2024 Vol. 22, No. 4

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Quantitative evaluation of the high-quality development policies of family doctor contract service at the provincial level in China
LI Linfeng, ZHAO Jing, LI Chunxiao, XU Pingping, LIU Senyuan
2024, 22(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.003444
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  Objective  To evaluate the policies related to the high-quality development of family doctor contract services at the provincial level in China, and put forward policy improvement countermeasures to promote the high-quality development of family doctor contract services at the provincial level given the shortcomings reflected in the evaluation results.  Methods  Based on the 22 policies related to the high-quality development of family doctor contracted service at the provincial level, the municipality level, or the autonomous region level in China from March 2022 to October 2023, 9 of these policies were selected as policies evaluation samples, and a quantitative evaluation system was constructed through text mining and PMC index modeling methods. To conduct quantitative analysis and evaluate the selected sample policies by this evaluation system.  Results  The PMC index values of the 9 sample policies were all ≥6.72 points, the policies evaluation grades were all good grades or above, and there were no policies for acceptable and poor grades. The sample policies scored higher in the three dimensions of policy function, policy content and, policy nature, with scores ≥0.93, the overall quality of the high-quality development policies of family doctor contract services at the provincial level in China was relatively high, which can effectively promote the high-quality development of family doctor contract services at the provincial level in China. However, the scores of the sample policies in the dimensions of policy innovation, responsibility subjects, guarantee incentives, issuing agencies, policies tools, and policy evaluation were relatively low, with scores ≤0.84 points, some indicators subordinated to these six dimensions had different degrees and relatively obvious deficiencies in the sample policies, which means there was still some room for optimization in the high-quality development policies of family doctor contracted services at the provincial level in China.  Conclusion  It is necessary to enrich the policy content and attach importance to the internalization of policy innovation; actively mobilize the efforts of all parties to create a sound environment for development; and improve the guarantee incentive mechanism to ensure the effectiveness of policy implementation.
DCPR was used to assess psychosomatic disorders after SARS-Cov-2 in elderly patients with coronary heart disease
HE Huan, SUN Zhonghua, WENG Yangyang, JIA Jian, QU Chen
2024, 22(4): 544-547. doi: 10.16766/j.cnki.issn.1674-4152.003445
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  Objective  To provide individualized interventions aimed at improving the quality of life of elderly patients, the diagnostic criteria for psychosomatic research (DCPR) was used to evaluate the psychosomatic related disorders in elderly patients with coronary atherosclerotic heart disease after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).  Methods  Using random sampling, 101 elderly patients with coronary heart disease admitted to the Second Affiliated Hospital of Nanjing Medical University from September 2022 to June 2023 were selected as the research subjects. According to whether they were infected with SARS-CoV-2, 69 cases were in the infected group and 32 cases were in the uninfected group. The DCPR scale was used to evaluate the current psychosomatic status of the patients, and statistical methods such as group t-test, Wilcoxon rank-sum test, χ2 test, and logistic regression analysis were used to analyze the impact of psychosomatic symptoms on the elderly patients with coronary heart disease after infection with COVID-19.  Results  The infected group was more likely to develop depressed moods [Mild depression: 27 (39.10%) vs. 5 (15.60%); Moderate to severe depression: 9 (13.10%) vs. 1 (3.10%)]and psychosomatic symptoms [(37 (53.60%) vs. 25 (78.10%), χ2=5.537, P < 0.05]. The differences in the scores of happiness total score, sleep disturbance, psychological distress, and abnormal disorder behavior between the two groups were all statistically significant(P < 0.05).  Conclusion  Infection with SARS-CoV-2 is one of the influencing factors of psychosomatic disorders in elderly patients with coronary heart disease, DCPR can make a more comprehensive assessment and help to propose reasonable and targeted interventions in time.
Application of lipoprotein a, fibrinogen and C-reactive protein in early diagnosis of coronary heart disease
XU Hongzhou, TAO Yanyan, LU Guoyu, WU Xiaofei
2024, 22(4): 548-550. doi: 10.16766/j.cnki.issn.1674-4152.003446
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  Objective  To investigate the application value of serum lipoprotein a (Lpa), plasma fibrinogen (FIB) and C-reactive protein (CRP) levels in the diagnosis of coronary heart disease (CHD).  Methods  Forty-three patients with CHD who received medical treatment in the First Affiliated Hospital of Bengbu Medical University from March 2020 to May 2021 were selected as the experimental group, and 45 healthy volunteers who received normal coronary angiography results in the same hospital during the same period were selected as the control group. Volunteers served as the control group. The clinical data of the two groups were compared. The plasma levels of Lpa, FIB and CRP were measured using the immunoturbidimetric method, coagulation method and immunoturbidimetric method, respectively, and a comparison of their levels was made between the CHD group and the control group. The optimal threshold for CHD diagnosis was determined by analyzing the individual diagnostic value of each indicator and the combined diagnostic value of the three through the ROC curve analysis.  Results  The levels of Lpa, FIB and CRP in the CHD group were higher than those in the control group (P < 0.05). The AUC of serum Lpa, FIB, and CRP for diagnosing CHD were 0.771 (95% CI: 0.674-0.868), 0.749 (95% CI: 0.640-0.859), and 0.791 (95% CI: 0.697-0.886), respectively, with sensitivities of 53.13%, 50.00%, 59.38% and specificities of 81.08%, 78.39%, 78.29%. The combined detection of the three to diagnose CHD area had an AUC of 0.884 (95% CI: 0.813-0.956), a sensitivity of 81.25%, and a specificity of 78.29%. The combined detection of serum Lpa, FIB, and CRP was better than individual detection.  Conclusion  The combined detection of Lpa, FIB and CRP can improve the sensitivity of CHD diagnosis and facilitate the early detection, thereby enabling proactive intervention to mitigate the development of the disease.
Evaluation effect and clinical application value of CT angiography on plaque status and luminal stenosis in patients with coronary heart disease
ZHANG Lanlan, HUANG Haishen, LI Junchao, CHENG Shuai
2024, 22(4): 551-554. doi: 10.16766/j.cnki.issn.1674-4152.003447
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  Objective  To evaluate the evaluation effect and clinical application value of CT angiography (CTA) on plaque status and lumen stenosis in patients with coronary heart disease, in order to provide reference for clinical search for appropriate non-invasive examination methods.  Methods  The clinical data of 166 patients with coronary heart disease admitted to the Seventh People' s Hospital of Zhengzhou from October 2019 to October 2022 were retrospectively analyzed. Coronary angiography (CAG) was used as the "gold standard" to calculate the consistency of CTA and CAG results. The types of coronary segmental plaque in patients with different degrees of stenosis were compared based on CTA, and the effects of coronary plaque characteristics and stenosis degree on the risk of major adverse cardiac events (MACE) were analyzed.  Results  A total of 172 coronary stenosis lesions were detected by CAG, and the sensitivity, specificity and coincidence rate of CTA were 96.51% (166/172), 71.54% (352/492) and 78.01% (518/664), respectively, which were in good agreement with the results of CAG (Kappa=0.818, P < 0.001). A total of 89 coronary plaques were detected by CTA. The proportions of non-calcified plaques (35.71%, 10/28) and mixed plaques (32.14%, 9/28) in the mild stenosis segments were lower than those in the moderate/severe stenosis segments [57.37%(35/61), 39.34%(24/61)]. The proportion of calcified plaques in mild stenosis segments (32.14%, 9/28) was higher than that in moderate/severe stenosis segments (3.27%, 2/61), and the difference was statistically significant (P < 0.05). Non-calcified plaque volume, plaque length and lumen diameter stenosis rate were independent risk factors for MACE (P < 0.001).  Conclusion  CTA can accurately evaluate the plaque status and lumen stenosis in patients with coronary heart disease.
Analysis clinical characteristics and pathology of colorectal polyps in various age groups
ZHAO Ning, WANG Yuanyuan, JIANG Xia, ZHAO Zengren
2024, 22(4): 555-558. doi: 10.16766/j.cnki.issn.1674-4152.003448
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  Objective  This study aims to investigate the characteristics of colorectal polyps in different age populations, providing a clinical foundation for early screening of intestinal tumors.  Methods  We conducted a retrospective analysis of clinical data from 571 patients with colorectal polyps at the First Hospital of Hebei Medical University, covering the period from April 2022 to March 2023. These patients were divided into three groups based on age: young group (75 patients, ≤44 years old), middle-aged group (256 patients, 45-59 years old), and elderly group (240 patients, ≥60 years old). The biological characteristics of colorectal polyps in each group were analyzed using the Chi-squared test.  Results  Male patients were more common in the young and middle-aged groups, whereas female patients were more prevalent in the elderly group (P < 0.001). Comparing the three groups, the incidence of polyps in the ascending colon was highest in elderly group (P=0.002), and the incidence of rectal polyps was highest in young group (P=0.001). Notably, the elderly group exhibited a significantly higher incidence of neoplastic rectal polyps compared to the middle-aged and young group [64.7% (139/215) vs. 34.9% (60/172) vs. 21.2% (14/66), P < 0.001]. Additionally, the incidence of multiple polyps, polyps with a size ≥1.0 cm, and tubular adenomas were highest in elderly group (P < 0.05), while there was no significant difference in the lengths among different pathological types of polyps (P>0.05). The incidence of tubular adenomas in polyps with ≤0.5 cm and 0.6-0.9 cm were highest in elderly group (P < 0.001), while the incidence of hyperplastic polyps was lowest in elderly group (P < 0.001). However, there was no significant difference in the pathological types of polyps with a size ≥1.0 cm among the three groups, with tubular adenomas being the most common for this size polyps (P>0.05).  Conclusion  The biological characteristics of colorectal polyps exhibit variations across different age groups, including changes in the risk population, growth position, size, number, and pathological types, which tend to follow a discernible trend with increasing age.
Analysis of factors affecting recurrence in patients with benign paroxysmal positional vertigo after manual repositioning
LIU Bin, XU Xiaotian, FU Xuetao, WANG Yingge, LIU Yufei, TANG Tieyu
2024, 22(4): 559-561. doi: 10.16766/j.cnki.issn.1674-4152.003449
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  Objective  This study aims to analyze the factors influencing the recurrence of benign paroxysmal positional vertigo (BPPV) following manual repositioning, revealing potential risk factors for BPPV recurrence, and providing a theoretical basis for reducing the recurrence rate.  Methods  A total of 170 patients diagnosed with and cured for BPPV at the Neurology Department of Affiliated Hospital of Yangzhou University between January 2020 and December 2021 were selected in this study. A 2-year follow-up was conducted, and the patients were divided into the recurrence group (n=70) and non-recurrence group (n=100) based on recurrence status. Patient data were collected and logistic regression analysis was performed to identify risk factors associated with BPPV recurrence.  Results  Among the 70 recurrent patients, 39 experienced a single recurrence, while 27 encountered two recurrences, and 4 had three or more recurrences. Logistic regression analysis showed that female (OR=11.623, 95% CI: 4.104-20.634, P < 0.001), anxiety (OR=4.200, 95% CI: 1.186-14.873, P=0.026), fatigue (OR=5.025, 95% CI: 1.771-14.255, P=0.002), sleep disorder (OR=4.080, 95% CI: 1.152-14.447, P=0.002), trauma (OR=4.802, 95% CI: 1.692-13.622, P=0.023) and comorbid hypertension (OR=4.938, 95% CI: 1.740-14.009, P < 0.001) were risk factors for recurrence in BPPV patients, and diabetes, family history and smoking history were not significantly correlated with the presence or absence of recurrence.  Conclusion  Gender, anxiety, fatigue, sleep disorders, trauma, and hypertension were the influencing factors contributing to the recurrence of BPPV. These findings offer more targeted insights for the management and prevention of BPPV recurrence.
Efficacy of cervical expansive open-door laminoplasty under ultrasound bone curette in the treatment of multilevel cervical spondylotic myelopathy
REN Yi, ZHANG Haihong
2024, 22(4): 562-565. doi: 10.16766/j.cnki.issn.1674-4152.003450
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  Objective  To explore the efficacy of cervical expansive open-door laminoplasty (CEOL) under ultrasound bone curette (UBC) in the treatment of multilevel cervical spondylotic myelopathy (MCSM).  Methods  A total of 90 MCSM patients who received CEOL treatment at the Second Hospital of Lanzhou University from September 2021 to November 2022 were collected and divided into UBC group (48 cases) and conventional group (42 cases) according to whether UBC was used or not. Perioperative indexes, pain/function scores and imaging parameters were compared between the two groups.  Results  The operation duration [(115.00±18.74) min vs. (130.12±23.38) min], intraoperative blood loss [(152.17±27.36) mL vs. (246.39±30.05) mL] and postoperative drainage volume [(120.35±21.17) mL vs. (211.06±42.58) mL] in UBC group were lower than those in conventional group (t=3.403, 15.568, 13.039, P < 0.001). With the passage of time after surgery, visual analogue score (VAS), cervical posterior extension range of motion (ROM) and cervical curvature all showed a decreasing trend (P < 0.05). Japanese Orthopaedic Association (JOA) score, sagittal vertical axis (SVA) and vertebrae-spinal cord posterior margin distance all showed an increasing trend (P < 0.05). Differences in the comparison of all scores and imaging parameters between the two groups and on the interaction between the groups and time were not statistically significant (P>0.05).  Conclusion  UBC and CEOL assisted with bone rongeur can alleviate pain in MCSM patients, promote spinal cord to drift backward, restore nerve function, and have little effect on cervical motion. Compared with bone rongeur, UBC can significantly shorten the duration of operation, reduce intraoperative blood loss and postoperative drainage flow, but CEOL has a certain impact on the cervical sagittal balance of patients, and clinical attention should be paid to it.
A meta-analysis of the prevalence of sarcopenia in patients with obstructive sleep apnea syndrome
ZHAO Libo, CAI Weimeng, ZHAO Zhe, HE Zijun, FANG Fengfeng, LIU Lin, FAN Li
2024, 22(4): 566-570. doi: 10.16766/j.cnki.issn.1674-4152.003451
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  Objective  To investigate the prevalence of sarcopenia in patients with obstructive sleep apnea syndrome (OSAS), to improve the awareness of the disease and aid in its prevention and treatment.  Methods  Relevant studies on OSAS and sarcopenia in patients were searched in the CNKI, Wanfang, PubMed, Web of Science and Cochrane databases from 1994 to January 28, 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. Meta-analysis was performed using Stata 16.  Results  The analysis comprised nine studies, with a total of 2 815 patients diagnosed with OSAS, among whom 362 were diagnosed with sarcopenia. The meta-analysis revealed that the prevalence of sarcopenia in patients with OSAS was 31.58% (95% CI: 18.65% - 44.50%). The prevalence of sarcopenia in moderate to severe OSAS was 43.81% (95% CI: 12.66% - 74.95%), while the corresponding prevalence in mild to moderate to severe OSAS was 28.17% (95% CI: 13.80% - 42.54%). A subgroup analysis based on age revealed that the prevalence of sarcopenia was 17.89% (95% CI: 8.15% - 27.62%) in patients aged 40-60 years. The prevalence significantly increased in patients aged ≥ 60 years to 50.86% (95% CI: 42.46% - 59.25%).  Conclusion  The prevalence of sarcopenia was high in patients with OSAS, and this varied across different age groups. The prevalence of sarcopenia was higher in elderly patients aged 60 years or older. To effectively prevent and treat sarcopenia, it is important to focus on screening and treating sleep disorders. This will require increased attention to be paid to identifying and addressing sleep-related issues.
Clinical effect observation of prednisone combined with sodium aescinate tablets in the treatment of facial neuritis
LUO Song, WANG Xiaorui, MA Bo, QU Hongdang
2024, 22(4): 571-573. doi: 10.16766/j.cnki.issn.1674-4152.003452
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  Objective  To explore the clinical efficacy of combining sodium aescinate tablets with prednisone in the treatment of facial neuritis and to explore the clinical value of this scheme in treating facial neuritis.  Methods  This study enrolled 60 patients with facial neuropathy from January 2020 to December 2022 at the Department of Neurology, the First Affiliated Hospital of Bengbu Medical University. The patients were randomly divided into two groups using a random number table method: the control group (n=30) received conventional treatment, while the observation group (n=30) received conventional therapy along with the addition of sodium aescinate tablets. After a 30-day treatment period, the clinical effects were assessed by comparing neural function scores, House-Brackman (H-B) rating, and record adverse events between the two groups.  Results  Following clinical treatment, the observation group showed 9 patients achieving complete recovery (30.0%), 10 patients with significant improvement (33.3%), 9 were effective (30.0%), and 2 patients with no improvement (6.7%). In the control group, 7 patients achieved complete recovery (23.3%), 9 patients showed significant improvement (30.0%), 6 patients had moderate improvement (20.0%), and 8 patients showed no improvement (26.7%). The difference in total effective rate between the two groups was statistically significant (P < 0.05). The mean score of the patients in the observation group was 69.33±14.41, which was higher than that in the control group (61.63±9.45) after treatment, with a statistical difference (P < 0.05). There was no significant difference in H-B grade between the observation group and the control group (P>0.05). Additionally, no significant difference in adverse events was observed between the observation group and the control group (P>0.05).  Conclusion  The combination of sodium aescinate tablets and propionate promotes improved facial neuropathic function and enhances safety.
Correlation between mRNA expression levels related to iron death and prognosis in patients with acute myeloid leukemia and analysis of decision curve
ZHAO Yaoshun, YANG Baimei, LU Meng, LUO Sijun, WANG Zhihua, WU Huaying, WANG Fang
2024, 22(4): 574-577. doi: 10.16766/j.cnki.issn.1674-4152.003453
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  Objective  Drug resistance and disease recurrence are primary factors contributing to poor prognosis in patients with acute myeloid leukemia (AML). In addition to the anti-death effects of malignant clones caused by genetic, epigenetic, and proteomic changes, iron death also plays a role in various cellular biological processes. The purpose of this study is to investigate the correlation between iron death related mRNA expression and prognosis in patients with AML.  Methods  A total of 88 AML patients admitted to the General Hospital of North China Petroleum Administration between January 2020 and March 2021 were included in this study. The patients were divided into two groups based on their prognosis at 24 months: a good prognosis group and a poor prognosis group. The expression levels of mRNA related to iron-death were compared between the two groups. LASSO-logistic regression analysis was used to identify iron-death related mRNA highly correlated with AML prognosis. Furthermore, a decision curve was drawn to compare the prognostic value of ELN risk classification with that of iron-death related mRNA expression levels in AML patients.  Results  After 24-month follow-up, 35 patients experienced death, recurrence, and disease progression were categorized as the poor prognosis group, while the remaining 53 patients were classed as the good prognosis group. Prognostic models were constructed using LASS-logistic regression analysis for the mRNA markers PHKG2, STEAP3, ARNTL, and DPP4. According to the ELN risk classification, 49 cases had a good prognosis, while the remaining 39 cases had a moderate or poor prognosis. The decision curve showed that the predictive models based on PHKG2, STEAP3, ARNTL, and DPP4 mRNA markers exhibited a higher net benefit rate for predicting AML outcomes compared to the ELN risk classification within the threshold range of 0-1.0.  Conclusion  The expression level of iron-death related mRNA is related to the prognosis of AML patients, and analyzing this expression level using a decision curve holds significant value in predicting AML prognosis.
Study on healthy fitness and sleep status of the elderly with regular exercise over 65 years old
YANG Lin, REN Mengting, YAO Jiaqin, SUN Tengfang, WANG Hongyu
2024, 22(4): 578-581. doi: 10.16766/j.cnki.issn.1674-4152.003454
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  Objective  To analyze the health and sleep status of elderly people over 65 years old and explore the relationship between regular exercise and sleep status.  Methods  A convenient sampling method was adopted to collect the basic information, disease status, grip strength, vital capacity, sitting forward bending, sitting up and standing for 30 s, 2.44 m corner walking, 2 min standing in place, and sleep test results from 590 elderly individuals aged 65 and above in Bengbu city from January to August 2022. Intergroup analysis was conducted using SPSS 26.0 statistical software. Binary logistic regression analysis was employed to investigate the relationship between regular exercise and sleep status.  Results  A total of 176 males and 215 females participated in regular exercise in 590 elderly cases. Compared with the regular exercise group, muscle strength, balance and cardiorespiratory fitness were worse in the male irregular exercise group (P < 0.05); and muscle strength, balance and cardiorespiratory fitness were worse in the female irregular exercise group (P < 0.05). More people had "worse" sleep in the irregular exercise group than in the regular exercise group (P=0.005 for men and P=0.009 for women). Unadjusted logistic regression models showed statistically significant differences in sleep status in the irregular exercise group compared to the regular exercise group for both males and females (P < 0.05). After further adjustment for age and weight, the results showed that regular exercise was a significant factor in sleep status (P < 0.001).  Conclusion  Irregular exercise in the elderly is associated with decreased muscle strength, balance ability, cardiopulmonary function, and a higher likelihood of experiencing "poor" sleep. On the other hand, regular exercise is an effective means of preventing disease, supporting treatment, and improving endurance training. It is also a cost-effective approach. To promote regular exercise among the elderly, active involvement from family, schools, institutions, and the media is crucial. Equally important is the role of primary care workers and all health professionals in encouraging and fostering regular excise habits among the elderly.
Value of multidimensional tibial tuberosity parameters in predicting patellar instability
LUO Wenli, ZHANG Sixiao, YING Lyufang, WU Yangyang
2024, 22(4): 582-585. doi: 10.16766/j.cnki.issn.1674-4152.003455
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  Objective  To analyze the diagnostic efficiency of various multidimensional tibial tuberosity (TT) parameters in patellar instability, revealing their clinical applicability.  Methods  Patients diagnosed with patellar instability who underwent knee joint CT scans at Ningbo Hangzhou Bay Hospital from January 2020 to January 2023 were included as the observation group. A control group was randomly selected from patients who underwent knee joint CT scans during the same period but were excluded for patellar instability. Each group comprised 45 cases. Patient data were collected, and the clinical diagnostic efficiency of various TT parameters was analyzed through logistic regression and ROC curve analysis.  Results  A total of 90 eligible patients were included, with 33 males and 57 females. There was no significant difference in gender distribution between the two groups, but the observation group had a significantly younger age with statistical significance (P < 0.001). Logistic regression analysis showed that TT-TG, TT-RA, TT-TG/PL, and TT-TG/PTL related TT parameters were effective indicators for predicting patellar instability. At the same time, ROC curve analysis indicated the diagnostic efficacy of the related TT parameters, with the AUC value of TT-TG/PL being 0.826, TT-TG 0.816, TT-RA 0.761, and TT-TG/PTL 0.769.  Conclusion  Multidimensional TT parameters, such as TT-TG, TT-RA, TT-TG/PL, and TT-TG/PTL, have good clinical value in predicting patellar instability. Given that a single quantitative indicator may not fully assess patellar instability, combining multiple dimensional TT parameters can provide a more comprehensive and precise evaluation, thereby offering early guidance for the diagnosis and treatment of patellar instability.
Association between PG-SGA scores and the risk of poor outcomes in stroke patients with dysphagia
YU Wenjuan, ZHENG Hongjian, YU Shuangjuan, DONG Jinjiang
2024, 22(4): 586-588. doi: 10.16766/j.cnki.issn.1674-4152.003456
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  Objective  Dysphagia is commonly observed in stroke patients and can have an impact on their nutritional status. This study aims to investigate the correlation between the patient-generated subjective global assessment (PG-SGA) score and the risk of poor prognosis in stroke patients with dysphagia.  Methods  A total of 116 patients with post-stroke dysphagia from Chun'an Branch of Zhejiang Provincial People's Hospital between October 2021 and October 2022 were selected as the study objects. According to the modified Rankin scale (mRS), the patients were divided into a good prognosis group (mRS≤2 points) and a poor prognosis group (mRS 3-5 points). Multivariate logistic regression analysis and restricted cubic spline were used to investigate the association between nutritional status and the risk of poor prognosis.  Results  After a 90-day follow-up observation, 88 cases (75.86%) with mRS≤2 scores were classified as the good prognosis group, while the remaining 28 cases (24.14%) were categorized as the poor prognosis group. The admission National Institutes of Health stroke scale (NIHSS) and PG-SGA scores were higher in the poor prognosis group compared to the good prognosis group, whereas the serum albumin level and triceps skin fold thickness were lower (P < 0.05). Multivariate logistic regression analysis revealed that older age (OR=1.179, 95% CI: 1.059-1.314), high NIHSS score on admission (OR=1.775, 95% CI: 1.161-2.713), and high PG-SGA score (OR=1.741, 95% CI: 1.069-2.834) were risk factors for poor prognosis. Conversely, high serum albumin (OR=0.883, 95% CI: 0.804-0.970) was identified as a protective factor for poor prognosis (P < 0.05). The restricted cubic spline analysis showed a dose-response relationship between PG-SGA score and poor prognosis in stroke patients with dysphagia (χ2=0.029, P < 0.05).  Conclusion  The nutritional status of stroke patients with dysphagia is related to the risk of poor prognosis, highlighting the importance of timely clinical attention and nutritional support based on individual needs.
Effects of transcranial direct current stimulation on therapeutic effect and cognitive function in patients with depression
CAO Jiang, ZHANG Yan, YUAN Nahua, ZHU Guidong
2024, 22(4): 589-591. doi: 10.16766/j.cnki.issn.1674-4152.003457
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  Objective  To investigate the therapeutic effect of transcranial direct current stimulation (tDCS) on patients with depression, and to observe its influence on the patients' cognitive function in order to provide a reference for the clinical application of tDCS in the treatment of depression.  Methods  A total of 112 patients with depression admitted to the Second People's Hospital of Lishui from March to December 2023 were selected as observation objects, and divided into control group (n=55) and tDCS group (n=57) according to whether they were treated with tDCS or not. The 17-item Hamilton depression scale (HAMD-17) score, Wisconsin card sorting test (WCST) score, and adverse reactions were compared between the two groups.  Results  After treatment, the overall efficacy rate of the tDCS group was higher than that of the control group [89.47% (51/57) vs. 69.09% (38/55), P < 0.01]. Before treatment, there was no significant difference in HAMD-17 score and WCST score between the two groups (P>0.05). After treatment, the HAMD-17 scores of both groups were significantly decreased (P < 0.05). After 4 weeks of treatment, the HAMD-17 score of the tDCS group was lower than that of the control group [(10.64±2.57) points vs. (15.82±2.96) points]. After 4 weeks of treatment, the 5-item WCST scores of the tDCS group were better than those of the control group (P < 0.001), and the patients' cognitive function was significantly improved. During treatment, adverse events occurred in both groups, including 1 case of nausea in the control group, 1 case of skin tingling, and 1 case of nausea in the tDCS group. There was no statistically significant difference in side effects between the two groups (P>0.05).  Conclusion  tDCS can effectively relieve the clinical symptoms of depression patients, the effect is obvious, and can improve the cognitive function of depression patients.
Clinical effect of IVR+PRP combined with PPV on ocular surface function, refractive status and renal function in patients with proliferative diabetic retinopathy
DONG Zeying, YANG Qingqing, PAN Yan, CHEN Zhiping, LI Xin
2024, 22(4): 592-596. doi: 10.16766/j.cnki.issn.1674-4152.003458
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  Objective  To observe the effects of pars plana vitrecto (PPV) assisted intravitreal ranibizumab (IVR) + pan-retinal photocoagulation (PRP) on ocular surface function, refractive status and renal function of patients with proliferative diabetic retinopathy (PDR), and to provide reference for the diagnosis and treatment of PDR.  Methods  A total of 103 patients with mild vitreous hemorrhage due to PDR were selected and divided into laser group (n=62) and combined group (n=41), according to their recorded treatment plans at Ophthalmology Department of the Second People's Hospital of Bengbu from April 2021 to June 2023. The laser group received IVR along with PRP, whlie the combined group underwent PPV in addition to the laser group. Before and after treatment, various parameters including tear film function [breakup time of tear film (BUT), Schirmer Ⅰ test (SIT), central corneal perception], VEGF level in fluid, central macular thickness (CMT), best corrected visual acuity (BCVA), refractive change, glycosylated hemoglobin (HbA1c), urinary microalbumin (mAlb) level and complications were detected and compared between the 2 groups.  Results  After 3 months of treatment, BUT and SIT values were increased in both groups, whlie CMT, BCVA, refractive change value, HbA1c level, and urinary mAlb level were decreased. Furthermore, BUT and central corneal perception in the combined group were higher than those in the laser group. On the other hand, CMT, BCVA, refractive status change, HbA1c level, and urinary mAlb level in the combined group were all significantly lower than those in the laser group (P < 0.05). After 7 days of treatment, VEGF level in aqueous fluid decreased in both groups. However, it was significantly lower in the combination group [(107.57±24.18) pg/mL] compared to that in the laser group [(184.38±30.25) pg/mL, t=14.325, P < 0.001]. The complication rate of the combination group was significantly lower than that of the laser group (P=0.041).  Conclusion  The additional PPV treatment, based on IVR+PRP, for PDR with mild vitreous hemorrhage does not impact the stability of ocular surface function. Moreover, it improves the visual acuity and refractive status in patients while alleviating edema and reducing the VEGF levels in aqueous humor. Furthermore, this treatment has minimal renal damage and low incidence of complications, making it highly suitable for clinical promotion and application.
Clinical effect of Weifuchun tablets combined with omeprazole enteric-coated capsules in the treatment of functional dyspepsia
KANG Niansong, HUANG Jian, QIAN Rong, GU Hongping, HAN Xufeng, SU Wentao
2024, 22(4): 597-600. doi: 10.16766/j.cnki.issn.1674-4152.003459
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  Objective  To explore the clinical effect of Weifuchun tablets combined with omeprazole enteric-coated capsules on patients with functional dyspepsia and their influence on serum pepsinogen and gastrin-17 levels.  Methods  Using a random number table, 128 patients diagnosed with functional dyspepsia at Yuyao Hospital of Traditional Chinese Medicine between October 2021 and December 2022 were divided into two groups: Weifuchun group and Mosapride group, eaching consisting of 64 cases. The mosapride group was given a combination of omeprazole and Mosapride tablets, while the Weifuchun group was given a combination of omeprazole and Weifuchun tablets. After 4 weeks of continuous treatment, the therapeutic effect, serum pepsinogen, and gastrin-17 levels were compared between the two groups.  Results  After 4 weeks of treatment, the Weifuchun group demonstrated a higher total effective rate (87.50%, 56/64) compared to the Mosapride group (71.88%, 46/64), with a statistically significant difference (χ2=4.827, P < 0.05). The Weifuchun group also exhibited higher levels of pepsinogen Ⅰ [(113.20±10.21) μg/L] compared to the Moxapride group [(98.26±9.64) μg/L, P < 0.05]. Moreover, the Weifuchun group showed lower levels of pepsinogen Ⅱ[(17.21±2.58) μg/L] and gastrin-17 [(15.31±2.09) pmol/L] compared to the Mosapride group [(20.31±3.11) μg/L, (18.22±2.67) pmol/L, P < 0.05].  Conclusion  The combination of Weifuchun tablets and omeprazole enteric-coated capsules significantly improves the clinical symptoms of patients with functional dyspepsia. It effectively corrects abnormal levels of serum pepsinogen and gastrin-17, leading to improved prognosis and enhanced quality of life for patients.
Analysis of medication adherence and influencing factors in hypertensive patients combined with diabetes mellitus
CHEN Weier, QIU Yan, PAN Xiaohua, YE Yun, REN Jingjing
2024, 22(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.003460
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  Objective  The study aimed to assess the medication compliance status in hypertensive patients combined with diabetes mellitus and to explore the influencing factors based on socio-demographic characteristics, lifestyle behaviors, and medical records.  Methods  Between November 2021 and March 2022, a total of 381 patients from four community hospitals in Ningbo were randomly selected as participants. They were surveyed using a questionnaire based on the Chinese version of the 8-item Morisky medication adherence scale (MMAS-8). Binary logistic analysis was used for data analysis.  Results  The average medication adherence score for 381 patients combined hypertension and diabetes mellitus was (5.67±1.05) points, with 163 patients (42.78%) demonstrating high adherence. Univariate analysis revealed that significant associations between medication adherence and various factors, including gender, medical payment methods, daily medication types, daily medication frequency, and alcohol consumption (P < 0.05). Multiple logistic regression revealed that patients with medical insurance for urban workers payment had higher medication compliance (OR=2.141, 95% CI: 1.346-3.405, P=0.001). Additionally, patients with a daily medication frequency of ≥3 (OR=0.438, 95% CI: 0.208-0.921, P=0.030) and those with daily medication types ≥3 (OR=0.342, 95% CI: 0.216-0.540, P < 0.001) exhibited lower medication compliance.  Conclusion  The medication compliance among patients with combined hypertension and diabetes mellitus is suboptimal, primarily influenced by factors such as daily medication frequency, daily medication types, and medical payment methods. Therefore, proactive interventions should be implemented based on these influencing factors.
Effect of action research-based Montessori feeding training on feeding behavior of Alzheimer's disease patients
ZHU Ruhuang, ZHENG Huihui, WANG Wanhui, WANG Zhen
2024, 22(4): 605-608. doi: 10.16766/j.cnki.issn.1674-4152.003461
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  Objective  To establish Montessori feeding training based on action research method, observe its influence on eating behavior of patients with Alzheimer's disease, so as to provide theoretical basis for improving patients' ability to eat independently and reducing the burden of caregivers.  Methods  A total of 104 patients with Alzheimer's disease treated in the First Affiliated Hospital of Wenzhou Medical University from March 2022 to March 2023 were divided into two groups by random number table method. The control group (52 cases) received routine feeding care intervention, and the observation group (52 cases) received Montessori feeding training intervention based on action research method. The eating behavior, eating capacity and nutritional status of the two groups were compared before and after the intervention.  Results  The incidence of abnormal eating behavior in the observation group was lower than that in the control group (P < 0.05), and the time of eating independently was longer than that in the control group [(17.89±3.11) min vs. (11.34±2.10) min, t=13.568, P < 0.05]. The score of eating behavior scale (EBS) was higher than that of control group (14.23±3.14 vs. 10.12±2.67, t=9.076, P < 0.05), and the Edinburgh feeding evaluation in dementia scale (EdFED) was lower than that of control group (10.13±2.11 vs. 16.34±3.56, t=11.906, P < 0.05), the score of mini nutritional assessment (MNA) was higher than that of control group (10.67±2.18 vs. 8.33±1.14, t=10.987, P < 0.05). There was no significant difference in BMI between the two groups (20.47±4.12 vs. 20.24±4.67, t=0.675, P>0.05).  Conclusion  Montessori feeding training based on action research has a positive effect on reducing abnormal eating behavior, improving eating ability and preventing malnutrition in patients with Alzheimer's disease.
Analysis of influencing factors on the development of Chinese phonological awareness among 298 preschool children in Nanjing
WANG Xiuhong, YAO Mengmeng, ZHANG Lei, GUO Yanru, WANG Jingyu, ZHANG Jialin, ZHANG Yue, WANG Cai, CHI Xia
2024, 22(4): 609-613. doi: 10.16766/j.cnki.issn.1674-4152.003462
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  Objective  To analyze the developmental characteristics of Chinese phonological awareness in 298 preschool children in Nanjing, and to explore the influence factors. The findings will provide a basis for promoting the development of Chinese phonological awareness in preschool children.  Methods  A simple random sampling method was used to select the participants from two kindergartens in Nanjing during June and July of 2021. Investigations were conducted using a questionnaire to gather information on children' s basic characteristics. Additionally, the preschool learning skills scale and phonological awareness test were applied. The development of Chinese phonological awareness in preschoolers was analyzed using multiple linear regression to identify the influencing factors.  Results  A total of 298 kindergarten children were included in the study, comprising 89 children in the elementary class, 97 children in the middle class, and 112 children in the senior class. The study found that children in the primary class had a phonological awareness score of 37.00 (32.00, 44.00) points, while those in the middle class scored 43.00 (37.00, 49.00) points, and those in the senior class scored 47.00 (42.00, 52.00) points. The phonological awareness scores of the children in the three grades were differed significant (H=52.027, P < 0.001). The results indicate that the phonological awareness score of children in the senior class was significantly higher than that of children in the middle and primary classes (P < 0.001). Additionally, the phonological awareness score of children in the middle class was significantly higher than that of children in the primary class (P=0.001).The multiple linear regression analysis results indicate that grade level (β=0.326, P < 0.001), participation in English interest classes (β=0.113, P=0.039), parents' average daily playing time with children (β=-0.124, P=0.019), and verbal ability (β=-0.296, P < 0.001) were factors that influence the score of Chinese phonological awareness in preschool children.  Conclusion  The phonological awareness of preschool children in higher grades are greater than that of children in the lower grades. The development of phonological awareness increases progressively with grade level, and is related to children' s verbal ability, exposure to bilingualism, and the content and quality of the games and playing that parent engage in with their children.
Effect observation of compound sulfamethoxazole in the treatment of pertussis in children
WANG Yao, HE Liting, CHEN Leyuan, PAN Jiahua, ZHANG Lan
2024, 22(4): 614-617. doi: 10.16766/j.cnki.issn.1674-4152.003463
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  Objective  To investigate the clinical efficacy and safety of compound sulfamethoxazole (SMZco) in treating pertussis in children.  Methods  A retrospective analysis was conducted on 124 children diagnosed with pertussis by polymerase chain reaction (PCR) at Anhui Provincial Hospital between June 2018 and January 2022. The children were divided into two groups: the SMZco group (59 cases) and macrolide group (65 cases). The total effective rate of treatment, duration of nocturnal cough, duration of spastic cough, duration of vomiting after coughing, duration of red face during coughing, duration of hospitalization, and incidence of drug side effects were compared between the two groups.  Results  Among the macrolide group, 23 cases (35.38%) showed a significant effect, 12 cases (18.46%) were effective, and 30 cases (46.15%) were invalid, resulting in a total effective rate of 53.85%; In the SMZco group, 35 cases(59.32%) were effective, 16 cases (27.12%) were significantly effective, and 8 cases (13.56%) were invalid, resulting in a total effective rate of 86.44%, the effective rate of SMZco group was significantly higher than that of macrolide group (P < 0.05). The hospital stay was 8.18 (6.00, 10.00) days in the SMZco group and 9.43 (7.00, 11.00) days in the macrolide group. The SMZco group had a statistically significant shorter hospital stay than the macrolide group (P < 0.05). Compared to the macrolide group, the duration of nocturnal coughing, spasmodic coughing, and the time of facial redness during cough were significantly shorter in the SMZco group, and the differences were statistically significant (P < 0.05). The vomiting time after cough was 1.31 (0.00, 3.00) days in the SMZco group and 1.92 (0.00, 4.00) days in the macrolide group, but the difference was not statistically significant (P>0.05).The incidence of adverse digestive reactions in the SMZco group was 6 cases (10.17%), which was lower than that in the macrolide group [16 cases (24.62%)], and the incidence of rash was 10 cases (16.95%), which was higher than that in the macrolide group [2 cases (3.08%)], and the differences were statistically significant (P < 0.05). The incidence of abnormal liver function in 9 cases (15.81%) in the SMZco group was lower than that in the macrolide group in 15 cases (25.40%), and the difference was not statistically significant (P>0.05).  Conclusion  SMZco can effectively treat whooping cough in children, and compared with macrolides in the treatment of whooping cough in children, it can significantly improve the overall effectiveness of treatment, shorten the duration of hospitalization and clinical symptoms, and reduce the incidence of adverse reactions. Therefore, the treatment of childhood pertussis with SMZco is of great significance and deserves the attention of pediatricians.
Observation on the therapeutic effect of combined butylphthalide and repeated transcranial magnetic stimulation on mild cognitive impairment after cerebral infarction
ZHANG Shuhong, LING Yingchun, LUO Fang, SHENG Gaoyang
2024, 22(4): 618-621. doi: 10.16766/j.cnki.issn.1674-4152.003464
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  Objective  This study aims to explore the efficacy and safety of combing butylphthalide with repetitive transcranial magnetic stimulation for treating mild cognitive impairment in patients following cerebral infarction, offering valuable insights for clinical treatment.  Methods  A total of 190 patients with mild cognitive impairment after cerebral infarction were randomly divided into either Group A (n=95) or Group B (n=95) at Longyou People' s Hospital from February 2020 to January 2023. Group A received butylphthalide treatment, while Group B received a combination of butylphthalide and repetitive transcranial magnetic stimulation. The study aimed to compare the treatment effects, cognitive function, cerebral blood flow indicators, inflammatory reactions indicators, and adverse reactions between the two groups.  Results  The total effective rate of treatment in Group B (90.53%, 86/95) was significantly higher than in Group A (71.58%, 68/95, P < 0.05). Both groups demonstrated improved cognitive function compared to before treatment, with Group B showing a significantly higher Montreal cognitive assessment (MoCA) score than Group A [(26.33±2.50) points vs. (24.21±2.84) points, P < 0.05]; After treatment, both groups exhibited decreased pulsatile index of blood flow in both groups of patients decreased, and the systolic and average blood flow velocities of blood flow and increased systolic and average blood flow velocities (P < 0.05). However, Group B showed better cerebral blood flow indicators compared to Group A (P < 0.05). Post-treatment C-reactive protein, tumor necrosis factor-α, and interleukin-1β decreased in both groups (P < 0.05), with all indicators in Group B being lower than in Group A (P < 0.05). There were no significant differences in adverse reactions between the two groups (P>0.05).  Conclusion  The combination of butylphthalide and repetitive transcranial magnetic stimulation demonstrates a significant therapeutic effect on mild cognitive impairment following cerebral infarction. It effectively improves cognitive function, enhances cerebral blood flow indicators, reduces inflammatory reactions, and exhibits minimal adverse reactions. This treatment approach is both effective and safe, warranting its promotion.
Effects of tubeless management following ureteroscopy combined with negative pressure suction sheath on stress and inflammation in patient with upper urinary tract calculi
ZHENG Feng, TIAN Wenjun
2024, 22(4): 622-624. doi: 10.16766/j.cnki.issn.1674-4152.003465
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  Objective  This study aims to analyze the effects of tubeless management following ureteroscopy combined with negative pressure suction sheath on stress and inflammation in patients with upper urinary tract calculi, proving valuable insights for the clinical application of tubeless management in patients with urinary tract calculi.  Methods  A total of 98 patients with upper urinary tract calculi admitted to the Department of Urology of Pujiang People ' s Hospital from July 2022 to July 2023 were selected. They were divided into two groups based on whether tubeless treatment was performed after surgery: the control group (47 cases) and the observation group (51 cases). Stone clearance rate, complications, as well as stress and inflammatory indexes were observed, compared, and analyzed between the two groups.  Results  No significant difference was found in postoperative stone clearance between the patients with tubeless treatment compared to the control group [95.7% (45/47) vs. 96.1% (49/51), P>0.05]. Preoperative stress response indexes showed no significant difference between the two groups (P>0.05). However, after surgery, the patients with tubeless treatment exhibited lower stress levels compared to the control group (P < 0.001). Similarly, there was no significant difference in preoperative inflammatory response indicators between the two groups (P>0.05), but the observation group showed lower inflammation levels than the control group after surgery (P < 0.001). Furthermore, postoperative complications were compared between the two groups, and the patients with tubeless treatment demonstrated significantly improved outcomes compared to the control group (P < 0.01).  Conclusion  Tubeless management following ureteroscopy combined with negative pressure suction sheath can effectively alleviate the stress, inflammation, and postoperative complications in patients with upper urinary tract stones, making it a valuable clinical approach.
Sleep patterns and factors influencing sleep in patients with bipolar disorder
WEI Jianhong, FENG Hong
2024, 22(4): 625-628. doi: 10.16766/j.cnki.issn.1674-4152.003466
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  Objective  This study aims to explore the sleep status of patients with bipolar disorder and analyze the related factors affecting the sleep status of patients with bipolar disorder, and to analyze the related factors, and to provide theoretical basis for the sleep management of patients with bipolar disorder.  Methods  A total of 149 hospitalized patients with bipolar disorder from April 2018 to May 2022 at Shaoxing Seventh People' s Hospital were enrolled in this study. According to their Pittsburgh sleep quality index (PSQI) score, the subjects were divided into two groups: sleep disorder group and non-sleep disorder group. The general data and laboratory test results of both groups were analyzed. Additionally, multivariate stepwise logistic regression with binary variables was conducted to identify factors infulencing the sleep status of patients with bipolar disorder were analyzed by.  Results  Out of the 149 distributed questionnaires, 142 valid questionnaires were collected. Among them, 24 participants with a PSQI score ≥8 were divided into the sleep disorder group, while 118 participants with a PSQI score < 8 were classified into the non-sleep disorder group. The overall PSQI score for the 142 patients with bipolar disorder was (12.09±3.89) points, indicating a low level of sleep quality. In the sleep disorder group, the levels of melatonin (MLT) and adrenocorticotropic hormone (ACTH) were lower than that of the non-sleep disorder group. Conversely, the levels of homocysteine (Hcy) and cortisol (COR), as well as the scores of Hamilton depression scale (HADA) and Hamilton anxiety scale (HAMA), were higher in the non-sleep disorder group (P < 0.05). Multivariate logistic regression analysis showed that high COR (OR=1.444, 95% CI: 1.127-1.850) and high Hcy (OR=1.875, 95% CI: 1.154-3.047) were risk factors for sleep disorders. Low ACTH (OR=0.758, 95% CI: 0.609-0.943) and low MLT (OR=0.794, 95% CI: 0.700-0.900) were all protective factors for sleep disorders (P < 0.05).  Conclusion  Sleep disorders are commonly observed in individuals with bipolar disorder, and several factors including MLT, ACTH, Hcy, and COR are associated with the sleep status of these patients.
Study on the status and influencing factors of mental health in the second and third trimesters of pregnancy
ZHAO Jinlong, LU Hui, XIAO Lingyan, TAN Jie
2024, 22(4): 629-632. doi: 10.16766/j.cnki.issn.1674-4152.003467
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  Objective  To analyze the depressive state of pregnant women in the second and third trimesters of pregnancy and to explore the influencing factors. This will provide a reference for early identification of high-risk groups for depression during these stages of pregnancy.  Methods  From January 2022 to September 2023, we selected pregnant women in the middle and third trimester of obstetric pregnancy who anderwent routine prenatal care at Jiaxing Maternal and Child Health Hospital as research subjects. We used a general data questionnaire and the Edinburgh depression scale (EPDS-10) to investigate and analyze the factors influencing depressive states during pregnancy using logistic regression.  Results  The second trimester had a higher incidence of depression (14.93%, 268/1 795) compared to the third trimester (9.77%, 55/563), the difference was statistically significant (P < 0.05). However, there was no statistically significant difference in the proportion of mild depression and moderate to severe depression between the second and third trimesters (P>0.05). The proportion of pregnant women with depression in the second trimester who were aged 35 or older, had a college education, had an adverse pregnancy history, were unmarried or divorced, or had an unplanned pregnancy was significantly higher than that of non-depressed pregnant women (P < 0.001). College education, adverse pregnancy history, unmarried or divorced status and unplanned pregnancy were identified as the independent risk factors for depression in the second trimester of pregnancy (P < 0.05). There was no statistically significant difference in the second trimester of depression between pregnant women with the regular residence, delivery history, and monthly family income and those who were not depressed (P>0.05). The proportion of pregnant women with depression in the third trimester who were aged ≥35 or older had a college education, no history of childbirth, adverse pregnancy history, unmarried or divorced, or had an unplanned pregnancy was higher than that of non-depressed pregnant women, the differences were statistically significant (P < 0.05). In the third trimester, pregnant women with adverse pregnancy history and unplanned pregnancy were found to be at a higher risk of depression (P < 0.05). There was no significant difference in the regular residence and monthly family income of pregnant women with depression in the third trimester and those without depression (P>0.05).  Conclusion  Depression is more common in pregnant women during the second trimester than in the third. Risk factors for depression during the second trimester include having a college education, a history of adverse pregnancy, being unmarried or divorced, and having an unplanned pregnancy.
The application of failure mode and effect analysis in risk management for suicide prevention in hospitalized patients with depression
WANG Yuanyuan, GAN Jianguang, CHEN Jing, YE Mengfei
2024, 22(4): 633-637. doi: 10.16766/j.cnki.issn.1674-4152.003468
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  Objective  This study aims to assess the effect of failure mode and effect analysis in risk management on the mental state and suicidal ideation of hospitalized patients with depression, and to explore its effectiveness in suicide prevention.  Methods  A total of 235 hospitalized patients with depression, admitted to Shaoxing Seventh People ' s Hospital from January 2021 to August 2023, were randomly divided into two groups using a random number table method: the control group (117 cases) and the observation group (118 cases). The control group received conventional risk management, while the observation group received risk management intervention using failure mode and effect analysis, based on the control group. The incidence of suicide (or attempted suicide) in both groups was analyzed. Furthermore, the risk priority index, mental state, negative automatic thinking, and suicidal ideation scores before and after intervention were compared between the two groups.  Results  After the intervention, the risk priority index (RPN) of the observation group was lower than that of the control group, with an incidence of suicide (or attempted suicide) of 2.5% (3/118) in the observation group, significantly lower than the 8.5% (10/117) in the control group (P < 0.05). After intervention, the psychological state of patients in both groups was improved. The observation group had lower scores on the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) [(15.73±3.11) points and (17.22±3.34) points, respectively], compared to the control group [(17.06±3.50) points and (19.29±4.01) points, P < 0.05]. The intervention led to improved negative automatic thinking in both groups, with the observation group showing lower scores on the frequency and belief scores of ATQ compared to the control group (P < 0.05). Additionally, the intensity of suicidal ideation decreased in both groups. The total score of BSI-CV in the observation group was (16.30±3.82) points, which was lower than that in the control group [(20.28±4.43) points, P < 0.05].  Conclusion  The implementation of failure mode and effect analysis in risk management can significantly improve the mental state and negative automatic thinking of hospitalized patients with depression. Moreover, it can effectively reduce the level of suicidal ideation, demonstrating its potential for suicide prevention.
Consistency analysis of micro-flow imaging and contrast-enhanced ultrasound in evaluating the condition and synovial blood flow of patients with rheumatoid arthritis
ZENG Ge, JIANG Junjie, SUN Xing, CONG Huiqin, LI Qiaofeng
2024, 22(4): 638-641. doi: 10.16766/j.cnki.issn.1674-4152.003469
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  Objective  To detect synovial blood flow by micro-flow imaging and contrast-enhanced ultrasound, and analyze the consistency of the two imaging methods in evaluating the condition of patients with rheumatoid arthriti.  Methods  A total of 50 patients with active rheumatoid arthritis who were treated in Huzhou Third Municipal Hospital from July 2019 to October 2022 were selected as the research objects. All patients were examined by micro-flow imaging and contrast-enhanced ultrasound, and the synovial blood flow of patients was recorded. After 6 months of treatment, the synovial blood flow of patients was evaluated by micro-flow imaging and contrast-enhanced ultrasound again, and the correlation between the results and laboratory indexes was analyzed by Spearman.  Results  Before treatment, the detection rate of blood flow signals in active patients (Kappa=0.730, P < 0.05) and synovial blood flow evaluation (Kappa=0.797, P < 0.05) were strongly consistent with each other in the micro-flow imaging and contrast-enhanced ultrasound. After 6 months ' treatment, the detection rate of blood flow signals (Kappa=0.845, P < 0.05) and synovial blood flow evaluation (Kappa=0.741, P < 0.05) of patients in remission were both consistent in the micro-flow imaging and contrast-enhanced ultrasound. Micro-flow imaging and contrast-enhanced ultrasound were positively correlated with erythrocyte sedimentation rate, CRP and rheumatoid factor levels in both active and remission stages (P < 0.05), and the correlation of micro-flow imaging was stronger than that of contrast-enhanced ultrasound.  Conclusion  Micro-flow imaging and contrast-enhanced ultrasound have strong consistency in the assessment of synovial blood flow in patients with rheumatoid arthritis in active stage and remission stage, and both have clinical guiding significance for disease assessment.
Clinical effectiveness observation of left ventricular pressure strain loop technique for evaluating early changes in myocardial function among patients with hyperthyroidism
LUO Qinyin, TAO Binwen, GAN Li, HUANG Lizhu
2024, 22(4): 642-645. doi: 10.16766/j.cnki.issn.1674-4152.003470
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  Objective  The objective is to enable early assessment and intervention of hyperthyroidism heart disease, improve the overall prognosis of hyperthyroidism patients, and explore the clinical effectiveness of utilizing left ventricular pressure strain loop (LVPSL) technology for monitoring early changes in myocardial function among hyperthyroidism patients.  Methods  A retrospective study was conducted at Baise People ' s Hospital from January 2021 to August 2023. A total of 100 patients with hyperthyroidism and 100 healthy subjects were selected as research participants. All subjects underwent routine echocardiography and LVPSL analysis. The study compared the differences in conventional echocardiographic and LVPSL indicators between hyperthyroidism patients and healthy subjects, and analyzed the correlation between LVPSL indicator values and serum thyroid hormone levels in hyperthyroidism patients.  Results  There was no statistically significant differences in conventional echocardiography indicators such as LAD, LVPWT, IVST, LVEDD, LVESD, and LVEF between patients with hyperthyroidism and the control group (P>0.05). However, hyperthyroidism patients exhibited significantly lower values of GLS (absolute value), GWI, GCW, and GWE compared to healthy subjects, while the GWW detection value was significantly higher (P < 0.001). Furthermore, GLS (absolute value), GWI, GCW, and GWE showed negative correlations with serum FT3 and FT4 levels (P < 0.001), but positive corrections with serum TSH levels (P < 0.001). On the other hand, GWW demonstrated positive correlations with serum FT3 and FT4 levels (r=0.526, 0.547; P < 0.001), while showing a negative correlation with serum TSH levels (r=-0.641, P < 0.001).  Conclusion  LVPSL technology can effectively identify early myocardial functional changes in hyperthyroidism patients that are not detectable through conventional echocardiography. It serves as a valuable tool for evaluating myocardial injury in hyperthyroidism patients and predicting the onset of early hyperthyroidism heart disease.
Construction and analysis of preoperative lymph node metastasis load model of breast cancer patients based on dual-mode ultrasound
YANG Junyu, SHEN Ji, SHEN Siping, LI Dan, WU Wanbo
2024, 22(4): 646-650. doi: 10.16766/j.cnki.issn.1674-4152.003471
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  Objective  To construct a risk model using dual-mode ultrasound to identify breast cancer patients with a high lymph node metastasis load. This model provides references for the formulation of surgical protocols.  Methods  The study included 168 breast cancer patients who underwent surgical treatment at Huzhou Central Hospital between May 2021 and May 2023. Preoperative dual-mode ultrasonography was performed and the patients were divided into two groups based on the status of lymph node metastasis: high metastatic load group (62 cases, ≥3 metastatic lymph nodes) and low metastatic load group (106 cases, ≤2 metastatic lymph nodes). LASSO-logistic regression was used to screen variables and construct a prediction model for preoperative high metastatic load of lymph nodes in breast cancer patients based on dual-mode ultrasound. The effectiveness of the model was also verified.  Results  Four representative characteristics, namely vascular invasion, catheter dilation, Adler blood flow grading and elastic strain rate were selected through LASSO regression analysis with 10-fold cross-validation. Multivariate logistic analysis revealed that vascular invasion (OR=2.250, 95% CI 1.012-5.002), Adler blood flow grade Ⅱ/Ⅲ (OR=2.929, 95% CI: 1.256-6.827), catheter dilation (OR=2.548, 95% CI: 1.066-6.093) and high elastic strain rate (OR=4.167, 95% CI: 2.486-6.982) were identified as risk factors for preoperative high burden of lymph node metastasis in breast cancer patients (P < 0.05). The C-index for factors predicting preoperative high metastatic load of lymph nodes in breast cancer patients was 0.834 (95% CI: 0.771-0.898), and the calibration curve demonstrated good agreement between measured and predicted values.  Conclusion  The model constructed using conventional two-dimensional ultrasound and shear-wave elastography ultrasound images combines the characteristics of multiple modes to make their information complementary. This is helpful in improving the accuracy of qualitative and localization analysis of lymph node metastasis load before breast cancer.
Analysis on the construction of early missed abortion prediction model based on ultrasonic characteristics
KONG Wencui, ZHANG Yaojia, LIU Mingsong
2024, 22(4): 651-655. doi: 10.16766/j.cnki.issn.1674-4152.003472
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  Objective  Ultrasound features can be used to predict early missed abortion, but there is no research to explain the value of transvaginal ultrasound features in predicting early missed abortion in different gestational weeks, so this study established a prediction model of early missed abortion based on ultrasound features and analyzed its prediction efficiency.  Methods  A total of 251 pregnant women diagnosed as intrauterine singleton pregnancy by transvaginal ultrasound from January 2021 to February 2022 in Huzhou Maternal and Child Health Hospital were included as the research objects. The gestational sac (GS), yolk sac (YS) diameter, crown-rump length (CRL) and fetal heart rate (HR) were detected by the ultrasound until the 10th week of pregnancy. Two hundred and fifty-one patients were followed up and recorded the incidence of missed abortion in 11-12 weeks and the levels of GS, YS, CRL and HR. Logistic regression data package in SPSS 22.0 software was used to screen the influencing factors of early missed abortion, and a logistic regression prediction model was constructed to draw ROC curve to analyze the prediction efficiency.  Results  Pregnant women were divided into abortion group (43 cases) and continued pregnancy group (208 cases) according to whether the patients had early missed abortion. The results of multivariate logistic regression showed that testosterone (OR=0.452), estradiol (OR=1.422) and progesterone (OR=1.442) were all predictors of early missed abortion (P < 0.05). The prediction model based on clinical features predicted the area under the curve of early missed abortion was 0.815, the prediction model of 6-week ultrasound characteristics was 0.801, the prediction model of 7-week ultrasound characteristics was 0.926, the prediction model of 8-week ultrasound characteristics was 0.906, the prediction model of 9-week ultrasound characteristics was 0.883 and the prediction model of 10-week ultrasound characteristics was 0.924. According to Delong analysis, the area under the curve of the ultrasonic feature prediction model at the 7th and 10th weeks of pregnancy is higher than that of the prediction model based on clinical features (P < 0.05).  Conclusion  The prediction model based on ultrasound characteristics of 6-10 weeks can be used to predict missed abortion in 11-12 weeks of pregnancy, but the prediction value of the prediction model based on ultrasound characteristics of 7-week and 10-week of pregnancy are higher than that based on clinical characteristics, and the prediction value of other pregnancy ultrasound characteristics prediction models is equivalent to that based on clinical characteristics, among which YS is the strongest ultrasound characteristic index to predict early missed abortion.
Research progress of the effect of glycemic control on the prognosis of diabetes with corona virus disease 2019
CONG Riping, ZHANG Yujian, GAO Binxue, ZHANG Jianbo, XU Lujia, DIAO Yingli, WANG Wei, TANG Kuanxiao
2024, 22(4): 656-660. doi: 10.16766/j.cnki.issn.1674-4152.003473
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Corona virus disease 2019 (COVID-19) is an acute infectious disease caused by severe acute respiratory syndrome coronavirus 2 with high incidence, strong infectivity and rapid state change. The characteristics of type 2 diabetes mellitus (T2DM) with COVID-19 are uncontrollable, many complications, high critical rate and mortality. Blood glucose variability is one of the main reasons. Currently, there is no accepted time in range (TIR), and TIR is closely associated with prognosis. Glucose variability parameters are independent risk factors for predicting mortality in critical patients. The monitoring of glucose variability is important to realize the fine management of blood glucose. This article reviews the research progress of the effect of glycemic control on the prognosis of T2DM with COVID-19. The main contents include the epidemiological status, major pathophysiological mechanisms (e.g., cytokine release syndrome, abnormal expression of angiotensin-converting enzyme 2, etc.), glycemic control goals, and scientific management of patients. This review provides a theoretical reference for optimizing the diagnosis and treatment strategy, improving the prognosis, and reducing the incidence of complications and mortality.
The role of adipocytokines in ovarian senescence
TAN Chenlei, LI Yanhua
2024, 22(4): 661-664. doi: 10.16766/j.cnki.issn.1674-4152.003474
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Ovarian senescence is characterized by a decline in the number and quality of oocytes or follicular pools, causing a decline in fertility. With the continuous development of social and economic levels and the promulgation of China ' s three-child policy, there is a growing tension between the ever-delayed reproductive age and the ever-declining follicular pool. Declining fertility at an advanced age is also a serious challenge. How to delay ovarian senescence and meet the reproductive needs of women of childbearing age has become a focus of medical researchers in recent years. At present, common adipocytokines are biologically active molecules mainly produced by adipocytes. They are involved in a variety of physiological processes such as energy metabolism and internal and external environment balance of the body and may be involved in the occurrence of a series of obesity-related diseases such as diabetes and atherosclerosis. In the female reproductive system, some common adipocytokines, such as leptin, visfatin, adiponectin, chemokine, and adipoinflammatory factors, regulate follicle quality and growth and development through endocrine, paracrine, and autocrine pathways. Leptin has been found to promote follicle maturation within a certain range of concentrations, and either too high or too low concentrations may cause adverse effects on oocytes. Visfatin has been reported to stimulate ovarian angiogenesis, thereby enhancing fertility. Adiponectin can regulate the metabolism and apoptosis of granulosa cells and cumulus cells through related pathways, thereby protecting follicle development. Chemerin inhibits granulosa cell proliferation, induces apoptosis, and inhibits follicle-stimulating hormone-induced production of estradiol and progesterone by granulosa cells. Inflammation caused by adipocytokines may be one of the mechanisms involved in the age-related regulation of follicle number. Through reviewing relevant literature, this paper attempts to explore the role of common adipocytokines in ovarian aging, to provide some theoretical references for general practitioners in the health care of women of reproductive age.
Effect of acupoint catgut embedding therapy on metabolism and hormone levels in patients with polycystic ovary syndrome
XU Ying, MI Haixia, YANG Yang
2024, 22(4): 665-668. doi: 10.16766/j.cnki.issn.1674-4152.003475
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  Objective  The incidence of polycystic ovary syndrome (PCOS) is on the rise, which seriously puzzles the majority of female patients. Acupoint catgut embedding therapy is an improved acupuncture therapy. This study will explore the influence of acupoint catgut embedding therapy on the metabolism and hormone levels of PCOS patients.  Methods  A total of 156 PCOS patients admitted to Wenzhou People ' s Hospital from March 2021 to January 2023 were selected as the study objects and were divided into a control group and an observation group according to the random number table method. During the observation process, 8 cases fell out due to poor patient compliance and other reasons, so the total number of enrolled cases was 148, with 74 cases in each group. The control group was given routine treatment according to "Chinese Guidelines for the Diagnosis and Treatment of PCOS". The observation group received acupoint catgut embedding therapy based on the control group. Clinical efficacy, glucose and lipid metabolism [triglyceride (TG), total cholesterol (TC), high-density liptein cholesterol (HDL-C) and low-density lipoprotein (LDL-C), fasting insulin (FINS), glycated hemoglobin (HbA1c), homeostasis model insulin resistance index (HOMA-IR)], hormone [testosterone (T), luteinogen hormone (LH), follicle-forming hormone (FSH)] and ovarian reserve function [anti-Mullerian hormone (AMH), statin B (INHB), sinus follicle count] in the two groups after treatment were observed.  Results  There were 61 effective cases in the observation group, and the total effective rate was 82.43% (61/74), which was higher than that of the control group [67.57% (50/74), χ2=4.360, P=0.037]. After treatment, TG, TC, LDL-C, FINS, HbA1c, and HOMA-IR in the observation group were lower than the control group, and HDL-C was higher than the control group (P < 0.05). FSH, AMH, and INHB in the observation group were higher than those in the control group, and T, LH, and sinus follicle count were lower than those in the control group (P < 0.05).  Conclusion  Acupoint catgut embedding therapy can regulate the metabolism and hormone levels of PCOS patients, improve ovarian reserve function, and have a significant effect.
A comparative study of different electromagnetic stimulation schemes in the intervention of post stroke pseudobulbar paralysis swallowing disorders
LUO Yali, CHEN Jinsong, CHEN Shasha, SU Mouxiao, BAI Jie, LIU Shuang
2024, 22(4): 669-673. doi: 10.16766/j.cnki.issn.1674-4152.003476
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  Objective  To compare the efficacy of different combinations of electromagnetic stimulation schemes in the treatment of pseudobulbar palsy, and provide reference for the optimization of treatment plans.  Methods  A total of 120 patients with pseudobulbar palsy after stroke were selected at Mianyang Central Hospital from January 2022 to March 2023. They were randomly divided into four groups: a control group, a group receiving transcranial direct current stimulation (tDCS)+neuromuscular electrical stimulation (NMES), a group receiving repetitive transcranial magnetic stimulation (rTMS)+NMES, and a group receiving tDCS+rTMS. Each group consisted of 30 cases. The control group received routine treatment, while the other three groups received different combinations of electromagnetic stimulation. The evaluation included the swallowing efficacy score of Ichiro Fujishima, the standardized swallowing assessment (SSA), the swallowing-quality of life (SWAL-QOL), PAS grading under fiberoptic endoscopic evaluation of swallowing (FEES), hyoid laryngeal complex motility, and average surface electromyography (AEMG).  Results  After treatment, the rTMS+NMES group exhibited significantly higher Ichiro Fujishima ' s swallowing efficacy scores (5.04±0.79) compared to the control group (3.51±0.64), tDCS+NMES group (4.19±0.79), and tDCS+rTMS group (3.96±0.73). The rTMS+NMES group also demonstrated a significantly lower SSA than the other three groups (P < 0.05). In terms of SWAL-QOL, the rTMS+NMES group only showed improvement compared to the control group, with no difference when compared to the other two groups. However, in PAS assessment, the rTMS+NMES group was superior to the other three groups (P < 0.05). Regarding mobility of the bone throat complex, the rTMS+NMES group displayed a greater distance of upward and forward movement of the hyoid bone compared to all other groups (P < 0.05). Additionally, rTMS+NMES group revealed higher sEMG than both control and tDCS+NMES groups (P < 0.05).  Conclusion  The combination of rTMS+NMES has the best overall effect in the treatment of pseudobulbar palsy.
Application of Jigsaw teaching method based on PBL in practice teaching of gastroenterology
ZHAO Rui, GU Lin, MA Zhenzeng, HUANG Jun
2024, 22(4): 674-676. doi: 10.16766/j.cnki.issn.1674-4152.003477
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  Objective  To apply the mixed teaching model of Jigsaw teaching method and PBL teaching method to practice teaching of gastroenterology to improve the effect of clinical practice teaching of gastroenterology.  Methods  Eighty medical undergraduates were selected to practice in the Department of Gastroenterology of the First Affiliated Hospital of Bengbu Medical University from 2023 to 2024. They were randomly divided into the control group (PBL teaching method alone) and the experimental group (Jigsaw teaching method combined with PBL teaching method). After teaching, the two groups were compared on the theoretical evaluation, skill evaluation, and clinical comprehensive ability evaluation, as well as the students ' self-evaluation.  Results  In addition to no significant difference in learning efficiency between the students in the experimental group and the control group (P>0.05), their learning interest, independent learning ability, teamwork ability, self-satisfaction and total score were significantly higher than those in the control group (P < 0.05). The theoretical test score of the experimental group (29.85±4.07) was higher than that of the control group (25.78±2.64), and the skill test score of the experimental group (8.41±0.62) was also higher than that of the control group (7.32±0.88), and the differences were statistically significant (P < 0.05). The total score of the clinical comprehensive ability test in the experimental group (40.85±1.87) was higher than that in the control group (35.81±3.77), and the scores of history taking, physical examination, clinical diagnosis and treatment thinking, and medical record writing in the experimental group were higher than those in the control group (P < 0.05).  Conclusion  The mixed teaching mode of Jigsaw teaching method combined with PBL teaching method can achieve remarkable effect in the application of clinical practice teaching of gastroenterology department, with high satisfaction of interns, and can be popularized in the future clinical practice teaching.
Exploration and practice of constructing a general practice teaching case library based on SPO model
ZHU Xiayuan, WU Hao, GE Caiying, LIU Xinying, KONG Min, LI Zhili, GAO Wenjuan, YU Xiaoyi
2024, 22(4): 677-681. doi: 10.16766/j.cnki.issn.1674-4152.003478
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  Objective  To introduce the practical experience of Fangzhuang Community Health Service Center in constructing a case library of general practitioner reception and teaching, and to provide reference for the implementation of case teaching in other grassroots teaching bases.  Methods  Based on the SPO (structure-process-outcome) model, the practical experience of the construction of the general practitioner reception teaching case library was sorted out from the three dimensions of structure, process and result, and the training of general practitioners ' reception ability was carried out with LAP as the training content, and the case evaluation was carried out with KSA as the tool. Eight general practitioners trained at Fangzhuang Community Health Service Center from February to November 2023 were selected to conduct "one-on-one" semi-structured interviews to evaluate the effectiveness of the case database.  Results  A total of 11 general practice teaching case videos were recorded, covering 8 systems, including cardiovascular system, respiratory system, digestive system, genitourinary system, and endocrine, involving the cultivation of knowledge, skills, and literacy. Through semi-structured interviews, it was found that the learning enthusiasm, knowledge mastery, general practice diagnosis and treatment thinking, learning interest, and teamwork awareness of general practitioners were significantly improved.  Conclusion  The general practitioner teaching case database based on the SPO model can stimulate the subjective initiative of general practitioners, improve the ability of general practitioners, realize the transformation from students to doctors, and help to promote the construction of general practice discipline.
Application of competency-based and diversified teaching methods in clinical teaching of emergency surgery
XIE Fuchen, ZHANG Taizhe, QIU Zhaolei, DOU Hehe, JIAO Yumeng, XUAN ling, WANG Zhengjie
2024, 22(4): 682-684. doi: 10.16766/j.cnki.issn.1674-4152.003479
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  Objective  This study aims explore the effect of professional competence-oriented diversified teaching methods in the clinical teaching of emergency surgery.  Methods  A total of 60 students of Grade 2018 practicing in the Emergency Surgery Department of our hospital were selected as participants for this study. They were randomly divided into 2 groups: an experimental group consisting of 30 students who received diversified teaching methods oriented by professional competence, and a control group consisting of 30 students who were instructed by traditional teaching methods in clinical teaching. The evaluation results of theory, practical skills, humanistic care, as well as the assessments from teachers and interns, were compared between the two groups.  Results  The interns in the experimental group demonstrated higher test scores in theory (80.93±5.30), practical skills (81.43±5.39), humanistic care (81.33±5.65), and other comprehensive ability examinations compared to the control group (70.77±6.86, 71.03±6.69, 72.30±6.75), with statistically significant (P < 0.05). The clinical teachers ' evaluations of the experimental group ' s basic clinical ability, knowledge acquisition and application, doctor-patient communication, teamwork, and information management abilities were all higher than those of the control group (P < 0.05). The satisfaction score of the experimental group (96.77±2.22) was significantly higher than that of the control group (90.90±2.50, P < 0.05). Furthermore, all the interns in the experimental group acknowledged the effectiveness of the diversified teaching method oriented by professional competence.  Conclusion  The application of diversified teaching methods oriented by professional competence in clinical teaching of emergency surgery benefits the acquisition of theoretical knowledge, skill proficiency, and humanistic care, while also fostering the vocational competency of medical students. Therefore, the widespread adoption of these methods in clinical teaching of emergency surgery in recommended.
Development and reliability and validity test of scale on adult scientific fitness literacy under the integration of sports and medicine
ZHAO Jiali, LIU Xinyu, CHEN Zhihua, SHI Xiaoyang, GAO Shangshang, GUO Jianjun, WANG Yan
2024, 22(4): 685-689. doi: 10.16766/j.cnki.issn.1674-4152.003480
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  Objective  To develop the scientific fitness literacy scale for adults based on the idea of integration of sports and medicine and to test the reliability and validity of the scale, that will provide an evaluation tool for the assessment for adult scientific fitness literacy.  Methods  Based on the evaluation index system of adult scientific fitness literacy previously constructed by the research group, the three-level indicators were transformed into the specific items of the scale. The content validity of the scale was preliminarily formed through expert consultation and language debugging of scale in small sample preliminary experiment. Convenience sampling method was used to select adults between 18 and 59 years old for questionnaire survey. The 581 valid questionnaires were divided into two parts, of which 300 samples were used for item screening and 281 samples were used to test the reliability and validity.  Results  Scientific fitness literacy scale consisted of three dimensions of scientific fitness knowledge, scientific fitness attitude, scientific fitness behavior and skills, with a total of 53 items. The S-CVI/Ave of the scale was 0.981 and I-CVI ranged from 0.833 to 1.000. The exploratory factor analysis identified three principal factors and explained for 52.26% variance. Confirmatory factor analysis showed that the model fitted well with the data (χ2/df=2.054, RMSEA=0.061, SRMR=0.049, IFI=0.882, TLI=0.876, CFI=0.881), supporting the three-factor model. The Cronbach' s α coefficient of the total scale was 0.964, and the test-retest reliability was 0.871 for the overall scale after two weeks.  Conclusion  The scientific fitness literacy scale for adults has good reliability and validity. It can be used to assess adult scientific fitness literacy.
Application of external medical device chain management scheme based on coding in safety management of Central Sterile Supply Department
XIA Chunxiao, QIU Xiaodan, NI Ledan, FENG Yongzeng, CHEN Guoguo
2024, 22(4): 690-694. doi: 10.16766/j.cnki.issn.1674-4152.003481
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  Objective  The chain management scheme based on coding was implemented in the Central Sterile Supply Department for external medical devices, and its influence on the unqualified rate of quality control and job satisfaction rate of medical staff was discussed.  Methods  A total of 90 external medical instrument sets from the Central Sterile Supply Department of the Second Affiliated Hospital of Wenzhou Medical University from January 17 to February 6, 2022 were randomly selected as the control group, and 90 external medical instrument sets from June 13, 2022 to July 3, 2022 were randomly selected as the intervention group. The control group adopted the traditional external medical device management mode, and the intervention group implemented the external medical device chain management scheme based on coding on the basis of the control group in our hospital on March 1, 2022. The unqualified rate of external medical device management and the satisfaction rate of medical staff were compared between the two groups.  Results  The unqualified rate was 24.76% (156/630)in the intervention group and 7.30% (46/630) in the intervention group, the difference between the two groups was statistically significant (P < 0.05).The satisfaction rate of the operating room doctors, nurses and nurses in the disinfection supply center in the intervention group was significantly higher than that in the control group, and the difference was statistically significant (P < 0.01).  Conclusion  The external medical device chain management model based on coding is beneficial to reduce management errors, to ensure medical safety and improve the job satisfaction of medical staff. It is a scientific management model worthy of clinical reference.
Construction a quality evaluation index system for the management of Class A infectious disease wards
CHEN Lili, PAN Aihong, TANG Li, ZHANG Tong, HU Yaqing, HU Guozhi
2024, 22(4): 695-699. doi: 10.16766/j.cnki.issn.1674-4152.003482
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  Objective  The objective is to construct a scientific and practical quality evaluation index system for managing Class A infectious disease wards, offering a comprehensive and measurable reference framework to standardize their management.  Methods  Based on Donabedian ' s three-dimensional quality theory and Service Quality evaluation model, the index system for the management of Class A infectious disease wards was initially constructed through literature research and by referencing China ' s guidelines for managing novel coronavirus pneumonia. A questionnaire survey involving five categories of personnel was conducted from May to July 2022. The purpose sampling method was adopted to select 13 consulting experts specializing in infectious disease healthcare, nursing management, clinical nursing, hospital infection, and logistics management. Two rounds of expert letter consultation and the Delphi method were utilized to finalize the evaluation index system and determine the weightage of each index.  Results  The recovery rate and effective rate for both rounds of expert correspondence questionnaires were 100.0%, with expert authority coefficient values of 0.842 and 0.838. Kendall ' s coefficients of concordance (Kendall ' s W) for the first and second indexes, following two rounds of letter consultation, were 0.116 and 0.098 respectively. The corresponding chi-square statistics were 180.961 and 152.882, with P-values less than 0.01. The final evaluation index system for managing Class A infectious disease wards include 3 first-level indexes, 8 second-level indexes, and 114 third-level indexes. The 3 first-level indexes are structure quality, process quality, and result quality, with weights of 0.2, 0.4, and 0.4, respectively. The 8 second-level indexes included fundamentality, supportability, standardization, reliability, scientificity, effectiveness, safety, and economy.  Conclusion  The quality evaluation index system for managing of Class A infectious disease wards demonstrates excellent scientific validity, reliability, and practicality. The assigned index weights are reasonable, and there is a high level of consistency among expert evaluation results. This system serves as a valuable reference for standardizing the management of Class A infectious disease wards.
Effect of upper limb exercise combined with FMEA nursing on the incidence and endothelial function of hospital-acquired venous thromboembolism in patients with PICC catheterization
LIN Xiaofei, TIAN Yuan, LIN Yuanyuan, WANG Jianqun, XU Shengmei, WANG Hongxia
2024, 22(4): 700-703. doi: 10.16766/j.cnki.issn.1674-4152.003483
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  Objective  To explore the effect of upper limb exercise combined with failure modes and effects analysis (FMEA) nursing on patients with peripherally inserted central catheter (PICC), as well as its influence on endothelial function and the incidence of hospital-acquired venous thromboembolism.  Methods  A total of 102 patients with PICC catheterization in the First Affiliated Hospital of Wenzhou Medical University from June to December 2022 were selected and randomly divided into control group (51 cases, routine nursing) and observation group (51 cases, upper limb exercise combined with FMEA Nursing). The endothelial function (EMCS, FMD), failure mode RPN value, exercise compliance, venous thromboembolism and complications were compared between the two groups before and after nursing.  Results  Compared with the control group, the RPN values of patients in the observation group and their failure modes such as evaluation, catheter factors, catheterization, flushing, sealing, health education and daily care were significantly lower (P < 0.05). The EMCs value increased and the FMD value decreased following care in both groups, as compared to pre-care levels. However, the EMCs of the observation group [(1 094.59±101.10)%] was significantly lower than that of the control group [(1 205.73±109.55)%], while the FMD value of the observation group [(4.66±0.48)%] was significantly higher than that of the control group [(3.73±0.48)%], with significance levels of P < 0.05. After care, the observation group had higher overall exercise compliance compared with the control group (P < 0.05), and overall acquired venous thromboembolism lighter (P < 0.05). The incidence of complications was lower in the observation group (P < 0.05).  Conclusion  The application of upper limb exercise combined with FMEA nursing in patients with PICC catheter can improve their exercise compliance, improve endothelial function, reduce the incidence of hospital acquired venous thromboembolism, and help to prevent thrombosis.
Effect of attributed psychological adjustment combined with progressive muscle relaxation training on physical and mental health of patients with breast cancer chemotherapy and insomnia
LIU Haifeng, DAI Xiaoyan, SANG Juan, MA Yingzhi, LIN Bo, HOU Yan
2024, 22(4): 704-708. doi: 10.16766/j.cnki.issn.1674-4152.003484
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  Objective  Breast cancer chemotherapy is prone to insomnia and other adverse reactions, necessitating close attention. This study investigated the effect of attributive psychological adjustment combined with progressive muscle relaxation (PMR) on breast cancer patients undergoing chemotherapy and experiencing insomnia.  Methods  A total of 325 breast cancer patients with chemotherapy and insomnia admitted to the People ' s Hospital of Xinjiang Uygur Autonomous Region from January 2022 to August 2023 were selected and divided into control group (162 cases) and study group (163 cases) by random number table method. On the basis of routine care, the control group received PMR, and the study group received attributional psychological adjustment combined with PMR. The intervention lasted for 6 weeks, and the changes of Pittsburgh sleep quality index (PSQI), Connor-Davidson resilience scale (CD-RISC), cancer fatigue scale (CFS) and functional assessment of cancer therapy-breast (FACT-B) were compared between the two groups.  Results  A total of 117 cases in control group and 132 cases in study group successfully completed the study. After 6 weeks of intervention, both groups showed significant decrease in PSQI scores after intervention (P < 0.05). The study group exhibited significantly lower PSQI scores [(7.70±2.08) points vs. (9.81±3.10) points] and a lower incidence of sleep disorders [41.67% (55/132) vs.55.56% (65/117)] compared to the control group, with statistically significant differences (P < 0.05). After 6 weeks of intervention, the scores of CD-RISC, CFS and FACT-B in both groups were significantly improved (P < 0.05), and the scores of CD-RISC and FACT-B in the study group were significantly higher than those in the control group, while the CFS scores were significantly lower than those in the control group, with statistical significance (P < 0.05).  Conclusion  Attributive psychological adjustment combined with PMR can effectively alleviate sleep disorders, improve mental resilience, reduce cancer-related fatigue, and improve patients ' quality of life during chemotherapy.
Effect of "one point, two sources" adaptive nursing strategy on self-efficacy, treatment compliance and blood glucose level in diabetic foot patients
SU Qiaodan, WANG Jun, TU Xin
2024, 22(4): 709-712. doi: 10.16766/j.cnki.issn.1674-4152.003485
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  Objective  There are many nursing difficulties in diabetic foot, and the disability rate is high. This study investigated the effect of "one point, two sources" adaptive nursing strategy on self-efficacy, treatment compliance and blood glucose level in diabetic foot patients.  Methods  A total of 84 patients with diabetic foot who were admitted to the Endocrine Clinic of Shaoxing People ' s Hospital from March 2020 to March 2022 were selected and divided into control group (42 cases) and observation group (42 cases) by drawing lots. The control group was given routine care, and the observation group was given "one point, two sources" adaptive nusing on the basis of routine care for 3 months. Self-efficacy, treatment compliance and blood glucose levels were compared between the two groups.  Results  The score and total score of self-efficacy (diabetes self-efficacy scale, DSES, diet, medication, exercise, disease monitoring, foot care and emergency management) were higher than before care (P < 0.05), and the scores of the observation group were higher than that of the control group (P < 0.05). Post-care treatment compliance in the observation group was higher than that of the control group (P < 0.05). Fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c) were decreased compared with before care [(6.44±1.32) mmol/L, (9.24±2.10) mmol/L and (5.80±0.57) % vs. (7.13±1.45) mmol/L, (11.02±3.23) mmol/L and (6.19±0.56) %, P < 0.05].  Conclusion  The implementation of "one point, two sources" adaptive nursing strategy for diabetic foot patients can effectively improve the level of self-efficacy and treatment compliance, and reduce the level of blood glucose, the effect is ideal.
The effect of lithotomy positions placement at different times before and after anesthesia on the comfort and placement time of patients undergoing general anesthesia surgery
XU Yinghao, WANG Lei, ZHANG Yexian, CHENG Yi, WANG Yan
2024, 22(4): 713-716. doi: 10.16766/j.cnki.issn.1674-4152.003486
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  Objective  Analyze the application effect of lithotomy positions at different times before and after anesthesia in patients undergoing general anesthesia surgery, and analyze their impact on preoperative anxiety, comfort, pressure injury, and placement time.  Methods  A total of 210 patients who underwent general anesthesia surgery at the lithotomy position in the operating room of the Pinghu First People ' s Hospital from January 2022 to August 2023 were selected as the study subjects. They were equally divided into a control group and an observation group using a random number table method. The control group patients were placed in the lithotomy position after induction of general anesthesia and intubation, while the observation group patients received posture education and placement before anesthesia. The position placement time, comfort scores, preoperative anxiety, and stress injury of patients in the two groups were compared.  Results  The positioning time of the observation group patients was (6.46±1.75) min, which was shorter than the control group [(10.14±2.28) min]. The comfort score of the observation group was 70.24±6.33, which was higher than the control group (59.55±7.47), with a statistically significant difference (P < 0.05). After intervention, the Amsterdam preoperative anxiety information scale (APAIS) was significantly lower than that of the control group, with statistically significant differences (P < 0.05). The incidence of pressure injury in the observation group was 3.8% (4/105), significantly lower than the 11.4% (12/105) in the control group (P < 0.05).  Conclusion  Conducting lithotomy position education and placement before general anesthesia surgery can shorten the time for position placement, reduce preoperative anxiety, improve patient comfort, and reduce the incidence of stress injury.
Primary aldosteronism in young child: a case report and literature review
ZHAN Shumin, HUANG Ke, WU Wei, GU Weizhong, FU Junfen, DONG Guanping
2024, 22(4): 717-720. doi: 10.16766/j.cnki.issn.1674-4152.003487
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Primary aldosteronism (PA) is a disorder of aldosterone hypersecretion leading to sodium retention, potassium loss, increased blood volume and suppression of renin, characterized by hypertension with or without hypokalemia. PA is usually diagnosed between the ages of 30 and 50, and cases in children are rare. This article presents a child aged four years and eleven months who was admitted to hospital with markedly elevated aldosterone levels. The symptoms of hypertension and hypokalemia were not obvious, and whole exome sequencing of peripheral blood showed a normal result. Later, a partial adrenalectomy was performed. The postoperative pathology of the adrenal gland showed cortical hyperplasia, and whole exome sequencing of the adrenal gland showed no obvious mutations. Finally, this young patient was considered to have primary hyperaldosteronism caused by adrenal cortical hyperplasia.

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