2022 Vol. 20, No. 8

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Expert Forum
Research management strategies for multimorbidity in elderly patients
YAO Yuan-long, SHI Wei-li, FENG Xian, HUANG Wen-bo, WANG Liu-yi
2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574
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At present, the aging of the global population is serious and China has also entered the accelerated stage of aging. Multimorbidity caused by aging brings severe challenges to economic and social development. Multimorbidity seriously affects the quality of life of elderly patients and increases the burden of multiple medications and treatments. With the increase in the number of chronic diseases, some patients are troubled by psychological diseases. Elderly multimorbidity could also lead to an increase in the number of hospitalisation, which directly leads to a remarkable increase in medical costs and resource utilisation. Thus, multimorbidity has gradually become a social health problem. Comorbid chronic disease management has also become the concerns of "Healthy China 2030". The current chronic disease management guidelines for single disease are more concentrated in the processing and they are often overlooked in the elderly with comorbidity. A large number of clinical practice showed that the guide for single disease is not a suitable for multimorbidity as the solution of the problem in better manage patients, with much research from domestic and foreign scholars. In 2012, The American Geriatrics Society issued guidelines for the diagnosis and treatment of geriatric multimorbidity, proposing patient-centred diagnosis and treatment strategies. The principles provide a reference and theoretical framework for multimorbidity management in China and domestic scholars have accumulated relevant experience in multi-morbidities research. The emphasis is on enhanced management of multimorbidity by establishing a multidisciplinary integrated team, developing a general practitioner system, adopting patient-centred management model and self-management model, attaching importance to comprehensive geriatric assessment and paying attention to multiple medications. This paper reviews the concept, epidemiology, hazard and management of multimorbidity to promote the health management of elderly multimorbidity in China.
Patient Management in United Kingdom General Practice (the end)
Rodger Charlton, XIE Wan-ling, LIU Man-ling
2022, 20(8): 1271-1272.
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Clinical application effect study of graded exercise rehabilitation training in patients with chronic heart failure
CHEN Ling-yun, QIN Qiong, WANG Li-juan, HUANG Yu-li
2022, 20(8): 1339-1342. doi: 10.16766/j.cnki.issn.1674-4152.002591
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  Objective  Through grading the cardiac function of patients with chronic heart failure, implementation of graded exercise rehabilitation training intervention, to explore the intervention effect of rehabilitation training on the overall therapeutic effect, cardiac function related indexes and life quality level of patients with chronic heart failure, so as to provide theoretical basis for developing safe and effective rehabilitation exercise plan for patients with chronic heart failure.  Methods  A total of 72 patients with chronic heart failure who came from the Department of Cardiovascular Medicine, the Fifth People' s Hospital of Fuyang from Jan. 2020 to Dec. 2020 were selected. They were divided into control group and intervention group with 36 cases each using the random number table method. The control group was treated with routine drugs, and the intervention group received exercise rehabilitation training on the basis of drug treatment. The overall efficacy, cardiac function indicators and quality of life were compared between the two groups before and after treatment.  Results  The total effective rate in the intervention group (94.44%) was higher than that in the control group (61.11%), and the difference was statistically significant (χ2=11.571, P=0.001). For patients with grade Ⅱ and Ⅲ cardiac function, the LVEF in the intervention group was (49.97±6.12)% and (47.83±5.33)%, which were better than those in the control group [(43.41±5.22)% and (41.17±5.08)%]; the 6MWT distance were [(402.57±69.13) m and (388.48±67.56) m, which were both better than the control group [(338.11±64.56) m and (332.82±62.31) m]; BNP values were [(215.33±48.72) pg/mL and (376.17±54.47) pg/mL], respectively, which were both lower than the control group [(314.43±51.52) pg/mL and (474.92±58.49) pg/mL, all P < 0.05]; the total quality of life scores were (43.02±12.48) points and (45.64±13.20) points, respectively, which were lower than those of the control group [(55.96±12.11) points and (60.72±12.78) points], and the differences were statistically significant (all P < 0.05).  Conclusion  Clinical application of graded exercise rehabilitation training in patients with chronic heart failure can improve overall efficacy, improve cardiac function and promote the quality of life. It is an important measure for secondary prevention of patients with chronic heart failure so it is deserved to be applied.
Effect of self-management ability on fall fear in elderly patients undergoing haemodialysis
LYU Su-ling, LIN Xiang-dong, CHEN Ru, CHEN Ling
2022, 20(8): 1343-1345. doi: 10.16766/j.cnki.issn.1674-4152.002592
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  Objective  To understand the status quo of elderly haemodialysis patients' self-management ability and fear of falling and analyse the influence of self-management ability on fear of falling.  Methods  A total of 328 haemodialysis patients treated in Wenzhou Hospital of Traditional Chinese Medicine from October 2019 to December 2020 were selected as the research objects, and the general data questionnaire, the modified fall efficacy scale and the haemodialysis patients' self-management ability scale were used for investigation. The measurement data conforming to normal distribution were described by x±s, and the comparison between groups was performed by t-test of independent samples and ANOVA. Pearson correlation analysis was used to analyse the correlation between self-management ability and fear of fall in elderly haemodialysis patients. Multiple linear regression was used to analyse the influencing factors of fall fear in elderly haemodialysis patients.  Results  The scores of fall fear and self-management ability of elderly haemodialysis patients were (65.11±18.81) points and (51.64±9.42) points, respectively. Significant differences in fall fear score were found amongst patients of different genders, ages, marital status, whether they exercised regularly, whether they had fallen or not and dialysis age (all P < 0.05). The self-management ability of elderly haemodialysis patients was positively correlated with the total score of fear of falling and the scores of all dimensions (all P < 0.01). Multiple linear regression analysis showed that the age, self-care ability, experience of falling and dialysis duration of elderly haemodialysis patients were the main influencing factors for fear of falling (all P < 0.01).  Conclusion  Elderly haemodialysis patients' fear of falling is at a high level, and self-management ability can affect patients' fear of falling. Clinically, health education on elderly haemodialysis patients' self-management ability should be strengthened to improve patients' fear of falling.
Effects of tobacco exposure during pregnancy on pregnant women and foetuses based on placental gene expression profiling
LIU Xuan-shi, HAO Chan-juan, XU Li-xin, LI Wei
2022, 20(8): 1346-1349. doi: 10.16766/j.cnki.issn.1674-4152.002593
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  Objective  To expand the understanding of the molecular mechanisms underlying tobacco exposure during pregnancy on pregnant women and their foetuses.  Methods  Firstly, the NCBI GEO database and EBI ArrayExpress database were systematically searched, and two gene expression profile datasets from placental tissues of smoking and non-smoking pregnant women were selected. After integrating and correcting these datasets, various bioinformatics methods and models including differential expression, functional annotation, enrichment analysis and regression analysis were applied to study the effects of tobacco exposure on pregnant women and foetuses.  Results  Amongst 476 significantly differentially expressed genes (FDR < 0.5, |log2FC|>0.3), 317 were up-regulated and 159 were down-regulated. After functional annotations and enrichment analyses using KEGG, GO, Reactome and MSigDb, these genes mainly appeared in extracellular structure (P=1.10×10-28), extracellular matrix (P=3.44×10-25) and mesenchymal development (P=2.60×10-13). Regression analysis was conducted to study molecular markers of tobacco exposure. CDCA7L was the most significant gene correlated with cotinine level after adjusting for confounding factors (FDR=0.046).  Conclusion  The pathways and the possible molecular mechanisms that pregnant women and foetuses may be affected by tobacco exposure are explored and discussed, and the ideas for future molecular mechanism research are proposed.
Risk factors of postpartum hyperglycaemia in pregnant women with gestational diabetes mellitus
LIN Miao, ZHOU Ping
2022, 20(8): 1350-1352. doi: 10.16766/j.cnki.issn.1674-4152.002594
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  Objective  To investigate postpartum hyperglycaemia in pregnant women with gestational diabetes mellitus (GDM) and analyse the influencing factors of postpartum hyperglycaemia in pregnant women with GDM.  Methods  A total of 206 pregnant women with GDM who were admitted to the outpatient department of Wenchang City People ' s Hospital from May 2017 to February 2020 were selected. According to the results of 75 g oral glucose tolerance test (OGTT) at 2 months postpartum, the patients were divided into the postpartum hyperglycaemia group (54 cases) and postpartum normal blood glucose group (152 cases). The general clinical data of pregnant women in the two groups were collected, and the influencing factors of postpartum hyperglycaemia were analysed.  Results  Postpartum hyperglycaemia occurred in 54 of 206 pregnant women with GDM, and the incidence of postpartum hyperglycaemia was 26.21%. Univariate analysis showed that age, pregnancy body mass index, body mass index (BMI), macrosomia, diabetes (diabetes mellitus, DM) family history, pregnancy OGTT abnormality, using insulin therapy during pregnancy and postpartum BMI, fasting blood glucose level during pregnancy and postpartum movement were closely related to postpartum hyperglycaemia in GDM pregnant women (all P < 0.05). According to logistic regression analysis, Age (OR=2.261, P=0.023), family history of DM (OR=3.865, P=0.001), postpartum BMI (OR=2.502, P=0.020), fasting blood glucose during pregnancy (OR=2.130, P=0.029), increased number of abnormal OGTT during pregnancy (OR=4.864, P < 0.001) and insulin treatment during pregnancy (OR=3.251, P=0.001) were independent risk factors for postpartum hyperglycemia in GDM pregnant women.  Conclusion  Age, DM family history, postpartum BMI, increased OGTT abnormalities during pregnancy, fasting blood glucose during pregnancy and insulin treatment during pregnancy are independent risk factors for postpartum hyperglycaemia in GDM pregnant women. Therefore, active intervention measures should be taken clinically to prevent postpartum hyperglycaemia.
Comparison of enteral feeding status of extremely low birth weight infant of different gestational ages
KE Ruo, CHEN Si-si, ZHOU Rui-xi, HU Ying-ying
2022, 20(8): 1353-1356. doi: 10.16766/j.cnki.issn.1674-4152.002595
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  Objective  To investigate and compare the differences in enteral feeding status amongst extremely low birth weight infants (ELBWI) of different gestational ages.  Methods  A total of 120 ELBWI patients admitted to the neonatal intensive care unit (NICU) of the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 were selected as the research subjects. According to the gestational age, the children were divided into the gestational age < 28 weeks group (n=68) and the gestational age ≥28 weeks group (n=52). Enteral feeding status and enteral nutritional intolerance (FI) were compared between the two groups.  Results  The amount of milk in the first 3 weeks after birth in the gestational age < 28 weeks group was significantly lower than that in the gestational age ≥28 weeks group (t=-2.208, -13.148, -27.781, all P < 0.05). The time to reach sufficient enteral feeding for the first time and the total length of hospital stay in the gestational age < 28 weeks group were significantly higher than those in the gestational age ≥28 weeks group (t=8.459, 22.654, all P < 0.05). The rate of weight gain after birth weight recovery and weight at discharge were significantly lower than those in the gestational age ≥28 weeks group (t=-10.034, -12.042, all P < 0.05). During hospitalisation, the incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, invasive mechanical ventilation, ibuprofen use within 2 weeks and antibiotic use >2 weeks in gestational age < 28 weeks were significantly higher than those in gestational age≥28 weeks (χ2=7.169, 6.114, 4.544, 4.834, 4.488, all P < 0.05). The duration of FI, the incidence of FI within 2 weeks after birth and the recurrence rate of FI in gestational age < 28 weeks were significantly higher than those of gestational age ≥28 weeks (all P < 0.05).  Conclusion  The enteral feeding status of ELBWI at different gestational ages varies greatly. Compared with ELBWI of ≥28 weeks of gestational age, ELBWI of < 28 weeks of gestational age have higher FI recurrence rate, poor feeding tolerance and slow growth and development.
Analysis of the clinical characteristics and stool pathogen of necrotising enterocolitis in preterm neonates
LU Yan, PAN Shan-shan
2022, 20(8): 1357-1359. doi: 10.16766/j.cnki.issn.1674-4152.002596
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  Objective  To investigate the clinical characteristics of neonatal necrotising enterocolitis (NEC) in preterm infants.  Methods  A retrospective study was conducted from January 2017 to November 2020 at the Affiliated Hangzhou First People ' s Hospital, Zhejiang University School of Medicine. NEC was defined according to Bell ' s staging criteria.  Results  Fifty-nine neonates were included in the study. Amongst them, 22 (37.3%) cases developed stage Ⅰ, and 37 cases (62.7%) cases developed stage Ⅱ or Ⅲ. Analysis of the time of NEC onset showed that the median age of NEC onset was 14.0 (13.0, 18.0) day. The gestational age was (30.7±2.7) weeks, and the birth weight was (1 493.9±460.3) g. There were 36 (61.0%) male cases and 23 (39.0%) female cases. The most common clinical presentations were bloody stools (79.7%, 47/59 cases), gastric residuals (78.0%, 46/59), absent bowel sounds (57.6%, 34/59 cases) and abdominal distension (52.5%, 31/59 cases). Compared with the stage Ⅰ group, the stage Ⅱ or Ⅲ group had significantly higher incidence rates of abdominal distension, poor response, absent bowel sound, bradycardia, greater white blood cell count (< 4×109/L) and CRP≥50 mg/L, P < 0.05. The positive rate of stool culture was 65.5% (36/55 cases), mainly including 29.1% Klebsiella pneumoniae (16/55 cases), 20.0% Enterococcus faecium (11/55 cases) and 12.7% Escherichia coli (7/55 cases). The positive rate of blood culture was 15.1% (8/53 cases), including 3.8% Escherichia coli (2/53 cases) and 3.8% Klebsiella pneumoniae (2/53 cases). The incidence of surgical NEC was 20.3% (12/59 cases). The mortality rate of NEC was 16.9% (10/59 cases).  Conclusion  NEC mainly affects preterm neonates with gestational age of 28-32 weeks and birth weight of 1 000-1 950 g. Gastrointestinal symptoms and signs are prominent. There are significant differences in clinical manifestations and laboratory parameters between neonates in the stage Ⅰ group and those in the stage Ⅱ or Ⅲ group. The positive rate of stool sample culture is high in NEC neonates. Monitoring of intestinal pathogen may be helpful to guide clinical therapy.
Prevalence and influencing factors of thyroid nodule amongst residents aged 50 and above in Shanghai community
LI Li, YU De-huai, MA Yu, JIN Hua, LU Yuan, FU Qiang-qiang
2022, 20(8): 1360-1362. doi: 10.16766/j.cnki.issn.1674-4152.002597
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  Objective  To investigate the prevalence of thyroid nodules in residents aged 50 and above in Yangpu District, Shanghai, and to analyse their possible risk factors.  Methods  From April 2016 to April 2017, multi-stage random cluster sampling was adopted, and residents aged 50 and above were selected for thyroid B-ultrasound examination and questionnaire survey.Ordinal logistic regression analysis was used for the analyses.  Results  A total of 6 002 valid questionnaires were obtained.The overall prevalence rate of thyroid nodules amongst elderly residents in the community was 29.1%(1 747/6 002), and the prevalence increased with age.The difference was statistically significant (P < 0.05).The prevalence of thyroid nodules was 31.2%(1 241/3 980) in females and 25.0%(506/2 022) in males.The prevalence was significantly higher in females than in males (P < 0.05).The incidence of multiple nodules, bilobular nodules, isthmus nodules, right lobe nodules and left lobe nodules was 1.8%(110/6 002), 11.8%(106/6 002), 0.1%(6/6 002), 7.7%(464/6 002) and 7.7%(461/6 002), respectively.Multivariate logistic regression analysis showed that female gender (OR=1.364, 95%CI: 1.207-1.542), increasing age (66-80 years, OR=1.188, 95%CI: 1.047-1.348;81 years and above, OR=1.415, 95%CI: 1.123-1.784), central obesity (OR=1.167, 95%CI: 1.039-1.310), lack of physical activity (OR=1.236, 95%CI: 1.099-1.390) and poor sleep status (OR=1.297, 95%CI: 1.154-1.459) were risk factors for thyroid nodules.  Conclusion  The prevalence rate of thyroid nodules in elderly residents aged 50 years and above in Yangpu District is 29.1%, and the prevalence rate of females is significantly higher than that of males.Age, female gender, lack of physical exercise, central obesity and poor sleep quality may be risk factors for thyroid nodules.
Correlation study between subjective cognitive decline and grip strength in elderly community population
DONG Ya-qin, WANG Wei-qiang
2022, 20(8): 1363-1366. doi: 10.16766/j.cnki.issn.1674-4152.002598
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  Objective  To explore the relationship between subjective cognitive decline (SCD) and grip strength and identify related risk factors in the elderly population in a certain community.  Methods  A total of 264 permanent residents in a community in Suzhou, Anhui Province, were selected as research objects by convenient sampling method from January to March of 2021.According to the evaluation results of subjective cognitive decline questionnaire 9(SCD-Q9), they were divided into two groups: the SCD group (153 cases) and the healthy control group (111 cases).General information questionnaire survey, physical examination, biochemical indexes and other related examinations were conducted.The test results of the two groups were collected for comparison.The relationship between grip strength and subjective cognitive decline was analysed by logistic regression analysis and step-to-step selection method, which included confounding factors such as gender and age into the regression model.  Results  (1) There were 153 cases of subjective cognitive decline in 264 subjects, accounting for 57.95%.(2) The grip strength of the SCD group (23.08±3.09) kg was significantly lower than that of the control group (27.99±4.79) kg, and the difference was statistically significant (t=8.475, P < 0.001).(3) Statistically significant differences in age, sex and sleep status were noted between the two groups (P < 0.05).(4) Logistic regression analysis showed a correlation between grip strength and subjective cognitive decline without adjusting for confounding factors (OR=0.723, 95%CI: 0.664-0.788, P < 0.001), as well as a correlation between grip strength and subjective cognitive decline after adjusting for corresponding confounding factors (OR=0.716, 95%CI: 0.653-0.786, P < 0.001).  Conclusion  Low grip strength, female, advanced age and insomnia are the risk factors for SCD.The measurement of grip strength has the advantages of simplicity, low cost and strong operability, and it can be used as an index for community assessment of cognitive decline within a population.
The relationship between coping style and anxiety and depression and the mediating effect of psychological elasticity in medical staff aiding at high altitude in the primary stage
SONG Bing, SUN Yong-bing, LIU Hui-juan, SUN Xiao-jian, GUO Jia-jia, WANG Wan-xue, WANG Xin-hua
2022, 20(8): 1367-1371. doi: 10.16766/j.cnki.issn.1674-4152.002599
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  Objective  To explore the coping style, the relationship between psychological resilience and anxiety and depression, and the mediating effect of psychological resilience among medical staff who perform tasks at plateau area.  Methods  A questionnaire survey was conducted among 113 medical staff who went to plateau areas to perform tasks, using general questionnaires, simple coping style questionnaire (SCSQ), connor-davidson resilience scale (CD-RISC) and hospital anxiety and depression scale (HADS).  Results  (1) There were differences in anxiety level among gender, educational background and income; There were differences in marital status and income level in depression level; There are differences in coping styles between education and income; There were significant differences in the scores of psychological elasticity between marital status and income (all P < 0.05).(2) There was a positive correlation between coping style and psychological elasticity (r=0.390, P < 0.01).There was a positive correlation between coping style and anxiety and depression (r=0.371, P < 0.01).There was a positive correlation between psychological elasticity and anxiety and depression (r=0.206, P < 0.05).Among them, anxiety was positively correlated with negativity (r=0.550, P < 0.01), and negatively correlated with positivity, strength and tenacity (r=-0.221, 0.257, -0.221, all P < 0.05).Depression was positively correlated with positivity, optimism, strength and tenacity (r=0.425, 0.560, 0.696, 0.694, all P < 0.01).It was proved that psychological resilience had a mediating effect between coping style and anxiety and depression (P=0.001, R2=0.142).Among them, psychological resilience had a complete mediating effect between positive coping and depression.Strength and tenacity had some mediating effects in the level of positive coping and anxiety.  Conclusion  There are anxiety and depression in medical staff who work at plateau area for the first time.There is a correlation between coping style, psychological elasticity and anxiety and depression; and psychological resilience has a mediating effect between coping style and anxiety and depression.
Mental health status and quality of life in families of children with recurrent respiratory infections
LIU Wei, CHEN Chang-hao, WANG Fang
2022, 20(8): 1372-1375. doi: 10.16766/j.cnki.issn.1674-4152.002600
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  Objective  Recurrent respiratory tract infection (RRTI) is a common clinical paediatric problem that affects the growth and development of children and places a burden on families and society.By comparing the differences in mental health and quality of life indicators between the families of children with RRTI and control families, we analysed the impact of children's RRTI on their families'mental health status and quality of life.  Methods  In the cross-sectional survey, chaperone family members of children who attended the paediatric (Research group, 315 cases) department of Suzhou Hospital of Anhui Medical University and were diagnosed with RRTIs from January to May, 2021, as well as parents of young children recruited (Control group, 278 cases) during the same period and in the same region were selected.General information was collected, and depression and anxiety symptoms and quality of life were assessed using the patient health questionnaire-9(PHQ-9), 7-item generalised anxiety dsorder scale (GAD-7) and World Health Organization quality of life schedule-brief version (WHOQOL-BREF), respectively.We compared the prevalence of depression and anxiety and quality of life scores in each domain between two groups and analysed the relationship amongst depression, anxiety and quality of life.  Results  The prevalence of depression (27.1% vs.9.5%) and anxiety (21.7% vs.6.0%) was higher in the study group than in the control group (all P < 0.001).After controlling for sociodemographic variables, the differences remained statistically significant (all P < 0.001).Total quality of life scores, physical, psychological, social and environmental scores were lower in the study group than in the control group (all P < 0.05).After controlling for sociodemographic variables, the difference was still statistically significant (all P < 0.05).Both depression and anxiety reduced the total quality of life score and each domain score (all P < 0.05).  Conclusion  Families of children with RRTI are prone to depression, anxiety and decreased quality of life in all domains, suggesting the need for changes in care with enhanced communication and the provision of appropriate individualised psychological interventions.
Value evaluation of carotid atherosclerotic plaque ultrasound combined with blood lipid index in predicting cardiovascular disease
GUAN Jing-jing, SHI Peng, LI Bao-wu, LIU Bei-bei, SUI Yang, ZHOU Ping-hui, CHEN Yu
2022, 20(8): 1376-1379. doi: 10.16766/j.cnki.issn.1674-4152.002601
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  Objective  To conduct the value evaluation of carotid atherosclerotic plaque ultrasound combined with blood lipid index in predicting cardiovascular disease.  Methods  Fifty-nine physical examination patients diagnosed with carotid plaque in The First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2021 were selected as the observation group, and 59 healthy physical examination patients attending our hospital were selected as the control group during the same period.All subjects underwent carotid ultrasound examination and lipid level measurement.  Results  The IMT value of the observation group was (1.58±0.34) mm, which was significantly higher than that of the control group[(0.76±0.12) mm], and the difference was statistically significant (P < 0.05).The LDL-C value and HDL-C value of the observation group were (3.09±1.01) mmol/L and (1.18±0.37) mmol/L respectively.Compared with the LDL-C value[(2.67±0.68) mmol/L]and HDL-C value[(1.33±0.32) mmol/L]of the control group, the former was significantly higher and the latter was significantly lower, and the difference was statistically significant (all P < 0.05).However, the TC value of the observation group was (4.94±1.18) mmol/L and TG value was (1.85±0.67) mmol/L, which were higher than those of the control group[TC value was (4.69±0.76) mmol/L and TG value was (1.71±0.92) mmol/L].Although there was a certain increase, the difference was not statistically significant (all P>0.05).  Conclusion  Cardiovascular diseases are closely related to dyslipidemia and the development of atherosclerotic plaque formation.High levels of TC, TG and LDL-C lead to the thickening of arterial IMT and the development of atherosclerotic plaque.Therefore, carotid ultrasound should be performed in patients with hyperlipidemia to determine the condition of atherosclerotic plaque, which can provide some diagnostic value for the early regulation of blood lipids and active predicting of related complications.
Application value of ultrafast pulse wave velocity in carotid artery elastic function detection in patients with systemic lupus erythematosus
KONG Shu-jun, SHI Yan, NING Yan, LI Yang
2022, 20(8): 1380-1383. doi: 10.16766/j.cnki.issn.1674-4152.002602
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  Objective  The elastic function of carotid artery in patients with systemic lupus erythematosus (SLE) was measured by ultrafast pulse wave velocity to explore its clinical application value.  Methods  A total of 93 patients with SLE who visited the First Affiliated Hospital of Bengbu Medical College from October 2020 to April 2021 were selected as the experimental group.According to the clinical symptoms, they were divided into SLE alone (45 cases, group B) and SLE involving multiple systems (48 cases, group C).A total of 20 healthy adults were selected as the control group (group A).Ultrafast pulse wave velocity (UFPWV) was used to quantitatively measure intima-media thickness (IMT), pulse wave velocity at the beginning of systole (PWVBS) and pulse wave velocity at the end of systole (PWVES) of the common carotid artery in all patients.The statistical results were compared and analysed.Spearman correlation analysis was used to analyse the correlation between IMT, PWVBS, PWVES and different clinical types of SLE.Finally, the ROC curve was drawn to evaluate the diagnostic efficiency.  Results  In terms of IMT level, group A was lower than group C, and the difference was statistically significant (P < 0.05);no significant difference was found amongst other groups (P>0.05).In terms of PWVBS level, group A was lower than group B and group B was lower than group C; the difference was statistically significant (F=10.068, P < 0.001).In terms of PWVES level, group A was lower than group B and group B was lower than group C; the difference was statistically significant (F=27.505, P < 0.001).The levels of ITM, PWVBS and PWVES were positively correlated with different clinical types of SLE (r=0.240, 0.442, 0.394, all P < 0.05).The areas under the ROC curve of PWVBS and PWVES were 0.794(95%CI: 0.694-0.894) and 0.960(95%CI: 0.919-1.000), respectively.  Conclusion  Carotid artery elasticity is lower in patients with SLE than in healthy adults, and its degree is more significant as the disease progresses.UFPWV can quickly measure the levels of IMT, PWVBS and PWVES in the carotid artery of patients with SLE.As a parameter index related to vascular elasticity, the results are objective and worthy of wide application in clinical practice.
Progress in diagnosis and treatment of Kawasaki disease with coronary artery disease in children
SUN Jing-wei, QI Dong, TIAN Jing-yi, DONG Nan, LIU Fang
2022, 20(8): 1384-1387. doi: 10.16766/j.cnki.issn.1674-4152.002603
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Kawasaki disease, or cutaneous mucocutaneous lymph node syndrome, has been reported in more than 60 countries and regions worldwide since it was first reported by doctors in Japan in 1967. Its incidence has been increasing in recent years in countries around the world. The etiology and pathogenesis of Kawasaki disease remain unclear. In general, we can assume that Kawasaki disease is a self-limiting disease with acute systemic vasculitis, mainly affecting small and medium-sized arteries, and it is prevalent in infants and children under 5 years of age. The most serious complication of Kawasaki disease is now coronary artery disease, which has replaced rheumatic fever as the main cause of acquired heart disease in children in developed countries. With the development of modern medical treatment technology, most children with Kawasaki disease can be diagnosed accurately in time. Coupled with active treatment with gammaglobulin, the incidence of Kawasaki disease combined with coronary artery lesions decreased, but eventually 2%-3% of children may still develop coronary artery stenosis, dilatation or occlusion, which can lead to myocardial infarction in severe cases. Therefore, identifying Kawasaki disease at an early stage, and detecting and intervening in Kawasaki disease combined with coronary artery lesions in time, to improve the quality of life of children and reduce the morbidity and mortality rate, has become the most noteworthy and urgent problem in the diagnosis and treatment strategy of Kawasaki disease. This article provides a review of the diagnosis and treatment of Kawasaki disease combined with coronary artery lesions to provide a reference point for pediatricians working in the clinic and for community general practitioners managing children affected by Kawasaki disease in the diagnosis and treatment of Kawasaki disease combined with coronary artery lesions.
Research progress of intestinal peptides and the occurrence of anxiety and depression on the basis of the microbiota-gut-brain axis
LIU Li
2022, 20(8): 1388-1391. doi: 10.16766/j.cnki.issn.1674-4152.002604
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Anxiety and depression are physical disorders caused by stress response or bad emotions. They are diseases in which psychological and physical symptoms coexist caused by the combined action of biological, psychological and social factors. They are the most common psychological diseases in contemporary society. They not only reduce the quality of life of an individual, but also bring huge economic burden to the family and society. In recent years, with the maturity of high-throughput sequencing, sequence recognition technology and intestinal metagenomics, the role of intestinal microbes has been widely recognised and valued. There is a complex two-way communication between the intestine and the central nervous system, which is finely orchestrated by multiple systems such as endocrine, immune and enteric nervous systems. Therefore, the intestine is also known as the "second brain" of the human body. Previous studies have shown that intestinal microbes may act as initiators of the micro-inflammatory response state, which mediates the imbalance of intestinal homeostasis, leading to "bacteria-gut-brain" dysfunction, which plays an important role in the onset of anxiety and depression. However, the specific pathogenic mechanism is currently unclear. As the largest endocrine organ of the human body, the intestine can secrete dozens of different signal molecules, mostly peptides. Intestinal peptides secreted into the systemic circulation can bind to immune cells and homologous receptors on the vagus nerve endings, thereby realising indirect intestinal-brain communication. Therefore, this article summarises the influence of intestinal peptides as signal molecules of the bacteria-gut-brain axis on anxiety and depression, in order to provide a certain basis and reference for the clinical diagnosis and treatment of anxiety and depression. Changing psychological diseases such as depression and anxiety by regulating intestinal microbes has become a hot topic in neuroscience and psychology. Maintaining a good intestinal flora may be an important direction for the prevention and treatment of depression and anxiety in the future.
Evaluation of the preventive and curative effects of Liuwei Dihuang Pills on the postmenopausal osteoporosis with the type of kidney-yin deficiency
LI Lun-shen, WU Lian-guo, LIANG Bo-cheng, XU Chao, SHI Xiao-lin, WEI Bing, LI Yan-hua, LI Min
2022, 20(8): 1392-1395. doi: 10.16766/j.cnki.issn.1674-4152.002605
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  Objective  To evaluate the effects of Liuwei Dihuang Pills on the bone density, bone turnover markers and quality of life in the postmenopausal osteoporosis patients with the type of kidney yin deficiency.  Methods  One hundred and twenty patients with postmenopausal osteoporosis characterized by kidney yin deficiency were involved in the present study, which were collected from January 2019 to June 2019 in the Second Clinical Medical College of Zhejiang Chinese Medical University. The 120 cases of patients were randomly divided into Liuwei Dihuang Pills group and the control one, with 60 cases in each group. The patients in every group were treated for 1 year, followed by the examination of serum N-terminal propeptide of type Ⅰ collagen(P1NP), β crosslinked C-telopeptide of type Ⅰ collagen(β-CTX), and bone mineral density of lumbar and hip before and after treatment. Meantime, SF-36 scale was used to evaluate the effects of treatment on the quality of life of patients in each group.  Results  Remarkable change was observed in the serum P1NP, β-CTX and the bone mineral density of the lumbar spine and hip of the patients in both groups after treatment, and there were significantly statistical differences in the average percentage changes in serum P1NP, β-CTX, and bone mineral density of the lumbar spine and hip between the two groups (P1NP: t=-12.902, P < 0.001; β-CTX: t=-3.646, P < 0.001; lumbar spine: t=13.814, P < 0.001; hip: t=21.606, P < 0.001). There was no significant difference on the basic SF-36 scores between the two groups (P>0.05). Interestingly, it was observed that the SF-36 scale score in the Liuwei Dihuang Pills group was higher than that in the control group [(122.60±3.25) points vs. (115.62±2.96) points, t=11.743, P < 0.001)].  Conclusion  The treatment with Liuwei Dihuang Pills can result in the significant decrease in the serum levels of bone turnover markers, increase in the bone mineral density of the waist and hip, and improvement of quality of life in the postmenopausal osteoporosis patients characterized by the type of kidney yin deficiency.
Analysis of monitoring results of suspected adverse event following immunization in Sanshui District, Foshan City, 2016-2019
ZHOU Kai-ju, HE Yong-hui, WU Bi-jiao, DENG Jie-ying, CHEN Jun-hu
2022, 20(8): 1396-1399. doi: 10.16766/j.cnki.issn.1674-4152.002606
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  Objective  To analyze the incidence of suspected adverse event following immunization (AEFI) in Sanshui District of Foshan City, to master the safety of vaccination, and to provide basis for immunization planning and management.  Methods  The AEFI cases reported in Sanshui District of Foshan City from 2016 to 2019 were collected through the China immunization planning information system, and descriptive analysis was carried out by using Excel and SPSS 17.0 software.  Results  A total of 437 cases of AEFI were reported in Sanshui District from 2016 to 2019, with an average annual reporting rate of 30.29/100 000 doses, 332 cases (73.68%) of general reactions and 76 cases (17.39%) of abnormal reactions. No vaccine quality accidents, vaccination accidents nor psychogenic reactions were reported. The sex ratio of the reported cases was 1.5 9∶ 1, with the most reported cases in the group under 1 year old, the least in the group over 7 years old and the most reported cases in the group under 1 year old. Amongst the cases, 8-month-old children accounted for the highest proportion (22.78%). The interval between vaccination and the occurrence of suspected adverse reactions after vaccination accounted for the highest proportion (64.76%). All the reported AEFI involved 27 kinds of vaccines and the top three vaccines with the highest reported incidence were 23 valent pneumonitis vaccine, leprosy vaccine and acellular DPT vaccine. The top three vaccines with abnormal reaction rate were leprosy vaccine, tetravalent HPV vaccine and 23 valent pneumonia vaccine. The top three vaccines with abnormal reaction rate were allergic reaction urticaria in 26 cases (34.21%); allergic rash in 17 cases (22.37%); and allergic reaction macular papule in 12 cases (15.79%).  Conclusion  From 2016 to 2019, all the AEFI monitoring indicators in Sanshui District of Foshan City met the requirements of the monitoring scheme and the system operated normally. The AEFI monitoring results reflect the safety of vaccines to a certain extent, especially the vaccines with the highest reported incidence. AEFI monitoring must be continuously strengthened and the sensitivity and timeliness of the monitoring system must be further improved.
The application of 3D reconstruction technology based on high-resolution CT and PBL teaching model in thoracic surgery clinical teaching
GONG Hui-yuan, LI Xiao-jun, YANG Xiao-song, ZHANG Lei, WANG Biao, GENG Yang
2022, 20(8): 1400-1402. doi: 10.16766/j.cnki.issn.1674-4152.002607
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  Objective  To explore the application experience and effect of 3D reconstruction technology based on chest high resolution CT (HRCT) combined with problem-based learning (PBL) in clinical teaching in thoracic surgery.  Methods  Sixty undergraduate interns in clinical medicine who were interns in the Thoracic Surgery Department at the First Affiliated Hospital of Bengbu Medical College from December 2019 to October 2020 were selected as the research objects. With the informed consent of the students, they were randomly divided into the experimental group and the control group, with 30 persons in each group. The control group was subjected to the conventional teaching mode for clinical teaching, whereas the experimental group adopted the 3D reconstruction technology based on chest HRCT combined with PBL teaching method. The application effects of the two teaching modes in clinical teaching were compared.  Results  The theoretical knowledge score of the experimental group was (80.17±8.43) points, whereas that of the control group was (77.33±13.33) points, there was no significant difference between the two groups (P>0.05). The clinical skill test scores of the students in the experimental group [(82.90±7.86) points] were significantly higher than those in the control group [(74.30±4.45) points], and the difference was statistically significant (P < 0.05). The students in the experimental group had improved clinical thinking ability [(9.12±0.56) points], improved practical ability [(9.04±0.52) points], improved learning interest and satisfaction [(8.62±1.65) points] and improved recognition degree of the teaching mode [(8.67±1.03) points] than those in the control group. The scores of the items mentioned above were higher than those of the control group [(6.72±1.26) points, (7.18±1.24) points, (7.33±1.84) points and (6.10±1.64) points, all P < 0.05].  Conclusion  The 3D reconstruction of chest HRCT combined with PBL teaching mode not only increases the learning interest and enthusiasm of intern students but also improves their clinical operation skills and comprehensive analysis of problems. The teaching mode effect is satisfactory.
Knowledge graph analysis of cardiac rehabilitation at home and abroad based on CiteSpace software
GE Ya-ru, WANG Cheng-long
2022, 20(8): 1403-1407. doi: 10.16766/j.cnki.issn.1674-4152.002608
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  Objective  To analyse the knowledge graph of papers in the field of cardiac rehabilitation at home and abroad in recent 20 years to explore the development process, research hotspot and cutting-edge trend of this field.  Methods  By searching and screening the relevant literature on cardiac rehabilitation published in CNKI and Web of Science databases from January 2000 to August 2021, the authors, institutions and countries of the included literature were analysed by CiteSpace software and the graphs were generated by keyword co-occurrence, clustering and emergence for visual analysis.  Results  Through subject word search, a total of 1 238 Chinese documents and 10 098 English documents were obtained. A total of 197 and 233 Chinese and English documents were excluded on the basis of the exclusion criteria. Finally, 1 041 and 9 865 Chinese and English documents were included in the analysis. Fuwai Hospital, Peking University People ' s Hospital, Beijing Anzhen Hospital and other institutions had a large number of Chinese papers. English papers were represented by the United States, with a large number of documents issued by European and American developed countries. Most research institutions are hospitals or schools, lacking leading participation at the national or government level and the scientific research force was single. For international cooperation, the European and American countries represented by the United States cooperate closely but the cooperation showed the characteristics of localisation. The contents mainly focused on six aspects: medical evaluation of cardiac rehabilitation, evaluation of exercise training, comprehensive health management, social psychological evaluation, evaluation of results and new exploration of cardiac rehabilitation model.  Conclusion  Knowledge graph analysis intuitively shows the current situation of the development of cardiac rehabilitation at home and abroad. Compared with the development of cardiac rehabilitation abroad, priority should speed up the development process of cardiac rehabilitation discipline, improve the cardiac rehabilitation model, pay equal attention to traditional Chinese and Western medicine and form a cardiac rehabilitation scheme with Chinese characteristics.
Application of analytic hierarchy process in refined management of medical equipment in endoscopy center
XU Duo, JIN Xiao-hui, WU Lei-ruo, WU Ting-ting, XU Xiao-qun, LIN Feng
2022, 20(8): 1408-1410. doi: 10.16766/j.cnki.issn.1674-4152.002609
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  Objective  To study the application effect of Analytic Hierarchy Process in the construction of a risk prediction system for improper use of medical equipment in endoscopy centers.  Methods  From January 2019 to September 2021, 245 pieces of endoscopic medical equipment and 46 medical staff in the Endoscopy Center of the First Affiliated Hospital of Wenzhou Medical University were selected as the research objects. According to the random number table method, the endoscopic equipment was divided into the control group (n=123) and the experimental group (n=122). In addition, according to the use of endoscopic equipment, medical staff were divided into control group A and experimental group B. The medical equipment in the control group was managed by conventional management, and the medical equipment in the experimental group was managed by the analytic hierarchy process on the basis of routine management. To observe the incidence of improper use of medical equipment in the endoscopic center, the comprehensive management effect, and the satisfaction of medical staff on the use of endoscopic medical equipment in the two groups.  Results  The incidence of failures, failure to fill in records as required, and illegal operations of the endoscopic medical equipment in the experimental group were lower than those in the control group, the difference was statistically significant (all P < 0.05); The cleaning qualification rate, distribution accuracy rate, recovery qualification rate, and disinfection/sterilization qualification rate of the endoscopic medical equipment in experiment group were higher than those in the control group, the difference was statistically significant (all P < 0.05); The satisfaction of medical staff in the experimental group B with the use of endoscopic medical equipment was 95.65% (22/23), which was higher than that in the control group A by 73.91% (17/23), the difference was statistically significant (P < 0.05).  Conclusion  The application effect of the analytic hierarchy process in the construction of the risk prediction system for improper use of medical equipment in the endoscopy center is accurate, which can reduce the incidence of improper use, improve the comprehensive management effect of medical equipment, and further improve the satisfaction of medical staff on the use of endoscopic medical equipment.
Incidence and mortality of oropharyngeal cancer in the northern part of Anhui Province, 2015-2020
LI Jian-cheng, CHEN Chuan-jun, XUE Hao-wei, CHEN Xu-bing, RUAN Min, MENG Jian
2022, 20(8): 1411-1414. doi: 10.16766/j.cnki.issn.1674-4152.002610
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  Objective  To analyze the incidence and mortality of oropharyngeal cancer in the northern part of Anhui Province from 2015 to 2020.  Methods  New cases and death cases of oropharyngeal cancer in the northern part of Anhui Province in 2015-2020 were collected. The incidence, mortality, cumulative rates (0-74 years), truncation rate (35 and 64 years) and other indicators of oropharyngeal cancer were calculated. The Chinese population census in 2010 were used for calculating the age-standardized cancer incidence/mortality rates (ASRIC/ASRMC) of China, and Segi ' s world population were used for calculating the age-standardized cancer incidence/mortality rates (ASRIW/ASRMW) of the world.  Results  The total new oropharyngeal cancer cases were 1 020, and oropharyngeal cancer deaths were 404 in the northern part of Anhui Province in 2015-2020. The crude incidence of oropharyngeal cancer in the northern part of Anhui Province was 3.67/105, the ASRIC and ASRIW were 3.91/105 and 3.12/105 with the cumulative incidence rate (0-74 years) of 0.37%, and the truncation incidence (35-64 years) of 5.80/105. The oropharyngeal cancer mortality in the northern part of Anhui Province in 2015-2020 was 1.46/105, the ASRMC and ASRMW were 1.56/105 and 1.24/105, respectively, and the cumulative mortality rate (0-74 years) was 0.15%, the truncation mortality rate (35-64 years) was 2.36/105.  Conclusion  The incidence and mortality rate of oropharyngeal cancer in the northern part of Anhui Province increased in the 2015-2020 years, especially in male and rural areas. Strengthening the early prevention, diagnosis and treatment of oropharyngeal cancer should be the focus of prevention and control of oropharyngeal cancer in the northern part of Anhui Province.
Influencing factors of the job attraction of general practitioners in primary medical and health institutions
TAI Qiu-yuan, HUANG Xue-mei, CHENG Xin, ZHU Yun, SHEN Jun-long
2022, 20(8): 1415-1418. doi: 10.16766/j.cnki.issn.1674-4152.002611
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  Objective  To explore the influencing factors of the job attraction of general practitioners in primary medical and health institutions and formulate effective strategies to attract more medical graduates to choose the position of general practitioners, so as to stabilise and expand the team of general practitioners in primary medical and health institutions.  Methods  A questionnaire was designed on the basis of literature research and pre survey. From April 2020 to July 2020, a total of 403 fresh medical graduates were selected for questionnaire survey. A total of 394 valid questionnaires were recovered, and the effective recovery rate was 97.77%. The structural equation model was used to analyse the relationship between work environment, policy guarantee, personal development, interpersonal relationship and the job attraction of general practitioners in primary medical and health institutions.  Results  In the model, the standardised path coefficients of work environment, policy guarantee, personal development and interpersonal relationship on job attraction were 0.375, 0.145, 0.236 and 0.176, respectively, indicating that the work environment had the greatest impact on job attraction. The other influencing factors included personal development, interpersonal relationship and policy guarantee. The standardised path coefficients of policy guarantee, interpersonal relationship and working environment on personal development were 0.255, 0.168 and -0.116, indicating that policy guarantee had the greatest impact on personal development and the working environment had a certain negative impact on personal development.  Conclusion  Relaxed working environment, stable policy guarantee, harmonious interpersonal relationship and good personal development space effectively enhance the job attraction of general practitioners in primary medical and health institutions, and stable policy guarantee and harmonious interpersonal relationship have a significant indirect impact on the job attraction of general practitioners by promoting personal development. However, the loose working environment is not conducive to the personal development of general practitioners.
Effect of fluorescent labeling combined with PDCA management on improving environmental cleaning quality in patients with multiple resistant bacteria
ZHANG Juan, XU Tong-mei, LIN Ning, XIE Qiang, TU Xiu, ZHANG Lan-lan
2022, 20(8): 1419-1422. doi: 10.16766/j.cnki.issn.1674-4152.002612
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  Objective  To solve the environmental cleaning quality management problems of patients with multidrug-resistant bacteria infection in hospital, through the combination of plan-do-check-action (PDCA) management and fluorescent labeling, to provide reference for clinical research on improving the environmental cleaning quality of such patients.  Methods  The bed linen of patients with multidrug-resistant bacteria infection in the First People ' s Hospital of Chuzhou City was selected as the research object. From January to March 2019, the cleaning status of bed linen of patients with multidrug-resistant bacteria infection was baseline investigated by fluorescence labeling (control group). From April to June 2019, the cleaning quality of patients ' bedsheets were monitored by fluorescence labeling method, and the environmental cleaning quality of patients ' bedsheets were gradually improved by combining the monitoring- feedback training- improvement and enhancement of PDCA management mode (observation group). The feedback effect of fluorescence labeling in two time periods was recorded. Meanwhile, the implementation of prevention and control measures for patients with multidrug-resistant bacteria infection in the two periods was compared.  Results  Compared with the control group, the clearance rate of fluorescent labeling points and the proportion of fluorescent spots detected in other environments in the observation group were improved from 59.87% (282/471) and 6.79% (32/471) to 88.03% (412/468) and 1.92% (9/468), the differences were statistically significant between groups (all P < 0.05).  Conclusion  The combination of PDCA management and fluorescent labeling can effectively improve the effect of environmental cleaning quality management in hospital patients with multidrug-resistant bacteria infection.
Statistics of surgical patients' complications based on performance appraisal of tertiary public hospitals
HUANG Jun-jie, HUANG Ming-zhi, ZHU Jing-rui, HUANG Jing-wen
2022, 20(8): 1423-1426. doi: 10.16766/j.cnki.issn.1674-4152.002613
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  Objective  The complication rate of surgical patients is one of the important outcome indicators to measure the medical technical ability and management level of hospitals. The statistics and management of surgical complications are the key and difficult points of medical quality management. Referring to the statistical methods of surgical complications in the performance appraisal of three-level public hospitals in China, the complications of surgical patients are counted through the medical record homepage.  Methods  On the basis of improving the quality of the medical record homepage, the complications of surgical patients in a three-level public hospital from 2019 to 2020 were counted using the first page of inpatient medical records. The complications of surgical patients in the hospital were preliminarily analysed and the high-risk departments and key diseases of surgical patients were determined in accordance with the statistical results.  Results  The complications of surgical patients with the largest number of cases were bleeding or hematoma, poor wound healing and pulmonary infection. The number of three complications accounted for 63.29% of the total number of surgical complications in the hospital. The clinical department with the largest number of complications had defects in the use of antibiotics and postoperative nursing.  Conclusion  The management of complications in surgical patients is complex. The causes of different complications are diverse and great differences may exist in the causes of the same complication. Accurate surgical operation, fine nursing, rational drug use and correct use of instruments and equipment are important means to prevent complications in surgical patients. The management of surgical patients' complications is the management of the whole process of diagnosis and treatment behaviour. It needs the support of informatisation, the effective implementation of supporting systems, the cooperation of multiple departments and the level of hospital medical technology as a guarantee. The intervention measures for the complications of surgical patients should also be evaluated and continuously optimised.
Application of predictive nursing based on the integration of medical and nursing in cooperative nursing of retrograde intrarenal surgery
LI Yu-jie, ZHOU Hao, XI Jun-hua
2022, 20(8): 1427-1429. doi: 10.16766/j.cnki.issn.1674-4152.002614
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  Objective  In the cooperative nursing of patients with retrograde intrarenal surgery, the predictive nursing model based on the integration of medical and nursing was adopted to study and analyse its clinical application effect.  Methods  The surgical data of 50 patients who received retrograde intrarenal surgery in the Department of Urology of the Third People's Hospital of Bengbu City from January 2021 to December 2021 were selected and randomly divided into observation group (integration of medical and nursing) in accordance with the nursing model adopted in the perioperative period (nursing model, 25 cases) and control group (conventional nursing model, 25 cases). SPSS 20.0 statistical software was used for statistical analysis of the data of this study. Postoperative first eating time, first ambulation time, catheter removal time, hospitalisation time, postoperative complication rate and nursing satisfaction were compared between the two groups.  Results  In the observation group, postoperative eating time [(6.72±0.79) h vs. (10.20±0.82) h], postoperative ambulation time [(6.88±1.00) h vs. (10.84±0.75) h], postoperative urinary catheter extraction time [(1.44±0.51) d vs. (2.40±0.65) d], postoperative intravenous infusion time [(3.40±1.12) d vs. (5.04±1.06) d], hospital stay [(6.52±1.05) d vs. (8.00±1.15) d] and the incidence of postoperative complications were lower than those in the control group, and the difference was statistically significant (all P < 0.05). The nursing satisfaction of the patients in the observation group was higher than that of the patients in the control group (χ2=4.878, P=0.027).  Conclusion  In the perioperative period of retrograde intrarenal surgery, the application of the predictive nursing model of integrated medical and nursing could promote the postoperative recovery of patients, reduce the occurrence of postoperative complications as much as possible, improve the quality of nursing and nursing effect and increase patient satisfaction with care.
Application of traditional Wuqinxi exercises in rehabilitation nursing of cervical spondylopathy
LIU Yan, TANG Ming-qi, JIANG Bo, JIANG Yong
2022, 20(8): 1430-1433. doi: 10.16766/j.cnki.issn.1674-4152.002615
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  Objective  To explore the influence of using traditional Wuqinxi exercises in rehabilitation nursing on cervical spine function of patients with cervical spondylosis and patients' satisfaction with nursing care.  Methods  Sixty patients with cervical spondylosis who met the inclusion criteria in Suzhou Hospital Affiliated to Anhui Medical University from June 2017 to June 2021 were divided into an intervention group and a control group with 30 cases each by the random number method. The control group received routine rehabilitation care every day, and the intervention group was given Wuqinxi exercise treatment on the basis of routine rehabilitation care, one in the morning and one in the afternoon, for five consecutive days a week, for a total of 4 weeks of intervention. Changes in nursing satisfaction, cervical joint range of motion and cervical spine dysfunction index (NDI) were compared before and after treatment.  Results  The NDI scores [(9.97±2.77) points, (12.47±6.02) points] of patients in the intervention group and control group after treatment were significantly different from those before treatment [(39.37±2.50) points, (38.37±4.05) points, all P < 0.05]. After treatment, NDI and nursing satisfaction in the intervention group were significantly higher than those in the control group (all P < 0.05). The range of motion of the cervical spine in the anterior flexion, posterior extension, left-right lateral flexion, and left-right rotation after treatment in the intervention group were better than the control group (all P < 0.05). The range of motion of the cervical spine in all directions after treatment in the two groups of patients increased to varying degrees compared with that before treatment in this group (all P < 0.05).  Conclusion  In the rehabilitation nursing of cervical spondylosis, combined with traditional exercises, Wuqinxi can significantly improve cervical spine function, neck muscle fatigue and pain in patients with cervical spondylosis, and improve the quality of life of patients with cervical spondylosis. Patients also achieved a high degree of satisfaction.
Observe on the clinical effect of evidence-based nursing model for postoperative nursing of patients with mandibular fracture
XU Shao-jun, XU Xu, YAN Qin, FAN Li-qin
2022, 20(8): 1434-1437. doi: 10.16766/j.cnki.issn.1674-4152.002616
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  Objective  To observe the clinical effect of evidence-based nursing mode on improving the postoperative rehabilitation level of patients with mandibular fracture.  Methods  Total 120 patients with mandibular fractures treated in Quzhou Hospital Affiliated to Wenzhou Medical University and the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to June 2021 were collected as the research objects. The 120 patients with mandibular fracture were divided into control group (n=60) and study group (n=60) according to the admission time. Patients in two groups were treated with small titanium plate jaw internal fixation. The control group were given routine nursing intervention while the study group were given cluster nursing intervention. The operation time, intraoperative blood loss, hospitalization time and fracture healing time were recorded. The masticatory ability, bite force, quality of life, mental health, oral health status and postoperative complications were evaluated at 3 and 6 months after surgery.  Results  The duration of hospital stay and healing time of fracture in study group were significantly lower than those in control group [(11.59±1.27) d vs. (16.94±1.45) d, (41.28±4.09) d vs. (49.62±4.31) d, t=21.543, 10.579, all P < 0.001]. Compared with control group, the masticatory function, bite force and SF-36 score of patients were significantly increased in study group at 3 months after operation (all P < 0.001), while there was no statistical significance at 6 months after surgery (all P > 0.05). The scores of HAMA, HAMD, PI, DI, GI and SBI were significantly decreased at 6 months after surgery in study group (all P < 0.001). The overall incidence of postoperative complications in study group (5.00%, 3/60) was significantly lower than that in control group (18.33%, 11/60, χ2=5.175, P=0.023).  Conclusion  Evidence-based nursing model can effectively shorten the postoperative rehabilitation period of patients with mandibular fracture and improve the early postoperative mandibular motor function and quality of life, which contributes to reduce the psychological burden of patients, improve oral health and reduce the risk of postoperative complications.
Early warning of the Braden individual score in the prevention of hospital pressure injury
FENG Chun, WANG Jing-nan, CHEN Ping
2022, 20(8): 1438-1441. doi: 10.16766/j.cnki.issn.1674-4152.002617
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  Objective  To explore the effect of Braden's individual score in the prevention of hospital pressure injury (PI) to reduce the incidence of PI.  Methods  A grid management team composed of experts from the nursing department, the head nurses of the section, wound ostomy specialist nurses, the head nurses and the PI quality controller was established to monitor and track PI events in the whole hospital by dividing the team into three grid levels. We analysed Braden's individual score, the locations of PI, and the causes of PI in 81 cases reported by the office automation (OA) adverse event system in our hospital from January to December in 2020. We also calculated the Braden scores of moisture, activity and mobility less than 3 points in the medical benefit system in 2021; carried out preventive measures according to Braden's individual score management warning system; and observed PI events.  Results  After the implementation of individual scoring management, the incidence of in-hospital PI decreased from 0.125% in 2020 to 0.085% in 2021. The number of PI patients with one or two aspects less than 3 points amongst moisture, activity and mobility scorings decreased from 33 in 2020 to 15 in 2021, with a statistically significant difference between the two groups (P < 0.05). Stage three PI and deep tissue pressure injury were significantly reduced, and the healing rate of patients with PI increased dramatically.  Conclusion  Early intervention through Braden's individual score management and implementation of preventive measures to patients with mid-low and no risk through Braden's scoring can effectively reduce the incidence of in-hospital PI.
Lupus nephritis complicated with pulmonary human cytomegalovirus infection: A case report and literature review
LIU Yi-kun, LIU Bing
2022, 20(8): 1442-1445. doi: 10.16766/j.cnki.issn.1674-4152.002618
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Human cytomegalovirus infection is common in immunocompromised hosts. Lupus nephritis patients are treated mainly with steroids and immunosuppressive agents, which render the patents more susceptible to human cytomegalovirus infection. Human cytomegalovirus infection is characterized by the formation of large type A eosinophilic intranuclear and cytoplasmic inclusions in infected cells. Most infections are asymptomatic. In immunocompromised patients and babies, this virus can cause severe lung infection and even death. In immunocompromised patients, human cytomegalovirus pneumonia with mild symptoms and severe imaging abnormalities is rare and is easy to be misdiagnosed. Here, we report case of patients with lupus nephritis complicated with human cytomegalovirus pneumonia that have mild symptoms and severe imaging abnormalities, and related literature are reviewed.
A case report of infantile Alexander disease caused by GFAP gene c.1249delG mutation
LAI Pan-jian, WANG Da-yan, LI Xiao-bing
2022, 20(8): 1446-1448. doi: 10.16766/j.cnki.issn.1674-4152.002619
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To discuss genetic characteristics of infantile Alexandria disease. Patients with unexplained repeated convulsions and abnormal white matter were subjected to high-throughput sequencing and full-exome sequencing to screen for pathogenic genes. Finally, gene mutations were verified in family members by Sanger sequencing. A GFAP gene mutation c.1249delG (p.Asp417MetfsTer15) was detected in patients. It indicates that the GFAP gene c.1249delG mutation can cause infantile Alexandria disease in Chinese.
General Practice Research
Investigation of children's scoliosis and analysis of related factors in Qinghai Province
GUO Hai-bin, HUANG Jiao-ling, JIN Hong-fang, ZHOU Xuan, CHEN Nan, LI Xin, YANG Yu-qi, DU Qing
2022, 20(8): 1273-1276. doi: 10.16766/j.cnki.issn.1674-4152.002575
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  Objective  To explore and study the incidence of scoliosis in children aged 5-18 years in Qinghai Province, provide a theoretical reference for the prevention of scoliosis.  Methods  From October 2020 to February 2021, three districts were selected from Xining City and Haidong City, Qinghai Province, by simple random sampling and two primary schools (partially including preschool classes) and two junior high schools were selected from each district by using stratified cluster sampling. Classes (1-2) were selected for each grade and a total of 12 schools and 3 582 children were selected as the research objects. Scoliosis screening and questionnaire surveys were performed. SPSS 25.0 statistical software was used to process and analyse the collected data and the related factors affecting scoliosis were summarised.  Results  The positive rate of screening for abnormal spine curvature was 5.6% (201/3 582). Amongst them, the positive rate of children over 10 years was 9.2% (143/1 549) and the positive rate of children less than 10 years was 2.9% (58/2 033). Univariate analysis showed that adolescence, rural household registration, low annual family income, low parents' educational level, parents' occupations as herders, birth season and parity may be factors influencing the onset of scoliosis (all P < 0.05). Multivariate unconditional logistics regression model showed that age growth, weight gain, father's occupation as herder (compared with farmer), mother's occupation as herder (compared with farmer), wholly-owned retail shops and odd jobs were risk factors for scoliosis. Meanwhile, height increase, increased BMI, second child and above, born in autumn, urban household registration and mother's high education were protective factors for the onset of scoliosis (all P < 0.05).  Conclusion  The children in Qinghai are more susceptible to scoliosis due to their parents' occupational characteristics (herders), education level, lower family income and rural household registration. The incidence of scoliosis in adolescents is relatively higher. Spinal deformities must be detected in clinic in time, risk factors must be explored, effective measures to cultivate good habits must be formulated to promote spine health, and the occurrence and progression of scoliosis must be actively prevented.
Association of high residual cholesterol levels and Lp-PLA2 expression in elderly patients with acute ischemic stroke
LIN Yong-juan, JIANG Cheng, HUANG Ming-min, LI Ling-ling
2022, 20(8): 1277-1282. doi: 10.16766/j.cnki.issn.1674-4152.002576
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  Objective  To investigate the correlation between residual cholesterol (RC) and lipoprotein-related phospholipase A2 (Lp-PLA2) and evaluated their predictive value in elderly patients with acute ischemic stroke (AIS) and high RC.  Methods  A total of 162 elderly AIS patients with high RC (observation group) admitted in Nanjing Drum Tower Hospital from Jan. 2019 to Mar. 2021 were included in the study, and 165 normal RC-AIS patients during the same period were selected as the control group. The levels of blood lipid parameters and Lp-PLA2 in the two groups were compared, and the correlation between RC and Lp-PLA2 were analysed by the Pearson method. ROC analysis was used to evaluate the predictive value of RC and Lp-PLA2 in neurological impairment.  Results  The levels of Lp-PLA2 and National Institute of Health stroke scale (NIHSS) score after treatment in the observation group were significantly higher than those in the control group (Z=4.361, 2.182, all P < 0.05). Logistic regression analysis showed that Lp-PLA2 (95% CI: 1.000-1.007, P=0.045) and NIHSS score after treatment (95% CI: 1.026-1.369, P=0.021) were independent factors of RC levels in patients with AIS. RC, Lp-PLA2 and NIHSS score after treatment in patients with AIS were positively correlated with each other (r=0.683, 0.635, 0.640, all P < 0.001). The area under the ROC curve for serum RC>0.845 mmol/L and Lp-PLA2>242 ng/mL in predicting the severity of AIS were 0.835 and 0.854, respectively. When combined with two indicators, the AUC was 0.897.  Conclusion  Lp-PLA2 levels were significantly increased in patients with high RC-AIS. A positive correlation was found between the levels of RC and Lp-PLA2. High levels of RC or Lp-PLA2 have a good value in predicting the degree of neurological impairment and the prognosis after treatment of patients with AIS.
Application of ultrasound imaging technology to evaluate the localisation of endotracheal intubation in critically ill premature infants
ZUO Li-li, REN Yi-mei, GUAN Ya-fei, GONG Li-ling, YAN Qi, CHEN Xiao-qing
2022, 20(8): 1283-1286. doi: 10.16766/j.cnki.issn.1674-4152.002577
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  Objective  To evaluate the clinical application of ultrasound imaging technology in the localisation of endotracheal intubation in critically ill preterm infants.  Methods  A total of 103 critically ill premature infants who received endotracheal intubation in the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from January 2019 to January 2021 were selected as the research object. By different methods of positioning endotracheal tube, they were divided into ultrasound group (50 cases) and control group (53 cases) by auscultation of lung and gastric vesicle. After the catheter was fixed, the catheter's position was evaluated by chest X-ray. The ultrasonographic characteristics of the ultrasound group were observed and analysed. Moreover, the suitability rate of endotracheal tube positioning and the rates of mistakenly entering the oesophagus and main bronchus (catheterisation too deep) and detubation (catheterisation too shallow) were compared between the two groups to evaluate the accuracy of endotracheal tube positioning by different methods.  Results  The suitability rate of catheter positioning in the ultrasound group was higher than that in the control group (86.0% vs. 54.7%, P=0.001). The rates of mistakenly entering the main bronchus (6.0% vs. 20.8%, P=0.029) and detubation (4.0% vs. 17.0%, P=0.033) were lower than those in the control group (P < 0.05). The suitability of X-ray localisation of endotracheal tube was taken as the gold standard, and the localisation mode of the two groups was considered as the screening standard. The Youden index (71.1% vs. 6.5%), sensitivity (91.1% vs. 88.9%), specificity (80.0% vs. 11.8%) and Kappa consistency coefficient (0.561 vs. 0.008) in the ultrasound group were significantly higher than those in the control group.  Conclusion  Ultrasound imaging technology can effectively evaluate the positioning of the endotracheal tube in real time. It can accurately judge the position and depth of the endotracheal tube and reduce the accumulation of radiation exposure. It is worthy to be popularised and applied in critically ill preterm infants.
Analysis of clinical features and results of Dsg1 and Dsg3 antibodies in patients with pemphigus
LIANG Bo, GAO Jin-ping, ZHANG Shu-mei
2022, 20(8): 1287-1290. doi: 10.16766/j.cnki.issn.1674-4152.002578
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  Objective   Methods To investigate the clinical features of pemphigus patients and analyse the correlation between the results of ELISA test on desmoglein 1 (Dsg1) antibody and Desmoglein 3 (Dsg3) antibody and the type and severity of pemphigus.  Methods  Fifty patients with pemphigus were selected from the First Affiliated Hospital of Anhui Medical University in 2021. The patients were classified and graded based on clinical manifestation and laboratory indexes. Retrospective analysis was conducted on the inducing factors, complications, skin infection status and Dsg1 and Dsg3 antibody titres.  Results  A total of 39 cases of pemphigus vulgaris, 8 cases of pemphigus erythematous, 2 cases of pemphigus foliaceus and 1 case of paraneoplastic pemphigus were confirmed amongst these 50 patients. Amongst them, 28 cases were mild, 11 cases were medium and 11 cases were severe. One of the common inducing factors was found to be the non-standard use of glucocorticoid, accounting for 20% (10/50) of all cases. The most common skin infection-related bacterium was Staphylococcus aureus, which was detected in 18% (9/50) of all cases. Amongst different types of patients with pemphigus, significant differences in Dsg3 antibody indexes were found (Z=-3.481, P < 0.001). In addition, there was a significant difference between the groups in patients with varying severity (P=0.002, 0.024).  Conclusion  Proper use of glucocorticoids is required in the treatment of pemphigus. Skin infection was found to be common in patients with pemphigus. The detection of Dsg1 and Dsg3 antibodies shows good sensitivity for pemphigus diagnosis, and the titres of these two types of antibodies can be utilised as indicators for the evaluation of pemphigus.
Value analysis of CT-guided puncture biopsy for oral and maxillofacial tumours
ZONG Kai-yang, LIU Ruo-yu, ZHANG Chuan-min, GUO Yun, XU Cao, LI Jian-cheng
2022, 20(8): 1291-1294. doi: 10.16766/j.cnki.issn.1674-4152.002579
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  Objective  To study the diagnostic value and clinical application of CT-guided needle biopsy for oral and maxillofacial tumours and discuss its advantages and disadvantages compared with conventional ultrasound-guided needle biopsy, as well as its indications and precautions in clinical application.  Methods  A total of 42 patients admitted to our hospital from January 2019 to May 2020 were selected for CT-guided puncture biopsy. The biopsies were submitted for examination, observation and analysis. The success rate of puncture, the incidence of complications and the accuracy of pathological results were determined.  Results  The success rate of localization was 100.00% in 42 patients, and the success rate of one puncture was 97.62% in 41 patients. One patient received two punctures. After puncture, 22 patients showed pain at the puncture site, and 1 patient presented with fever. Amongst the 42 patients, 21 patients were diagnosed with a malignant tumour by preoperative puncture pathology, and 23 patients were diagnosed with a malignant tumour by postoperative pathology. The preoperative pathological diagnosis results of 15 patients were benign tumours, and the postoperative pathological diagnosis results of 17 patients were conscience tumours. The preoperative pathological diagnosis of 6 patients was non-neoplastic, and the postoperative pathological diagnosis was 2 cases. The sensitivity was 90.00%, specificity was 100.00% and accuracy rate was 90.48%, demonstrating good clinical guidance and reference function.  Conclusion  Compared with ultrasound, CT has the advantages of clear images and continuous layers. CT involves the use of a contrast agent to capture enhancement films to show the changes in different densities in some soft tissue structures (muscle and blood vessels), which is more convenient to judge the scope, size and nature of lesion involvement. CT-guided puncture biopsy for oral and maxillofacial tumours has high accuracy, small injury and fast speed. Hence, it has an important reference role in clinical treatment and is worthy of clinical promotion and use.
Expression of interleukin-23 in carcinoma tissues and its relationship with clinical prognosis in patients with colorectal cancer
SU Bo, YAN Zhen-yu, WANG Xin-xin, QIAN Guo-wu, ZHANG Sen, WANG Jing-xuan
2022, 20(8): 1295-1298. doi: 10.16766/j.cnki.issn.1674-4152.002580
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  Objective  To investigate the association between interleukin-23 (IL-23) and colorectal cancer.  Methods  A total of 164 patients with colorectal cancer from January 1, 2015, to December 31, 2016, in Nanyang Central Hospital were enrolled. The expression of IL-23 in the carcinoma tissues of patients with colorectal cancer was detected by immunohistochemical methods. In accordance with the staining intensity score and positive cell count score, the 0-1, 2-3, 4-5 and ≥6 scores were defined as negative, weak positive, moderate positive and strong positive, respectively. The high and low expression of IL-23 in the carcinoma tissues of colorectal cancer in paraffin-embedded section were regarded as "moderate to strong positive" and "negative to positive", respectively. Another 70 patients with colorectal cancer and 35 normal individuals between January 1, 2019, and December 31, 2019, were enrolled as independent verification samples and the difference in the IL-23 expression in the serum of the two groups was compared. The influencing factors of postoperative recurrence in patients with colorectal cancer were analysed by Cox regression model and the clinical efficacy of serum IL-23 expression levels in the diagnosis of colorectal cancer was analysed by receiver operating characteristic (ROC) curve.  Results  In all colorectal cancer patients, there were 119 cases with high expression of IL-23 and the remaing with low expression of IL-23. The IL-23 were mostly expressed in the cytoplasm of cells. The lymph node metastasis (N1-N2), TNM stage (stage Ⅲ) and IL-23 expression (high expression) were independent risk factors affecting the prognosis of patients with CRC (P < 0.01).Compared with the control group, the serum expression level of IL-23 in the colorectal cancer experimental group was significantly increased (t=12.173, P < 0.001). ROC curve results showed that the AUC of IL-23 in the diagnosis of colorectal cancer was 0.935 (95% CI: 0.888-0.981). When the cut-off value was 36.195 ng/mL, the diagnostic sensitivity and specificity were 94.30% and 80.00%, respectively.  Conclusion  High expression of IL-23 is significantly associated with poor prognosis in patients with colorectal cancer. IL-23 could be used as a serological marker of CRC.
Expression and significance of CD8+ T cells and NK cells in peripheral blood of patients with cervical cancer
HATILA Tuerxun, MIKRBAN Tursun, LIU Qian, LI Jin-qiu, ALFIRA Abdujapar, AYSHAMGUL Hasim
2022, 20(8): 1299-1301. doi: 10.16766/j.cnki.issn.1674-4152.002581
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  Objective  To analyze the expression levels and clinical significance of natural killer cells (NK), CD8+ T cells and immune checkpoint molecules TIGIT, PD1 and PDL1 in peripheral blood of patients with cervical cancer in Xinjiang.  Methods  Fourteen cervical cancer patients and fourteen healthy people admitted to the First Affiliated Hospital of Xinjiang Medical University from September 2020 to February 2021 were divided into cervical cancer group and control group. Flow cytometry was used to detect the distribution ratio of CD8+ T cells and NK cells in peripheral blood and the expression levels of immune checkpoint molecules, TIGIT, PD1 and PDL1.  Results  The proportion of CD8+ T cells in peripheral blood of cervical cancer patients [(22.66±3.79)%] was lower than that of the control group [(28.30±8.61)%, P < 0.01], however, the proportion of NK cells in peripheral blood of cervical cancer patients has no difference compared with the control group (P>0.05). The level of PDL1 in NK cells from peripheral blood of cervical cancer patients [(5.40±4.44)%] was lower than that of the control group [(21.03±16.65)%], the difference was statistically significant (P < 0.01). However, the expression of TIGIT and PD1 in the peripheral blood of cervical cancer patient were not significantly different from those of the control group (all P>0.05). The proportions of TIGIT, PD1 and PDL1 on CD8+ T cells in peripheral blood of cervical cancer patients were not significantly different from those of the control group (P>0.05).  Conclusion  Detection of NK cells, CD8+ T cells and immune checkpoint molecules in peripheral blood of patients with cervical cancer can monitor the immune status of cervical cancer patients, which providing reference for clinical treatment.
Survival and prognostic factors of hypofractionated radiation therapy with helical tomotherapy for pulmonary oligometastases
CHEN Ru-jun, SUN Qian, WANG Geng-ming, JIANG Hao
2022, 20(8): 1302-1306. doi: 10.16766/j.cnki.issn.1674-4152.002582
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  Objective  Helical tomography (HT) has great advantages in protecting the normal tissues and organs around multiple lesions and large tumours and reducing the toxicity of radiotherapy. The aim of this study was to analyse treatment outcomes after hypofractionated stereotactic radiation therapy with HT for pulmonary oligometastases and identify prognostic factors for better survival outcomes.  Methods  The data of 45 patients with lung oligometastases who completed helical tomographic hypofractionation radiotherapy in the Department of tumor radiotherapy, the First Affiliated Hospital of Bengbu Medical College from January 1, 2018 to June, 30, 2021 were retrospectively analyzed. Kaplan-Meier was used to estimate overall survival (OS), local control rate (LCR) and progression-free survival (PFS). The Cox proportional hazards model was used to determine the independent prognostic factors of the patients. Treatment-related toxicity was evaluated using common terminology criteria for adverse events (CTCAE) version 5.0.  Results  Follow-up was performed until September 30, 2021. All patients completed the treatment plan during a median follow-up of 16.0 (12.3, 24.2) months. The median biological effective dose was 76.8 (72.8, 90.0) Gy. The 1-year and 2-year OS rates were 94.8% and 58.1%, respectively. The 1-year and 2-year local control rates were 83.8% and 74.1%, respectively. The 1-year and 2-year PFS rates were 57.8% and 43.3%, respectively. The Karnofsky performance status (KPS)>80 before treatment was significantly associated with better LCR in univariate analysis (P=0.043). Multivariate analysis showed that distant lymph node metastasis before diagnosis of lung metastases was associated with better OS (P=0.041, HR=3.014, 95% CI: 1.043-8.706); 4D computed tomography remained an independent factor significantly associated with better PFS (P=0.035, HR=2.693, 95% CI: 1.072-6.761). No treatment-related deaths and grade≥3 toxicities occurred.  Conclusion  Hypofractionated stereotactic radiation therapy with HT for lung oligometastases is safe and effective. Patients with KPS>80 and no distant lymph node metastasis before diagnosis of lung metastasis has a longer survival time.
Exploration of the pattern of lung hilar lymph node metastasis in cTNM-stage IA non-small cell lung cancer and its clinical significance
GAO Xiong, TANG Zhen, GONG Hui-yuan, LI Wei, ZHANG Lei, WANG Biao
2022, 20(8): 1307-1310. doi: 10.16766/j.cnki.issn.1674-4152.002583
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  Objective  To investigate the metastasis pattern of hilar lymph nodes (group 10 lymph nodes) in cTNM-ⅠA stage non-small cell lung cancer (NSCLC) and the clinical significance.  Methods  A retrospective analysis of tumor and lymph node pathology was performed in 233 patients with primary cTNM-stage Ⅰ NSCLC, who underwent lobectomy and systemic lymph node dissection from January 1, 2020 to January 1, 2021 in the thoracic surgery ward of the First Affiliated Hospital of Bengbu Medical College.  Results  A total of 3 145 lymph nodes were obtained from 233 patients, with an average of 13.5 lymph nodes per case, and 440 lymph nodes had cancer metastasis, with a metastasis rate of 14.0%. Among the 233 patients, 49 cases had intrathoracic lymph node metastasis, including 16 cases of N1, 25 cases of N1+N2 [Note: N1: metastasis of intrapulmonary lymph nodes alone; N1+N2: metastasis of N2 (mediastinal group 2-9 lymph nodes) and N1 (intrapulmonary group 10-14 lymph nodes) at the same time] and 8 cases of skipping status N2, with a total metastasis rate of 21.0% (49/233). Among them, 10 cases were positive for group 10 lymph nodes in N1, accounting for 62.5% (10/16), and 18 cases were positive for group 10 lymph nodes in N1+N2, accounting for 72.0% (18/25). The difference in metastasis rate of lymph nodes in group 10 was statistically significant between stage T1b and stage T1a (P < 0.05), and the metastasis rates of lymph nodes in group 10 in poorly and moderately differentiated lung cancer were 25.9% (21/81) and 8.3% (7/84), respectively, the difference was statistically significant (χ2=9.060, P < 0.05).  Conclusion  In NSCLC, group 10 lymph node metastasis is closely related to the primary tumor size, clinicopathological type and differentiation degree. In the case of lymph node metastasis in N1, N1+N2 and N2, the possibility of positive lymph node in group 10 is higher. Therefore, pathological detection of group 10 lymph nodes is a priority when NSCLC patients need a surgical operation, and it is more scientific to decide the subsequent surgical plan, depending on the pathological results.
Effects of antiplatelet therapy on inflammatory response, platelet function and therapeutic effect of sepsis
WU Shu-lu, NIU Kai-xuan, XU Yang, LIU Cheng, DENG Xi-ming
2022, 20(8): 1311-1314. doi: 10.16766/j.cnki.issn.1674-4152.002584
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  Objective  To investigate the anti-inflammatory effect and safety of antiplatelet drug aspirin in patients with sepsis.  Methods  A total of 61 sepsis patients admitted to the Department of Intensive Care Medicine of the First Affiliated Hospital of Bengbu Medical College from October 2020 to June 2021 were selected, including 31 patients in the control group and 30 patients in the experimental group. The control group received conventional sepsis treatment, and the experimental group received conventional treatment + aspirin 100 mg, one time a day, by gastric tube injection, once a day, for 7 days. Changes in the levels of procalcitonin, C-reactive protein and interleukin-6, coagulation function (prothrombin time, thrombin time and activated partial thrombin time), and platelet count and function (MA value in thromboelastic diagram) were compared between the two groups before and after treatment. The incidence of common adverse reactions (gastrointestinal bleeding) and treatment efficiency of aspirin were observed.  Results  After treatment, the levels of PCT, CRP and IL-6 in the two groups decreased, and the decreased levels in the experimental group were significantly higher than those in the control group (P=0.012, 0.006 and 0.043, respectively). There were no significant differences in coagulation function (prothrombin time, thrombin time and activated partial thromboplastin time) and platelet count PLT between the two groups (all P>0.05). The change in platelet function index MA in the experimental group was statistically different from that in the control group (P=0.023). There was no statistical difference in the incidence of aspirin side effects between the two groups (P=0.694). After treatment, acute physiology and chronic health evaluation Ⅱ and sequential organ failure assessment scores in the experimental group were significantly lower than those in the control group, with statistical differences (P=0.048, 0.028). There was no statistical difference in the therapeutic effect between the two groups (P=0.344).  Conclusion  The antiplatelet drug aspirin can control the inflammatory response in patients with sepsis, and it has no obvious inhibition on coagulation function, platelet count and function. It does not increase the incidence of bleeding in patients, but it does not improve the patients' final treatment outcome.
Effect of pre-stroke physical activity on pial collateral circulation and patient prognosis
YUAN Chang-hong, WU Xiao-yu, LIU Qun, ZHANG Lu, ZHU Ying-chun
2022, 20(8): 1315-1318. doi: 10.16766/j.cnki.issn.1674-4152.002585
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  Objective  To determine the effect of pre-stroke physical activity level on pial collateral circulation and prognosis in patients with acute anterior circulation cerebral infarction.  Methods  Patients with acute anterior circulation cerebral infarction admitted to the Department of Neurology, rhe Second People's Hospital of Anhui Province from January 2017 to June 2020 were enrolled. The regional leptomeningeal score (rLMC) evaluated by CT angiography (CTA) was used to semi-quantitatively evaluate the patients ' pial collateral circulation. The modern Saltin-Grimby Physical Activity Level Scale (SGPALS) was used to quantitatively evaluate the physical activity level of patients before stroke. The modified Rankin Scale (mRS) score was used to assess the patients ' ability to take care of himself at 3 months onset. The difference in rLMC between patients with different physical activity levels and the effect on 90-day mRS score were compared.  Results  A total of 157 patients were enrolled, including 72 patients in the low exercise group and 85 patients in the high exercise group. The baseline systolic blood pressure, baseline NIHSS score and 3-month mRS score in the high exercise group were lower than those in the low exercise group (P values were 0.001, 0.039, < 0.001, respectivey), and the rLMC score was higher in the high exercise group than in the low exercise group (P=0.023). The prognosis of 99 patients was good (mRS≤2) and 58 patients was poor (mRS > 2) after 3 months onset. The SGPALS score of the good prognosis group was higher than that of the poor prognosis group (P < 0.001), and the rLMC score of the good prognosis group was higher than that of the poor prognosis group (P < 0.001). The previous statin use rate of the good prognosis group was higher than that of the poor prognosis group (P=0.041). Multivariate logistic regression analysis showed that SGPALS score and rLMC score were protective factors of good prognosis (OR=1.455, 1.181, P=0.043, 0.003, respectively). Previous diabetes history and baseline NIHSS score were unfavourable factors for good prognosis (OR=0.366, 0.899, P=0.027, 0.023, respectively).  Conclusion  Pre-stroke physical activity can improve the pial collateral circulation of patients with acute anterior circulation cerebral infarction and the clinical prognosis for 3 months.
General Clinical Research
Risk factors for suicidal behaviour in patients with depressive episodes of bipolar disorder
SUN Shi-bang, ZHU Chun-yan, XIA Yong
2022, 20(8): 1319-1322. doi: 10.16766/j.cnki.issn.1674-4152.002586
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  Objective  Suicide is one of the key factors for high mortality in patients with depressive episodes of bipolar disorder. This study explored the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder to reduce the occurrence of suicidal behaviour in such patients.  Methods  Using the method of cross-sectional study, 182 patients with depressive episodes of bipolar disorder who were hospitalised in Hangzhou Seventh People's Hospital from January 2018 to December 2021 were enrolled. They were classified into the suicidal behaviour group (n=80) and non-suicide behaviour group (n=102). The demographic characteristics, clinical features and thyroid function parameters of the two groups were compared. The statistically significant factors were analysed by logistic regression to determine the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder.  Results  Compared with the non-suicide behaviour group, the suicidal behaviour group showed decreased age and age of onset, the number of previous suicide attempts, the number of non-suicidal self-injury in the past were higher. The proportion of previous suicide attempts and non-suicidal self-injury in the past was higher. The levels of free triiodothyronine (FT3) and total triiodothyronine (TT3) in peripheral blood were lower (all P < 0.05). Binary logistic regression showed, previous suicide attempt (OR=3.399), and non-suicidal self-injury (OR=4.190) were risk factors for suicidal behaviour in patients with bipolar in patients with major depressive episode of bipolar disorder, older age at first onset (OR=0.874) and higher FT3 (OR=0.153) were protective factors (all P < 0.05).  Conclusion  Previous attempted suicide behavior and previous non-suicidal self-injury behavior were risk factors of suicidal behavior in bipolar depression patients. Older age at first onset and higher FT3 were protective factors, which need to be paid attention to in clinic.
Randomised controlled trial of delayed versus undelayed bivalirudin in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
LI Xue-dong, HU Ye-mei, WANG Zhen, WU Gang, LI Jun, WU Yong-yuan, SHANG Zhuo
2022, 20(8): 1323-1327. doi: 10.16766/j.cnki.issn.1674-4152.002587
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  Objective  To evaluate the efficacy and safety of undelayed bivalirudin combined with intracoronary tirofiban only during primary percutaneous coronary intervention (PCI) in patients with acute elevation myocardial infarction (AMI).  Methods  A total of 150 patients with AMI admitted to the Department of Cardiology, Bengbu Second People's Hospital from April 2020 to March 2021 were selected and randomly divided into two groups: the experimental group (n=75) and the control group (n=75). Postoperative TIMI flow grade (TFG), corrected TIMI frame count(cTFC), 90 min postoperative ST segment resolution (STR), postoperative cardiac function parameters, any bleeding events and major adverse cardiovascular events (MACEs) after 30 days were recorded and analysed after completion of primary PCI.  Results  No significant differences between the two groups were found in terms of the TFG, cTFC, STR (Z=0.524, P=0.770), MACE (1.3% vs. 0, P=0.999), left ventricular ejection fraction [(49.5±6.6)% vs. (50.6±5.7) %, t=-1.092, P=0.276], left ventricular end-diastolic dimension [(50.0±8.9) mm vs. (51.2±7.6) mm, t=-0.888, P=0.376] and regional wall motion abnormality (86.7% vs. 90.1%, χ2=0.597, P=0.440). The bleeding events in the experimental group were significantly less than those in the control group, and the difference was statistically significant (5.3% vs. 18.7%, χ2=6.221, P=0.035).  Conclusion  The undelayed bivalirudin combined with intracoronary tirofiban only strategy, which is associated with good safety demonstrated by reduced bleeding events, is an alternative regimen for patients with AMI undergoing primary PCI.
Effects of different phase remote ischemic preconditioning on postoperative cognitive function and brain injury in patients with carotid endarterectomy
YUAN Hai-jun, HUANG Xiao-xia, LAN Zhi-jian, FU Li, PENG Wen-yong
2022, 20(8): 1328-1331. doi: 10.16766/j.cnki.issn.1674-4152.002588
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  Objective  To investigate the effects of different phases of remote ischemic preconditioning (RIPC) on cognitive function and brain injury after carotid endarterectomy (CEA).  Methods  Sixty patients with severe carotid stenosis treated in Jinhua Central Hospital from June 2020 to July 2021 were randomly divided into group A (RIPC scheme 1 h before operation) and group B (RIPC scheme 24 h before operation), with 30 patients in each group. The neurological and cognitive functions and serum central nerve specific protein (S100) of the two groups were compared, including brain-derived neurotrophic factor (BDNF), inflammatory factors, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (map), heart rate (HR) and complications.  Results  Significant differences were noted in the interaction between the two groups at each time point, between groups and between groups and time (F=3.302, 4.321, 8.717, all P < 0.05). One month after operation, the MMSE score of group B [(28.54±1.44) points] was significantly better than that of group A [(27.35±1.31) points, P < 0.05]. The level of BDNF in group B [(4.92±0.51) ng/mL] was higher than that in group A [(3.56±0.13) ng/mL, P < 0.05]. At 24 h after operation, the levels of IL-6 and hsCRP in the two groups were higher than those at 1 day before operation (all P < 0.05). Significant differences were found in the interaction of SBP, DBP, map and HR between groups, groups and time between the two groups (all P < 0.05). The incidence of cognitive impairment was 16.67% in group A and 10.00% in group B. The difference between the two groups was not significant (P>0.05).  Conclusion  The implementation of RIPC 24 h before operation can effectively alleviate brain injury after CEA and improve the neurocognitive function of patients.
Clinical treatment and effect analysis of patients with deep neck abscess: 3 special cases
WU Jun, ZHOU Lan-zhu, SUN Zhe, WANG Wen-zhong
2022, 20(8): 1332-1335. doi: 10.16766/j.cnki.issn.1674-4152.002589
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Abstract:
  Objective  To investigate the clinical manifestations and treatment of patients with deep neck abscess, and to summarize the treatment experience, in order to reduce complications and improve the level of treatment.  Methods  Retrospective analysis of the clinical data from 22 patients with neck abscess in the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical College, collected from January 2018 to October 2021, among which, 17 were male and 5 were female. After admission, patients actively treated with broad-spectrum antibiotics or surgical treatment, meanwhile, the patient ' s clinical characteristics, diagnosis and treatment methods and effects were recorded.  Results  Twelve cases underwent lateral neck incision and abscess drainage, of which 1 case underwent thoracoscopic thoracic abscess removal at the same time; 1 case showed a tonsillar foreign body with abscess on neck CT and three-dimensional CT before operation, and underwent tonsillectomy as well as pharyngeal foreign body exploration. There was a peritonsilar purulent secretion, and no foreign body was found, then, the patient was discharged for observation after recovery; 1 case showed a cervical foreign body with a retropharyngeal abscess on neck CT, before the operation. Further, intubation was difficult, and an emergency tracheotomy was performed in this case. Subsequently, postpharyngeal abscess incision and drainage, foreign body exploration, as well as esophagoscopy exploration were applied, and a large amount of pus was found, no obvious foreign body was discovered, then the patient was discharged for observation after recovery; 4 cases of continuous drainage under B-ultrasound puncture, among which, 1 case of poor drainage and complicated by sepsis, and the treatment was given up; 1 case of common carotid artery pseudoaneurysm was repaired after rupture; the remaining 3 cases were treated conservatively. After being discharged from the hospital, the patients were followed up for 1 month. Except for the 1 case who gave up the treatment, the remaining 21 cases were cured without recurrence.  Conclusion  Deep neck abscess is one of the critical illnesses in otolaryngology head and neck surgery. Preoperative diagnosis and emergency incision and drainage are the key to treatment. Diagnosis should be combined with a variety of examinations to prevent missed diagnosis or misdiagnosis, and angiographic examination can be performed if necessary. Patients with dyspnea choose tracheotomy, general anesthesia intubation assessment, rational use of antibiotics, and close attention to the general condition, which play an important role in the treatment.
Clinical effect of selective splenic artery embolization in the treatment of traumatic splenic rupture
JIN Jing, TAO Liang
2022, 20(8): 1336-1338. doi: 10.16766/j.cnki.issn.1674-4152.002590
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Abstract:
  Objective  To evaluate the efficacy and safety of selective splenic artery embolization in the treatment of traumatic splenic rupture.  Methods  A total of 120 patients with traumatic splenic rupture in Quzhou People ' s Hospital from March 2017 to March 2020 were selected. They were divided into control group (60 cases) and study group (60 cases) in accordance with different operation methods. Laparoscopic partial splenectomy was performed in the control group and selective splenic artery embolization was performed in the study group. The operation time, intraoperative blood loss, indwelling time of drainage tube, first postoperative anal exhaust time, first postoperative ambulation time and hospitalisation time were recorded. The levels of IgM, IgA, IgG and other immune factors in peripheral blood before and after operation were detected. The complications within 12 months after operation were followed up.  Results  The operation time, intraoperative bleeding, indwelling time of drainage tube, first exhaust time of anus after operation, first time out of bed and hospital stay after operation in the study group [(94.73±10.62) min, (196.49±24.62) mL, (2.25±0.36) d, (2.65±0.39) d, (2.84±0.41) d and (5.29±0.61) d, respectively] were significantly less than those in the control group [(128.52±12.03) min, (339.62±40.81) mL, (3.57±0.49) d, (3.86±0.51) d, (3.91±0.54) d and (7.46±0.82) d, respectively, all P < 0.05]. No significant difference was found in the levels of IgM, IgA and IgG between the two groups before and 3 months after operation (all P>0.05). The overall incidence of postoperative complications in the study group (6.67%) was significantly lower than that in the control group (21.67%, χ2=5.551, P=0.018).  Conclusion  Selective splenic artery embolization could effectively reduce the surgical trauma of patients with traumatic splenic rupture, shorten the postoperative rehabilitation cycle, less affect the immune function of patients and reduce the risk of postoperative complications.

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