中华全科医学

The restrictive factors and optimization of continuing medical education policy for general practitioners in China

WU Shuang, XI Biao

2023, 21(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.003275

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Abstract:
Postgraduate medical education is an important part of the medical education system, and it plays an increasingly important role in enhancing the postgraduate competence of general practitioners (GP) and improving the level of grassroots medical services. At present, GP training in China is in the stage of exploration and improvement, and GP training still faces many problems. Among them, the difficulty of implementation and the discrepancy in the effectiveness of implementation are the limiting factors for the further promoting of GP training. Based on the understanding of the development process and implementation status of continuing medical education the GP training policy, this study takes the theoretical framework of Smith ' s policy implementation model as a guide to analyze the difficulties in implementing the GP training policy from multiple perspectives: the policy itself, the policy implementing agencies, the policy target groups, and policy implementation environment. Research has found that the policy of continuing medical education for general practitioners in China is not systematic enough, and the policy plan is disconnected from the needs; Poor collaborative management among executing agencies, lack of supervision and assessment during the implementation process, and insufficient quantity and quality of general faculty; There are differences in the training needs of general practitioners, insufficient participation enthusiasm, regional economic differences, low resident recognition, and low professional identity of general practitioners in terms of economic and social policy environment, which are important factors hindering policy implementation. Based on this, it is suggested that the main aspects to break through the Restrictive factors for the implementation of China ' s continuing medical education policy include improving the design of policy frameworks, clarifying the responsibilities of implementing agencies and strengthening the implementation capabilities, enhancing the enthusiasm of target groups to participate, and perfecting the implementation environment of the policy on continuing medical education in general practice. This will explore the optimization path for the sustainable development of continuing medical education for general practitioners in China.

The mediating role of loneliness and social support between stigma and social avoidance in rural breast cancer survivors

JIANG Mengfan, WANG Wanxia, GAO Jin, YANG Liu, QIAN Jing, LI Jinzhi

2023, 21(12): 2000-2004. doi: 10.16766/j.cnki.issn.1674-4152.003276

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Abstract:
Objective To explore the relationship between stigma and social avoidance in rural breast cancer survivors, and to analyze the moderating effect of social support in order to provide a theoretical basis for promoting social integration. Methods A total of 260 rural breast cancer survivors were selected by convenience sampling from 2 grade A hospitals in Bengbu City from November 2021 to June 2022. They were administered questionnaires using social impact scale (SIS), loneliness scale (UCLA-8), perceived social support scale (PSSS), and social avoidance scale. Pearson correlation analysis and SPSS Process program were used to mediate the test. Results (1) The scores of stigma, loneliness, social avoidance and social support of rural breast cancer survivors were (63.06±7.33) points, (18.54±4.31) points, (7.48±3.54) points and (58.86±8.78) points.; stigma was positively correlated with loneliness and social avoidance (r=0.563, 0.543, all P < 0.001), and loneliness was positively correlated with social avoidance (r=0.536, P < 0.001). (2) Loneliness partially mediated the relationship between stigma and social avoidance, accounting for 35%. (3) Social support had a moderating effect on the relationship between stigma and loneliness (t=2.533, P=0.012), and the influence of stigma on loneliness gradually decreased as social support increased. Conclusion Stigma increases patients ' negative social experiences and affects them indirectly through loneliness; among rural patients, social support was relatively limited, which was important in alleviating loneliness but could not improve social behavior. From the perspective of reducing stigma and loneliness, medical staff develop effective interventions to promote patients ' social integration by combining emotional, cognitive, environmental and other factors.

Advances in the study of chemotherapy resistance mechanisms in breast cancer based on genomics perspective

CAI Lingyi, CHEN Tao, ZHANG Xiaolin, LI Zheyuan, ZHANG Niulin, KONG Lingqi, SHI Shangying, ZHANG Jingya, DU Fuquan, HAO JING

2023, 21(12): 2005-2008. doi: 10.16766/j.cnki.issn.1674-4152.003277

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Abstract:
Breast cancer, which became the cancer with the highest prevalence rate in the world for the first time in 2020, is one of the most common cancers in women. As a fast-growing invasive cancer, breast cancer has become a serious threat to women ' s health worldwide. Currently, the mainstay of breast cancer treatment is chemotherapy, however, along with the use of related drugs (mainly including paclitaxel, anthracyclines, and platinums), the problem of multidrug resistance has arisen due to membrane transporters, apoptosis-induced and autophagy-induced chemoresistance, enhanced DNA damage repair, and the tumor microenvironment. Multidrug resistance is one of the major causes of poor prognosis in breast cancer patients. Therefore, exploring the molecular mechanisms related to multidrug resistance and finding the corresponding key genes for drug resistance has been one of the hotspots of clinical research. Many studies have shown that ATP-binding cassette transporter proteins (this article focuses on ABCB1, ABCC and ABCG2) are involved in multidrug resistance, glutathione-S-transferase (GST-π), topoisomerase Ⅱ (TOPO Ⅱ), long non-coding RNA (LncRNA) and cysteine-containing aspartic acid protein hydrolase 3 (CASP3) are genes closely associated with chemoresistance in breast cancer. In this study, we systematically reviewed the literature related to chemoresistance genes in breast cancer, and explored the effective strategies to deal with breast cancer chemoresistance based on the existing studies on the mechanism of chemoresistance, so as to provide some references for the research on chemoresistance-targeted therapies in the future.

Clinical value of ultrasonography combined with shear wave elastography for the assessment of molecular subtypes of breast cancer

BI Weipei, SHI Yan, WANG Lingling, ZHANG Hui, CUI Zhen

2023, 21(12): 2009-2013. doi: 10.16766/j.cnki.issn.1674-4152.003278

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Abstract:
Objective To investigate the relationship between qualitative and quantitative parameters of contrast ultrasound combined with shear wave elastography and different molecular staging of breast cancer. Methods Fifty-two patients with suspected malignant lesions detected by mammography and/or routine ultrasonography and confirmed as invasive breast cancer by the Department of Pathology of the First Affiliated Hospital of Bengbu Medical College from October 2022 to July 2023 were enrolled, and immunohistochemical results were collected, and were divided into three groups of breast cancer types based on the pathological results: luminal type (26 cases), HER-2 type (17 cases) and triple-negative (9 cases). Ultrasonographic and elastographic features of these patients were observed and time-intensity curves of breast cancer lesions were analyzed using ultrasonographic software, and ultrasonographic features of mass and quantitative parametric indicators of elastography were analyzed in relation to different molecular subtypes of breast cancer. Results There were significant differences in histological grading and lymph node metastasis between different breast cancer subtypes (P < 0.05), HER-2 positive breast cancer lesions were more likely to have a rapidly enhancing enhancement pattern(n=15, 88.2%, P < 0.05) as well as hyper-enhancing enhancement features(n=14, 82.4%, P < 0.05), and ultrasound elastography Emax values and the quantitative contrast parameter PI were significantly higher in patients with HER-2 subtype breast cancer than in luminal and triple-negative types [(170.32±53.35) kPa vs. (119.26±36.95) kPa vs. (155.80±73.59) kPa, P=0.006); (25.22±5.79) dB vs. (20.82±4.80) dB vs.(24.51±6.75) dB, P=0.030]. Conclusion There is a correlation between ultrasound enhancement features and perfusion parameters combined with quantitative parameters of shear wave elastography and different molecular subtypes of breast cancer, so ultrasound analysis and quantitative parameters can be used as a more objective and accurate means of detection, which can provide a reference basis for clinical diagnosis of breast cancer, individualized treatment and prognostic analysis.

Effect of transauricular endoscopic tympanoplasty in the treatment of large tympanic membrane perforation

DONG Jianfei, DAI Yanhong, CHEN Jie, ZHOU Han, GAO Xia, LU Ling

2023, 21(12): 2014-2017. doi: 10.16766/j.cnki.issn.1674-4152.003279

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Abstract:
Objective To investigate the clinical effect of underlay (medial) tympanoplasty of "external auditory canal flap-tympanic annulus-residual tympanic membrane 360 degree full lift" under oto-endoscope for the treatment of large tympanic membrane perforation, and to introduce the key points and techniques of clinical surgery. Methods Thirty patients (30 ears) with large tympanic membrane perforation who underwent tympanoplasty at Nanjing Drum Tower Hospital from July 2019 to December 2021 were selected. They were divided into groups according to the type of surgery. In the observation group, 15 patients (15 ears) underwent tympanoplasty by underlay (medial) tympanoplasty after the external auditory canal flap, drum ring and residual tympanic membrane were completely opened under oto-endoscope. In the control group, 15 cases (15 ears) underwent underlay (medial) tympanoplasty after 270-degree elevation of the external auditory canal posterior wall flap, tympanic ring and residual tympanic membrane under oto-endoscope. Postoperative follow-up was conducted for 6 months, and operative time, blood loss, tympanic healing and postoperative hearing were compared between the two groups. Results The mean operating times of the observation group and the control group were (108.33±8.28) min and (111.00±12.96) min, respectively, with no statistical significance. The mean blood loss were (13.00±3.00) mL and (12.07±3.31) mL, respectively, and the difference was not statistically significant. The success rate of tympanic membrane repair at 6 months was 100.00% (15/15) in the observation group and 86.67% (13/15) in the control group. There were 12 cases (80.00%) of hearing improvement in the observation group and 9 cases (60.00%) in the control group, however, the difference was not statistically significant (P>0.05). Conclusion Compared to conventional tympanoplasty with underlay (medial) tympanoplasty after 270 degrees of external ear canal flap, tympanic annulus and residual tympanic membrane under oto-endoscope, tympanoplasty with underlay (medial) tympanoplasty after 360 degrees of full flap, tympanic annulus and residual tympanic membrane and residual tympanoplasty under oto-endoscope has the same advantages in the treatment of large tympanic membrane perforation, but it can improve the success rate of repair and postoperative hearing of patients.

The relationship between CD13 expression and clinicopathological parameters in gastric cancer and its predictive value for long term prognosis

ZHANG Chaoyang, YANG Zi, LI Hongtao, ZHANG Wenjing, ZHAO Meng, WANG Juan, ZUO Lugen, ZHANG Xiaofeng

2023, 21(12): 2018-2021. doi: 10.16766/j.cnki.issn.1674-4152.003280

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Objective To analyze the expression of alanyl (membrane) aminopeptidase (CD13) in gastric cancer tissues and its relationship with clinicopathological parameters, and to evaluate its value in predicting the long-term prognosis of patients with gastric cancer. Methods A total of 117 patients who underwent radical gastrectomy in the First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2018 were included. Immunohistochemistry was used to analyze the expression of CD13 in gastric cancer tissues and evaluate the relationship between CD13 and clinicopathological parameters, as well as the predictive value of CD13 on the 5-year postoperative survival rate of patients. Results The expression of CD13 in gastric cancer tissues was significantly higher than that in adjacent tissues (P < 0.001). Patients were divided into a high CD13 expression group (n=59) and a low CD13 expression group (n=58) based on the median relative expression of CD13 (4.25). The proportion of patients with CEA≥5 μg/L, vascular infiltration, T stages 3-4, N stages 2-3, and pathological grade 3-4 in the CD13 high expression group was significantly higher than that in the low expression group (all P < 0.05). KM survival curve analysis showed that the 5-year survival rate of patients with high CD13 expression was significantly lower than that of patients with low CD13 expression (P < 0.001). KM analysis and Cox multivariate analysis showed that high expression of CD13 (HR=2.125, 95% CI: 1.256-3.595) was an independent risk factor for the 5-year survival rate of gastric cancer patients after surgery. ROC curve analysis showed that with the relative expression level of CD13 4.22 as the cut-off value, the sensitivity, specificity and accuracy of predicting death 5 years after surgery in gastric cancer patients were 75.71%, 93.62% and 0.881 (P < 0.001). Conclusion CD13 is highly expressed in gastric cancer tissues and is closely related to clinicopathological parameters. It is an independent risk factor for the 5-year postoperative survival rate of gastric cancer patients and has certain predictive value for prognosis assessment.

Relationship between LMR, PNI and chemotherapy response and prognosis in patients with multiple myeloma

CHEN Xiaoshuang, GAO Zhengjie, GAO Panke, XING Rui, HAN Xiaolin, LI Jingdong

2023, 21(12): 2022-2026. doi: 10.16766/j.cnki.issn.1674-4152.003281

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Abstract:
Objective To investigate the effects of lymphocyte-monocyte ratio (LMR) and prognostic nutritional index (PNI) with chemotherapy response and prognosis in patients with multiple myeloma (MM). Methods A total of 243 MM patients admitted to the First Affiliated Hospital of Xinxiang Medical University from March 2016 to May 2022 were selected. LMR and PNI were calculated. According to the median, patients were divided into PNI group (< 47.2, 121 cases) and high PNI group (≥47.2, 122 cases), high LMR group (≥5.85, 123 cases) and low LMR group (< 5.85, 120 cases). The clinical data, chemotherapy efficacy and prognosis of patients in different groups were compared, and subgroup analysis of patients receiving bortezomib was performed. Results There was no significant difference in the efficacy of chemotherapy between the high PNI group and the low PNI group (P>0.05), and there was no significant difference in the efficacy of chemotherapy between the low LMR group and the high LMR group (P>0.05). After 1 to 92 months of follow-up, 110 patients died and 133 patients survived. The median OS of the low PNI group was shorter than that of the PNI group (31 months vs. 39 months, χ²=4.130, P < 0.05), and the median OS of the low LMR group was shorter than that of the high LMR group (31 months vs. 41 months, χ²= 10.308, P < 0.01). Among 136 patients who received bortezomib-based chemotherapy, there was no significant difference in median OS between the low and high PNI groups (30 months vs. 36 months, χ²=2.814, P>0.05). The median OS of the low LMR group was shorter than that of the LMR group (30 months vs. not reached, χ²=7.618, P < 0.05). Cox regression analysis showed that low PNI and low LMR were independent risk factors for OS. Conclusion PNI and LMR can be used as simple and reliable prognostic indicators for MM patients. PNI and LMR can identify high-risk patients early, but cannot predict response to chemotherapy.

Clinical study of endoscopic rubber ring ligation combined with foam sclerosing agent injection in the treatment of internal hemorrhoids of grade Ⅱ to Ⅲ mixed hemorrhoids

YIN Kaihong, CHENG Yinmeng, ZHANG Tao, KE Xiquan, XU Feng, ZHAO Changdong

2023, 21(12): 2027-2030. doi: 10.16766/j.cnki.issn.1674-4152.003282

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Abstract:
Objective Exploring the clinical efficacy and safety analysis of endoscopic rubber band ligation (ERBL) combined with foam sclerotherapy (FS) in the treatment of mixed hemorrhoids of grade Ⅱ to Ⅲ. Methods A total of 62 patients who underwent mixed hemorrhoid treatment at the Department of Gastroenterology and Gastrointestinal Surgery of Lianyungang Second People's Hospital from September 2020 to May 2022 were retrospectively included. According to different surgical methods, 30 patients who received ERBL combined with FS were included in the treatment group. Thirty-two patients who only underwent traditional surgical external stripping and internal ligation were included in the control group. The operation time, hospitalization time, hospitalization expenses, postoperative complications and clinical efficacy were compared between the two groups of patients. Follow-up for 6 months was conducted to evaluate the clinical effect and safety. Results Both groups of patients successfully completed the surgery. The operation time, hospitalization time, and hospitalization expenses in the treatment group were all less than those in the control group, and the differences were statistically significant (all P < 0.05). Six months after surgery, postoperative urinary retention, perianal redness and swelling, anal swelling, and defecation difficulty in the treatment group were all lower than those in the control group (all P < 0.05). The VAS score 24 hours after surgery in the treatment group was lower than that in the control group (U=252.000, P < 0.001). The bleeding situation in the treatment group 1 week after surgery was lower than that in the control group (U=192.500, P < 0.001). Six months after surgery, 25 cases were cured in the treatment group, 4 cases were effective, and 1 case was ineffective or relapsed. In the control group, 19 cases were cured, 7 cases were effective, and 6 cases were ineffective or relapsed. The difference in efficacy between the two groups was statistically significant (U=355.500, P=0.028). Conclusion The combination of ERBL and FS is safe and effective in the treatment of internal hemorrhoids in grade Ⅱ to Ⅲ mixed hemorrhoids, with fewer complications and a high cure rate, and is worthy of clinical promotion.

Value of systemic immune inflammation index in predicting the efficacy of first-line chemotherapy and survival outcome in patients with HER2 negative advanced gastric cancer

ZHOU Yangyang, LIU Jing, ZHU Yeqing, YANG Yan, ZHOU Zhengguang, WANG Mingxi

2023, 21(12): 2031-2035. doi: 10.16766/j.cnki.issn.1674-4152.003283

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Abstract:
Objective To explore the value of the systemic immune-inflammatory index (SII) in predicting the efficacy of first-line chemotherapy and survival in patients with human epidermal growth factor receptor 2 (HER2) negative advanced gastric cancer. Methods The clinical data of advanced gastric cancer patients who received standard first-line chemotherapy at the Department of Medical Oncology, the First Affiliated Hospital of Bengbu Medical College from February 2017 to June 2021 were retrospectively collected. The SII values were calculated based on the results of the baseline routine blood test. The receiver operating characteristic (ROC) curve and X-tile software were used to determine the optimal cut off value of SII for therapeutic effect and prognosis, and patients was classified into high and low SII groups. The relationship between SII and clinicopathological characteristics, efficacy of first-line chemotherapy, progression-free survival (PFS) and overall survival (OS) of patients with advanced gastric cancer was analyzed. Results A total of 90 patients with advanced gastric cancer were enrolled. The objective response rates of patients in the high and low SII groups were 3.45% (1/29) and 19.67% (12/61), and the disease control rates were 41.38% (12/29) and 77.05% (47/61), respectively; patients with lower baseline SII had better chemotherapy efficacy (χ²=11.075, P=0.001). The mPFS of patients in the low SII group was significantly longer than that of patients in the high SII group (4.57 months vs. 2.13 months, P<0.001), and patients with low SII achieved a longer OS than patients with high SII (9.83 months vs. 3.97 months, P<0.001). The results of univariate and multivariate Cox analysis showed that the level of baseline SII was an independent prognostic factor affecting PFS and OS of first-line therapy in patients with advanced gastric cancer. Conclusion The baseline level of SII has potential value in predicting the efficacy and prognosis of first-line chemotherapy in patients with advanced gastric cancer, and patients with high SII tend to have poor efficacy and prognosis.

Current status and influencing factors analysis of adverse reactions in hematopoietic stem cell infusion

CHENG Fang, SHEN Wangfang, HUANG Xinrui, ZHANG Yaohong, MAO Xiaopei

2023, 21(12): 2036-2039. doi: 10.16766/j.cnki.issn.1674-4152.003284

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Objective To investigate the current situation and influencing factors of adverse reactions of hematopoietic stem cell infusion, and to provide a basis for the construction of a safe infusion program for hematopoietic stem cells. Methods A total of 389 patients with hematological diseases who underwent hematopoietic stem cell transplantation at a tertiary Grade A hospital's Bone Marrow Transplantation Center in Zhejiang Province between January 2017 and July 2022 were selected as the study population. Data collection involved the use of general information questionnaire and adverse reaction assessment forms. Results Among the 389 patients who underwent hematopoietic stem cell infusion, the overall incidence of adverse reactions was 31.11% (121/389). Specially, allogeneic transplant recipients experienced an incidence of 34.04% (97/285), while autologous transplant recipients had an incidence of 23.08% (24/104). The cardiovascular system exhibited the highest occurrence of adverse reactions, accounting for 89 cases (52.35% of all adverse events). Univariate analysis showed that age, gender, transplantation type, stem cell source, human leukocyte antigen matching, CD34⁺ cell count, and infusion rate significantly influenced adverse reactions in hematopoietic stem cell transplantation (all P < 0.05). Furthermore, multivariate logistic regression analysis identified older age (OR=1.121, P < 0.001), stem cell source (bone marrow stem cell, OR=2.836, P=0.007), human leukocyte antigen mismatch between donor and recipient (OR=0.110, P < 0.001), and fast infusion rate of stem cell (OR=2.107, P < 0.001) as independent risk factors for adverse reactions of hematopoietic stem cell transplantation. Conclusion The occurrence in adverse reactions of hematopoietic stem cell infusion is relatively high with older age, bone marrow fast infusion rate of stem cell, incomplete human leukocyte antigen matching between donor and recipient, and high infusion rate identified as influencing factors. Preventive interventions should be implemented to reduce the occurrence of adverse reactions in hematopoietic stem cell infusion.

Effect of SFRP1 on the proliferation and invasion of head and neck squamous cell carcinoma and its mechanism

YANG Zhongyu, LI Wei, ZHU Guangzheng, ZHAO Wenyi, XU Jing

2023, 21(12): 2040-2044. doi: 10.16766/j.cnki.issn.1674-4152.003285

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Abstract:
Objective To observe the biological activities of head and neck squamous cell carcinoma (HNSC) in vitro by studying the proliferation, migration and mechanism of secreted frizzled related protein 1 (SFRP1), and to propose new therapeutic options for the treatment of HNSC. Methods The association of SFRP1 with head and neck squamous cell carcinoma was investigated using bioinformatics analysis of the correlation between SFRP1 expression levels in tumors and tumor invasion and proliferation. Skin cancer cells SCL-1 were knocked down the expression of SFRP1 using transfection, and the effect of cell proliferation, migration was examined using interference with SFRP1 group (si-SFRP1) and control group (si-NC) for CCK-8 assay analysis, scratch assay analysis and Transwell assay analysis, respectively. The Wnt/β-catenin signaling pathway and the expression levels of C-myc and cyclinD1 in SCL-1 cells were detected by Western blotting assay. Results Compared with the control head and neck squamous carcinoma cells, skin cancer cells were found to be low expressing SFRP1 protein (P < 0.010); the migration area ratio of the low expressing SFRP1 protein neck squamous cell carcinoma group was 0.602±0.019 at 24 hours, compared with 0.419±0.053 in the blank group and 0.435±0.009 in the control group, and the migration ability of the si-SFRP1 group was significantly higher than that of the control and blank groups (P < 0.01); in the Transwell experiment, the number of cells invaded by the si-SFRP1 group after 24 hours was 723.333±2.048, compared with 332.002±9.930 in the blank group and 343.332±32.504 in the control group, and the invasion ability of the si-SFRP1 group was significantly higher than that of the control and blank group (P < 0.01); knockdown of SFRP1 in SCL-1 was elevated through Wnt/β-catenin and downstream C-myc and cyclinD1 expression levels (P < 0.01). Statistical analysis of bioinformatics data revealed that knockdown of SFRP1 protein had promoted the proliferation of head and neck squamous cell carcinoma, which is a guide for clinical analysis. Conclusion SFRP1 is lowly expressed in skin cancer cells, and also promotes cell proliferation and migration ability through the Wnt/β-catenin signaling pathway.

Functional and mechanistic of TCF3 regulating linc00152 on carcinogenic effects in Burkitt's lymphoma

WEI Xiaofang, CHEN Qiaolin, FENG Youfan, FU Yuan, LIU Fei, ZHANG Wenjie, CHEN Yang, ZHAO Yangyang, HUANG Xiujuan, ZHANG Qike

2023, 21(12): 2045-2048. doi: 10.16766/j.cnki.issn.1674-4152.003286

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Abstract:
Objective To investigate the function and mechanism of TCF3 in regulating proliferation and apoptosis of Daudi and Raji cells through linc00152. Methods The interference efficiency of linc00152 was detected by real-time quantitative polymerase chain reaction (qPCR). CCK8, Western blotting, and flow cytometry were used to detect the effects of linc00152 on the proliferation and apoptosis of Daudi and Raji cells. ChIP-PCR detected the binding of TCF3 to the promoter region of linc00152. qPCR and Western blotting were used to detect the interference efficiency of TCF3. qPCR was used to detect the effect of TCF3 on the expression level of linc00152. Results siRNA successfully interfered with the expression of linc00152 in Daudi and Raji cells. CCK8 results showed that interference of linc00152 could inhibit the proliferation of Daudi and Raji cells, while Western blotting and flow cytometry results showed that interference of linc00152 could promote cell apoptosis (Daudi: 35.30±2.84 vs. 6.95±0.82; Raji: 33.17±2.18 vs. 6.47±0.38). ChIP-PCR results showed that TCF3 could bind to the promoter of linc00152. The results of qPCR and Western blotting showed that both the mRNA and protein levels of TCF3 could be successfully interfered by siRNA. In Daudi and Raji cells, si-TCF3 could reduce the expression of linc00152 (Daudi: 0.509±0.048 vs. 0.906± 0.146; Raji: 0.502±0.052 vs. 0.966±0.103). Conclusion Linc00152 can promote the proliferation of Daudi and Raji cells and inhibit apoptosis, which may be related to the regulation of linc00152 by TCF3.

Clinical observation of the effect of cytomegalovirus infection on pertussis in infants

CHEN Leyuan, WANG Yao, HE Liting, PAN Jiahua, ZHANG Lan

2023, 21(12): 2049-2052. doi: 10.16766/j.cnki.issn.1674-4152.003287

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Objective To investigate the effect of cytomegalovirus (CMV) infection on the clinical presentation, duration of illness, and severity of illness in children with pertussis. Methods A retrospective analysis was conducted on 241 children with pertussis who were admitted to the paediatric ward of the First Affiliated Hospital of the University of Science and Technology of China from April 2015 to December 2019. They were divided into an observation group of 80 cases (with CMV infection) and a control group of 161 cases (without CMV infection) based on whether they had CMV infection. Clinical data of the patients were collected, including gender, age, days of onset before admission, history of cough contact, vaccination history, nasal congestion, runny nose, sneezing, nocturnal cough, spasmodic cough, vomiting after coughing, redness after coughing, wheezing, shortness of breath, apnoea, fever, lung rales, pneumonia, length of hospital stay, duration of cough symptoms, total white blood cell count, liver function, chest X-ray and chest CT. The attractiveness indicators of two groups of children were analyzed. Results The incidence of shortness of breath [3.75%(3/80) vs. 0, P=0.036] was significantly higher in the observation group than in the control group, and the duration of cough symptoms [8.50 (6.00, 11.00) d vs. 7.00 (4.00, 9.00) d, Z=-3.632, P < 0.001] and hospitalization time [11.00 (8.00, 13.00) d vs. 8.00 (6.00, 10.00)d, Z=-5.026, P < 0.001] were significantly longer in the observation group than in the control group. Comparing the clinical manifestations and signs of nasal congestion, runny nose, sneezing, nocturnal cough, spasmodic cough, post-cough vomiting, post-cough redness, wheezing, apnoea, fever, lung rales, and pneumonia between the two groups, there were no statistically significant difference (all P > 0.05). There were no significant difference in total white blood cell count, liver function and imaging findings (all P > 0.05). Conclusion CMV infection may prolong the duration of pertussis in infants.

Correlation analysis between psychological health and treatment compliance in patients with chronic periodontitis

WU Yuanyuan, WANG Huimin, HE Ruanhui, ZHU Yesu

2023, 21(12): 2053-2056. doi: 10.16766/j.cnki.issn.1674-4152.003288

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Objective This study aims to analyze the current status of mental health and treatment compliance in patients with chronic periodontitis, while also investigating the correlation between the two factors. Methods This prospective study employed convenience sampling to enroll 86 patients with chronic periodontitis who sought treatment at the Department of Dentistry, Affiliated Stomatological Hospital of Wenzhou Medical University between October 2019 and October 2022 as the study group. Additionally, a control group consisting of 43 orally healthy individuals who underwent dental examinations during the same period was selected in a 2∶1 ratio. The objective of this study was to compare the psychological status between the two groups, as measured by SCL-90 scores. The patients in the study group were divided into the compliance group (39 cases), general compliance group (33 cases), and poor compliance group (14 cases) according to the Frankl compliance scale assessment scores. Multivariate logistic regression analysis was conducted to identify influencing factors, while linear regression equations were utilized to explore the correlation between treatment compliance and psychological status. Results The study group exhibited significantly higher scores for each factor in the SCL-90 assessment compared to the control group [(8.45±2.59) points, (6.98±1.33) points, (8.94±2.45) points, (8.26±1.70) points, (5.08±0.96) points, (4.79±0.98) points, (8.97±2.23) points, (4.83±1.04) points, (4.79±1.06) points, (6.34±1.63) points vs. (1.02±0.33) points, (1.08±0.37) points, (1.01±0.34) points, (0.72±0.21) points, (0.62±0.08) points, (0.20±0.05) points, (1.07±0.26) points, (0.36±0.08) points, (0.62±0.09) points, (0.88±0.20) points, all P < 0.05]. Multivariate logistic regression analysis revealed that a lower educational level (middle school and below) and lower scores in all SCL-90 factors were significant risk factors for poor treatment compliance (all P < 0.05). Furthermore, a significant correlation was observed between the scores of each factor in the SCL-90 assessment and the treatment compliance through linear correlation analysis (all P < 0.05). Conclusion Patients with chronic periodontitis are prone to psychological problems, and their psychological status is closely related to treatment compliance.

Study on the therapeutic effect of minimally invasive release under microscope combined with postoperative oral administration of Jiangu capsules on cubital tunnel syndrome

GAO Xing, MENG Yufeng, WANG Wei, LI Shiying, ZHANG Tongtong

2023, 21(12): 2057-2059. doi: 10.16766/j.cnki.issn.1674-4152.003289

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Objective To investigate the application effect of oral Jiangu capsules in minimally invasive release of elbow tunnel syndrome patients under microscope, It aims to provide reference for research on the treatment of the disease. Methods A total of 94 patients with cubital tunnel syndrome from January 2022 to April 2023 were selected as study subjects, and randomly divided into two groups of 47 patients each. Both groups underwent anterior ulnar nerve surgery, while the control group underwent minimally invasive release surgery under a microscope. The observation group received postoperative oral treatment with Jiangu capsules. Both groups completed 4 weeks of treatment, and efficacy, ulnar nerve conduction velocity, latency, amplitude, interleukin-1 (IL-1), nerve growth factor (NGF), motor function, sensory function and visual analogue scale (VAS) scores were compared between the two groups. Results The efficacy rate of the observation group after 4 weeks of intervention was 95.74% (45/47), which was higher than that of the control group [82.98% (39/47), χ²=4.029, P=0.045]; after 4 weeks of intervention, ulnar nerve conduction velocity, amplitude and NGF levels were higher in the observation group than in the control group (all P < 0.05). The incubation period and IL-1 levels were lower than in the control group (all P < 0.05). After 4 weeks of intervention, motor and sensory functions were improved in both groups, and pain was relieved. The grip strength of the index finger [(3.73±0.56) kg vs. (2.85±0.45) kg] and middle finger [(5.78±0.94) kg vs. (4.64±0.87) kg] in the observation group was higher than in the control group (both P < 0.05). DASH [(26.95±4.19) points vs. (36.39±5.51) points] and VAS [(1.03±0.43) points vs. (3.26±0.52) points] scores were lower than in the control group (both P < 0.05). Conclusion Minimally invasive microscopic release combined with postoperative oral administration of Jiangu Capsule can improve the efficacy rate of patients with cubital tunnel syndrome, help improve ulnar nerve conduction velocity, IL-1 and NGF levels, improve motor and sensory functions, and alleviate pain in patients. It is worth promoting and using.

The role of sleep quality and anxiety-depression on preoperative pain catastrophizing and early postoperative pain in patients undergoing abdominal surgery

YAO Guomei, YAO Hongying, SHEN Yunxia, CAO Liying, JIN Chaojie

2023, 21(12): 2060-2063. doi: 10.16766/j.cnki.issn.1674-4152.003290

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Abstract:
Objective To explore the mediating effects of sleep quality, anxiety-depression on pain catastrophizing before surgery and early postoperative pain in patients undergoing abdominal surgery. The findings will contribute to the development of intervention programs aimed at reducing early postoperative pain. Methods A total of 206 patients who underwent abdominal surgery at Linping Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2021 to January 2022 were selected for evaluation. The evaluation was conducted using the pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), Pittsburgh sleep quality index (PSQI) and visual analog scale (VAS). Pearson correlation analysis was used to investigate the correlation between sleep quality, anxiety-depression in preoperative pain catastrophizing and early postoperative pain in abdominal surgery patients. Additionally, a mediating effect test was conducted. Results A total of 206 questionnaires were distributed, and 192 valid questionnaires were collected, resulting in a response rate of 93.20%. The sample consisted of 104 males and 88 females, with an average age of (54.95±7.89) years. Pearson correlation analysis showed significant positive correlations between preoperative pain catastrophizing and early postoperative pain, anxiety-depression, as well as sleep quality (r=0.813, 0.745, 0.792, all P < 0.001), and early postoperative pain was significantly positively correlated with anxiety-depression and sleep quality (r=0.834, 0.842, all P < 0.001). The results of the Bootstrap method indicated that the mediating effect value for the three pathways was 0.106, according for 62.35% of the total effect. Specifically, the mediating ratio of path 1 (preoperative pain disaster → anxiety-depression → early postoperative pain) was 31.76%, and the mediating ratio of path 2 (preoperative pain disaster → sleep quality → early postoperative pain) was 15.29%. Path 3 (preoperative pain disaster → anxiety-depression → sleep quality → early postoperative pain) accounted for 15.29% of the total mediating effect. Conclusion Preoperative pain catastrophizing is associated with early pain in patients undergoing abdominal surgery. Additionally, sleep quality, anxiety-depression have an influence on both preoperative pain catastrophizing and early postoperative pain.

Visual analysis of traditional Chinese medicine in the treatment of diabetic cardiomyopathy based on CiteSpace

ZHAO Qiyao, LI Jiaoyue, WEN Yalu, YUAN Ruyue, ZHANG Ye, HU Chaoyue, ZHANG Li, YANG Xiaohui

2023, 21(12): 2064-2067. doi: 10.16766/j.cnki.issn.1674-4152.003291

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Objective To analyze the literature related to the treatment of diabetic cardiomyopathy (DCM) with traditional Chinese medicine (TCM) over the past 30 years using CiteSpace software, and to sort out the research status, research hotspots and development trends in this field, so as to provide a reference for the follow-up research. Methods Literature on DCM treated with TCM was retrieved from the CNKI database from its inception to December 2022. CiteSpace 6.1.R6 software was used to visually analyze the number of literatures, authors, institutions, keywords and emergent words. Results A total of 608 articles were retrieved and 548 articles were finally included after screening against the inclusion and exclusion criteria. The number of papers published in this area is generally increasing, with a total of 35 core authors, and a number of collaborative teams with different members have been formed. The top 10 institutions published a total of 152 articles (27.7%) and the top three were Heilongjiang University of Chinese Medicine, China Academy of Chinese Medical Sciences and Shandong University of Chinese Medicine. After analyzing, 315 keywords, 10 keyword clusters and 16 emerging words were obtained. The keyword co-occurrence map showed that animal experiments, oxidative stress and apoptosis were frequently studied. Keywords Clustering includes the observation of therapeutic effect and deep mechanism of DCM from Salvia miltiorrhiza decoction, pulse-making decoction and decoctions, Pueraria, Astragalus and Ganoderma polysaccharides. The analysis of emergent words showed that oxidative stress, autophagy, apoptosis and inflammation were the hottest research areas in recent years. Conclusion The current research hotspots in this field are the mechanism of action of single Chinese medicines, extracts and compound Chinese medicines on DCM, and the research hotspots mainly include the role of oxidative stress, inflammation, autophagy and apoptosis in the treatment of DCM with Chinese medicine.

Constructing a knowledge graph for health intervention in hypertension from the perspective of precise health management

GAO Ya, CHEN Ning, YUAN Ling, CHEN Hong, TAN Shuoyuan, HE Yibei, WU Qingyu, HOU Hongpan, WANG Zhaoxin, SHI Jianwei

2023, 21(12): 2068-2073. doi: 10.16766/j.cnki.issn.1674-4152.003292

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Objective Primary healthcare institutions face significant challenges in managing hypertension, necessitating practical and effective tools. Therefore, this study aims to construct a knowledge graph for hypertension health intervention offering valuable insights for precise health intervention. Methods A systematic search for hypertension related clinical guidelines and expert consensuses resulted in 5 Chinese guidelines, 3 Chinese expert consensus, and 9 English guidelines. Utilizing these guidelines and expert consensuses as the knowledge source for health interventions in hypertensive patients, a comprehensive list to form the initial batch of entities. Subsequently, an ontology framework was developed, encompassing three age groups (children and adolescents, adults, and the elderly), multiple coexisting diseases, special types of hypertension, and four health intervention modules (nutrition, exercise, psychology, and sleep). Based on the ontology framework, knowledge extraction was performed on the list of health intervention items, adhering to the principles of entity and attribute element extraction. The resulting annotated entity triples formed the data layer. Following knowledge fusion, the Neo4j graph database was used to store and display entity triples, ultimately generating a comprehensive knowledge graph was ultimately generated which can provide corresponding health intervention plans for various types of hypertension patients. Results The constructed knowledge graph of health intervention for hypertension visualizes the textual content derived from guidelines and expert consensus. It encompasses refined information on hypertension patients and offers specific intervention plans. This knowledge graph serves as a valuable tool for family physicians, enabling them to conduct long-term health intervention with greater convenience and precision for all the patients. Conclusion The knowledge graph of health inventions for hypertension provides an effective path for family physicians to access health intervention plans. It serves as a valuable resource for guiding community practice, providing effective guidance and support.

Correlation between uterine artery SD, THBS1 and coagulation dysfunction in pregnant women with pre-eclampsia

ZHANG Xia, XU Xiaomin

2023, 21(12): 2074-2076. doi: 10.16766/j.cnki.issn.1674-4152.003293

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Abstract:
Objective To explore the relationship that may help in the treatment of pre-eclampsia by measuring the peak systolic flow rate/end-diastolic flow rate (SD) of uterine arteries in pregnant women with pre-eclampsia, platelet thrombin protein 1 (THBS1), and changes in coagulation indices. Methods A total of 60 cases of pregnant women with pre-eclampsia who received consultation and treatment at the Obstetrics Department of Zhoushan Women' s and Children' s Hospital from March 1, 2020 to May 31, 2022 were randomly selected as study subjects. According to the condition, there were 25 cases in the mild group and 35 cases in the severe group, and 60 cases of healthy pregnant women were selected as the control group. The levels of uterine artery SD, THBS1 and coagulation function indexes were determined. The relationship between uterine artery SD, THBS1 and coagulation function and the influencing of patients' coagulation dysfunction were analyzed. Results As the worsened, the patients' SD and D-Dimer (D-D) levels were significantly increased, THBS1 levels were significantly decreased, and prothrombin time (PT) and trombin time (TT) were significantly shortened (all P < 0.05). On Pearson' s analysis, SD was negatively correlated with PT (r=-0.627, P=0.014) and TT (r=-0.412, P=0.023), and positively correlated with D-D (r=0.556, P=0.030); THBS1 was positively correlated with PT (r=0.833, P=0.001) and TT (r=0.680, P=0.008), and negatively correlated with D-D (r=-0.324, P=0.037). Logistic analysis, increased SD and increased SD were the patients with pre-eclampsia who developed coagulation dysfunction independent risk factors, and increased THBS1, prolonged PT, and prolonged TT were independent protective factors (all P < 0.05). Conclusion Pregnant women with pre-eclampsia have abnormal uterine artery SD, THBS1, coagulation function, and there is a significant relationship between these indicators, which are expected to become indicators for assessing coagulation dysfunction in patients.

Analysis of influencing factors and establishment of nomogram model for pneumonia complications in children with infectious mononucleosis

YANG Xingxing, SHAN Mingfeng, MENG Hui

2023, 21(12): 2077-2080. doi: 10.16766/j.cnki.issn.1674-4152.003294

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Objective To develop a nomograph model for predicting pneumonia in children with infectious mononucleosis (IM), offering a valuable screening tool for identifying pneumonia in this population. Additionally, to assess the model' s ability to differentiate and maintain consistency in predicting pneumonia cases. Methods A total of 272 children with IM who were admitted to Department of Infectious Diseases, Children' s Hospital Affiliated to Nanjing Medical University hospital from January 2020 to January 2022 were enrolled in this study. The study population was divided into two groups based on the presence or absence of pneumonia. A comparative analysis was performed to identify significant differences between the pneumonia group and the non-pneumonia group. Logistic regression model was employed to analyze the risk factors contributing to pneumonia in children with IM. Subsequently, using the identified risk factors, a nomogram prediction model was constructed using R software. Results Among the 272 patients included in the study, 40 were diagnosed with pneumonia while 232 did not have pneumonia. The overall incidence of pneumonia in children with IM was found to be 14.71% (40/272). Compared with the group without pneumonia, the children with pneumonia exhibited prolonged fever duration, increased hospitalization time, enlarged spleen size, elevated PCT and CRP levels (all P < 0.05). Moreover, a lower proportion of children with pneumonia had received preventive antibiotic treatment (P < 0.05). Binary logistic regression analysis showed that prolonged fever duration and enlarged spleen size were independent risk factors for pneumonia, whereas preventive use of antibiotics was found to be a protective factor against pneumonia in children with IM. The calibration curve of the nomogram model showed a slope close to 1. Furthermore, the Hosmer-Lemeshow test yielded a non-significant result (χ²=8.022, P=0.431), indicating excellent consistency of the nomograph model for predicting pneumonia in children with IM. Conclusion The duration of fever, spleen size, and prophylactic use of antibiotics were identified as independent risk factors for pneumonia in children with IM. A nomogram model constructed based on these factors can be used to predict the risk level of pneumonia in children with IM.

Clinical use of a multifunctional reflective observation stool in midwifery

XIA Hongxia, XU Yuying, LEI Xia

2023, 21(12): 2081-2085. doi: 10.16766/j.cnki.issn.1674-4152.003295

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Objective Comparison of the clinical effectiveness of foreign-imported birthing stools and our department' s multi-functional reflective observation birthing stool for seated delivery. Methods A retrospective study was conducted on low-risk primiparous women who gave birth at Hangzhou First People' s Hospital from July to December 2022. Based on the different types of birthing stools used, a total of 65 women who underwent seated delivery with foreign-imported birthing stools were assigned to the control group, and another 65 women who underwent seated delivery with the Hangzhou First People' s Hospital multi-functional reflective observation birthing stool were assigned to the experimental group. The degree of perineal tears, episiotomy rate, perineal oedema and pain, duration of second stage of labour, postpartum bleeding within 2 hours, mode of delivery, occurrence of neonatal asphyxia or neonatal death, maternal comfort, uterine involution, puerperal morbidity rate, and length of postpartum hospital stay were compared between the two groups. Results The experimental group, using the multifunctional reflective observation birthing stool had significantly lower rates of perineal laceration and episiotomy than the control group using foreign-imported birthing stools. In addition, the duration of the second stage of labour was significantly shorter in the experimental group [(33.43±11.26) min] than in the control group [(63.56±11.58) min]; The experimental group also had less postpartum bleeding [(234.42±37.68)mL vs. (265.67±37.99)mL], and these differences were statistically significant (all P < 0.05). In addition, the incidence of neonatal asphyxia in the experimental group (6.15%, 4/65) was significantly lower than in the control group (18.46%, 12/65). The experimental group showed better uterine involution than the control group, with a lower incidence of puerperal morbidity and shorter postpartum hospital stay. These differences were statistically significant (all P < 0.05). Conclusion Compared to foreign birthing stools, the use of the multifunctional reflective observation birthing stool for seated delivery offers advantages in protecting against perineal tears and episiotomy, reducing perineal pain, shortening the duration of labour and the length of hospital stay after delivery, thus promoting maternal comfort.

Mediating effect of leptin levels between insulin resistance and nonalcoholic fatty liver disease in obese children

BAI Min, HUANG Lieping, ZHU Bei, WU Jinhua, WU Qiong, HONG Kaiting, YU Youna

2023, 21(12): 2086-2088. doi: 10.16766/j.cnki.issn.1674-4152.003296

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Objective Paediatric non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and its prevalence is increasing with the rise in overweight and obesity. Leptin was the first adipokine to be isolated and identified. Therefore, the mediating role of leptin levels between insulin resistance and NAFLD in obese children is discussed. Methods Eighty obese children admitted to Zhoushan Women's and Children's Hospital from January 2022 to March 2023 were selected as research objects, and divided into NAFLD group (32 cases) and non-NAFLD group (48 cases) according to the presence or absence of NAFLD. General data, physical data, insulin resistance index, leptin level and liver function of all subjects were collected, and Pearson correlation was used to analyze the correlation between the above variables. Mediation effects were used to analyze the effects of leptin levels on insulin resistance and non-alcoholic fatty liver disease in obese children. Results Homeostasis model assessment forinsulin resistance (HOMA-IR), leptin, alanine transaminase (ALT), aspartate transaminase (AST) and intrahepatic lipiol (IHL) levels in the NAFLD group were higher than those in the non-NAFLD group (all P < 0.05). Pearson correlation showed that HOMA-IR was positively correlated with leptin and IHL (r=0.573, P < 0.001; r=0.577, P < 0.001); leptin was positively correlated with IHL (r=0.557, P < 0.001). Mediation effect analysis showed that HOMA-IR as a direct effect accounted for 56.48% (0.340) of the total effect and adipokines as a mediating effect accounted for 43.52% (0.262). Conclusion Insulin resistance in obese children is associated with non-alcoholic fatty liver disease, which may be mediated by adipokines.

The significance of MemTrax in screening mild cognitive impairment in elderly diabetes patients in community

ZHU Wenkui, LIU Wei, XU Qun, QIAN Yahui, XU Qi

2023, 21(12): 2089-2092. doi: 10.16766/j.cnki.issn.1674-4152.003297

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Objective To explore the relevance of using the MemTrax (MTX) online cognitive memory assessment system for screening diabetes in older people in the community, providing a basis for clinical promotion. Methods From September to October 2022, 89 elderly diabetic patients and 62 non-diabetic patients, including the management of diabetic chronic diseases, were selected as research subjects from the service targets contracted by family doctors in a community in Shanghai, Collected general clinical data from all study subjects, At the same time, venous blood was collected for fasting plasma glucose(FPG), creatinine, serum urea nitrogen, uric acid, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin, and the MTX online tool was used to determine the correct rate and reaction time. Spearman correlation analysis was used to analyze the relationship between MTX accuracy, reaction time and FPG, glycosylated hemoglobin and diabetes outcome. Multifactor logistic regression analysis was used to explore the factors associated with abnormal MTX accuracy results. Results The correct rate of MTX was 78% (72%, 82%) and 82% (78%, 88%) in the elderly diabetes group and control group, respectively; Spearman correlation analysis showed that the correct rate of MTX was negatively correlated with FPG, glycosylated hemoglobin, and diabetes course, and the correlation coefficients were -0.301, -0.393, and -0.291, respectively. Multivariate logistic regression analysis showed that the OR values of age and diabetes as risk factors for abnormal MTX accuracy were 0.902 (95% CI: 0.830-0.980), 3.523 (95% CI: 1.681-7.383). Conclusion Diabetes-related indicators are closely related to the accuracy of MTX, diabetes is a risk factor for abnormal accuracy of MTX, and the use of MTX accuracy has some value in community screening of elderly diabetes cognitive function.

Research on the influencing factors and countermeasures of depression among occupational women in functional communities based on IMB structural equation model

GAO Jing, JIANG Lianghua, NI Shuang, WU Huichao

2023, 21(12): 2093-2096. doi: 10.16766/j.cnki.issn.1674-4152.003298

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Objective To explore the factors influencing depression in working women in functional communities and to identify strategies to optimize and improve their level of self-management of depression. Methods Based on the literature review and expert consultation, a survey questionnaire was designed and filled out from 00:00 on May 1 to 24:00 on June 21 2021. Using the online questionnaire "Questionnaire Star" to push it point-to-point on the WeChat client, obtain the consent of the respondents, and then fill it out. Organize and clean the data in the backend of the "Questionnaire Star" client. Use SPSS 24.0 statistical software for data entry and statistical analysis. Descriptive statistical analysis is performed on the baseline situation and the classified data is compared between two or more groups using Chi-square tests. A linear regression analysis model is used to analyze the influencing factors. the structural equation of the information motivation behavioral skills model (IMB) model is created using AMOS software. Results A total of 1 128 questionnaires were collected, of which 1 044 were valid, giving an overall response rate of 92.55%. A total of 451 respondents had mild depression, and 11 had severe depression. Multivariate analysis showed that age, education level, social support (social motivational factors), job satisfaction (personal motivational factors), and self-efficacy (behavioral skills factors) were the main factors influencing depression in in working women in the community (all P<0.05). The structural equation model shows that information factors have a positive impact on self-efficacy in managing depression, motivational factors have a positive impact on behavioral skills, and behavioral skills have a positive impact on SDS scores. Self efficacy plays a partial mediating role in the influence of information and motivational factors on the generation of depression (all P<0.05). Conclusion It is necessary to strengthen the scientific popularization of depression among professional groups, to increase social support for professional women, to improve career satisfaction and to increase their self-efficacy in dealing with depression, thereby reducing the incidence of depression.

Effect of self-help mindfulness-based intervention on stigma and resilience in patients with depression

BI Hongsheng, DAI Jiali, SUN Dawei

2023, 21(12): 2097-2100. doi: 10.16766/j.cnki.issn.1674-4152.003299

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Objective Patients with depression have higher stigma and lower psychological resilience. Mindfulness intervention is one of the effective ways to reduce the stigma of patients with depression and improve their psychological resilience. This study used a self-help mindfulness course to intervene and explore its effects on the level of mindfulness, stigma, and psychological resilience of patients with depression. Methods Patients with depression who visited the outpatient department of the Third Hospital of Daqing from January 2022 to November 2022 were selected as the research subjects. One hundred and forty-two recruited depression patients were randomly divided into a control group (n=71) and an experimental group (n=71). The control group received routine drug treatment, while the experimental group received self-help mindfulness-based intervention based on routine drug treatment. Due to various reasons, 15 cases dropped out of the experimental group and 11 cases dropped out of the control group. Finally, the total number of patients who completed the experiment was 116, 56 cases in the experimental group and 60 cases in the control group. Five facet mindfulness questionnaire (FFMQ), depression stigma scale (DSS), and connor-davidson resilience scale (CD-RISC) were used before and after the intervention for 8 weeks. Results After intervention, the total score of the FFMQ in the experimental group [(112.80±15.86) points] was higher than that in the control group [(98.97±15.42) points], the total score of the CD-RISC [(54.52±10.46) points] was higher than that in the control group [(47.23±9.71) points], and the total score of the DSS [(43.84±10.95) points] was lower than that in the control group [(48.28±11.00) points], the differences were statistically significant (t=4.764, 3.889, 2.179; all P < 0.05). After the intervention, the total scores of FFMQ and CD-RISC in the experimental group were higher than before the intervention, while the total scores of DSS were lower than before the intervention, the differences were statistically significant (all P < 0.05). Conclusion Self-help mindfulness-based intervention can effectively improve the mindfulness level and resilience of patients with depression, and reduce their stigma.

Nursing effect of incentive health education combined with traditional Chinese medicine suitable technology in patients undergoing cesarean section

YAN Yanyan, HUANG Liuyan, CHEN Lifang, ZHAO Yi, CHENG Huifang

2023, 21(12): 2101-2105. doi: 10.16766/j.cnki.issn.1674-4152.003300

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Objective Applying motivational health education combined with appropriate technology of traditional Chinese medicine to cesarean section laboring women to explore the nursing effect. Methods The data of 150 cases of pregnant women undergoing cesarean delivery in Lishui Traditional Chinese Medicine Hospital's maternity checkups from January 2019 to December 2021 were selected for prospective analysis, and divided into a control group (60 cases, with motivational health education carried out in January 2019 to June 2020) and an observation group (90 cases, with motivational health education combined with appropriate technology of traditional Chinese medicine in July 2020 to December 2021) according to the time period of the development of clinical nursing care. The two groups were compared in terms of labor and delivery outcomes, rehabilitation, pain, emotional management, and maternal and infant complications. Results There was no statistically significant difference between the two groups in terms of 2 h postpartum hemorrhage (P>0.05), and the postoperative time of exhaustion in the observation group was lower than that in the control group [(1.92±0.64) d vs. (2.93±0.80) d], while the newborn Apgar score was higher than that in the control group [(9.03±1.69) points vs. (7.75±1.70) points], and the differences were statistically significant in all cases (all P < 0.05). The levels of maternal VAS scores at different postoperative time points in the two groups were down-regulated compared with the pre-intervention level (all P < 0.05), and the observation group had lower VAS scores than the control group at 1 day, 3 days, and 5 days post operation (all P < 0.01). After the intervention, the observation health knowledge level and self-care skills difference group were higher than the control group, and the difference was statistically significant (all P < 0.05), while the difference in self-concept and sense of self-care responsibility was not statistically significant (all P>0.05). The rates of puerperal infection, postpartum urinary retention, breast milk deficiency, neonatal jaundice, and neonatal pneumonia in the observation group were lower than those in the control group, and the differences were statistically significant (all P < 0.05). Conclusion The application of incentive education combined with appropriate technology of traditional Chinese medicine can improve the self-management ability of parturient women, eliminate negative emotions, improve maternal and infant outcomes and reduce complications.

Prediction of IDH-1 mutation status in WHO grade Ⅱ and Ⅲ gliomas by radiomics combined with T₁-weighted contrast-enhanced image

ZHAO Shasha, XIN Yongkang, ZHANG Kai, WANG Ying, LIU Jinlin, YANG Yang, WANG Wen

2023, 21(12): 2106-2110. doi: 10.16766/j.cnki.issn.1674-4152.003301

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Objective To explore the diagnostic efficiency of T₁-weighted contrast-enhanced image (T₁CE) radiomic features and clinical-related parameters in predicting isocitrate dehydrogenase-1 (IDH-1) gene mutations in WHO grade Ⅱ and Ⅲ gliomas. Methods MRI data of 135 patients with WHO grade Ⅱ and Ⅲ gliomas (51 cases in the IDH-1 wild type group and 84 cases in the IDH-1 mutant type group) confirmed by surgery and pathology from the Second Affiliated Hospital of Air Force Military Medical University between January 2017 and July 2019 were selected. The volume of interest (VOI) of the whole tumor-enhanced part was manually drawn on T₁CE using ITK-SNAP, and 1 044 radiomic features from the VOI were extracted by using the software of A.K. software. Random forest (RF) algorithm and 5-fold cross-validation method were used to verify the radiomic model in predicting the diagnostic efficiency of IDH-1 mutations of WHO grade Ⅱ and Ⅲ gliomas. Results There were statistical differences in the location of the disease and nodular/ring enhancement between IDH-1 mutant and IDH-1 wild-type groups (all P < 0.05), but no significant differences in other MRI morphological characteristics between the two groups. The AUC value of the area under the ROC curve from the iradiomic model was 0.794, the sensitivity was 61.4%, the specificity was 76.7%, and the accuracy was 70.9%. After the feature selection of the RF classifier, the first 30 optimal features were selected to predict IDH-1 mutation, which had the same efficiency as all the radiomic features, and significantly reduced the redundant information. Conclusion Radiomics combined with T₁CE can effectively predict the IDH-1 mutation status of WHO grade Ⅱ and Ⅲ gliomas. RF classifier model has the potential to predict IDH-1 mutations, which may provide an imaging basis for early diagnosis and individualized treatment of glioma patients.

Effect of Doppler ultrasound, CT and MRI in preoperative staging diagnosis of endometrial cancer

PAN Xuekui, ZHU Ling, SHAN Huaying, LU Yan

2023, 21(12): 2111-2113. doi: 10.16766/j.cnki.issn.1674-4152.003302

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Objective To investigate the application value of Doppler ultrasound, CT and MRI in the preoperative staging diagnosis of endometrial cancer, and to provide evidence for updating of clinical diagnostic methods. Methods From December 2019 to December 2021, 98 patients with endometrial cancer diagnosed by postoperative pathological examination in Huzhou maternal and child health hospital were retrospectively analyzed. All patients were examined by Doppler ultrasound, CT and MRI before surgery, and the results of the three examination reports were collected, and the diagnostic effect of their preoperative staging was analyzed and compared. Results Postoperative pathological analysis showed that 98 patients were all endometrioid adenomas, and the postoperative pathological stages were as follows: 61 cases in stage Ⅰ, 6 cases in stage Ⅱ, 21 cases in stage Ⅲ, and 10 cases in stage Ⅳ. The preoperative diagnostic stages of the 98 patients were reported as follows: Stage Ⅰ, 38 cases, 56 cases, 60 cases; Stage Ⅱ, 5 cases, 3 cases, 4 cases; Stage Ⅲ, 15 cases, 15 cases, 18 cases; Stage Ⅳ, 8 cases, 5 cases, 8 cases; Taking the results of postoperative pathological examination as the gold standard, the accuracy rates of preoperative Doppler ultrasound, CT and MRI for the preoperative staging of patients with endometrial cancer are 67.35% (66/98), 80.61% (79/98), 91.84% (90/98); ROC curve analysis showed that the results of the three preoperative examination stages had high clinical value on the pathological examination results (AUC values were 0.582, 0.653, 0.676 respectively, all P < 0.05), among which the comprehensive accuracy rate of MRI preoperative diagnosis stage was the highest in clinical value. Conclusion Doppler ultrasound, CT and MRI can be used as imaging modalities for preoperative staging of endometrial cancer patients, which can provide a strong basis for clinicians diagnosis of clinicians. However, the overall accuracy of preoperative diagnosis and staging of MRI for is significantly higher than that of Doppler ultrasound and CT, which may be preferred when clinical conditions allow.

FAM134B-mediated endoplasmic reticulum autophagy and its association with diseases

ZHANG Yi, WEI Na

2023, 21(12): 2114-2118. doi: 10.16766/j.cnki.issn.1674-4152.003303

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Abstract:
Autophagy has the ability to degrade damaged senescent organelles and abnormal proteins, providing energy and raw materials for life activities. Autophagy is mainly divided into four stages, including the formation of autophagic precursors, autophagosomes, autophagic lysosomes and the degradation of autophagic contents by lysosome hydrolase, which depends on the lysosomal degradation system. The endoplasmic reiculum (ER) is the largest organelle in eukaryotes, the site of protein synthesis and processing, and the storage site for calcium ions; protein folding errors and calcium ion imbalances lead to ER dysfunction and activate ER autophagy. Autophagy maintains cell homeostasis; selective and non-selective autophagy are two types of autophagy based on degraded substrate specificity. ER-phagy is a type of selective autophagy mediated by ER receptors. FAM134B is the first mammalian ER-phagy receptor to be identified, which mediates ER-phagy involved in the pathogenesis of all types of diseases. Family with sequence similarity 134, member B(FAM134B) induced the bending and fragmentation of the ER through the LC3 interaction domain and the reticular homologous domain, which facilitated transport to lysosomes and promoted the degradation of the ER. Moderate ER-phagy clears the damaged ER and restores ER homeostasis, whereas excessive ER-phagy induces apoptosis. In general, low levels of autophagy are beneficial for cell survival, whereas excessive autophagy or autophagy dysfunction under stress is detrimental. This paper introduces autophagy, ER structure and function, ER-phagy and how FAM134B mediates ER-phagy. By reviewing the relevant literatures, this paper explains the relationship between FAM134B-mediated ER-phagy and nervous system, digestive system, cardiovascular diseases and infectious diseases, and suggests that ER-phagy can be controlled by regulating the expression of FAM134B, thereby interfering with the progression of diseases.

Research progress on the cGAS-STING pathway in the kidney disease

HAN Zhenyuan, WANG Xiaoyan

2023, 21(12): 2119-2123. doi: 10.16766/j.cnki.issn.1674-4152.003304

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Abstract:
As an important component of the innate immune system, the cyclic guanosine monophosphate-adenosine monophosphate synthase stimulator of interferon genes (cGAS-STING) signaling pathway plays a critical role in mediating immune responses by inducing the secretion of type Ⅰ interferons and inflammatory cytokines. The cGAS-STING pathway activates interferon regulatory factor 3 or nuclear factor-κB and is involved in inflammation, infection, cellular homeostasis, obesity and organ fibrosis. In addition, the role of the cGAS-STING pathway in common kidney diseases is increasingly appreciated by clinical and basic researchers. Recent studies have shown that activation of the cGAS-STING pathway in acute kidney injury can trigger the release of inflammatory factors and exacerbate inflammation. This abnormal activation of the pathway is closely linked to the development and progression of kidney fibrosis in chronic kidney disease. In addition, the cGAS-STING pathway also plays an important role in kidney cancer. The cGAS-STING pathway is therefore a promising target for the treatment of kidney diseases. However, more research is needed to fully understand the specific mechanisms and therapeutic potential of the cGAS-STING pathway in kidney disease. In order to provide clinicians and researchers with new perspectives, this paper reviews recent research progress on the cGAS-STING pathway in common kidney diseases, discusses the role of this pathway in the pathogenesis of acute kidney injury, chronic kidney disease and renal cancer, and highlights the potential of this pathway as an effective therapeutic target, especially for acute kidney injury, in an attempt to provide new insights and approaches for the treatment of kidney diseases.

Research progress on the current situation of anesthesia nurse role pressure and intervention strategies

MA Shuning, ZHANG Anping, WANG Jing, LING Tao, CHEN Benzhen

2023, 21(12): 2124-2127. doi: 10.16766/j.cnki.issn.1674-4152.003305

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Abstract:
As a special group of specialized nurses, the development of anesthesia nurses has attracted wide attention at home and abroad. The research shows that the anesthesia nurses are under obvious role pressure due to the lack of staff ratio, work characteristics and obvious differentiation of responsibilities. In addition, the literature research finds that most of the factors related to the role pressure of anesthesia nurses are explained by single dependent variable or single model, the lack of test research on multivariate causality, and the empirical coping strategies are rare. So that the impact of the role pressure on the work of anesthesia nurses has not been effectively alleviated. In developed countries such as Europe and America, anesthesia nurses have the right to practice independently and high authority, meanwhile the education system and practice standards have been standardized. Research shows that the low professional skills and authority of anesthesia nurses lead to the high level of role pressure. In our country, although the scope of practice of nurse anesthesia across a wide range, but most do not have the management and technical authority, the work is mostly preoperative preaching, anesthesia drugs and equipment preparation, tracking follow-up and other assistant nature of the work, technology and authority is low. Although some hospitals have done exploratory implementation of the use of general anesthesia techniques by nurse anesthetists, they have also clearly expressed restrictions on the practice of nurse anesthesia. This paper summarizes the relevant factors leading to the role stress of nurse anesthetists contain nurse anesthetists' emotional intelligence, burnout, tendency to leave the job, and job satisfaction, etc. It also reviews the current research progress of nurse anesthetists' role stress at home and abroad in terms of the current status of nurse anesthetists' role stress, assessment tools, relevant factors, and intervention strategies, and provides a reasonable outlook of the existing intervention methods of role stress, so as to provide references for the exploration of suitable stress intervention programs for nurse anesthetists in China.

Correlation between caries and body mass index and waist circumference in children aged 11 to 13 in Sichuan Province

SUN Taolan, YAN Xinmiao, LU Yuhang, TAN Xin, WANG Zhuo, LI Miaojing

2023, 21(12): 2128-2132. doi: 10.16766/j.cnki.issn.1674-4152.003306

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Abstract:
Objective To investigate the prevalence of dental caries and obesity in children aged 11-13 years in Sichuan Province, and to explore the relationship between dental caries and body mass index and waist circumference, in order to provide a reference for formulating intervention strategies for childhood obesity and dental caries. Methods From May 2021 to March 2022, a total of 5 992 permanent resident children aged 11-13 years in 8 cities in Sichuan Province were examined by questionnaire, physical examination and dental caries examination, and their height and weight were measured to calculate their body mass index. Study participants were classified as emaciated, normal, overweight or obese according to the 2014 comprehensive assessment criteria for the developmental status of children and adolescents. Waist circumference was measured and recorded to determine whether central obesity was diagnosed according to the high waist circumference screening threshold recommended by the National Health Commission in 2018. Spearman correlation analysis was used to examine the relationship between body mass index, waist circumference and caries loss and the supplementation index. Unconditional logistic regression analysis was used to analyze the relationship between overweight, central obesity and dental caries. Results The prevalence of caries was 36.75% (2 202), overweight 20.64% (1 237) and central obesity 14.85% (890). Spearman correlation analysis showed that both body mass index and waist circumference were negatively correlated with the caries loss index (all P < 0.001). After adjustment for confounders, multivariate logistic regression analysis showed that compared with overweight OR obese children, children with normal body mass index (OR=1.363, 95% CI: 1.187-1.565) and those with wasting (OR=1.652, 95% CI: 1.309-2.085) had a higher risk of dental caries. Compared to children with central obesity, children with normal waist circumference had a higher risk of dental caries (OR=1.385, 95% CI: 1.186-1.618). Compared to children who were neither overweight nor centrally obese, the risk of dental caries was reduced in overweight obese children alone and in overweight obese children with central obesity. Conclusion The prevalence of dental caries in children aged 11-13 years in Sichuan Province is high, and oral intervention measures should be further strengthened. Body mass index and waist circumference were negatively correlated with dental caries in children. Overweight or obesity and central obesity reduced the risk of caries in children.

linical study on the treatment of urinary incontinence after prostatectomy with thunder fire moxibustion

CAI Qun, GUO Qin, HE Kelin, NIU Xuekang, GUO Fangfang, YUAN Kangni

2023, 21(12): 2133-2136. doi: 10.16766/j.cnki.issn.1674-4152.003307

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Abstract:
Objective To compare the clinical effect of thunder fire moxibustion (TFM) combined with pelvic floor muscle training and pelvic floor muscle training alone in the treatment of urinary incontinence after prostate surgery and its influence on patients' quality of life. Methods A total of 66 patients with urinary incontinence after prostate surgery were recruited from the outpatient department of the Third Affiliated Hospital of Zhejiang Chinese Medicine University from 1 January 1, 2021 to November 30, 2022, and divided into observation and control groups by the random envelope method, with 33 cases in each group. The observation group used TFM combined with pelvic floor muscle training, while the control group only received pelvic floor muscle training. The healing effect of traditional Chinese medicine, the degree of incontinence questionnaire-urinary incontinence short form (ICI-Q-SF), the urinary incontinence quality of life (I-QOL) and the pelvic floor function of the two groups were compared before and after treatment and 8 weeks after treatment. Results The efficacy rate of traditional Chinese medicine (TCM) in observation group was 96.97%(32/33), higher than that in the control group [81.82% (27/33)], and the difference was statistically significant (P<0.05).After treatment and 8 weeks after treatment, the degree of urinary incontinence in the observation group was significantly reduced compared with the control group, and the difference was statistically significant (all P<0.05). After treatment and 8 weeks after treatment, the ICI-Q-SF scores of the observation group were (5.67±3.33) points and (4.15±1.12) points respectively, which were lower than those of the control group [(7.70±3.57) points and (6.52±2.50) points], and the differences were statistically significant (all P<0.05). Conclusion TFM combined with pelvic floor muscle training and simple pelvic floor muscle training can improve the degree of urinary incontinence and the quality of life in patients after prostate surgery. Moreover, combined treatment is better than pelvic floor muscle training alone at improving the level of urinary incontinence and patients' quality of life.

The practical exploration of the team-based learning model in ICU clinical teaching under the guidance of multidisciplinary team collaboration

LI Zuotao, ZHONG Zhihong, LIU Yanquan, GUO Ling, XU Qinglin, WANG Yili

2023, 21(12): 2137-2140. doi: 10.16766/j.cnki.issn.1674-4152.003308

288 12

Abstract:
Objective To analyze and explore the application effect of team-based learning (TBL) under the guidance of multi-disciplinary team (MDT) in intensive care unit (ICU) clinical teaching practice, and to explore a new way for ICU clinical teaching reform. Methods A total of 87 resident physicians in the Department of Intensive Medicine of the First Affiliated Hospital of Gannan Medical University from July 2019 to June 2022 were selected as the study subjects, and randomly divided into control group (n=42) and experimental group (n=45) according to the random number table method. The control group was treated with the traditional bedside teaching mode by residents and the experimental group was treated with the TBL mode under the guidance of the MDT for clinical teaching. To compare the practical effectiveness and satisfaction of the two groups of teaching methods. Evaluate and compare the practical effects of the two groups of teaching methods and investigate the teaching satisfaction using the ICU teaching satisfaction questionnaire. Results The scores of the test group were higher than those of the control group [(88.24±3.57) points, (93.16±4.95) points, (84.09±5.12) points vs. (81.08±2.92) points, (86.43±3.31) points, (79.83±3.96) points], the differences between the two groups were statistically significant (all P<0.05). The results of the questionnaire survey showed that the experimental group in the ICU was superior to the control group in terms of learning goals and interests in the ICU, ICU theoretical knowledge and operational skills, training of team spirit, humanistic care ability, doctor-patient communication ability, document retrieval ability, training of critical thinking (all P<0.05). Conclusion The model of MDT combined with TBL teaching method in ICU clinical teaching practice can effectively improve the professional level and skills of young residents, cultivate team spirit and improve the quality of scientific research, but also contribute to the harmonious relationship between doctors and patients, and improve the satisfaction of ICU clinical teaching.

A study on the implementation effect and influencing factors of the parallel training for master's degree in general practice and residency standardized training in Anhui Province

YU Haiyan, ZHONG Ping, WANG Wei, ZHU Chuanbo, YU Xianqing, WANG Haoyang, CHEN Ren, XIAO Jincheng

2023, 21(12): 2141-2144. doi: 10.16766/j.cnki.issn.1674-4152.003309

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Abstract:
Objective By investigating the implementation effect of the concurrent training model for master' s degree in general practice and standardized residency training, as well as the factors influencing core competence in Anhui Province, this study offers value insights to enhance the core competence of residents and improve the management of residency training bases. Methods The study included a population of 311 general practice residents who took the 2022 business level test in Anhui Province, 198 general practice residents who completed their residency training in 2022, and 181 randomly selected second-year and third-year general medicine residents in Anhui Province who participated in the questionnaire survey. The participants were divided into two groups based on their status: master' s degree graduates and central program residents. The respective group sizes were 37, 28, and 70 for professional master' s degree students, and 274, 170, and 111 central program residents. The implementation effect of concurrent training for professional master' s degree students and residents was evaluated, and to analyze the influencing factors of core competence. Results The results revealed that among professional master ' degree students, 32.43% (12/37) achieved annual business proficiency test scores ≥P₆₀, while among central program residents, the percentage was 22.26% (61/274). The comparison between the two groups yielded χ²=1.877 and P=0.171, indicating no significant difference. The scientific research ability of professional master' s degree students was higher compared to central program residents. Conclusion The implementation of the parallel training model for the master' s degree in general practice in Anhui Province has proven to be effective, successfully achieving the desired standardization. Scientific research ability is a crucial factor influencing the core competence of residents. Therefore, residency training institutions should pay attention to the cultivation of scientific research ability among central program residents to enhance their overall core competence.

Comparative analysis of research status on general practice between China and overseas based on the Coronavirus disease 2019 literature

CHEN Xiaolei, SHAO Shuang, FENG Zhengwen, LI Hui, LUO Qi, ZHU Chenli, DU Juan

2023, 21(12): 2145-2150. doi: 10.16766/j.cnki.issn.1674-4152.003310

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Abstract:
Objective The purpose of this study was to understand the status of research in the field of general practice and the gaps with international research by analyzing the relevant published papers and providing a reference for future research. Methods The papers of general practice on Coronavirus disease 2019 (COVID-19) were searched by subject retrieval method. The Chinese retrieval database included CNKI and Wanfang database, and the English retrieval database included Web of Science. The retrieval time was from January 1, 2020 to December 31, 2022. The bibliometric analysis and content analysis were used to analyze the type, institution, and hotspots respectively. Results A total of 127 Chinese and 222 English papers were included, and the institutions were mainly located in Beijing, Wuhan, and Chengdu, lacing the cooperative relationship among institutions. The research of general practice on COVID-19 was mainly based on cross-sectional study, supplemented by qualitative research in China; and the international researches were mainly focused on cross-sectional studies, supplemented by qualitative and cohort studies. Domestic research topics mainly focus on psychology, education, and artificial intelligence, and a few studies involve home protection, vaccination, and medical consortiums. International research topics mainly focus on psychology, telemedicine, career planning, and education, and also involve some vaccines and "long COVID-19". Conclusion The research of general practice is still in the primary stage of development, and the cooperation between institutions was relatively insufficient. The research methods used are relatively simple, and there are certain differences in research hotspots between China and the international, with both commonalities and unique characteristics.

Construction and implementation of a collaborative work system between designated hospitals and infection control departments during a local outbreak of Coronavirus disease 2019 infection

FAN Shanhong, XUE Hong, XU Wen, GE Wei, SHEN Li, DONG Yu, FU Ting, HE Zhen, GENG Jie

2023, 21(12): 2151-2155. doi: 10.16766/j.cnki.issn.1674-4152.003311

175 8

Abstract:
Objective To explore the work system and operational mechanism of designated hospitals and infection control departments during local outbreaks of coronavirus disease 2019 (COVID-19) infection, so as to provide theoretical and practical references for the effective implementation of infection prevention and control measures in emergency situations. Methods In response to the significant risk of infection among healthcare workers in designated hospitals and the challenge of managing homogeneous medical teams effectively, we established a "Collaborative Infection Control Department." This department comprised national infection control experts serving as advisors and providing technical guidance, provincial-level infection control experts as directors, and infection control professionals from medical teams as members. The department aimed to construct an efficient and powerful command system, a scientifically rigorous prevention and control system, and a everyone participatory barrier system, so as to increase the recognition and engagement of infection control work among medical teams and promote the continuous enhancement of infection control quality. Results A total of 985 patients with COVID-19 in the designated hospitals were included in the study. Throughout the treatment process, no adverse medical safety incidents or nosocomial infections among healthcare professionals occurred. The hand hygiene compliance rate among all healthcare workers in the hospital increased from 52.30% to 98.89%. Furthermore, the qualification rate for cleanliness and disinfection improved from 43.59% to 99.25%. Remarkably, the rate of issues related to the removal of protective equipment decreased from 23.70% to 0. Additionally, the patient's awareness rate of hand hygiene increased from 73.21% to 100.00%. Conclusion Through the emergency practice, a designated hospital infection control management model with comprehensive leadership, multi-subject cooperation, and hierarchical implementation had been formed, the infection control management of multiple medical teams had been carried out homogeneously, and the medical treatment of patients had been ensured efficiently and orderly.

Implementation and evaluation of a multidisciplinary team-based model for managing and caring for elderly patients with traumatic hip fractures

XIONG Fei, SHAO Xiaoping, RUI Biyu

2023, 21(12): 2156-2159. doi: 10.16766/j.cnki.issn.1674-4152.003312

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Abstract:
Objective To investigate the impact of a multi-disciplinary team-based model on managing and caring for elderly patients with traumatic hip fractures, and analyze of surgical-related indicators, postoperative complications rate, and nursing satisfaction during the patient's hospitalization. Methods A retrospective analysis was conducted on 228 patients who underwent hip joint surgery at the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023. The patients were divided into two groups: an observation group (105 cases) and a control group (123 cases), based on their treatment and care processes. The control group followed the routine procedure, while the observation group received acre in a dedicated one-stop ward designed specifically for elderly patients with traumatic hip fractures in the emergency department. The treatment and nursing process in the observation group were optimized through the implementation of a streamlined pathway and multidisciplinary comprehensive consultation. The study compared operation-related indicators, postoperative complication rates, and nursing satisfaction between the two groups. Results Compared with the control group, the observation group demonstrated significant improvements in various aspects. The preoperative waiting time [(1.62±0.35) d vs. (2.70±0.52) d], postoperative mobilization time [(1.68±0.36) d vs. (2.37±0.52) d], and length of hospital stay [(5.62±1.76) d vs. (8.27±2.52) d] were significantly shortened in the observation group (all P < 0.05). Additionally, the observation group exhibited a significant decrease in the proportion of postoperative ICU admission (2.86% vs.9.76%) and 30-day readmission rate (2.86% vs.9.76%), all P < 0.05. Moreover, compared with the control group, the incidence of postoperative pulmonary infection (2.86% vs.9.76%), incision infection (4.76% vs.13.01%), and lower extremity deep vein thrombosis (8.57% vs.17.89%) in the observation group were significantly reduced (all P < 0.05). The overall nursing satisfaction rate in the observation group was 99.05%, which was significantly higher than in the control group (91.87%, P < 0.05). Conclusion The implementation of a multidisciplinary team-based model for managing and caring for elderly patients with traumatic hip fractures has demonstrated several positive outcomes. This model facilitates early surgical treatment, leading to shorter hospital stays, decreased perioperative complications, and improved nursing satisfaction.

The effect of therapeutic communication combined with routine care on sleep quality and psychological status of patients with obstructive sleep apnea syndrome

WANG Haiyan, ZHU Yazhen, PAN Yourang, YU Xiaoding, TAO Kewei

2023, 21(12): 2160-2164. doi: 10.16766/j.cnki.issn.1674-4152.003313

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Abstract:
Objective To observe the clinical application of routine care combined with therapeutic communication intervention in patients with obstructive sleep apnea syndrome (OSAS), and to analyze the impact of this plan on the quality of sleep and psychological status of the patients. Methods A total of 82 OSAS patients admitted to the Department of Psychosomatic Disorders of the Seventh People's Hospital of Shaoxing City from May 2021 to May 2023 were selected. The patients were randomly divided into two groups using a random number table. The control group received routine care, while the observation group received therapeutic communication in addition. The patient's psychological status, coping ability, healthy behavior, and sleep quality were assessed before and after intervention. Results After the intervention, the scores of the anxiety self-assessment scale and depression self-assessment scale in the observation group were significantly lower than those in the control group (all P < 0.05); The positive coping dimension score of the simple coping style questionnaire (SCSQ) was significantly higher than that in the control group (P < 0.05), while the negative coping dimension score was significantly lower than that in the control group (P < 0.05); The total score of health promoting lifestyle profile-Ⅱ R in the observation group was significantly higher than that in the control group (P < 0.05); the proportions of rapid-eye-movement sleep (REM) and nonrapid-eye-movement (NREM) 2-3 phases in the observation group were (15.13±2.87)%, (48.82±6.32)% and (13.52±3.42)%, respectively, which were significantly higher than (13.07±2.73)%, (45.24±7.67)% and (11.03±2.51)% in the control group (t=3.330, 2.307, 3.758, all P < 0.05). The frequency of micro awakening and the proportion of NREM 1 phase were (14.52 ±4.32) times, (16.53±3.24)%, which were significantly lower than those in the control group [(17.16 ± 4.53) times, (19.76±4.15)%, t=2.701, 3.928, all P < 0.05]. Conclusion The use of therapeutic communication combined with routine nursing interventions in OSAS patients can effectively reduce their negative emotions, change their coping styles, help establish healthy behaviors, and improve their sleep quality.

Application of nursing model based on enhanced recovery after surgery concept combined with ear point embedding in the perioperative period of elderly hip fractures

YANG Chang, LUO Guogang, ZHOU Minjie

2023, 21(12): 2165-2168. doi: 10.16766/j.cnki.issn.1674-4152.003314

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Abstract:
Objective To investigate the effects of a medical care model based on the concept of enhanced recovery after surgery (ERAS) combined with ear point embedding on postoperative pain, negative emotions and sleep quality in elderly hip fracture patients. Methods Selected 200 elderly hip fracture patients who admitted to Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from November 2022 to May 2023, and divided into control group (100 cases) and observation group (100 cases) by digital table method, the control group received perioperative routine care based on ERAS concept, and the observation group received ear point embedding intervention on this basis. Pain severity [visual analogue scale (VAS)], pain mediators [prostaglandin E2 (PGE2), beta-endorphin (β-EP)], anxiety status [self-rating anxiety scale (SAS)] and sleep quality [Pittsburgh sleep quality index (PSQI)] were compared between the two groups. Results The VAS scores of the observation group at 24 h, 48 h and 72 h were lower than those of the control group (P < 0.05); the levels of PGE2 and β-EP at 24 h, 48 h and 72 h after surgery were lower than those in the control group (P < 0.05). The SAS score after surgery was (33.45±4.78)points, which was lower than that in the control group[(38.90±6.09) points, t=7.040, P < 0.05]. The PSQI score after the intervention was (9.10±1.23) points, which was lower than that in the control group[(12.45±3.02) points, t=10.273, P < 0.05]. Conclusion The care model based on the ERAS concept, combined with ear point embedding, can effectively reduce postoperative pain in elderly hip fracture patients, eliminate anxiety, improve sleep quality and have a positive impact on early patient recovery.

Ustekinumab in the treatment of stenosis Crohn's disease: A case report and literature review

SHAO Xiaoxiao, SHI Ruixin, FANG Ye, WANG Weizhong, JIANG Yi

2023, 21(12): 2169-2172. doi: 10.16766/j.cnki.issn.1674-4152.003315

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Abstract:
Crohn's disease (CD) is a chronic granulomatous disease of unknown etiology that can affect any part of the alimentary tract from the mouth to the anus. CD is often accompanied by a variety of complications, such as intestinal lumen stenosis, intestinal fistula, abscess and perforation. Intestinal lumen stenosis is the most common complication, and there is still a lack of effective methods for the radical treatment of CD intestinal lumen stenosis. Recent studies have found that ustekinumab (UST) attenuates chronic inflammation-associated stenosis in the intestinal tract of CD patients by inhibiting IL-12 and IL-23-mediated cell signaling, activation, and downstream inflammatory cytokine production. In this paper, a case of CD complicated with intestinal stenosis admitted to the Second Affiliated Hospital of Wenzhou Medical University was treated with UST and achieved good therapeutic effect. The case is reported as follows and relevant literature is reviewed.

Congenital portosystemic shunts: 2 cases report and review of literature

XU Jiaxin, DAI Liying, ZHANG Jian, WANG Juan, LIU Yu

2023, 21(12): 2173-2176. doi: 10.16766/j.cnki.issn.1674-4152.003316

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Abstract:
To increase clinicians' awareness of congenital portosystemic shunts, pay attention to the details of the child's medical history, achieve early detection and develop individualized treatment plans. Retrospective analysis of clinical data of 2 cases of CPSS in children seen and treated at Anhui Children's Hospital in the past 10 years. Then we systematically searched relevant studies in Chinese and English literature between January 1, 2010 and December 31, 2022 in databases of China Knowledge Network, Wanfang database, Vipshop database, PubMed, GeenMedical, Web of Science using congenital portosystemic shunts, Abernethy syndrome, infants, case report as the keywords.After removing the duplicates and those with incomplete data, we conducted a review of 10 studies with 118 cases. Our analysis of the clinical manifestations, diagnosis and treatment of these cases may help to improve clinicians' understanding of congenital portosystemic shunts and their ability to diagnose and manage the condition.

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2023 Vol. 21, No. 12

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