2024 Vol. 22, No. 6

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General Practice Forum
Exploring comorbidity patterns in coronary heart disease patients in Jiading district of Shanghai based on medical big datasets
TANG Mingqiu, SHI Jianwei, ZHOU Liang, GONG Xin, SUN Chaojun, ZHOU Ying
2024, 22(6): 903-906. doi: 10.16766/j.cnki.issn.1674-4152.003531
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  Objective  This study aims to explore the comorbidities associated with CHD and support its precise management.  Methods  Data on CHD patients from all medical institutions in Jiading District, Shanghai, from December 2020 to December 2021 were analyzed. The Apriori algorithm was used to identify key comorbidities, and 2-STEP clustering method was used to explore patterns of multimorbidity.  Results  Among 192 060 CHD patients, 166 969 (86.94%) exhibited comorbidities, with a higher rate in women (98 802, 87.18%) than in men (68 167, 86.59%, χ2=695.555, P < 0.001). The proportion of comorbidity increased significantly along with the age increase: 73.46% in the 18-60 age group (18 017), 86.94% in the 61-75 age group (87 180), and 91.85% in the over 75 age group (61 772, Z=-13.704, P < 0.001). CHD typically presents with 2-4 comorbidities, with hypertension (71.59%) and chronic gastroenteritis (49.96%) being the primary comorbidities identified through association rule analysis. Five distinct multimorbidity patterns were identified by 2-STEP clustering analysis: triggers, complications, cardiovascular-metabolic, circulatory system, and multi-system mixed.  Conclusion  CHD patients exhibit high comorbidity rates and diverse patterns of co-existing diseases, indicating the need for differentiated management strategies. These strategies should focus on proactive health measures, managing polypharmacy, and delaying progression to effectively address multimorbidity.
Interpretation Guidelines
Interpretation of key points from the "EAU guidelines on urological infections (2023)"
LIU Changsheng, XU Zhijie
2024, 22(6): 907-914. doi: 10.16766/j.cnki.issn.1674-4152.003532
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Urinary system infections are common in clinical practice, especially in the female population with a high incidence. However, there is no unified standard for clinical diagnosis, classification, and treatment, leading to inconsistencies, even within internal medicine and surgery textbooks. In March 2023, The European Association of Urology (EAU) published the latest guidelines on urologic infections. Compared with the 2022 version, the prevention of recurrent urinary tract infections, perioperative antibiotic prophylaxis, and prostate biopsy have been updated in the 2023 version of the guideline, and new contents of genitourinary tuberculosis had been added. This article interprets the relevant contents of urinary tract infection from the new guidelines to provide evidence-based instructions for general practitioners on the diagnosis, treatment, and standardized management of urinary tract infection.
Special Topic/General Discipline Training
Application of multi-disciplinary collaborative and situational simulation teaching in standardized training for general practitioners
YE Chenjing, WANG Jiayu, SHI Ting, ZHANG Xian, TONG Jianjing, GONG Yanchun, YAN Hua, ZHANG Chenli
2024, 22(6): 915-918. doi: 10.16766/j.cnki.issn.1674-4152.003533
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  Objective  To explore the application effect of multi-disciplinary collaborative and situational simulation teaching in standardized training for general practitioners, so as to improve the quality of clinical teaching.  Methods  Situational simulative teaching was introduced into the training of general practitioners. A total of 45 general practitioners in the Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in 2022 were divided into experimental group and control group by simple random grouping. The experimental group (23 students) received routine teaching training combined with situational simulative teaching, while the control group (22 students) received routine teaching training. The year-end assessment results of the two groups of students were compared, and the teaching effect of situational simulative teaching in the training of general practitioners was observed.  Results  The average score of the experimental group (80.22±4.10) in the theoretical exam was slightly higher than that of the control group (79.73 ± 3.28), but the difference was not statistically significant (P > 0.05). In the experimental group' s OSCE exam, the scores of medical history collection (81.22±4.09) and doctor-patient communication (81.39±9.06) were significantly better than those of the control group (78.45 ± 3.78 and 72.14±7.27), and the differences were statistically significant (P < 0.05). The experimental group showed better satisfaction with teaching than the control group, and the difference was statistically significant (P < 0.05). At the same time, the experimental group' s learning enthusiasm and participation had significantly improved.  Conclusion  In the process of general practitioner training education, the use of multi-disciplinary collaborative and situational simulation teaching can effectively enhance the learning initiative of students, help improve doctor-patient communication skills and clinical adaptability, and students have higher satisfaction with teaching. It is worthwhile to promote in the teaching of general practice.
Analysis of the national proposition to promote the standardized training quality of general practice residents
ZHAO Wenxuan, YUAN Sheng, LIU Sha, TANG Xiaoyan, JIN Yalei, MA Chunwei
2024, 22(6): 919-921. doi: 10.16766/j.cnki.issn.1674-4152.003534
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  Objective  In 2023, the national unified proposition was adopted in the assessment of clinical practice ability after standardized training for general practice residents. There is no research on the effect of this proposition on the assessment of the clinical practice ability level of residents and the impact on the improvement of the quality of resident training. This paper aims to compare the evaluation effect of the national proposition and provincial proposition method on the clinical practice ability of general practice residents in standardized training, analyze the promotion effect of the national proposition on the improvement of assessment quality, and put forward reliable suggestions.  Methods  The results of the clinical practice ability assessment of standardized training of general practice residents in Hubei Province in 2022 and 2023 were collected, the difficulty of the examination was analyzed, and the suggestions and feedback of candidates and examiners on different proposition methods were collected by questionnaires.  Results  There was no significant difference in the pass rate between 2023 (98.88%) and 2022 (98.38%). The average score of the basic skills operation test station in 2023 (19.00±2.34) was lower than that in 2022 (20.88±2.40), the average score of the doctor-patient communication test station in 2023 (11.78±1.44) was lower than that in 2022 (13.20±1.09), and the average score of the total score in 2023 (79.24±6.75) was lower than that in 2022 (81.86±7.29), all of which showed significant significance(P < 0.001). Candidates and examiners tend to choose the organizational form of the practical assessment of the national unified proposition assessment. The difficulty coefficient of the 2023 exam (0.79) was more difficult than that of 2022 (0.82).  Conclusion  The national proposition promotes the improvement of the standardized training and assessment quality of general practice residents, which is more in line with the current development situation of resident training.
Application of Calgary-Cambridge guideline combined with SEGUE scale in the teaching reform of general practitioner standardized training
JING Zehui, LIU Ji, LI Xiaoping, YANG Qingyan, XU Yinghua
2024, 22(6): 922-925. doi: 10.16766/j.cnki.issn.1674-4152.003535
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  Objective  Doctor-patient communication ability is one of the important skills to improve the competency of general practitioners, and it is also an important content in the general practice standardized training. This study aims to explore the application of Calgary-Cambridge guidelines doctor-patient communication model in the teaching of general practitioners' doctor-patient communication, so as to provide reference for improving the doctor-patient communication ability and humanistic quality.  Methods  A total of 30 general practitioners who underwent general practice standardized training in the Qinghai University Affiliated Hospital from May 2021 to May 2023 were selected. They were divided into experimental group (n=15) and control group (n=15) by random number table method. The control group only received the traditional doctor-patient communication skills training during the clinical work, while the experimental group received the Calgary-Cambridge guideline doctor-patient communication skills training. The doctor-patient communication effectiveness evaluation scale (SEGUE) was used to evaluate the two groups of doctors before training, 3 months, 6 months, and 9 months after training.  Results  There was no significant difference in the scores of doctor-patient communication skills between the two groups before the training (P > 0.05). After training, the scores of communication skills in both groups showed a significant upward trend, and there was a significant difference between the two groups. With the extension of time the difference became more obvious as the scores of communication skills in 3 months [(15.67±1.84) points vs. (11.67±2.06) points], 6 months [(19.53±1.73) points vs. (15.73±1.49) points, and 9 months (21.07±1.22) points vs. (18.20±1.70) points]. The scores of the experimental group were significantly higher than those of the control group in the aspects of preparation and initiation, information collection, information giving, understanding patients, and ending inquiry (P < 0.05).  Conclusion  The Calgary-Cambridge guideline doctor-patient communication model is superior to the traditional doctor-patient communication model in all dimensions of doctor-patient communication evaluation, including preparation and initiation, information collection, information giving, understanding the patients, and ending inquiry.
General Practice Research
Protective effect and mechanism of Alpiniae oxyphylla fructus on myocardial injury after exhaustive exercise in mice
WEN Tao, XU Baichao, WANG Jiameng, WU Haolin, LUO Ding, XIAO Man
2024, 22(6): 926-930. doi: 10.16766/j.cnki.issn.1674-4152.003536
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  Objective  To establish a mouse model of exercise-induced myocardial injury caused by exhaustive exercise and to investigate the intervention effect and possible mechanism of Alpiniae oxyphylla fructus pretreatment on myocardial injury after exhaustive exercise by observing the changes of myocardial injury indexes after acute exhaustive exercise in mice, thus providing a theoretical basis and reference for further related studies.  Methods  Mice were randomly assigned to five different experimental groups by simple random grouping: Control group (Con, n=6), Yizhiren group (Yz, n=6), Exhaustion group (EE, n=6), Exhaustion exercise model + Yizhiren low dose group (EE+EYz, n=6), and Exhaustion exercise model + Yizhiren high dose group (EE+HYz, n=6), all mice received specific exercise intervention and drug feeding for six weeks. The mice were sacrificed at the end of the experiment, and data on biomarkers associated with myocardial injury were collected.  Results  In terms of exhaustion frequency, EE+HYz group and EE+EYz group showed statistically significant difference compared with EE group (P < 0.05). Statistically significant differences were observed between EE+HYz group, Con and Yz group, EE+HYz and EE group (P < 0.05). In the analysis of biochemical parameters, the level of tumor necrosis factor α (TNF-α) in the EE+HYz group was significantly decreased compared with that in the EE group (P < 0.05). There was significant difference in erythroprotein (MYO) among the 5 groups (P < 0.05). Myocardial creatine kinase (CK-MB) was significantly different between the other 4 groups and EE group (P < 0.001).  Conclusions  Alpiniae oxyphylla fructus has significant anti-fatigue, anti-inflammation and protective effects on myocardial injury. By inhibiting the increase of myocardial CK-MB and MYO activity induced by exhaustive exercise, Alpiniae oxyphylla fructus reduced the degree of myocardial injury. These findings reveal the potential antioxidant effects of Alpiniae oxyphylla fructus in heart protection and may be an important strategy for the prevention and treatment of exercise-related myocardial injury. In addition, these results provided new research ideas for the development of intervention and treatment drugs for myocardial injury.
Study on plantar pressure characteristics of Tibetan knee osteoarthritis patients living at different altitudes
LOU Benjing, CI Wang, QIANGBA Danzeng, YAN Huatao, ZUN Zhu, XIE Lu, BIAN Ba
2024, 22(6): 931-935. doi: 10.16766/j.cnki.issn.1674-4152.003537
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  Objective  To analyze the changes of plantar pressure in patients with different altitudes, and to provide a quantitative basis for the changes of plantar pressure in patients with Tibetan knee osteoarthritis (KOA) living in the plateau.  Methods  Patients with knee osteoarthritis who underwent total knee arthroplasty in the Second People' s Hospital of Tibet Autonomous Region from March to August 2023, were selected according to their long-term residence, and 29 cases were classified according to their long-term residence, 29 cases were 3 000-3 700 m, 38 cases were 3 701-4 500 m, and 27 cases were 4 501-5 500 m. Static standing and dynamic walking analysis was performed using the LorAn plantar pressure test system, and the correlation between different elevation gradients and plantar pressure were analyzed by Spearman method.  Results  There were significant differences in T1, MH and LH between the replaced and non-replaced sides (P < 0.05). Differences in patient static indices, foot-axis angle between replacement and non-replacement sides, pelvic rotation, walking speed, and patient joint scores were statistically significant between elevations (P < 0.05). The static standing and dynamic walking indexes were negatively correlated with altitude (P < 0.05), joint scores were positively correlated with altitude (P < 0.05), plantar pressure peaks in T1 and M4 regions and stress time ratios in M5 region were negatively correlated with altitude (r=-0.287, -0.282, -0.252, P < 0.05), and BMI were positively correlated with mid-foot and post-foot pressure peaks (r=0.330, 0.238, 0.226, P < 0.05).  Conclusion  The change of the peak plantar pressure can be used as an indicator to monitor the occurrence of knee joints in Tibetan people living at different altitudes. Tibetan patients with osteoarthritis of the knee who live at high altitudes have poor balance compared with patients at very high altitudes.
Effects of exosomes derived from hepatocellular carcinoma cells on their biological behaviors of proliferation, apoptosis and autophagy
GAO Jie, LI Jiangyan, HUANG Hua, ZHANG Lunjun, DENG Rong
2024, 22(6): 936-939. doi: 10.16766/j.cnki.issn.1674-4152.003538
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  Objective  Exosomes play an important role in the occurrence and development of hepatocellular carcinoma. This study aims to investigate the effects of exosomes on the proliferation, apoptosis, autophagy, and exosome release of HepG2 hepatocellular carcinoma cells and the related mechanisms.  Methods  Exosomes of HepG2 cells were extracted by ultrafast centrifugation. Exosome morphology, diameter distribution and marker protein expression of HepG2 cells were analyzed by transmission electron microscopy, nanoparticle tracking and Western blotting analysis. After the co-culture of exosomes and HepG2 cells, a CCK-8 kit was used to detect the proliferation of HepG2 cells, the apoptosis of HepG2 cells was detected by flow cytometry, and the expressions of apoptosis-related proteins (Bax, Bcl-2) and autophagy-related proteins (LC3-Ⅱ/LC3-Ⅰ, p62, Beclin-1) were detected by Western blotting.  Results  The morphology of exosomes extracted from HepG2 cells was consistent with the characteristics of exosomes, and the diameter between 30 and 150 nm. The marker proteins Alix and CD63 were significantly expressed. The results of CCK-8 showed that the absorbance of HepG2 cells in the 24 h exosome group was not significantly different from that in the control group(P > 0.05), but the absorbance of the exosome group at 48 hours and 72 hours were higher than that of the control group (P < 0.05). Flow cytometry showed that the apoptosis rate was (14.96±0.28) % in the control group and (11.16±0.50) % in the exosome group, and the apoptosis rate decreased (t=11.485, P < 0.001). Western blotting results showed that compared with the control group, the expression of apoptosis-related protein Bcl-2 in exosome group was up-regulated (P < 0.01), and the expression of Bax was down-regulated (P < 0.01). Autophagy associated protein LC3-Ⅱ/LC3-Ⅰ expression was up-regulated (P < 0.01), Beclin-1 expression was up-regulated (P < 0.05), and p62 expression was down-regulated (P < 0.01).  Conclusion  Exosomes derived from HepG2 cells can promote cell proliferation and inhibit apoptosis by inducing up-regulation of autophagy.
The effect of bracketless invisible appliance on periodontal health in periodontitis with malocclusion deformity
YI Xuan, GE Huabing, CAO Yu
2024, 22(6): 940-942. doi: 10.16766/j.cnki.issn.1674-4152.003539
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  Objective  To investigate the effect and safety of bracketless invisible appliance on periodontitis with malocclusion deformity, and to analyze the influence on periodontal health and inflammation of patients, in order to provide reference for clinical treatment of this disease.  Methods  A total of 200 patients with periodontitis with malocclusion deformity admitted to Beijing Stomatological Hospital Capital Medical University from January 2021 to December 2022 were selected and divided into the control group (94 cases, straight wire appliance) and the study group (106 cases, bracketless invisible appliance) according to the orthodontic methods. The treatment effect was compared between the two groups.  Results  The total effective rate in the study group was 95.28% (101/106), which had no difference compared with 92.55% (87/94) in the control group (P > 0.05). There was no difference in tooth leveling time and occlusal opening time between the two groups (P > 0.05). In the study group, clinical attachment loss (CAL), gingival line probe depth (PD), gingival sulcus bleeding index (SBI), plaque index (PLI), gingival index (GI) [(3.26±1.05) mm, (2.44±0.61) mm, 1.21±0.31, 1.56±0.41, 0.65±0.17] after treatment were lower than those in the control group [(3.81±1.19) mm, (2.83±0.49) mm, 1.75±0.49, 2.51±0.50, 1.12±0.25], all P < 0.05. After treatment, the levels of interleukin-8 (IL-8), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in the study group were lower than those in the control group (P < 0.05). The total complication rate in the study group was 5.66% (6/106), which was lower than that in the control group [15.96% (15/94), χ2=5.621, P=0.018].  Conclusion  The bracketless invisible appliance has a definite effect on the treatment of periodontitis with malocclusion deformity, which can significantly improve the periodontal health of patients.
Comparative on the efficacy of percutaneous cervical nucleoplasty and posterior endoscopic cervical discectomy for cervical spondylotic radiculopathy
HU Jun, WANG Zi, GUO Yuyu, HAN Liuhu, CHEN Liyang, WANG Likui
2024, 22(6): 943-946. doi: 10.16766/j.cnki.issn.1674-4152.003540
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  Objective  To explore the clinical effects of percutaneous cervical nucleoplasty (PCN) and posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy.  Methods  Sixty-seven cases of cervical spondylotic radiculopathy due to a single-level contained soft-disc herniation in the Department of Pain Medicine of the First Affiliated Hospital of Anhui Medical University from May 2019 to June 2021 were selected, and divided into Group PPECD (n=35) and Group PCN (n=32) according to surgical methods. Pain was assessed by VAS scores at multiple time points before and after surgery, and cervical functional recovery was evaluated using the cervical dysfunction index (NDI). The modified MacNab criteria were used to evaluate the surgical efficacy at the final follow-up.  Results  All patients completed the surgery and had complete follow-up data. There was no significant difference in the general preoperative conditions of the two groups of patients. The operation time of PCN treatment [(42.0±6.4) min] was significantly shorter than that of the PPECD group [(94.7±6.3) min, P < 0.001]. Compared with those before surgery, the VAS scores and NDI index of the two groups of patients at each postoperative time were significantly improved (P < 0.05). According to the Macnab standard, the clinical effective rate of patients treated with PPECD (82.9%, 29/35) was higher than that of PCN (75.0%, 24/32), but the difference was not statistically significant (P > 0.05). No serious postoperative complications were observed in either group of patients.  Conclusion  For patients with poor tolerance to surgery, PCN can be a good alternative to PPECD for patients with cervical spondylotic radiculopathy due to a single-level contained soft-disc herniation.
The prognostic value of lymph node ratio in 89 patients with stage ⅢC1p cervical cancer who underwent surgery
YANG Bo, ZHANG Qingsong, WANG Beibei, NI Fangfang, ZHANG Ying, HAN Shuqi
2024, 22(6): 947-950. doi: 10.16766/j.cnki.issn.1674-4152.003541
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  Objective  To investigate the prognostic impact of lymph node ratio (LNR) on 2018 International Federation of Gynaecology and Obstetrics Stage ⅢC1p cervical cancer patients.  Methods  A total of 89 patients with lymph node-positive cervical cancer from January 2014 to December 2017 in the Oncology Department of the First Affiliated Hospital Bengbu Medical University underwent radical hysterectomy and systematic pelvic lymphadenectomy with or without abdominal aortic dissection. All patients received concurrent chemoradiotherapy. LNR was defined as the ratio of positive lymph nodes to the total number of LNS removed. Patients were divided into 2 groups according to LNR; LNR < 0.06(42 cases) and LNR≥0.06 (47 cases). The prognostic value of LNR was assessed by univariate log-rank test and multivariable Cox regression models.  Results  The median follow-up was 44.6 months (range, 6-115 months), and the 5-year disease-free survival (DFS) rate for the entire cohort was 61.6%, while the 5-year overall survival (OS) rate was 69.7%. The 5-year DFS rates for LNR < 0.06 and LNR≥0.06 were 65.4% and 54.2%, respectively (P=0.027). Furthermore, the 5-year OS rates for LNR < 0.06 and LNR≥0.06 were 82.8% and 59.6%, respectively (P=0.003). In multivariable analysis, LNR≥0.06 was associated with worse DFS (HR=2.040, 95% CI: 1.130-3.870, P=0.013) and OS (HR=1.940, 95% CI: 1.020-3.780, P=0.038).  Conclusion  LNR≥0.06 may be an independent prognostic factor for decreased DFS and OS in patients with stage ⅢC1P cervical cancer.
Expression and function of IL-22 in rheumatoid arthritis-associated interstitial lung disease
FANG Quanquan, QU Ziye, XIE Jingzhi, ZONG Juan, ZHOU Dongmei, YIN Songlou, YIN Hanqiu
2024, 22(6): 951-956. doi: 10.16766/j.cnki.issn.1674-4152.003542
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  Objective  This study aims to observe the expression of IL-22 in patients with rheumatoid arthritis-associated interstitial lung disease(RA-ILD)and establish an experimental model to explore its role in pulmonary fibrosis.  Methods  We selected 33 patients with rheumatoid arthritis with or without interstitial lung disease, who were newly diagnosed and treated at the Affiliated Hospital of Xuzhou Medical University from October 2021 to October 2022. Additionally, 14 healthy subjects were chosen as controls during the same period. ELISA was used to detect the peripheral blood IL-22 levels in the three groups, and a comparison was made among them. Spearman correlation test was employed to analyze the correlation between IL-22 and lung HRCT scores. Logistic regression was used to analyze risk factors for RA-ILD and to draw ROC curves. Wild mice (WT) and IL-22 knock-out mice (IL-22KO) were treated with normal saline (NS) and Bleomycin (BLM). Following modeling, mice were given intraperitoneal injections of IL-22. HE and Masson staining were used to observe the histopathological changes in the lung tissues. Relevant markers were detected by RT-qPCR and Western blotting.  Results  The levels of IL-22 were higher in the RA-NILD group compared to the RA-ILD group and the healthy control group. There was a negative correlation between IL-22 levels and lung HRCT scores (r=-0.940, P < 0.05). Logistic regression analysis suggested that a low level of IL-22 was an independent risk factor for RA-ILD. The combined diagnosis of RA-ILD with IL-22, age, smoking, APCA, and MCHC had an AUC of 0.959 (95% CI: 0.916-1.000), with a sensitivity of 97.0% and specificity of 87.9%. HE and Masson staining found that the collagen deposition in the lungs of BLM groups were increased compared with the NS groups, accompanied by Szapiel ' s scores and Ashcroft scores. The mRNA and protein expression of fibrosis-related genes (Collagen Ⅰ, Vimentin, and α-SMA) were increased in the BLM groups compared to the NS group, and the IL-22KO group showed even higher levels (P < 0.05). Treatment with IL-22 resulted in a reduction in collagen deposition, mRNA, and protein expression of fibrosis-related genes (P < 0.05).  Conclusion  IL-22 exhibits potential as a protective effect against pulmonary fibrosis, suggesting it may be a potential therapeutic target and clinical predictor in the future interventions.
Short term safety research of total laparoscopic π-shaped esophagojejunal anastomosis in radical surgery for adenocarcinoma of esophagogastric junction
ZHANG Chensong, PAN Chengwu, WANG Qingkang, WANG Yuanpeng, WU Han, MA Jiachi
2024, 22(6): 957-961. doi: 10.16766/j.cnki.issn.1674-4152.003543
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  Objective  To analyze the short-term clinical efficacy and safety of total laparoscopic π-shaped esophageal jejunostomy and laparoscopic assisted Roux-en-Y esophago-jejunostomy for adenocarcinoma of the esophagogastric junction.  Methods  The clinical and pathological data of 72 patients with adenocarcinoma of the esophagogastric junction treated in the First Affiliated Hospital of Bengbu Medical University from June 2020 to July 2022 were collected. All patients underwent laparoscopic total gastrectomy + D2 lymphadenectomy, in whom 38 patients underwent total laparoscopic radical resection of cardiac cancer + π-shaped esophageal jejunostomy and 34 patients underwent laparoscopic-assisted radical resection of cardiac cancer + Roux-en-Y esophago-jejunostomy. The safety and effects on stress response indicators of different surgical methods were analyzed.  Results  The mean operation time of the total endoscopy group was longer than that of the laparoscopic-assisted group and the length of the incision was significantly shorter than that in the laparoscopic-assisted group (P < 0.001). In terms of intraoperative bleeding, the amount of intraoperative bleeding in the total endoscopy group (130.26±23.54) mL was significantly lower than that in the laparoscopic group [(167.21±28.53) mL, t=6.017, P < 0.001]. The first postoperative exhaust time in the total endoscopy group was significantly lower than that in the laparoscopic-assisted group (P=0.003). There were no significant differences in extubation time, postoperative hospitalization days, postoperative complications, and number of surgically removed lymph nodes between the two groups (P>0.05). The serum level of CRP in the total endoscopy group was significantly lower than that in the laparoscopic-assisted group on the first and fifth day after surgery (P < 0.05).  Conclusion  Total laparoscopic radical resection of cardiac cancer + π esophagojejunostomy is safe, which can reduce intraoperative bleeding, shorten the recovery time of patients, relieve postoperative pain, greatly reduce the occurrence of postoperative complications, and has little effect on the body's traumatic stress response.
Effect of atherosclerotic plaque characteristics of middle cerebral artery on cerebral infarction caused by arterial stenosis
SHI Jingjing, BAO Jieyu, ZHANG Jing, CAI Mengmeng, CHAO Linlin, ZHAO Jianhua
2024, 22(6): 962-965. doi: 10.16766/j.cnki.issn.1674-4152.003544
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  Objective  To explore the correlation between vessel wall characteristics and infarction patterns in patients with atherosclerotic stenosis of the middle cerebral artery (MCA) using high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) and diffusion-weighted imaging (DWI).  Methods  A retrospective study was conducted at the People's Hospital of Zhengzhou University from January 2021 to December 2022, involving 68 patients with acute ischemic stroke in the MCA due to atherosclerotic stenosis. Patients were categorized into single-and multiple-infarct groups based on DWI findings, and various atherosclerosis risk factors, degree of lumen stenosis, and plaque characteristics were compared between the two groups. Logistic regression analysis was performed to assess the relationship between vessel wall properties and infarct patterns in MCA atherosclerotic stenosis patients.  Results  Among 68 patients with atherosclerotic stenosis in the middle cerebral artery, 45 patients (66.18%) had multiple infarcts, and 23 (33.82%) had single infarcts. There were no significant difference in age, sex, hypertension, diabetes, hyperlipidemia, smoking history, cardiovascular disease history, cerebrovascular disease history and NIHSS score between the two groups (P>0.05). Degree of stenosis and prevalence of intraplaque hemorrhage (IPH) were significantly greater in the multiple-infarction group than those in the single-infarction group (degree of stenosis: P=0.029; IPH: P=0.025). There was no significant difference in eccentricity and plaque enhancement between the two groups (P>0.05). After adjusting for age, sex, hypertension, diabetes, hyperlipidemia, smoking history, cardiovascular disease history, cerebrovascular disease history, NIHSS score and other confounding factors, logistic regression analysis showed that IPH (adjusted OR=6.525, 95% CI: 1.108-38.442, P= 0.038) was independent predictor for multiple infarction.  Conclusion  IPH is independently associated with multiple infarcts. HRMR-VWI may provide new insight into the mechanisms underlying the different MCA infarction patterns.
Expression of PD-1 and PD-L1 in platinum-resistant ovarian epithelial carcinoma and their clinical significance
ZHAI Xinying, WANG Lihua, LI Yanhua
2024, 22(6): 966-970. doi: 10.16766/j.cnki.issn.1674-4152.003545
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  Objective  To investigate the expression of programmed death receptor 1 (PD-1) and programmed death receptor-ligand 1 (PD-L1) in the tissues of patients with platinum-resistant ovarian epithelial cancer, and to analyze the relationship between the expression of PD-1 and PD-L1 in patients with platinum-resistant ovarian epithelial cancer and clinical characteristics and prognosis.  Methods  The tissue paraffin blocks of 111 patients with ovarian cancer (71 cases of platinum-resistant tissue paraffin blocks and 40 cases of platinum-sensitive tissue paraffin blocks) who underwent surgical treatment in the First Affiliated Hospital of Bengbu Medical University from January 2018 to June 2021 were collected, and 10 cases of benign ovarian tissue paraffin blocks were taken as controls. The expression levels of PD-1 and PD-L1 in ovarian cancer tissues were detected by ELiVisionTM immunohistochemistry method, and the relationships between the expression levels and pathological features and prognosis were analyzed.  Results  The positive rates of PD-1 and PD-L1 in the platinum-sensitive group and platinum-resistant group were 22.5%, 32.5% and 42.3%, 53.5%, respectively. The positive rates of PD-1 and PD-L1 in the drug-resistant group were higher than those in the platinum-sensitive group (P < 0.05). The positive expression rates of PD-1 and PD-L1 in serous and non-serous cancer tissues were 50.0%, 61.5% and 21.1%, 31.6%, respectively. The positive expression rates of PD-1 and PD-L1 in surgical pathological stage Ⅲ-Ⅳ and Ⅰ-Ⅱ were 51.0%, 63.3 %, and 22.7%, 31.8%, respectively. The expressions of PD-1 and PD-L1 were significantly lower than those in serous carcinoma and stage Ⅲ to Ⅳ patients, with statistical significance (P < 0.05). The multifactorial Cox proportional risk model shows: PD-1 positive group (HR=3.905, P=0.001), PD-L1 positive group (HR=4.581, P=0.002), surgical pathological stage Ⅲ and Ⅳ stages (HR=3.948, P=0.026) were independent risk prognostic factors affecting survival of patients with platinum-resistant ovarian epithelial cancer. Survival analysis showed that the two-year survival rate of PD-1 and PD-L1 positive patients were lower than that of negative patients (P < 0.05).  Conclusion  The high expression of PD-1 and PD-L1 in ovarian epithelial carcinoma tissues is related to drug resistance, which leads to malignant progression of tumor and shortened survival time, and is one of the indicators of poor prognosis of patients.
A retrospective analysis of 395 cases of non-syndromic supernumerary teeth in the anterior maxilla
CHENG Xu, WU Xiaoting, WANG Yinlong
2024, 22(6): 971-974. doi: 10.16766/j.cnki.issn.1674-4152.003546
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  Objective  Polydontia is a common disease in which the number of teeth increases due to abnormal tooth development. Clinically, polydontia can be classified into syndromic and non-syndromic types based on whether it is associated with systemic diseases, with the former being rare. This study discusses the clinical characteristics, imaging findings, and treatment methods of non-syndromic polydontia in the anterior maxillary region, providing references and a basis for clinical diagnosis, treatment, and research.  Methods  A total of 395 patients with polydontia in the anterior maxillary region treated at the Department of Oral and Maxillofacial Surgery of Anhui Medical University Affiliated Stomatological Hospital from January 2019 to June 2023 were selected. Retrospective analysis was conducted on the patients' personal data, clinical manifestations, imaging examinations, surgical plans, etc. Statistical analysis of the data was performed using SPSS 22.0 software.  Results  This study included 395 patients with polydontia in the anterior maxillary region, totaling 551 supernumerary teeth. The number of male patients was higher than that of female patients, with 293 male patients and 102 female patients, a male-to-female ratio of 2.87∶1. The ages of the patients ranged from 3 to 45 years old. Single supernumerary teeth were the most common, with 256 cases, accounting for 64.81%. Most patients presented during the mixed dentition period, with 251 cases, accounting for 63.54%. The most common shapes of supernumerary teeth were conical and nodular, totaling 529 teeth, accounting for 96.01%. The most common positional relationship with adjacent teeth was inversion, with 264 teeth, accounting for 47.91%. The most common surgical approach was through the palatal side, with 292 cases, accounting for 73.92%.  Conclusion  Non-syndromic maxillary anterior teeth are asymptomatic, with a few clinical manifestations such as impacted teeth and widened dental space, and are more common in children during their transitional period. Male patients are more common than female patients. High impacted teeth are the most common, and the palatal approach is often used for surgery.
Analysis of curative effect of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve
SUN Shuyun, YIN Yihong, YE Liqun
2024, 22(6): 975-978. doi: 10.16766/j.cnki.issn.1674-4152.003547
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  Objective  To observe and analyze the clinical efficacy of Zishen Huoxue Decoction in treating kidney deficiency and blood stasis type of diminished ovarian reserve, and its effect on ovarian function and ovarian blood flow, providing a basis for clinical treatment.  Methods  A total of 750 patients with diminished ovarian reserve (kidney deficiency and blood stasis type) admitted to Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) from July 2022 to November 2023 were selected as the study subjects, and the included patients were divided into group A (treated with Zishen Huoxue Decoction), group B (treated with estradiol valerate tablets combined with dydrogesterone tablets), and group C (treated with Zishen Huoxue Decoction + estradiol valerate tablets combined with dydrogesterone tablets) using the random number table method, with 250 patients in each group. Treatment effects, changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume (OV), and ovarian stromal flow index before and after treatment were compared among the three groups of patients.  Results  The total effective rates of group A, group B, and group C were 82.0% (205/250), 64.4% (161/250), and 90.8% (227/250), respectively, and the total effective rates of group C were all higher than those of group B and A, and the total effective rate of group A was higher than that of group B (P < 0.05). After treatment, FSH and LH decreased more significantly in group C than in groups A and B, and FSH and LH decreased more significantly in group A than in group B (P < 0.05). AMH rose more significantly in group C than in groups A and B, and AMH rose more significantly in group A than in group B (P < 0.05). AFC and OV rose more significantly in group C than in groups A and B after treatment, and AFC and OV rose more significantly in group A than in group B (P < 0.05). PSV, VI, and FI rose were more significantly in group C than in groups A and B after treatment, and VI levels rose was more significantly in group A than in group B (P < 0.05).  Conclusion  Zishen Huoxue Decoction can effectively regulate ovarian function and improve ovarian blood supply in patients with kidney deficiency and blood stasis type of diminished ovarian reserve, with remarkable clinical efficacy, and is worth applying in clinical practice.
Investigation of the clinical efficacy of transabdominal single-port endoscopic combined with transanal endoscopic techniques in managing low rectal cancer
ZHENG Jiujian, WANG Jianping
2024, 22(6): 979-982. doi: 10.16766/j.cnki.issn.1674-4152.003548
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  Objective  To explore the short-term and mid-term clinical effects of single-port laparoscopy combined with transanal total mesenteric excision for treating low rectal cancer.  Methods  From January 2018 to June 2022, patients diagnosed with low rectal cancer and treated with anterior rectal resection and coloanal anastomosis at Lishui Central Hospital were included in this study. The early and mid-term clinical efficacies were analyzed and compared based on specimen extraction methods.  Results  Among the 62 patients, the average operation time was (182.6±30.5) minutes, with 22 requiring internal sphincter resection. All patients underwent either colostomy end-to-end stapler or manual anastomosis. The first bowel movement at the ileostomy site occurred on average (1.5±0.3) days post-surgery. R0 resection was achieved in 61 patients, with only 1 patient of R1 resection. The average distal resection margin was (6.2±0.3) mm, and 3 patients had positive circumferential resection margins. Pathological analysis showed that 45 complete and 17 nearly complete cases. The average number of lymph nodes obtained was 13.5, with 25 patients yielding fewer than 12 lymph nodes on their specimens. Specimens were extracted from the ileostomy site in 35 cases and through the anal canal in 27 cases. There were significant differences in BMI-related variables (χ2=39.388, P < 0.001) and tumor size (t=4.415, P=0.020) between the two methods. The average postoperative follow-up time was (40.6±5.5) months. The mid-term outcome evaluation indicated an overall survival rate of 98.4%, disease-free survival rate of 80.6%, and local control rate of 95.2% among the study subjects.  Conclusion  Laparoscopy combined with transanal endoscopic techniques can achieve ideal short-and medium-term clinical effects in the treatment of low rectal cancer, facilitate sufficient tumor resection, and minimize complications through smaller wounds.
Correlation and diagnostic significance of serum LncRNA NEAT1 and SP1 with H-Y grade in patients with Parkinson's disease
LIU Yuecun, LIU Qingxia, LIU Qi
2024, 22(6): 983-986. doi: 10.16766/j.cnki.issn.1674-4152.003549
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  Objective  To investigate the expression levels of long non-coding RNA para-plaque assembly transcript 1 (LncRNA NEAT1) and SP1 in the serum of patients with Parkinson's disease (PD) and their relationship with disease severity.  Methods  A total of 80 patients with PD (PD group) admitted to Binhaiwan Central Hospital of Dongguan from November 2020 to January 2022 were selected and divided into mild PD subgroup (n=26), moderate PD subgroup (n=31) and severe PD subgroup (n=23) according to the revised Hoehn-Yahr (H-Y) classification, and 57 healthy subjects (control group) were selected during the same period. The differences in serum LncRNA NEAT1, and SP1 mRNA expression in each group and their correlation with the H-Y stage were compared. The ROC curve was used to analyze the diagnostic value of the expression of lncRNA NEAT1 and SP1 in PD.  Results  The serum levels of LncRNA NEAT1 and SP1 mRNA in the PD group were higher than those in the control group (t=6.887, 6.303, all P < 0.001). The serum levels of LncRNA NEAT1 and SP1 mRNA in mild, moderate, and severe PD subgroups increased in turn (F=66.803, H=59.259, all P < 0.001). The expressions of serum LncRNA NEAT1 and SP1 mRNA in PD patients were positively correlated with the H-Y stage (rs=0.790, 0.840, P < 0.001), and the areas under the curve were 0.787, 0.784, and 0.858, respectively. The sensitivity was 58.75%, 51.25% and 70.00%, and the specificity was 91.23%, 96.49% and 89.47%, respectively.  Conclusion  The increased expression of serum LncRNA NEAT1 and SP1 mRNA in PD patients is closely related to the progression of the disease, which has a certain diagnostic value for PD, and the combined diagnostic value is higher.
Clinical study on treating chronic heart failure of Qi deficiency and blood stasis type with modified Yangxin Decoction and Guan's ear needle combination therapy
WU Dongdong, LIU Xuying, YU Guoqiang, TENG Jinyan, TAN Zengde, ZHOU Yabin, ZHANG Mingming
2024, 22(6): 987-990. doi: 10.16766/j.cnki.issn.1674-4152.003550
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  Objective  To observe the effects of modified Yangxin Decoction combined with Guan's ear needle on heart function, activity endurance, Chinese medicine syndrome, and clinical efficacy in patients with chronic heart failure (CHF), and to explore the mechanism by which this combination improves these parameters in CHF patients.  Methods  During the period from January to December 2021, 100 patients with Qi deficiency and blood stasis type CHF were treated at the Internal Medicine Clinic. They were randomly divided into an observation group and a control group using a single-blind protocol. Finally, 48 patients in the observation group and 47 patients in the control group were completed. Both groups of patients were given basic treatment. The control group received routine western medicine treatment, including cardiac strengthening, diuresis, and vasodilation. The observation group received a combination of modified Yangxin Decoction and Guan's ear needle treatment in addition to the control group. Changes in Chinese medicine syndromes, cardiac function, activity endurance, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, and cardiac ultrasound were observed before and after treatment in two groups of patients. The clinical efficacy of the two groups was then compared.  Results  After treatment, the Chinese medicine syndrome score, NT-proBNP level, and Lee's heart failure score in the observation group were significantly lower than those in the control group, and the activity endurance was significantly improved compared to the control group (P < 0.05). The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI), and interventricular septal thickness (IVST) in the observation group were significantly decreased, while left ventricular ejection fraction (LVEF) was significantly increased compared to the control group (P < 0.05). The total effective rate of the observation group was 93.8% (45/48), significantly higher than the 78.7% (37/47) in the control group (P < 0.05).  Conclusion  The combination of modified Yangxin Decoction and Guan's ear needle can significantly improve the clinical efficacy for CHF patients. It effectively improves their Chinese medicine syndrome, activity endurance, and heart function, increases LVEF, and reduces LVEDD, LVESD, LVMI, IVST, and NT proBNP levels.
Study on the influence factors of frailty and the construction of risk prediction model in elderly inpatients with chronic heart failure
TAN Jie, CHEN Manman, CHEN Lingyun, HUANG Yuli
2024, 22(6): 991-994. doi: 10.16766/j.cnki.issn.1674-4152.003551
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  Objective  To explore the influencing factors of frailty in elderly patients with chronic heart failure, and build a frailty risk prediction model to provide clinical reference for preventing and reducing frailty.  Methods  A total of 198 elderly patients with chronic heart failure who were hospitalized in the cardiovascular Department of the Fifth People ' s Hospital of Fuyang from March 2022 to March 2023 were selected by convenience sampling method. They were divided into a frailty group and a non-frailty group according to whether frailty occurred. The influencing factors of frailty were analyzed by binary Logistic regression. Hosmer-Lemeshow test and ROC curve were used to detect the goodness of fit and prediction effect respectively.  Results  The incidence of frailty in elderly CHF patients was 32.32% (64/198), and fatigue was the main symptom (51.01%, 101/198). Age (OR=1.101, P=0.007), NYHA cardiac function grade (OR=2.550, P=0.011), course of disease (OR=2.210, P=0.014), sleep state (OR=2.215, P=0.010), N-terminal brain natriuretic peptide precursor (OR=1.003, P < 0.001), left ventricular ejection fraction (OR=0.910, P < 0.001) and self-management level (OR=0.229, P < 0.001) were influencing factors in the occurrence of frailty. The regression model had good goodness of fit (χ2=2.915, P=0.940), and the AUC under the ROC curve was 0.913 (P < 0.001, 95% CI: 0.870-0.956), sensitivity was 89.1%, specificity was 81.3%.  Conclusion  The incidence of frailty in elderly patients with chronic heart failure is high. Clinical attention should be paid to elderly patients with poor heart function, long course of disease, poor sleep quality, and low self-management ability. The frailty risk prediction model established in this study is effective in elderly patients with chronic heart failure, which can provide a reference for frailty risk assessment and intervention.
Parental experience in caring for children with attention deficit hyperactivity disorder: a qualitative study
SUN Qiaozhi, CHEN Changying, LI Hong, ZHANG Jie, WANG Junxia, WANG Panpan, XU Haili
2024, 22(6): 995-999. doi: 10.16766/j.cnki.issn.1674-4152.003552
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  Objective  This paper aims to interview parents of children with attention deficit hyperactivity disorder (ADHD) to explore their firsthand experiences in providing healthcare for their children. The findings will provide a basis for developing a multi-dimensional and comprehensive intervention program for families coping with ADHD.  Methods  A phenomenological study was conducted from April to August 2022 in the pediatric wards of the First Affiliated Hospital of Zhengzhou University. Purposive sampling was adopted, and individual semi-structured interviews were conducted among 20 parents of children with ADHD. The interviews were conducted until data saturation was achieved. The interview guideline was formulated based on a literature review, group discussion, and pre-interview. The interviews were audio-recorded, and the data were transcribed and managed using Nvivo12 software. Finally, the data were analyzed using Colaizzi' s 7-step analysis method.  Results  Five themes were emerged from the data analysis: (1) Difficulty in symptom management including multiple coexisting symptoms, highlighting the significant difficulty parents face in symptom management due to their lack of symptom management skills. (2) Heavy caregiving burden including subjective and objective burdens. (3) High psychological pressure including elevated levels of anxiety and depression experienced by parents, as well as the sense of uncertainty in illness and concern about the child' s growth and development. (4) Misperceptions including the belief that ADHD will resolve on its own and misattribution. (5) Multiple needs including professional guidance from medical staff and the desire for support from family, school, and social network.  Conclusion  The parents of ADHD children faced many challenges and have many needs. Medical staff should provide targeted professional guidance, pay attention to their physical and mental feelings, and offer emotional support. The support system with the interaction between hospitals, families, and schools for children with ADHD should be developed, aiming to meet the needs of prevention and treatment ADHD in children.
Establishment and validation of an individual nomogram model for predicting the risk of allergic rhinitis in children with bronchial asthma
SHANG Shengli, YAO Yajun, CHEN Ming, XU Shufang
2024, 22(6): 1000-1004. doi: 10.16766/j.cnki.issn.1674-4152.003553
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  Objective  To analyze the influencing factors of children with bronchial asthma complicated with allergic rhinitis, and to build a personalized predictive nomogram model.  Methods  A total of 358 children with bronchial asthma admitted to Tangshan Third People' s Hospital from July 2019 to November 2022 were collected as the research objects. The risk factors of allergic rhinitis in children with bronchial asthma were analyzed by univariate and multivariate logistic regression. R software was used to build a nomogram model, and the consistency of the nomogram model was verified by calibration curves. Finally, two groups of clinical volumes were collected to evaluate the predictive value and differentiation of the model through the area under the curve of the subject' s working characteristic curve.  Results  One hundred ang eight of 358 children with bronchial asthma complicated with allergic rhinitis (30.17%); the results of the univariate analysis showed that there were obvious differences in smoking by family members, early use of antibiotics, interleukin-8 (IL-8), C-reactive protein (CRP), white blood cell count (WBC) between the allergic rhinitis group and the nonallergic rhinitis group (P < 0.05); that early use of antibiotics, IL-8, CRP, and WBC were influencing factors for children with bronchial asthma complicated with allergic rhinitis (P < 0.05); the slope of the calibration curve of nomogram model for predicting children with bronchial asthma complicated with Allergic rhinitis was close to 1, and the Hosmer-Lemeshow goodness of fit test was χ2=3.107, P=0.927, with good consistency.  Conclusion  This study constructs a nomogram model to predict the risk of allergic rhinitis in children with bronchial asthma based on the four risk factors of early use of antibiotics, IL-8, CRP, and WBC. It has relatively good differentiation and consistency and provides a reference for clinical intervention.
Effect of mother-infant skin contact duration on blood glucose and breast feeding of newborns of diabetic mother
LI Xiaofen, XU Mengyan, XU Jie, WU Qingqing
2024, 22(6): 1005-1007. doi: 10.16766/j.cnki.issn.1674-4152.003554
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  Objective  To explore the effects of extended mother-infant skin contact on improving blood sugar levels in newborns of mothers with diabetes mellitus (GDM), stabilizing body temperature, and promoting breast feeding.  Methods  A total of 90 full-term newborns of diabetic pregnant women who gave birth naturally in Hangzhou Women' s Hospital from February to April 2023 were selected for this study. The newborns were randomly divided into an observation group (45 cases, 90-min skin contact) and a control group (45 cases, 30-min skin contact). The body temperature, blood glucose levels, and breastfeeding status of two groups were compared at birth, 30 minutes, 90 minutes, and 2 hours.  Results  The body temperature of newborns in the observation group were higher than that in the control group at 90 minutes and 2 hours of birth (P < 0.05). The blood glucose levels of newborns in the observation group were also higher than those in the control group at these times (P < 0.05). The incidence of 2-hour hypoglycemia in the observation group was 2.22% (1/45), lower than the control group (15.56%, 7/45), but the difference was not statistically significant (χ2=3.430, P > 0.05). The success rate of the first breastfeeding, duration of sucking, and the breastfeeding scale scores of newborns in the observation group were higher than those in the control group (P < 0.05).  Conclusion  Ninety minutes of mother-infant skin contact after birth for newborns of diabetic mothers is conducive to maintaining the stability of blood sugar and temperature of newborns, and promoting exclusive breastfeeding.
Evaluation of the effect of a new intelligent management model in community follow-up management of patients with atrial fibrillation
YAN Shan, SHEN Hui, GU Zhichun, PAN Mangmang, WANG Xinhua, YE Aoxing
2024, 22(6): 1008-1012. doi: 10.16766/j.cnki.issn.1674-4152.003555
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  Objective  To explore the construction of a new intelligent management model based on the Internet + medical combination for patients with atrial fibrillation, analyze its management effect on community patients with atrial fibrillation, and scientifically and standardized management of patients with atrial fibrillation.  Methods  In Huamu Community Health Service Center, 60 patients with atrial fibrillation in Renji-Huamu Medical Union from May 2021 to May 2022 were selected as the research objects, and 30 patients were divided into control group and observation group by random number method. Routine follow-up management was performed in the control group, and intelligent follow-up management was added to the observation group based on routine follow-up. The incidence of adverse events was compared between the two groups. The management effect was evaluated by the atrial fibrillation effect on quality-of-life (AFEQT), the hospital anxiety and depression scale (HADs, including anxiety score A and depression score D), and the Morisky medication adherence scale-8 (MMAS-8).  Results  After 12 months of follow-up, AFEQT score (Z=-2.972), HADs score (ZA value=-5.255, ZD value=-5.105) and MMAS-8 score (Z=-5.353) between the two groups were statistically significant (P < 0.05). There was no significant difference in the rates of ischemic stroke/transient ischemic attack, small bleeding events, hospitalization for cardiovascular reasons or visits to secondary or tertiary hospitals, and postoperative recurrence rates between the two groups (P>0.05).  Conclusion  The new intelligent management model is beneficial for improving the quality of life of atrial fibrillation patients, enhancing medication compliance, and reducing anxiety and depression.
Cross-cultural adaptation, reliability and validity of GP-pharmacist collaboration assessment questionnaire
LI Wanchao, CAI Songtao, YAN Ming, LU Yiting, DENG Zhiling, LU Panpan, LI Haixin, XU Zhijie
2024, 22(6): 1013-1017. doi: 10.16766/j.cnki.issn.1674-4152.003556
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  Objective  The collaboration between pharmacists and general practitioners (GPs) is essential to the quality of patient care. Attitudes toward collaboration instrument for GPs (ATCI-GP) and frequency of interprofessional collaboration instrument for GPs (FICI-GP) have been used to assess GPs' attitudes towards collaboration with pharmacists and their frequency of collaboration, respectively, yet they had not been validated in the Chinese version. To provide a research tool for assessing the collaboration between GPs and pharmacists, we translate ATCI-GP and FICI-GP into Chinese and test the reliability and validity of the Chinese version.  Methods  Following the guidelines for cross-cultural adaptation and the Brislin translation principle, the ATCI-GP and FICI-GP were translated into Chinese versions of questionnaires C-ATCI-GP and C-FICI-GP. From December 2022 to February 2023, a survey was conducted among general practitioners from 25 primary health institutions in Shenzhen, Hangzhou, Xi' an, Changsha, and Beijing to analyze the reliability and validity of the questionnaire by convenience sampling method.  Results  A total of 346 questionnaires were collected, of which 320 were valid. The overall Cronbach' s α coefficient for C-ATCI-GP was 0.958, and for C-FICI-G, it was 0.967. The |CR values| for all items in both questionnaires were greater than 3.000 (P < 0.001), and the correlation coefficients between item scores and the total scale score were greater than 0.300 (P < 0.001). The content validity index (S-CVI) for C-ATCI-GP was 0.876, and for C-FICI-GP, it was 0.882. The construct validity analysis showed that C-ATCI-GP extracted 2 common factors, accounting for a cumulative variance contribution rate of 72.546%, and C-FICI-GP extracted 1 common factor, accounting for a variance contribution rate of 77.713%.  Conclusion  The Chinese versions of ATCI and FICI have good reliability and validity and can be used as reliable evaluation tools for domestic researchers to evaluate the attitude and frequency of general practitioners towards collaboration with pharmacists.
The impact of Kolb theory-based education model on care burden and psychological consistency among caregivers with recurrent schizophrenia
XU Yue, MAO Lili, ZHANG Fen
2024, 22(6): 1018-1021. doi: 10.16766/j.cnki.issn.1674-4152.003557
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  Objective  This study aims to analyze the application effect of the Kolb theory-based education model on caregivers of individuals with recurrent schizophrenia, specifically examining its impacts on caregiver care burden and psychological consistency.  Methods  A Convenience sampling was used to select a total of 110 caregivers and individuals with recurrent schizophrenia admitted to the Huzhou Third Municipal Hospital from June 2021 to June 2023. They were divided into a control group and an observation group using a random number table method, with 55 cases in each group. The control group received traditional educational guidance methods, while the observation group received an educational model based on the Kolb theory in addition to the traditional methods used in the control group. The study aimed to analyze the levels of caregiver burden, psychological consistency, anxiety, and depression in both groups of patients before and after intervention.  Results  Following the intervention, the scores and total scores of all dimensions of the caregiver burden inventory (CBI) scale decreased in both groups. However, the total score of the observation group was (37.81±3.92) points, much lower than the control group with (39.73±5.32) points, P < 0.05. Moreover, the sense of coherence-13 (SOC-13) in the observation group was (83.22±2.17) points, which was higher than that of the control group with (78.73±4.52) points, P < 0.05. Additionally, the self-rating anxiety and depression scale (SAS, SDS) in the observation group were (42.75±4.82) points and (40.26±4.81) points, respectively, which were significantly lower than those of the control group with (48.99±5.13) points and (46.78 ±5.30) points, P < 0.05.  Conclusion  The educational model based on Kolb theory can alleviate the care burden, anxiety, and depression of caregivers with recurrent schizophrenia. Additionally, it improves their psychological consistency, and play a positive role in the rehabilitation of recurrent schizophrenia patients.
Normal values of T1, T2, and ECV in 1.5T cardiovascular magnetic resonance scanning in health adults
MA Li, WU Yue, DUAN Lian, BAO Mengyuan, WU Yongshun, XING Yan
2024, 22(6): 1022-1027. doi: 10.16766/j.cnki.issn.1674-4152.003558
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  Objective  This study aims to describe normal adult myocardium, analyze the range of T1, T2, and ECV, and establish a quantitative technical reference value of cardiovascular magnetic resonance (CMR) parameters suitable for Xinjiang.  Methods  A total of 122 healthy adults who underwent CMR examination in the First Affiliated Hospital of Xinjiang Medical University from March to September 2023 were collected and analyzed. The myocardial was performed using Cvi software, and the differences in cardiac function parameters, T1, T2, and ECV values among different genders, ages, and nationalities were analyzed.  Results  The average value of T1, T2, and ECV of the whole myocardium was (1 090±74) ms, (53.0±1.7) ms, and (28.3±3.3)%, respectively. The values of T1, T2, and ECV in females were higher than those in males: T1 [(1 121±78) ms vs. (1 065±61) ms, P < 0.05], T2 [(53.3±1.4) ms vs. (52.7±1.9) ms, P < 0.05], and ECV [(29.1±2.9)% vs. (27.7±3.5)%, P < 0.001]. The values of T1 and ECV increased with age, but there was no statistical difference. The T2 values of myocardium basal segment showed statistically significant differences between different age groups, and there was a correlation between T1 and T2 values and age in the whole population. The age correlation of T2 values was shown only in the male population, and the age correlation of T1 and ECV values was independent of gender. In the analysis of ethnic variability, ethnic minorities had significantly higher T1 values than Han Chinese, but the between-group differences in T2 and ECV values were not statistically significant.  Conclusion  In this study, the values of T1, T2, and ECV in the myocardium of health adult vary with age, gender, and ethnicity. It is necessary to correct the age, gender, and ethnicity when using quantitative techniques for CMR parameters to help clinicians diagnose cardiac disease more accurately and determine disease progress based on local reference values.
Predictive value of micro-blood flow imaging in the response of patients with rheumatoid arthritis to lguratimod therapy
ZENG Ge, LONG Jun, JIANG Junjie, CAI Hui, LI Qiaofeng
2024, 22(6): 1028-1032. doi: 10.16766/j.cnki.issn.1674-4152.003559
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  Objective  The response of patients with rheumatoid arthritis (RA) to Elamod therapy is significantly related to their prognosis. It is of great significance to identify patients who do not respond to treatment with Elamod at an early stage and adjust the treatment plan in time. Based on this, this study applied micro-blood flow imaging technology to the patients with RA treated by Elamod, and discussed its predictive value for the curative effect of Erasmus in the treatment of RA patients.  Methods  A total of 139 patients with RA who received Elamod in the Huzhou Third Municipal Hospital from January 2022 to January 2023 were divided into response group (n=88) and non-response group (n=51) according to their treatment response. The data of micro-blood flow imaging before treatment were collected, and the factors influencing non-response to RA Elamod treatment were screened by multivariate logistic regression, and a prediction model was constructed to analyze the predictive value of the model.  Results  Multivariate logistic regression analysis showed that high arterial resistance index (OR=0.362), blood flow grade 0 (OR=0.440), grade Ⅰ (OR=0.314), and grade Ⅱ (OR=0.120) were the protective factors for the non-response of RA' Elamod (P < 0.05). High ESR (OR=1.117), high DAS score (OR=1.367), and long-term morning stiffness (OR=1.159) were the risk factors (P < 0.05). Based on the prediction model of the above five indexes, the C-index and AUC of RA patients who did not respond to Elamod treatment were 0.816 and 0.816 (95% CI: 0.808-0.938), respectively.  Conclusion  Pulse resistance index, blood flow classification, ESR, DAS score, and morning stiffness time are the factors influencing treatment response of patients with RA, and the prediction model on them can be used to predict the risk of non-response of RA patients to treatment.
Research progress on the relationship between trimethylamine oxide and atrial fibrillation
CHEN Xianhui, MA Yulan
2024, 22(6): 1033-1037. doi: 10.16766/j.cnki.issn.1674-4152.003560
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The gut microbiota is a complex community that interacts with the dynamic functions of the host, and proper gut microbiota structure and metabolite function are essential for maintaining homeostasis. In recent years, a large number of studies have demonstrated that the gut microbiota and its derived metabolites influence the development of cardiovascular diseases, including cardiac arrhythmias, of which atrial fibrillation is one of the most common. Trimethylamine oxide (TMAO) is one of the most studied gut microbiota-derived metabolites, and TMAO has been found to be strongly associated with the development of atrial fibrillation. Many epidemiological studies have shown that TMAO plays a role in the onset, development and prognosis of atrial fibrillation (AF). TMAO increases the susceptibility to AF by contributing to the development of multiple cardiovascular risk factors. In addition, TMAO promotes atrial structural remodeling by stimulating inflammatory responses, causing cardiac fibrosis and atrial pyroptosis. Elevated levels of TMAO also increase atrial electrophysiological instability, triggering ectopic activity that leads to electrophysiological remodeling, and directly or indirectly activate the autonomic nervous system to cause neural remodeling that induces atrial fibrillation. In addition, elevated levels of TMAO induce platelet hyper-reactivity, which promotes arterial thrombosis, increases the incidence of thromboembolism in AF, and is also significantly associated with AF recurrence after ablation. TMAO has been shown to have some potential values in the prevention and treatment of AF. The composition of the gut microbiota can be modulated through dietary habits by reducing the intake of trimethylamine-producing dietary precursors and thereby reducing circulating levels of TMAO, by increasing the excretion of TMAO from the kidneys through certain drugs, and by directly taking prebiotics, probiotics, or through fecal flora transplantation, which can in turn alter the levels of gut microbiota -derived metabolites. In this paper, we review the above aspects based on the findings of the related literature, with the aim of providing a theoretical basis for future related studies.
The advancing research progress of the correlation and mechanism between osteoporosis and bacterial flora
MU Yapeng, ZHUANG Xianghua, SONG Yuwen, XU Peichen, LOU Nengjun, CHEN Shihong
2024, 22(6): 1038-1042. doi: 10.16766/j.cnki.issn.1674-4152.003561
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Osteoporosis (OP) is a serious public health problem that affects the quality of life of patients and can lead to fragility fracture. Various studies have shown that OP is closely associated with dysbiosis, which refers to an imbalance of the body's microbiota. Dysbiosis has been linked to a range of systemic diseases, including OP. This paper provides an overview of both fundamental and clinical studies related to flora and OP, summarizing the underlying mechanisms behind alterations in intestinal and oral flora with a specific focus on distinct bacterial species and genera. Bacterial flora affects pathways related to OP pathogenesis by mediating hormonal effects, producing specific metabolites, inducing immune cell differentiation, and altering the levels of inflammatory factors. Different genera have different roles in the pathogenesis of the disease. Lactobacillus, bifidobacterium and fusobacterium in the intestinal flora have protective roles, while Serratia marcescens is a risk factor. TM7 and Lactobacillus in oral flora may have protective effects, and actinomyces and Forsestanella may promote bone resorptive through inflammatory response. Some genera also play a role in maintaining flora balance. This review aims to provide ideas and references for the treatment of OP by summarizing the connection and interaction mechanism between OP and flora.
Research progress on biomarkers of mild cognitive impairment
GAO Song, ZHANG Min, LU Yuan
2024, 22(6): 1043-1046. doi: 10.16766/j.cnki.issn.1674-4152.003562
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Mild cognitive impairment (MCI) is a clinical transitional state between normal aging and dementia, which is considered to be the preclinical stage of Alzheimer's disease (AD). Due to the irreversible nature of the course of AD, and the lack of clinically available therapies to improve or delay the disease progression, the early detection, diagnosis and intervention of MCI are crucial in reducing the incidence of AD and delaying its progression. On one hand, research on biomarkers can serve as the foundation for elucidating the pathological mechanisms underlying the disease. On the other hand, it provides objective evidence for early screening and diagnosis. This paper reviewed the research progress of MCI biomarkers from the cerebrospinal fluid, blood and genetics perspectives with a focus on the analysis and discussion advancements in biomarkers (especially amyloid protein, phosphorylated tau protein) found in cerebrospinal fluid and blood. The study of biomarkers from different sources and pathways has their own advantages and disadvantages. MCI hematological biomarkers have significant potential for clinical translation with promising research prospects. The standardization of biomarkers is still a major direction in MCI research field.
Pelvic floor ultrasound evaluation of the clinical efficacy of floating needle therapy combined with pressing needle and embedding needle at acupoints in the treatment of patients with stress urinary incontinence
WANG Shishuai, XU Qiudong, CHEN Fengna
2024, 22(6): 1047-1050. doi: 10.16766/j.cnki.issn.1674-4152.003563
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  Objective  To analyze the clinical efficacy of floating needle therapy combined with pressing needle point embedding therapy in the treatment of patients with stress urinary incontinence, and to explore the clinical value of evaluating its efficacy through perineal pelvic floor ultrasound.  Methods  A total of 110 patients with stress urinary incontinence admitted to Ningbo Traditional Chinese Medicine Hospital from September 2022 to November 2023 were selected as the study subjects. They were randomly divided into a control group and an experimental group, with 55 cases in each group. The control group was treated with biofeedback electrical stimulation combined with pelvic floor muscle training, and the experimental group was treated with floating needle therapy combined with pressing and embedding acupuncture points. The ultrasound parameters of two groups of patients during resting state and maximum Valsalva maneuver were observed, including bladder neck position, detrusor muscle thickness (DWT), urethral inclination angle (UTA), bladder neck movement (BND), posterior angle of bladder urethra (RVA), and urethral rotation angle (URA). The incidence of urethral infundibulum during the maximum Valsalva maneuver was calculated.  Results  After the treatment, there was no statistically significant difference in the resting bladder neck position, DWT, and RVA between the two groups (P>0.05), and the UTA in the experimental group was higher than that in the control group (P < 0.05). The BND of both groups of patients significantly decreased during the maximum Valsalva maneuver (P < 0.05), and the BND in the experimental group was lower than that in the control group (P < 0.05) after the treatment. There was no statistically significant difference between the two groups of RVA and URA (P>0.05). The incidence of urethral infundibulum in the experimental group was 87.27% (48/55), significantly lower than 100.00% (55/55) in the control group (P < 0.05).  Conclusion  The combination of floating needle therapy and pressing needle embedding therapy at acupoints is more effective for patients with stress urinary incontinence, which is more conducive to reducing the incidence of urethral infundibulum. The evaluation of the rehabilitation effect by perineal pelvic floor ultrasound has a certain clinical reference value.
Effects of different moxibustion methods on cancer-related fatigue in patients with gastrointestinal cancer undergoing chemotherapy
ZHU Xiaoyan, HU Yingying
2024, 22(6): 1051-1054. doi: 10.16766/j.cnki.issn.1674-4152.003564
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  Objective  To compare the effects of different moxibustion methods on cancer-induced fatigue in patients with gastrointestinal tumors during chemotherapy, and provide evidence for improving the efficacy of adjuvant therapy for gastrointestinal tumors.  Methods  A total of 108 patients with gastrointestinal malignancies who received postoperative chemotherapy in Jinhua Traditional Chinese Medicine Hospital from January 2021 to April 2023 were selected and randomly divided into the conventional group, the traditional group, and the moxibustion warm group with 36 cases in each group according to random number table method. Cancer fatigue degree, quality of life, and blood routine were compared before and after intervention.  Results  After the intervention, the scores of all dimensions (emotional, physical, and cognitive) and the total score of the cancer fatigue scale in the traditional group and the warm moxibustion group were significantly lower than those in the conventional group (P < 0.05). After the intervention, all QLQ-C30 scales (physical, role, emotional, cognitive, social, overall quality of life, fatigue, nausea and vomiting, pain, dyspnea, sleep disorders, appetite loss, constipation, diarrhea, and perceived economic hardship) in the traditional group were significantly better than those in the conventional group, and the scores in the moxibustion warm group were significantly better than those in the traditional group (P < 0.05). After the intervention, red blood cell count and platelet count were (4.98±1.63) ×1012/L and (141.96±27.85) ×109/L in the traditional group, and (5.65±0.74) ×1012/L and (149.75±26.89) ×109/L in moxibustion warm group, respectively, which were significantly higher than those in the conventional group (4.15±1.52) ×1012/L and (133.76±25.77) ×109/L (F= 4.255, 8.175, both P < 0.05).  Conclusion  Moxibustion can effectively relieve the symptoms of cancer-related fatigue in patients with gastrointestinal tumors during chemotherapy, and improve the level of blood routine and their quality of life. Moxibustion applied at 41-42 ℃ is more conducive to improving the efficacy of moxibustion.
Application of simulation combined with PBL integrated teaching in clinical skills teaching of electrocardiogram
LIAO Pinliang, ZHANG Zhihui, LI Huakang, ZHANG Yu, CUI Yuanting
2024, 22(6): 1055-1058. doi: 10.16766/j.cnki.issn.1674-4152.003565
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  Objective  To explore the effect of electrocardiogram (ECG) simulation combined with problem-based learning (PBL) teaching on clinical skills of electrocardiogram on five-year undergraduate students.  Methods  A total of 138 fourth-year students of 2019 five-year clinical medicine who participated in the training of "Clinical Skills" electrocardiogram section at the First Affiliated Hospital of the Army Medical University in March 2023 were selected as the research subjects. They were divided into an observation group, a simulation group, and a control group by random drawing method, with 46 participants in each group. The observation group used simulation combined with PBL integrated teaching method, the simulation group only used simulation teaching tools combined with traditional lecture-based learning (LBL) teaching method, and the control group used standardized patient (SP) combined with traditional LBL teaching method. At the end of the course, the implementation effects of the three teaching methods were evaluated through the electrocardiogram skill operation, ECG judgment, and questionnaire survey.  Results  There was no statistical difference in skill operation assessment scores among the three groups. However, the ECG diagnostic scores of the observation group were significantly higher than that of the simulation group and the control group (91.54±3.73 vs. 87.78±5.41 vs. 86.06±5.25, F=15.290, P < 0.001). The questionnaire results showed that the questionnaire results showed that the active learning interest achievement rate of the observation group was higher than that of the control group, and the difference was statistically significant (95.65% vs. 78.26%, P < 0.05). At the same time, in terms of student evaluation of teaching methods, the observation group had a higher satisfaction rate than the other two groups, and the difference was statistically significant (97.83% vs.82.61%, P < 0.05; 97.83% vs.80.43%, P < 0.05).  Conclusion  Compared with the LPL teaching method based on SP and simulation tools, the integrated teaching method of simulation and PBL improves the teaching quality of ECG clinical skills, which is helpful to improve medical students' interest in learning electrocardiogram skills and their teaching satisfaction.
Analysis of trend and age-period-cohort model on ischemic stroke incidence and mortality from 1990 to 2019 in China
WANG Qianyou, ZHAO Boxuan, WANG Wen'an
2024, 22(6): 1059-1063. doi: 10.16766/j.cnki.issn.1674-4152.003566
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  Objective  To analyze the incidence and mortality trend of ischemic stroke in China from 1990 to 2019, and explore the effects of age, period, and cohort on the incidence and mortality risk of ischemic stroke.  Methods  The incidence and mortality of ischemic stroke in China were collected from the Global Burden of Disease database. The joint regression model and age-period-cohort (APC) model were used to analyze the trend of incidence and mortality of ischemic stroke and the age, period, and cohort effects affecting the incidence and mortality of ischemic stroke, respectively. Jointpoint software and Stata software were used.  Results  The average annual percent change in incidence and mortality of ischemic stroke in China from 1990 to 2019 was 3.5% (95% CI: 3.5%-3.6%) and 2.8% (95% CI: 2.5%-3.1%), showing an increasing trend. The APC model suggested that the risk of ischemic stroke and death increased with age and year, with the later birth cohort having a lower risk of onset and death than the earlier birth cohort.  Conclusion  The overall incidence and mortality of ischemic stroke in China increased year by year from 1990 to 2019. The risk of ischemic stroke incidence and death is higher in people with older age, more recent lifetimes, and earlier birth. Prevention of ischemic stroke should be strengthened in special groups to reduce the disease burden.
The effect of flexion position maintenance time on Hb, ROM and VAS after total knee arthroplasty
WENG Huiying, SHEN Dandan, SHEN Jiamin, DING Liying
2024, 22(6): 1064-1067. doi: 10.16766/j.cnki.issn.1674-4152.003567
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  Objective  To investigate the effect of postoperative flexion position maintenance time on Hb, Range of motion (ROM) and visual analogue scale (VAS) in patients undergoing total knee arthroplasty (TKA), and to analyze the effect of position maintenance time on postoperative complications.  Methods  A total of 110 TKA patients admitted to the First People's Hospital of Huzhou from March to November 2023 were selected as the study subjects. TKA patients were divided into 6 h group, 24 h group and 48 h group according to the time of postural maintenance. The swelling degree and subcutaneous ecchymosis area of the three groups were compared at 7 days after operation. The postoperative blood loss was compared among the three groups. The postoperative knee joint activity and pain level were compared among the three groups.  Results  The level of Hb in 48 h group was higher than that in 6 h group and 24 h group at 3 d and 5 d after operation (P < 0.05). The ROM of 5 d and 7 d in 48 h group were higher than those in 6 h group and 24 h group, and the VAS scores were lower than those in 6 h group and 24 h group (P < 0.05). Bivariate correlation Tau-b (K) analysis showed that the duration of flexion position was positively correlated with Hb and ROM (r=0.519, 0.491, P < 0.001), and the duration of flexion position was negatively correlated with VAS (r=-0.494, P < 0.001). There was no significant difference in the incidence of complications among the three groups [48 h group: 5.41%(2/37); 24 h group: 8.11%(3/37); 6 h group: 13.89%(5/36), P>0.05].  Conclusion  Forty-eight hours of flexion position maintenance can promote the recovery of knee joint function, reduce blood loss and relieve postoperative pain in TKA patients. At the same time, the position maintenance time is positively correlated with Hb, ROM and VAS.
The application of low-temperature hand and foot covers combined with "five precautions" education in the prevention of taxane-related peripheral neuropathy
XU Lingjie, RAO Weiwei, LIU Jing, HAN Yueyue, YANG Yan
2024, 22(6): 1068-1072. doi: 10.16766/j.cnki.issn.1674-4152.003568
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  Objective  To explore the application effect of non-pharmacological intervention in the prevention of taxane-related peripheral neuropathy.  Methods  A total of 252 patients who were hospitalized in the Department of Oncology of the First Affiliated Hospital of Bengbu Medical University and received taxane-based chemotherapy were selected as the study subjects. Among them, 125 patients from July to December 2022 were taken as the control group, and 127 patients from January to June 2023 were taken as the observation group. Patients in the control group received routine chemotherapy care from the medical oncology department, while patients in the observation group received low-temperature hand and foot covers combined with "five precautions" education. The peripheral neuropathy including symptom experience, quality of daily life, and adverse home safety events between the two groups were compared.  Results  The incidence, severity, and degree of symptom distress of finger/hand numbness, toe/foot numbness, toe/foot tingling, finger/hand or toe/foot discomfort, and muscle or joint pain in the observation group were lower than those in the control group (P < 0.05). The observation group had lower rates of holding small items [38.58% (49/127)], sleeping [46.46% (59/127)], writing [55.91% (71/127)], and doing household chores [62.99% (80/127)] compared to the control group [52.00% (65/125), 61.60% (77/125), 69.60% (87/125), 82.40% (103/125), P < 0.05]. The incidence of home falls (5.51%, 7/127) and collisions (7.87%, 10/127) in the observation group were lower than those in the control group [16.00% (20/125) and 18.40% (23/125), P < 0.05].  Conclusion  The use of low-temperature hand and foot covers in combination with "five precautions" education can effectively reduce the occurrence of taxane-related peripheral neuropathy, improve patients' symptom experience and quality of daily life, and reduce the occurrence of adverse home safety events.
Establishment of nursing quality evaluation index of awake prone position ventilation
LIU Pengting, ZHANG Xue
2024, 22(6): 1073-1076. doi: 10.16766/j.cnki.issn.1674-4152.003569
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  Objective  To construct a scientific and feasible nursing quality evaluation index for prone ventilation in awake patients, and to provide a comprehensive, standardized and quantifiable theoretical framework for evaluating the nursing quality of prone ventilation in awake patients.  Methods  Guided by Donabedian's "structure-process -result" three-dimensional quality structure model, the research group conducted literature analysis and semi-structured interview to gradually formulate the evaluation indexes for nursing quality during prone ventilation in awake patients. Objective sampling was adopted from November 2022 to January 2023. Two rounds of Delphi expert consultation were conducted on 25 nursing and public health experts with respiratory, acute and critical care experience from 5 tertiary hospitals in Shanxi, Shaanxi and Henan. After statistical processing, the evaluation indexes of nursing quality of prone ventilation for awake patients were finally established according to the importance scores and coefficient of variation of the indexes.  Results  The recovery rates for both rounds of expert correspondence consultation questionnaires were 100%. The expert authority coefficient was 0.960, and the Kendall harmony coefficient were 0.136 and 0.160 (P < 0.01). The final evaluation index of prone ventilation nursing quality for conscious patients was composed of 3 primary indexes, 9 secondary indexes and 51 tertiary indexes.  Conclusion  The evaluation index of prone ventilation nursing quality for awake patients established in this study is highly reliable, scientific and practical. The weight of the index is set reasonably to provide a theoretical reference for nursing managers to evaluate the nursing quality of clinical nurses implementing prone ventilation for awake patients. It also provide operational guidance and decision-making basis for comprehensively improving the nursing quality of clinical nurses implementing prone ventilation for awake patients.
A case of neonatal type Ⅰ Alagille syndrome caused by nonsense mutation of JAG1 gene c.439C>T
LIU Song, CHENG Rui
2024, 22(6): 1077-1080. doi: 10.16766/j.cnki.issn.1674-4152.003570
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To explore the clinical and genetic characteristics of a newborn suspected of Alagille syndrome. The clinical data and peripheral blood DNA of the newborn were collected. The target gene capture technology was used to detect related gene mutations, and the source of mutations was verified by Sanger sequencing. The main clinical manifestations of this newborn were cholestasis, congenital heart disease, and butterfly vertebra. Gene sequencing showed that a spontaneous heterozygous mutation named c.439C>T (p.Q147X) occurred in the JAG1 gene. This nonsense mutation leads to premature termination of the peptide chain synthesis encoding JAG1 protein. According to American College of Medical Genetics and Genomics (ACMG) guidelines, the variant was determined to be pathogenic (PVS1+PS2+PS4+PM2_Supporting). The newborn was diagnosed with type Ⅰ Alagille syndrome caused by a mutation in the JAG1 gene. This provides a reference basis for later diagnosis and treatment or genetic counseling.
Refractory hypertension caused by bilateral renal artery stenosis: a case report and literature review
LI Wentao, LIU Chuan, XAING Tong, CAO Ruojin, WU Hao
2024, 22(6): 1081-1084. doi: 10.16766/j.cnki.issn.1674-4152.003571
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Refractory hypertension caused by bilateral renal artery stenosis (RAS) has a low incidence and is difficult to diagnose and treat clinically. The Department of General Medicine of Xuanwu Hospital Capital Medical University admitted a 48-year-old male patient with a recent history of severe hypertension. Considering the patient's age and severity of hypertension, we screened for common causes of secondary hypertension. Further abdominal aortic CTangiography showed moderate to severe stenosis at the openings of the bilateral renal arteries, which led to refractory hypertension. Therefore, angioplasty of both renal arteries was performed as a staged procedure, and the patient's blood pressure was gradually controlled and stabilized during postoperative follow-up. This article reviews the specific diagnosis and treatment process and reviews relevant literature.

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