中华全科医学

The status of sub-health assessment methods for young and middle-aged people from the perspective of family doctor contract promotion

YUAN Ling, SHI Jianwei, YU Wenya, CHEN Ning, CHEN Hong, GAO Ya, TAN Shuoyuan, HUANG Guangcheng, PENG Derong, WANG Zhaoxin, SUN Wanju

2023, 21(3): 357-360. doi: 10.16766/j.cnki.issn.1674-4152.002882

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Abstract:
Family doctor contract service is an important part of whole life-cycle health management in community. Improving the contract rate of family doctors for normal groups is a major challenge at present. This paper focuses on young and middle-aged people, and sorts out the sub-health status and assessment methods respectively, and proposes that the pre-disease sub-health status assessment with fatigue as the main symptom may become a breakthrough for promoting contracts signing in the young and middle-aged population. Sub-health status is closely related to the occurrence and development of chronic diseases. It is helpful to evaluate the sub-health status of young and middle-aged people by limiting it to pre-disease sub-health states with fatigue as the main symptom. Secondly, we comparatively analyzed the advantages and disadvantages of existing sub-health assessment methods and the shortcomings of sub-health assessment for young and middle-aged people. We found that the current sub-health status assessment is mainly based on scales and questionnaires, with strong subjectivity and lack of objective evaluation indicators. In addition, compared with traditional statistical modeling methods, machine learning algorithms can process large sample sizes and multi-dimensional data, which has better evaluation efficiency. In view of the lack of objective evaluation indicators and methods in sub-health assessment in young and middle-aged people, it is recommended that multi-dimensional objective evaluation indicators should be included to integrate machine learning methods to construct a scientifically feasible assessment model of pre-disease sub-health status, as well as to set the model threshold with chronic disease critical indicators. Expecting that the scientific and effective pre-disease sub-health status assessment can improve the active health awareness of young and middle-aged people and provide personalized health management services to meet their needs for family doctor services, thereby increasing their willingness to sign family doctor contracts.

Analysis of the critical values of partial coagulation function indicators in 1 057 neonates in the early stages of life

ZHANG Mengmeng, TANG Huili, HUANG He, CAI Jingxing, WU Xiaoying, YANG Chuanzhong, YU Zhangbin, LI Sitao, ZHOU Xiaoguang

2023, 21(3): 361-364. doi: 10.16766/j.cnki.issn.1674-4152.002883

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Abstract:
Objective To investigate the critical values of four coagulation indexes in neonates of different gestational ages at the beginning of life. Methods A total of 1 110 eligible newborns hospitalized in 3 level-A tertiary hospitals in Shenzhen from January 1, 2012 to December 31, 2021 were selected. Based on the gestational age, they were divided into early preterm infants, middle preterm infants, late preterm infants and term infants, and four indicators of coagulation function were detected within 24 hours after admission. To establish the reference ranges of four critical values of neonatal coagulation function in the early stage of life, and to determine the condition of 1 588 neonates admitted to the Eighth Affiliated Hospital of Sun Yat-sen University during the same period. Results The critical values of coagulation function in early preterm infants were APTT ≥96.6 s or ≤46.7 s, PT ≥21.4 s or ≤12.5 s, TT ≥23.9 s or ≤15.7 s, FIB ≥3.1 g/L or ≤0.9 g/L; In medium preterm infants were APTT ≥92.4 s or ≤49.1 s, PT ≥18.9 s or ≤12.3 s, TT ≥23.5 s or ≤15.4 s, FIB ≥3.0 g/L or ≤1.1 g/L; In Late premature infants were APTT ≥93.4 s or ≤54.8 s, PT ≥17.1 s or ≤12.5 s, TT ≥19.3 s or ≤15.3 s, FIB ≥2.2 g/L or ≤1.1 g/L; In full-term infants were APTT ≥77.6 s or ≤42.0 s, PT ≥17.4 s or ≤12.2 s, TT ≥19 s or ≤14.5 s, FIB ≥2.4 g/L or ≤1.3 g/L. Among the 1 588 neonates, the detection rate of critical values in early preterm infants was 12.61% (14/111), mainly respiratory distress syndrome; the detection rate of critical values in mid-term preterm infants was 10.99% (21/191), mainly respiratory distress syndrome and neonatal hemorrhagic diseases. The detection rate of critical values in late preterm infants was 5.33% (25/469), mainly neonatal hyperbilirubinemia, neonatal hemorrhagic diseases and neonatal asphyxia. The detection rate of critical values in full-term infants was 4.28% (35/817), mainly neonatal hemorrhagic diseases and neonatal asphyxia. Conclusion The reference ranges of four critical values of coagulation function in neonates with different gestational ages at the early stage of life have been established, which has an important reference value for predicting the condition of severe neonates.

Expression and significance of miR-124, NSE and S100B in neonatal hypoxic-ischemic encephalopathy

ZHUO Feixiang, ZHANG Zhen, CHEN Xin

2023, 21(3): 365-368. doi: 10.16766/j.cnki.issn.1674-4152.002884

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Abstract:
Objective To investigate the expression levels of central neuron-specific protein (S100B), neuron-specific enolase (NSE) and miR-124 in neonatal hypoxic-ischemic encephalopathy (HIE) and to explore their diagnostic value. Methods A total of 100 full-term neonates in the First Affiliated Hospital of Bengbu Medical College from December 2020 to December 2021 were selected, including 50 neonates in the HIE group and 50 neonates in the healthy group. Umbilical cord blood was collected within 2 hours after birth, and the level of miR-124 was detected by real-time fluorescence quantification PCR (qRT-PCR); and femoral vein blood was collected from neonates within 6 hours after birth to detect S100B and NSE levels by ELASA, and the receiver operating characteristic (ROC) curve was constructed to evaluate the clinical significance of the above biomarkers in HIE. Results Compared to healthy neonates, the expression level of miR-124 was decreased in neonates with HIE (0.63±0.11 vs. 0.90±0.22), whereas the levels of S100B and NSE were significantly increased [0.45 (0.34, 0.78) μg/L vs. 0.33 (0.24, 0.50) μg/L, 39.30 (23.71, 67.48) μg/L vs. 21.16 (16.27, 27.25) μg/L], the differences were statistically significant (all P < 0.05), and there were statistically significant differences in miR-124, S100B and NSE in neonates with different HIE levels (all P < 0.05). ROC analysis results showed that the area under the curve AUCs of serum miR-124, S100B and NSE for HIE diagnosis were 0.897, 0.690 and 0.801, respectively, and the AUC of combined detection of miR-124, S100B and NSE for HIE diagnosis was 0.908, indicating the best diagnostic efficiency. The Neonatal Behavioral Neurological Assessment (NBNA) score of HIE was negatively correlated with S100B and NSE, and positively correlated with miR-124. Conclusion The expression level of miR-124 in umbilical cord blood of neonates with HIE is decreased, and miR-124 combined with S100B and NSE is of high diagnostic value for HIE.

Establishment of a nomogram prediction model for the risk of hypoxic-ischemic encephalopathy in neonates with intrauterine distress

WANG Congying, ZHANG Fan

2023, 21(3): 369-373. doi: 10.16766/j.cnki.issn.1674-4152.002885

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Abstract:
Objective To analyze the risk factors for hypoxic-ischemic encephalopathy (HIE) in neonates with intrauterine distress, and to develop a personalized nomograph prediction model. Methods Ninety-six neonates with exposure factors of intrauterine distress and HIE (case group) treated in the Neonatology Department of Huaian Second People ' s Hospital from January 2017 to December 2021 were collected, 96 neonates with exposure factors of intrauterine distress who did not develop HIE (control group) treated in our hospital during the same period were selected. Logistic regression analysis was performed to screen the risk factors affecting the risk of HIE in neonates with intrauterine distress; R software was used to construct a nomogram model to predict the risk of HIE in neonates with intrauterine distress, and the model was meanwhile validated. Results 1 min Apgar score < 7 points (P < 0.001), irregular prenatal examination (P=0.003), pregnancy-induced hypertension (P < 0.001), abnormal umbilical cord (P=0.043), abnormal labor process (P=0.001), pH < 7.0 (P=0.009), alkaline residue < -12.0 mmol/L (P=0.003) were independent risk factors for HIE in neonates with intrauterine distress. The area under the ROC curve was 0.875 (95% CI: 0.826-0.925). The slope of the calibration curve was close to 1, and the H-L goodness-of-fit test χ²=7.221, P=0.513. Conclusion 1 min Apgar score < 7, irregular prenatal examination, pregnancy induced hypertension, umbilical cord abnormality, abnormal labor process, pH < 7.0, and alkaline residue < -12.0 mmol/L are all independent risk factors for HIE in neonates with intrauterine distress. The nomograph prediction model constructed using the above indicators has good predictive power and can accurately predict the risk of HIE in neonates with intrauterine distress.

Advantages of using skeletonized internal thoracic artery for coronary artery bypass grafting

QI Xianjie, WANG Yatao, WEI Ting, LIU Ge, JIANG Yiyao, SHI Chao

2023, 21(3): 374-376. doi: 10.16766/j.cnki.issn.1674-4152.002886

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Abstract:
Objective Skeletonized internal thoracic arteries (ITA) are widely used in coronary artery bypass grafting. The aim of this study is to analyze the correlation between the skeletonized internal thoracic artery and postoperative chest wall pain and paresthesia. Methods Seventy patients who underwent coronary artery bypass grafting with extracorporeal circulation in the First Affiliated Hospital of Bengbu Medical College from September 2020 to January 2021 were selected for retrospective analysis. Among them, 36 patients had skeletonized ITA grafts and 34 patients had pedicled ITA grafts. Results There were no significant differences in the mean flow and pulse index of ITA grafts between skeletonized ITA grafts [42.0 (33.0, 53.5) mL/min, 2.75 (2.15, 3.60)] and pedicled ITA grafts [41.0 (27.0, 51.0) mL/min, 3.10 (2.20, 3.60)], all P>0.05. At 1 month postoperatively, the pain disability index was lower in the skeletonized ITA graft group [3 (2, 3)] than in the pedicled ITA graft group [5 (4, 5)], and the difference was statistically significant (P < 0.05). The incidence of paresthesia was lower in the skeletonized ITA graft group than in the pedicled ITA graft group at 1 month and 1 year postoperatively, with statistically significant differences (both P < 0.05). Conclusion Skeletonized ITA grafts are able to provide bridge vessel flow that was not inferior to that of pedicled ITA grafts and do not increase the bridge vessel pulsatility index (fluid resistance); In the long term, skeletonization of the ITA can reduce the incidence of postoperative chest wall paresthesia, but does not reduce post-coronary artery bypass grafting pain.

Influencing factors of infection or colonization with multidrug-resistant organisms in ICU based on active screening

ZHAO Xue, LIU Guomei, ZHANG Wenhui, WAN Xiaochuan, WANG Wenbin, WU Yile

2023, 21(3): 377-380. doi: 10.16766/j.cnki.issn.1674-4152.002887

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Abstract:
Objective To investigate the incidence and influencing factors of multidrug-resistant organisms (MDROs) infection or colonization in the intensive care unit (ICU), so as to provide scientific basis for MDROs prevention and control measures. Methods A total of 466 ICU patients admitted to the Fourth Affiliated Hospital of Anhui Medical University from July 2019 to June 2021 were selected as the research objects. The occurrence of MDROs nosocomial infection or colonization was monitored by means of active screening and microbiological cultures according to clinical status. Multivariate logistic regression analysis was performed in examining the influencing factors of MDROs infection or colonization. Results Among 466 ICU inpatients, MDROs nosocomial infection or colonization was detected in 161 cases (34.55%), including 41 cases (8.80%) of MDROs infection and 120 cases (25.75%) of MDROs colonization. Multivariate logistic regression analysis showed that more than 7 days of ICU hospitalization, high acute physiology and chronic health evaluation (APACHE) Ⅱ score, invasive mechanical ventilation, more than 3 kinds of combined antibiotics, steroid use and having a prior bed occupant with MDROs were risk factors for MDROs infection or colonization in ICU inpatients(all P < 0.05). Conclusion ICU inpatients have a high incidence of MDROs nosocomial infection or colonization, which is related to multiple factors. Comprehensive measures should be taken to reduce the incidence of MDROs nosocomial infection or colonization.

The level and significance of HIGD-1A and HIGD-1B protein in patients with acute coronary syndrome

ZENG Chaochao, HU Qingtian, WANG Yuexiang, GENG Zhijun, HU Sigan, LIU Jinjun, LI Miaonan

2023, 21(3): 381-384. doi: 10.16766/j.cnki.issn.1674-4152.002888

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Abstract:
Objective To detect serum hypoxia induced genetic structure domain protein-1A (HIGD-1A) and hypoxia induced genetic structure domain protein-1B (HIGD-1B) protein levels in patients with acute coronary syndrome (ACS) and analyze their relationship with the development of ACS. Methods A total of 106 patients with acute coronary syndrome (ACS) diagnosed by coronary angiography in the Department of Cardiovascular Medicine, the First Affiliated Hospital of Bengbu Medical College from September 2019 to September 2021 were selected, including 50 patients with acute myocardial infarction (AMI), 56 patients with unstable angina pectoris (UAP), and 20 patients with stable angina pectoris (SAP). Thirty-four patients with normal coronary angiography during the same period were selected as the normal group. The protein levels of HIGD-1A and HIGD-1B were detected by ELISA to evaluate the differences between the groups. Results Serum HIGD-1B protein was statistically significant between the ACS and control group (P < 0.001). There was no significant difference in HIGD-1A protein among ACS group, SAP group and normal group (P=0.123). According to Gensini score, the degree of coronary artery disease was divided into mild group (n=29), moderate group (n=40) and severe group (n=37). There was a significant difference in HIGD-1B level among patients with different degrees of coronary artery disease in ACS group (P < 0.001). Pearson correlation analysis showed that HIGD-1B level was positively correlated with Gensini score in ACS group (r=0.685, P < 0.001). When drawing ROC curve, the AUC of serum HIGD-1B level in predicting acute coronary syndrome was 0.940, the sensitivity was 84.0%, the specificity was 94.1%, and the Youden index was 0.781, which had certain diagnostic reference value. Conclusion The serum HIGD-1B protein is significantly elevated in patients with acute coronary syndromes and positively correlated with coronary severity, which is of great significance for the diagnosis of ACS.

The influence of liraglutide on insulin secretion function of E23K mutation of Kir6.2 gene in β cells

ZHUANG Langen, JIN Guoxi, YANG Qingqing, HU Xiaolei, PEI Xiaoyan

2023, 21(3): 385-388. doi: 10.16766/j.cnki.issn.1674-4152.002889

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Abstract:
Objective Polymorphism of Kir6.2 is associated with diabetes and insulin resistance. This study aims to explore whether liraglutide can improve the insulin secretion function and mechanism of the E23K mutation of Kir6.2 gene of β cell of islet under a high glucose condition. Methods Taking NIT-1 cells as the object, Kir6.2 gene-overexpressed wild-type and E23K mutant NIT-1 cells were constructed, and liraglutide was adopted to intervene in a high-glucose environment for 24 hours. Flow cytometry was used to detect the NIT-1 cell apoptosis rate, the cell membrane potential and the calcium ion concentration. Western blotting and immunofluorescence assay were conducted to detect insulin contents in cells. ELISA was utilized to detect insulin contents in nutrient fluid, based on which insulin secretion was indirectly studied. Results NIT-1 cells had an optimal high glucose culture concentration of 60 mmol/L, with the highest amount of insulin synthesis, whereas 10 mmol/L was selected for liraglutide in vitro. The insulin secretion of Kir6.2 gene-overexpressed wild-type NIT-1 cells was higher than that of Kir6.2 gene E23K mutant NIT-1 cells. The Kir6.2 gene-overexpressed wild-type NIT-1 cells presented less membrane potential and higher Ca²⁺ concentration in cells in a high-glucose environment, while Kir6.2 gene E23 mutant NIT-1 cells made no significant changes compared with those cultured under high glucose concentration. Liraglutide could effectively reduce apoptosis of wild-type and mutant NIT-1 cells, decrease membrane potential, increase Ca²⁺ concentration in the cells, and promote insulin secretion in a high-glucose environment. In addition, liraglutide was of greater significance to the survival of mutant NIT-1 cells. Conclusion In a high-glucose environment, liraglutide can improve the insulin secretion function of polymorphic of E23K site Kir6.2 gene islet β cell. This study provides basic evidence for the clinical application of liraglutide.

Clinical observation of Xiaoaiping Injection combined with TP regimen in the treatment of advanced non-small cell lung cancer with phlegm-damp-stasis syndrome

LIU Dianlong, LI Jinglei, DI Mingyi, ZHANG Wei, HOU Wei

2023, 21(3): 389-392. doi: 10.16766/j.cnki.issn.1674-4152.002890

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Abstract:
Objective This study aims to observe and compare the clinical efficacy of Xiaoaiping Injection combined with TP chemotherapy and chemotherapy alone in patients with non-small cell lung cancer with phlegm dampness stasis syndrome. Methods A prospective cohort study was used to enroll patients with stage ⅢB-Ⅳ non-small cell lung cancer with phlegm dampness stasis syndrome, There were 53 cases in the treatment group and 53 cases in the control group. The control group was treated with TP chemotherapy, while the treatment group was treated with TP regimen combined with Xiaoaiping Injection. The objective response rate (RR), disease control rate (DCR), TCM syndrome scale score, and the European Quality of Life Collaboration Cancer Core (QLQ-C30) scale score were evaluated and compared between the 2 groups after 2 courses of treatment. The levels of tumor markers, coagulation indicators and inflammatory factors before and after treatment were compared, and the adverse events during treatment were evaluated. Results The objective RR and DCR in the treatment group were 41.5% (22/53) and 71.7% (38/53), after 2 courses of treatment, while those in the control group were 35.8% (19/53) and 62.3% (33/53) respectively. The integral of TCM syndrome scale in the treatment group were lower than those in the control group (P < 0.05), and the QLQ-C30 scale had significant advantages in fatigue improvement and overall health sub items (both P < 0.05). The tumor markers CEA and cytokeratin 19 fragment in the treatment group were lower than those in the control group (all P < 0.05). The activated partial thromboplastin time in the treatment group was higher than that in the control group, and D-dimer was lower than that in the control group (all P < 0.05). The inflammatory factor PCT in the treatment group was lower than that in the control group (P < 0.05). The incidence of thrombocytopenia amongst adverse events in the treatment group was lower than that in the control group (P < 0.05). Conclusion Xiaoaiping Injection combined with TP regimen has advantages in improving TCM clinical symptoms and quality of life. It can prevent the occurrence of thrombocytopenia, and comprehensively improve the treatment effect of advanced non-small cell lung cancer with phlegm damp blood stasis syndrome.

Effects of stearic acid on the functions of L-type calcium channel in vascular smooth muscle cells

JIANG Chuanyue, TAO Yafen, WU Yue, WANG Qianghua, WANG Xuegu, DING Biao, LI Xiang

2023, 21(3): 393-395. doi: 10.16766/j.cnki.issn.1674-4152.002891

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Abstract:
Objective High-fat diet has adverse effects on cardiovascular health, but the mechanism remains unclear. This study aims to investigate the effect of stearic acid induced by high-fat diet on the function of L-type calcium channel in vascular smooth muscle cells(VSMCs). Methods Four week-old SD rats were randomly divided into control group (6 rats) and high-fat group (6 rats) using a lottery method, and fed with normal standard diet and high-fat diet (containing 45% fat) for 12 weeks, respectively. The commercial kits and rat femoral artery cannulation techniques were used to detect blood free fatty acids and rat blood pressures respectively. Calcium currents in rat mesenteric VSMCs was detected by patch clamp technique. Results Compared with control group, the free fatty acids [(0.667±0.027) mmol/L vs. (0.468±0.012) mmol/L, t=6.841, P < 0.001], systolic [(136.50±2.19) mmHg vs. (121.20±3.78) mmHg, t=3.507, P=0.006] and diastolic [(87.10±2.42) mmHg vs. (73.70±2.74) mmHg, t=3.660, P=0.004)] blood pressure was significantly increased in rats with high-fat diet. Patch-clamp results showed that the calcium channel currents were significantly increased in VSMCs of mesenteric artery of the rats with high-fat diet (the ratio of pA/pF at a membrane potential of 10 mV was -16.86±2.58 in control group and -23.80±2.15 in high-fat group, t=4.449, P < 0.001). In addition, stearic acid could significantly increase calcium channel currents (the pA/pF at 10 mV: -12.93±2.58 in 0 μmol/L stearic acid group; -18.10±2.15 in 30 μmol/L stearic acid group; t=4.097, P=0.001) while not affect the calcium channel inactivation and activation. Conclusion Stearic acid induced by high-fat diet can affect the function of L-type calcium channel on VSMCs membrane of mesenteric vessels.

Correlation between oxidative stress related cell senescence indicators and osteoarthritis

CAO Juan, LI Lingling, YAO Yao, XIAO Yunyun, WU Wenhui, LU Bangchao, DING Congzhu

2023, 21(3): 396-400. doi: 10.16766/j.cnki.issn.1674-4152.002892

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Abstract:
Objective To investigate the correlation between chondrocyte senescence and osteoarthritis (OA) by detecting chondrocyte senescence related indicators. Methods The OA patients and non-OA patients hospitalized in the Department of Orthopedics in Nanjing Drum Tower Hospital were selected from January 2018 to December 2020. Normal knee chondrocytes and OA knee chondrocytes were isolated and cultured, and divided into normal human chondrocytes group (control group) and OA chondrocytes group (OA group). P2 generation cells were selected for the experiment. β galactosidase staining was performed. The reactive oxygen species (ROS) level and mitochondrial membrane potential were detected by flow cytometry. The mRNA expressions of P21 and P53 genes were detected by quantitative PCR (qPCR), and the protein levels of P21 and P53 in chondrocytes were detected by Western blotting. Results The positive rate of β-galactosidase staining in chondrocytes in the OA group was significantly higher than that in the control group. The level of ROS in the OA group [(24.72±2.40) %] was significantly higher than that in the control group [(4.96±0.14) %, P < 0.01]. The green fluorescence intensity of JC-1 staining in the OA group [(21.87±3.03) %] was significantly higher than that in the control group [(3.13±0.25) %, P < 0.01]. The mRNA expressions of P21 and P53 genes in the OA group were (2.72±0.21) and (2.90±0.23), which were significantly higher than those in the control group (1.00±0.03) and (1.00±0.06), all P < 0.05. The expression levels of cyclin P21 and P53 in the OA group [(0.51±0.02) and (0.55±0.03)] were also significantly higher than those in the control group [(0.40±0.03) and (0.45±0.02), P < 0.01]. Conclusion Compared with normal chondrocytes, OA chondrocytes senesce significantly. Oxidative stress-induced cell senescence may play a key role in the pathogenesis of OA. Anti-oxidative stress may be an effective target for the treatment of OA.

Efficacy observation of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of postherpetic neuralgia

WANG Yiyi, LI Xiaohong, LIU Peng, WANG Yahui, LIN Xuewu

2023, 21(3): 401-404. doi: 10.16766/j.cnki.issn.1674-4152.002893

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Abstract:
Objective To analyze the clinical efficacy and safety of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of chest and back postherpetic neuralgia. Methods A total of 80 patients with thoracolumbar post-herpetic neuralgia admitted to the Department of Pain, the First Affiliated Hospital of Bengbu Medical College from October 2020 to December 2021 were randomly divided into control group and treatment group according to the random number table method, with 40 patients in each group. The control group was treated with ultrasound-guided paravertebral block, and the treatment group was treated with ultrasound-guided paravertebral block combined with lidocaine gel plaster. The visual analog scale (VAS) score and Pittsburgh sleep quality index (PSQI), the dosage of pregabalin and the incidence of adverse reactions were compared between the two groups before treatment (T0), 1 week after treatment (T1), 2 weeks after treatment (T2), 3 weeks after treatment (T3), 4 weeks after treatment (T4) and 8 weeks after treatment (T8). Results The VAS scores of treatment groups at T1, T2, T3, T4 and T8 were (5.20±0.82) points, (3.90±0.77) points, (3.58±0.76) points, (2.62±0.69) points, (1.98±0.48) points respectively, which were lower than those in the control group [(6.03±1.07) points, (4.95±0.81) points, (4.03±0.83) points, (3.05±0.76) points and (2.55±0.50) points, all P < 0.05]. The PSQI of the treatment group was significantly lower than that of the control group at the same time point, and the difference was statistically significant (all P < 0.05). The effective rate of the treatment group was 77.5% (31/40), better than that of the control group [50.0% (20/40)], and the difference was statistically significant (P < 0.05). Conclusion Ultrasound-guided paravertebral nerve block combined with lidocaine gel patch can effectively relieve postherpetic neuralgia and improve sleep quality of patients with good safety.

Chlorogenic acid effects of intestinal epithelial barrier function with septic rats through TLR4/NF-κB signaling pathway

WANG Jinxin, RAO Chunhui, DAI Bo, YU Huiqin, WANG Zhigang

2023, 21(3): 405-408. doi: 10.16766/j.cnki.issn.1674-4152.002894

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Abstract:
Objective To observe the effect of chlorogenic acid on reducing intestinal oxidative stress injury and improving intestinal cell barrier function through TLR4/NF-κB signaling pathway in septic rats. Methods Sixty SD rats were randomly divided into four groups by the random number table method: sham operation group, model control group and chlorogenic acid (low and high dose) group, with 15 rats in each group. 24 hours after operation, the levels of tumor necrosis factor-α (TNF-α), interleukin (IL-6) and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA), the levels of nitric oxide (NO), superoxide dismutase (SOD) and malondialdehyde (MDA) in small intestine were measured by colorimetry, and western blot was used to detect claudin-1, ZO-1 and TLR-4/NF-κB pathway related protein expression. Results Compared with the model control group, Chiu score in low dose group (4.17±0.22) and high dose group (1.95±0.08) decreased significantly (t=4.159, 60.048, all P < 0.01). The levels of TNF-α, IL-6, IL-10 and the contents of NO and MDA in the small intestine in high dose group were significantly decreased (all P < 0.05), the content of SOD, the expression of Claudin-1, ZO-1 protein, MyD88, TLR-4 protein and p-NF-κB p65 (Ser536) increased significantly (all P < 0.05). Conclusion Chlorogenic acid can reduce serum inflammatory response, reduce oxidative damage of small intestine in septic rats through inhibiting TLR4/NF-κB signal transduction, and then improve intestinal barrier function.

Reliability evaluation of manual and digital measurements for orthodontic models under different crowding degrees

YIN Xiaoxuan, GAN Hongqin, TIAN Ruixue, XIE Xiaofei

2023, 21(3): 409-412. doi: 10.16766/j.cnki.issn.1674-4152.002895

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Abstract:
Objective To evaluate the reliability and accuracy of digital measurement of dental model under different levels of crowding, so as to clarify the application prospect of digital model measurement in orthodontic clinical work. Methods A total of 30 sets of orthodontic plaster were selected as storage models in the Department of Orthodontics of the First Affiliated Hospital of Bengbu Medical College from September 2020 to September 2021, and 30 digital models were obtained by scanning the gypsum model. According to the crowding degree, they were divided into mild group (crowding degree ≤4 mm), moderate group (4 mm < crowding degree≤8 mm) and severe crowding group (crowding degree >8 mm), with 10 models in each group. The gypsum model was measured with vernier caliper, and the digital model was measured with corresponding software. The difference between the results of the two measurement methods when measuring relevant parameters was compared. Results In the mild crowding group, the difference between the 7 measurement values was statistically significant (P < 0.05): crown width, maxillary anterior arch length, mandibular posterior arch length, and palatal dome height at 14, 36, 44, and 46 positions. In the moderately crowded group, the difference between nine measurements was statistically significant (P < 0.05): Crown width, anterior length of maxillary arch, middle length of mandibular arch, overlaying, and measurement time at 16, 26, 36, 45, 46 positions. In the severe crowding group, the difference between the 10 measurements was statistically significant (P < 0.05): 15, 13, 12, 11, 23, 43 tooth position crown width, maxillary posterior arch width, mandibular arch middle length, overlying, measurement time. However, the difference between the above results was less than 1 mm. Conclusion Although the degree of dentition crowding has a certain influence on the measurement results of the digital model, it does not affect the development of clinical orthodontic plan. The digital model measurement can replace the traditional manual measurement method in clinical application.

Short-term clinical effect analysis of unilateral biportal endoscopic surgery for of single responsible segment lumbar spinal stenosis

LU Huaiwang, TIAN Lin, HU Peng, LIU Bin, ZHANG Yuhong

2023, 21(3): 413-416. doi: 10.16766/j.cnki.issn.1674-4152.002896

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Abstract:
Objective To investigate the short-term clinical effect of spinal canal decompression under Unilateral Biportal Endoscopy (UBE) in the treatment of single-segment lumbar spinal stenosis (LSS). Methods The clinical data of 119 patients with LSS in spine surgery from June 2020 to March 2021 in the Affiliated Hospital of Binzhou Medical University were analyzed retrospectively. There were 57 males and 62 females, with an average age of (58.3±10.0) years, a course of disease of (19.6±9.2) months, segmental L_3/4 9 cases, L_4/5 85 cases and L₅/S₁ 25 cases. All patients underwent partial laminectomy through unilateral approach with UBE technology to achieve full decompression of unilateral or bilateral compressed nerves. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were compared before operation, 3 months and 1 year after operation. The area of dural sac was compared before and 1 month after operation. The clinical efficacy (modified MacNab standard) at 1 year after operation was evaluated, and the operation time, intraoperative blood loss and complications were recorded. Results All operations were successfully completed. The intraoperative blood loss was (15.3±10.0) mL, the operation time was (75.2±31.2) min, the postoperative hospital stay was (6.7±1.6) days, and the follow-up time was (14.5±1.4) months. There were 1 case of dural sac tear and 2 cases of epidural hematoma after operation. The dural sac area was significantly improved [(129.6±13.8) mm² vs. (52.6±11.5) mm², P < 0.05] one month after operation. The VAS score and ODI were significantly improved at 3 months and 12 months after operation (all P < 0.05). The clinical efficacy was excellent in 84 cases, good in 26 cases, fair in 6 cases, and poor in 3 cases. The excellent and good rate was 92.4% (110/119). Conclusion The UBE has definite curative effect, less trauma, convenient operation and rapid postoperative recovery in the treatment of single responsible segmental LSS.

Analysis of incidence and related factors of postoperative complications of Pilon fracture

QIAN Jinfeng, HUANG Wei, ZENG Zhongyou

2023, 21(3): 417-419. doi: 10.16766/j.cnki.issn.1674-4152.002897

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Abstract:
Objective To analyze the incidence and influencing factors of postoperative complications of Pilon fracture, and provide reference basis for clinical prevention and treatment of postoperative complications of Pilon fracture. Methods A total of 126 patients with Pilon fracture who were admitted to the Fourth Department of Osteology of the Marine Police Corps Hospital of the Chinese People ' s Armed Police Force from January 2017 to February 2022 were included in the study. The patients were divided into complication group (38 cases) and non-complication group (88 cases) according to whether there were complications. The relevant data (gender, age, smoking, history of diabetes, history of hypertension, fracture type, fracture classification, combined fibular fracture, fracture reduction effect, bone graft) between the two groups was compared, and then the influencing factors of complications were analyzed by Logistic analysis. Results All patients were followed up for 6 months, 119 cases (94.44%) had good fracture healing, 7 cases (5.56%) had delayed or nonunion fracture healing. Complications occurred in 38 cases (30.16%), which were treated symptomatically and healed after treatment. There was significant difference in fracture type, fracture classification, combined fibular fracture, fracture reduction effect and bone graft between the complication group and the non-complication group (P < 0.05). Multivariate logistic regression analysis results showed that fracture type (closed), fracture classification (type Ⅱ), and fracture reduction effect (good) were protective factors for postoperative complications of Pilon fracture, fibular fracture and bone graft were risk factors for postoperative complications of Pilon fracture. Conclusion The incidence of postoperative complications of Pilon fracture is high. The risk factors of Pilon fracture are fibular fracture and bone graft. Preoperative evaluation should be strictly carried out, and complications should be actively prevented during and after the operation to promote the recovery of patients as soon as possible.

Efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi with hydronephrosis

GUO Yinli, YU Jian, SHEN Junwen

2023, 21(3): 420-422. doi: 10.16766/j.cnki.issn.1674-4152.002898

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Abstract:
Objective Flexible ureteroscopic holmium laser lithotripsy (FUHLL) was a minimally invasive operation that uses natural anatomical channels to reach the lesion, and can quickly relieve the obstruction. This study aims to explore the efficacy and safety of FUHLL in the treatment of ureteral calculi with hydronephrosis. Methods A total of 280 cases of ureteral calculi with hydronephrosis treated in Zhoushan Branch of Shanghai Ruijin Hospital from January 2020 to December 2021 were randomly divided into observation group (140 cases) and control group (140 cases). The observation group was treated with FUHLL, and the control group was treated with ureteroscopic holmium laser lithotripsy (UHLL). The renal function indexes and serum inflammatory factor levels of the two groups were measured before and 3 days after treatment. The pain degree was evaluated with visual analogue scale (VAS) scale on the first, second and third days after operation. The stone clearance and operation related indexes were compared between the two groups. Results Compared with the control group, the serum levels of IL-10, IL-6, PCT and CRP in the observation group were significantly lower after treatment [(17.59±4.35) ng/L vs. (20.16±5.08) ng/L, (12.52±3.17) ng/L vs. (16.97±5.29) ng/L, (19.76±4.13) ng/L vs. (22.53±4.91) ng/L, (11.76±2.24) mg/L vs. (16.31±3.19) mg/L, all P < 0.05]. Compared with the control group, the serum adrenocorticotrophin (ACTH) in the observation group were significantly lower after treatment (P < 0.05). While there was no significant difference in serum urea nitrogen and blood creatinine levels between the two groups after treatment (all P>0.05). Compared with the control group, the VAS scale scores after surgery were lower in the observation group at 1 d, 2 d and 3 d after operation (P < 0.05). The amount of intraoperative bleeding, duration of surgery and length of hospital stay between the two groups were significantly different (all P < 0.05). There was no significant difference in hospitalization costs and successful rate of one-time stone removal between the two groups (all P>0.05). Compared with the control group, the incidence of postoperative complications in the observation group was lower (P < 0.05). Conclusion Both FUHLL and UHLL can effectively treat ureteral calculi with hydronephrosis. However, the surgical trauma of FUHLL is less, which can reduce the postoperative inflammatory response and pain, and it is beneficial to protect renal function and reduce postoperative complications.

Predictive analysis of cost utility of lower extremity artery repair in prevention of diabetes and lower extremity arteriosclerosis obliterans

XIN Wenlin, SUN Xiaowei, YU Zexing, LI Li, FAN Enfang, ZHU Xiaoxia, LIU Chunfeng, NI Chunming, TANG Jingdong

2023, 21(3): 423-428. doi: 10.16766/j.cnki.issn.1674-4152.002899

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Abstract:
Objective To analyse the cost-effectiveness of regular full-course repair of lower extremity arteries in the prevention and treatment of diabetes complicated with lower extremity arteriosclerosis obliterans (ASO), to demonstrate the application value of the full-course repair of lower extremity arteries in the management of diabetes patients in the community. Methods Literature research and consultation with Shanghai Pudong Hospital ' s vascular surgery experts were conducted from December 2020 to February 2021. Status classification, transition probability, cost, quality-adjusted life year and other related data of diabetes complicated with lower extremity arterial disease were collected to establish diabetes combined with the Markov model of lower extremity ASO, generate cohort data under conventional treatment and regular full-course repair of lower extremity arteries and compare the cost-effectiveness of treatment costs and quality-adjusted life-year output. Results The simulated sample was 1 000 cases under conventional treatment, and 18.5% (185 cases) of patients developed ulcers in the terminal stage, with an amputation rate of 50.3% (503 cases) and a mortality rate of 36.7% (367 cases). Under regular full-course repair of lower limb arteries, the rate of terminal ulcers was less than 10%, the rate of amputation was 1.0%-4.9% and the mortality rate was between 0.7%-3.3%. When the lower extremity arterial repair treatment was performed regularly, the average treatment cost of each diabetic patient in 20 years was 397 476.8-706 237.5 yuan higher than that of conventional treatment, and the incremental cost-utility ratio was 129 087.4-213 034.5 yuan/quality-adjusted life year. Conclusion The lowest value of the incremental cost-utility ratio of regular full-course repair of lower extremity arteries is less than the GDP per capita of Shanghai in 2019, and the highest value is less than three times the GDP per capita of Shanghai in 2019, which is worthy of being included in the advanced and appropriate technology for prevention and treatment of diabetes foot in diabetes patients with lower limb ASO in Shanghai.

Chain mediating effect between health literacy and frailty in maintenance hemodialysis patients

CAO Min, LI Qin, FENG Li, MA Xin, KANG Li, YANG Qian

2023, 21(3): 429-433. doi: 10.16766/j.cnki.issn.1674-4152.002900

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Abstract:
Objective To explore the multiple mediating roles of social support and psychological resilience between health literacy and frailty in patients with maintenance hemodialysis and to provide some reference and basis for the development of frailty management strategies. Methods A convenience sampling method was used to select 382 maintenance hemodialysis patients in three hospitals in Sichuan Province from November 2021 to April 2022 as the study population. The survey was conducted by using the general information questionnaire, health literacy management scale, social support rating scale, connor-davidson resilience scale and Tilburg scale. Amos 23.0 software was used to construct the structural equation-model diagram and perform the intermediary effect test. Results The scores of health literacy, social support, psychological resilience and frailty were (94.23±11.49) points, (34.89±7.87) points, (63.20±14.26) points and 3.00 (2.00, 7.00) points, respectively. The specific mediating effect and chain-mediating effect of social support and psychological resilience between health literacy and frailty were all established. The specific mediating effect of social support accounted for 31.19% of the total effect, and that of psychological resilience accounted for 8.09% of the total effect. The chain-mediating effect accounted for 7.86% of the total effect. Conclusion There are multiple mediating effects of social support and psychological resilience on maintenance hemodialysis patient ' s health literacy and frailty. Healthcare professionals should take targeted measures to help maintenance hemodialysis patients establish health beliefs, improve health literacy, expand social support networks, and develop psychological resilience, thereby improving frailty symptoms.

Analysis of influencing factors in 106 children with sleep disorders and the related management strategies

SU Rongying, PEI Yaohua

2023, 21(3): 434-437. doi: 10.16766/j.cnki.issn.1674-4152.002901

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Abstract:
Objective To study the prevalence of sleep disorders in children and analyze related influencing factors from various aspects, so as to provide a scientific basis for the development of interventions to prevent and reduce sleep disorders in children. Methods A total of 500 children from the outpatient department of Shijiazhuang People's Hospital between January 2020 and October 2022 were selected as the research subjects, using polysomnography, children's sleep habits questionnaire (CSHQ) and sleep diary to comprehensively assess and diagnose children's sleep disorders. Parents are asked to complete a questionnaire about their child's sleep time and sleep habits, including demographic data and informative factors related to potential risk factors for sleep disorders, and are divided into sleep disorder group and non-sleep disorder group. Univariate and Logistic regression were used to analyze the factors influencing children's sleep disturbance and to suggest intervention strategies. Results A total of 477 questionnaires were received for this study, including 106 children with sleep disorders and 371 children without sleep disorders. Univariate analysis showed that the differences between the 2 groups of children were statistically significant with regard to weight, obesity, preterm birth, parents' snoring, allergic rhinitis, presence of noise in the night-time environment, history of asthma, watching electronic devices, being active, or eating 1 hour before bedtime (all P < 0.05). Multivariate logistic regression analysis showed that obesity, allergic rhinitis, night-time noise, history of asthma, watching electronic devices, being active, or eating 1 hour before bedtime were independent risk factors for sleep disorders in children (all P < 0.05). Conclusion Independent risk factors for sleep disorders in children include obesity, allergic rhinitis, nocturnal ambient noise, history of asthma, watching electronic devices, being active, or eating 1 hour before bedtime. Reducing and preventing the incidence of sleep disorders in children has important clinical implications for their physical and mental development.

Evaluation of the efficacy of individualized nutritional guidance on blood glucose and complications in patients with gestational diabetes mellitus

ZOU Suzhen, YE Qiong, WU Linlin, NI Juanjuan

2023, 21(3): 438-441. doi: 10.16766/j.cnki.issn.1674-4152.002902

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Objective This study aims to explore the evaluation of the efficacy of individualized nutritional guidance on blood glucose and complications in patients with gestational diabetes mellitus, and to provide a reference for the management of patients with gestational diabetes. Methods A total of 110 patients with gestational diabetes admitted to the Second Hospital of Wenzhou Medical University from June 2019 to December 2021 were randomly divided into control group (n=55) and observation group (n=55), according to the random number table method. The control group received routine gestational diabetes regimen, and the observation group received individualized nutritional guidance on the basis of the control group. After 4 weeks of intervention, the compliance rate of gestational diabetes knowledge attainment and nursing satisfaction of the two groups were compared. Fasting blood glucose and 2-hour postprandial blood glucose in the 2 groups were measured, and the pregnancy complications and neonatal complications in the 2 groups were compared. Results The knowledge attainment rate of gestational diabetes and nursing satisfaction score in the observation group were significantly better than those in the control group (both P < 0.05). Fasting blood glucose and 2-hour postprandial blood glucose in the observation group were (5.56±0.26) mmol/L, (6.59±0.54) mmol/L, respectively, which were significantly lower than those in the control group (5.73±0.30) mmol/L, (7.28±0.69) mmol/L (both P < 0.05). The incidence of pregnancy complications and neonatal complications in the observation group were 14.55% (8/55) and 10.91% (6/55), respectively, which were lower than 38.18% (21/55) and 34.55% (19/55) in the control group (both P < 0.05). Conclusion The effect of individualized nutritional support for patients with gestational diabetes mellitus is excellent, which can effectively control the blood glucose level and reduce complications.

Capacity for chronic obstructive pulmonary disease prevention and control of community health service centers in Shanghai

YANG Qundi, SU Qiuyun, CHEN Xiaoying, ZHENG Yang, LIU Danni, LIU Xiaoxia, SHI Yan, FU Chen

2023, 21(3): 442-444. doi: 10.16766/j.cnki.issn.1674-4152.002903

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Abstract:
Objective To evaluate the capacity for chronic obstructive pulmonary disease (COPD) prevention and control of community health service centers in Shanghai in order to improve future work. Methods A self-designed questionnaire survey was conducted to investigate the progression on prevention and control of COPD and the related equipment and drugs among all community health service centers in Shanghai. Results Among the 242 community health service centers, 28.51% were equipped with spirometer while 19.83% provided pulmonary function testing service. Community health service centers equipped with X-ray machines account for 97.52%. The proportion of community health service centers providing bronchodilators, glucocorticoids, and phosphodiesterase inhibitors were 93.80%, 34.30%, and 6.61%, respectively. The percentage of community health service centers providing long-acting beta2-agonists and long-acting muscarinic antagonists were 30.58% and 19.01%. In terms of COPD prevention and control, 50.83% of the centers carried out COPD health education, mainly in the form of lectures, theme publicity day activities and distribution of publicity materials. Total 16 (6.61%) community health service centers had carried out COPD active screening, of which 10 used questionnaires combined with simple pulmonary function test, and 6 used simple pulmonary function tests. The proportion carrying out the projects on high-risk population management and patient community management were 4.13% and 18.18%. The main intervention contents included health education, risk factor intervention and regular assessment. Conclusion The prevention and control of COPD in community health service centers in Shanghai is still in its infancy, and the related equipment and facilities of diagnosis and treatment needs to be strengthened.

Qualitative study on capacity construction of children's health service in community health service centers in two cities

WANG Xi, YIN Tao, YANG Huimin, YIN Delu

2023, 21(3): 445-448. doi: 10.16766/j.cnki.issn.1674-4152.002904

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Abstract:
Objective In order to meet the rapid growth of children's health services and solve the problem of weak comprehensive capacity of children's health services in community health service centers in China, summarize the experience of children's health service capacity building in community health service centers in Chengdu and Xiamen, and provide reference for strengthening the children's health service capacity of primary medical and health institutions in China. Methods Convenient sampling was used to conduct semi-structured interviews with children's health service workers in five community health service centers in Xiamen and Chengdu from June to November 2020, including 24 participants. The MAXQDA software was used to encode and classify according to the subject, and to describe, sort out and analyze the subject. Results (1) In terms of resource input, although the two cities were the same as the national community health service centers, there was a problem of a small number of pediatricians, but they focused on improving the capacity of existing pediatricians, while giving play to the role of general practitioners in pediatrics, and the investment in children's related equipment, facilities and drugs was relatively perfect. (2) In terms of service output, children's diagnosis and treatment service capacity were strong, and the signing service rate of children's families was high. (3) In terms of service effect, the appropriate performance distribution scheme made the income level of staff high, and comprehensive health services improved the satisfaction of children's parents. Conclusion Community health service centers in Xiamen and Chengdu have strong ability to provide children's health services, which benefit from the strong support of policies, the full use of staff and the development of children's health services with local characteristics.

Effect of contracting contracts of "1+1+1" medical institutions based on propensity score

JI Hui

2023, 21(3): 449-453. doi: 10.16766/j.cnki.issn.1674-4152.002905

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Abstract:
Objective To evaluate the effect of the "1+1+1" medical institution combination contract in a community in Huangpu District, Shanghai, and point out for the next step of optimisation direction. Methods From June 2019 to October 2019, based on the length of contract signing and the number of visits, 603 cases of residents in a community in Huangpu District, Shanghai, were hierarchically and randomly selected, and the medical visits and cost information of the study subjects between 2018 and 2019 were collected in November 2019 and June 2020, respectively. Results A total of 602 cases of contracted and non-contracted residents were obtained. Significant differences in the degree of trust in the community health service centre, willingness for first consultation, convenience, service attitude, service effect and views on family doctor cost management were observed between the two groups (all P < 0.05), and the residents in the contract group highly expressed trust, willingness, satisfaction, hope for early implementation and other positive attitudes. Before and after propensity score matching, the two groups of residents had significant differences in the number of community visits, the difference between the number in two years, and the total drug expenditure in 2018 and 2019 (all P < 0.05). No significant difference in the total cost difference and out-of-pocket expenses in 2018 and 2019 was observed (all P > 0.05). This difference between out-of-pocket expenses in 2018 and 2019 was significantly different before matching but not after matching. Conclusion The contracted service satisfies the needs of residents in the community who have high subjective evaluations of community health centres and high drug dispensing needs and promotes their community visits, but it has not formed a word-of-mouth transmission effect and a driving effect. Furthermore, family doctors have not yet used the contract service to control the cost, and the contract service is still in the stage of promoting the establishment of management service relationships between family doctors and residents.

A mediation model analysis of emotional abuse on adolescent insomnia

CUI Yanan, HUANG Yunheng, GUO Yaru, FANG Haijian, JI Yifu, YU Fengqiong

2023, 21(3): 454-457. doi: 10.16766/j.cnki.issn.1674-4152.002906

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Abstract:
Objective To assess the relationship between emotional abuse and insomnia in adolescents and to discuss the mechanism of action and the mediating role played by shame tendencies and ruminative thinking. Methods In May 2021, students from 4 secondary schools in Hefei, Anhui Province were randomly selected as the study population for questionnaire survey. The emotional abuse scale, the shame scale for secondary school students, the regurgitated thinking scale, and the index of insomnia severity scale were used to measure 6 916 secondary school students. Descriptive statistics, correlation analysis and serial mediated effects analysis were performed. Results The results showed that, overall, emotional abuse positively and significantly predicted the current insomnia status in adolescents (β=0.291, P < 0.001). The results of the mediation effect analysis showed that emotional abuse significantly and positively predicted adolescent shame tendencies (β=0.365, P < 0.001), while shame tendencies significantly and positively predicted adolescent insomnia symptoms (β=0.245, P < 0.001), indicating that shame tendencies mediated the relationship between emotional abuse and adolescent insomnia symptoms. Emotional abuse significantly and positively predicted ruminative thinking in adolescents (β=0.183, P < 0.001), while ruminative thinking significantly and positively predicted insomnia symptoms in adolescents (β=0.981, P < 0.001), showing that ruminative thinking mediates the relationship between emotional abuse and insomnia symptoms in adolescents. Meanwhile, shame tendencies significantly and positively predicted ruminative thinking (β=0.433, P < 0.001), demonstrating a chain mediating role of shame tendencies and ruminative thinking between emotional abuse and insomnia in adolescents. Conclusion (1) Emotional abuse is significantly and positively associated with insomnia symptoms in adolescents. (2) Emotional abuse can affect insomnia symptoms in adolescents directly and also through three indirect effects, namely the mediating role of shame tendencies, the mediating role of ruminative thinking, and the chain mediating role of shame tendencies and ruminative thinking. This study reveals the mechanism of emotional abuse on adolescent insomnia and provides a theoretical basis for adolescent insomnia intervention.

Effectiveness and compliance analysis of vonoprazan fumarate combined with targeted health education intervention on patients with chronic atrophic gastritis with positive Helicobacter pylori

SUN Lihong, KONG Fangfang, ZHAO Qi, PAN Jianfeng, PEI Jingbo

2023, 21(3): 458-462. doi: 10.16766/j.cnki.issn.1674-4152.002907

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Abstract:
Objective To explore the effects of vonoprazan fumarate combined with targeted health education intervention on Helicobacter pylori (Hp) eradication rate, gastrointestinal hormones and treatment compliance in patients with Hp positive chronic atrophic gastritis. Methods As a retrospective cohort study, 90 patients with Hp-positive chronic atrophic gastritis admitted to our hospital from January 2020 to September 2022 were selected and divided into observation group and control group according to treatment methods, with 45 patients in each group. Patients in both groups were treated with amoxicillin + pectin ingot + clarithromycin. Patients in the control group were treated with omeprazole to clear Hp and received routine nursing intervention. Patients in the observation group were treated with vonoprazan fumarate combined with targeted health education intervention. The clinical efficacy and Hp clearance after 8 weeks of treatment, the changes of serum motilin (MLT), gastrin 17 (GAS-17) and pepsinogen levels before and after treatment, and the influence of treatment compliance were observed in the two groups. Results The total effective rate of treatment in the control group was 77.78% (35/45), which was significantly lower than that in the observation group [100.00%(45/45), P < 0.05]. The Hp clearance rate in the observation group was 84.44% (38/45), which was significantly higher than that in the control group [68.89% (31/45), P < 0.05)]. After treatment, After treatment, there were statistically significant differences in MLT, GAS-17 and pepsinogen between the two groups (all P < 0.05), the above indexes in the two groups were significantly improved compared with those before treatment (all P < 0.05). The incidence of adverse reactions in the observation group was 4.44% (2/45), which was not significantly different from 8.89% (4/45) in the control group (P > 0.05). The compliance rate of the observation group was 97.78% (44/45), which was significantly higher than 75.56% (34/45) of the control group (P < 0.05). Conclusion Vonoprazan fumarate combined with targeted health education intervention can help to cure Hp infection in patients with Hp positive chronic atrophic gastritis, improve the expression levels of motilin, gastrin 17 and pepsin, and improve treatment compliance, with good safety.

Value of dynamic enhanced imaging radiomics in differentiating benign and malignant parotid gland neoplastic lesions

WANG Yan, QU Yuan, CHEN Jie, TIAN Hui, SHANG Yurong

2023, 21(3): 463-468. doi: 10.16766/j.cnki.issn.1674-4152.002908

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Abstract:
Objective The classification of parotid gland tumors is complex, qualitative analysis of dynamic enhancement scan is difficult to distinguish benign and malignant parotid tumors. To determine the clinical value of dynamic enhanced imaging in distinguishing the benign and malignant parotid gland mass through radiomics analysis of quantitative parameter images. Methods Magnetic resonance images of 51 cases of parotid gland mass confirmed by pathology in People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to April 2022 were retrospectively analyzed, including 12 pleomorphic adenomas, 19 Warthin tumors, 8 malignant tumors, and 15 non-neoplastic lesions. Quantitative parametric maps of transfer constant (K_trans), extracellular volume fraction (V_e), plasma volume fraction (V_p), and outflow rate constant (K_ep) were generated from dynamic enhancement images of parotid gland, and the imaging features were extracted by FAE software to establish a radiomics model for the diagnosis of benign and malignant parotid lesions. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were used to evaluate the radiomics model and assess the efficacy of distinguishing benign and malignant parotid gland lesions. At the same time, pleomorphic adenoma, Warthin tumors and non-neoplastic lesions were separately compared with malignant parotid adenoma in terms of radiomics. Results Feature extraction and radiomics analysis of dynamic enhanced images were performed to determine the efficacy of benign and malignant parotid gland mass. The AUC, accuracy, sensitivity, and specificity were 0.612, 0.844, 0.500 and 0.875, respectively. When pleomorphic adenoma, Warthin's tumor and non-neoplastic lesions were separately compared with malignant parotid tumors, the AUC, accuracy, sensitivity, and specificity were 0.736, 0.781, 0.909, 0.714, and 0.886, 0.880, 0.933, 0.857, and 0.805, 0.781, 0.700, 0.818. Conclusion Radiomics analysis using dynamic enhanced quantitative images can preliminarily determine the benign and malignant parotid gland tumors. The better performance of radiomics is achieved in distinguishing different pathological subtypes of benign parotid tumors, non-neoplastic lesions and malignant parotid tumors.

High frequency ultrasound characteristics of postpartum rectus abdominis separation after delivery and its correlation with delivery mode

YE Xiuqin, PAN Qunyan

2023, 21(3): 469-472. doi: 10.16766/j.cnki.issn.1674-4152.002909

295 5

Abstract:
Objective The ultrasonic characteristics of the rectus abdominis in women with different delivery methods may be different, however, the clinical experience is not rich. Therefore, this study aims to observe the influence of delivery methods on the ultrasonic characteristics of the rectus abdominis in women in the early postpartum period. Methods A total of 200 women who underwent postpartum examinations at Zhuji Maternal and Child Health Hospital from August 2020 to October 2022 were taken as the study subjects. All of them underwent high-frequency ultrasound examination of the rectus abdominis. The incidence of diastasis recti abdominis (DRA) in the study subjects was statistically analyzed. The incidence of DRA, the thickness of the rectus abdominis and the difference of inter-recti distance (IRD) values in different delivery modes, different locations and different conditions were compared. The ultrasound characteristics of the midline abdominis and the echo characteristics of the rectus abdominis in DRA women and non-DRA women were observed. Results Between 6 and 8 weeks postpartum, the overall incidence of DRA in the vaginal delivery group (62.12%, 82/132) was significantly lower than that in the cesarean delivery group (82.35%, 56/68), P < 0.05, and the incidence of DRA in the upper, lower and 3 cm above umbilicus was significantly lower than that in the cesarean group (all P < 0.05). The thickness of rectus abdominis muscle [(0.79±0.11) cm, (1.13±0.18) cm, (0.71±0.09) cm] in the supine, flexed and upright positions of women in the vaginal delivery group were significantly higher than in the cesarean delivery group [(0.68±0.10) cm, (0.98±0.16) cm, (0.64±0.08) cm], all P < 0.05, and the IRD values at different positions in the supine, flexed and upright positions were significantly lower than those in the cesarean delivery group (all P < 0.05). There were statistically significant differences between DRA and non-DRA women in mid-abdominal ultrasound characteristics and rectus abdominis echo characteristics (all P < 0.05). Conclusion The incidence of DRA in the early postpartum period is higher in women who have had a cesarean section than in women who have had a vaginal delivery. The rectus abdominis is thinner, and the IRD is larger. In women with DRA, the midline of the abdomen is wider, and the echo of the rectus abdominis is more enhanced.

Epidemiology Research Progress of Degenerative Disc Disease in Pilots

HENG Wei, QIAN Jixian, ZHOU Chengpei, DU Mingrui, WEI Feilong, ZHU Kailong, QIAN Shu

2023, 21(3): 473-476. doi: 10.16766/j.cnki.issn.1674-4152.002910

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Abstract:
Degenerative disc disease is a common chronic degenerative disease, which is also the primary cause of neck, waist and leg pain. Studies have shown that the intervertebral disc began to degenerate from about 18 years old. In the middle-aged group and elderly, the biochemical composition of the intervertebral disc changes because of the joint influence of internal and external factors, leading to the gradual loss of structure and function, thereby resulting in degenerative diseases. However, investigation results show that the prevalence of degenerative disc disease is higher in pilots, particularly in fighter pilots, and the onset age is earlier than that of ordinary people. In recent years, with the development of aviation technology and the continuous improvement of fighter jets performance, the prevalence of degenerative disc disease in pilots also has been increasing, which has gradually become an important and common disease in pilots. Degenerative disc disease also ranked first amongst the diseases of hospitalisation and of pilots who failed to pass the physical examination. Amongst the diseases, cervical spondylosis and lumbar disc herniation are most common. The changes in spinal physiological curvature are the most common early signs of imaging, which can be used as the basis for diagnosis and intervention. In addition, previous studies have found that intervertebral disc degeneration is related to pilot age, flight duration and type of aircraft flown. Cervical and lumbar back pain caused by degenerative disc diseases has a great impact on the health and mental state of pilots, which is a major problem in the medical and health field of our armed forces. This paper reviews the epidemiological investigation results and characteristics of degenerative disc diseases in pilots, home and abroad in recent 20 years, particularly in high-performance fighter pilots, providing effective basis for the study of disease characteristics, prediction of development trend and implementation of prevention and control strategies.

Atrial fibrillation and erectile dysfunction

LI Dong, WU Qiang, ZHANG Hongliang, BAI Feng

2023, 21(3): 477-480. doi: 10.16766/j.cnki.issn.1674-4152.002911

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Abstract:
Despite advances in health care technology that have reduced mortality rates caused by cardiovascular disease over the years, cardiovascular events continue to be a significant cause of shortened life expectancy in the global population, with men developing the disease at an earlier age than women. Identifying and reducing the risk factors of cardiovascular diseases plays an important role in improving the prognosis of cardiovascular diseases. A good sexual life is also an important part of health. Sexual dysfunction, particularly erectile dysfunction in men, has a high prevalence in the population, which increases progressively with age. Atrial fibrillation (AF) and erectile dysfunction are often coexisting, and they share many similar risk factors, as well as pathophysiological pathways. Erectile dysfunction, as an independent risk factor for cardiovascular diseases, is also important in predicting the occurrence and progression of AF. In addition, erectile dysfunction is an important cause of discontinuation or poor compliance with treatment for cardiovascular diseases. Screening and diagnosis of erectile dysfunction may provide a simple and practical tool for assessing the prognosis of AF. Some therapies for erectile dysfunction have improved vascular endothelial function while improving atrial myocardial blood supply and reducing inflammation levels, with testosterone acting on atrial myocardial membrane ion channels to reduce abnormal spontaneous triggering potentials in atrial myocardium, thereby reducing the risk of AF. The relationship between erectile dysfunction and AF has been increasingly studied, and endothelial dysfunction, inflammation and testosterone deficiency play an important role in the pathogenesis of both conditions, but the exact mechanisms remain unclear. This article provides a review of the effects of erectile dysfunction and related treatments on AF.

Correlation between insomnia and telomere length and aging

PAN Xianli, SU Zengfeng

2023, 21(3): 481-484. doi: 10.16766/j.cnki.issn.1674-4152.002912

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Abstract:
Sleep is a neurochemical process regulated by sleep promotion and arousal centres in the brain. Circadian rhythm stability decreases with age, and the prevalence of sleep disorders increases. Insomnia is the most common sleep disorder, and it affects millions of people and has profound consequences for individuals and society. The sleep pattern, sleep duration and quality of elderly have undergone significant changes, such as sleep fragmentation, early awakening, slow wave sleep reduction and significantly increased incidence of insomnia, compared with those of young and middle-aged individuals. Long-term serious insomnia not only affects the quality of life of patients but also increases the risk of some diseases and mortality. The mechanism of age-related changes in sleep patterns is not fully understood, and whether insomnia is a normal part of aging remains unclear. Telomeres are the ends of eukaryotic chromosomes that protect chromosome ends, maintain genome stability during transcription, and play a central role in the control of cell and body aging. Shortening of telomere length or changes in telomere structure can eventually lead to replicative senescence in cells and chromosomal instability, which are both markers of senescence. Aging is an inevitable consequence of life. In most organisms, the rate of aging is inversely proportional to average life span. Aging is also the biggest risk factor for cancer, neurodegeneration and cardiovascular diseases. Two studies were conducted on the relationship between insomnia and telomere length and aging, however, a systematic review of such studies is lacking. This paper will elaborate three aspects, namely, influence of insomnia on telomere length, significance of telomere length on aging and the effects of insomnia on aging.

General practice thinking and strategy of diagnosis and treatment of undifferentiated diseases

WANG Jianqiang

2023, 21(3): 485-489. doi: 10.16766/j.cnki.issn.1674-4152.002913

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Abstract:
With the improvement of the medical care system and the enhancement of residents' health awareness, the number of patients seeking treatment for undifferentiated diseases or sub-health problems is increasing. This type of problem is different from chronic diseases in the traditional sense. Norms and guidelines in diagnosis and treatment are lacking. General practitioners are arbitrary in handling, and the patients' satisfaction is low. In addition, the quality of medical services is difficult to evaluate, thereby leading to excessive examination and referral, unreasonable consumption of medical resources and an important factor affecting the smooth implementation of graded diagnosis and treatment. Based on relevant research results at home and abroad, this article conducted a review analysis and experience sharing and provided examples of common symptoms of general practice thinking and the significance of improving the general practice system. Analysing the relationship between sub-health and various functional symptoms and psychosocial factors, as well as the different cognitive characteristics of doctors and patients, enriches the connotation of undifferentiated diseases and elaborates the importance of effective treatment of undifferentiated diseases for strengthening primary medical care. Firstly, starting from the characteristics of undifferentiated diseases, the diagnosis ideas that are different from ordinary diseases are discussed: disease risk investigation is conducted by identifying early warning symptoms and combined with the search for symptom-related psychosocial clues to support judgment. With regard to treatment, comprehensive measures such as symptom improvement, lifestyle management and risk monitoring are adopted, and targeted explanations and consultations are used to promote joint decision-making between doctors and patients. Secondly, by establishing a model of the medical treatment behaviour amongst patients with undifferentiated diseases, we illustrate the core position of general practitioners in dealing with such diseases, and the importance of their role as gatekeepers to medical reform. Finally, general practitioners should pay attention to the research and learning of such diseases. In particular, the concepts and methods of clinical medicine, preventive medicine, social behaviour and other disciplines must be comprehensively applied to enhance patient-centred and demand-oriented medical service capabilities.

Effect of wheat grain moxibustion combined with rehabilitation function training on relieving joint pain in patients with degenerative knee arthritis

SUN Xiao, ZHAO Yun, ZHANG Baoan, ZHANG Dundun, LIU Qiang, XIONG Xiaoyun, YANG Man, DUAN Chuntian, LIU Huixing

2023, 21(3): 490-493. doi: 10.16766/j.cnki.issn.1674-4152.002914

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Abstract:
Objective To analyze the effect of wheat grain moxibustion combined with rehabilitation function training on patients with degenerative knee arthritis. Methods A total of 110 patients of degenerative knee arthritis treated in the Third People's Hospital of Henan Province from March 2019 to March 2022 were selected as the research object. They were randomly divided into control group and observation group by random number table method, with 55 cases in each group. The control group was given rehabilitation training on the basis of routine treatment, and the observation group was given wheat grain moxibustion on the basis of the control group. The clinical efficacy was compared between the two groups. Results The visual analogue scale (VAS) score [(3.51±1.62) points vs. (1.76±0.54) points], tumor necrosis factor-α[(29.25±3.17) ng/L vs. (23.75±2.86) ng/L], interleukin-6 [(25.36±2.14) ng/L vs. (17.56±1.57) ng/L], matrix metalloproteinase-1 [(0.75±0.24)ng/L vs. (0.59±0.18)ng/L], cathepsin D[(153.25±28.34) pg/mL vs. (128.32±21.04) pg/mL], matrix metalloproteinase-9 [(15.24±2.54) mg/L vs. (11.05±2.17) mg/L] and matrix metalloproteinase tissue inhibitor-1 [(1.82±0.28) pg/mL vs. (1.54±0.16) pg/mL] in the observation group were lower than those in the control group, and Lysholm knee score [(74.36±7.54) points vs. (82.24±8.25) points], interleukin-10 [(27.82±5.21) ng/L vs. (34.24±6.05) ng/L] and clinical efficacy were higher than those in the control group (P < 0.05). Conclusion Wheat grain moxibustion combined with rehabilitation function training in the treatment of degenerative knee arthritis has a significant effect.

Study on traditional Chinese medicine immersion combined with functional training in the rehabilitation of hand burns in children

YU Fangzhen, ZHANG Jianfen, WU Xiaoxia, BIAN Weixia

2023, 21(3): 494-497. doi: 10.16766/j.cnki.issn.1674-4152.002915

193 4

Abstract:
Objective It is very important to take scientific, systematic and effective postoperative rehabilitation physiotherapy measures for children with hand burn to improve their overall prognosis. This study aims to observe the rehabilitation treatment of traditional Chinese medicine immersion combined with functional training after skin grafting for children with hand burn. Methods A total of 104 children with hand burns who were treated with skin grafting in Zhejiang Quhua Hospital from January 2019 to March 2022 were taken as the study subjects. The children were divided into research group (52 cases) and control group (52 cases) according to the random number table method. The pressure rehabilitation treatment was carried out for the children in the control group, and on the basis of this, the children in the research group were treated with the addition of traditional Chinese medicine immersion and combined with functional training. The numerical rating scale (NRS), face rating scale (FRS) and Vancouver scar scale (VSS) were used to assess the degree of itch, pain and scar symptoms of the injured limb before and after the intervention. The changes of the exercise function of the injured limb such as wrist dorsiflexion mobility, the time of total action motion (TAM) and Jebsen' s hand function test were compared. The recovery level of the injured limb and the overall health condition of the child were also evaluated. Results After the intervention, the scores of NRS, FRS and VSS in the research group [(1.49±0.54) points, (1.59±0.62) points, (4.23±0.56) points] were significantly lower than those in the control group [(2.16±0.61) points, (2.23±0.73) points, (4.97±0.63) points, all P < 0.05]. After the intervention, the degree of back stretching and TAM of the injured limbs in the research group [(68.59±4.93)°, (157.84±6.29)°] were significantly higher than those in the control group [(57.66±4.85)°, (139.71±6.17)°], while the time of Jebsen' s hand function test [(6.14±0.75) min] was significantly shorter than that of the control group [(7.23±0.82) min], all P < 0.05. The excellent recovery rate of the injured limb in the research group was significantly higher than that in the control group (P < 0.05). Conclusion The combination of traditional Chinese medicine immersion and functional training could relieve the itch and pain of the burned hand, improve the aesthetic level of the burned wound healing, and the recovery of the motor function of the injured limb.

Construction of an online and offline blended teaching model for introduction to general practice

PANG Xuerui, ZHAO Lingli, LIU Feng, YANG Xiumu

2023, 21(3): 498-501. doi: 10.16766/j.cnki.issn.1674-4152.002916

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Abstract:
Introduction to General Practice is a professional course for rural-oriented medical students. This course plays a very important role for students to have a deeper understanding of China' s primary care, hierarchical diagnosis and treatment system, and to strengthen their professional knowledge. To further adapt to modern medical education reform and respond rapidly to emergencies such as novel coronavirus pneumonia outbreaks. This research is based on the concept of "putting learning at the center". This study took Introduction to General Practice as the object of reform, combined advanced online teaching technology, reintegrated the curriculum system and incorporated the content of the Civic Education course, and carried out the top-level design of the online and offline blended teaching model. In teaching practice, online teaching is based on simplicity, modularity and efficiency, while offline teaching is based on case-based, interactive and exploratory, and they are closely related and complementary. The results showed that the clever integration of online and offline teaching modes could further reshape the roles of teachers and students in the classroom, and essentially promote the gradual transformation of teaching contents and modes. Moreover, while enriching the internal construction of the curriculum, a suitable formative evaluation system was used to design the layers of teaching links and contents in the evaluation and assessment system, so as to establish the correct knowledge of general medical care for more professional medical students, and to motivate and guide the students' learning initiative, internal drive and competence. Through the preparation before class, implementation during teaching and reflection after class, the teachers motivated themselves to continuously improve their teaching enthusiasm, expand their teaching ideas and pursue educational innovation. The construction of this teaching model is worthy of further learning by more medical faculty.

Application of mind mapping method in epilepsy teaching

ZHU Yingbiao, GUAN Changrong, LYU Jin, CHEN Weikang, HE Ting, LAN Likang

2023, 21(3): 502-504. doi: 10.16766/j.cnki.issn.1674-4152.002917

242 15

Abstract:
Objective To explore the impact of mind mapping approach on trainees' theoretical and practical achievements in epilepsy teaching. Methods A total of 186 students who participated in the training in the Sixth Affiliated Hospital of Wenzhou Medical University from July 2018 to June 2021 were select as the research objects. According to the random number method, the observation group and the control group were distributed equally, with 93 cases in each group. The observation group adopted mind mapping teaching, and the control group adopted traditional lecture-based teaching. The training time was 1 month. All students take the epilepsy theory test and clinical practice assessment before and after the training. The superiority of mind mapping method was verified by comparing results. Results There was no significant difference between the two groups' theoretical scores [(48.4±6.4) points vs. (48.5±5.6) points] and clinical practice scores [(46.8±5.5) points vs. (45.9±5.2) points] before training (both P>0.05). After training, the theoretical scores in the observation group [(68.8±5.5) points vs. (64.5±4.5) points] and clinical practice scores [(74.5±6.9) points vs. (71.7±6.9) points] were higher than those in the control group (both P < 0.001). Both the scores of concept questions [(40.5±3.2) points vs. (38.7±3.1) points] and scores of applied questions [(28.3±5.7) points vs. (25.8±3.3) points] in the observation group were higher than those in the control group (both P < 0.001), and the score ratio of applied questions in the observation group was significantly higher than that in the control group (41.1% vs. 39.9%). Conclusion In the teaching activities of epilepsy, compared with the traditional lecture-based teaching method, the mind mapping method can significantly improve the epilepsy theory and practice performance of regular training trainees, is better in terms of concept mastery and clinical application, more scientific and effective in clinical application, and worthy of promotion and application.

Application of the microlecture-based flipped classroom teaching mode in the teaching of internal medicine nursing

ZHANG Yangli, JANG Nannan, LI Xiuchuan, CHEN Yongxia, LI Jing, XU Guixia

2023, 21(3): 505-508. doi: 10.16766/j.cnki.issn.1674-4152.002918

298 13

Abstract:
Objective To improve the classroom learning effect of nursing students, the flipped topic teaching model based on micro lesson was introduced into the teaching of internal medicine nursing, and the application effect was evaluated. Methods In this study, 120 undergraduate nursing students in the class of 2019 from one university were selected as the research subjects. They were divided into experimental group and control group by random sampling method. The experimental group was taught by micro-lecture based flipped classroom teaching mode, while the control group was taught by traditional teaching mode. Results At the end of the teaching period, the test results showed that the total score in the experimental group (78.55±5.27) was higher than that in the control group (72.20±7.17), and the comprehensive application score in the experimental group (48.40±4.11) was higher than that in the control group [(41.45±5.34), P < 0.05], while, there was no significant difference between the experimental group and the control group in terms of comprehension and memory test scores [(30.15±3.54) points vs. (30.75±4.32) points, P>0.05]. The total score of independent learning ability in the experimental group (323.33±14.16) points was higher than that in the control group (206.00±12.21) points, the difference was statistically significant (P < 0.05), in addition, the scores in the experimental group were higher than those in the control group in all dimensions, the difference was statistically significant (all P < 0.05). Conclusion The microlecture-based flipped classroom teaching mode is conducive for students to establish a comprehensive and systematic curriculum knowledge framework, which fully improves students' independent learning ability, and meanwhile, also consolidates the teaching effect of the class.

Comparison of the effect between closed endotracheal suctioning and open endotracheal suctioning on patients with severe craniocerebral injury: a meta-analysis

WANG Bin, DING Xingxing, SUN Yaohuan, WANG Hui, DONG Yinfeng

2023, 21(3): 509-513. doi: 10.16766/j.cnki.issn.1674-4152.002919

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Abstract:
Objective To systematically evaluate the effects of closed and open endotracheal suctioning on patients with severe craniocerebral injury and provide scientific evidence for their selection. Methods We searched databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP database and China Biology Medicine Disc (CBM), for randomised controlled trials of closed and open endotracheal suctioning on patients with severe craniocerebral injury. Studies were independent selected by two researchers in accordance with the inclusion and exclusion criteria. Then, data were extracted, and the quality of literature was evaluated. Finally, RevMan 5.3 software was used to meta-analysis. Results Seven randomised controlled trials including 462 patients were included. The results of meta-analysis showed that the closed endotracheal suctioning was significantly superior to open endotracheal suctioning in decreasing intracranial pressure during suctioning (MD=-3.46, 95% CI: -4.85 to -2.08, P < 0.001) and at 5 min after suctioning (MD=-3.33, 95% CI: -3.92 to -2.74, P < 0.001), increasing SpO₂ (MD=3.95, 95% CI: 3.28-4.62, P < 0.001) and PaO₂(MD=19.06, 95% CI: 12.97-25.15, P < 0.001), and reducing the incidence of ventilator-associated pneumonia (RR=0.21, 95% CI: 0.10-0.43, P < 0.001). However, no significant influence on intracranial pressure was observed at 15 min after suctioning and on cerebral operfusion pressure during or after suctioning. Conclusion Compared with open endotracheal suctioning, closed endotracheal suctioning is more conductive to stabilising intracranial pressure, SpO₂ and PaO₂ and reducing the incidence of ventilator-associated pneumonia in patients with severe craniocerebral injury.

Caregivers' acceptance of enhanced recovery after surgery and its influencing factors

WANG Bixuan, QU Qingrong, ZHANG Kuanxin, HE Weifang, GAO Yaxin

2023, 21(3): 514-518. doi: 10.16766/j.cnki.issn.1674-4152.002920

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Abstract:
Objective To investigate the status of caregivers' acceptance of enhanced recovery after surgery (ERAS) and analyse the influencing factors from the perspective of patient caregivers themselves and to provide a reference for medical staff to carry out targeted intervention. Methods Data were collected from 165 patient caregivers in a tertiary first-class hospital, and a self-designed questionnaire was used to measure the acceptance of ERAS among them. Total 160 valid questionnaires were collected. Multiple linear regression was used to analyse the influencing factors. Results The total scores of acceptances of ERAS, preoperative preparation, intraoperative treatment and postoperative management of 160 caregivers were (53.16±11.50)points, (17.73±4.42) points, (14.66±2.82) points and (20.77±4.92) points, respectively. The results of multivariate linear stepwise regression analysis showed that age, habitat, culture level, average monthly income and operation history were the main influencing factors of caregivers' acceptance of ERAS concept (B values were -4.074, -2.058, 2.289, 2.922 and -3.020, respectively, all P < 0.05). Age, habitat and operation history were negatively correlated with the acceptance of ERAS, whereas culture level and average monthly incomes were positively correlated with it. Conclusion The acceptance of ERAS among caregivers is at mid-level, but a large difference is observed. The medical staff should be educated on the concept of ERAS according to the characteristics of different caregivers, and take targeted interventions to improve the acceptance of the concept of ERAS by caregivers, so as to select the best treatment scheme for patients and promote their postoperative recovery.

Current situation and correlation analysis between readiness for hospital discharge and continuing nursing needs of patients with pulmonary tuberculosis

YAO Liwei, ZHANG Jinjuan, FU Genlian, LIU Xiaoxia, LIN Lihua, SHI Yan, LANG Yazhen

2023, 21(3): 519-521. doi: 10.16766/j.cnki.issn.1674-4152.002921

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Abstract:
Objective To understand and analyse the current situation of readiness for hospital discharge and continuing nursing needs of patients with pulmonary tuberculosis and to explore the correlation between them, thereby providing basis for effective nursing strategies. Methods A total of 170 eligible patients with tuberculosis from the Tuberculosis Diagnosis and Treatment Centre in Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine from July to October 2020 were selected using convenience sampling. They were investigated on the day of discharge using the social demographic questionnaire, readiness for hospital discharge scale and self-made tuberculosis continuing nursing needs table. Results The total score of the discharge readiness scale of patients with pulmonary tuberculosis was (94.58±14.53) points, and the average score of items was (7.88±1.21) points, which was in the middle level. The total average score of continuing care needs was (4.15±1.07) points, and the overall level was high. The top three continuing care needs included medication guidance (4.52±1.02) points, follow-up and visit guidance (4.40±1.20) points and nutrition and diet guidance (4.22±1.27) points. The total score of discharge readiness and the score of each dimension of patients with pulmonary tuberculosis were negatively correlated with the demand for continuous nursing (r ralue was from -0.646 to -0.511, all P < 0.001). Conclusion The level of discharge readiness of patients with pulmonary tuberculosis must be further improved, and patients with low discharge readiness have high demand for continuous nursing. The overall level of continuing care needs of patients with pulmonary tuberculosis is high, particularly in medication guidance, follow-up and visit guidance and nutrition and diet guidance. Therefore, the nursing strategies during hospitalisation and after discharge should adjust according to patient' s needs.

Risk factors and preventive nursing measures of acute leukaemia complicated with respiratory tract infection in children

WANG Runping, ZHENG Xiaofen, CHEN Yingqiu, CHEN Aiwu, JIN Zhizhi, LI Yuxi

2023, 21(3): 522-525. doi: 10.16766/j.cnki.issn.1674-4152.002922

347 8

Abstract:
Objective To analyse the risk factors of acute leukaemia (AL) complicated with respiratory tract infection in children and to propose preventive nursing measures based on the results, thereby providing reference for clinical treatment. Methods A retrospective analysis was performed on 140 paediatric AL patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from February 2018 to February 2021, who were divided into the respiratory tract infection group (72 cases) and non-respiratory tract infection group (68 cases). Relevant clinical data of the patients were collected to analyse the risk factors affecting children with AL complicated with respiratory tract infection, and the preventive nursing measures were proposed. Results Severe anaemia, white blood cell count >10×10⁹/L or < 2×10⁹/L, platelet < 20×10⁹/L, hypoproteinaemia, prolonged hospital stay, chemotherapy regimen and prophylactic use of antibiotics were the influencing factors of paediatric leukaemia complicated with respiratory tract infection (all P < 0.05). Multivariate logistic regression analysis showed that severe anaemia (OR=2.440, 95% CI: 1.073-5.546), platelet < 20×10⁹/L (OR=1.972, 95% CI: 1.061-3.663), hypoproteinaemia (OR=2.959, 95% CI: 1.115-7.853) and IA chemotherapy regimen (OR=3.799, 95% CI: 1.207-11.957) were independent risk factors for AL complicated with respiratory tract infection in children. Conclusion The risk factors of children with AL complicated with respiratory tract infection include severe anaemia, platelet < 20×10⁹/L, hypoproteinaemia and IA chemotherapy regimen, and preventive nursing measures should be taken in accordance with the above-mentioned risk factors in clinic.

Study on the application of continuity nursing in patients with diabetic retinopathy based on the interactive attainment theory

XU Shaojun, TONG Yuhua, ZHOU Mengling, LIU Jiamin, ZHU Chunyan

2023, 21(3): 526-529. doi: 10.16766/j.cnki.issn.1674-4152.002923

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Abstract:
Objective To observe the effect of continuous nursing based on the interactive attainment theory on blood glucose levels, self-management ability and quality of life in patients with diabetes retinopathy (DR). Methods A total of 92 patients with DR who were treated at the Quzhou Hospital of Wenzhou Medical University from June 2020 to July 2021 were selected and divided into 2 groups of 46 cases each, according to the order of the files. The control group received regular nursing care, and the experimental group received continuity nursing based on the interactive standard theory. Both interventions were continued for 1 year. Changes of visual acuity, blood glucose, self-management ability, visual function and quality of life were compared between the 2 groups. Results After the intervention, the visual acuity decline rate in the experimental group was 2.17% (1/46), which was significantly lower than 17.39% in the control group (8/46, χ²=4.343, P=0.035); After the intervention, the fasting blood glucose and 2 h postprandial blood glucose levels in the experimental group were (5.74±0.66) mmol/L, (9.35±0.92) mmol/L respectively, which were lower than those in the control group [(6.79±0.87) mmol/L, (11.41±1.00) mmol/L, t=6.521, 10.282, both P < 0.001]. After the intervention, scores for diet, exercise, medication according to medical advice, blood glucose monitoring and foot management were higher in the experimental group than those in the control group (all P < 0.01). Except for eye pain and color perception, all quality of life scores related to visual function were higher in the experimental group than in the control group (all P < 0.01). Conclusion The continuity nursing based on the theory of interactive standard can improve self-management ability, blood glucose control and visual acuity and quality of life for patients with DR.

Effect of bio-wave acupoint stimulation combined with emotional nursing of traditional Chinese medicine on recovery in patients with post-stroke depression

MAO Yadi, SUN Jianhong, LIU Lanbing, MA Lan, XIANG Songfei, HUANG Chunmin, YUAN Zigang

2023, 21(3): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.002924

241 8

Abstract:
Objective To analyze the effect of bio-wave acupoint stimulation combined with traditional Chinese medicine (TCM) emotional nursing on the depressive status, quality of life and rehabilitation compliance in patients with post-stroke depression. Methods A convenience sampling method was used to select 120 patients with post-stroke depression (PSD) admitted to Shaoxing People' s Hospital from June 2020 to May 2022 as the research objects, and the patients were divided into control group (60 cases) and observation group (60 cases) according to the random number table method. The control group received routine nursing, while the observation group received bio-wave acupoint stimulation combined with TCM emotional nursing. The Hamilton depression scale (HAMD), modified barthel index (MBI), stroke specific quality of life scale (SS-QOL) and rehabilitation compliance scale were used to evaluate the two groups of patients before the intervention and at the first, second and third weeks after the intervention. Results After the intervention, the HAMD scores of patients in both groups were lower than that before intervention, and the HAMD scores in the observation groups were (22.52±1.87) points, (15.16±2.62) points and (10.24±1.78) points at the first, second, and third weeks after intervention, respectively, which were lower than in the control group [(24.16±2.64) points, (19.22±2.97) points, (15.34±2.13) points, all P < 0.05]; The MBI and SS-QOL scores in both groups were higher than those before the intervention, and the MBI and SS-QOL scores in the observation group were higher than those in the control group at the 1st, 2nd and 3rd weeks after the intervention (all P < 0.05); The rehabilitation compliance in the observation group was 96.7% (58/60), which was better than that in the control group [83.3% (50/60), P < 0.05]. Conclusion Bio-wave acupoint stimulation combined with TCM emotional nursing can effectively reduce depression in patients with post-stroke depression, improve their daily life and ability, quality of life and rehabilitation compliance.

Treatment of coronavirus disease 2019 complicated with acute heart failure of a super-elderly patient: a case report and literature review

HUANG Huifeng, YU Min, ZHOU Ren

2023, 21(3): 534-538. doi: 10.16766/j.cnki.issn.1674-4152.002925

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In the spring of 2022, a pandemic outbreak of the Omicron variant of SARS-CoV-2 occurred in Shanghai. The vaccination rate is low among elderly patients with various chronic underlying diseases, making them susceptible and prone to critical illnesses. Therefore, the treatment of elderly patients has become one of the difficulties in the clinical management of coronavirus disease 2019. This paper reported a case of a super-elderly patient diagnosed with coronavirus disease 2019 complicated with acute heart failure, whose disease progressed from mild to severe. We analysed the reliable aetiology and clinical features of the case and shared the gains and losses in the treatment of elderly patients with severe coronavirus disease 2019 in a primary care hospital. We planned to provide an important experience for the treatment of patients with coronavirus disease 2019 combined with cardiovascular complications.

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2023 Vol. 21, No. 3

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