2024 Vol. 22, No. 3

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General Practice Forum
Application and prospects of cognitive-behavioral therapy based digital therapeutics of chronic disease management in the community
ZHU Ting, HUANG Yafang, XIANG Tong, WU Hao
2024, 22(3): 357-360. doi: 10.16766/j.cnki.issn.1674-4152.003402
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Digital therapeutics, as an emerging effective and safe intervention driven by high-quality software programs, are increasingly being used in primary care based clinical practice. Cognitive-behavioral therapy (CBT) is the most widely used classical approach in psychotherapy and is also a core technology in many digital therapeutics products. CBT interventions are usually limited by the lack of treatment space and professionals, which makes it impossible to reach out to a wider target group of patients. With the help of digital therapeutics, CBT technology can be integrated into the corresponding design module to break through these limitations. At present, CBT-digital therapeutics products are mainly used in the field of primary chronic disease prevention and treatment in the field of lifestyle intervention and patient-centered care, and there is still a large development potential for their application in health monitoring and prevention of common chronic diseases, disease treatment and optimization of drug treatment effects. As an important support to lead the efficient promotion of the quality of primary care services and meet the development of active health technology, CBT-digital therapeutics have ushered in key development opportunities driven by the strong support of the policy environment, the comprehensive technological innovation empowered by emerging technologies, and the increased willingness of patients with chronic diseases to manage their health. At the same time, there are still some key points that need to be broken through and improved in the future of CBT-digital therapeutics. In the future, it is necessary to pay attention to the accumulation of clinical data that meets the needs of supervision, and use algorithm technology to further accurately locate the personalized needs of patients based on patients ' chronic disease data, so as to broaden the indications for chronic disease management of CBT-digital therapeutics. At the same time, it is necessary to further improve the regulatory regulations related to digital therapeutics, formulate an approval system suitable for digital therapeutics products, and improve industry standards in terms of data security, privacy protection, and medical insurance payment policies.
2024, 22(3): 361-367. doi: 10.16766/j.cnki.issn.1674-4152.003403
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Value of cTnI, NT-proBNP and CA-125 in diagnosis of pulmonary infection in elderly patients with chronic heart failure
YAO Yao, LU Ning, CHEN Jianguo
2024, 22(3): 440-442. doi: 10.16766/j.cnki.issn.1674-4152.003421
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  Objective  To investigate the diagnostic value of cardiac troponin I (cTnI), N-terminal precursor brain natriuretic peptide (NT-proBNP) and carbohydrate antigen-125 (CA-125) in elderly patients with chronic heart failure who have pulmonary infection.  Methods  During the period between January 2020 and June 2023, we selected 40 elderly patients with chronic heart failure and pulmonary infection as the combined lung infection group, 40 elderly patients with simple heart failure as the simple heart failure group, and 40 elderly patients who underwent physical examination as the control. The study compared the levels of serum cTnI, NT-proBNP, and CA-125 among the three groups, including the group with pulmonary infection. The diagnostic efficiency of serum cTnI, NT-proBNP and CA-125 in patients with pulmonary infection was analyzed by using the ROC curve.  Results  The levels of serum cTnI, NT-proBNP and CA-125 were higher in patients with pulmonary infection compared to those in the simple heart failure group and control group (P < 0.05). Additionally, the levels of serum cTnI, NT-proBNP and CA-125 were higher in grade Ⅳ patients with pulmonary infection were higher than those in grade Ⅲ and grade Ⅱ, and those in grade Ⅲ were higher than those in grade Ⅱ (P < 0.05). The serum cTnI, NT-proBNP and CA-125 AUC values for diagnosing pulmonary infection with chronic heart failure alone and in combination were 0.935, 0.977, 0.996 and 1.000, respectively (P < 0.05).  Conclusion  In elderly patients with chronic heart failure and pulmonary infection, serum levels of cTnI, NT-proBNP and CA-125 were found to be abnormally elevated. The combined detection of these three biomarkers could improve the diagnostic efficiency of the disease.
The status quo of pregnancy stress and its influencing factors in women with re-fertility
YANG Liu, YANG Lijuan, QIAN Jing, SANG Kunfeng, LI Jinzhi
2024, 22(3): 443-446. doi: 10.16766/j.cnki.issn.1674-4152.003422
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  Objective  This study investigated and analyzed the influencing factors of pregnancy stress in women with re-fertility, and provided a reference for reducing pregnancy stress in women with re-fertility and improving women ' s willingness to regenerate.  Methods  From December 2022 to June 2023, 320 re-fertile women who underwent obstetric examination in the obstetric clinic of the First Affiliated Hospital of Bengbu Medical University and the Third People ' s Hospital of Bengbu City were selected as research objects by convenient sampling method. The general information questionnaire, pregnancy stress scale, perceived social support scale and general well-being scale were used to examine the research objects.  Results  The pregnancy stress score was 0.533 (0.325, 0.808), the social support score was 62.000 (55.000, 72.000), and the general well-being score was 79.000 (71.000, 86.250). There were statistically significant differences in pregnancy stress among women with high-risk pregnancy, marital status, sex of existing offspring, and whether the pregnancy was a high-risk pregnancy (P < 0.05). The results of correlation analysis showed that social support (r=-0.338) and general well-being (r=-0.364) were negatively correlated with pregnancy stress (P < 0.001). Multiple regression analysis showed that marital status, sex of existing offspring, perceived social support and general well-being were important factors influencing pregnancy stress in women with re-fertility (P < 0.05).  Conclusion  Pregnancy stress in women with infertility is generally low. Social support can reduce the pregnancy stress of women with re-fertility and improve the overall well-being of women with re-fertility. Therefore, society, government and medical staff should take relevant measures to reduce the pregnancy stress of re-fertility women, improve women ' s willingness to reproduce, and promote maternal and child health.
Changes and clinical significance of serum LncRNA NNT-AS1, IL-17A levels in children with refractory mycoplasma pneumonia
YAN Jing, HOU Yanmiao, WANG Zhenhua
2024, 22(3): 447-450. doi: 10.16766/j.cnki.issn.1674-4152.003423
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  Objective  To investigate the expression and clinical value of serum LncRNA NT-AS1 and interleukin (IL) 17A in children with refractory mycoplasma pneumoniae pneumonia (RMPP).  Methods  A total of 148 children with MPP (MPP group) diagnosed and treated at Zhangjiakou Maternal and Child Health Hospital from February 2021 to March 2022 were selected and divided into RMPP group (48 cases) and non-RMPP group (100 cases) according to whether RMPP occurred. Sixty children who underwent surgery for hydrocele in the same period were selected as the control group. The differences of serum LncRNA NNT-AS1 and IL-17A between all groups were compared. The correlation between serum LncRNA NNT-AS1, IL-17A and inflammatory markers was analyzed by Pearson correlation analysis. Multivariate logistic regression analysis of factors affecting the incidence of RMPP. The predictive value of LncRNA NNT-AS1 and IL-17A in the incidence of RMPP was analyzed by subject operating characteristic curve.  Results  Serum LncRNA NNT-AS1 and IL-17A in the MPP group were higher than those in the control group (P < 0.05). Serum LncRNA NNT-AS1 and IL-17A in the MPP group were positively correlated with CRP, PCT, IL-6 and TNF-α (r=0.623-0.721, P < 0.001). Elevated levels of serum LncRNA NNT-AS1 and IL-17A were independent risk factors for RMPP. The area under the curve of RMPP in MPP children was 0.906, which was better than that of single detection.  Conclusion  The elevated levels of serum LncRNA NNT-AS1 and IL-17A in children with RMPP are independent risk factors for the development of RMPP, and the combined detection of LncRNA NNT-AS1 and IL-17A is helpful in assessing the occurrence of RMPP.
Study on pregnancy characteristics, delivery modes, and perinatal outcomes of after three-child Policy
CHENG Xianying, WANG Yuanyuan, ZHANG Penghui, XU Liya
2024, 22(3): 451-454. doi: 10.16766/j.cnki.issn.1674-4152.003424
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  Objective  To examine changes in pregnancy characteristics, mode of delivery and perinatal outcomes following the three-child policy.  Methods  We retrospectively collected clinical data from 1 049 parturients from Shulan (Hangzhou) Hospital who gave birth between January 2020 and June 2021 (control group) before the three-child policy and 725 parturients who gave birth between April 2022 and September 2023 (study group) after the policy. We compared the demographics, pregnancy complications, obstetric complications, mode of delivery and perinatal outcomes of the two groups.  Results  The incidences of gestational diabetes mellitus (18.76%, 136 cases), placenta accreta (1.93%, 5 cases), fetal distress (9.79%, 71 cases), and pregnancy associated with hypothyroidism (12.83%, 93 cases) were significantly higher in the study group those in the control group [14.68% (154 cases), 0.76% (8 cases), 3.53% (37 cases), 8.77% (92 cases), P < 0.05]. The incidences of intrahepatic cholestasis of pregnancy (1.24%, 9 cases) and pregnancy combined with hepatitis B (2.07%, 15 cases) were significantly lower those in the control group [2.67% (28 cases), 3.72% (39 cases), P < 0.05]. The rate of vaginal assisted delivery in the study group was higher than that in the control group, whereas the rate of vaginal delivery in women with scarred uterus was lower than that in the control group (P < 0.05). The rates of caesarean section for first and second births in the study group were significantly lower than those in the control group, while the rate of caesarean section for third birth was significantly higher than that in the control group (P < 0.05). The non-medical indication cesarean section rate and the non-medical indication cesarean section rate for the second and third births in the study group were significantly higher than those in the control group, whereas the non-medical indication cesarean section rate for the first births was significantly lower those that in the control group (P < 0.05). The incidences of postpartum hemorrhage, postpartum anemia, hypoproteinemia, macrosomia and neonatal asphyxia were higher in the study group than in the control group (P < 0.05).  Conclusion  The main birth population after the implementation of the three-child policy remains first and second births, with a higher number of older second births. Some pregnancy complications, obstetric complications and adverse perinatal outcomes have increased.
The relationship between sodium and potassium intake and mild cognitive impairment in community population
LI Mei, Mulalibieke Heizhati, SUN Le, WANG Zhongrong, YANG Zhikang, LI Jing, LI Wei, LI Nanfang
2024, 22(3): 455-459. doi: 10.16766/j.cnki.issn.1674-4152.003425
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  Objective  To investigate the association between sodium and potassium intake, as assessed by 24-hour urinary sodium and potassium excretion, and mild cognitive impairment (MCI) in a community population.  Methods  A cross-sectional study was conducted in Emin County from March to June 2019 using multi-level stratified random sampling, a total of 561 community residents aged ≥ 35 years were included in this study. The mini-mental state examination (MMSE) was used to assess cognitive function. The subjects were divided into three groups according to 24-hour urinary potassium interquartile grouping: the lowest group (T1, n=187), the middle group (T2, n=187) and the highest group (T3, n=187). Multivariate linear regression model analysis and logistic regression model were used to analyze the risk of MCI.  Results  Twenty-four-hour urinary potassium total MMSE score was lower in the T1 group than in the T3 group [25.0 (20.0, 28.0) vs. 27.0 (24.0, 29.0), P=0.009], and the prevalence of MCI was significantly lower in the T3 group than in the T1 group (9.1% vs. 24.6%, P < 0.001). Multivariate linear regression analysis showed that 24-hour urinary potassium was positively correlated with MMSE (β=0.027, 95% CI: 0.000 to 0.054, P=0.047) and 24-hour urinary sodium was negatively correlated with MMSE (β=-0.007, 95% CI: -0.013 to -0.001, P=0.025). Multivariate logistic regression analysis showed that T1 and T2 groups with lower 24-hour urinary potassium increased the risk of MCI compared with T3 group with higher urinary potassium excretion by 3.222 times (95% CI: 1.577 to 6.562, P=0.001) and 3.022 times (95% CI: 1.513 to 6.029, P=0.002), respectively. The risk of MCI in the T2 group with higher 24-hour urinary sodium was 2.812 times (95% CI: 1.502 to 5.256, P=0.001) compared with the T1 group with lower urinary sodium.  Conclusion  Higher sodium intake and lower potassium intake were independently associated with MCI.
Clinical value of serum PCT, CRP and IDO levels in predicting prognosis in patients with community-acquired pneumonia
LI Qun, LYU Yunxiang, XIA Shenhong, LI Ziguang, ZHANG Yong, SHAO Lu
2024, 22(3): 460-463. doi: 10.16766/j.cnki.issn.1674-4152.003426
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  Objective  To investigate the clinical value of serum levels of procalcitonin (PCT), C-reactive protein (CRP) and indoleamine 2, 3-dioxygenase (IDO) in patients with community-acquired pneumonia (CAP).  Methods  A total of 100 patients with a definite diagnosis of CAP and 40 healthy subjects were enrolled in the Second Affiliated Hospital of Bengbu Medical College from October 2019 to September 2021. According to CURB-65 criteria, patients with CAP were allocated into three groups: the low-risk group (38 cases), the moderate-risk group (32 cases), and the high-risk group (30 cases). Healthy subjects were served as the control group (40 cases). Serum PCT, CRP and IDO levels of all subjects were measured, and assessed their correlation. Serum PCT and IDO levels were applied to predict patient mortality.  Results  Serum levels of PCT, CRP and IDO in patients with CAP significantly increased compared to that of control subjects (P < 0.001). Additionally, serum PCT, CRP and IDO levels of patients with CAP in the high-risk group were significantly elevated relative to that in the moderate-risk group (P < 0.001). Meanwhile, serum PCT, CRP and IDO levels of patients with CAP in the low-risk group were significantly decreased compared with that in moderate-risk group and high-risk group (P < 0.001). Serum IDO levels were positively correlated with CURB-65 score (r=0.750, P < 0.001). Serum IDO levels were positively correlated with PCT and CRP levels (r=0.724, P < 0.001; r=0.634, P < 0.001). PCT combined with IDO predicted a significantly higher 28-day ICU admission rate or mortality in CAP patients (AUC=0.913, P < 0.05).  Conclusion  Serum levels of PCT, CRP and IDO are significantly increased in patients with CAP. Serum IDO levels is positive correlation with CURB-65 score, serum levels of PCT and CRP. Serum PCT combined with IDO levels predicted 28-day ICU admission rate or mortality is more accurately.
A randomized controlled study of the combined treatment of tamsulosin and escitalopram for pelvic pain syndrome with comorbid anxiety and depression
SUN Jingcun, ZHANG Hongliang
2024, 22(3): 464-468. doi: 10.16766/j.cnki.issn.1674-4152.003427
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  Objective   To determine the difference between the combination therapy of tamsulosin and escitalopram and conventional therapy in patients with chronic pelvic pain syndrome (CPPS) complicated with anxiety and depression, and to evaluate the clinical application potential of the combination therapy.   Methods   A total of 150 CPPS patients comorbid with anxiety and depression admitted to the Department of Urology at the Integrated Traditional Chinese and Western Medicine Hospital in Cangzhou, Hebei Province, from July 2019 to July 2022 were selected. They were randomly divided into an observation group and a control group, with 75 cases in each. The observation group received tamsulosin plus escitalopram, while the control group received tamsulosin plus a placebo. The effectiveness and safety were compared after a 3-month course of treatment.   Results   The clinical efficacy showed that the total effective rate in the observation group was significantly higher than that in the control group [96.00% (72/75) vs. 84.00% (63/75), P < 0.05]. In the observation group, urinary symptoms, pain, and discomfort on the National Institutes of Health chronic prostatitis symptom index scale significantly decreased, and the quality of life dimension improved compared to before (P < 0.05). Compared with the control group, the Hamilton anxiety scale (8.37±1.89 vs. 11.85±2.67) and Hamilton depression scale (6.71±1.64 vs. 9.26±2.42) scores in the observation group showed a significant reduction in negative emotional scores. After combined medication, the levels of serum inflammatory factors TNF-α and IL-8 in the observation group were significantly lower than those in the control group (P < 0.05). The total incidence of adverse reactions [9.33% (7/75) vs. 12.00% (9/75)] showed no statistically significant difference between the groups (P > 0.05).   Conclusion   The combination of tamsulosin and escitalopram not only alleviates psychological symptoms and reduces anxiety and depression scores but also improves inflammatory levels and enhances the quality of life in patients with CPPS comorbid with anxiety and depression. This combination therapy demonstrates good safety and effectiveness in patients with this comorbidity and is worthy of promotion.
Effect of acceptance and commitment therapy on stigma, self-efficacy, and medication adherence in patients with schizophrenia
YANG Hao, PAN Yuhong, WANG Shuang, ZHOU Guangfeng
2024, 22(3): 469-472. doi: 10.16766/j.cnki.issn.1674-4152.003428
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  Objective  Patients with schizophrenia have a severe stigma and low self-efficacy, which seriously affects their medication adherence and recovery of the disease. This study explores the effects of acceptance and commitment therapy on the stigma, self-efficacy, and medication adherence of patients with schizophrenia, in order to provide an effective and safe method for reducing the stigma, improving self-efficacy, and medication adherence of patients with schizophrenia.  Methods  Patients with schizophrenia who visited the Harbin Psychiatry Specialist Baiyupao Hospital from October 2022 to April 2023 were selected as the research subjects. A total of 178 recruited patients with schizophrenia were divided into a control group of 89 cases and a study group of 89 cases using a random number list method. The control group received conventional drug treatment, while the study group received acceptance and commitment therapy. Before and after the intervention, the internalized stigma of mental illness scale (ISMI), general self efficacy scale (GSES), and Morisky medication adherence scale-8 (MMAS-8) were used to evaluate the efficacy of mental illness.  Results  After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that of the control group [(67.34±10.48) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that of the control group [(19.21±3.93) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that of the control group [(6.07±1.48) points], and the differences were statistically significant (P < 0.05). After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that before intervention [(67.24±10.34) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that before intervention [(19.17±3.89) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that before intervention [(6.01±1.42) points], and the differences were statistically significant (P < 0.05).  Conclusion  Acceptance and commitment therapy can effectively reduce the stigma in patients with schizophrenia, improve their self-efficacy and medication adherence.
Value of strain elastography and shear wave elastography combined with BI-RADS in determining the nature of breast masses
YAN Limei, GE Yibing, WU Zhengsheng
2024, 22(3): 473-477. doi: 10.16766/j.cnki.issn.1674-4152.003429
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  Objective  To investigate the diagnostic value of strain elastic imaging and shear wave elastic imaging combined with breast imaging reporting and data system (BI-RADS) in benign and malignant breast masses.  Methods  The clinicopathological data of 105 patients with breast masses (105 lesions in total) admitted to our hospital from April 2021 to March 2023 were reviewed. Preoperatively, they underwent routine ultrasonography, strain elastography, and shear wave elastography. The lesions were classified into benign and malignant groups using the pathological findings as the gold standard. Elastic strain ratio (SR), and shear wave maximum elastic modulus value (Emax) were compared between the two groups. The efficacy of BI-RADS, SR, Emax, and the combined diagnosis of malignancy of breast masses was evaluated by plotting the working characteristic ROC curves of the subjects.  Results  A total of 105 breast masses were examined pathologically showing 41 (39.05%) malignant and 64 (60.95%) benign masses. BI-RADS classification showed 10 cases in category 2, 16 cases in category 3, 21 cases in category 4a, 19 cases in category 4b, 18 cases in category 4c, and 21 cases in category 5. With a diagnosis of malignancy at 4b classification and above, the sensitivity of the BI-RADS classification for diagnosing malignant breast masses was 92.68% and the specificity was 68.75%. The SR and Emax values were higher in the malignant group than in the benign group (P < 0.05). ROC curve analysis showed that the AUCs of SR and Emax for diagnosing malignant breast masses were 0.739 and 0.784, and the optimal cut-off values were 4.17% and 98.21 kPa, respectively, and the AUCs of SR+Emax combined diagnosis were 0.861, with a sensitivity of 70.73% and a specificity of 92.19%, and a Yoden index of 0.629, which showed that the efficacy of the combination was higher than that of the single diagnosis (P < 0.05). ROC curve analysis showed that the AUCs of SR+BI-RADS, Emax+BI-RADS, and SR+Emax+BI-RADS for diagnosing malignant breast masses were 0.826, 0.830, and 0.892, respectively, and the diagnostic efficacy of SR+Emax+BI-RADS was higher than that of SR+BI-RADS, Emax+BI-RADS, and BI-RADS (P < 0.05).  Conclusion  The combined diagnosis of SR+Emax+BI-RADS can significantly improve the diagnostic efficacy of breast cancer, and improve the specificity of BI-RADS classification diagnosis.
Application of combined detection of MA, BUN, sCr and eGFR in early renal graft injury induced by tacrolimus
WANG Hao, LAI Dahai, HUANG Shuaishuai, JIN Aihui, XU Chenlong, CEN Dong
2024, 22(3): 478-480. doi: 10.16766/j.cnki.issn.1674-4152.003430
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  Objective  To assess the clinical value of early detection of the risk of graft dysfunction in post-renal transplant patients after continued use of tacrolimus (Tac) by combined detection of urinary microalbumin (MA), blood urea nitrogen (BUN), serum creatinine (sCr) and estimated glomerular filtration rate (eGFR).  Methods  Fifty-four renal transplant patients who had been using Tac for a long time and were admitted to Ningbo Hospital for urinary nephropathy between August 2015 and July 2020 were selected. The patients were divided into two groups: group A, which used Tac continuously for 12 months, and group B, which used Tac continuously for 24 months. The clinical value of MA, BUN, sCr, eGFR and combined detection were evaluated through comparative analysis.  Results  Compared to group A, group B showed significant differences in MA and eGFR (P < 0.05), but not in BUN and sCr (P > 0.05). There was a negative correlation between eGFR and MA, BUN and sCr [r values of 12 months (group A) and 24 months (group B) were-0.413, -0.538, -0.797 (P < 0.01) and -0.333, -0.647, -0.738 (P < 0.05), respectively], and was significantly correlated with Tac duration, particularly in the early post-transplantation period. Based on the receiver operating characteristic curve, the AUC for MA, BUN, sCr and eGFR individually were 0.680, 0.594, 0.581 and 0.689, respectively. The combined detection of the four indicators resulted in an AUC of 0.839.  Conclusion  The detection of four renal injury markers (MA, BUN, sCr and eGFR) can aid in the early diagnosis of renal insufficiency in patients who continue to use Tac after renal transplantation.
Advances in the application of AI in chronic disease management in primary care
HU Jiamin, QIU Yan, REN Jingjing
2024, 22(3): 481-485. doi: 10.16766/j.cnki.issn.1674-4152.003431
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In the current healthcare sector, the integration of artificial intelligence (AI) technology has opened new avenues for improving the efficiency and quality of chronic disease management. Especially within primary healthcare systems, the application of AI is gradually transitioning from theory to practice, supporting general practitioners in better responding to patient needs and providing personalized and efficient medical services. In the field of chronic disease management, the involvement of AI has made the comprehensive management of chronic diseases more intelligent, enhancing the accuracy of prevention, diagnosis, and treatment. The role of general practitioners, with the aid of AI, is also undergoing a transformation; they are no longer simply the executors of diagnosis and treatment, but have become integrators of medical resources and guides for patient health management. AI can provide personalized rehabilitation treatment plans based on patients ' conditions and needs. Intelligent technology can be used to continuously monitor patients ' vital signs and changes in their condition, alerting potential health risks. AI can also assist patients in improving their lifestyle habits, such as by using smart reminders and behavioral guidance to help patients maintain a reasonable diet and exercise. AI can build local health education knowledge bases, popularizing knowledge and management skills for chronic diseases. However, the limitations of information technology may lead to insufficient data processing capabilities and service coverage. Security and privacy issues require strict compliance with relevant laws and regulations to ensure protection. Moreover, over-reliance on AI technology may overlook the human care and direct communication between doctors and patients. In the future, by strengthening the understanding and mastery of AI technology among primary healthcare workers, and by increasing the public ' s awareness and acceptance of AI technology, we can promote the deep application of AI in grassroots chronic disease management, making a positive contribution to improving the health level of the entire population.
Application status of frailty assessment tools in primary care
CHENG Lian, RUAN Jinting, LIANG Lei, HUANG Yanfei, LI Qiangxiang
2024, 22(3): 486-490. doi: 10.16766/j.cnki.issn.1674-4152.003432
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Advances in medicine have led to an increase in human longevity, a year-on-year increase in the number of elderly people, and a gradual acceleration of the aging process. The physical functions of the elderly are gradually declining and their ability to cope with stress is decreasing. Therefore, the social medical burden required for old-age care is increasing. Frailty is a common geriatric syndrome, which is mainly characterized by the decline of the body ' s physiological reserve capacity and can lead to a variety of adverse outcomes, seriously affecting the quality of life of the elderly. With the rapid development of general medicine, primary healthcare organizations have gradually become the main battle field for elderly patients to enjoy health services, and the elderly are regarded as the key population to be managed by primary healthcare organizations. Early identification and timely intervention by general practitioners to actively improve the functional status of the elderly will reduce the occurrence of adverse events such as falls, infections, hospitalization, and even death as a result. As the mechanism of the occurrence and development of frailty is not yet clear and the related research is limited, the identification and prediction of frailty can often rely on frailty assessment tools to realize, so it is extremely important to choose the appropriate frailty assessment tools. At present, the research on frailty assessment tools in foreign countries is earlier and more comprehensive, while in China, the research on frailty assessment tools in primary care is in its initial stage, and a recognized unified "gold standard" for frailty assessment tools has not yet been formed. Therefore, this paper reviews the existing domestic and international literature on the application of frailty assessment tools in primary care, analyzes the characteristics and application scenarios of various types of frailty assessment tools, and aims to give full play to the advantages of primary care physicians as the gatekeepers of residents ' health, slow down the development of frailty, promote healthy aging, improve the quality of life of the elderly, reduce the burden of medical care, and achieve the goal of Healthy China by providing reference and basis.
Application of acupoint application of Chinese medicine to relieve abdominal pain and distension after colonoscopy under general anesthesia
HUANG Xiaolin, ZHONG Xiaojing, XU Yan, LING Yan, BAO Linjun
2024, 22(3): 491-494. doi: 10.16766/j.cnki.issn.1674-4152.003433
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  Objective  The phenomenon of abdominal pain and distension after colonoscopy under general anesthesia should be paid more attention to. This study discussed the effect of acupoint application of Chinese medicine on relieving abdominal pain and distension.  Methods  A total of 340 patients who planned to undergo general anesthesia colonoscopy in Wenzhou of Integrated Traditional Chinese and Western Medicine Hospital from February 2022 to April 2023 were selected and divided into a control group and an observation group by random number table method, with 170 cases in each group. The control group was given routine nursing after examination, and the observation group was given acupoint application of traditional Chinese medicine based on routine nursing. The relief of abdominal pain and distension, the time of first anal exhaust, gastrointestinal symptoms rating scale (GSRS), and nursing satisfaction were compared between the two groups after the examination.  Results  The VAS scores of abdominal pain and abdominal distension in both groups showed a downward trend after examination (P < 0.05). The VAS scores of abdominal pain and abdominal distension in the observation group at 6 h and 12 h were lower than those in the control group, with statistical significance (P < 0.05). The first anal exhaust time [(17.14±5.60) min vs. (25.26±7.43) min] and GSRS score [(6.51±2.03) points vs. (7.72±2.25) points] of the observation group were lower than those of the control group (P < 0.05), the remission rates of abdominal pain, abdominal distension and nursing satisfaction 12 h after examination were higher than those of control group [96.75% (149/154) vs. 91.28% (136/149)], and the difference was statistically significant (P < 0.05).  Conclusion  Acupoint application of Chinese medicine after general anesthesia colonoscopy can effectively relieve abdominal pain and distension, shorten the time of anal exhaust, improve the comfort and safety of colonoscopy, and improve nursing satisfaction.
Efficacy and risk factors of ultrasound-guided low-dose compound betamethasone injection on shoulder joint function in patients with rotator cuff injury
XU Qiong, WU Shan, DU Xin, TIAN Taotao, ZHANG Maoliang, DU Fenfei
2024, 22(3): 495-499. doi: 10.16766/j.cnki.issn.1674-4152.003434
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  Objective   To explore the effect of ultrasound-guided low-dose compound betamethasone injection on shoulder joint function in patients with rotator cuff injuries, and to analyze the factors affecting its efficacy, to provide help for clinical improvement of the therapeutic effect of patients with rotator cuff injury.   Methods   A retrospective study was conducted to select the clinical data of 96 patients with rotator cuff injuries who were treated in Dongyang People' s Hospital from January 2022 to March 2023 as the study subjects. All patients were treated with an ultrasound-guided injection of low-dose betamethasone combined with ropivacaine. The pain level at different time points, shoulder joint function, upper limb motor ability, and daily living ability before treatment and 1 month after treatment were compared. The clinical efficacy of the patients was evaluated according to the Neer shoulder function score at 1 month of treatment. According to the score, the patients were divided into an excellent group and a poor group. The baseline data of patients were statistically analyzed, and binary logistic regression analysis was used to analyze the factors affecting the clinical efficacy of ultrasound-guided low-dose hormone injection in patients with rotator cuff injury.   Results   After 1 month of treatment, the excellent and good rate was 80.21% (77/96) evaluated by Neer score. The Neer scores at 1 month of treatment were higher than those before treatment (P<0.05). The VAS scores at 1 hour, 1 week, and 1 month after treatment were lower than those before treatment and showed a downward trend (P<0.05). The upper limb Fugl-Meyer functional score and Barthel index score of the patients at 1 month after treatment were higher than those before treatment (P<0.05). At 1 month of treatment, the active range of motion of shoulder joint mobility was higher than that before treatment (P<0.05). The results of binary logistic regression analysis showed that age ≥ 60 years old, labor intensity of grade Ⅲ-Ⅳ, and diabetes mellitus were risk factors affecting the clinical efficacy of patients with rotator cuff injury (OR>1, P<0.05).   Conclusion   Ultrasound-guided injections of low-dose betamethasone combined with ropivacaine can effectively improve shoulder joint function, upper limb movement, and daily living ability of patients with rotator cuff injuries. At the same time, age, labor intensity, and diabetes are closely related to the clinical efficacy of patients.
Application of CBL combined with PBL in Tumor Bioinformatics teaching
LI Mingyang, LIU Yixiong, FAN Linni, WANG Zhe
2024, 22(3): 500-503. doi: 10.16766/j.cnki.issn.1674-4152.003435
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  Objective   To explore the application effect of case-based learning (CBL) combined with problem-based learning (PBL) in Tumor Bioinformatics teaching and students' evaluation of the teaching mode.   Methods   A total of 62 four-year biomedical engineering students who were studying Tumor Bioinformatics in Air Force Medical University were selected. The random digital table method was used to divide the subjects into experimental group and control group, with 31 students in each group. The experimental group adopted CBL combined with PBL teaching mode, while the control group adopted traditional teaching mode. After the teaching, the teaching effect was evaluated by the test of proposition. The questionnaire survey was used to evaluate the students' satisfaction with the two teaching modes.   Results   By statistical analysis, the experimental group students' scores on multiple-choice questions (24.52±2.69), short-answer questions (35.21±3.03), essay questions (24.28±3.41) and total scores (78.15±5.89) were higher than those of the control group (21.94±3.17, 32.85±2.78, 22.31±3.89, 73.81±6.21, P<0.05). In the questionnaire survey, the experimental group had better approval of improving the enthusiasm for theoretical knowledge learning, fostering clinical transformational thinking, improving the mastery of theoretical knowledge, expanding the knowledge of oncology medicine, improving the ability to solve clinical problems, improving the ability of independent learning, improving the efficiency of literature retrieval, and improving the ability of cooperative learning than the control group (P<0.05).   Conclusion   CBL combined with PBL has achieved better results in the teaching of Tumor Bioinformatics courses, which improves the students' learning ability and knowledge mastery, and the students are highly satisfied with this teaching mode.
Application effect of introducing PBL and CBL dual track models into mind mapping in cardiology training teaching
WANG Xiaodong, BAI Xuelei, FAN Liyong, LI Ke, QIAO Linshang
2024, 22(3): 504-507. doi: 10.16766/j.cnki.issn.1674-4152.003436
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  Objective   To explore the application effect of the dual track model of problem-based learning (PBL) and case-based learning (CBL) introduced by mind mapping in cardiology training.   Methods   Sixty-five students from the Cardiology Department of the Second People' s Hospital of Nanyang City who participated in the standardized training for resident physicians from January to September 2022 were selected as the experimental group (receiving PBL and CBL dual track teaching with mind mapping); using 65 cases from January to December 2021 as the control group (receiving PBL and CBL dual track teaching mode, without the introduction of mind mapping). Closed-book examination and distribution of teaching effectiveness evaluation questionnaires; Two groups of students will be evaluated on their critical thinking skills.   Results  The total score of the students in the experimental group in the theoretical examination (79.28±7.06) was significantly higher than that of the students in the control group (67.08±11.08, P<0.05). The scores of communications among students in the experimental group, interaction with teachers, classroom atmosphere, students' attention in class, students' participation initiative, and time rationality were significantly higher than those of the control group (P<0.05). The scores of knowledge comprehension, knowledge extension, pre-class preview, material review, subject connection, and consolidation review in the experimental group were significantly higher than those in the control group (P<0.05). The scores of independent thinking, active learning, communication ability, cooperation ability, and problem solving ability in the experimental group were significantly higher than those in the control group (P<0.05). The scores of knowledge depth, thinking ability, and teaching method of the experimental group were significantly higher than those in the control group (P<0.05). The total score of students' critical thinking ability (380.42±41.41) was significantly higher in the experimental group after the introduction of PBL and CBL dual track teaching mode using mind mapping than before the teaching (319.65±40.22, t=29.715, P<0.001).   Conclusion   The introduction of PBL and CBL dual-mode mind mapping can effectively improve the teaching effectiveness of cardiology training, improve learning ability and critical thinking ability is conducive to mutual learning and satisfaction with the curriculum.
Influencing factors of hemodialysis patients' dietary behavior adherence: a qualitative study
JIN Weiyi, ZHANG Yuan, FENG Chunyan, SU Chunyan
2024, 22(3): 508-512. doi: 10.16766/j.cnki.issn.1674-4152.003437
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  Objective  Related complications such as volume overload, hypertension, electrolyte disturbances, bone mineral metabolism disorders and malnutrition in dialysis patients are closely related to their dietary intake. Therefore, it is very important to manage the diet and nutrition of dialysis patients. In this study, the phenomenological research method was used to explore the experiences and views of dialysis patients on dietary adjustment based on the health belief model from a subjective point of view, and to identify the essential reasons that affect dialysis patients' dietary compliance through qualitative research. in order to provide guidance for specific and personalized improvement of dietary compliance of haemodialysis (HD) patients.  Methods  From November to December 2021, 28 HD patients in Peking University Third Hospital were selected by convenience sampling method. Phenomenological research method was applied to the interview and the data were analyzed using targeted content analysis to extract themes.  Results  Four themes were extracted, and named as perceived threat, perceived barriers, self-efficacy & successful experience, and external factors respectively. Perceived threat affected the adherence of dialysis patients, especially the perceived severity. Perceived barriers included subjective and objective barriers, and subjective barriers were related to dietary recommendations, eating habits and concepts, and patient experience, etc. Comorbidity, social activities and eating out were objective barriers to dietary compliance in dialysis patients. Self-efficacy and success experiences included belief building, self-dietary modification, dietary control habits, and exercise. External factors included social support and other social factors.  Conclusion  The perception and cognition of dietary behavior change in HD patients was complicated. Their dietary adherence was influenced by many factors. Improving patients' perceived threat, reducing barriers, improving self-efficacy and social support will help to improve dietary adherence in HD patients.
Quality of work and life and its influencing factors in lung cancer patients returning to work
DAI Jianjuan, WANG Wei, YAN Boer, WU Dongdong, YUAN Xujing, CHEN Zhijun, ZHANG Yanfei
2024, 22(3): 513-516. doi: 10.16766/j.cnki.issn.1674-4152.003438
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  Objective  To explore the status quo of quality of work and life of patients with lung cancer who returned to work, and to analyze its influencing factors, so as to provide theoretical basis for nursing managers to formulate targeted intervention measures.  Methods  Using a cross-sectional study, 157 cases of lung cancer patients in Zhoushan hospital from October 2022 to October 2023 were selected as the research objects, using the general situation questionnaire, cancer patients ' working quality of life scale, psychological adaptation scale and return to work preparation scale.  Results  The quality of work and life score of lung cancer patients who returned to work was (75.36±10.01) points. Among all the dimensions, the score of work meaning was the highest, the score of work environment was the second, and the score of health condition was the lowest. In the univariate analysis, sex, education level, and length of return to work were different in quality of work scores of patients with return to work, the difference were statistically significant (P<0.05). In Pearson ' s correlation analysis, the quality of work and life of return-to-work lung cancer patients was positively correlated with psychological adjustment, total score of readiness to return to work, and scores of each dimension (P<0.05). In the multiple stepwise regression analysis, readiness to return to work, psychological adjustment, the length of returning to work and education level explained 36.3% of the total variation.  Conclusion  The quality of work and life of lung cancer patients who return to work needs to be improved. The preparation of returning to work, psychological adaptation, the length of returning to work and education level can have an impact on the quality of work and life of lung cancer patients. Nursing managers can take active measures as soon as possible and carry out personalized continuation nursing measures.
Construction of evidence-based nursing practice protocol for the preventive management of pressure injuries in surgical patients
SONG Hui, WANG Yue, ZHENG Chen
2024, 22(3): 517-521. doi: 10.16766/j.cnki.issn.1674-4152.003439
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  Objective  To construct a scheme for the prevention and management of stress injury in surgical patients based on evidence, to provide a reference for the homogenization and standardized development of clinical nursing and management in the operating room.  Methods  A research group was set up to search the literature related to intraoperative stress injury in the past 5 years under the theoretical guidance of evidence-based nursing. AGREE Ⅱ, AMSTAR2 (version 2014), and JBI evidence classification criteria were used to evaluate the quality and classification of evidence. The evidence was extracted and the first draft of a protective strategy against intraoperative stress injury was drawn up. Twenty experts were consulted by the Delphi method for 2 rounds, and the strategy items were modified. Finalize the final draft of the plan.  Results  Ten articles were searched and screened, including 2 clinical guidelines, 2 clinical decisions, 1 expert consensus, and 5 evidence summaries and 28 pieces of best evidence were extracted to form the best evidence for the prevention and management of stress injury in surgical patients. including education and training, risk assessment, preoperative prevention, intraoperative prevention, postoperative evaluation, quality improvement chain overall management strategy. The participation rate of experts in the two rounds of expert meetings was 100%, and all experts expressed relevant opinions and suggestions on the specific contents of the plan. The positive coefficient of the two rounds of expert letters was 100%, the expert authority coefficient was 0.92, the importance of each item were 0.392 and 0.420 respectively (P<0.01), and the maneuverability Kendall's W coefficient were 0.322 and 0.366 (P<0.01). Finally, the prevention management program includes 4 first-level items, 11 second-level items, and 25 third-level items, including quality management, preoperative management, inter-operative management, and postoperative management.  Conclusion  The prevention and management plan for stress injury of surgical patients based on evidence-based nursing theory is scientific and reliable, has strong clinical application value and can lay a foundation for homogeneous prevention and management of stress injury in the operating room.
A study on the current situation and influencing factors of evidence-based nursing practice knowledge-attitude-practice among nurses in third Class A hospitals
XING Sisi, DUAN Xiaoxia, YUAN Yue, CHEN Lingling
2024, 22(3): 522-525. doi: 10.16766/j.cnki.issn.1674-4152.003440
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  Objective  A study was conducted to investigate the current status of capacity levels and factors influencing the knowledge-attitude-practice of evidence-based nursing in Grade 3A general hospital.  Methods  In March 2023, a convenience sampling method was employed to select 251 clinical nurses as research subjects from three Grade 3A general hospitals in Bengbu City. Questionnaire surveys were conducted using the general information questionnaire and the evidence-based practice questionnaire to analyze the current situation and explore the relevant influencing factors.  Results  The total scores of evidence-based nursing practice knowledge-attitude-practice among 251 clinical nurses in Grade 3A general hospitals were (105.24±20.98) points. The entry mean score was (4.38±0.87) points. The scores for each dimension were as follows: knowledge skills had a total score (55.61±11.22) points and a mean score of (4.27±0.86) points, attitude towards practice behavior had a total score (22.80±5.15) points and a mean score of (4.56±1.03) points, and practice behavior had a total score of (26.82±7.05) points and a mean score of (4.47±1.17) points. Among these dimensions, practical attitude had the highest mean scores, while knowledge skills had the lowest mean scores. One-way analysis showed significant differences among the 251 clinical nurses in terms of age, title, years of experience, computer skills, specialized technical skills, professional attitudes, knowledge of evidence-based nursing, experience of training in evidence-based nursing, experience of evidence-based practice, ability to implement personalized nursing care, and the practicality of evidence-based nursing practice (P<0.05). Multiple linear regression analysis indicated that computer skills, professional attitude, knowledge of evidence-based nursing, experience of evidence-based practice, and ability to implement personalized care were the factors influencing the level of knowledge, belief, and practice of evidence-based nursing practice among clinical nurses in Grade 3A general hospitals in Bengbu City (P<0.05).  Conclusion  Evidence-based practice competencies of clinical nurses in Grade 3A general hospital need to be further improved. Management leadership should develop and implement targeted training programs that take into account all relevant factors in order to enhance the level of medical care services.
Venetoclax combined with azacitidine in treatment of acute megakaryoblastic leukemia transformed from primary myelofibrosis: report of 1 case and review of literature
WEI Xiaofang, FENG Youfan, DING Guosheng, FU Yuan, CHEN Yang, ZHANG Qike
2024, 22(3): 526-529. doi: 10.16766/j.cnki.issn.1674-4152.003441
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We retrospectively analyzed the clinical data of an elderly patient of acute megakaryoblastic leukemia transformed from primary myelofibrosis treated with venetoclax combined with azacitidine in Gansu Provincial People' s Hospital and reviewed the relevant literature. This patient, a 72-year-old man, was diagnosed with primary myelofibrosis and was transformed to acute megakaryoblastic leukemia after 2 years of treatment with ruxolitinib, then given venetoclax combined with azacitidine. After the first course of treatment, the patient had partial remission of bone marrow and clinical improvement significantly. After the second course of treatment, although the bone marrow had complete remission and flow minimal residual disease (MRD) was negative, agranulocytosis persisted for up to 45 days and finally died due to infection.
One case of diabetic nephropathy treated with multi-glycosides of tripterygium wilfordii and efficacy analysis of its anti-inflammatory and anti-fibrosis
LI Wenliu, XING Chunyan, LI Qin, ZHAO Yongli, HE Chunlin, WANG Lizhuo, GAO Jialin
2024, 22(3): 530-533. doi: 10.16766/j.cnki.issn.1674-4152.003442
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Diabetic nephropathy (DN) is one of the most worrisome chronic microvascular complications of diabetes and a leading cause of end-stage renal disease (ESRD). In the case of aggressive intervention in patients with DN and improvement of basic treatment such as diet, exercise, blood glucose, blood pressure, kidney-specific drugs still have good benefits for DN patients. In particular, traditional Chinese medicines, Chinese medicines formed under modern medical technology, represented by multi-glycosides of tripterygium wilfordii (GTW), Bailing Capsules, etc. Clinically rational selection and use of Chinese medicines is one of the important methods for the treatment of DN. This paper reports a case analysis of DN treated with GTW, aiming to improve the understanding of the disease and GTW.
Hemophagocytic lymphohistiocytosis secondary to chronic mucocutaneous candidiasis caused by gain-of-function STAT1 mutations: a case report
RUAN Peisen, ZHENG Yao, CHEN Hehe
2024, 22(3): 534-538. doi: 10.16766/j.cnki.issn.1674-4152.003443
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Chronic mucocutaneous candidiasis disease is characterized by repeated or persistent candida albicans infection of the nail, skin, oral cavity and genital tract mucosa. This disease is rare in clinical practice. The patient in this case mainly presented with recurrent oral candidiasis, low body weight, and growth retardation. The examination on admission showed enlarged liver, spleen, and lymph nodes, and the laboratory tests showed low blood tertiary, hypofibrinogenemia, hypertriglyceridemia, high ferritin, low activity of NK cells, and the bone marrow smear showed hemophagocytic cells, and the peripheral blood metagenomic next generation sequencing, blood culture and bone marrow culture all suggested Candida albicans infection. Whole exon sequencing of the child revealed a heterozygous missense variation c.1154C>T (p.Thr385Met) in the STAT1 gene, which was a spontaneous variation. The diagnosis was acquired mutation in the STAT1 gene causing chronic mucocutaneous candidiasis disease secondary to hemophagocytic lymphohistiocytosis. The patient received anti-infection treatment with caspofungin and fluconazole successively, and was discharged from hospital after 5 weeks of hospitalization. No recurrence or sequelae were observed over 1 year after discharge.
Special Topic/Colorectal Cancer
Circulating tumor DNA in colorectal cancer
WU Long, WU Huan, HUANG Fei, LI Xiaoyun, ZHEN Yunhuan, LI Haiyang
2024, 22(3): 368-371. doi: 10.16766/j.cnki.issn.1674-4152.003404
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Colorectal cancer is a prevalent form of cancer in China and is the second leading cause of death worldwide. The prognosis of the disease has greatly improved with the development of diagnostic techniques and advances in therapeutic methods, including surgery and chemotherapy. However, a certain percentage of patients still experience recurrence after radical treatment circulating tumor DNA (ctDNA) is a cell-free circulating DNA (cfDNA) fragment derived from tumor cells. It is a novel biomarker that can be used to monitor the efficacy of radiotherapy and postoperative recurrence in colorectal cancer patients. Compared to traditional biomarkers, the ctDNA has higher specificity and sensitivity and can be stably present in patients ' serum. Detecting ctDNA levels allows for a more accurate assessment of the patient ' s condition and the formulation of a personalized treatment plan based on test results. The use of ctDNA in the diagnosis and treatment of colorectal cancer offers high specificity and sensitivity. By detecting the level of ctDNA in a patient ' s serum, it is possible determined whether they may have colorectal cancer at an early stage. Meanwhile, by comparing the changes in serum ctDNA levels before and after treatment, the therapeutic effect of patients can be evaluated. In colorectal cancer follow-up, ctDNA has high specificity and sensitivity. By detecting the patient ' s serum ctDNA level, recurrence can be effectively determined. If the serum ctDNA level of the patient continues to increase, it suggests that the patient may have relapsed and requires prompt examination and intervention. In conclusion, ctDNA is a promising biomarker with high specificity and sensitivity. It can be used to monitor the effectiveness of radiotherapy and detect postoperative recurrence in patients with colorectal cancer. It is currently considered one of the novel biomarkers in liquid biopsy. It can be used to assess radiotherapy effect and monitor postoperative recurrence. This makes it a valuable biomarker. This paper presents a review of the characteristics of ctDNA and its applications in the diagnosis, treatment and follow-up of colorectal cancer.
Value of c-MYC expression in a lymph node metastasis risk prediction model for colon cancer
WANG Yu, CHEN Fangfang, WANG Chao, GUO Han, WANG Suhang, LIU Mulin
2024, 22(3): 372-375. doi: 10.16766/j.cnki.issn.1674-4152.003405
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  Objective  To examine the correlation between the expression of cellular-myelocytomatosis viral oncogene (c-MYC) and lymph node metastasis risk in colon cancer, develop a risk prediction model and evaluate its significance.  Methods  The medical records of 304 patients who underwent radical colon cancer surgery at the First Affiliated Hospital of Bengbu Medical University from January 2020 to December 2022 were collected. The patients were randomly divided into a model group and a validation group, each comprising 152 cases. We analyzed the factors influencing lymph node metastasis and identified the risk variables for input into the prediction model. The characteristics of colon cancer lymph node metastasis were then analyzed using an artificial intelligence system through deep learning. Finally, we assessed the effectiveness of the model.  Results  Univariate analysis showed that the neutrophil-to-lymphocyte ratio (NLR), c-MYC expression, tumor morphology, vascular cancer thrombus, tumor length, and tumor differentiation degree of 152 colon cancer patients in the model group were related to their lymph node metastasis. Further multivariate analysis identified the neutrophil-lymphocyte ratio, c-MYC expression, tumor morphology, vascular cancer thrombus, tumor length and diameter, and tumor differentiation degree as significant risk relevant variables for lymph node metastasis in colon cancer. The ROC curve based on the prediction model showed an AUC of 0.745 (95% CI: 0.712-0.803) in the validation group and 0.832 (95% CI: 0.796-0.875) in the model group, suggesting the effective predictive capability of the risk prediction model for lymph node metastasis in colon cancer patients.  Conclusion  The NLR, c-MYC expression, tumor morphology, vascular cancer thrombus, tumor length, and tumor differentiation were significant risk variables affecting lymph node metastasis in colon cancer. The risk prediction model constructed in this study demonstrates accurate identification of lymph node metastasis risk in colon cancer patients, holding promising clinical applications.
The expression and correlation between circPRKCI and miR-545 in colorectal cancer
LIU Jinghua, WANG Hailing, ZHAO Yang, MA Jianfeng
2024, 22(3): 376-379. doi: 10.16766/j.cnki.issn.1674-4152.003406
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  Objective  To investigate the expression of circular RNA PRKCI (circPRKCI) and microrNA-545 (miR-545) in colorectal cancer tissues and their effects on prognosis.  Methods  From March 2013 to April 2018, 102 patients with colorectal cancer underwent surgical resection in Zhengzhou Seventh People ' s Hospital were collected. The expression levels of circPRKCI and miR-545 in colorectal cancer patients with different clinicopathological characteristics were analyzed. The effects of circPRKCI and miR-545 expression levels on the prognosis of patients were analyzed by Cox regression and survival curve.  Results  The expression of circPRKCI was significantly up-regulated in colorectal cancer tissues compared to paracancer tissues (1.47±0.69 vs. 0.82±0.42, t=8.644, P < 0.05). Conversely, miR-545 expression was significantly down-regulated in colorectal cancer tissues (0.86±0.55 vs. 1.60±0.66, t=8.908, P < 0.05). The expression of circPRKCI increased and the expression of miR-545 decreased in patients with lymph node metastasis and TNM stage Ⅲ-Ⅳ (P < 0.05). Furthermore, patients with high expression of circPRKCI and low expression of miR-545 exhibited poor prognosis (P < 0.05). Both circPRKCI and miR-545 were identified as independent risk factors for poor prognosis in patients with colorectal cancer, and their expression showed a negative correlation.  Conclusion  The expression of circPRKCI and miR-545 is related to the adverse pathological parameters and prognosis in patients with colorectal cancer, suggesting a potential regulatory role of circPRKCI in the progression of colorectal cancer involving miR-545.
General Practice Research
Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"
ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong
2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407
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  Objective  This study retrospectively reanalyzed the reflux parameters of patients with gastroesophageal reflux disease (GERD) detected through esophageal pH and impedance pH monitoring, following the "Lyon Consensus". The DeMeester scores (DMS) were compared to the acid exposure time (AET).  Methods  This study included a total of 1 023 GERD patients who underwent 24-hour esophageal pH monitoring or impedance pH monitoring at the Gastrointestinal Dynamics Center of Peking Union Medical College Hospital from January 2008 to December 2022. The reflux parameters were reanalyzed and compared using DMS and AET, respectively.  Results  (1) According to the "Lyon Consensus", AET demonstrates 94.7% sensitivity and 99.0% specificity, while DMS shows 98.1% sensitivity and 97.2% specificity. DMS exhibits higher sensitivity than AET, whereas AET has greater specificity than DMS. The monitoring results of the both methods are highly consistent (P < 0.05). (2) Among the 105 patients with AET ranging from 4% to 6%, they were divided into DMS (+) and DMS (-) groups. Significant differences were observed between the two groups in terms of the total number of reflux episodes, number of reflux episodes lasting≥5 min, %supine time esophageal pH < 4, and longest reflux episode (in minutes). These findings suggest that these parameters should be considered and analyzed in addition to AET. (3) It is worth noting that more than 50% GERD patients with AET ranging from 4% to 6% still cannot determine the presence or absence of pathological reflux.  Conclusion  Both the diagnostic standards of AET and DMS provide robust supporting evidence for esophageal acid exposure. AET exhibits lower sensitivity but higher specificity compared to DMS. To enhance the sensitivity of AET, considering the hypothesis of AET>4% demonstrates esophageal acid exposure might be beneficial.
Development of a prediction model for enteral feeding intolerance in patients with sepsis
YANG Ling, ZHANG Li, PENG Hu, GU Xin, YU Xiangyou
2024, 22(3): 384-388. doi: 10.16766/j.cnki.issn.1674-4152.003408
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  Objective  To explore the risk factors of enteral feeding intolerance (EFI) in sepsis patients and to understand the occurrence of EFI in sepsis patients. To construct a risk prediction model for the occurrence of EFI in sepsis patients to facilitate the screening of high-risk groups to prevent and control the occurrence of EFI.  Methods  Convenience sampling method was used to select sepsis patients admitted to the Department of Critical Care Medicine of a tertiary-level hospital in Xinjiang who underwent enteral nutrition therapy from January 2022 to June 2023 as study subjects and were divided into the feeding tolerance group and feeding intolerance group by whether or not EFI occurred in the patients, and a one-way analysis was carried out on the patients ' general, clinical, and feeding intolerance-related data, and LASSO regression was applied to solve the covariance problem among variables, then the variables in the results of LASSO regression analysis were included in logistic regression analysis to derive the risk factors for EFI in patients with sepsis, on the basis of which we constructed a prediction model for the risk of EFI in patients with sepsis, and plotted a Nomogram, ROC curve, decision curve analysis, and calibration curve to evaluate and validate the diagnostic efficacy of the prediction model.  Results  A total of 199 sepsis patients with enteral nutrition therapy were included, including 93 cases in the intolerant group and 106 cases in the tolerant group, and the incidence rate of EFI was 46.7%. Multifactorial analysis showed that sequential organ failure assessment (SOFA) score, nutritional risk screening (NRS-2002) score, analgesics, and ICU length of stay were independent risk factors for the occurrence of EFI in patients with sepsis. The area under the ROC curve was 0.885 (95% CI: 0.833-0.933), and the maximal Youden index was 0.689, with a sensitivity of 0.849, and a specificity of 0.839.  Conclusion  SOFA score, NRS-2002 score, analgesics, and ICU length of stay are risk factors for EFI in septic patients. The risk prediction model constructed in this study based on this was validated and found to be a more accurate predictor of the risk of EFI in patients with sepsis, which can help clinical healthcare professionals provide scientific and individualized enteral nutrition therapy to patients.
Doctor-nurse integrated management in the first case of adult living donor liver transplantation in Anhui Province
ZHANG Ling, HU Jingrong, YU Xiaojun, ZHAO Hongchuan, GENG Xiaoping
2024, 22(3): 389-392. doi: 10.16766/j.cnki.issn.1674-4152.003409
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  Objective  To summarize the experience in rehabilitation management in the first case of adult living donor liver transplantation in Anhui Province.  Methods  The doctor-nurse integrated group was established in the Department of Organ Transplantation, Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in December 2021. The doctor-nurse integrated management consisted of precise care in three courses: preoperative evaluation stage, perioperative period and domestic management period of both of the liver transplant donor and recipient. During the preoperative evaluation period of transplantation, comprehensive assessment and intervention of medical care integration were carried out from three aspects: anatomy, physiology and social psychology. The living donor liver transplantation must be especially approved from the senior ethics committee. A precise overall evaluation of both the donor and the recipient is a cornerstone in a successful living donor liver transplantation. In addition to routine perioperative care during the perioperative period, a good recovery of both the donor and the recipient is dependent on the following five aspects: adequate preoperative preparation, refined care in immunosuppressive drugs management, monitoring of transplanted organ function, protective isolation in case of infection prevention, and optimization of rapid recovery management strategies. During the domestic care course, various nursing interventions were used to improve the self-efficacy level of the recipients, to encourage patients to adopt healthy behaviors, to optimize the postoperative examination process and to track the drug compliance by monitoring the blood drug concentration, counting tablet and collecting questionnaire survey.  Results  Both donor and recipient underwent successful operations. The donor recovered well and was discharged from the hospital 11 day after operation and the recipient was discharged on the 18th day with satisfied recovery. The blood biomarkers of both the donor and the recipient indicated sufficient liver function. The plasma concentration of immunosuppressants was maintained at an ideal level, and the remnant liver volume of both the donor and the recipient was appropriate. The follow-up was conducted intensively during the domestic care course. It turned out that both the donor and the recipient showed satisfied recovery 8 months after the operation.  Conclusion  Adult living donor liver transplantation requires close cooperation of the medical team, rigorous attitude, high-quality management, and precise treatment and nursing measures, so as to obtain a satisfactory prognosis for both the donor and the recipient.
Study on the predictive value of innovative adipose indexes for metabolic syndrome of Yi people in Yunnan Province
GUO Ni, JI Yanmei, MENG Ni, LI Jisheng, HE Xianyu, DAO Mengyao, JIN Xingfang
2024, 22(3): 393-397. doi: 10.16766/j.cnki.issn.1674-4152.003410
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  Objective  To compare the predictive value of innovative and traditional adiposity indices for metabolic syndrome (MS) risk in the Yi people of Yunnan Province.  Methods  A total of 508 residents from 3 Yi settlements in Yunnan Province were selected by random cluster sampling during November 2018 to September 2023. The traditional adipose indexes of waist circumference, hip circumference, BMI, waist-to-height ratio (WHtR) and related laboratory indexes were collected, and the innovative adipose indexes of China visceral adipose index (CVAI), visceral adipose index (VAI) and lipid accumulation product (LAP) were calculated. Statistical analysis was performed.  Results  The prevalence of metabolic syndrome was 20.01% (102/508) in the in the Yi population of Yunnan Province. Spearman correlation analysis showed that MS was significantly correlated with all adiposity indices. ROC curve analysis showed that the area under the curve of each adipose indexes was greater than 0.7, and the AUC of CVAI was the largest (AUC=0.872). The optimal cut-off values of CVAI, VAI and LAP were 120.20, 2.02 and 56.36, respectively. In different gender and body mass subgroups, the predictive value of the innovative adipose indexes is better than that of the traditional indices. According to the optimal cut-off value of the ROC curve, the groups were defined as C0 (CVAI < 120.20), C1 (CVAI≥120.20), V0 (VAI < 2.02), V1 (VAI≥2.02), L0 (LAP < 56.36) and L1 (LAP≥56.36), Multivariate logistic regression analysis showed that the risk of MS was 8.484 times higher in group C1 than in group C0. The risk of MS was 13.602 times higher in group V1 than in group V0. The risk of MS was 4.916 times higher in group C1 than in group C0.  Conclusion  The innovative adipose index has certain advantages in predicting MS in the Yi population of Yunnan Province, but the traditional index is also valuable when the relevant lipid index is missing. When the innovative adipose indexes exceed the optimal cut-off value, the risk of MS is significantly increased.
Relationship between whole blood iron and hyperuricemia in Kailuan study population
WANG Jierui, ZHU Baojie, WANG Li, SHI Huijing, CUI Liufu, SHU Rong, SONG Haicheng, XU Aigang, ZHANG Yanshu
2024, 22(3): 398-401. doi: 10.16766/j.cnki.issn.1674-4152.003411
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  Objective  To explore the relationship between whole blood iron level and hyperuricemia in Kailuan study population, and to provide evidence for the early prevention of hyperuricemia.  Methods  A cross-sectional study was conducted in 3 579 employees and retirees of Kailuan Group who participated in the health examination and completed the whole blood iron test in Linxi Hospital, Majiagou Hospital and Jinggezhuang Hospital from August, 2017 to May, 2018. According to the level of serum uric acid, the subjects were divided into normal serum uric acid group (n=2 983) and hyperuricemia group (n=596). Multivariate logistic regression model was used to analyze the association between whole blood iron (divided into Q1 to Q3 three subgroups according to tertiles) and hyperuricemia, and the effect of different ages on the association between whole blood iron and hyperuricemia was analyzed.  Results  The whole blood iron in hyperuricemia group [(464.73±104.05) mg/L] was significantly higher than that in normal serum uric acid group [(420.96±109.60) mg/L, P < 0.001]. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, compared with the whole blood iron Q1 group, the OR value (95% CI) of hyperuricemia in the whole blood iron Q3 group was 1.989 (1.487-2.661). In the subjects aged < 60 years, the OR value (95% CI) of hyperuricemia in the whole blood iron Q3 group was 2.304 (1.539-3.450), while which was 1.269 (0.818-1.969) in the subjects aged ≥60 years. In sensitivity analysis, compared with the whole blood iron Q1 group, the OR value (95% CI) of hyperuricemia in the whole blood iron Q3 group was 2.018 (1.499-2.716).  Conclusion  Higher whole blood iron level is associated with an increased risk of hyperuricemia, especially in people younger than 60 years old.
Efficacy of apatinib combination in second-line treatment of advanced gastric cancer
LU Changqing, HU Ting, SU Fang, WANG Zishu
2024, 22(3): 402-406. doi: 10.16766/j.cnki.issn.1674-4152.003412
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  Objective  To retrospectively analyze the adverse effects and efficacy of apatinib monotherapy, combination chemotherapy, or immune second-line treatment for advanced gastric cancer, and to explore the factors that influence treatment efficacy.  Methods  The study involved 145 patients with advanced gastric cancer who were admitted to the First Affiliated Hospital of Bengbu Medical University between January 2015 and December 2020.The patients were divided into three groups based on their medication regimen: apatinib single-agent group (n=36), combination chemotherapy group (n=94) and combination immunization group (n=15). The effectiveness of the three second-line treatments for advanced gastric cancer was compared using the Kaplan-Meier method. The study employed a Cox regression model to analyze the factors that impact treatment efficacy. The study employed a Cox regression model to analyze the factors that impact treatment efficacy.  Results  In the second-line treatment of advanced gastric cancer. The combination chemotherapy and combined immunization group showed significantly higher median progression-free survival (mPFS) and median overall survival (mOS) compared to the apatinib monotherapy group (mPFS, 8.3 months vs. 3.6 months, P < 0.001; 8.4 months vs. 3.6 months, P=0.003; mOS, 11.0 months vs. 7.5 months, P < 0.001; 14.0 months vs. 7.5 months, P < 0.001). The objective response rates (ORRs) for the three treatments were 5.56%, 18.09% and 26.67% (P=0.097), respectively. The disease control rates (DCRs) were 19.44%, 37.23% and 33.33% (P=0.151), respectively. However, the differences were not statistically significant (P > 0.05). The incidence of grade Ⅲ-Ⅳ adverse reactions among the three treatment options was 22.2% (8/36), 19.1%(18/94) and 26.7% (4/15), respectively, and the difference was not statistically significant (P=0.863). The statistical analysis revealed that there was a significant correlation between the ECOG score, peritoneal metastasis, and combination and progression-free survival in patients (P < 0.001).  Conclusion  In the second-line treatment of advanced gastric cancer, combining apatinib with chemotherapy or immunotherapy can lead to better efficacy while maintaining reliable safety.
Surgical treatment and curative effect analysis of 73 cases of primary cardiac tumor
LIU Tan, YU Yunsheng, HUANG Haoyue, YE Wenxue, HUA Fei, CHEN Yihuan, FAN Hongyou, JI Zhenchun
2024, 22(3): 406-409. doi: 10.16766/j.cnki.issn.1674-4152.003413
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  Objective  To summarize the experience of surgical treatment of 73 cases of primary cardiac tumors and improve the level of diagnosis and treatment of cardiac tumors.  Methods  A retrospective analysis was performed on 73 patients with cardiac tumors who were treated by cardiac macrovascular surgery in the First Affiliated Hospital of Soochow University from January 2018 to November 2022. General clinical data was collected, and their preoperative clinical manifestations, intraoperative surgical approach selection, tumor location and proportion, postoperative tumor pathology and prognosis were analyzed.  Results  A total of 30 patients showed congestive heart failure, accounting for 41.1%. There were 18 cases with embolism history, accounting for 24.7%. Two cases showed fever or systemic symptoms, accounting for 0.03%. Eight cases were complicated with arrhythmia (11.0%). Fifteen cases showed no clinical symptoms, accounting for 20.5%. In this group, there were 63 myxoma (86.3%), 8 non-myxomatous benign tumors (11.0%), and 2 malignant tumors (2.7%), most of which originated from the left atrium, 53 were located in the left atrium, 4 in the right atrium, 4 in the left ventricle, 1 in the right ventricular outflow tract, 2 in the left and right atrium, 1 in the left atrium and 1 in the left atrium, and 4 involved the mitral valve. Tricuspid valve was involved in 1 case, pulmonary vein in 1 case, inferior vena cava in 1 case, pericardial cavity in 1 case. In the whole group, 1 case died perioperatively, and the remaining patients had no surgery-related death. Follow-up ranged from 6 months to 5 years, with an average follow-up of 34 months, and 1 case was lost to follow-up. There was no recurrence of primary cardiac benign tumor, and 2 patients with malignant tumor died at 3 months and 6 months, respectively.  Conclusion  Primary cardiac tumors lack characteristic clinical manifestations. Myxoma is the most common primary cardiac tumor, and surgical resection is an effective treatment.
The clinical value of IL-6 in predicting the incidence of pulmonary infections during chemotherapy period in patients with multiple myeloma
ZHANG Lingxiu, YANG Cui, ZHANG Yuan, YANG Man, HUANG Yan, LIU Xiankai, WU Sun
2024, 22(3): 410-413. doi: 10.16766/j.cnki.issn.1674-4152.003414
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  Objective  This study aims to investigate the correlation between serum IL-6 expression levels and the occurrence of pulmonary infection in patients with multiple myeloma (MM).  Methods  This study enrolled a total of 160 MM patients diagnosed with multiple myeloma (MM group) and 40 healthy controls (Control group) from the Department of Hematology of the First Affiliated Hospital of Xinxiang Medical University between January 2021 and August 2022. Within the MM group, patients were divided into an infected group (n=65) and an uninfected group (n=95) according to the incidence of pulmonary infection during chemotherapy. Respiratory secretions were subjected to bacterial culture and identification. Risk factors of pulmonary infection in MM patients during chemotherapy period was analyzed. The clinical value of serum IL-6 expression levels in predicting the incidence of pulmonary infection during chemotherapy in MM patients was assessed using ROC curve analysis.  Results  Compared to the control group, the serum IL-6 expression level in the MM group significantly increased [(76.45±6.59) mg/mL vs. (34.23±4.34) mg/mL, t=38.449, P < 0.001]. Among the infected group, a total of 78 strains of pathogenic bacteria were detected, with gram-positive bacteria accounting for 52.56% (41/78), gram-negative bacteria accounting for 43.59% (34/78), and fungi accounting for 3.85% (3/78). Logistic regression analysis showed that Durie-Salmon stage, international staging system stage, agranulocytosis, and IL-6 were identified as influence factors for pulmonary infection during the chemotherapy period in MM patients. The area under the curve for serum IL-6 in predicting pulmonary infection during chemotherapy in MM patients was 0.924. The diagnostic sensitivity and specificity were 89.35% and 93.22%, respectively.  Conclusion  The serum expression level of IL-6 is significantly increased in MM patients. The pre-chemotherapy serum IL-6 expression level in MM patients can be used as a serological marker to predict the incidence of pulmonary infection during their chemotherapy period.
Correlation between time in range and diabetic foot in patients with type 2 diabetes mellitus
WU Daoai, JIN Guoxi, SHI Zhaoming, WU Chenchen, SUN Weihua, CHEN Li
2024, 22(3): 414-417. doi: 10.16766/j.cnki.issn.1674-4152.003415
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  Objective  To investigate the correlation between glycemic variability such as time in range (TIR) and diabetic foot (DF).  Methods  The study included 163 inpatients with T2DM who underwent prompt dynamic blood glucose monitoring at the Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2020. The participants were divided into two groups based on the presence or absence of DF: the DF group (n=26) and the non-DF group (NDF, n=137). The DF group were divided into two sub-groups based on the Wagner classification: Wagner grade 3 group (n=17), Wagner grade 4 group (n=9). All patients underwent fundus photography and sensory threshold (VPT) measurement, additionally, their glucose levels were monitored using TIR, time above range (TAR), time below range (TBR), glucose coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE). The above indices were compared statistically.  Results  TIR [(35.19±10.94) % vs. (44.79±10.60) %], CV [36.65 (29.45, 38.75) % vs. 29.90 (24.60, 34.80) %], TAR [(61.46±12.21) % vs.(54.01±11.22) %], TBR [1.00 (0.00, 5.75) % vs. 0.00 (0.00, 1.00) %], fundus photography (19/26 vs. 96/137) and abnormal proportion of VPT (25/26 vs. 45/137), there were statistical differences between the DF and NDF groups. The rates of CRP and VPT were higher in the Wagner grade 3 and 4 groups compared to the NDF group. Additionally, the TIR was lower in both groups compared to the NDF group, with statistically significant differences. The results of the multiple logistic regression analysis indicate that CRP (OR=1.024, P=0.011), fundus radiography (OR=0.113, P=0.013) and VPT (OR=31.803, P=0.042) were independent influencing factors for DF.  Conclusion  DF can be complicated by DM retinopathy and neuropathy, and infection is an independent risk factor. A higher CV was observed with lower TIR, indicating poor and fluctuating blood glucose levels. This may be associated with the development of DF.
Mechanism of circ0006152/miR-557/Wnt3a signal axis in the genesis and development of non-small cell lung cancer A549 cells
WANG Jinyu, LI Guoping
2024, 22(3): 418-423. doi: 10.16766/j.cnki.issn.1674-4152.003416
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  Objective  To investigate circular RNA is associated with the occurrence and development of non-small cell lung cancer. This study aims to investigate the mechanism of circ0006152/miR-557/Wnt3a signaling axis in the occurrence and development of non-small cell lung cancer A549 cells.  Methods  Take A549 cells in logarithmic growth period for grouping and transfection, and divide them into control group (cells are only routinely cultured), si-NC group (transfected with si-NC), si-circ0006152 group (transfected with si-circ0006152), miR-NC group (transfected with miR-NC), miR-557 mimics group (transfected with miR-557 mimics) and si-circ0006152+miR-557 inhibitors group (transfected with miR-557 inhibitors and si-circ0006152) by random number table method. Proliferation, apoptosis, migration invasion and Wnt3a, beta-catenin protein were detected.  Results  Compared with the si-NC group, the proliferation inhibition rate and apoptosis rate of A549 cells in the si-circ0006152 group were significantly increased, and the number of invasion was significantly decreased (P < 0.001); Compared with the miR-NC group, the proliferation inhibition rate of A549 cells [(48.42 ± 5.73)% vs.(4.27 ± 0.19)%] and apoptosis rate of A549 cells in miR-557 mimics group [(45.38±5.96)% vs. (8.94±2.11)%] were significantly increased. The number of cells invaded (55.42±8.65 vs. 167.42 ± 19.53) was significantly decreased (P < 0.001). The cell proliferation inhibition rate and apoptosis rate in the si-circ0006152+miR-557 inhibitors group were significantly decreased, and the number of cell invasion was significantly increased in the si-circ0006152+miR-557 inhibitors group (P < 0.05). The expressions of Wnt3a and β-catenin proteins in the inhibitors group were significantly increased (P < 0.05).  Conclusion  Silencing circ0006152 can reduce the malignancy of NSCLC A549 cells by regulating the miR-557/Wnt3a signaling axis.
General Clinical Research
Clinical value of count of circulating tumor cells detection in patients with adenocarcinoma of esophagogastric junction
MA Guojun, LI Yang, FU Jianhua, YANG Dawei
2024, 22(3): 424-428. doi: 10.16766/j.cnki.issn.1674-4152.003417
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  Objective  To investigate the relationship between the count of circulating tumor cells (CTCs) in peripheral blood and the clinical characteristics and overall survival (OS) of patients with adenocarcinoma of esophagogastric junction (AEG), and to explore the clinical application value of CTCs detection in AEG patients.  Methods  A total of 154 patients with AEG were eligible for enrollment in Liaocheng People ' s Hospital from July 2016 to June 2020 in the retrospective study. Negative enrichment techniques and fluorescence in situ hybridization (NE-FISH) were used to detect CTCs one week before treatment and the relationship between CTCs count and clinical characteristics of AEG patients was then investigated. Moreover, relationship between CTCs count and OS in prognosis were also explored.  Results  The positive rate of CTCs was 57.1% (32/56) and the positive rates of CEA, CA19-9 and CA72-4 were 19.6% (11/56), 1.8% (1/56) and 12.5% (7/56) respectively in the early AEG patients. The presence of CTCs was significantly correlated with AEG patients, CTCs were positive (≥2) in patients with AEG was significantly correlated with intravascular tumor thrombus (χ2=45.262, P < 0.001), TNM stage (χ2=14.304, P < 0.001)and lymph node metastasis (χ2=5.158, P=0.023). Log-rank univariate analysis showed that CTCs ≥ 2 (χ2=12.486, P < 0.001) and CTCs ≥ 3 (χ2=45.344, P < 0.001) were closely related to OS in AEG patients(P < 0.001). Cox multivariate analysis showed that CTCs ≥ 3 (HR=2.459, 95% CI: 1.472-4.107, P=0.001) was an independent risk factor for the prognosis of OS in AEG patients.  Conclusion  The detection of CTCs by negative enrichment fluorescence in situ hybridization can be used as an auxiliary diagnostic indicator for early AEG patients, which is closely related to the pathological stage of AEG patients and tumor recurrence and metastasis. CTCs ≥ 3 can be used as an independent risk factor for poor prognosis of AEG patients and have a certain clinical application value.
Construction and application of standardized non-drug management scheme for progeny patients with degenerative diseases after liver transplantation
SHEN Chen, LI Lisha, FU Jianying, XU Ping, LI Juan
2024, 22(3): 428-432. doi: 10.16766/j.cnki.issn.1674-4152.003418
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  Objective  To establish standardized non-drug management scheme for progeny patients with degenerative diseases based on Delphi expert correspondence method, and analyze the practical effect.  Methods  Sixty-nine patients with progeny degenerative disease after liver transplantation treated in Li Huili Hospital of Ningbo Medical Center from May 2021 to March 2023 were selected as the study objects. According to different intervention methods, they were divided into the study group (34 cases) and the control group (35 cases). The study group received standardized non-drug management of progeny degenerative disease patients after liver transplantation, while the control group received routine nursing management. The blood glucose, blood pressure, blood uric acid, blood lipid and BMI levels of the two groups were compared before intervention and 3 and 6 months after intervention.  Results  The levels of fasting blood glucose, systolic blood pressure, diastolic blood pressure, blood uric acid, low density lipoprotein cholesterol, triglyceride, total cholesterol and BMI in both groups decreased gradually with the extension of time (P < 0.001), and there were interactions except BMI (P < 0.05). Regardless of time, 3 to 6 months after the intervention, the levels of fasting blood glucose[(7.20±1.23) mmol/L vs. (7.92±1.56) mmol/L, (6.82±1.09) mmol/L vs. (7.51±1.35) mmol/L, t=2.125, 2.332, P=0.037, 0.023], systolic blood pressure, diastolic blood pressure, blood uric acid, low density lipoprotein cholesterol, triglyceride, total cholesterol and BMI in the study group were lower than those in the control group (P < 0.05).  Conclusion  The establishment of a standardized non-drug management program for patients with degenerative diseases after liver transplantation, which guides patients to eat a healthy diet, exercise reasonably, change their bad habits, and enhance their mental health status, is conducive to the correction of metabolic disorders.
Effects of different concentrations of isoproterenol on renal pelvic pressure in rabbit perfusion model
ZHOU Xianming, XIA Wei, HUANG Jun, DONG Ping, ZHU Tianchang, WANG Fengcheng, ZHU Rui, YIN Tong, HUANG Houbao
2024, 22(3): 433-436. doi: 10.16766/j.cnki.issn.1674-4152.003419
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  Objective  The rabbit kidney was injected with different concentrations of isoproterenol, and the influence of renal pelvis pressure and vital signs was monitored to explore the optimal perfusion concentration.  Methods  A total of 60 New Zealand male white rabbits were divided into four groups randomly: A, B, C and D, with 15 rabbits in each group. Among them, A, B and C were the experimental group and D was the control group, 1.0, 0.9, 0.8 μg/mL isoproterenol solution were respectively used for renal pelvis perfusion in the experimental group, while group D received normal saline. Renal pelvis pressure, mean arterial pressure, heart rate and blood drug concentration at the beginning of perfusion, 0, 4, 8, 16, 25 min following perfusion were recorded.  Results  Three white rabbits died due to excessive anesthesia, one for each group A, B and D, and the experimental data of 57 white rabbits were obtained. After renal pelvis perfusion, the renal pelvis pressure increased in all four groups, and the difference between the experimental groups and the control group was statistically significant (P < 0.05). The renal pelvis pressure of groups A, B and C began to decrease after 4 minutes of perfusion, and the renal pelvis pressure of group D continued to increase after perfusion. The difference in renal pelvic pressure among the four groups at 4, 8, 16, 25 min was statistically significant (P < 0.05). At 16, 25 min, the differences between groups A, B, and C were statistically significant (P < 0.05). After 4 minutes, the mean arterial pressure, heart rate and blood drug concentration of the experimental groups were higher than those of the control group, and the differences were statistically significant (P < 0.05).  Conclusion  Isoproterenol can reduce the renal pelvis pressure when injected into the rabbit kidney as perfusion solution, more obvious when the concentration was 1.0 μg/mL, but it affects the blood pressure and heart rate of rabbits, whereas the concentration below 1.0 μg/mL is safe.
Correlation between corneal nerve fiber changes and dry eye in adolescents with primary dry syndrome
JIN Xia, WANG Ying, WU Xiaolan, GUO Xiaohong, GUI Mengfang, ZHANG Xiaojin
2024, 22(3): 437-439. doi: 10.16766/j.cnki.issn.1674-4152.003420
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  Objective  Corneal confocal laser microscopy was applied to analyze changes in corneal nerve fibers in adolescent patients with primary dry syndrome and to discuss their correlation with dry eye.  Methods  Seventy-eight left eyes of adolescent patients with primary dry eye syndrome admitted to Ningbo Eye Hospital between January 2020 and May 2022 were selected as the observation group, and then 78 left eyes of healthy people with physical examination during the same period were selected as the control group, and the enrolled patients were examined for ocular surface disease index (OSDI) values, tear film break-up test, tear secretion test and other indices (all were consistent), and other causes of dry eye were excluded, and the in vivo confocal fibre-optic microscopy related indices and OSDI scores were compared between the two groups. Pearson ' s test was used to analyse the correlation between corneal nerve fibre changes and dry eye in patients with primary dry syndrome.  Results  The diameter of the nerve fibres in the observation group was (2.12±0.58)μm, which was smaller than that in the control group [(3.21±0.45)μm]. The number of nerve fibre bundles, Langerhans cell density and OSDI scores of the observation group were (7.25±2.15)/100 μm, (636.05±38.15)/100 μm and (45.23±5.21) points, respectively, which were higher than that in the control group [(2.85±1.36)/100 μm, (13.85±4.02)/100 μm, (11.23±3.21) points, P < 0.05]. Pearson correlation test showed a negative correlation between OSDI score and nerve fibre diameter in patients with primary dry syndrome (r=-0.432, P < 0.05); and a positive correlation with nerve fibre count and Langerhans cell density (r=0.562, 0.515, P < 0.05).  Conclusion  There is a correlation between dry eye and nerve fibre diameter, number of nerve fibre bundles and Langerhans cell density in juvenile patients with primary dry syndrome, and the above indicators can be used as suggestive factors for clinical diagnosis and treatment of primary dry syndrome.

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