中华全科医学

General practice ideas for low back pain

XU Peiyu, LU Zijian, TANG Jianpeng, YAO Dingye, REN Jingjing, SUN Junsheng

2024, 22(10): 1631-1635. doi: 10.16766/j.cnki.issn.1674-4152.003699

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Abstract:
Low back pain is a prevalent health concern in general medical settings that significantly impacts patients' quality of life and can lead to systemic disability. This article seeks to offer general practitioners standardized and clear diagnostic and treatment guidelines by conducting a comprehensive review of relevant literature and exploring the diagnostic and therapeutic approaches for low back pain in general practice medicine, with the goal of enhancing the quality of clinical services. The review reveals that general practitioners often encounter challenges in diagnosing and treating complex low back pain stemming from various causes, particularly when advanced diagnostic tools are unavailable, resulting in misdiagnoses and overlooked conditions. Therefore, it is imperative to train general practitioners to adopt a holistic approach and enhance their differential diagnosis skills. The John Mortara safety diagnostic strategy is recommended as it considers a wide range of potential diagnoses, serious illnesses, commonly missed conditions, underlying disorders, and patient-specific information. Regarding treatment, general management strategies encompass non-pharmacological interventions, medication therapy, preventive measures, proactive care, and follow-up appointments. Non-pharmacological treatments like exercise therapy, acupuncture, spinal manipulation, massage, extracorporeal shock wave therapy, and traditional Chinese medicine approaches have demonstrated positive outcomes in addressing chronic and challenging low back pain conditions. Furthermore, the article underscores the significance of preventive care, including maintaining proper posture, implementing workplace safety measures, engaging in low back exercises, and adopting a healthy diet. These measures not only alleviate low back pain but also help prevent its recurrence. Regular follow-up visits help monitor disease changes, adjust treatment plans, provide psychological support, and promote doctor-patient communication. In summary, general practitioners should adopt a holistic approach to diagnosis and treatment when dealing with low back pain, following the biological-psychological-social medical model. They should use safe diagnostic strategies, conduct comprehensive evaluations, and develop reasonable diagnosis and treatment plans. Additionally, attention should be given to patients' mental health to help them establish a positive attitude and improve their quality of life, which is crucial for the treatment and management of low back pain.

Changes in ERK1/2 signaling pathway in the progression of ulcerative colitis and its association with intestinal opportunistic infections

CUI Xiaoting, LU Jie, NIU Haoshu, ZHAO Cuijuan

2024, 22(10): 1636-1639. doi: 10.16766/j.cnki.issn.1674-4152.003700

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Objective To observe the changes of extracellular regulatory protein kinase (ERK) 1/2 signaling pathway in the progression of ulcerative colitis (UC) and analyze its association with intestinal opportunistic infection in UC patients. Methods A total of 105 UC patients admitted to the gastroenterology department of Baogang Hospital of Inner Mongolia from May 2021 to May 2023 were selected as the study group, and 50 healthy subjects were selected as the control group during the same period, the mRNA transcription levels of ERK-1 and ERK-2 were compared between the two groups. According to the occurrence of intestinal opportunistic infection, 105 UC patients were divided into an infected group and an uninfected group, and the risk factors were screened to analyze the predictive value of UC patients with intestinal opportunistic infection. Results The mRNA relative expression levels of ERK-1 and ERK-2 in the study group were higher than those in the control group (P < 0.05), and their changes increased with the progression of UC patients (P < 0.05). Compared with the uninfected group, the disease activity severity rate, hemoglobin, erythrocyte sedimentation rate (ESR) levels, ERK-1 and ERK-2 mRNA transcription levels in the infected group were higher (P < 0.05), and the albumin level was lower (P < 0.05). Severity, decreased albumin and up-regulated expression of ERK-1 mRNA and ERK-2 mRNA were independent risk factors for intestinal opportunistic infections in UC patients. ROC curve results showed that the AUC of ERK-1 mRNA, ERK-2 mRNA, and their combined application model for predicting intestinal opportunistic infection in UC patients were 0.823, 0.835, and 0.907 respectively. Conclusion The expression levels of ERK-1 and ERK-2 increased with the progression of UC patients, and they were independent risk factors affecting the occurrence of intestinal opportunistic infections in UC patients, the combined expression levels of ERK-1 and ERK-2 were highly effective in predicting intestinal opportunistic infections in UC patients.

Comparison and analysis of traditional Chinese medicine and Western medicine in the treatment of ulcerative colitis

XU Boyang, YANG Wendi, LI Wei, JIA Zhichun, XU Wei, WANG Jiawan

2024, 22(10): 1640-1644. doi: 10.16766/j.cnki.issn.1674-4152.003701

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Ulcerative colitis (UC), as a common inflammatory bowel disease (IBD), has an etiology that is not yet fully understood. Many scholars believe that an imbalance between host genetic susceptibility and abnormal environmental factors disrupted relationship between host immunity and intestinal microbiota, promoting the development of intestinal inflammation in UC patients. In treatment, Western medicine typically uses aminosalicylates, steroids, immunomodulators, and biological agents. These medications primarily target inflammatory responses and immune regulation, significantly improving symptoms in a short time, especially in controlling acute attacks and severe UC. However, these medications generally come with varying degrees of side effects and may lead to patient dependency, increasing the risk of relapse after discontinuation. Traditional Chinese medicine (TCM) views UC as a disease caused by external pathogens, improper diet, and emotional disturbances, all occurring against a backdrop of inherent spleen and stomach weakness. In treatment, TCM has shown significant efficacy in managing mild cases of UC and during remission stages. TCM treatment not only focuses on the disease itself but also pays great attention to individual differences among patients. Through syndrome differentiation, personalized treatment plans are formulated for each patient. Additionally, TCM offers a variety of treatment methods, including oral decoctions, herbal enemas, suppository anal administrations, and acupuncture. These treatments help alleviate symptoms, improve intestinal function, enhance quality of life, have fewer side effects, and provide lasting efficacy. This article aims to compare and analyze the current status of TCM and Western medicine in treating UC from four aspects: TCM etiology and pathogenesis, TCM treatment, Western medicine pathogenesis, and Western medicine treatment. It also explores the feasibility of integrating TCM and Western medicine in treating UC, providing new insights and methods for the diagnosis and treatment of this disease.

Evaluation of the feasibility and safety of capsule endoscopy in newly diagnosed Crohn's patients

LÜ Huijie, FENG Qian, LÜ Wen, XIE Lu, ZHANG Hongchen, LI Shudan

2024, 22(10): 1645-1647. doi: 10.16766/j.cnki.issn.1674-4152.003702

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Objective To explore the feasibility and safety of capsule endoscopy as a diagnostic tool in newly diagnosed Crohn's patients. Methods From August 2019 to August 2023, 60 patients with Crohn's disease newly diagnosed at the First People's Hospital Affiliated to West Lake University in Hangzhou were selected as the research subjects, and they all underwent capsule endoscopy. Statistics were made on the clinical characteristics of the subjects and the observation results of capsule endoscopy. The completion rate of this examination and the incidence of adverse clinical events reflect the feasibility and safety of its clinical application. Simultaneously analyze the lesion characteristics and inflence infactor of positive capsule endoscopy result, and effect of patient age on capsule endoscopy result. Results The mean age of the 60 patients was (37.0±14.2) years, and 35.0% (21/60) of the patients were diagnosed with Crohn's disease before CE examination. 21.7% of the patients were accompanied by perianal lesions and parenteral complications, with abdominal pain and diarrhea as the main clinical symptoms. The positive rate of capsule endoscopy was 80.0% (48/60), and the mean passage time of the small intestine was (258.5±128.2) min. 59 patients successfully completed the examination, and 1 patient had capsule retention (retention rate 1.7%, 1/60). CE examination found that the most common lesions of this disease were erosion, ulcer, and stenosis, and 72.9% (35/48) of patients in the lower small intestine lesions than the upper segment. The proportion of bleeding and upper small intestine lesions in young patients (≤30 years old) was higher than that in patients >30 years old (P < 0.05). CRP is a significant factor affecting the positive results of capsule endoscopy (P < 0.05). Conclusion Capsule endoscopy is feasible and safe in newly diagnosed patients with Crohn's disease, especially in young patients with lesions in the upper small intestine. CRP is a related factor affecting the positive results of capsule endoscopy.

Mediating effect of coping mode and anxiety on the relationship between self-efficacy for exercise and kinesiophobia in patients with heart failure with preserved ejection fraction

WEN Gaoqin, SUN Guozhen, GAO Min, YU Tianxi, LIU Shenxinyu

2024, 22(10): 1648-1651. doi: 10.16766/j.cnki.issn.1674-4152.003703

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Objective To examine the mediating effect of disease coping mode and anxiety on exercise self-efficacy and kinesiophobia in patients with heart failure with preserved ejection fraction (HFpEF). In order to provide new perspectives on the management and intervention of kinesiophobia. Methods A total of 156 patients diagnosed with HFpEF between March and October 2022 at a Grade A tertiary hospital in Nanjing were selected as the study subjects using the convenience sampling method. The questionnaire survey was conducted using the exercise self-efficacy scale (SEE), the medical coping mode questionnaire (MCMQ), the generalized anxiety disorder scale-7 (GAD-7), and the Chinese version of the fear of activity scale for patients with chronic heart failure (Fact-CHF). The results were analyzed to determine the chain mediation effect. Results A total of 147 valid questionnaires were collected, with an effective recovery rate of 94.23%. Fact-CHF score (40.347±10.523) in HFpEF patients. The results demonstrated a significant correlation between HFpEF patients' exercise self-efficacy, medical coping style (yield dimension), anxiety and kinesiophobia (r: -0.211 to 0.611). The medical coping style (yield dimension) exerts a dual mediating influence between exercise self-efficacy and kinesiophobia (95% CI: -0.515 to -0.031), as well as a chain mediating effect with anxiety between exercise self-efficacy and kinesiophobia (95% CI: -0.314 to -0.013). The cumulative mediation effect is 52.91%, with the chain mediation effect accounting for 30.49% of the total mediation effect. Conclusion The majority of patients with HFpEF exhibit kinesiophobia, and exercise self-efficacy can indirectly influence kinesiophobia through the single mediating effect of yielding coping or the chain mediating effect of yielding coping and anxiety. This suggests that medical staff can guide patients to adopt positive coping styles based on their medical coping style and emotions. Concurrently, the objective is to alleviate patient anxiety and mitigate kinesiophobia, thereby enhancing exercise adherence.

Clinical observation of low-dose esketamine for the prevention and treatment of hyperalgesia after remifentanil general anesthesia

FENG Tao, LIU Gang, YU Xiangtian, LI Min, TAO Jing, LIANG Qisheng

2024, 22(10): 1652-1655. doi: 10.16766/j.cnki.issn.1674-4152.003704

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Objective To investigate the effects of low-dose esketamine on the incidence of nociceptive hypersensitivity, pain level, analgesic dosage, and safety after remifentanil general anesthesia. Methods Eighty patients who attended the First Affiliated Hospital of Bengbu Medical University for elective radical cervical cancer surgery from December 2021 to September 2022 were selected. The patients were divided into the esketamine group (Group E) and the control group (Group C) using the randomized numerical table method, with 40 cases in each group. The induction and maintenance methods were the same in both groups, with esketamine 0.12 mg/(kg·h) intravenously pumped after induction in Group E and an equal amount of saline pumped in Group C. Mean arterial pressure (MAP) and heart rate (HR) at different time points, incidence of postoperative nociceptive hypersensitivity, time to first pain, immediate VAS score and OAA/S score, postoperative analgesic pump use, and adverse reactions were recorded in both groups. Results The MAP at the time points of T3 to T6 in the group E which were higher than that in the group C (P < 0.05); the HR at the time points of T3 to T6 in group E which were higher than that of Group C (P < 0.05); 4 cases of nociceptive allergy appeared in Group E after operation, with an incidence rate of 10%, and 16 cases appeared in the Group C, with an incidence rate of 40%. The incidence rate of nociceptive allergy in the Group E was lower than that in the Group C. The difference was statistically significant (P < 0.05). Compared with group C, the first postoperative pain occurred later in group E [(138.75±16.67) min vs. (40.75±26.16) min], the immediate VAS score was lower (3.35±0.53 vs. 4.60±0.87), and the immediate OAA/S score was higher (4.08±0.76 vs. 3.60±0.93), with statistically significant differences (P < 0.05), and analgesic pump in group E used less medicinal fluid and had satisfactory postoperative analgesia, and the difference was significant (P < 0.05). There is no significant difference in the postoperative adverse reactions between the two groups (P>0.05). Conclusion The application of esketamine in patients undergoing radical surgery for cervical cancer resulted in stable intraoperative hemodynamics and satisfactory postoperative analgesia and was able to effectively prevent and control remifentanil-induced nociceptive hypersensitivity.

Establishment of a prediction model of risk factors for psoriasis vulgaris based on machine learning

XU Ruiyao, YAN Xiaoning, HUANG Yongmei, JING Huiling, ZHAO Chan, WANG Yasha, SUN Liping, ZHAO Yiding

2024, 22(10): 1656-1659. doi: 10.16766/j.cnki.issn.1674-4152.003705

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Objective This study aims to identify sensitive indicators and their combinations to distinguish psoriasis, providing support for augmenting diagnostic evaluations and clinical decisions. Methods A total of 301 patients with psoriasis vulgaris from multiple centers, who visited from November 1, 2019 to October 31, 2021, were included. Data were collected on general characteristics, psoriasis scale information, TCM syndrome, and laboratory tests. Six machine learning algorithms were used to construct and verify the classification model for predicting mild and severe psoriasis. The classification performance of the models was evaluated by the parameters of receiver operating characteristic (ROC) area under the curve (AUC), precision, recall, and accuracy. Result The Naive Bayesian Model achieve an AUC of 0.801 4, while the AUC values of the other implicit classification models of logistic regression, SVM, random forest, AdaBoost, and SGD were 0.759 1, 0.754 6, 0.800 4, 0.712 6, and 0.773 7, respectively. Both Bayesian and random forest models had true positive rates of more than 80% in the ROC curve. Conclusion "DLQI", "TCM syndrome", "Baso", "PDW", and "Onset season" were found as key indicators for predicting psoriasis severity. Machine learning and data mining can use real-world clinical data to develop predictive models for psoriasis risk factors, providing a basis for early disease assessment and medical decision-making.

Study of condylar motion trajectory changes before and after occlusal reconstruction in severe attrition

TIAN Ruixue, XIE Xiaofei, GUO Yun, LI Jie, DU Yue, LU Xiaomiao

2024, 22(10): 1660-1664. doi: 10.16766/j.cnki.issn.1674-4152.003706

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Objective In patients with severe wear, the trajectory of the condyle is of critical importance during the mandibular movement. Therefore, the purpose of this study was to analyze the characteristics of condylar movement in such patients before and after occlusal reconstruction. Methods Thirty patients with severe attrition occlusion in the First Affiliated Hospital of Bengbu Medical University from January 2022 to June 2023 were selected as the study objects. After occlusal reconstruction, CADIAX was used to trace the condylar movement. Results During mouth opening and closing movement, the Y-axis, Z-axis, and S values on the irreducible anterior displacement side decreased after treatment, while the X-axis and position distance ofcondyle movement(DIF) values were higher after treatment (P < 0.05). However, the values of X, Y, Z, S, and DIF increased. On the reducible anterior displacement side, the X, Y, Z, S, and DIF values all decreased after treatment (P < 0.05). In addition, the sagittal condylar inclination (SCI), transversal condylar inclination (TCI), and these indicators at 5 mm displacement on the reducible anterior displacement side and irreducible anterior displacement side also decreased after treatment (P < 0.05). In the forward and backward movement, the displacement along the X, Y, Z axes, as well as the S and DIF values on both the reducible and irreducible anterior displacement sides significantly decreased after treatment (P < 0.05). In addition, SCI, TCI, and TCI at 5 mm of the irreducible anterior displacement were higher than those after treatment, and TCI and TCI at 5 mm of the reducible anterior displacement were higher than those after treatment as well (P < 0.05). In lateral movement, the X axis and Y axis displacement and the DIF were significantly reduced after treatment. When the working side had reducible or irreducible anterior displacement, the peak displacement of the condylar space increased significantly in the treatment group. In addition, the irreducible anterior displacement side had lower SCI and SCI at 5 mm displacement after treatment, while SCI of the reducible anterior displacement side also decreased (P < 0.05). Conclusion In patients with severe attrition, condylar trace can evaluate the dynamic range of condylar movement and serve as an important basis for effectiveness of diagnosis and treatment.

MiR-375 Modulates HK2 via SP1 to Impact Proliferation and Glycolysis in Hepatocellular Carcinoma

YAN Junwei, ZHOU Lei, CHEN Shanshan, ZHANG Heng

2024, 22(10): 1665-1670. doi: 10.16766/j.cnki.issn.1674-4152.003707

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Objective To investigate the aberrant expression of hexokinase 2 (HK2) in hepatocellular carcinoma (HCC) and the regulatory mechanisms of cell proliferation and glycolysis in HCC. Methods A total of 41 cases of HCC and paracancerous tissues that underwent surgical resection at the Central Hospital of Wuhan between January 2017 and December 2019 were collected for pathological examination. The expression of HK2 and SP1 was evaluated through immunohistochemical staining. In the HepG2 cell line, HK2 and SP1 were knocked down, and miR-375 was overexpressed. The assessment of cell proliferation and glycolytic capacity was conducted through the utilization of CCK-8, glucose, and lactate concentration assays. The regulatory relationships among HK2, SP1, and miR-375 were validated through the implementation of real-time quantitative PCR (RT-qPCR) and Western blotting techniques. The correlation among these factors was analyzed through the utilization of the gene expression omnibus (GEO) HCC dataset. The direct interaction between miR-375 and SP1 was confirmed through the utilization of a luciferase reporter assay. Results IHC revealed that the high expression rates of SP1 and HK2 in paracancerous tissues were 39.0% (16/41) and 26.8% (11/41), respectively. In HCC tissues, these rates increased to 58.5% (24/41) and 53.7% (22/41) respectively. A positive correlation was observed between SP1 and HK2 expression scores (r=0.611, P < 0.001). The downregulation of HK2 and SP1, and the upregulation of miR-375, resulted in the inhibition of HCC cell proliferation and glycolysis. The upregulation of miR-375 and downregulation of SP1 resulted in the suppression of HK2 expression. Bioinformatics analysis revealed a negative correlation between HK2 and miR-375 expression (r=-0.584, P < 0.001) and a positive correlation between HK2 and SP1 expression (r=0.297, P=0.005). Additionally, miR-375 was identified as a direct target of SP1, exhibiting inhibitory effects at both mRNA and protein levels. The luciferase reporter assay provided confirmation of the direct interaction between miR-375 and SP1. Conclusion The miR-375 has been demonstrated to regulate HK2 by targeting the transcription factor SP1, thereby influencing the proliferation and glycolysis of HCC.

Effect of radiotherapy dose on prognosis of cervical esophageal squamous cell carcinoma after define concurrent chemoradiotherapy

LIU Jia, CUI Zhen, SUN Qiaoyu, CHANG Fangfang

2024, 22(10): 1671-1674. doi: 10.16766/j.cnki.issn.1674-4152.003708

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Objective The dose of define concurrent chemoradiotherapy for cervical esophageal squamous cell carcinoma(CEC) is controversial. This study analyzed the efficacy of patients with CEC who received define concurrent chemoradiotherapy, hoping to provide a clinical reference for the dose of radiotherapy for CEC. Methods A retrospective analysis was performed on 89 patients with CEC who received intensity-modulated radiotherapy (IMRT) in the Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical University from January 2013 to December 2021 and were divided into two groups according to radiotherapy dose: a low-dose group (EQD2Gy≤60 Gy) and a high-dose group (EQD2Gy>60 Gy). Chemotherapy regimens include platinum-based dual drug combination or S1 alone. The Kaplan-Meier method was used to calculate loco-regional control (LRC), progression-free survival (PFS), and overall survival (OS). The log-rank method was used to test differences and univariate analysis. The Cox model was used to analyze prognostic factors. Results The follow-up rate was 100% and the median follow-up time was 100 months. The 1-year, 3-year, and 5-year LRC rates were 76.1%, 37.9%, and 22.4%, respectively, and the PFS rates were 67.4%, 30.0%, and 16.2%, respectively. The OS rates were 85.4%, 47.1%, and 29.6%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, and radiotherapy dose were the influencing factors of OS, PFS, and LRC, and radiotherapy dose was the independent prognostic factor of 0S, PFS, and LRC in cervical esophageal squamous cell carcinoma (P < 0.05). Conclusion When cervical esophageal squamous cell carcinoma is treated with define chemoradiotherapy, EQD2Gy>60 Gy showed a better survival benefit, and radiotherapy dose was an independent prognostic factor for OS, PFS, and LRC.

Factors influencing traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture

HU Guanqiong, ZHOU Yeli, CHEN Qunying, HUANG Kelun

2024, 22(10): 1675-1678. doi: 10.16766/j.cnki.issn.1674-4152.003709

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Objective To explore the risk of traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture (FNF) and analyze associated factors. Methods A total of 257 cases of FNF from the First Affiliated Hospital of Wenzhou Medical University, treated from January 2019 to July 2021, were selected as the research object. According to the imaging findings of the last follow-up, all patients were divided into necrosis group and non-necrosis group. The general data and laboratory examination results of all patients were collected, and the factors affecting the development of traumatic osteonecrosis were analyzed by multivariate logistic regression. Results At the last follow-up, 21 patients had fallen out and 236 patients were included in the study. There were 87 cases (36.86%) in the necrotic group and 149 cases (63.14%) in the non-necrotic group. There were significant differences in injury mechanism, reduction mode, and reduction quality between the two groups (P < 0.05). The levels of apolipoprotein A1, procollagen Ⅰ N-terminal propeptide (PⅠNP), nitric oxide (NO), and stromal cell-derived factor-1 (CXCL12) in the necrotic group were lower than those in the non-necrotic group, while the levels of apolipoprotein B and IL-33 were higher (P < 0.05). Multivariate logistic regression analysis showed that the reduction quality of C, high IL-33 and high apolipoprotein B were risk factors for traumatic osteonecrosis, while high CXCL12, high NO and high apolipoprotein A1 were protective factors for traumatic osteonecrosis (P < 0.05). Conclusion The incidence of Pauwels type III FNF traumatic osteonecrosis is higher. Reduction quality C, IL-33, CXCL12, NO, lipoprotein A1, and apolipoprotein B were influencing factors of traumatic osteonecrosis in patients with femoral neck fracture.

Safety and feasibility of partial tubeless percutaneous nephrolithotripsy

LIU Jun, HE Wei, LOU Yanting, LU Zhaoxiang, SHI Dong, TANG Yurui

2024, 22(10): 1679-1683. doi: 10.16766/j.cnki.issn.1674-4152.003710

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Objective To investigate the safety and clinical efficacy of partial tubeless percutaneous nephrolithotripsy(PCNL). Methods A total of 87 patients with renal ureteral stones admitted to the Chaohu Hospital of Anhui Medical University between January 2021 to June 2023 were divided into 47 cases in the traditional percutaneous nephrolithotomy (with indwelling nephrostomy tube and double J-tube) surgical group and 40 cases in the percutaneous nephrolithotomy partially untubed (with indwelling double J-tube only) surgical group according to surgical methods. All 87 surgical procedures were performed by the same surgical team. The data pertaining to the preoperative and perioperative periods, along with the factors that may potentially influence the incidence factors that may potentially influence the incidence of complications associated with percutaneous nephrolithotomy were comparable between the two groups. Results In the traditional percutaneous nephroscopic surgery group, the postoperative hospitalization duration [7.00 (6.00, 9.00) d vs. 5.00 (4.00, 6.00) d], first time out of bed [4.00 (3.00, 5.00) d vs. 2.00 (2.00, 3.00) d], incidence of postoperative complications [17 cases (36.2%) vs. 3 cases (7.5%)] and postoperative VAS score [7.00 (7.00, 8.00) vs. 5.00 (5.00, 5.00)] were significantly different from those in the percutaneous nephroscopic partial tubeless surgery group (P < 0.05). With the exception of gender, the two groups exhibited statistically significant differences in preoperative age, BMI and STONE score. Preoperative urinary leukocytes, comorbidities of diabetes mellitus, hypertension, and cardiac disease did not reach statistical significance (P>0.05). A multifactorial analysis revealed that STONE score and surgical approach were independent risk factors for postoperative complications. Conclusion Percutaneous nephrolithotomy for partial tubelessness offers significant advantages in terms of surgical safety, postoperative VAS score, postoperative recovery time, average hospital stay, treatment cost, and treatment efficiency. It is therefore a procedure that merits further promotion.

The gene characteristics of carbapenem-resistant enterobacteriaceae in patients with urinary tract infection

LU Xiufang, KANG Yali, LI Xia, HU Jinding, TIAN Jinjing

2024, 22(10): 1684-1686. doi: 10.16766/j.cnki.issn.1674-4152.003711

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Objective To explore the drug resistance and gene characteristics of carbapenem-resistant Enterobacteriaceae (CRE) in patients with urinary tract infection, and to provide reference for the prevention and treatment of CRE in this area. Methods Clinical data of 81 strains of CRE isolated from urinary tract infection patients in the Second People ' s Hospital of Liaocheng from January 2017 to December 2022 were collected, and their drug resistance and resistance gene characteristics were analyzed. Results Among the 81 strains of CRE, Escherichia coli accounted for 55.56% (45/81) and Klebsiella pneumoniae accounted for 28.40% (23/81). The drug resistance rates of CRE to polycolistin and tigecycline were lower [4.94% (4/81), 0]. The resistance rate of Escherichia coli to ceftazidime/avibactam was as high as 84.44% (38/45), while the resistance rate of Klebsiella pneumoniae to ceftazidime/avibactam was 8.70% (2/23). Among 81 CRE strains, 22 were bla_KPC, and all were bla_KPC-2. There were 59 strains of bla_NDM, including 57 bla_NDM-5 and 2 bla_NDM-1. The main resistance gene of Escherichia coli was bla_NDM-5 [97.78% (44/45)], and that of Klebsiella pneumoniae was bla_KPC-2 [95.65% (22/23)]. ST11 dominated the ST type of 23 strains of carbapenem-resistant Klebsiella pneumoniae [CRKP, 86.96% (20/23)], and ST410 dominated the ST type of 45 strains of carbapenem-resistant Escherichia coli [CREC, 51.11% (23/45)]. Conclusion The resistance rate of CRE in patients with urinary tract infection was higher, bla_NDM-5 was the main resistance gene of Escherichia coli, bla_KPC-2 was the main resistance gene of Klebsiella pneumoniae, and ST11 was the main ST type.

Analysis of the effect of comprehensive intervention measures in preventing hypothermia during laparoscopic rectal cancer surgery under deep muscle relaxation

YANG Mingming, ZHU Qiuyan, GU Bin, WANG Luping

2024, 22(10): 1687-1690. doi: 10.16766/j.cnki.issn.1674-4152.003712

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Objective To investigate the efficacy of comprehensive intervention measures in preventing intraoperative hypothermia in laparoscopic rectal cancer surgery under deep muscle relaxation. Methods A total of 120 patients with rectal cancer treated at Zhejiang Cancer Hospital between June 2022 and January 2023 were selected for inclusion in the research analysis. The subjects were randomly assigned to either the study group or the control group, with 60 cases in each group. The study group received comprehensive intervention measures, while the control group was administered routine heat preservation. The differences in intraoperative and postoperative recovery body temperature changes and other treatment-related variables were compared between the two groups. Results No significant differences were observed between the study group and the control group with regard to basic demographic characteristics, preoperative radiotherapy and chemotherapy, American society of aneshesiologists classification, total infusion volume, and urine volume (P>0.05). Following the administration of anaesthetic agents, a decline in core body temperature was observed in all patients. A statistically significant difference in body temperature was observed between the study group and the control group at various time points during the surgical procedure (P < 0.001). A significant difference in body temperature was observed between the study and control groups during the 0.5-3.0 h following surgery (P < 0.001). The overall trend for the core body temperature of all patients in the recovery room was an increase. A statistically significant difference was observed in body temperature between the study group and the control group at various time points during the postoperative recovery period (P < 0.001). At different time points within the postoperative recovery room, the body temperature of patients in the study group was found to be significantly higher than that of the control group (P < 0.001). Furthermore, the mean time to achieve an Aldrete score of 10 was significantly shorter in the study group than in the control group (P < 0.001). Nine patients in the control group exhibited chills, whereas only two patients in the study group did so. Conclusion The implementation of comprehensive intervention and nursing measures has been demonstrated to effectively prevent the incidence of hypothermia in patients undergoing deep muscle paralysis laparoscopic rectal cancer surgery, while also reducing the recovery time.

The effect of preoperative hand motor nerve conduction velocity and grip strength on prognosis in 85 patients with moderate to severe cubital tunnel syndrome

GAO Xing, MENG Yufeng, ZHANG Tongtong, WANG Wei

2024, 22(10): 1691-1695. doi: 10.16766/j.cnki.issn.1674-4152.003713

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Objective To investigate the influence of hand motor nerve conduction velocity (MNCV) and grip strength on prognosis in 85 patients with moderate to severe cubital tunnel syndrome, and to provide guidance for prognosis evaluation. Methods Data of 85 patients with moderate to severe cubital tunnel syndrome treated in Cangzhou Hospital of Integrated Chinese and Western Medicine, Hebei Province from July 2021 to July 2023 were collected. Different cubital tunnel syndrome grades, different prognosis, and grip strength levels were compared, and the value of these indicators in predicting poor prognosis was evaluated. Results (1) Before the operation, the hand MNCV and grip strength in the severe group were lower than those in the moderate group (P < 0.05); After the operation, the above indexes increased in the two groups, and the moderate group was higher (P < 0.05); (2) After the surgery, comparison of hand MNCV and grip strength as follows: Excellent functional recovery group > good functional recovery group > fair functional recovery group > poor functional recovery group, with statistically significant difference (P < 0.05); (3) Among the 81 patients with complete follow-up data, 20 patients had poor functional recovery (poor prognosis group), and the remaining 61 patients were considered as the good prognosis group. The hand MNCV and grip strength in the poor prognosis group were lower under different conditions (P < 0.05); (4) Hand MNCV and grip strength under different conditions of moderate and severe cubital tunnel syndrome were more effective in predicting the poor prognosis of patients. (5) The proportion of patients aged ≥50 years, duration ≥10 months, long-term elbow bending and muscle atrophy in the poor prognosis group was higher than that in the good prognosis group (P < 0.05); (6) Long-term elbow bending and muscle atrophy were risk factors for poor prognosis in patients with moderate to severe cubital tunnel syndrome (P=0.008, 0.001). Conclusion After treatment, the cubital length hand MNCV and grip strength of patients with moderate and severe cubital tunnel syndrome are improved in different states, and the above indexes were improved more significantly in patients with moderate cubital tunnel syndrome, which could be used as effective indicators to predict the prognosis.

The Clinical Effect of CT-guided Pulse Radiofrequency Combined with Nerve Block in the Treatment of Patients with Head and Face Postherpetic Neuralgia

LU Leilei, GENG Zhusheng

2024, 22(10): 1696-1699. doi: 10.16766/j.cnki.issn.1674-4152.003714

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Abstract:
Objective To investigate the efficacy and possible mechanism of CT-guided pulse radiofrequency (PRF) combined with nerve block in the treatment of post-herpetic neuralgia (PHN) of the head and face. Methods A total of 104 patients with head and face PHN admitted to the First People ' s Hospital of Lianyungang from February 2021 to August 2023 were randomly divided into the study group (52 cases) and the control group (52 cases) using the random number table method. The control group underwent a nerve block procedure. The study group received CT-guided PRF combined nerve block treatment. Efficacy and safety were evaluated after 1 month of treatment, and changes in VAS, Pittsburgh sleep quality index (PSQI), Hamilton anxiety/depression scale (HAMA/HAMD) scores were compared between the two groups before and after treatment. Pain transmitters [β-endorphin (β-EP), substance P (SP), calcitonin gene-related peptide (CGRP), neuropeptide Y (NPY)] and inflammatory markers [interleukin-6, IL-26, CC chemokine receptor 2 (CCR2)] were measured in blood samples before and after treatment. Results Following treatment, the total effective rate in the study group was significantly higher [90.38% (47/52) vs. 73.08% (38/52), P < 0.05]; Additionally, the VAS score in the study group was (2.21±0.64) points, which was lower than that in the control group [(3.37±1.00) points, F=802.273, P < 0.001]. The PSQI, HAMA, HAMD scores, as well as serum pain transmitters and inflammatory marker levels, were significantly lower in the study group (P < 0.05). Conversely, there was no statistically significant difference in the incidence of adverse reactions (P>0.05). Conclusion CT-guided PRF combined with nerve block in the treatment of PHN of the head and face is safe and effective and can reduce pain in patients. The mechanism may be related to inhibition of pain mediators and reduction of serum levels of IL-6, IL-26 and CCR2.

Correlation analysis between serum lipoprotein(a) levels and mitral annulus calcification

PAN Luhua, ZHU Mingli, CHEN Duoxue, TU Sheng

2024, 22(10): 1700-1704. doi: 10.16766/j.cnki.issn.1674-4152.003715

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Abstract:
Objective This investigation delineates the potential correlation between serum Lipoprotein(a) [Lp(a)] levels, mitral annular calcification (MAC), and associated mitral valve dysfunction. Methods A retrospective analysis was conducted on the clinical data of 131 patients admitted to the Department of Cardiology at People ' s Hospital of Bozhou for coronary CT angiography (CTA) from January 2022 to November 2023. Based on image analysis, patients were divided into the MAC group (62 cases) and the normal group (69 cases). Comprehensive data collection encompassed demographic information (age, gender), medical history (hypertension, diabetes), and a spectrum of biochemical parameters including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), Apolipoprotein A, Apolipoprotein B, Serum Lipoprotein(a), Creatinine, Uric Acid, Homocysteine, and history of statin use. The basic clinical data of the two groups were compared, focusing on the differences in the occurrence of mitral stenosis and regurgitation. The study also analyzed the risk factors for MAC and the risk of MAC-related mitral valve diseases. Results Significant differences were observed in the levels of LDL-C and Lp(a) between the MAC and the control group (P < 0.01). Logistic regression analysis identified Lp(a) as an independent risk factor for MAC (OR=1.256, 95% CI: 1.002-1.490, P=0.008). Lp(a) levels significantly differed between the normal group and both severe MAC and mild-to-moderate MAC groups (P < 0.05). The incidence of mitral stenosis did not differ significantly between the groups [8.06% (5/62) in the MAC group vs. 1.45% (1/69) in controls, P=0.165]. However, mitral regurgitation was significantly more prevalent in the MAC group [17.74% (11/62) in the MAC group vs. 4.35% (3/69) in controls, P=0.013]. Conclusion Elevated Lp(a) levels are significant risk factors for mitral annular calcification. The presence of MAC may increase the risk of mitral regurgitation. Monitoring and controlling Lp(a) levels in patients with MAC is crucial for preventing MAC progression and associated mitral valve diseases.

Effect of Zishuihanmu prescription combined with polyene phosphatidylcholine on immune function in patients with chronic hepatitis B cirrhosis

LAN Shaobo, ZHOU Mi, WU Xinjuan, SHAO Jiawei

2024, 22(10): 1705-1708. doi: 10.16766/j.cnki.issn.1674-4152.003716

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Abstract:
Objective To evaluated the clinical efficacy of Zishuhanmu prescription combined with polyene phosphatidylcholine in treating patients with chronic hepatitis B cirrhosis by observing the changes in liver function, liver fibrosis, inflammatory response, oxidative stress, immune function, and other indicators of patients. Methods A total of 100 patients with chronic hepatitis B cirrhosis, admitted to the Affiliated Hospital of Shaoxing University of Arts and Sciences from March 2021 to March 2024, were selected and divided into a control group and a combination group, with 50 patients in each group by random number table method. The control group was treated with polyene phosphatidylcholine, and the combination group was treated with Zishuihanmu prescription combined with polyene phosphatidylcholine. Traditional chinese medicine (TCM) syndrome scores were compared between the two groups, liver function, liver fibrosis index levels, and serum levels of total antioxidant capacity (TAOC), advanced oxidation protein products (AOPP), hypersensitivity C-reactive protein (hs-CRP) and TNF-α were also compared between the two groups. CD4⁺ and CD3⁺ levels were detected by flow cytometry, and the therapeutic effects of the two groups were compared. Results After treatment, the TCM syndrome score of the combination group was lower than that of the control group (P < 0.05). The indexes of liver function and liver fibrosis in the combination group were lower than those in the control group (P < 0.05). Additionally, the levels of TAOC, AOPP, hs-CRP, and TNF-α in the combination group were lower than those in the control group (P < 0.05). The CD4⁺ and CD3⁺ levels in the combination group were 42.63±4.89 and 68.57±6.87, respectively, which were higher than those in the control group (39.41±3.75 and 64.21±6.32, P < 0.05). The effective treatment rate of the combination group was 94.00%, 47/50, higher than that in the control group (80.00%, 40/50, P < 0.05). Conclusion The combination of Zishuihanmu prescription and polyene phosphatidylcholine in the treatment of chronic hepatitis B cirrhosis patients can reduce severity of TCM syndromes, improve liver function and liver fibrosis, alleviate oxidative stress and inflammatory reaction, and enhance immune function, resulting a notable therapeutic effect.

Correlation between serum creatinine/cystatin C ratio, calf circumference and type 2 diabetes with sarcopenia

LYU Mingyan, LIANG Lanyu, SHAN Qing

2024, 22(10): 1709-1713. doi: 10.16766/j.cnki.issn.1674-4152.003717

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Abstract:
Objective To investigate the value of serum creatinine/cystatin C ratio (CCR) combined with calf circumference for screening type 2 diabetes mellitus combined with sarcopenia. Methods The data of 276 patients with type 2 diabetes diagnosed in the Department of Endocrinology of the Affiliated Hospital of Yangzhou University from December 2022 to June 2023 were included, and they were divided into a sarcopenia group and a non-sarcopenia group according to the JSH standard. Spearman correlation analysis was used to study the relationship between CCR and indicators affecting sarcopenia. The risk of CCR value affecting the incidence of sarcopenia was analyzed by stepwise regression of binary logistic regression. The receiver operating characteristic (ROC) curve was used to analyze the value of CCR, and calf circumference alone and jointly in screening type 2 diabetes with sarcopenia. Results The prevalence of type 2 diabetes mellitus with sarcopenia in this study was 14.13% (39/276). CCR was positively correlated with BMI, urinary creatinine (UCR), erector spinae muscle area (T₁₂ CSA) at the 12th thoracic vertebra level, skeletal muscle mass index (L₃ SMI) at the third lumbar vertebra level, and calf circumference (P < 0.05), and negatively correlated with age, CysC and urinary albumin to creatinine ratio (ACR, P < 0.05). The study used two-way stepwise binary logistic regression analysis to obtain BMI, history of diabetes peripheral vascular disease, ACR, CCR, total cholesterol (TC), and calf circumference were all risk factors for type 2 diabetes with sarcopenia (P < 0.05). ROC curve analysis showed that the AUC of CCR combined with calf circumference to predict diabetes with sarcopenia was 0.817, the sensitivity and specificity were 91.1% and 56.4%, respectively, and the Yoden index was 0.475. Conclusion CCR and calf circumference are closely related to the occurrence of sarcopenia in diabetes. CCR combined with calf circumference will become an effective indicator for early screening of sarcopenia in patients with type 2 diabetes.

The correlation between serum KLF2 and S1P1 levels and coronary artery injury in children with Kawasaki disease

XIA Kun, ZHANG Yong, ZHOU Dan

2024, 22(10): 1714-1717. doi: 10.16766/j.cnki.issn.1674-4152.003718

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Abstract:
Objective To explore the correlation between Krüppel-like transcription factor 2 (KLF2) and sphingosine 1-phosphate receptor 1 (S1P1) levels and coronary artery injury in children with Kawasaki disease, and the risk factors for coronary artery injury. Methods A total of 120 children with Kawasaki disease admitted to Wuhan Children ' s Hospital, Tongji Medical College, Huazhong University of Science and Technology from December 2021 to December 2023 were studied. Serum KLF2 and S1P1 levels were determined, the presence and the degree of coronary artery injury were assessed, and the correlation among serum KLF2, S1P1 levels, and coronary artery injury was analyzed. Results The levels of serum KLF2 and S1P1 in children with coronary artery injury were lower than those without injury [(2.48±0.72) vs. (4.29±0.92) pg/mL, (287.65±42.88) vs. (427.64±52.86) ng/mL, P < 0.01]; The levels of serum KLF2 and S1P1 in coronary dilatation group were higher than those in small, medium and large coronary aneurysm group; The levels of serum KLF2 and S1P1 in the small and medium coronary aneurysm group were higher than those in the large coronary aneurysm group; Serum KLF2 and S1P1 levels were negatively correlated with the degree of coronary artery injury (r=-0.522, -0.634; P=0.003, P < 0.001); Multiple Logistic regression analysis showed the duration of fever, white blood cell count, KLF2 and S1P1 were the influencing factors of coronary artery injury in children (P < 0.05). Conclusion The levels of serum KLF2 and S1P1 in children with Kawasaki disease with coronary artery injury decrease, and the decreased degree is closely related to the degree of coronary artery injury. The course of fever duration, white blood cell count, and the levels of KLF2 and S1P1 are influential factors for coronary artery injury.

The value of gastric juice and peripheral blood total bile acids in the diagnosis of bile reflux gastritis in children

FANG Haiying, ZHANG Linqian

2024, 22(10): 1718-1721. doi: 10.16766/j.cnki.issn.1674-4152.003719

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Abstract:
Objective To investigate the expression of total bile acid (TBA) in gastric juice and peripheral blood in children with bile reflux gastritis (BRG) and its diagnostic value. Methods The clinical data of 120 children with BRG diagnosed and treated in Jinhua Maternal and Child Health Care Hospital from May 2021 to June 2023 were retrospectively analyzed. The BRG children were set as the observation group, and 59 healthy children were selected as the control group during the same period. The gastric fluid and peripheral blood TBA were compared. Kendall ' s tau-b method was used to analyze the correlation between gastric fluid and peripheral blood TBA and the clinical characteristics of BRG children. Receiver operating characteristic (ROC) curve was drawn to analyze the AUC value, sensitivity and specificity of TBA diagnosis of BRG. Results The TBA of gastric juice and peripheral blood in the observation group were [(13.55±4.74) μmol/L and (11.24±3.04) μmol/L], respectively, which were higher than those in the control group [(8.08±1.83) μmol/L and (7.71±2.05) μmol/L, P < 0.05]. There were statistically significant differences in TBA in gastric juice and peripheral blood among different Helicobacter pylori infection, intestinal metaplasia, lymphoid follicular hyperplasia, gastric fovea hyperplasia and mucosal superficial vasodilation (P < 0.05). Kendall ' s tau-b correlation analysis showed that gastric fluid and peripheral blood TBA were positively correlated with Helicobacter pylori infection, intestinal metaplasia, lymphofollicular hyperplasia, gastric fovea hyperplasia, mucosal superficial vasodilation, and total bile reflux (P < 0.05). ROC curve analysis showed that the AUC values of TBA in gastric juice and peripheral blood were 0.872 and 0.780, respectively. The sensitivity were 90.80% and 50.00%. The specificity were 69.50% and 96.60%. Conclusion The expression of TBA in gastric juice and peripheral blood is abnormal in BRG children, and the observation of its expression is helpful to provide guidance for clinical diagnosis.

Application effect of hospital-community-family linkage model in community coronary heart disease management

XUAN Ling, TANG Bi, LI Miaonan, XIE Caixia, WANG Lichao, WANG Cuixiang

2024, 22(10): 1722-1726. doi: 10.16766/j.cnki.issn.1674-4152.003720

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Abstract:
Objective To implement a standardized management model of coronary heart disease (CHD) patients in the community, utilizing a third-class hospital-community-family linkage approach, and to analyze the changes in outcomes before and after this three-mode management. Methods A total of 480 patients with coronary heart disease from July to November 2022 in four communities in Bengbu City were selected. Cardiovascular specialists from the First Affiliated Hospital of Bengbu Medical University, in conjunction with community healthcare providers and patient ' s family, managed the patients. The main evaluation indicators included changes in risk factors of CHD, awareness rates of CHD, utilization rates of secondary prevention drugs, annual hospitalization annual number of hospitalization and scores of Seattle angina questionnaire (SAQ) before and after management. Results The blood pressure, blood glucose, blood lipid, body mass index, smoking rate of patients with coronary heart disease decreased and the number of exercise increased after combined management (P < 0.05). The awareness rate of CHD was increased (59.79% vs. 95.63%, χ²=177.900, P < 0.05). And the utilization rates of antiplatelet drugs (90.21% vs. 96.88%, χ²=17.656, P < 0.05), lipid-regulating drugs (83.13% vs. 92.92%, χ²=21.823, P < 0.05), β-blockers (51.46% vs. 85.83%, χ²=131.761, P < 0.05), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/sacubitril-valsartan (52.29% vs. 87.29%, χ²=139.450, P < 0.05) increased. The number of annual hospitalizations decreased, and SAQ scores improved (P < 0.05). Conclusion The standardized management mode of coronary heart disease linking tertiary hospitals, communities, and families improved control of risk factors of CHD patients, reduced attack of angina pectoris, enhanced quality of life, decreased rehospitalization, and elevated the prevention and treatment capabilities of community doctors. This model is worthy promoting for managing other chronic diseases.

A study of health information needs of elderly lung cancer patients based on an online health community

ZHANG Chu, ZHENG Ying, ZHANG Taotao, LI Chao, XIE Hui, LIU Yuwen

2024, 22(10): 1727-1731. doi: 10.16766/j.cnki.issn.1674-4152.003721

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Abstract:
Objective To analyze the health information needs and distribution patterns of elderly lung cancer patients using a combination of thematic and statistical analysis. Methods Firstly, the Octopus data collector was used to crawl the consultation information of elderly people aged ≥60 years posted on the health platform of "Good Doctor Online" from November 2022 to April 2023, to screen the consultation data of lung cancer patients, and to pre-process the data. Subsequently, Python integrated machine learning tools were used to execute K-means clustering procedures to divide the inquiry data into topics, so as to deeply explore the health information needs of elderly patients with lung cancer. Finally, the differences of health information needs of elderly patients with lung cancer were analyzed from the perspective of gender and age. Results A total of 44 354 standardized datasets were obtained, including 2 538 consultations from elderly lung cancer patients. The health information needs of lung cancer patients were predominantly distributed across seven thematic areas which included disease management and risk control related to lung cancer during the COVID-19 period (445, 17.53%), examinations and diagnosis (569, 22.42%), pathological features (604, 23.80%), treatment (665, 26.20%), postoperative management (114, 4.49%), pain management (97, 3.82%), and healthy lifestyle and prevention (44, 1.73%). There was a statistical difference (P < 0.05) in the needs for health information among elderly lung cancer patients of different genders (χ²=18.004, P=0.006) and ages (χ²=61.178, P < 0.001). Conclusion The health information needs of elderly patients with lung cancer show complexity and diversity. Gender and age are the influencing factors of the health information needs of patients. Medical personnel should develop personalized and diversified health education content oriented to patients ' needs, so as to promote the effect of patients ' health management.

Current status and influencing factors of emotional and behavioral problems of preschool children in southern Hebei Province

MENG Jie, WANG Shiyue, ZHAO Yang, WANG Haitao

2024, 22(10): 1732-1736. doi: 10.16766/j.cnki.issn.1674-4152.003722

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Abstract:
Objective To investigate the current situation of emotional and behavioral problems in preschool children in southern Hebei Province, and explore the factors related to the occurrence. Methods From July to August 2023, 1 145 preschool children from 4 general kindergartens in southern Hebei were randomly selected as a multi-stage stratified cluster. The Basic information questionnaire, parental version strengths and difficulties questionnaire, and sensory integration ability development rating scale were used to investigate the emotional and behavioral problems of preschool children and their influencing factors. Results A total of 995 valid questionnaires were obtained in this survey, and 237 preschool children had emotional behavioral problems, with 26.23% (123/469) of the girls having emotional and behavioral problems and 21.67% (114/526) of the boys having emotional and behavioral problems. There were significant differences in birth weight, whether they were the first child, family type, mother ' s occupation, father ' s occupation, children ' s sensory integration disorder and vestibular balance, tactile defensiveness, and proprioception scores between the preschool children with and without emotional and behavioral problems (P < 0.05). Multivariate logistic regression analysis indicated that child gender, child age, mother ' s occupation, father ' s occupation, vestibular balance score, tactile defensiveness score, and sensory integration disorder were the influencing factors for the occurrence of emotional and behavioral problems in preschool children. Conclusion The emotional and behavioral problems of preschool children in southern Hebei Province are increasingly serious with multiple influencing factors, which need more attention and targeted early intervention.

Qualitative efficacy of AI-assisted multimodal ultrasound combined with serum thyroid stimulating hormone in guiding thyroid nodules

TUO Jingmei, SI Xiaojuan, SONG Heqin

2024, 22(10): 1737-1741. doi: 10.16766/j.cnki.issn.1674-4152.003723

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Abstract:
Objective To explore the guiding efficacy of artificial intelligence (AI) assisted multimodal ultrasound combined with serum thyroid stimulating hormone (TSH) in qualitative diagnosis of thyroid nodules, in order to provide reference for clinical diagnosis and treatment of thyroid nodules. Methods A total of 100 patients with thyroid nodular disease treated in Zhangjiakou First Hospital from January 2021 to June 2022 were selected and examined by AI routine ultrasound, contra-ultrasound, and real-time shear wave elastography (SWE). The patients were divided into a benign group (23 cases) and a malignant group (77 cases) with pathological results as the gold standard. Serum TSH levels were detected in the two groups. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of TSH in the qualitative diagnosis of thyroid nodules, and the diagnostic efficacy of AI-assisted multimodal ultrasound combined with TSH in the qualitative diagnosis of thyroid nodules was evaluated. Results A total of 113 nodules were found by pathological findings, including 26 benign nodules and 87 malignant nodules. The sensitivity of AI conventional ultrasound + CEUS +SWE combined diagnosis was 89.66% (78/87), which was higher than that of single and pairwise combined diagnosis (P < 0.05). The serum TSH level in the benign group was lower than that in the malignant group (P < 0.05). The ROC curve showed that the AUC (95% CI), sensitivity, specificity, and cut-off values of serum TSH diagnosis were 0.800, 74.71%, 84.62%, and 4.44 mIU/L, respectively. The accuracy, sensitivity, and negative predictive value of AI-assisted multimodal ultrasound combined with serum TSH diagnosis were 93.81% (106/113), 97.70% (85/87), and 91.30% (21/23), respectively, which were higher than that of single diagnosis (P < 0.05). Conclusion AI-assisted multimodal ultrasound combined with serum TSH is effective and valuable in the qualitative diagnosis of thyroid nodules.

The relationship between CT perfusion parameters, short-term efficacy and prognosis after CT-guided microwave ablation of hepatocellular carcinoma

ZHOU Wei, GENG Nawei, WANG Ying, ZANG Wei, LIU Bingmu, CAO Liming

2024, 22(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.003724

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Abstract:
Objective Preoperative CT perfusion imaging is beneficial to the prognosis assessment of patients with liver cancer, but there are few studies on the effect of postoperative CT perfusion imaging. This study analyzed the relationship between CT perfusion imaging parameters and short-term efficacy and long-term prognosis of patients with liver cancer after CT-guided microwave ablation (MWA), so as to further explore its application value in patients with liver cancer. Methods A total of 150 patients with primary liver cancer admitted to Baoding First Central Hospital from January 2020 to January 2022 were selected and separated into the effective group and the ineffective group according to the modified response evaluation criteria in solid tumor (mRECIST). CT perfusion parameters between the two groups were compared after 4 weeks of MWA treatment, and the receiver operating characteristic (ROC) curve was used to evaluate the value of CT perfusion parameters in predicting the short-term efficacy; With all-cause death as the end event, Kaplan-Meier survival curve was used to evaluate the relationship between CT perfusion parameters and prognosis of patients, and log-rank test was used to compare the differences. Results Hepatic artery perfusion volume (HAP) in the effective group was lower than that in the ineffective group, and the portal vein perfusion volume (PVP) was higher (P < 0.001); Both HAP and PVP had certain predictive value for the short-term efficacy of patients, and their combined detection had the highest predictive efficacy, with AUC of 0.894, sensitivity and specificity of 94.64% and 65.96%, respectively; The overall survival rate of HAP low-level group and PVP high-level group was higher than that of HAP high-level group and PVP low-level group (P < 0.05). Conclusion CT perfusion parameters are closely related to the short-term efficacy and long-term prognosis of HCC patients after MWA. The higher the HAP and lower the PVP, the worse the therapeutic effect and prognosis.

The predictive value of MRI-DWI-IVIM multiparameter imaging in tumor infiltrating lymphocyte levels after neoadjuvant chemotherapy for invasive breast cancer

BIAN Guifeng, LI Xiaodong, HE Song, ZHANG Bin, LI Jiaojiao

2024, 22(10): 1746-1749. doi: 10.16766/j.cnki.issn.1674-4152.003725

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Abstract:
Objective To investigate the potential of magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and intravoxel incoherence motion (IVIM) multiparameter imaging in predicting tumour infiltrating lymphocyte (TILs) levels in patients with invasive breast cancer who have undergone neoadjuvant chemotherapy. Methods A total of 140 patients with invasive breast cancer admitted to the hospital between December 2021 and December 2022 were selected as the study subjects. All patients underwent an MRI-DWI-IVIM examination, received neoadjuvant chemotherapy, and had their TILs evaluated after treatment. The utility of MRI-DWI-IVIM multiparameter imaging in predicting TIL levels was evaluated. Results The positive rate of TILs after treatment (80.71%) was significantly higher than that before treatment (63.57%, χ²=10.236, P < 0.05). Furthermore, there was a statistically significant difference in the boundary, T₂WI signal and DWI signal between TILs positive and TILs negative patients (P < 0.05). The pseudo-diffusion coefficient (D*) of TILs-positive patients was observed to be lower than that of TILs-negative patients, while the simple diffusion coefficient (D) and microvascular volume fraction (f) were found to be higher than those of TILs-negative patients (P < 0.05). Receiver operating characteristic curves demonstrated that the area under the curve (AUC) predicted by the boundary, T₂WI signal, DWI signal, D*, D and f on TILs were 0.640, 0.610, 0.640, 0.866, 0.720 and 0.674, respectively. Furthermore, the combined AUC of all indicators was 0.948. Conclusion The level of TILs was observed to increase following the administration of neoadjuvant chemotherapy for invasive breast cancer. Multiparameter imaging by MRI-DWI-IVIM can be used to evaluate the level of TILs after chemotherapy. Furthermore, the combination of all indicators can improve the predictive value of the TILs level.

Current advances in diagnosis and treatment of antiphospholipid syndrome

ZHENG Hui, YANG Chengde

2024, 22(10): 1750-1754. doi: 10.16766/j.cnki.issn.1674-4152.003726

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Abstract:
Antiphospholipid syndrome (APS) is an autoimmune and inflammatory disease that is characterized by the persistent presence of high titers of antiphospholipid antibodies (aPL) in serum, recurrent arteriovenous or microvascular thrombosis, and pregnancy morbidity. It is currently believed that the aetiology of APS is based on the interaction between aPL (antibody-driven) and the innate immune system (non-antibody-driven). A variety of immune cells, the coagulation system, the complement system and cytokines are all involved in the pathogenetic process of APS. In addition to the characteristic manifestations of thrombosis and pregnancy morbidity, patients with APS frequently present with so-called "extra-criteria" clinical manifestations that have not been included in previous classification criteria. These may include thrombocytopenia, cardiac valve involvement, cognitive dysfunction, livedo reticularis, or other autoimmune/inflammatory complications. As our understanding of the pathogenesis and clinical characteristics of APS has deepened, and as our clinical practice has broadened, it has become increasingly clear that the previous classification criteria are unable to meet the current clinical and research needs. Accordingly, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have jointly published the latest iteration of the APS classification criteria, dated 20 August 2023. In accordance with the prevailing management recommendations, anticoagulation and antiplatelet therapy represent the fundamental cornerstones of APS treatment. However, there invariably remain numerous unmet clinical needs. The research progress in the pathogenesis of APS has revealed numerous new potential therapeutic targets in recent years, which may provide more treatment options for some refractory patients. The objective of this article is to provide a comprehensive review of the current status of research into the diagnosis and treatment of APS. The objective is to enhance the understanding of this disease among clinicians and researchers in related fields, thereby facilitating more effective management of APS patients by clinicians.

Advances in prognostic factors for anti-melanoma differentiation-associated gene 5 antibody positive dermatomyositis

ZHANG Cen, BAI Ling, LI Feifei, ZHAO Peipei, ZHUO Cui, MA Wenlan, ZHANG Sigong

2024, 22(10): 1755-1760. doi: 10.16766/j.cnki.issn.1674-4152.003727

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Abstract:
Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis is a special subtype of idiopathic inflammatory myopathies, mainly characterized by dermatomyositis-specific skin lesions and interstitial lung disease. It is prone to rapidly progressive interstitial lung disease with a significantly high 6-month mortality rate. Besides, there is a great difference in prognosis among individuals. Therefore, early assessment of prognosis is crucial for the development of individualized diagnosis and therapeutic strategies. Available research suggests that several factors are associated with poor prognosis in anti-melanoma differentiation-related gene 5 antibody-positive dermatomyositis, including advanced age at onset, male gender, smoking, fever, dyspnea, pleural effusion, high titer of anti-melanoma differentiation-associated gene 5 antibodies, positive IgG1 subtype of anti-melanoma differentiation-associated gene 5 antibodies, positive anti-Ro-52 antibodies, elevated inflammatory markers (such as serum C-reactive protein, lactate dehydrogenase, and creatine kinase), elevated lung injury markers (such as serum Krebs von den Lungen-6), elevated markers of macrophage activation (such as serum ferritin), decreased peripheral blood lymphocyte counts, decreased oxygenation index, and a lower percentage of the predicted value for fprced vital capacity. The prognosis tends to be better for patients with a longer course of disease and joint symptoms. In addition, some scholars have constructed risk prediction models based on these prognostic factors. However, the existing models are relatively limited. More comprehensive and reliable risk prediction models need to be further developed and verified. Currently, effective treatments for anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis are lacking. For patients at high risk of death, early treatment with triple therapy, comprising high-dose glucocorticoids, Janus kinase inhibitors, rituximab, plasma exchange, and prophylactic use of cotrimoxazole/metronidazole, shows promise for improving prognosis.

cupuncture treatment mechanism and research progress of insulin resistance in polycystic ovary syndrome

CHEN Lin, WANG Hongyu, LI Ruixue, WANG Xiaomei, YIN Haiyan, GUO Yan

2024, 22(10): 1761-1764. doi: 10.16766/j.cnki.issn.1674-4152.003728

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Abstract:
Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of childbearing age, typically characterized by abnormalities in glucose and lipid metabolism and hormone secretion. Modern medicine believes that the pathogenesis of PCOS is closely related to insulin resistance (IR) and hyperandrogenemia (HA), of which IR is one of the core pathological features, and modern medicine usually adopts medication (e.g., clomiphene citrate, insulin sensitizers, etc.) and surgery, which can relieve patients ' symptoms to a certain extent. From the perspective of Chinese medicine, the development of PCOS is closely related to kidney qi deficiency, spleen deficiency and dampness, and liver depression and qi stagnation, and dialectic treatment can partially alleviate the patient ' s symptoms by targeting the above etiology. Acupuncture and moxibustion (AM) is a kind of "internal disease external treatment" unique to Chinese medicine. Under the guidance of the theory of meridians and collaterals, AM can relieve symptoms and treat systemic diseases through specific manipulation methods. According to the use of equipment and different means of operation, AM can be divided into acupuncture and moxibustion, with the continuous progress of medical technology, acupuncture point buried wire and electro-acupuncture and other therapies are also gradually applied in clinical work. In recent years, acupuncture and moxibustion have been widely used in the treatment of PCOS. This article details the mechanism and methods of acupuncture in improving insulin resistance in PCOS, aiming to provide reference for clinical practice and basic research.

The clinical study of modified Wuling Powder Combined with conbercept in the treatment of diabetic macular edema of liver depression and spleen deficiency

ZHOU Na, JIANG Feng, LIU Ruibao

2024, 22(10): 1765-1768. doi: 10.16766/j.cnki.issn.1674-4152.003729

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Abstract:
Objective To examine the clinical impact of a modified Wuling Powder combined with Conbercept on diabetic macular edema (DME) in patients with liver depression and spleen deficiency. Methods The study subjects were 86 patients (86 eyes) with DME of liver depression and spleen deficiency treated in the Department of Ophthalmology at the First Affiliated Hospital of Henan University of Chinese Medicine between December 2020 and May 2023. The subjects were randomly assigned to either the observation group (n=43, modified Wuling Powder combined with Conbercept) and the control group (n=43, Conbercept) using a random number table method. A comparison was made of the clinical efficacy, traditional Chinese medicine (TCM) syndrome score, visual acuity level, macular thickness, serum factor level and incidence of adverse reactions in the two groups. The statistical analysis was conducted using SPSS 22.0 software. Results The observation group exhibited higher total effective rate [95.35% (43/43) vs. 81.40% (35/43)] 3 months following treatment (χ²=4.074, P=0.044). The TCM syndrome scores, visual acuity levels, macular thickness indexes, interleukin-6 and vascular endothelial growth factor levels in both groups decreased, with the observation group exhibiting lower levels (P < 0.05), conversely, the nitric oxide synthase levels increased in both groups, with the observation group demonstrating higher levels (P < 0.05). With regard to adverse reactions, no statistically significant difference was observed between the two groups [9.30% (4/43) vs. 11.63% (5/43), P>0.05]. Conclusion The combination of modified Wuling Powder with Conbercept has been demonstrated to be an effective treatment for DME caused by hepatic depression and splenic deficiency. It has the capacity to significantly improve the clinical symptoms of patients, enhance their visual acuity, reduce macular thickness, alleviate inflammatory response, and improve vascular endothelial function. Furthermore, it has been shown to be a safe treatment option.

Efficacy of musculoskeletal ultrasound-guided acupotomy with tendon release in patients with iliotibial bundle syndrome

JIN Wei, WANG Haidong, HAN Hongsheng, CHEN Dongyu, ZHAN Hongsheng, ZHU Fuxiang

2024, 22(10): 1769-1773. doi: 10.16766/j.cnki.issn.1674-4152.003730

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Objective To explore the effects of musculoskeletal ultrasound-guided acupotomy via tendon release on pain, lower limb function, anxiety, postoperative complications, and recovery in patients with iliotibial band syndrome, and to analyze the therapeutic effectiveness. Methods A total of 90 patients with iliotibial band syndrome, treated at the Orthopedics and Traumatology Department of Jiaxing Hospital of Traditional Chinese Medicine from January 2022 to May 2023, were randomly divided into the ultrasound group, the release operation group, and the control group, with 30 cases in each group. The ultrasound group was treated with musculoskeletal ultrasound-guided needle-knife transtendon release, while the release operation group was treated with unoriented and unguided needle-knife transtendon release. The control group was treated with local pain point blocking. The clinical efficacy of the three groups was observed, and the effects on visual analogue scale (VAS), lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) scores were statistically analyzed. Complications and recurrence of surgery were compared among there groups. Results The total effective rate of the ultrasound group, the release group, and the control group was 96.67%, 83.33%, and 66.67%, respectively, with statistically significant differences (χ²=9.274, P=0.010). The total effective rate of the ultrasound group was higher than that of the control group (P < 0.05). After 2, 4, and 6 weeks of treatment, VAS and SAS scores in all 3 groups were decreased compared with the baseline, the ultrasound group showing the lowest scores, followed by the release group, and the control group (P < 0.05). After 2, 4, and 6 weeks of treatment, LEFS scores increased over the same time points, with the ultrasound group showing the highest improvement, followed by the release group, and the control group (P < 0.05). No complications were found in 3 groups. The recurrence rates of the ultrasound group, the release group, and the control group were 6.67%, 26.67%, and 36.67%, respectively, with statistically significant differences between groups (χ²=7.826, P=0.020). The recurrence rate of the ultrasound group was lower than that of the control group (P < 0.05). Conclusion Musculoskeletal ultrasound-guided acupotomy via tendon release demonstrates excellent efficacy in the treatment of patients with iliotibial band syndrome, helping to relieve pain, improve lower limb function, and alleviate anxiety, with a high safety profile.

Latent profile analysis and influencing factors of clinical belongingness among nursing interns

YUAN Niu, LYU Zhanghong, HE Lingying

2024, 22(10): 1774-1777. doi: 10.16766/j.cnki.issn.1674-4152.003731

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Objective To explore the latent categories and characteristics of clinical belongingness among nursing interns, and to analyze the influencing factors of various categories, so as to provide references for formulating precision intervention strategies. Methods From March 22 to December 7, 2023, a total of 836 nursing students from 11 hospitals in Zhejiang, Jiangxi, Anhui, and Henan were conveniently selected as survey participants. General demographic information questionnaires, belongingness scale-clinical placement experience, Jefferson scale of physician empathy for nursing students, and perceived stress scale were utilized for investigation. Latent profile analysis was employed to identify categories and characteristics of clinical sense of belonging among internship nursing students. An unordered multinomial logistic regression model was utilized to analyze the factors associated with latent categories of clinical belongingness. Results The clinical sense of belonging among nursing interns can be classified into three categories: low (46.89%), moderate (44.74%), and high belonging (8.37%). Compared to those in the low belonging category, male nursing interns had a higher likelihood of belonging to the high belonging category (OR=2.504, P=0.011). Nursing interns whose fathers work as entrepreneurs are more likely to belong to the moderate belonging category (OR=1.923, P=0.037). The probability of belonging to the moderate and high belonging categories increases with stronger empathy (OR=1.054, P < 0.001; OR=1.052, P < 0.001), and the likelihood of belonging to the moderate and high belonging categories increases with lower perceived stress (OR=0.898, P < 0.001; OR=0.816, P < 0.001). Conclusion The clinical sense of belonging among nursing interns is generally moderate and exhibits heterogeneity, categorized into three distinct groups. Nursing education administrators can implement precise interventions based on the characteristic differences among these groups to enhance the clinical sense of belonging among nursing interns.

The exploration and practice of pathological teaching reform for medical graduate students

YUAN Yuan, WANG Yanxia, XU Yuqiao, ZHAO Shuyan, FAN Linni, YE Jing

2024, 22(10): 1778-1780. doi: 10.16766/j.cnki.issn.1674-4152.003732

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Objective Graduate education represents the pinnacle of the national education structure. Its core objective is to cultivate students ' scientific research skills, scientific research thinking, and innovation ability. This study aims to explore the dislocation and disconnection between medical graduate students ' theoretical knowledge and scientific research practice, and to implement a teaching reform of the pathology course. Methods This study examines the shortcomings in pathological morphology cognition in graduate research practice. Guided by the educational philosophy of "value shaping, ability cultivation, and knowledge transmission", teaching reforms were implemented in the content, methods, and case discussions to develop a teaching system that is suitable for medical graduate students. Results We first established a knowledge system for the core pathology course, ran two postgraduate courses, "Frontier Advances in Pathology" and "Basic Theory of Cancer", and wrote the second edition of the course textbook "Basic Theory of Cancer". Based on the clinical pathology department, we have integrated molecular pathology and ultrapathology teaching content and used information technology to build a digital pathology section library and teaching website. This has solved the problem of few and difficult to understand morphology lessons. Ninety-five percent of the students believe that studying this course is helpful for clinical work and scientific research. This teaching reform has achieved preliminary positive results in expanding research ideas, practicing research thinking, and solving morphological problems encountered in research practice for graduate students. Conclusion This teaching reform has been praised by most graduate students and mentors. Through the study of pathology courses, graduate students can basically solve pathological morphological problems in scientific research. This study offers a novel approach to the training of medical graduate students, with significant practical implications for the nexus between teaching, scientific research, and clinical practice.

Global research trends of pyroptosis in tumor based on bibliometrics and visualization analysis

LIANG Bo, YUAN Ding, WANG Jianye, ZHOU Shaolong, LIU Rongjun, WANG Xinjun

2024, 22(10): 1781-1786. doi: 10.16766/j.cnki.issn.1674-4152.003733

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Objective Through bibliometric analysis, comprehensively review and analyze research in the field of tumor pyroptosis, revealing the global distribution of research hotspots in this area. Based on this, speculate on the future development directions and trends in this field. Methods Retrieve english-language literature on tumor pyroptosis from the Web of Science database from January 1, 2007 to December 31, 2023. Use VOSviewer and CiteSpace for multi-dimensional analysis. Results A total of 2 709 articles were included in the analysis. The volume of publications in the field showed explosive growth after 2019. The top three countries in terms of publication volume were China, the United States and Germany. Among the top 10 most productive authors, 6 were from China. In addition, three of the top five publications came from Frontiers journals. The keyword analysis showed that before 2020, the focus was mainly on mechanisms and pathways such as "NLRP3 inflammasome" "autophagy" "NF-Kappa-B" "pathways" and "proliferation". However, in recent years, keywords such as "tumor microenvironment" "prognosis" "treatment" "survival" "cisplatin" and "immunotherapy" have begun to appear frequently. Conclusion Tumor pyroptosis has become a global research hotspot, and its crucial role in both anticancer and cancer-promoting processes is gradually attracting the attention of researchers. With the deepening exploration of the mechanisms of tumor pyroptosis, we have reason to believe that it will have a profound impact on the future of tumor treatment.

Application effect of prescription pre-audit system in medication management of PPIs

LIU Qindong, LIU Yin, LI Yanyan, LI Zhi, YU Yingying

2024, 22(10): 1787-1790. doi: 10.16766/j.cnki.issn.1674-4152.003734

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Objective To explore the application effect of pre-prescription review system in the fine management of proton pump inhibitor (PPIs) medication, and to promote clinical rational drug use. Methods The rule-base system was established for the pre-prescription review process, and based on actual PPIs usage patterns in our hospital, we refined the indications, usage and dosage, combined medication rules, and course of treatment of PPIs. The use of PPIs before (January to April 2021) and after (May to August 2021) fine management was counted. A total of 23 medical staff working in prescription and review of PPIs were selected, and the satisfaction of medical staff before and after management was compared. Results The use of PPIs in our hospital decreased after fine management, from 515 600 yuan before management to 104 900 yuan (May), 143 100 yuan (June), 83 900 yuan (July), 97 800 yuan (August) after management. The total amount of PPIs medication showed a downward trend. After careful management, the incidence of unreasonable PPIs prescriptions in our hospital decreased. The unsuitable usage and dosage decreased from 14.2% before management to 5.1% (May), 3.6% (June), 2.0% (July), 1.3% (August). Indications inappropriate also decreased from 15.5% before management to 7.4%, 5.4%, 2.6%, 0.8% after management. Inappropriate combination medication decreased from 1.3% before management to 0.6%, 0, 0, 0 after management. Similarly, the inappropriate course of treatment decreased from 16.8% before management to 4.6%, 1.8%, 0, 0 after management. The overall satisfaction rate of medical staff increased following this new system [95.65% (22/23) vs. 69.57% (16/23), χ²=5.447, P < 0.05]. Conclusion Pre-prescription review system used in PPIs fine management can effectively promote clinical rational drug use and improve the satisfaction of medical workers.

Application of LEER model in perioperative period of laparoscopic pancreatoduodenectomy

WU Dan, XIA Yan, SHENTU Minjiao, XU Yangli, JIN Jing, SHEN Dan

2024, 22(10): 1791-1794. doi: 10.16766/j.cnki.issn.1674-4152.003735

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Objective To explore the perioperative application of "LEER" model with less pain, early move, early eat and reassuring as the ultimate goals in patients with laparoscopic pancreaticoduodenectomy (LPD). Methods Using random number table, the clinical data of 86 patients treated with LPD in the Zhejiang Provincial People' s Hospital from August 2021 to August 2023 was randomly selected, including 41 cases of traditional rehabilitation surgery protocol (traditional group) and 45 cases of "LEER" mode protocol (LEER group). The perioperative relevant indexes were compared between the two groups. Results The first time of getting out of bed, the time of anal exhaust, the time of first eating and the total length of hospital stay in LEER group were lower than those in traditional group (P < 0.05). The VAS scores of the LEER group on the first, second and third day after operation were lower than those of the traditional group (P < 0.05). Serum immunoglobulin (Ig) A, IgG, IgM and serum prealbumin (PA), albumin (ALB) total protein (TP) in LEER group were higher than those in traditional group at 3d after surgery (P < 0.05). The complication rate of LEER group was 11.11% (5/45), which was lower than that of traditional group (31.71%, 13/41, χ²=5.499, P=0.019). Conclusion LEER mode can significantly reduce postoperative pain, improve nutritional status, protect immune function, reduce the risk of complications, and accelerate postoperative recovery.

Effect of temperature protection-based nursing intervention on anesthesia resuscitation and flap outcomes in patients undergoing complex trauma surgery

CHEN Lanping, BAO Yingxue, ZHOU Xiaodong, SHEN Guohua, SHAO Xuanhe, XU Zhidi

2024, 22(10): 1795-1799. doi: 10.16766/j.cnki.issn.1674-4152.003736

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Objective To evaluate the effect of thermoprotection-based nursing interventions on anaesthesia resuscitation and flap survival in patients undergoing complex trauma surgery, and to provide a reference for postoperative recovery. Methods A total of 152 complex trauma surgery patients were treated at the Affiliated Hospital of Shaoxing University of Arts and Sciences from January 2023 to February 2024 were selected. The patients were divided into two groups using the red and blue ball method: 76 in the control group and 76 in the thermostatic group. The control group received standard operating room care, while the thermostatic group received nursing interventions based on thermoprotection in addition to standard card. The two groups of patients were compared in terms of core temperature changes, anesthesia resuscitation efficiency, and skin flap prognosis. Results The surgeries were successfully completed by both patient groups. The thermostatic group had significantly higher core body temperature during tracheal intubation, at the start of surgery, and 30 minutes after surgery compared to the control group (P < 0.01), with the largest fluctuation occurring during tracheal intubation. The thermostatic group experienced a decreased incidence of hypothermia (7.89%, 6/76) compared to the control group (21.05%, 16/76), with statistically significant difference (P < 0.05). Patients in the thermostatic group woke up earlier and spent less time in the anesthesia recovery room than patients in the control group. At 15 minutes post-operation, the Steward awakening score of the thermostatic group was higher than that of the control group, with statistically significant difference (P < 0.05). Regarding flap survival, the control group had 40 cases of complete flap survival, 27 cases of partial flap survival, and 9 cases of necrosis, while the thermostatic group had 54 cases of complete flap survival and 20 cases of partial flap survival, and 2 cases of necrosis. Additionally, the thermostatic group had a shorter time of flap elasticity recovery than the control group, with statistically significant differences (P < 0.05). Conclusion Thermoprotection-based nursing interventions for patients undergoing complex trauma surgery can prevent and lessen the risk of intraoperative hypothermia, maintain the relatively stable body temperature, enhance early postoperative anesthesia recovery, shorten recovery time, and encourage the restoration of flap tissues elasticity, thereby facilitating faster trauma healing.

Influence of perioperative nursing education based on mind map on the anxiety of family members of patients with malignant tumor during operation

XU Yun, XU Xiang, HE Lifang, HUANG Manli, SU Yongshun

2024, 22(10): 1800-1803. doi: 10.16766/j.cnki.issn.1674-4152.003737

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Objective To explore the evaluation of anesthesia nursing education based on mind map on the anxiety and nursing satisfaction of family members of patients with malignant tumor during operation, so as to alleviate the bad mood of family members waiting during operation and improve their satisfaction with nursing work. Methods From January 2022 to October 2022, 180 family members of patients with malignant tumor who received surgical treatment in the Cancer Hospital Affiliated to Shantou University School of Medicine were selected as the research objects, and were randomly divided into observation group and control group, with 90 cases in each group. The control group was given routine anesthesia nursing education to the families of patients with malignant tumor during the waiting period, while the observation group was given anesthesia nursing education based on mind map on the basis of the control group. The anxiety, depression, and nursing satisfaction rates of the two groups were compared before operation (preoperative visit), during operation (1 hour after the patient entered the operating room) and after operation (postoperative return visit). Results The scores of anxiety (39.33±6.41, 36.05±8.43) and depression (35.34±10.54, 31.31±4.69) of intraoperative and postoperative in the observation groups were lower than those in the control group (41.65± 8.27, 32.19±10.37, 40.38±8.36, 33.97±7.35, P < 0.05). The nursing satisfaction of family members in the observation group was better than that in the control group (P < 0.05). Conclusion Giving anesthesia nursing education mainly based on mind map to the family members of malignant tumor patients undergoing surgery can reduce the influence of negative emotions such as anxiety and depression, and at the same time improve the influence on nursing satisfaction.

The analysis of the discharge preparation and influencing factors after replantation of severed fingers

HONG Xuejiao, LIU Qingbai, SHI Haifeng, WU Ke, YU Fanghua

2024, 22(10): 1804-1808. doi: 10.16766/j.cnki.issn.1674-4152.003738

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Objective To explore the discharge preparation of patients after replantation of severed fingers and its influencing factors, so as to provide more efficient rehabilitation programs for patients and provide guidance for the nursing team to formulate more scientific discharge strategies. Methods From January 2021 to May 2023, a cross-sectional survey was conducted on 102 patients who underwent replantation of severed fingers in Wuxi Ninth People' s Hospital. The questionnaire survey included the collection of general information, disease-related information, discharge readiness, and discharge guidance quality of the selected patients. Univariate and multivariate linear regression analyses were used to further analyze the related factors of discharge readiness and the correlation between discharge readiness and discharge instruction quality. Results The data of 102 patients with replantation of severed fingers were effectively recovered. Multivariate analysis showed that the readiness for hospital discharge of patients after replantation of severed fingers was related to age, residence, education, marital status, complications, length of hospital stay, and quality of discharge guidance. Among them, in this study, the average score of discharge readiness of 102 patients was 170.43±15.70, and the average score of discharge instruction quality was 140.61±12.25. There was a positive correlation between the total score of discharge readiness and the total score of discharge teaching quality (r=0.736, P < 0.001). Conclusion This study reveals that the readiness for hospital discharge of patients with replantation of severed fingers is affected by age, residence, education, marital status, complications, length of hospital stay, and the quality of discharge instruction. It also points out that there is a positive correlation between readiness for hospital discharge and the quality of discharge instruction, and there is a positive correlation between readiness for hospital discharge and teaching skills. The results have guiding significance for the management and practice of clinical nursing.

Severe anorexia nervosa with hepatic and cardiac abnormalities: a case report

CHEN Yin, ZHANG Zhitian, LIU Jiaojiao, YAN Hongmei, LI Fan, ZHANG Yan

2024, 22(10): 1809-1812. doi: 10.16766/j.cnki.issn.1674-4152.003739

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Anorexia nervosa (AN) is an eating disorder characterised by abnormal body weight, an excessive fear of gaining weight, and a distorted perception of body weight and shape, which can lead to various physical consequences.This disease can be accompanied by complications in multiple systems, which can affect the effectiveness of treatment and prognosis. The treatment burden is heavy and the mortality rate is relatively high. Here, we present the treatment of a young female patient diagnosed with severe anorexia nervosa, exhibiting a meager body weight, with the lowest BMI of 8.6. She displayed both liver and cardiac damage. Complications associated with anorexia developed progressively during the course of disease, with impaired liver and heart function being prominent and contributing to a critical condition that could potentially culminate in an unfavorable outcome. These symptoms showed gradual improvement with a carefully planned, multidisciplinary, collaborative, and step-by-step approach to nutritional supplementation, her body weight climbed up gradually as well. The success of this case may provide a reference for the future diagnosis and treatment of patients with similar conditions.

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2024 Vol. 22, No. 10

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