2023 Vol. 21, No. 9

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Expert Forum
Study on the application of indicator system for evaluating the informatization level of grassroots healthcare
WU Hui, WENG Huifen, LIU Bao, ZHAO Yanping
2023, 21(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.003143
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  Objective  To study the application of an indicator system for evaluating the informatization level of grassroots healthcare of the M District of Shanghai and verify the feasibility and robustness of the indicator system.  Methods  As the early stage, an indicator system had been constructed for evaluating the informatization level of grassroots healthcare through the literature research and expert consultation. According to the different digitalization levels, three community healthcare centers (C1, C2 and C3) with different informatization levels in the M district of Shanghai were selected, and the data related to the indicator system were collected. Comprehensive evaluation model, weighted TOPSIS, and weighted rank-sum ratio (RSR) were used to analyze the data. The higher comprehensive score showed the better development of health digitalization level. As the weighted TOPSIS method, according to the degree to which the evaluation object and the idealized targets were close to each other, if a feasible solution was the closest to the ideal solution, it means that the evaluation object was closer to the optimal level. While the weighted RSR method was a non-parametric evaluation method which considered the relative magnitude of the indicators to be evaluated, and the larger the magnitude was, the better the evaluation object was.  Results  There were certain differences in the informatization level of the 3 community healthcare centers (C1, C2 and C3) in M District of Shanghai, with comprehensive scores of 81.997, 73.080 and 82.142, respectively. The weighted TOPSIS method ranked C3, C1, and C2 from good to bad. The weighted RSR method results showed that C3 was at the top class, while C1 and C2 were both at the middle class. The evaluation results of the three methods were positively correlated (P < 0.05), implying good consistency.  Conclusion  The empirical results suggested the feasibility and robustness of the indicator system constructed for evaluating the informatization level of grassroots healthcare.
Special Topic/New exploration of organ preservation in urinary tumor
Clinical diagnosis, treatment and analysis of 71 cases of chromophobe renal cell carcinoma in a single center
LI Yu, XIANG Ping, KONG Lingquan, HUANG Tao
2023, 21(9): 1453-1456. doi: 10.16766/j.cnki.issn.1674-4152.003144
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  Objective  To investigate the clinical features, pathological features, surgical efficacy and prognosis of chromophobe renal cell carcinoma (chRCC), and to improve the level of diagnosis and treatment of this disease.  Methods  Clinical and follow-up data of 71 patients with chRCC from the First Affiliated Hospital of University of Science and Technology of China from June 2015 to March 2023 were retrospectively analyzed. Clinical experience was summarized. Meanwhile, the perioperative indexes of the partial nephrectomy (PN) group and the radical nephrectomy (RN) group were compared.  Results  There were 26 cases of PN and 45 cases of RN in 71 patients with chRCC. There were 24 cases of T1a, 31 cases of T1b, 12 cases of T2a, and 4 cases of T2b. CT mainly showed isodense or slightly low-density solid space occupying in the kidney, light and moderate enhancement in the arterial phase, and the enhancement degree was lower than the renal parenchyma, showing a slowly increasing state, and the enhancement degree in the venous phase and the delayed phase slowly decreased. Among 65 cases, 61 cases were positive for CD117 staining, and 1 case was weakly positive. Among 69 cases, 62 cases were positive for CK7 staining, and 1 case was weakly positive. Vimentin staining was negative in 54 of 60 cases. Among 44 cases, 33 were positive for colloidal iron staining and 8 were weakly positive. Seventy cases of Ki-67 were all positive, with a median Ki-67 value of 4.5%. There were no statistically significant differences in age, preoperative creatinine clearance (Ccr), intraoperative blood loss, postoperative hemoglobin decline, postoperative albumin decline, drainage indent time and postoperative hospital stay between PN and RN groups (all P > 0.05). The postoperative Ccr in PN group was significantly better than that in RN group, and the maximum tumor diameter and T stage in PN group were lower than those in RN group (all P < 0.05). Sixty-eight patients were followed up successfully, and all of them were tumor free until the end of follow-up.  Conclusion  chRCC is a rare, low malignant and low invasive subtype of renal cell carcinoma with good prognosis. It has unique CT imaging findings and can be confirmed by routine pathology and immunohistochemistry. PN is superior to RN in renal function protection, and PN is a safe and effective surgical method for treating chRCC at T1 stage.
Risk factors analysis and clinical significance of acute kidney injury after laparoscopic nephron sparing surgery
WU Ying, ZHANG Yue, QIAN Weiwei, SUN Xin, MA Jiaxing, YU Dexin, ZHANG Tao
2023, 21(9): 1457-1460. doi: 10.16766/j.cnki.issn.1674-4152.003145
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  Objective  To investigate the risk factors of postoperative acute kidney injury (AKI) after laparoscopic nephron sparing surgery (LNSS) in renal tumor patients.  Methods  Clinical data of 442 patients who received LNSS in Urology Department of the Second Affiliated Hospital of Anhui Medical University from January 2010 to September 2022 were retrospectively analyzed. The diagnosis of AKI according to the 2012 kidney disease improving global outcomes standard. Patients were divided into AKI group and non-AKI group according to whether they had postoperative AKI. Clinical parameters of the two groups were collected, including general data, preoperative blood and urine biomarker data, renal artery clamping time, maximum tumor diameter, pathology results, RENAL score, etc. The risk factors for AKI after LNSS were analyzed by univariate and multivariate logistic regression.  Results  There were 129 patients with postoperative AKI, with an incidence of 29.2% (129/442), including 115 patients (89.2%) with stage Ⅰ AKI, 12 patients (9.3%) with stage Ⅱ AKI and 2 patients (1.5%) with stage Ⅲ AKI. The univariate analysis showed that there were significant differences in body mass index (BMI, P=0.018), preoperative coronary heart disease (P=0.042), serum cystatin C (CysC) level (P=0.004), renal artery clamping time (P=0.006), surgery time (P < 0.001), maximum tumor diameter (P=0.003), and RENAL score (P < 0.001) between the two groups (all P < 0.05). Multivariate logistic regression analysis showed that preoperative coronary heart disease (P=0.042), high serum CysC level (P=0.013), long surgery time (P=0.004) and high RENAL score (P < 0.001) were independent risk factors for AKI after LNSS.  Conclusion  The risk factors of AKI after LNSS include BMI, preoperative coronary heart disease, serum CysC level, renal artery clamping time, surgery time, maximum tumor diameter, and RENAL score. For renal tumor patients with the above risk factors, special attention and coping strategies should be given before LNSS.
Effect analysis of laparoscopic partial nephrectomy combined with modified renal artery perfusion in the treatment of complex renal tumors
WANG Jinhang, GUO Yuanyuan, SUN Wei, GAO Wuyue, LIU Jianmin, LIU Beibei
2023, 21(9): 1461-1465. doi: 10.16766/j.cnki.issn.1674-4152.003146
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  Objective  To evaluate the safety, feasibility and short-term efficacy of laparoscopic partial nephrectomy (LPN) combined with modified renal artery perfusion in the treatment of complex renal tumors.  Methods  Fifty patients with complex renal tumors treated with LPN in the Department of Urology of the First Affiliated Hospital of Bengbu Medical College from October 2021 to October 2022 were selected, in which LPN combined with modified renal artery cryogenic perfusion was used as the study group (20 cases), and not combined with modified renal artery cryogenic perfusion was used as the control group (30 cases). Operation related indexes, renal function indexes and complications were compared between the two groups. H&E staining were performed on the slices of normal kidney tissues adjacent to the tumor to observe the changes of ischemia and hypoxia under the microscope.  Results  Compared with the control group, the decrease of total GFR and GFR on the affected side of renal function index in the study group after operation were lower [(8.81±2.50) mL/min vs. (14.48±2.90) mL/min, (9.37±2.50) mL/min vs. (14.38±1.80) mL/min, P < 0.01]. The intraoperative renal temperature and blood loss in the study group were significantly lower than those in the control group [(21.18±2.34) ℃ vs. (32.48±1.13) ℃, (105.00±30.17) mL vs. (141.30 ±57.00) mL, all P < 0.05]. Pathological score of microscopic tissue inflammatory changes in the study group was significantly lower than that in the control group [(2.98±0.66) points vs. (4.07±0.66) points, P < 0.05], the expression of IL-18 and NAG in the study group was lower than that in the control group in immunohistochemistry. There were no significant differences in cold perfusion/renal artery occlusion time, body temperature, operation time and postoperative hospital stay between the two groups (all P>0.05).  Conclusion  LPN combined with modified renal artery perfusion can reduce blood loss, reduce inflammation and protect renal function in the treatment of complex renal tumors.
General Practice Research
Analysis of long-term prognostic factors in patients with acute pulmonary embolism
WANG Hang, XU Qixia, LI Xiaoqing, WANG Yueyue
2023, 21(9): 1466-1469. doi: 10.16766/j.cnki.issn.1674-4152.003147
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  Objective  To analyze the clinical data and laboratory tests of patients with acute pulmonary embolism (APE) in different conditions, explore the influencing factors of adverse events in patients with APE, and carry out reasonable treatment to improve the prognosis.  Methods  A single center of the First Affiliated Hospital of Bengbu Medical College enrolled 202 patients with APE in the national "Twelfth Five-Year Plan" and "Thirteenth Five-Year Plan" registration studies from May 2012 to June 2019, of which 191 patients completed at least 6-month follow-up, and 146 patients completed 3-year follow-up. The follow-up outcome was all-cause mortality. Univariate and multivariate regression were used to analyze the impact of clinical data and laboratory indicators on the long-term prognosis of patients.  Results  A total of 191 patients were followed up at 6 months after diagnosis: 164 cases survived and 27 died. Multivariate COX regression showed that underlying disease of malignancy or chronic cardiopulmonary disease had a significant effect on APE 6-months prognosis (short-term prognosis, P < 0.05). Totally 146 patients completed the 36-month follow-up, 111 survived and 35 died. Multivariate COX regression showed that the combination of malignant tumors, chronic cardiopulmonary diseases, and low serum albumin levels had a significant impact on the 36-month prognosis of patients. The independent risk factors for the long-term prognosis of APE included combination of malignant tumors, chronic cardiopulmonary diseases, and low serum albumin levels.  Conclusion  The combination of malignant tumors, chronic cardiopulmonary diseases, and low serum albumin levels are independent factors affecting the long-term prognosis of pulmonary embolism. Combination of malignant tumors and chronic cardiopulmonary diseases, both long-term and short-term prognosis are poor. Low serum albumin level is an adverse factor for long-term prognosis in acute pulmonary embolism.
Correlation between multiple chronic conditions and long-term heart failure after acute myocardial infarction
CHEN Zhiqian, YE Xinying, QIAN Yan, GONG Kaizheng, ZHAO Pei
2023, 21(9): 1470-1473. doi: 10.16766/j.cnki.issn.1674-4152.003148
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  Objective  To analyze the incidence of long-term heart failure (HF) in patients with acute myocardial infarction (AMI), and explore the correlation between multiple chronic conditions (MCC) with it.  Methods  An analysis was performed on 355 patients with AMI hospitalized in the Department of Cardiology of Affiliated Hospital of Yangzhou University from January 2016 to December 2018. Patients were divided into HF group (149 cases) and non-HF group (206 cases) according to the outcome, with a median follow-up of 43.0 months. The baseline data of the two groups were retrospectively analyzed. Kaplan-Meier analysis and Cox regression analysis were used to evaluate the role of MCC in long-term HF in patients with AMI. The Cochran-Armitage trend test was used to analysis the relationship between the number of coexisting diseases and the incidence of long-term HF in AMI patients.  Results  (1) Patients in the HF group were older, with lower left ventricular ejection fraction, and had higher GRACE scores and proportion of MCC. The proportion of MCC in the HF group was 1.6 times higher than that in the non-HF group. (2) Age (HR=1.024, 95% CI: 1.003-1.045), low left ventricular ejection fraction (HR=0.963, 95% CI: 0.946-0.980), GRACE scores (HR=1.011, 95% CI: 1.004-1.018) and MCC (HR=1.517, 95% CI: 1.073-2.146) were independent influence factors for long-term HF in AMI patients. (3) The cumulative incidence of HF after AMI was significantly higher in patients with MCC than that in patients without MCC (P < 0.05). (4) There was a positive correlation between the incidence of distant HF and the number of coexisting diseases in AMI patients (P < 0.05).  Conclusion  MCC is an independent risk factor for long-term HF in patients with AMI, which has predictive value for the occurrence of long-term HF in AMI patients, and the incidence of long-term HF after AMI increases with the number of coexisting diseases.
Investigation of the downstream target gene network regulated by KDM5A using ChIP-seq in Cardiac fibroblasts
WEI Ting, QI Xianjie, ZHANG Xu, WANG Yatao, JIANG Yiyao, SHI Chao
2023, 21(9): 1474-1477. doi: 10.16766/j.cnki.issn.1674-4152.003149
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  Objective  To investigate the potential mechanism of KDM5A in regulating the biological function of cardiac fibroblasts.  Methods  Cardiac fibroblasts from patients with myocardial fibrosis were isolated and cultured, chromatin immunoprecipitation sequence (ChIP-seq) was performed to analyze immunoaffinity separation of specific binding DNA fragments with KDM5A for sequence identification, differentially expressed genes (DEGs) were screened for gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis.  Results  The binding peak of KDM5A in the gene promoter region, intron region, and exon region accounted for 14.59%, 44.14% and 1.84%, respectively. Among them, the proportion of ≤1 kb, >1-2 kb and >2-3 kb promoter regions were 5.91%, 4.56% and 4.12%, respectively. The binding ratio of KDM5A to the first intron region and other intron regions were 12.19% and 31.95%, respectively. The distribution of KDM5A binding peaks relative to the transcription start site (TSS) was mainly concentrated at -3 to 3 kb, and the reads count frequency was the highest at the TSS coordinates -1.0 kb and 2.5 kb. Homer software was applied to identify 20 motifs that bind to KDM5A, including FOXE1, PB, ZNF460, etc. GO functional annotation analysis suggested that the KDM5A binding genes were involved in the regulation of cell morphogenesis, axon development, regulation of neuron projection development, plasma membrane protein complex, cation channel, actin cytoskeleton, metal ion transmembrane transporter activity, cation transmembrane transporter activity and GTP enzyme binding, etc. The KEGG signaling pathway enrichment results showed that KDM5A-related genes were significantly enriched in the phospholipase D signaling pathway, cholinergic synapse, calcium signaling pathways, Wnt signaling pathway, growth hormone synthesis, secretion and action, insulin secretion, ErbB signaling pathway and Rap1 signaling pathways, etc.  Conclusion  KDM5A regulates the transcription expression of genes and the expression of signal pathways, thereby affecting the function of cardiac fibroblasts and participating in the onset and development of myocardial fibrosis.
Sedentary behavior and its influencing factors among patients with colorectal cancer
ZHU Chunjing, CHEN Niaoniao, WANG Shaoyan, MA Xiangwei, TENG Yangyang, WANG Chaoling
2023, 21(9): 1478-1481. doi: 10.16766/j.cnki.issn.1674-4152.003150
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  Objective  To understand the status and influencing factors of sedentary behavior among patients with colorectal cancer, and to provide reference for the formulation of targeted interventions.  Methods  A total of 201 patients with colorectal cancer in two Grade A tertiary hospital in Wenzhou were selected by convenience sampling method and investigated with the questionnaire. The general information characteristics, sedentary behavior, social support and psychosomatic symptoms of the patients were investigated using the general information questionnaire designed by the research team, the Chinese version of the international physical activity questionnaire (IPAQ), social support rate scale (SSRS), and Edmonton symptom assessment scale (ESAS).  Results  A total of 217 patients with colorectal cancer were investigated in this study, and 201 questionnaires were effectively collected. The total score of sedentary behavior among patients with colorectal cancer patients was (8.69±2.40) h. Univariate analysis showed that there were statistically significant differences in the sedentary behavior scores of colorectal cancer patients with different gender, occupational status, education level, family monthly income, living style, TNM stage and whether stoma (all P < 0.05). Multivariate regression analysis showed that degree of education, stoma, fatigue, depression and social support were the influencing factors of sedentary behavior among patients with colorectal cancer.  Conclusion  The sedentary behavior of patients with colorectal cancer is at a high level. The patients with low education level, stoma, fatigue, depression and low levels of social support are prone to experience sedentary behavior. In the future, cognitive behavioral therapy and remote wearable devices can be combined to develop targeted interventions to reduce sedentary behavior of patients.
Application of modular systematic lymph node dissection in uniportal thoracoscopic radical resection for stage Ⅰ non-small cell lung cancer
GONG Huiyuan, XING Fubao, LI Chen, LI Xiaojun, GENG Yang, CHEN Pengfei
2023, 21(9): 1482-1486. doi: 10.16766/j.cnki.issn.1674-4152.003151
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  Objective  To optimize the process of systematic lymph node dissection in single-port video-assisted thoracoscopic radical resection of non-small cell lung cancer and evaluate the clinical application effect and safety.  Methods  From October 2020 to October 2022, 100 patients who underwent single-port thoracoscopic radical resection of non-small cell lung cancer at the Thoracic Surgery Department of the First Affiliated Hospital of Bengbu Medical College, were selected as the research subjects. They were then divided into study group and control group according to different ways of lymph node dissection, with 50 cases in each group. The study group used a modular approach to systematic lymph node dissection. In the control group, systematic lymph node dissection was performed routinely during the operation. Evaluation indicators included the number of dissected mediastinal lymph nodes, operation time, intraoperative blood loss, postoperative drainage volume, chest tube indwelling time and postoperative hospital stay. The application of two lymph node dissection techniques in single-port thoracoscopic radical resection of lung cancer was compared.  Results  The number of dissected mediastinal lymph nodes in the study group (7.6±0.9) was significantly better than that in the control group (7.2±1.0), and the difference was statistically significant (P < 0.05). The operation time of the study group [(103.8±9.9) min] was significantly shorter than that of the control group [(121.4±9.3) min], and the intraoperative blood loss [(77.5±9.2) mL], postoperative drainage volume [(268.1±16.4) mL], chest tube indwelling time [(3.4±0.9) d] and postoperative hospital stay[(4.0±1.0) d] were all less than those of the control group [(84.9±11.8) mL, (304.9±18.3) mL, (4.8±1.1) d, (5.4±1.1) d], and the differences were statistically significant (all P < 0.05).  Conclusion  In single-port thoracoscopic radical resection of non-small cell lung cancer, systematic lymph node dissection using modular procedures can shorten the operation time, reduce postoperative drainage volume and chest tube indwelling time, help patients recover quickly, and is worthy of clinical application with good safety.
Application of tooth supported guide plate combined with navigation technology in the treatment of mandibular fracture
HONG Xiao, ZHAN Zhaojun, CHEN Yongfeng, LIAO Shengkai, ZHOU Jing
2023, 21(9): 1487-1490. doi: 10.16766/j.cnki.issn.1674-4152.003152
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  Objective  To compare two methods of open incision and internal fixation for mandibular fractures and to explore the application value of tooth-supported guidesin combination with navigation technology.  Methods  Sixty patients with mandibular fracture admitted to the Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College from January to June 2022 were selected, excluding multiple injuries of the whole body. According to the random number table, they were divided into A group and B group, with 30 cases in each group. Three-dimensional maxillofacial CT and oral panoramic films were taken before and one week after surgery. The operation was performed by a chief surgeon, and the data analysis and navigation software was AccuNavi-A 2.1. The patients in group A were treated with open incision and internal fixation guided by tooth support template combined with navigation, and the patients in group B were treated with traditional open incision and internal fixation. The maximum and average deviation distance between the two images were measured by fitting the three-dimensional CT images of the maxillofacial region after surgery and the preoperative and postoperative simulated reduction. The patients were reviewed 3 months after surgery to evaluate the therapeutic effect of the two methods.  Results  The operation of the two groups was successfully completed, with good postoperative wound healing, normal facial shape and occlusal relationship, and no complications occurred. In group A, the maximum deviation was (1.47±0.18) mm and the average deviation was (1.09±0.12) mm after fitting the preoperative simulation design and postoperative reconstruction images. In group B, the maximum deviation distance was (3.05±0.40) mm, and the average deviation distance was (2.57±0.28) mm. The maximum deviation value and mean deviation value of group B were greater than those in group A, and the difference was statistically significant (all P < 0.05). At 3 months after operation, the function and physical evaluation of patients in both groups was excellent.  Conclusion  Compared with the traditional open incision and internal fixation, the open incision and internal fixation of mandibular fracture guided by tooth supported guide plate and navigation technology can shorten the operation time, improve the accuracy of the operation, with good clinical treatment effect, and has the value of promotion.
Study on correlation between serum hypersensitive C-reactive protein and nonalcoholic fatty liver disease in the elderly
CHEN Changxi, DU Juan, SONG Jian, ZHANG Cheng, LI Mengting, LI Hongliang
2023, 21(9): 1491-1494. doi: 10.16766/j.cnki.issn.1674-4152.003153
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  Objective  To investigate the relationship between serum hypersensitive C-reactive protein (hs-CRP) and nonalcoholic fatty liver disease (NAFLD) in the elderly, and provide the basis for prevention and treatment of NAFLD.  Methods  A total of 2 124 senior citizens aged 60 and above in a petrochemical enterprise in Zhenhai District, Ningbo City were investigated from March to November 2013, and their waist circumference, body mass index, blood pressure, fasting blood glucose, uric acid, blood lipid profile, liver function, hs-CRP and upper abdominal B-ultrasound were measured. Groups were categorized by quartiles of hs-CRP levels as follows: group Q1 (≤0.4 mg/L, n=667), Q2 (>0.4 mg/L-≤0.7 mg/L, n=437), Q3 (>0.7 mg/L-≤1.4 mg/L, n=515), and Q4(>1.4 mg/L, n=505). The risk factors of NAFLD were analyzed by logistic regression.  Results  The prevalence of NAFLD in the elderly was 25.8% (548/2 124), and with the growth of age, the prevalence rate gradually decreases (P < 0.05). The prevalence of NAFLD in Q1, Q2, Q3 and Q4 groups were 13.2%(88/667), 24.5%(107/437), 32.6%(168/515) and 36.6% (185/505), respectively, and the prevalence gradually increased (χ2=99.246, P < 0.001). Multivariate unconditional logistic regression analysis showed that elevated serum hs-CRP was an independent risk factor for NAFLD in the elderly. The prevalence of NAFLD in Q2, Q3 and Q4 groups before the adjustment of the relevant factors were 2.133, 3.185, 3.804 times of Q1, and 1.554, 1.828, 1.895 times of Q1 group after the adjustment of the relevant factors.  Conclusion  Elevated serum hs-CRP is an independent risk factor for NAFLD in the elderly.
Characteristics and drug resistance of Pseudomonas aeruginosa infection in a general hospital
WANG Li, CUI Zhuo, GUO Pu, ZHANG Xiangjun, ZHU Jingrui
2023, 21(9): 1495-1497. doi: 10.16766/j.cnki.issn.1674-4152.003154
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  Objective  To study the clinical distribution characteristics and drug resistance changes of Pseudomonas aeruginosa infection in hospital, so as to provide basis for prevention and control of hospital infection and rational use of antibacterial drugs.  Methods  The distribution and drug resistance of Pseudomonas aeruginosa in hospitalized patients from January 2019 to December 2021 were searched by electronic medical record system and hospital infection real-time monitoring system. The relevant data were statistically analyzed by Whonet 5.6 software and SPSS 25.0.  Results  A total of 1 106 strains of non-duplicated Pseudomonas aeruginosa were detected in hospitalized patients from 2019 to 2021, with the highest detection rate in intensive care units (25.68%), followed by emergency departments (9.22%) and respiratory departments (8.23%). Among all kinds of samples submitted for examination, respiratory tract samples accounted for 63.02%, followed by pus (9.40%) and urine samples (3.44%). The detected Pseudomonas aeruginosa showed different degrees of resistance to commonly used clinical antimicrobials, with the highest resistance rate being ciprofloxacin (37.79%) and the lowest resistance rate being amikacin (18.90%). The resistance rate to imipenem and ciprofloxacin exceeded 30% for 3 consecutive years. The resistance rates to cefepime, aztreonam, tobramycin, gentamicin and amikacin showed a downward trend, and the differences in resistance rates during the three years were statistically significant (all P < 0.05). The fluctuation of levofloxacin and ciprofloxacin resistance rate during three years was statistically different (P < 0.05).  Conclusion  The infection of Pseudomonas aeruginosa is mainly distributed in the intensive care unit, mainly respiratory tract infection, and the resistance rate to common clinical antibiotics shows different trends in the past 3 years. Carbapenem-resistant Pseudomonas aeruginosa strains are still one of the focuses of clinical attention. In the future clinical work, it is necessary to continuously monitor the prevalence and drug resistance of Pseudomonas aeruginosa in order to provide effective basis for infection prevention and control.
Effect of multidimensional cardiac rehabilitation model on prognosis and Lp-PLA2 in patients with acute myocardial infarction after PCI
HU Yemei, SHAO Shengsheng, ZHANG Yawen, TANG Hui, LI Jun, SHANG Zhuo
2023, 21(9): 1498-1502. doi: 10.16766/j.cnki.issn.1674-4152.003155
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  Objective  To investigate the effects of multidimensional cardiac rehabilitation model on cardiac function, quality of life and plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).  Methods  A total of 234 AMI patients who underwent PCI in the Second People' s Hospital of Bengbu from January to October 2021 were selected and divided into control group and observation group according to the random number table method, with 117 cases in each group. The control group received general cardiac rehabilitation model intervention, and the experimental group received multidimensional cardiac rehabilitation model intervention. Cardiac function, including left ventricular ejection fraction (LVEF), six-minute walking distance (6MWD), major adverse cardiovascular events (MACE), 36-item short-form (SF-36) score, patient health questionnaire-9 (PHQ-9) score and Lp-PLA2 level were compared between the two groups before intervention, 6 months and 12 months after intervention.  Results  After 6 months and 12 months of intervention, the LVEF and 6MWD of the two groups were higher than those before intervention, and the indexes of the experimental group were significantly better than those of the control group (all P < 0.05). The SF-36 scores of the two groups were higher than those before intervention, the PHQ-9 scores were lower than those before intervention, and there was significant difference between the experimental group and the control group (all P < 0.05). After intervention, the level of Lp-PLA2 in the experimental group was significantly lower than that in the control group (282.54±21.82 vs. 318.66±12.89, t=243.340, P < 0.001).  Conclusion  The multidimensional cardiac rehabilitation model after PCI in AMI patients can reduce the risk of atherosclerotic plaque rupture, effectively improve their cardiac function, reduce adverse cardiovascular events, and improve their quality of life.
General Clinical Research
Construction and validation of a predictive model for the risk of intracranial infection in patients after decompressive craniectomy
YANG Chenjie, CHEN Hui, GUO Chunfeng, ZHOU Chenhui
2023, 21(9): 1503-1507. doi: 10.16766/j.cnki.issn.1674-4152.003156
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  Objective  To analyze the risk factors for intracranial infection in patients after decompressive craniectomy (DC), to construct a risk prediction model for intracranial infection in DC patients, and to conduct internal and external validation of the model.  Methods  The 61 DC patients who had intracranial infections in the neurosurgery department of a tertiary care hospital from January 2020 to September 2021 were retrospectively analyzed and included in the infection group, and 122 DC patients of the same department and similar age who did not have intracranial infections were selected according to the ratio of 1:2 to be included in the non-infection group for a case-control study, and the column line graph model was established and internally validated by applying R software using univariate analysis and multi-factor logistic regression analysis. Sixty-one clinical data of patients receiving DC from January to December 2019 were selected for external validation of the model.  Results  The incidence of intracranial infection in the modeled group of patients was 33.3% (61/183). Logistic regression analysis showed that surgery time (OR=1.006, P=0.039), hematoma size (OR=1.037, P=0.004), ICU stay (OR=1.092, P=0.004), cerebral hemorrhage (OR=16.128, P=0.019), traumatic brain injury (OR=18.100, P=0.028), and brain tumor (OR=44.286, P=0.003) were independent risk factors for intracranial infection in DC patients. The column line graph model was developed accordingly, and the model AUC was 0.863 (95% CI: 0.760-0.967), and the external validation results showed an AUC of 0.933 (95% CI: 0.862-1.000) for the model.  Conclusion  The longer the surgery time, the larger the hematoma, the longer the ICU stay, the history of cerebral hemorrhage, the history of traumatic brain injury, and the history of brain tumor, the higher the risk of intracranial infection in DC patients. The prediction model of intracranial infection in DC patients constructed in this study has good accuracy and has some clinical application value.
Efficacy and safety of lupatadine combined with LED-LLLT yellow light in the treatment of facial hormone-dependent dermatitis
YAN Yan, SUN Wei, ZHAO Lian, YANG Chunsheng
2023, 21(9): 1508-1511. doi: 10.16766/j.cnki.issn.1674-4152.003157
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  Objective  The treatment effect of facial hormone-dependent dermatitis is limited and the short-term recurrence rate is high. This study discussed the efficacy and safety of lupatadine combined with LED yellow light treatment in order to find an effective and safe treatment method.  Methods  A total of 96 patients with facial hormone-dependent dermatitis treated in Huaibei Miners General Hospital from October 2018 to September 2021 were selected as research objects and randomly divided into study group and control group, with 48 cases in each group. The control group was irradiated with LED-LLLT yellow light 15 min/time, once every other day, and the study group was combined with lupatadine tablets 10 mg once a day on the basis of yellow light therapy. The course of treatment was 4 weeks. After treatment, the total effective rate, improvement of subjective and objective symptoms, quality of life of skin diseases, adverse reactions and recurrence rate 1 month later were compared between the two groups.  Results  After treatment, the total effective rate of the study group was 87.23%(41/47), which was significantly higher than that of the control group (31/46, 67.39%, P=0.022). The total score of subjective and objective symptoms in the study group [7.0(4.0, 10.0) points] was lower than that in the control group [9.5(6.0, 14.0) points, Z=-2.751, P=0.006]. The total DLQI score of study group [(8.00±1.96) points] was lower than that of control group [(9.89±2.18) points, P < 0.001]. The total incidence of adverse reactions in the two groups were 10.64% (5/47) and 8.70%(4/46), respectively, with no significant difference (P=0.751). The recurrence rate of the study group was 7.32%(3/41), which was lower than that of the control group (25.81%, 8/31) one month after treatment (P=0.031).  Conclusion  Lupatadine combined with LED yellow light treatment can improve the therapeutic effect, reduce the short-term recurrence rate, and has good safety.
Feasibility study of DCE-MRI parameters combined with CA199, CA125, HE4 in differentiating BOT from stage Ⅰ EOC
LI Xingwu, YE Guoliu
2023, 21(9): 1512-1515. doi: 10.16766/j.cnki.issn.1674-4152.003158
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  Objective  Diagnosis of borderline ovarian tumor (BOT) and stage Ⅰ epithelial ovarian cancer (EOC) is of key significance for clinical selection of treatment. In this study, dynamic enhanced MRI (DCE-MRI) parameters combined with glycoantigen 199 (CA199), CA125, and human epididymal protein 4 (HE4) were used to differentially diagnose BOT and stage Ⅰ EOC, and analyze the feasibility of the clinical application.  Methods  A total of 95 BOT patients admitted to Fuyang Cancer Hospital from January 2018 to April 2022 were collected as BOT group, and 62 stage Ⅰ EOC patients were collected as EOC group. The DCE-MRI signs, quantitative parameters, and expression levels of CA199, CA125, and HE4 were compared between the two groups, and the diagnostic effects of different examinations on BOT and stage Ⅰ EOC were analyzed.  Results  There was no difference in conventional morphology between the two groups (all P > 0.05). The time to peak (TTP) values of EOC group were lower than those of BOT group, while the contrast agent maximum concentration (Cmax), area under curve (AUC) and maximum linear slope (MS) values of EOC group were higher than those of BOT group (all P < 0.05). Expression levels of CA125, HE4 and CA199 in EOC group were higher than those in BOT group (all P < 0.05). ROC curve results show DCE-MRI parameters (TTP, Cmax, AUC, MS) combined with CA199, CA125, HE4 for BOT and Stage Ⅰ EOC were 0.789, 0.682, 0.799, 0.786, 0.792, 0.789, 0.816, respectively. The AUC value of combined diagnosis was 0.956, which was higher than that of the four patients diagnosed alone (P < 0.05). The sensitivity and specificity of combined diagnosis were 97.60% and 94.80%, respectively.  Conclusion  There are differences in DCE-MRI parameters and CA199, CA125, HE4 expression levels between BOT and stage Ⅰ EOC, and DCE-MRI combined with serological indicators is highly feasible for the differential diagnosis of the two.
Study on the treatment of upper urinary tract stones 2-3 cm in diameter using a flexible negative pressure suction sheath combined with flexible ureterorenoscopy holmium lithotripsy
WU Xiaojiang, TIAN Wenjun, ZHENG Dawen, ZHENG Feng
2023, 21(9): 1516-1519. doi: 10.16766/j.cnki.issn.1674-4152.003159
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  Objective  To observe the clinical efficacy and safety of flexible negative pressure ureteral access sheath combined with flexible ureterorenoscopy holmium lithotripsy (FURL) for upper urinary tract calculi.  Methods  A total of 168 patients with upper urinary tract calculi (2 to 3 cm in diameter), who admitted to Pujiang People' s Hospital from March 2019 to September 2022, were selected as the research objects. They were divided into study group (84 cases) and control group (84 cases) by random number table method. The study group was treated with flexible negative pressure suction sheath combined with FURL, and the control group was treated with percutaneous holmium laser nephrolithotomy (PCNL). The operation duration, urine clearance time, first time out of bed, hospital stay and other surgical indicators were recorded, and the stone clearance rate was calculated, the levels of serum inflammatory factor, stress response factors and renal function index content were determined before and after operation, and the postoperative complications were observed.  Results  The study group had significantly shorter operative duration, urine clearance time, first time out of bed, and hospitalization time [(64.75±5.62) min, (2.53±0.36) d, (1.81±0.32) d, (7.25±0.86) d] compared to the control group [(73.84±5.93) min, (3.29±0.41) d, (2.47±0.39) d, (9.48±1.07) d, all P < 0.05]. There was no significant difference in stone clearance rate between the two groups [94.05% (79/84) vs. 97.62% (82/84), P > 0.05]. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), IL-6 and IL-8], stress response factors [norepinephrine (NE), cortisol (Cor)] and renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN), uric acid (UA) and cystatin C (Cys-C)] were significantly lower than the control group 3 days after operation (all P < 0.05). The overall incidence of postoperative complications was significantly lower in the study group than that in the control group (P < 0.05).  Conclusion  The flexible negative pressure suction sheath combined with FURL can be used to treat upper urinary tract calculi with a diameter of 2-3 cm. On the basis of ensuring the effectiveness of stone removal, it can shorten the operation time, promote the rapid recovery of patients after operation, reduce iatrogenic trauma, reduce the degree of inflammation and stress reaction of patients, reduce postoperative complications.
Correlation of serum copper and inducible nitric oxide synthase with neurological deficit and prognosis in patients with acute ischemic stroke
WANG Sa, YU Hao
2023, 21(9): 1520-1522. doi: 10.16766/j.cnki.issn.1674-4152.003160
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  Objective  To analyze the relationship between serum copper, inducible nitric oxide synthase (iNOS) levels and neurological impairment and prognosis in patients with acute ischemic stroke (AIS), and to provide reference for clinical treatment of AIS.  Methods  A total of 118 patients with AIS admitted to the Department of Neurology of Wenling First People' s Hospital from January 2020 to December 2022 were selected as the observation objects. According to NIHSS score, the AIS patients were divided into mild group (35 cases), moderate group (47 cases) and severe group (36 cases). According to mRS score, AIS patients were divided into good prognosis group (83 cases) and poor prognosis group (35 cases). In the same period, 100 healthy subjects were selected as control subjects. The levels of serum copper and iNOS were detected and compared among all groups, and the correlation between their levels and the scores of NIHSS and mRS was analyzed.  Results  The serum copper [(1 436.35±128.53) μg/L vs. (1 076.64±98.41) μg/L] and iNOS [(29.78±3.04) U/mL vs. (15.43±2.26) U/mL] levels in the observation group were significantly higher than those in the control group (all P < 0.001). Compared with the mild group, the serum copper and iNOS levels in the moderate group and the severe group showed a rising trend (all P < 0.05). Serum copper [(1 468.63±136.81) μg/L vs. (1 046.83±115.65) μg/L] and iNOS [(32.94±3.15) U/mL vs. (20.74±3.23) U/mL] levels in patients with good prognosis were significantly higher than those in the good prognosis group (all P < 0.001). Pearson correlation analysis showed that serum copper and iNOS levels in AIS patients were positively correlated with NIHSS scores and mRS scores (all P < 0.05).  Conclusion  The higher the levels, the more severe the neurological deficit and the worse the prognosis of AIS patients. The detection of the above indicators can provide certain reference for clinical diagnosis and treatment of AIS, and can be used as prognostic indicators for AIS patients.
Construction of exercise intervention index system for patients with hyperlipidemia
HUANG Zhiyang, LI Ran, DAI Manting
2023, 21(9): 1523-1527. doi: 10.16766/j.cnki.issn.1674-4152.003161
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  Objective  The exercise intervention index system for patients with hyperlipidemia was constructed as a quantitative decision-making tool to assist community doctors or sports instructor to make accurate judgments according to patients'needs before making exercise prescriptions and determine the goals of exercise intervention.  Methods  Based on Pubmed, Web of science, Cochrane Library, CNKI, Wanfang Data and other databases, the RCT studies related to exercise intervention in hyperlipidemia were retrieved.The outcome indexes were extracted to construct the index pool, and the expert consultation table was designed.From September 2021 to January 2022, two rounds of Delphi consultations were conducted on 16 experts in the fields of sports human science, sports rehabilitation, sports medicine, evidence-based medicine, endocrinology or cardiovascular medicine, and traditional Chinese medicine prevention and treatment of chronic diseases, to demonstrate and screen indexes at all levels.According to the scores of experts on each index, the analytic hierarchy process was used to establish the weight of the index and test the logical consistency of the indexes at all levels, and finally the index system of exercise intervention for patients with hyperlipidemia was formed.  Results  The expert positivity coefficients of the two rounds of expert's questionnaire surveys were 100.00% and 93.75%, the authoritative coefficients of each index were 0.838 and 0.882, and the coordination coefficients were 0.216 and 0.229, respectively (χ2 test P < 0.001).According to the concentration of expert opinions, 4 first-level indexes, 24 second-level indexes and 55 third-level indexes were determined.For the convenience of use, the index system of exercise intervention for patients with hyperlipidemia was made into "general information questionnaire", "physical measurement information table"and "medical examination information table" according to the evaluation content.  Conclusion  The exercise intervention index system for patients with hyperlipidemia was constructed complete and reliable, which provides reference for community doctors or sport instructors to make a quantitative decision-making tool before exercise prescription for hyperlipidemia patients, and improves the pertinence and application scope of exercise intervention.
Application of health management plan based on boost theory in patients with chronic diseases
ZHANG Ru, GE Menghua, CHEN Yejun, WANG Aifang, RUAN Guodong
2023, 21(9): 1528-1531. doi: 10.16766/j.cnki.issn.1674-4152.003162
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  Objective  To explore the application effect of health management plans based on boosting theory in chronic disease patients, and analyze their impact on patients'health behavior, health literacy, self-monitoring ability, and service satisfaction.  Methods  A total of 200 patients with chronic diseases who were admitted to Shaoxing Second Hospital from July 2020 to January 2023 were selected as the research objects using the convenient sampling method, and divided into control group and observation group according to the random number table, with 100 cases in each group.The control group adopted routine health management, while the observation group adopted a health management program based on the boost theory on the basis of the control group.The health behavior, health literacy, self-monitoring ability and service satisfaction of the two groups were compared.  Results  Before intervention, there was no statistically significant difference in the scores of health behavior, health literacy, and self-monitoring ability between the two groups of patients (all P>0.05).After intervention, the total score of the health promotion lifestyle scale for patients in the observation group was (117.51±3.89) points, which was higher than the score of the control group (101.27±3.44) points (P < 0.05);The health literacy level of the observation group was higher than that of the control group (P < 0.05);The self-monitoring ability score of the observation group patients was (8.87±0.64) points, which was higher than that of the control group[(7.33±1.26) points, P < 0.05];Service satisfaction in the observation group was higher than in the control group (P < 0.05).  Conclusion  The health management program based on the boost theory can significantly improve the health behavior and health literacy of patients with chronic diseases, and is conducive to improving patients'self-monitoring ability and service satisfaction, which is worthy of clinical application.
Analysis on the characteristics and risk factors of spontaneous abortion of childbearing age women in Chengdu from the perspective of compound constitution
CHEN Wei, LIU Yangchun, ZHOU Congrong, LAI Fan, LI Xiaohong, LUO Erdan
2023, 21(9): 1532-1536. doi: 10.16766/j.cnki.issn.1674-4152.003163
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  Objective  To understand the compound constitution characteristics of patients with spontaneous abortion (SA), to explore the risk factors of SA in women of childbearing age, and to provide reference for the prevention of SA.  Methods  The information of pregnancy and traditional Chinese Medicine (TCM) constitution of childbearing age women who visited the TCM Department of Chengdu Women's and Children's Central Hospital in January 2016 to December 2021 were collected, and their compound constitutions were identified.Univariate analysis was used to compare the differences of major and concurrent constitutions between SA patients and non-SA people, and logistic regression model was established to explore the risk factors of SA.  Results  A total of 2 878 childbearing age women were included, and 759 of them had a history of SA, with an average age of 32.34, and only 11.86% of them were of balanced constitution, which was less than that of non-SA people (χ2=4.059, P=0.044).The proportion of SA patients with special intrinsic constitution was higher than that of non-SA people (χ2=8.542, P=0.003), and the compound constitutions containing Qi-deficiency (χ2=5.113, P=0.024) and Yang-deficiency constitution (χ2=5.724, P=0.017) were higher than non-SA population.The biased constitutions of SA patients were aggregative.Age growth, Yang-deficiency and Special Intrinsic constitutions were the risk factors of SA.  Conclusion  The proportions of Qi-deficiency and Yang-deficiency as compound constitutions in SA patients are higher than those in non-SA population, and Yang-deficiency, Qi-depression and Qi-deficiency show aggregation.Age, Yang-deficiency and special intrinsic constitutions are the risk factors of spontaneous abortion.It is suggested in clinical practice to adjust the constitution of preparing pregnant women when with Yang-deficiency and special intrinsic constitutions as soon as possible to prevent spontaneous abortion.
Relationship between UGT1A1 gene mutation and breast milk jaundice
YIN Hanjun, ZHU Suyue, JIANG Yazhou, ZHU Juan
2023, 21(9): 1537-1540. doi: 10.16766/j.cnki.issn.1674-4152.003164
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  Objective  To study the distribution of UGT1A1 gene in newborns of Han nationality and explore the effect of UGT1A1 gene mutation on the occurrence of breast milk jaundice in newborns.  Methods  Using the case-control study design, 109 newborns with breast milk jaundice in Suqian Hospital of Nanjing Gulou Hospital Group from January 2018 to June 2020 were selected as the case group, and another 109 healthy newborns in the same period were selected as the control group.Clinical data were collected, peripheral blood was collected, whole blood DNA was extracted, and UGT1A1 gene was amplified and sequenced by PCR.The association of UGT1A1 gene polymorphism with breast milk jaundice and peak concentration of unconjugated bilirubin was analyzed.Through a prospective follow-up study, the regression of jaundice in newborns with different genotypes of breast milk jaundice was analyzed.  Results  There was no statistically significant difference between the case group and the control group in gender, birth mode, birth weight and gestational age (all P>0.05).There was no statistically significant difference in the frequency of UGT1A1*28 7TA/7TA, UGT1A1*63 C/T and UGT1A1*7 T/G between the two groups (all P>0.05).There was a correlation between UGT1A1*6 and neonatal milk jaundice (OR=3.561, 95%CI: 2.179-5.822).The serum bilirubin concentration of UGT1A1*6 homozygous mutation group was higher than that of the other two groups (P=0.001).A total of 65 cases of neonatal jaundice due to breast milk were followed up.Among them, 55 newborns completely disappeared within three months, and 8 cases of UGT1A1*6G/A mutant neonatal jaundice lasted more than three months.  Conclusion  UGT1A1*6 mutation is a risk factor for breast milk jaundice in Han nationality in this region.
Influencing factors for prolonged mechanical ventilation in infants after cardiac surgery with congenital heart disease
CHEN Yuanyuan, ZHANG Lan, PAN Jiahua
2023, 21(9): 1541-1543. doi: 10.16766/j.cnki.issn.1674-4152.003165
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  Objective  To investigate the influencing factors of prolonged mechanical ventilation (PMV) in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) open heart surgery.  Methods  A total of 83 infants with CHD who needed CPB open heart surgery in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to July 2019 were retrospectively analyzed.According to the PMV time, they were divided into early-stage withdrawal group (< 24 h, 60 cases) and delayed-stage withdrawal group (> 24 h, 23 cases).The influencing factors of PMV were analyzed and compared, including month age, body weight, RACHS-1 grade, preoperative pneumonia, left ventricular ejection fraction (LVEF), preoperative pulmonary artery pressure, intraoperative CPB time and aortic cross clamp (ACC) time, intraoperative minimum pH, maximum vasoactive-inotropic score (VIS) in the 24 hours after operation.  Results  There were sixty cases in early-stage withdrawal group and twenty-three cases in delayed-stage withdrawal group.Univariate analysis showed that month age, body weight, preoperative pneumonia, preoperative pulmonary artery pressure, CPB time, ACC time, maximum VIS in the first 24 hour after operation were the influencing factors of PMV (P < 0.05).Multivariate logistic regression analysis showed that CPB time (OR=1.128, 95%CI: 1.008-1.262, P=0.035) and maximum VIS in the first 24 hours after operation (OR=1.233, 95%CI: 1.023-1.485, P=0.028) were the independent influencing factors.  Conclusion  Long CPB time and high maximum VIS in the first 24 hours after operation are the main influencing factors for PMV of infants with CHD after operation.
Therapeutic effect of triptorelin combined with recombinant human growth hormone on central precocious puberty in girls
SONG Jian, CUI Beiyong, ZHU Hongwei
2023, 21(9): 1544-1546. doi: 10.16766/j.cnki.issn.1674-4152.003166
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  Objective  To study the clinical effect of triptorelin combined with recombinant human growth hormone in the treatment of girls with central precocious puberty (CPP).  Methods  Sixty girls with CPP admitted to Department of Pediatrics of Bengbu First People's Hospital from August 2018 to August 2020 were divided into control group (n=30) and study group (n=30).The control group was given triptorelin therapy, and the study group was given triptorelin combined with recombinant human growth hormone therapy.The changes of sex hormone level, insulin-like growth factor-1(IGF-1), insulin-like growth factor binding protein-3(IGFBP-3), clinical efficacy and incidence of adverse reactions were observed.  Results  There were no significant differences in the levels of FSH[(2.52±0.63) U/L vs.(2.42±0.56) U/L], LH[(1.56±0.52) U/L vs.(1.62±0.60) U/L]and E2[(10.84±2.50) ng/L vs.(12.10±3.20) ng/L]between the control group and the study group after treatment (P>0.05).IGF-1[(345.62±39.65)μg/L vs.(282.02±25.40)μg/L]and IGFBP-3[(5.54±2.64) mg/L vs.(4.22±1.46) mg/L]levels in the study group were significantly higher than those in the control group after treatment, and the differences were statistically significant (all P < 0.05).The levels of predicted adult height[(161.4±5.2) cm vs.(154.2±3.8) cm]and growth velocity[(9.8±2.8) cm per year vs.(6.2±2.0) cm per year]in the study group were significantly higher than those in the control group, and the differences were statistically significant (all P < 0.05).But there was no significant difference in bone age[(10.3±0.5) year of age vs.(10.1±0.7) year of age]between the two groups after treatment (P>0.05).The adverse reactions of the two groups of children were mild, the incidence was not high and could be controlled by treatment.  Conclusion  Triptorelin combined with recombinant human growth hormone has a significant effect in the treatment of girls with CPP.It has positive significance for growth and development indicators, and is worthy of clinical promotion and application.
Evaluation of the implementation effect of basic public health service performance management in Tongzhou District Community Health Service Center of Beijing
GONG Yanan
2023, 21(9): 1547-1551. doi: 10.16766/j.cnki.issn.1674-4152.003167
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  Objective  To evaluate the implementation effect of internal basic public health service performance management system in community health service centers constructed since 2018, and provide reference suggestions for the performance management of basic public health service in the future.  Methods  The effect evaluation indexes were determined through expert discussion and Delphi expert consultation method. The indicators of service quantity, quality and effect, residents' awareness, usage, satisfaction and performance management evaluation of public health personnel from 2019 to 2021 were compared and analyzed.  Results  In the 4 centers, the number of outpatient visits decreased by 2.2%, the number of health management of the elderly, the standardized management rate of hypertension and diabetes and the standardized management rate of patients with severe mental disorders increased by 6.8%, 16.9%, 19.0% and 2.0%, respectively, the true rate of health records and physical examination of the elderly increased by 1.4% and 8.8% respectively, the dynamic utilization rate of health records, blood pressure and blood glucose control rate increased by 16.9%, 8.2% and 18.8%, respectively; The residents' awareness, usage and satisfaction increased, the greatest improvement was in the awareness of health education (14.4%), the usage of vaccination (15.0%) and the satisfaction of the service level of public health personnel (7.8%). The number of public health personnel who thought that the salary and workload were relatively matched or very matched increased by 12.1%, the assessment index was consistent with the actual work increased by 19.8%, the index weight setting was reasonable increased by 20.0%, the incentive was strong increased by 18.3%, the improvement effect was obvious increased by 25.1%, and the recognition of performance management level increased by 11.0%, the above differences were all statistically significant (all P<0.05).  Conclusion  Through the demonstration of community health service centers with different economic development levels, the quantity, quality and effect of basic public health, the residents' awareness, usage and satisfaction are improved, the scientificity, incentive and management level of performance management have been significantly improved, which indicate that the system has a significant application effect and has a certain promotion value.
Longitudinal study of gestational psychological health and sleep quality
JI Wenjia, RAO Lin, ZHOU Xuan, LIU Zhiwei, LI Hong
2023, 21(9): 1552-1555. doi: 10.16766/j.cnki.issn.1674-4152.003168
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  Objective  To explore changes of gestational psychological health and sleep quality in women, and to analyze influencing factors of sleep quality.  Methods  A total of 3 904 natural conception women undergoing antenatal examinations in the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine were enrolled as the research objects from January 2020 to December 2021. The psychological health and sleep quality of women in early (10-14 gestational weeks), middle (20-24 gestational weeks) and late pregnancy (28-32 gestational weeks) were evaluated by self-rating anxiety scale (SAS), the center for epidemiological studies depression scale (CES-D), the perceived stress scale (PSS-10) and Pittsburgh sleep quality index (PSQI), and influencing factors of sleep quality were analyzed.  Results  In early pregnancy, proportions of anxiety, depression and stress were 11.83%, 42.32% and 71.47%, which were higher than those in middle and late pregnancy. The proportions of sleep disorders in early, middle and late pregnancy were 14.81%, 50.59% and 16.14%, respectively. Linear mixed model analysis showed that anxiety (B=0.548, P<0.001), depression (B=0.768, P<0.001), stress (B=0.649, P=0.002), age (B=0.646, P=0.023), education level of college degree or above (B=0.699, P=0.023), unemployment (B=0.429, P=0.004), family income (B=0.452, P=0.039), gravidity (B=0.608, P=0.044) and parity (B=0.606, P=0.017) were influencing factors of sleep disorders (all P<0.05). The random intercept model showed that with the increase of pregnant time, the change trend of sleep quality was the same in women with different gestational periods (B=9.621, P<0.001).  Conclusion  The incidence of psychological problems (anxiety, depression, stress) is high in women during pregnancy. Gestational psychological health is closely related to sleep quality. Professional staffs for women and children should pay attentions to psychological status in early pregnancy and sleep quality during pregnancy.
Survey and analysis of mental health status of general practitioner training and interns in Yunnan Province
PAN Li, YUAN Xianglin, YANG Zhongce, DONG Lintao, YANG Yan, LIU Fen, ZHANG Jingrong, WU Yanan, ZHANG Lihua
2023, 21(9): 1556-1558. doi: 10.16766/j.cnki.issn.1674-4152.003169
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  Objective  To investigate the mental health status of general practitioners in Yunnan province, and to provide a basis for promoting their mental health.  Methods  Symptom check list-90 (SCL-90) was used to conduct an online questionnaire survey among trained general practitioner training and interns in Yunnan Province by WeChat questionnaire. SPSS 23.0 was used for statistical analysis of data.  Results  A total of 323 participants were involved, including 254 general practitioners training (78.6%) and 69 interns (21.4%). Except for somatization, interpersonal relationship, paranoia and hostility, the total mean score and other factors were significantly higher than the normed-reference control (all P<0.05). There were no significant differences in gender, category of doctors, educational status and level of designated service hospital after graduation (all P>0.05). The differences of somatization factors at different ages were statistically significant (P<0.05). Among different working hospitals group, the total score and the scores of each factor of the general practitioners who were trained in the municipal grade hospitals were higher than those in the provincial hospitals, and the differences in somatization and phobia factors were statistically significant (P<0.05). There were 73 (22.6%) general practitioners training and interns with a total score rating >160. There were 206 participants (63.8%) with no symptoms, 94 (29.1%) with tiny symptoms, 17 (5.3%) with symptoms, 4 (1.2%) with relative obvious symptoms, and 2 (0.6%) reported severe symptoms appearing frequently.  Conclusion  There are some mental health problems in general practitioners training and interns. It is necessary to carry out targeted mental health intervention for them.
Correlation between childhood trauma, self-esteem, impulsivity/aggression and the severity of symptoms and suicide risk in patients with bipolar mania
ZHAO Shimiao, FENG Hong
2023, 21(9): 1559-1562. doi: 10.16766/j.cnki.issn.1674-4152.003170
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  Objective  To evaluate the relationship between childhood trauma, self-esteem, impulsivity/aggression and symptom severity and suicide risk in patients with bipolar mania by correlation analysis.  Methods  A total of 104 first-episode manic patients with bipolar disorder in Shaoxing Seventh People's Hospital from June 2020 to December 2022 were selected and grouped according to the severity of mania and suicidal tendency. The scores of childhood trauma questionnaire (CTQ), self-esteem score (SES), impulsivity (BIS-11) and aggression (AQ-CV) were compared between groups. The correlation between the above indicators and manic symptoms and suicide risk was analyzed respectively.  Results  There were statistically significant differences in each index between the manic severity groups (all P<0.05). There were significant differences in childhood trauma, impulsivity and aggression between the groups of suicidal tendency severity (all P<0.05). Correlation analysis showed that the correlation coefficients between BRMS mania score and CTQ total score, emotional neglect, emotional abuse and sexual abuse were 0.935, 0.819, 0.828 and 0.837, respectively. The correlation between suicidal behavior questionnaire score and BIS-11 total score, cognitive impulsivity, motor impulsivity and unplanned impulsivity dimension scores were 0.936, 0.871, 0.897 and 0.846, respectively. The BRMS mania score was highly correlated with the total score of the aggression questionnaire (r=0.845), and the scores of each dimension were also more than 0.8.  Conclusion  Childhood trauma can promote the degree of mania in patients with bipolar disorder. This group is highly aggressive, and impulsiveness can increase suicidal tendency, which should be paid attention to in treatment and intervention.
Predictive value of uterine artery ultrasound parameter prediction model for preeclampsia risk in early pregnancy
CHU Hua, LU Yan, LIU Mingsong
2023, 21(9): 1563-1565. doi: 10.16766/j.cnki.issn.1674-4152.003171
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  Objective  To explore the value of uterine artery ultrasound parameters in the prediction of preeclampsia at 11-13 weeks of gestation, we constructed a uterine artery ultrasound parameter prediction model at 11-13 weeks of gestation, and analyzed its prediction value for the risk of preeclampsia.  Methods  A total of 200 patients who visited Huzhou Women's and Children's Health Care Hospital in early pregnancy from May 2020 to May 2022 were included. They were divided into occurred group (100 cases) and not occurred group (100 cases) according to whether they had preeclampsia. The ultrasonic parameters of uterine artery in the 11-13 weeks of pregnancy were extracted from the electronic medical record system, and a logistic regression prediction model based on the ultrasonic parameters of uterine artery in early pregnancy was established. The ROC curve was drawn to analyze its sensitivity and specificity for predicting preeclampsia.  Results  The multivariate logistic regression analysis showed that high body mass index (BMI, OR=1.311, P<0.001), high cholesterol (OR=1.673, P=0.004), high uterine artery pulsatility index (UtA-PI, OR=1.327, P<0.001) and high resistance index (RI, OR=1.846, P=0.036) were the risk factors for preeclampsia. ROC curve showed that the AUC of the model for predicting the risk of preeclampsia was 0.762 (95% CI: 0.696-0.819), the sensitivity was 81.00%, and the specificity was 63.00%.  Conclusion  The prediction model based on uterine artery ultrasound parameters UtA-PI, RI, high BMI and cholesterol in early pregnancy can be used for the prediction of preeclampsia.
Research progress in treatment of perimenopausal vasomotor symptoms
PAN Qi, REN Jingjing
2023, 21(9): 1566-1570. doi: 10.16766/j.cnki.issn.1674-4152.003172
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Perimenopausal period refers to a period before and after menopause in women, and it's also a period of gradual decline of ovarian function. This stage due to estrogen levels decreased, may appear a series of menopausal symptoms, short lasting 1-2 years, long lasting 10-20 years. Among them, hot flashes and sweating are the prominent manifestation of vasomotor symptoms and the main reason for perimenopausal women to come to see a doctor, which seriously affects women's sleep, work and life. Therefore, how to alleviate perimenopausal vasomotor symptoms has become a hot topic for medical researchers. At present, postmenopausal hormone replacement therapy is still recognized as the primary treatment for women with moderate to severe tidal fever. Hormone replacement therapy has strict indications and contraindications. Long-term use requires regular and comprehensive physical examination to assess the benefit/risk ratio to ensure medication safety. But there are still some risks in cardiovascular disease, venous thrombosis, endometrial cancer, breast cancer and other hormone-dependent tumors, the acceptance of hormone replacement therapy is not high. In recent years, more and more research has been conducted on the treatment of vasodilatory symptoms. Non-hormonal medications such as selective 5-hydroxytryptamine reuptake inhibitors (SSRI)/selective 5-hydroxytryptamine and norepinephrine dual reuptake inhibitors (SNRI), black cohosh extract, and kuntai capsules, as well as non-pharmacological treatments such as mind-body therapies, and acupuncture treatments, have also provided more treatment choices for women who are deeply afflicted by vasodilatory symptoms. This paper summarizes the treatment measures of vasomotor symptoms in perimenopausal women, including hormone drug therapy, non-hormone drug therapy and non-drug therapy, and provides theoretical guidance for formulating individualized clinical treatment programs to improve the quality of life of perimenopausal women.
Research advances of eye tracking technology in children with autism spectrum disorder
XU Jinbo, HAN Hui, SHI Lei, TONG Guanglei
2023, 21(9): 1571-1575. doi: 10.16766/j.cnki.issn.1674-4152.003173
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Autism spectrum disorder (ASD) is a group of neurodevelopmental disorder whose core symptoms are social deficits, narrow interests, and repetitive stereotype-like behaviors. Abnormal eye fixation is one of the clinical symptoms and early behavioral markers in children with ASD. Eye movement characteristics of children with ASD differ significantly from those of normally developing children, mainly in terms of reduced or absent visual gaze to socially attributed stimuli. Analysis of eye movement characteristics can provide an objective indicator for ASD research. Eye tracking (ET) technology is a new objective and non-invasive examination technique that can visually and accurately observe visual gaze duration and time allocation, and can provide more accurate and sensitive measurements of social attention, restricted interest, and emotion recognition in children with ASD. It has become a research hotspot in the field of ASD. In early identification screening, ET can understand and assess the early behavioral development of children with ASD and serve as one of the pathways for early identification screening. In diagnosis, ET combines subjective behavioral observations with objective behavioral indicators. In treatment, ET can assist in developing individualized intervention plans. In analyzing prognosis, ET can serve as a predictive tool for symptom severity. The application of ET in early screening and identification, early diagnosis, early intervention and treatment, prognosis analysis and the research progress of the neural mechanism of eye movement in children with ASD are summarized. Future research should further explore the neural mechanisms of eye movements in children with ASD and combine ET with 5G technology, virtual technology, and robotics to expand the application of ET and provide new ideas and methods for the exploration of the etiology and rehabilitation treatment of ASD.
Research status and perspective of Postoperative ileus
ZHONG Jianhong, SU Jiayong, MA Liang
2023, 21(9): 1576-1580. doi: 10.16766/j.cnki.issn.1674-4152.003174
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Postoperative gastrointestinal dysfunction and even postoperative ileus (POI) are common complications after abdominal surgery, with an incidence rate of about 10%. POI is a temporary non-mechanical cessation of gastrointestinal coordination following surgical intervention that prevents effective transport of gastrointestinal contents or tolerates oral ingestion, manifested by bloating, tenderness, and no noise of borborygmus. POI is characterized by temporary gastrointestinal motility suppression after surgical intervention due to non-mechanical causes, affecting normal diet. POI and its associated perioperative complications reduce patient comfort, prolong the length of hospital stay and significantly increase the cost of hospitalization. The etiology of POI is diverse and its pathogenesis is complex, mainly involving the release of inflammatory mediators at the injured site, inhibitory neural reflex and pharmacological mechanism. Risk factors for POI include old age, open surgery, difficult surgery, surgery longer than 3 hours, no bowel treatment before surgery, infection, or the need for blood transfusion. POI focuses on prevention, including preoperative, intraoperative and postoperative interventions. Minimally invasive surgery and multimodal analgesic therapy can reduce the incidence of POI. In the past decade, many clinical studies have explored different intervention methods to prevent the occurrence and shorten the duration of POI after surgery. Current guidelines for enhanced recovery after surgery mainly recommend minimally invasive surgery, early enteral nutrition, chewing gum, preoperative oral laxatives and alvimopan, which have certain effects on promoting postoperative gastrointestinal function recovery, reducing the occurrence of POI and shortening postoperative hospital stay.
Study on the correlation between TCM constitution and blood lipid, uric acid and body mass index
ZHENG Meihong, ZHANG Bin, LI Dongcai, LIANG Qijun, DONG Chengxuan, PAN Zhibin, GUAN Jintu, XU Guangzhen, LIU Jihong
2023, 21(9): 1581-1584. doi: 10.16766/j.cnki.issn.1674-4152.003175
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  Objective  To explore the correlation between traditional Chinese medicine (TCM) constitution and blood lipid, body mass index, uric acid and fat content, and analyze the risk factors affecting the occurrence of dyslipidemia.  Methods  A cross-sectional retrospective study was conducted on 1 061 patients who underwent physical examination in Foshan Hospital of Traditional Chinese Medicine from January 2019 to December 2020. SPSS 24.0 statistical software was used to analyze the correlation between blood lipid, uric acid, body mass index and fat content of people with different physical conditions, as well as the incidence of dyslipidemia and overweight/obesity. Binary logistic regression analysis was used to analyze the risk factors of dyslipidemia.  Results  Among the 1 061 cases of physical examination, 300 cases (28.28%) of peaceful constitution, 761 cases (71.73%) of biased constitution, of which 202 cases (19.04%) of phlegm-wet, 172 cases (16.21%) of Yang deficiency, 136 cases (12.82%) of qi deficiency; The proportion of phlegm-wet in male was higher than that in female, and the proportion of Qi-stagnation, Yin deficiency and blood stasis in female was higher than that in male (all P < 0.05).The TC, LDL-C and BMI of the biased constitution were higher than those of the peaceful constitution (all P < 0.05). TG, LDL-C and BMI were higher and HDL-C was lower in phlegm-wet patients, LDL-C, BMI and fat contents were higher in damp-heat patients, and BMI was lower in Qi-stagnation patients (all P < 0.05). The incidence of overweight/obesity was higher in phlegm-wet and damp-heat constitution than in peaceful constitution (all P < 0.05). The risk of dyslipidemia in males was 2.521 times higher than that in females, and the risk of dyslipidemia in those with high uric acid was 1.808 times higher than that of those with normal uric acid. Fat content and BMI were positively correlated with dyslipidemia (all P < 0.05).  Conclusion  Sex for male, high uric acid, high BMI and high fat content are risk factors for dyslipidemia. Correcting biased constitution and controlling weight can help reduce the occurrence of dyslipidemia and overweight/obesity.
A randomized controlled study of warm needle ginger moxibustion combined with Xingnao Kaiqiao acupuncture method in treatment of urinary incontinence after stroke
LI Xiaohua, WANG Lingyan, YAN Junhua, FANG Yan, ZHUGE Lejun, JIN Minjuan
2023, 21(9): 1585-1589. doi: 10.16766/j.cnki.issn.1674-4152.003176
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  Objective  Urinary incontinence is a common sequela after stroke. In this study, warm acupuncture and ginger moxibustion combined with Xingnao Kaiqiao acupuncture were used to treat urinary incontinence after stroke, aiming to find a more effective treatment method for urinary incontinence after stroke.  Methods  A total of 45 patients with stroke and urinary incontinence treated with warm needle and ginger moxibustion combined with Xingnao Kaiqiao acupuncture method were selected as the observation group from January 2021 to June 2022 in Jinhua Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, and 45 patients with stroke and urinary incontinence treated with Xingnao Kaiqiao acupuncture method were enrolled as the control group during the same period. The clinical efficacy, adverse events and scores before and after treatment were compared between the two groups.  Results  The total effective rate of clinical efficacy in the observation group was significantly higher than that in the control group. At 2, 4 weeks, 1 and 3 months of treatment, international continence advisory committee urinary incontinence questionnaire short form (ICIQ-SF) score (14.52±3.16, 10.49±3.20, 9.24±2.47, 7.63±2.34 vs. 14.68±3.41, 12.23±2.66, 11.50±1.97, 10.33±2.62), nocturnal incontinence grade score (3.71±1.23, 3.06±1.28, 2.26±0.87, 2.59±0.73 vs. 4.54±1.66, 4.13±1.85, 3.41±0.96, 3.29±0.87) and residual urinary volume of the observation group were significantly lower than those of the control group, while the maximum detrusor muscle pressure, maximum urine flow rate, maximum bladder volume and single urine volume in observation group were significantly higher than those in control group (all P < 0.05).  Conclusion  Warm needle ginger moxibustion combined with Xingnao Kaiqiao acupuncture and pelvic floor muscle function training in the treatment of urinary incontinence after stroke can effectively improve urination function, reduce the degree of urinary incontinence and nocturnal urinary incontinence, and the security is better.
Application of 3D printing technology in nursing practice teaching in neurosurgery
ZHANG Fang, HONG Wenming
2023, 21(9): 1590-1592. doi: 10.16766/j.cnki.issn.1674-4152.003177
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  Objective  To explore the teaching effect of 3D printing technology in nursing practice teaching in neurosurgery, and lay a certain foundation for the application of this technology in medical teaching.  Methods  A total of 116 undergraduate nursing interns were selected for practice in Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from January 2021 to October 2022. They were randomly divided into experimental group (3D technology teaching group) and control group (traditional teaching group) according to random number method, with 58 in each group. All the students were evaluated by quizzing in class, practical test, theory test and questionnaire, and the results were statistically analyzed.   Results  The scores of the experimental group [class test (93.2±4.7) points, practical operation (89.6±4.6) points, theory test (91.5±4.9) points, comprehensive average test score (91.4±4.7) points] were higher than those of the control group [(84.5±4.9) points, (80.5±4.7) points, (83.8±5.2) points, (82.9±4.9) points, all P<0.001]. The questionnaire results included, the experimental group scored [(9.2±0.7) points, (8.4±1.2) points, (9.3±0.7) points, (8.9±0.9) points, (9.2±0.8) points, (9.2±0.7) points, (9.4±0.5) points in teaching attraction, learning subjective initiative, knowledge understanding, theoretical knowledge mastery, skill operation level, divergent thinking, teaching satisfaction and other items] were higher than the control group [(6.8±0.9) points, (6.8±0.6) points, (8.3±0.9) points, (7.2±0.9) points, (7.2±0.8) points, (8.2±0.4) points, (7.8±1.1) points, all P<0.001].  Conclusion  In neurosurgery nursing practice teaching, 3D technology can significantly improve the teaching efficiency and practice effect of students, and students have a high evaluation of its overall teaching, which provides a new direction for neurosurgery nursing teaching.
Application of ultrasound visual vascular puncture technology in clinical teaching of vascular puncture technology
WANG Xiaogao, MA Qiang, GUAN Zeyu, NIE Zhonglin, CHEN Shiyuan, LU Ran, YU Chaowen
2023, 21(9): 1593-1595. doi: 10.16766/j.cnki.issn.1674-4152.003178
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  Objective  To explore the application of ultrasound visual vascular puncture technology in clinical teaching of vascular puncture technology, and hope to improve the teaching effect of vascular puncture.  Methods  A total of 70 undergraduate interns and standardized trained doctors in vascular surgery of the First Affiliated Hospital of Bengbu Medical College from April 2021 to April 2022 were selected as the research objects. They were first trained in routine admission education and vascular puncture techniques, and then divided into a vascular puncture teaching group applying ultrasound visual vascular puncture technology (observation group, 35 people), and a conventional vascular puncture technology teaching group (control group, 35 people) using the random number method. The teaching effect of the two groups was evaluated by analyzing the completion time of blood vessel puncture, the successful rate of puncture, and the indicators of complications of the two groups of students.  Results  Both groups of students successfully completed the vascular puncture operation. The time of puncture needle entering the target vessel, the total time of vascular puncture completion and the incidence of complications in the observation group were less than those in the control group [(14.06±1.98) min vs. (17.84±2.07) min; (23.51±3.49) min vs. (28.64±2.94) min; 5.71% (2/35) vs. 25.71% (9/35)], the differences were statistically significant (all P<0.05).  Conclusion  The application of ultrasound visual vascular puncture technology in clinical teaching of vascular surgery is effective. Compared with the traditional puncture teaching method, it has higher efficiency, fewer complications, better teaching effect and higher safety, and should be widely used in vascular puncture teaching.
Time series study on the effect of air pollutants on hospitalization risk of arrhythmia patients in Hefei
ZHANG Qianru, ZHU Jirong, ZHU Mei, GE Jianjun, LI Baozhu
2023, 21(9): 1596-1600. doi: 10.16766/j.cnki.issn.1674-4152.003179
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  Objective  To investigate the effect of air pollutant exposure on the daily hospitalization number of cardiac arrhythmias in Hefei, and to provide a scientific basis for the development of appropriate intervention measures.  Methods  Meteorological data such as daily average temperature, daily average humidity, air pollutants (PM2.5, PM10, NO2, SO2, CO, O3) and the number of hospitalizations of patients with cardiac arrhythmias were collected in Hefei city from 2015 to 2020. A time-series distributed lag nonlinear model was used to analyze the cumulative and lag effects of air pollutants on the number of hospital cases and hospitalizations in Hefei from 2015 to 2020, and subgroup analysis was performed.  Results  After controlling for long-term trends and confounding factors, this study showed that PM2.5, PM10, NO2 and CO had a significant effect on the number of hospitalizations for arrhythmia onset. In the subgroup, PM2.5, PM10 and CO had an effect on the number of female patients and patients aged <65 years, and all had a lag effects. NO2 had an effect on the number of male inpatients with a lag effect. Every increase of PM10 concentration by 10 μg/m3 had a statistically significant difference in the number of hospitalized patients with arrhythmia on the same day, and the effect value was the largest(RR=1.021, 95% CI: 1.004-1.038). When PM2.5 concentration increased by 10 μg/m3, there was a statistically significant difference in the number of hospitalized patients with arrhythmia on the first day, and the cumulative effect value reached the largest(RR=1.025, 95% CI: 1.011-1.041). When NO2 and CO concentrations increased by 10 μg/m3, the effects on the number of hospitalized patients with arrhythmia accumulated to the second day, and the cumulative effect value reached the largest(RR=1.111, 95% CI: 1.010-1.223; RR=1.248, 95% CI: 1.065-1.462). The effects of SO2 and O3 on the number of hospitalized patients with arrhythmia were not statistically significant (all P>0.05).  Conclusion  The increased concentrations of air pollutants (PM2.5, PM10, NO2, CO) in Hefei can lead to an increased risk of hospitalization for the development of cardiac arrhythmias in the population.
Visual analysis of current community traditional chinese medicine research based on CiteSpace
YANG Linxia, ZHANG Ailian, ZHANG Yongkang, YUE Luanyi, FAN Yu, TIAN Qiqi
2023, 21(9): 1601-1606. doi: 10.16766/j.cnki.issn.1674-4152.003180
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  Objective  The development of community traditional chinese medicine (TCM) is an important part of the improvement of community health service capacity and also an important step to improve the community health service system. By sorting out the development process and research status of community TCM in China, it provides a reference for future research.  Methods  The relevant literature published in the field of TCM from CNKI and Wanfang Data until November 30, 2021 was selected as the data sources, and the statistics of institutions, keywords, authors of the relevant literature were jointly analyzed by CiteSpace software and Excel.  Results  A total of 731 valid literature records were included, among which journal papers accounted for the highest proportion. The number of literatures on community TCM research in China generally fluctuated and showed obvious stage development. The visual analysis results of the knowledge graph showed that the core authors in the field of community TCM research had not yet formed. The top three institutions in terms of publications were Nanjing University of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine and Guangzhou University of Traditional Chinese Medicine. High-frequency keywords included TCM service, TCM appropriate technology, influencing factors, community residents, survey and other words, and the strongest sudden words included TCM health management, diabetes, hypertension, health education and other words.  Conclusion  There is still very much room for the development of community TCM in China. The development of community TCM has gone further through exchanges and cooperation, improving system building, building an evaluation index system, cultivating TCM talents, spreading TCM culture, and strengthening community TCM participation in epidemic prevention and control and other measures. Community pension may become a new research hot topic in the future.
A Multi-factor analysis of the current state of disability among economically disadvantaged older people in rural ethnic minority areas
HUANG Jinglin, ZHOU Qian, LI Huiju, DING Junzhou, HU Zhengjun, ZENG Bo
2023, 21(9): 1607-1611. doi: 10.16766/j.cnki.issn.1674-4152.003181
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  Objective  To analyze the current status of self-care ability of economically disadvantaged older adults over 60 years old in Linxia Hui Autonomous Prefecture, Gansu Province.  Methods  Using multistage stratified sampling, 3 724 older adults were surveyed in Kangle County of the region from December 2021 to May 2022, and the influencing factors of self-care ability were explored using multi-classified unordered logistic regression analysis according to the Specification for the Assessment of Elderly People ' s Ability (Draft for Public Comments).  Results  Ability was intact in 44 (1.2%), mildly disabled in 2 316 (64.0%), moderately disabled in 828 (22.8%), moderately severely disabled in 320 (8.8%), and severely disabled in 116 (3.2%). Gender, ethnicity, religious beliefs, marital status, diagnosis of disease, obesity level, age group, falls, choking, pressure sores, joint mobility, wound condition, missing loose teeth, dysphagia, ineffective airway clearance, and basis for change in competency class had an effect on the final class of competency of the elderly (all P < 0.05). Multi-classified unordered logistic regression analysis showed that marital status (severe disability, OR=0.269, 95% CI: 0.091-0.793), disease diagnosis (severe disability, OR=0.283, 95% CI: 0.125-0.643), degree of obesity (severe disability, OR=5.867, 95% CI: 1.443-23.862), age group (severe disability, OR=6.036, 95% CI: 2.488-14.643), joint mobility (severe disability, OR=17.337, 95% CI: 5.067-59.320), loose tooth defect (severe disability, OR=3.678, 95% CI: 1.487-9.096), pressure ulcer (severe disability, OR=43.535, 95% CI: 1.273-1 488.906) were the influencing factor of the final level of the ability of the elderly.  Conclusion  The incapacity rate of economically disadvantaged older people over 60 years old in Linxia Hui Autonomous Prefecture, Gansu Province, reaches 98.8%, and great attention should be paid to their elderly care services and health needs.
Study on the status of sleep duration and its influence factors among women aged 40-69 years in Zhejiang Province
LIN Dongdong, WANG Feixue, LING Ruolan, HU Kailing, QIU Jianfei, NING Yumei
2023, 21(9): 1612-1616. doi: 10.16766/j.cnki.issn.1674-4152.003182
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  Objective  To explore the current situation and influence factors of sleep duration of women aged 40-69 years in Zhejiang Province.  Methods  A multi-stage stratified cluster random sampling method was used to investigate the sleep duration of 6 717 women aged 40-69 years in Zhejiang Province. EpiData software was used to set the database of the research objects, and SPSS 20.0 software was used for statistical analysis of the data. Multiple linear regression model was used to analyses the factors of sleep duration.  Results  The average sleep time of women aged 40 to 69 in Zhejiang Province was (6.93±1.33) h, the median sleep time was 7 h, and the sleep time decreased with the increase of age (P < 0.001). The sleep time of menopausal women [(6.76±1.42) h] was significantly lower than that of premenopausal women [(7.12±1.19) h], the difference was statistically significant (P < 0.001), and the sleep time decreased with the increase of the grade of menopausal symptoms (Kupperman score grade, P < 0.001). Education level, household registration, and family monthly income were correlated with sleep time, and the differences were statistically significant (all P < 0.05). The sleep time of different tea drinkers was significantly different (P < 0.05). The average sleep time of depressed patients was significantly less than that of non-depressed patients, and the difference was statistically significant (P < 0.001). The results of multiple linear regression model showed that age, menopause, household registration and depression were the independent influencing factors of sleep time (all P < 0.05), and depression was the biggest influencing factor, followed by age, menopause and residence registration.  Conclusions  (1) The average sleep time of 40-69 year old women in Zhejiang Province is generally short; (2) Age, menopausal status, household registration and mental depression are independent factors affecting sleep time; (3) Among the independent influencing factors, mental state is an intervenable factor, and it is suggested to take corresponding measures to intervene in women ' s mental depression, so as to improve sleep and quality of life.
Effect of E-Coach mode combined with dynamic glucose management on peripheral blood glucose and lipid levels in patients with severe diabetes
CHEN Yu, WANG Qiong, XING Hongye
2023, 21(9): 1617-1620. doi: 10.16766/j.cnki.issn.1674-4152.003183
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  Objective  To analyze the effect of E-Coach mode combined with dynamic glucose management on peripheral blood glucose and lipid levels in patients with severe diabetes, and to provide more suitable blood glucose management methods for clinical practice.  Methods  A convenient sampling method was used to select 100 patients with severe diabetes who were admitted to the Intensive Care Medicine of Ningbo Second Hospital from March 2022 to March 2023 as the research objects. According to the random number table, they were divided into a control group and an observation group with 50 patients in each group. Patients in the control group were treated with traditional blood glucose management, while patients in the observation group were treated with E-Coach mode combined with dynamic blood glucose management based on the control group. The changes of peripheral blood fasting blood sugar (FBG), 2 h blood glucose (2hPG), glycated hemoglobin, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), treatment compliance and nursing satisfaction were observed before and after the intervention in the two groups.  Results  After intervention, the levels of peripheral blood FBG, 2hPG, and HbA1c were compared between the two groups, and the observation group was lower than the control group, with statistically significant differences (P < 0.05); The TG and LDL-C in peripheral blood of the observation group were lower than those of the control group, and the HDL-C was higher than that of the control group (all P < 0.05). The treatment compliance of the observation group was 90% (45/50), which was higher than 74% (37/50) of the control group, and the nursing satisfaction of the observation group was 92% (46/50), which was higher than 76% (38/50) of the control group, the differences were statistically significant (all P < 0.05).  Conclusion  E-Coach mode combined with dynamic blood glucose management is more conducive to improving the peripheral blood glucose and lipid levels of ICU diabetes patients than conventional nursing care, which is conducive to improving patients' treatment compliance and nursing satisfaction.
Risk factors of urinary tract infections after radical prostatectomy for prostate cancer and PDCA nursing strategy analysis
WANG Haiyan, HONG Lijuan, WANG Shengxing, XU Siyi, LIANG Peiyu
2023, 21(9): 1621-1624. doi: 10.16766/j.cnki.issn.1674-4152.003184
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  Objective  To investigate the risk factors of urinary tract infections after radical prostatectomy (RP) and the nursing strategy of the plan-do-check-act (PDCA) cycle management model based on the logistic regression model, and provide reference for postoperative care of RP patients.  Methods  A total of 284 patients with prostate cancer who underwent RP surgery in the First Affiliated Hospital of Hainan Medical University from April 2019 to January 2023 were selected as the study subjects. They were randomly divided into control group and observation group by using radom number table method with 142 cases each. The control group received routine nursing after surgery, while the observation group received PDCA nursing mode on the basis on control group. The incidence of postoperative urinary tract infections between the two groups was compared, and the influencing factors of urinary tract infections after RP surgery were analyzed.  Results  Compared to the control group, the observation group had a higher implementation rate of intervention measures (all P < 0.05) and a lower incidence of urinary tract infections [2.82% (4/142) vs. 13.38% (19/142), P < 0.05]. Univariate analysis and multivariate logistic regression analysis showed that age (≥65 years old), combined with diabetes, operation time (≥90 min), and postoperative catheter retention time (≥5 days) were independent risk factors for postoperative urinary tract infection in RP patients, and nursing program (PDCA circulation management) was the protective factor for postoperative urinary tract infection in RP patients.  Conclusion  The nursing plan (PDCA cycle management) is a protective factor for postoperative urinary tract infections in patients with prostate cancer undergoing radical surgery. Applying PDCA cycle management mode to RP patients can help improve the execution of nursing measures and reduce the risk of postoperative urinary tract infections.
The outcome of systemic lupus erythematosus complicated with MRSA infectious arthritis: A case report and literature review
ZHAO Fuyu, LIU Ying, WEI Zhiliang, LUN Xueping, LI Zuoqiang, LI Hui
2023, 21(9): 1625-1630. doi: 10.16766/j.cnki.issn.1674-4152.003185
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A retrospective analysis of a patient with systemic lupus erythematosus (SLE) combined with recurrent joint methicillin-resistant staphylococcus aureus (MRSA) infections over 10 years of clinical management was conducted. We searched for relevant case reports and conducted a literature review. The aim was to alert SLE patients with co-infectious arthritis and to adjust the treatment plan of SLE underlying disease in a timely manner. This will increase the awareness of the disease and avoid delay in treatment.

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