for further clinical treatment.  Methods  Sixty patients admitted at the Department of Otolaryngology of the Third People's Hospital of Bengbu from January 2016 to December 2019 were selected. The inclusion criteria of outpatients with epistaxis included large amount of epistaxis, no obvious position of epistaxis and ineffective nasal packing. All patients were excluded from nasal diseases and epistaxis caused by systemic diseases. The patients were randomly divided into two groups to compare the haemostatic effect, postoperative complications, time of nasal mucosa loss and time of nasal mucosa recovery.  Results  The effective rate of haemostasis in the ablation electrode group was 93.3%, which was higher than that in the control group (83.3%). The treatment group had 8 cases of postoperative complications, which was significantly lower than that of the control group (21 cases). The time of pseudomembrane loss in the treatment group was (4.64±0.66) days, which was lower than that in the control group[(6.34±0.78) days]. The recovery time of nasal mucosa in the treatment group was (6.66±0.53) days, which was lower than that in the control group[(9.47±0.86) days]. The difference was statistically significant (all P < 0.05).  Conclusion  Ablative electrode haemostasis was superior to bipolar electrocoagulation in controlling epistaxis, reducing complications and promoting functional recovery of nasal mucosa.
Analysis and treatment of the risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis
CHEN Jin-qiang, LI Chun-da, LI Fu-qiang, LU Li-ming, FANG Bin, JIN Zhi-hua
2021, 19(7): 1131-1134. doi: 10.16766/j.cnki.issn.1674-4152.002003
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Abstract:
  Objective  To explore the risk factors and treatment of spontaneous peritonitis in patients with decompensated liver cirrhosis.  Methods  A total of 120 patients with decompensated liver cirrhosis who were treated in our hospital from January 2011 to December 2019 were divided into the concurrent group and non-complicated group based on whether they were complicated by spontaneous peritonitis (60 cases in each group). Logistic regression analysis was used to analyse the risk factors of spontaneous peritonitis in patients with decompensated liver cirrhosis. According to the different treatment drugs, the concurrent components were divided into the piperacillin and sulbactam group and ceftriaxone group (30 cases in each group). The clinical efficacy and inflammatory factor levels of the two groups were compared.  Results  Univariate analysis showed that the incidence of gastrointestinal bleeding, past history of SBP, Child-Pugh classification, total bilirubin level and blood sodium level had a certain effect on patients with decompensated liver cirrhosis complicated with spontaneous peritonitis (all P < 0.05). Multivariate analysis showed that gastrointestinal bleeding, Child-Pugh classification and total bilirubin levels were independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis (OR=0.191, 0.259, 0.922, all P < 0.05). The total effective rate of treatment in the piperacillin and sulbactam group was apparently higher than that in the ceftriaxone group (P < 0.05). After treatment, the levels of serum procalcitonin and C-reactive protein in the two groups were significantly lower than those before treatment (all P < 0.05), and the levels in the piperacillin and sulbactam group were apparently lower than those in the ceftriaxone group (all P < 0.05).  Conclusion  Gastrointestinal bleeding, high Child-Pugh grade and high total bilirubin levels are independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis. Piperacillin and sulbactam can be used in patients with spontaneous peritonitis to reduce the level of inflammatory factors in the body.

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