2022 Vol. 20, No. 10

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Expert Forum
The current situation and prospect of the primary public health services in China in the new era
LYU Yi-peng, CHENG Fan, ZHANG Xiao-qiong, KUANG Hai-dong, YU Hong-jie, WANG Zhao-xin
2022, 20(10): 1631-1634. doi: 10.16766/j.cnki.issn.1674-4152.002666
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With the development of the economy and society, the disease characteristics and its corresponding health needs have changed. Improving the capacity of primary public health services will help improve people ' s health and reduce health expenditure. At the National Health Conference, it was proposed that the health work in the new era should "focus on the primary health". This paper focuses on primary public health service, especially the chronic disease management, health management and primary health emergency. There are three main current health demand situations: the increase in the burden of chronic diseases, the expansion of health needs for active health management, and the increase in primary health needs for epidemic prevention and control which bring new challenges to primary public health management. We analyzed the current situation of primary medical and health services and found several problems. Firstly, the primary health service institutions take several management measures on the chronic diseases management but still remains problems like the lagging primary prevention and management of chronic diseases and lagging information system construction. Secondly, in terms of active health management, there are problems such as limited development level, formalistic management, and shortage of human resources at the primary health service institutions. Thirdly, concerning the health emergency management, there are weak "before control" capabilities for pandemic prevention and control. With the comparing and analysis, we introduce the importance of construction in these field and the current status. Based on the main contradictions and gaps between the demand and supply, we propose to take chronic disease management as the core, widening the boundaries of health management, enriching primary health resources, appropriately tilt to the field of public health management, enhancing enthusiasm, promoting the construction of informatization system and platforms, fully amplifying the effectiveness of big data on health improving the self-health management initiative of the population, completing the construction of primary health emergency response policies, regulations and plans to improve emergency response efficiency. With all these measures, we intend to enhance primary public health service capabilities in the new era and achieve the "Healthy China 2030" strategic goal.
Development of Additional GP skills in United Kingdom General Practice（to be continued）
Rodger Charlton, LIU Zi-zhen, LIU Man-ling
2022, 20(10): 1635-1636.
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Study on the relationship between dietary factors and mean amplitude of glycemic excursions in patients with diabetes mellitus type 2
WANG Xian, PAN Yan, BA Ming-yu, WAN Hong, FU Yu, YAN Shu-xun
2022, 20(10): 1691-1694. doi: 10.16766/j.cnki.issn.1674-4152.002681
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  Objective  To observe the relationship between dietary factors and mean amplitude of glycemic excursions in diabetes mellitus type 2 (T2DM) patients with a dynamic blood glucose monitoring system.  Methods  A total of 346 patients with T2DM aged from 18 to 60 who were hospitalized in the Department of Endocrinology, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2016 to December 2017 were selected as the study subjects. They were monitored continuously for 72 hours and their amplitude of glycemic excursions were analyzed. The average daily intake of various foods was obtained by 24 hours dietary review method and 3 days condiment estimation method, and the adjusted dietary balance index-07 (DBI-07) was used to calculate the intake score of various foods. The subjects were divided into three groups according to the mean amplitude of glycemic excursions (MAGE) level, and the differences in food intake scores of each group were compared. Multivariate linear regression was used to assess the influence of dietary factors on amplitude of glycemic excursions.  Results  With the increase of the amplitude of glycemic excursions, the level of prealbumin and skeletal muscle mass of the limbs decreased (F=47.124, 17.354, trend P < 0.001, < 0.001). Participants consumed 250 mL of dairy products per day had a 14.0% decrease in the mean amplitude of glycemic excursions compared to those who did not consume enough dairy products (OR=0.860, 95% CI: 0.818-0.895). Participants with vegetable intake greater than 150 g/d had a 9.9% decrease in the mean amplitude of glycemic excursions compared with less vegetable intake (OR=0.901, 95% CI: 0.845-0.962).  Conclusion  Insufficient intake of dairy products and vegetable is associated with increased blood glucose fluctuation, and the prevention of protein malnutrition should be emphasized in the medical nutritional treatment in type 2 diabetes.
Analysis of the level of physical activity and influencing factors of the young and middle-aged maintenance haemodialysis patients
WANG Ying-wei, ZHANG Geng-rui, LIU Xin-yu, YANG Yang
2022, 20(10): 1695-1699. doi: 10.16766/j.cnki.issn.1674-4152.002682
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  Objective  To explore the level of physical activity of young and middle-aged maintenance haemodialysis (MHD) patients and analyse its influencing factors.  Methods  A total of 267 young and middle-aged patients with MHD treated in the blood purification department of four hospitals in Nanyang from May to December 2020 were enrolled. The basic data questionnaire and the international physical activity questionnaire (IPAQ) were used in collecting relevant data and analysing the level of physical activity, and influencing factors were examined through multiple-factor logistic regression analysis.  Results  A total of 267 cases of MHD were investigated: 81 cases were adequately physically active (30.34%), and 186 cases were insufficiently physically active (69.66%). As dialysis age increased, the proportion of insufficient physical activity gradually increased (Z=5.459, P < 0.001). The results of multivariate logistic regression analysis showed that dialysis age (OR=1.726, P=0.002), family monthly income (OR=1.213, 1.457, all P < 0.001), dialysis frequency (OR=1.572, P < 0.001), dialysis mode (OR=1.425, P < 0.001), nutritional level (OR=1.253, P < 0.001; OR=0.634, P=0.021), comorbidity index (OR=1.715, P < 0.001), blood creatinine level (OR=1.919, P < 0.001), blood urea nitrogen level (OR=1.895, P < 0.001), hemoglobin level (OR=1.172, P=0.004), blood calcium level (OR=0.435, P=0.038) and brain natriuretic peptide level (OR=3.186, P < 0.001) were influential factors of physical activity of young and middle-aged patients with MHD (all P < 0.05).  Conclusion  Patients with MHD consitute a high-risk group of insufficient physical activity. The level of physical activity is mainly affected by adequacy of dialysis, nutritional level, frequency and mode of dialysis, family economics and comorbidities. It is suggested that the evaluation and intervention of nutrition and physical activity in MHD patients should be emphasized.
Expression of NLRC5 in cervical cancer and the correlation with the patients ' survival prognosis
HE Run-hua, ZHAN Lei, SONG En-xue, WEI Bing, LING Lin
2022, 20(10): 1700-1703. doi: 10.16766/j.cnki.issn.1674-4152.002683
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  Objective  To investigate the correlation between the expression of NLRC5 (NOD-like receptor family caspase recruitment domain family-containing 5) in cervical cancer tissue and paracancerous tissue and the prognosis of cervical cancer patients.  Methods  A total of 60 patients with cervical cancer who were diagnosed and treated in the Second Affiliated Hospital of Anhui Medical University from January 2013 to June 2016 were selected. The cancer tissues and paracancerous tissues of cervical cancer surgery were collected and detected by immunohistochemistry. The expression of NLRC5 in cervical cancer tissues and paracancerous tissues was analyzed, and the correlation between the expression of NLRC5 and the prognosis of cervical cancer patients was analyzed.  Results  The positive expression of NLRC5 in cervical cancer tissues was lower than that in paracancerous tissues [15(25.00)% vs. 50(83.33%), P < 0.05)]. The expression of NLRC5 in cervical cancer tissue and the clinicopathological characteristics of patients were analyzed, and it was found that the negative expression of NLRC5 was correlated with the depth of invasion and tumor size of cervical cancer (χ2=11.769, 5.926, all P < 0.05). The expression of NLRC5 was not correlated with age, pathological type, lymph node metastasis (all P>0.05). The Kaplan-Meier curve of survival and prognosis of cervical cancer was drawn. It was found that the survival time of patients with negative NLRC5 expression were shorter than those with positive expression (P < 0.05). Univariate or Cox multivariate analysis was performed on the prognostic factors of cervical cancer, and it was found that the negative expression of NLRC5, lymphatic metastasis and depth of invasion were independent risk factors for the prognosis of cervical cancer (all P < 0.05).  Conclusion  Compared with paracancerous tissues, NLRC5 shows a low expression pattern in cervical cancer tissues. Meanwhile, the negative expression of NLRC5 is an independent risk factor affecting the prognosis of cervical cancer patients. This finding may be used for the diagnosis and treatment of cervical cancer.
Clinical application value of R-way colposcopy diagnosis system in diagnosing cervical diseases
WANG Li-qun, HE Yu, LI Xu, YANG Kang, ZHU Hong, WANG Ya-fei
2022, 20(10): 1704-1707. doi: 10.16766/j.cnki.issn.1674-4152.002684
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  Objective  To evaluate the clinical value of the R-way colposcopy diagnosis system in diagnosing cervical diseases.  Methods  From January 2018 to December 2018, amongst the patients who visited the colposcopy clinic of the First Affiliated Hospital of Bengbu Medical College, 380 patients with complete image and pathological follow-up results were selected. The R-way diagnosis system was used to analyse the images retrospectively and provide diagnosis results. Histopathological diagnosis was taken as the "gold standard" to compare the sensitivity, specificity, Youden index, and consistency test of the R-way diagnostic system and 2011 colposcopy diagnostic terms in the diagnosis of cervical lesions. We further calculated the area under the ROC curve and evaluated the clinical value of the R-way diagnostic system in diagnosing cervical diseases.  Results  The R-way diagnosis system had a sensitivity of 62.9%, a specificity of 100.0%, Youden index of 69.2%, and a concordance rate of 98.9% for diagnosing cervical cancer. The sensitivity for diagnosing high-grade squamous intraepithelial lesions (HSIL) was 84.9%, the specificity was 89.5%, the Youden index was 74.5%, and the concordance rate was 88.4%. The sensitivity for diagnosing low-grade squamous intraepithelial lesions (LSIL) was 76.1%, specificity was 79.0%, Youden index was 55.1%, and concordance was 78.2%. With the assumption that HSIL and above lesions were the positive group, LSIL and other lesions were the negative group. The sensitivity of the positive group of the R-way system and colposcopic terminology were 86.8% and 73.6%, respectively, the specificity were 90.5% and 90.9%, and the area under the ROC curve were 0.887 and 0.822.  Conclusion  The R-way diagnostic system is a simple, easy, stable and effective diagnostic system for objectively evaluating colposcopic images. It has high-potential clinical application and promotion value.
Current status and related risk factors of stress injury in children in neonatal intensive care unit
FENG Zhe, WANG Yang, LAN Duan-yun, YI Jing, JU Min
2022, 20(10): 1708-1710. doi: 10.16766/j.cnki.issn.1674-4152.002685
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  Objective  To understand the occurrence, distribution characteristics and risk factors of neonatal intensive care unit (NICU) pressure injuries.  Methods  Total 467 children admitted to the NICU of Nanyang Central Hospital from January to December 2019 were selected. The relevant demographic data, condition, location and physical signs of pressure injury that affect the risk of pressure injury in children were collected. These factors were analysed by logistic regression.  Results  Amongst the 467 children, 79 cases (93 places) had different degrees of stress injury, the incidence of stress injury was 16.92%. Among 93 places, 62.37% (58 places) of the stress injuries were related to medical equipment and 83.87% (78 places) of the degree of damage was a phase 1 injury. The high-risk part of the stress injury was the nose [20.43% (19/93)] followed by the appendix [17.20% (16/93)], the cheek [11.83% (11/93)], the occipital [10.75% (10/93)], the mouth [9.68% (9/93)], the heel [7.53% (7/93)], and behind the ears [6.45% (6/93)]. NICU stay ≥7 days (OR=3.025, 95% CI: 1.178-7.729), mechanical ventilation (OR=4.568, 95% CI: 2.110-9.848), unconsciousness (OR=4.397, 95% CI: 1.860-10.351), somnolence (OR=5.447, 95% CI: 2.359-12.578) and critical illness (OR=3.142, 95% CI: 1.184-8.340) were independent risk factors for stress injury in children in the NICU.  Conclusion  NICU injuries are mainly medical equipment-related stress injuries. The high-risk predisposing factors vary and are related to the child' s condition, restricted activities and use of medical equipment.
Effect of continuous intraspinal pump injection of patient-controlled labor analgesia in vaginal delivery
GUO Hui-fang, CHEN Yi-jun, ZHAO Wan-ping, SHI Liang-fang
2022, 20(10): 1711-1714. doi: 10.16766/j.cnki.issn.1674-4152.002686
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  Objective  To investigate the effects of patient-controlled epidural analgaesia (PCEA) on labour pain, labour process, postpartum complications and pelvic floor muscle strength of vaginal delivery.  Methods  From January 2019 to October 2021, 153 pregnant women with vaginal delivery were included in the Obstetrics Department of Xianju County People' s Hospital, they were divided into observation group (77 cases) and control group (76 cases) using random number table method. The control group used routine reasonable body position guidance, psychological counselling and other delivery support measures, whereas the observation group used PCEA painless delivery technology. Labour pain, labour process time, postpartum complications and pelvic floor muscle strength of vaginal delivery women in the two groups were compared.  Results  No statistical difference was found between the two groups (all P > 0.05). The levels of labour pain in the control group were as follows: 18 cases of grade Ⅱ (23.68%), 58 cases of grade Ⅲ (76.32%) in the control group, 20 cases of grade 0 (25.97%), 57 cases of grade Ⅰ (74.03%) in the observation group, there significant difference was found between the two groups (Hc=128.090, P < 0.001). There were significant differences in the total stage of labour, the first stage of labour, the rate of uterine dilatation and the rate of foetal head descent between the two groups (all P < 0.05). Difference in incidence of postpartum urinary retention was found between the groups, and the difference was statistically significant (P < 0.05). The pelvic floor muscle strength score by intravaginal digital diagnosis of the control group was (2.36±0.85) points and that of the observation group was (3.82±0.69) points, significant difference was found between the two groups (t=11.672, P < 0.001).  Conclusion  PCEA painless delivery technology is safe and effective in vaginal delivery, which is conducive to maternal and infant outcomes.
Healthy examination results and 5-year follow-up analysis of the elderly in a community of Pudong New Area, Shanghai
TAN Shu-feng, SHEN Hong-wei, LI Tao, WANG Xiong, LIAO Qiao
2022, 20(10): 1715-1717. doi: 10.16766/j.cnki.issn.1674-4152.002687
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  Objective  To investigate dynamic changes in the results of healthy examination and incidence of chronic diseases in the elderly aged 65 and then to provide a reference for the formulation of regional health management plan for the elderly.  Methods  A total of 2 846 elderly people over 65 in a community of Pudong New Area in Shanghai who continued to participate in healthy examination from January 2014 to December 2019 were selected as the research subjects. Subjects with malignant tumours, serious blood system diseases and liver and kidney diseases were excluded. All subjects maintained a bland diet one day before sample collection, did not undergo strenuous exercise 24 hours before sample collection and fasted for 12 hours before sample collection. Blood samples were obtained while their stomachs were empty in the morning. Height, weight, body mass index and blood pressure were measured by professional physical examination doctors, and general data were collected. Biochemical indexes and abdominal ultrasound examination data were collected and analysed.  Results  The blood pressure, blood glucose, glycosylated haemoglobin, low-density lipoprotein, triglyceride, total cholesterol and blood uric acid levels in the elderly people in 2019 significantly increased relative to those in 2014 (all P < 0.05). In addition, the detection rates of hypertension, diabetes, hyperlipidaemia, hyperuricaemia and hyperuricemia in 2 846 elderly people in 2019 (33.1%, 28.3%, 24.2%, 23.8%, 28.4%) were significantly higher than those in 2014 (22.6%, 18.1%, 15.1%, 14.9%, 19.2%, all P < 0.05).  Conclusion  The levels of metabolic indexes and the detection rates of hypertension, diabetes, hyperlipidaemia and hyperuricaemia in the community aged over 65 in Pudong New Area show an upward dynamic change. These results suggeste that early intervention and health education for hypertension and abnormal glucose and lipid metabolism should be carried out in community elderly.
Application of standard chemical quantity method and target management method in the performance evaluation of contracted family doctors in the suburb of Beijing
CHEN Jing-jing, PENG Ying-chun, WANG Hai-li, YANG Kai-wen
2022, 20(10): 1718-1723. doi: 10.16766/j.cnki.issn.1674-4152.002688
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  Objective  To establish a set of performance appraisal schemes for the contracted service of family doctors in community health service agencies in the mountainous area to mobilise the enthusiasm of family doctors in mountainous areas and improve the effect of contracted services.  Methods  From September 2019 to May 2020, through questionnaire surveys, key insider interviews, focus group discussions and field studies of typical cases, researchers can describe the current situation of contracted family doctor services in mountainous areas, establish a performance appraisal plan for family doctors contracted in mountainous areas in Beijing and evaluate the actual application effect of the program in the organisation. The qualitative data adopted the thematic framework method and content analysis method for descriptive analysis and explanatory analysis.  Results  The research completed the design of the performance appraisal plan for family doctors contracted by community health service institutions. Using a combination of standard chemical quantity method and target management method, the assessment of contracted family doctor services in mountainous areas was carried out from the four dimensions of service quantity, service quality, satisfaction and target completion. The awareness, satisfaction and awareness rate of contracted services of family doctors by the residents of Liulimiao Community Health Service Centre who carried out the case study increased from 55.00% (ranking 12th), 50.00% (ranking 9th) and 60.00% (ranked 4th) in 2019 to 92.00%, 92.49% and 89.80% in 2020, respectively. All three indicators ranked first amongst the 16 community health service centres in the district.  Conclusion  Constructing a performance appraisal program for contracted family doctor services that conforms to the work characteristics of mountainous areas can mobilise family doctors' enthusiasm for work and promote the benign development of family doctors' contracted services.
Application of life and social skill training in elderly patients with bipolar disorder in remission stage
LI Yong-mei, WANG Jian-nyu
2022, 20(10): 1724-1727. doi: 10.16766/j.cnki.issn.1674-4152.002689
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  Objective  To investigate the effect of life and social skills training on affective symptoms, overall function, and cognitive function in elderly patients with bipolar disorder in remission stage.  Methods  A total of 106 elderly patients with bipolar disorder in remission stage from January 2018 to January 2021 in Hangzhou Seventh People' s Hospital were selected. They were randomly divided into the study group (life and social skill training + routine-nursing group) and control group (routine-nursing group) by using the random-number-table method, with 53 cases in each group. After 8 weeks, 43 and 52 patients in the study and control groups, respectively, completed the treatment. Before and after treatment, the 17-item Hamilton rating scale for depression (HAMD-17), Young manic rating scale (YMRS), functioning assessment short test (FAST), and Wisconsin card sorting test-modified (WCST) were used to evaluate the affective symptoms, overall function, and cognitive function of the two groups of patients.  Results  After treatment, the HAMD-17 [(3.233±1.280) points] and YMRS [(2.411±0.502) points] scores of the study group were lower than those in the control group [(4.193±1.317) points, (3.119±0.612) points], and the differences were statistically significant (t=3.577, 6.118, all P < 0.05). In terms of overall function, after treatment, the total score of FAST, autonomous life score, and cognitive function score in the study group were lower than the control group' s score, and the differences were statistically significant (all P < 0.05). In terms of cognitive function, after 8 weeks of treatment, compared with the control group, response corrects (Rc) and categories completed (Cc) in the study group were higher, and response errors (Re) and response perseverative errors (Rpe) in the study group were lower, with statistical significance (all P < 0.05).  Conclusion  Life and social skill training can improve the residual affective symptoms of elderly patients with bipolar disorder in remission stage, as well as promote the improvement in overall function and cognitive function.
Research on the effect of health education based on empowerment theory on elderly hypertensive patients
HAN Yu, LUO Yao-guo, LI Zhuan-zhen
2022, 20(10): 1728-1732. doi: 10.16766/j.cnki.issn.1674-4152.002690
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  Objective  To evaluate the impact of health education based on the empowerment theory on the blood pressure control level of elderly hypertensive patients in a community, the rates of compliance to smoking cessation, alcohol restriction, reasonable diet and regular exercise and their health literacy levels, and to provide a theoretical basis and practice methods for the self-health management of elderly hypertensive patients in community.  Methods  From May 2020 to September 2020, taking the community annual health checkup as an opportunity, we selected 80 hypertensive patients who met the inclusion and exclusion criteria from six communities in Luoyang City. With the random-number-table method, the patients were equally divided into experimental (40 cases) and control (40 cases) groups. The control group only received regular health education in the community. The experimental group applied the health education based on the empowerment theory of elderly hypertensive patients in the community. Before and after the intervention, the two groups of patients' living habits and risk factor control questionnaires, health literacy and other information were collected for analysis.  Results  After intervention, the systolic blood pressure [(132.1±5.3) mm Hg vs. (142.5±10.8) mm Hg, 1 mm Hg=0.133 kPa] and diastolic blood pressure [(81.8±5.2) mm Hg vs. (87.5±7.1) mm Hg] between the experimental and control groups were significantly different (all P < 0.001). The rates of reasonable diet [73.7% (28/38) vs. 27.8% (10/36)], alcohol restriction [94.7% (36/38) vs. 77.8% (28/36)] and exercise compliance [92.1% (35/38) vs. 72.2% (26/36)] between the experimental and control groups were significantly different (all P < 0.05). There was no significant difference between the two groups in the smoking cessation rate (P=0.463). After the intervention, the health literacy scores [(104.13±6.12) points vs. (86.97±8.02) points] and the four dimensions of the experimental group and the control group were significantly different.  Conclusion  Health education based on the empowerment theory can significantly improve the blood pressure and health literacy levels of hypertensive patients in a community and improve their self-management awareness and ability.
Study on the clinical effect of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation
XIAO Ling-na, ZENG An-ning, LUO Yong, MA Bing-lian, LYU Ting-yong
2022, 20(10): 1733-1736. doi: 10.16766/j.cnki.issn.1674-4152.002691
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  Objective  To observe the clinical effect of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation (AF).  Methods  Three hundred and fifty AF patients admitted to the People' s Hospital of Buyi and Miao Autonomous Prefecture of Qiannan Prefecture from April 2019 to April 2022 were selected as the study objects. All patients underwent transesophageal echocardiography (TEE), real-time three-dimensional transthoracic echocardiography (RT-3DTTE) and dual phase enhanced CT scanning. Taking the results of TEE as the gold standard, the diagnostic efficacy of RT-3DTTE and dual phase enhanced CT scanning were evaluated. The differences of left atrial structural indexes between patients with auricular thrombosis and patients without auricular thrombosis were compared.  Results  The detection rate of left atrial appendage thrombosis in patients with AF was 12.29%(43/350) using TEE examination. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with AF (97.67%, 98.70%, 98.57%, 91.30%, 99.67%) were significantly higher than those of RT-3DTTE (79.08%, 87.30%, 86.28%, 46.57% and 96.75%; χ2=7.242, P=0.007; χ2=30.634, P < 0.001; χ2=37.745, P < 0.001; χ2=24.464, P < 0.001; χ2=5.682, P=0.017). The area under ROC curve (0.955) of dual phase enhanced CT scanning in the diagnosis of left atrial appendage thrombosis in patients with AF was higher than that of RT-3DTTE (0.717). The detection values of left atrial anterior posterior diameter, left atrial transverse diameter and left atrial upper and lower diameter in patients with left atrial appendage thrombosis diagnosed by dual phase enhanced CT scanning were significantly higher than those in patients without left atrial appendage thrombosis (all P < 0.05).  Conclusion  The diagnostic ability of dual phase enhanced CT scanning for left atrial appendage thrombosis in patients with AF is comparable to TEE, but the operation is simpler, non-invasive and has high clinical value.
Clinical value of carotid ultrasound, energy spectral CT and MR high-resolution vessel wall imaging in judging the stability of carotid artery plaque
LI Yi-ming, ZHENG Yin-shi, LIN Guang-yao, HUANG Wen-qi, PAN Xiang-zhen, HUANG Xiao-yan
2022, 20(10): 1737-1741. doi: 10.16766/j.cnki.issn.1674-4152.002692
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  Objective  To explore the diagnostic efficacy of carotid artery ultrasound (US), energy spectral CT and MR high-resolution wall imaging (HR-VWI) in the stability of carotid plaque.  Methods  A total of 42 patients with carotid atherosclerosis undergoing carotid endarterectomy were selected from January 2018 to June 2020 in the Shangqiu First People' s Hospital. All patients underwent US, energy spectral CT and MR HR-VWI examinations. The diagnostic values of US, energy spectral CT and MR HR-VWI in evaluating the stability of carotid plaques were judged based on the pathological analysis results of plaques as the gold standard.  Results  A total of 53 plaques were obtained from 42 patients after surgery. A total of 43 plaques were detected by US examination, and 49 plaques were detected by energy spectral CT. The slopes of energy spectrum curves and effective atomic numbers of plaques with different components were calcified plaque, internal bleeding plaque, fibrous plaque and lipid plaque from high to low. Significant differences were found in the slopes of energy spectrum curves and effective atomic numbers of plaques with different components (all P < 0.05). A total of 51 plaques were detected by MR HR-VWI. With the pathological results as the gold standard, the detection rates, accuracy, specificity and sensitivity of energy spectral CT and MR HR-VWI were higher than those of US (all P < 0.05). Both energy spectral CT and MR HR-VWI showed a higher area under the curve of 0.819 (95% CI: 0.698-0.941) and 0.859 (95% CI: 0.750-0.967), respectively, for the diagnosis of carotid plaque stability than US (0.669, 95% CI: 0.517-0.821).  Conclusion  Energy spectral CT and MR HR-VWI are superior to US in the analysis of carotid plaque composition and plaque stability, providing clinical reference for the diagnosis of carotid plaque stability and the selection of treatment methods.
Application value of ultrasound in adult patients with thyroid nodules ≥3 cm
LI Yan-hui, ZHAO Chen-xi, CHEN Ming, YANG Shuang-ling, XUE Xian-jun
2022, 20(10): 1742-1745. doi: 10.16766/j.cnki.issn.1674-4152.002693
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  Objective  To clarify the difference of ultrasound (US) images between ≥3.0 cm thyroid nodules (TNS) and < 3.0 cm TNS, and to explore the application value of US in patients with ≥3.0 cm thyroid nodules.  Methods  From March 2017 to August 2019, 545 patients underwent US examination and thyroid surgery in the Shenma Medical Group General Hospital, Sanquan College, and Oilfield General Hospital of Puyang City were selected and divided into the large nodule group (115 cases, 152 nodules) and small nodule group (352 cases, 417 nodules) according to the maximum diameter of thyroid nodules. The large nodule group comprised patients with thyroid nodules ≥ 3.0 cm, whereas patients with thyroid nodules < 3.0 cm were in the small nodule group. The clinical and US imaging features were compared between the two groups.  Results  (1) The microcalcification rate (28.94%), hypoechoic rate (40.13%) and irregular shape rate (13.82%) in patients with large nodules were higher than those in patients with small nodules (18.94%, 7.19% and 3.36%, respectively, all P < 0.05). The cystic structure rate (9.21%), mixed nodule rate (30.26%), hyperechoic rate (30.92%) and perinodal vascular rate (4.61%) in patients with large nodules were lower than those in patients with small nodules (18.94%, 48.44%, 42.93% and 13.43%, respectively, all P < 0.05). (2) No significant difference was found between the diagnosis results of TI-RADS classification of large thyroid nodules and small thyroid nodules (P>0.05). (3) The correct rate of US in diagnosing large thyroid nodules was 74.3% (113/152). Large nodules were the risk factors of malignant thyroid nodules (OR=2.674, 95% CI: 1.116-6.405, P=0.027).  Conclusion  There are differences in US characteristics between patients with TNS ≥3.0 cm and patients with TNS < 3.0 cm. Compared with small thyroid nodules, large thyroid nodules have a higher risk of malignant transformation.
Research progress of respiratory microbiota and lung disease in neonates
LI Han-yue, DING Shi-tian, CHEN Xiao-qing
2022, 20(10): 1746-1750. doi: 10.16766/j.cnki.issn.1674-4152.002694
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The neonatal period is the key period for the establishment of stable physiological function between the microbiota and the host. During this period, the number of respiratory microbiota increases, and the species changes from single to diversified. Progress in neonatal respiratory tract specimen collection technology and microecological monitoring technology has broken the original technical "barrier". The progress in specimen extraction technology and improved detection technology accuracy have increased the credibility of microecological research and offered convenience for clinical research. In the neonatal respiratory tract, the decreased abundance of beneficial bacteria, such as Moraxella, Corynebacterium and Dolosigranulum, the increased proportion of potential pathogenic bacteria, such as Pseudomonas aeruginosa, Haemophilus influenzae and Staphylococcus aureus, and the change in bacterial diversity were closely related to the occurrence and development of respiratory diseases, such as bronchopulmonary dysplasia, asthma, cystic fibrosis and pneumonia. The establishment and evolution of neonatal respiratory flora are regulated by many factors, such as delivery mode, feeding mode, use of antibiotics, gestational age, birth date and age. Research from the perspective of microorganisms can clarify the action mechanism of respiratory microorganisms in neonatal respiratory diseases, open up a new perspective for disease prevention and treatment and achieve the purpose of accurate treatment. This paper reviews the influencing factors of neonatal respiratory tract microbiota, the relationship between intestinal microbiota and respiratory diseases.
Analysis of the current status of FRAXⓇ application in evaluating osteoporotic fractures in China
WU Wan, LI Yi-wen, LIANG Bing, WEN Ting-yu, YANG Miao, WANG Wei, WANG Tao
2022, 20(10): 1751-1754. doi: 10.16766/j.cnki.issn.1674-4152.002695
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The fracture risk assessment tool (FRAXⓇ) was released in 2008 to provide country-specific algorithms. It was established on the basis of patient clinical risk factors (such as age, gender, height, weight, history of osteoporosis fracture, history of hip fracture in parents, history of smoking, history of excessive drinking, application history of adrenal cortical hormone, history of rheumatoid arthritis and other history of secondary osteoporosis and femoral neck bone mineral density) to assess the probability of hip fracture and major osteoporotic fracture (such as vertebral, hip, forearm or proximal humeral) in the next 10 years. When FRAXⓇ was launched, only eight national and regional models were available to choose from. At present, 71 models are available for 66 countries. The number of users is more than 80% of the world population, and FRAXⓇ is widely used in the United Kingdom, the United States, Japan, Sweden and other countries. The initial intervention threshold of FRAXⓇ was defined on the basis of nine large population cohorts, eight of which were Caucasian and one from Japanese population. However, FRAXⓇ is rarely studied and applied in China and according to the intervention thresholds recommended by the current guidelines, FRAXⓇ may underestimate the risk of fractures in the Chinese population, especially major osteoporotic fractures. Therefore, some scholars are trying to improve the application of FRAXⓇ to explore intervention thresholds suitable for Chinese population. This paper analysed the application status and adjustment plan of FRAXⓇ in China in recent years through evaluation of hip fracture and major osteoporotic fracture with FRAXⓇ for its better applicability in China and to better predict fracture risk, identify people at high risk of fracture and early intervention in time and reduce the incidence of fractures.
Review of clinical aplication of cognitive behavioural therapy
CHEN Xiao-yang, REN Wen, QIU Yan, REN Jing-jing
2022, 20(10): 1755-1759. doi: 10.16766/j.cnki.issn.1674-4152.002696
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Cognitive behaviour therapy (CBT) is a structured, short-term and cognitive-oriented psychotherapy proposed by A.T.Beck in the 1960s and mainly focuses on the unreasonable cognitive problems of patients. Psychological problems can be solved by changing patients' views and attitudes towards themselves, people or things. Its evolution includes cognitive therapy, behavioural therapy, acceptance and commitment therapy and dialectical behaviour therapy, and it has gradually extended. It developed mindfulness-based cognitive therapy, metacognitive therapy, internal cognitive therapy and other cognitive behavioural analysis systems and cognitive processing therapy. Numerous clinical studies have shown that CBT is the first-choice treatment for adolescent mental illness and can effectively treat non-severe depression, anxiety, anorexia nervosa, post-traumatic stress disorder and borderline personality disorder. Substantial literature has provided evidence of the efficacy of CBT in the field of children' s mental diseases, including social anxiety disorder, autism, behavioural disorders and other diseases. This article will briefly summarise the current status of CBT in clinical practice and its prospects for future applications.
Effect of acupuncture and massage combined with rehabilitation training on elderly patients with spastic hemiplegia after stroke
WANG Lin-xiang, CONG Wen-jie, FU Ying, ZHENG Yang-yang, WU Chun-xiu
2022, 20(10): 1760-1762. doi: 10.16766/j.cnki.issn.1674-4152.002697
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  Objective  To probe into the effect of acupuncture and massage combined with rehabilitation training on elderly patients with spastic hemiplegia after stroke and the influence of Ashworth, activities of daily living (ADL), and neurological deficit scale (NDS) scores.  Methods  From October 2018 to August 2020, 100 patients with spastic hemiplegia after stroke admitted to the First Hospital Affiliated to Wenzhou Medical University were analysed retrospectively. According to the different treatment methods, they were divided into 40 cases in the acupuncture group, 30 cases in the massage group, and 30 cases in the rehabilitation group. The rehabilitation group was given only rehabilitation training, the acupuncture group was given rehabilitation training combined with acupuncture, and the massage group was given rehabilitation training combined with massage. The clinical effect and the changes in Ashworth score of upper and lower limbs, as well as the ADL and NDS scores before and after treatment, were compared.  Results  The total effective rate in the acupuncture group was 92.50% (37/40), which was higher than 63.33% (19/30) in the rehabilitation group (χ2=10.513, P < 0.05), but no significant difference existed between the rehabilitation group and the massage group (86.67%, 26/30), and between the massage and acupuncture groups (all P>0.05). Before treatment, no significant difference existed in Ashworth scores of upper and lower limbs and ADL and NDS scores amongst the three groups (F=0.062, 0.118, 0.025, 0.002, all P>0.05). Compared with before treatment, the Ashworth score and NDS score of upper and lower limbs in the three groups significantly decreased, ADL score significantly increased (all P < 0.05), and the rehabilitation, massage, and acupuncture groups were better in turn (F=16.303, 21.294, 18.291, 36.720, all P < 0.05).  Conclusion  Acupuncture and massage combined with rehabilitation training exert a better effect on spastic hemiplegia after stroke in the elderly. Acupuncture combined with rehabilitation training have the best effect, effectively relieving limb spasm and improving the ability of daily life.
Study on the rehabilitation effect of Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on unilateral spatial neglect after stroke
ZHAO Wen-hua, LU Jun-ying, ZHAO Huai-xiao, LIU Yin-fang, ZHANG Xiao-man
2022, 20(10): 1763-1768. doi: 10.16766/j.cnki.issn.1674-4152.002698
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  Objective  To observe the effect of rehabilitation intervention using Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on patients with unilateral spatial neglect after stroke.  Methods  A total of 94 patients suffering from stroke and unilateral spatial neglect and admitted to the Staff Hospital of Henan Wujian Construction Group from January 2019 to June 2020 were divided into treatment group (47 cases) and control group (47 cases) by the random-number table method. The patients in the control group underwent visual observation training on the basis of routine rehabilitation training, whereas the patients in the observation group received a combination of Kaiqiao Dingzhi Prescription and head acupuncture. The indicators of the two groups were compared.  Results  Compared with the control group, the scores of linear bisection test, bell drawing test, copy drawing test and number deletion test in the observation group all decreased after treatment (all P < 0.05). The Fugl-Meyer motor function assessment (FMA), activities of daily living (ADL) and stroke specific quality of life scale (SS-QOL) scores of the observation group significantly increased (all P < 0.05). After 2 and 4 weeks of treatment, the Catherine Bergego scale (CBS) score of the observation group was significantly lower than that of the control group [(16.17±2.32) points vs. (18.24±3.27) points, (12.58±1.83) points vs. (16.06±2.10) points, all P < 0.05]. The mini-mental state examination (MMSE) score of cognitive function was significantly higher than that of the control group [(24.16±3.25) points vs. (22.30±3.20) points, (26.51±2.78) points vs. (25.10±1.69) points, all P < 0.05]. After treatment, the serum S100β, macrophage inflammatory protein-1α (MIP-1α), neuron-specific enolase (NSE) levels, platelet aggregation rate, fibrinogen, whole blood high shear viscosity and whole blood low shear viscosity of the observation group were significantly lower than that of the control group (all P < 0.05).  Conclusion  Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training are beneficial to control unilateral spatial neglect of patients after stroke, which may be related to the inhibited expression of S100β, MIP-1α and NSE, improving hemorheology to promote brain function recovery and improve cerebral blood perfusion.
Discussion on the effect of online teaching and influencing factors of learning initiative of "Health Statistics"
SUN Na, LI Xing-hui, LIU Qi-ling, LI Xiang-wen, QI Bao-ning, ZHANG Rong-qiang, SHI Chuan-dao
2022, 20(10): 1769-1772. doi: 10.16766/j.cnki.issn.1674-4152.002699
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  Objective  In 2020, the COVID-19 epidemic has swept across the whole country and online teaching has been fully implemented in various colleges and universities. This study aimed to survey the development of online teaching of the "Health Statistics" course of food hygiene and nutrition in Shaanxi University of Chinese Medicine, analyse the effect of student learning and its influencing factors and propose corresponding countermeasures to provide reference for the later development of mixed teaching reform and improvement of students' academic level.  Methods  Cluster sampling method was used to select 58 undergraduates majoring in food hygiene and nutrition from Shaanxi University of Chinese Medicine as the research objects. The self-made questionnaire, students' learning initiative and academic self-efficacy scale were used to collect the general information of the research object, the development of online teaching, students' learning initiative and academic self-efficacy. SPSS 25.0 was used to process data. Simple linear correlation analysis was performed to determine the relationship between academic self-efficacy and learning initiative. The influencing factors of learning initiative were analyzed by multiple linear regression analysis.  Results  Amongst the 58 research subjects, 21 attended completely online teaching, accounting for 36.2%, whilst 31 attended online+offline, accounting for 53.4%. The overall satisfaction of online teaching reached 93.4% and the recognition of learning effect evaluation reached 81.0%. There were significant differences in learning initiative between students of different genders, whether they were the only child or not, whether they took postgraduate entrance examination or not, whether they recognized the major being studied or not (all P < 0.05). Gender, postgraduate entrance examination, recognition of their major being studied and academic self-efficacy were the influencing factors of students' learning initiative (all P < 0.05).  Conclusion  The overall satisfaction of online teaching is relatively high. Regardless of being an only child, gender, postgraduate entrance examination, recognition of the major being studied and academic self-efficacy could affect students' learning initiative, which, in turn, affects the learning effect. Different reform and incentive measures should be adopted to improve students' learning initiative and ultimately enhance the learning effect.
CAD-RP technique combined with three-dimensional finite element analysis in orthopedics practice and exploration in clinical teaching
WANG Xu-yi, LI Huan-yu, ZHANG Heng, ZHAO Zhi, ZHANG Pei, LI Kuan-xin, ZHOU Ping-hui, GUAN Jian-zhong
2022, 20(10): 1773-1776. doi: 10.16766/j.cnki.issn.1674-4152.002700
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  Objective  To explore the effect and feasibility of computer aided design (CAD) and rapid prototyping (RP) technique combined with three-dimensional (3D) finite element analysis in clinical teaching of orthopedics.  Methods  Eighty-four clinical medicine students who were practicing in the Department of Orthopedics in the First Affiliated Hospital of Bengbu Medical College in 2019-2020 were randomly divided into observation group and control group, with 42 students in each group. The observation group adopted the PBL teaching method combined with CAD-RP technology and 3D finite element analysis, while the control group adopted the traditional PBL teaching method. After the completion of the course, the final examination and teaching satisfaction survey carried out. The examination method included the theoretical course content of orthopedics specialty and the operation of clinical practice skills. The satisfaction survey included learning interest, knowledge mastery efficiency, teacher-student interaction and teaching environment.  Results  Professional theoretical knowledge: the average scores of the observation group and the control group were (35.36±2.40) points and (33.90±2.55) points, respectively. Clinical practice skills: the average score of completion examination in the observation group and the control group were (35.21±2.41) points and (33.36±2.84) points, respectively. Satisfaction: the satisfaction rates of the observation group and the control group were 78.6% (33/42) and 45.2% (19/42), respectively. Compared with the control group, the examination scores and teaching satisfaction were improved in the observation group (all P < 0.05).  Conclusion  CAD-RP combined with 3D finite element analysis is of great significance in clinical teaching of orthopedics. It has stimulated the learning interest of medical students and is worth promoting and adopting.
Discussion on nuclear medicine experiment teaching of clinical medicine from the perspective of CEA radioimmunoassay
LI Wei-peng, HE Juan-juan, LI Hui, SUN Jun-jie, YUAN Chao
2022, 20(10): 1777-1780. doi: 10.16766/j.cnki.issn.1674-4152.002701
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In the experimental teaching of nuclear medicine, how to eliminate the fear of "nuclear" psychology of medical students, stimulate students' learning interest, improve students' learning enthusiasm, fully master the relevant theoretical knowledge of nuclear medicine course and improve students' ability to analyse and solve clinical problems are the key and difficult points of nuclear medicine teaching. Nuclear medicine is a special medical course, involving the application of radionuclides in medicine. It is an interdisciplinary course and covers a wide range of contents, which are complex and abstract. Students often have difficulty in understanding and digesting the course content. Therefore, carrying out experimental teaching of nuclear medicine will improve the teaching quality of theoretical courses after the teaching of a theory course. Combining relevant professional knowledge in the experimental course enables students to have a correct grasp and deep understanding of the theoretical knowledge of nuclear medicine. The students' fear of learning can be eliminated through the teaching of the current situation of clinical radiation protection. Teaching combined with clinical case analysis strengthens students' understanding and mastery of nuclear medicine knowledge. The narration of the relevant knowledge of radiation protection is helpful to the training of good experimental habits among students. Professionals interested in nuclear medicine and nuclear medicine research are cultivated, while the teaching quality of nuclear medicine improves. Thus, in this paper, we explore improvements in the quality of theoretical teaching through a nuclear medicine experiment course and discuss nuclear medicine experiment teaching of clinical medicine from the perspective of CEA radioimmunoassay. The aims are to provide a certain guiding value of the teaching of nuclear medicine experiment course and to contribute to the cultivation of high-quality professionals in nuclear medicine.
Analysis of current situation of rural order orientation free medical students in Anhui Province
ZHANG Fei, LIU Zhi-qiang, XU Wei, QIAN Shu-wen, LI Ya-li, HUANG Chao, XIA Hai-long
2022, 20(10): 1781-1785. doi: 10.16766/j.cnki.issn.1674-4152.002702
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  Objective  To grasp the status of the training of free medical students in Anhui Province, proposes targeted and feasible countermeasures and suggestions for the development of free medical students in Anhui Province.  Methods  Tencent questionnaire was used in investigating 967 free medical students enrolled in six medical universities from 2015 to 2019 in Anhui Province. Basic information, current study status, willingness to perform and employment plans of free medical students were analysed.  Results  Among the respondents, 874 free medical students intend to perform the agreement (90.4%). Approximately 46.5% (450/967) of the students choose to apply for general medical post-graduate or take the entrance examination for college to a university after the service period expires, and 8.1% of students choose to stay at the grassroots level (78/967). Binary logistic regression analysis showed that the willingness of free medical students to fulfill their contract was related to their majors, interest in the profession, monthly living expenses and the degree of satisfaction with the school ' s professional identity education (all P < 0.05).  Conclusion  Anhui Province ' s free medical students have a low willingness to perform contracts, and most students expect to take the post-graduate examination or work in other hospitals after the service period expires. Some students apply for this major without understanding about the policy. This finding suggests that government can improve guarantees, incentives and management policies by focusing on increasing training quality, improving treatment and grassroot construction to increase free medical students' willingness to perform.
Visualised analysis of knowledge graph of domestic manipulation treatment of degenerative lumbar spondylolisthesis
HAN Tao, YU Jie, ZHU Li-guo, WEI Xu, FENG Min-shan, WANG Shang-quan
2022, 20(10): 1786-1791. doi: 10.16766/j.cnki.issn.1674-4152.002703
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  Objective  Focusing on the related literature on manual treatment of degenerative lumbar spondylolisthesis, this study used CiteSpace software to conduct knowledge graph and visual analysis, understand the research hotspots and trends of manual treatment of degenerative lumbar spondylolisthesis and provide development suggestions and references for follow-up research.  Methods  The relevant literatures on "manual treatment of degenerative lumbar spondylolisthesis" were retrieved from the CNKI database from January 1, 2000 to December 31, 2020. The relevant knowledge graphs were generated and analysed by CiteSpace software in terms of the number of literatures, fund support, authors and institutions, and research hotspots and trends.  Results  (1) A total of 83 related papers were included. Amongst them, most papers were published in 2014 and 2016. (2) The most funded projects were the National Natural Science Foundation of China (3 projects) and the National Science and Technology Support Program (3 projects). (3) In terms of author analysis, ZHU Li-guo (10 papers), YU Jie (8 papers) and FENG Min-shan (5 papers) were the top three authors that published the most number of papers. (4) In terms of research institutions, Wangjing Hospital of the Chinese Academy of Chinese Medical Sciences (13 papers) was the research institution with the largest number of published articles. (5) The keyword clustering labels were mainly "degenerative lumbar spondylolisthesis", "manipulation therapy", "manipulation", "degenerative lumbar spondylolisthesis" and "massage".  Conclusion  Research on "manipulation treatment of degenerative lumbar spondylolisthesis" is still relatively small in terms of publication volume and large-scale national collaborative research. In the future, strengthening academic exchanges and cooperation is still an important direction for researchers and research institutions in this field. The research direction of manual therapy will be the hotspot and trend of clinical treatment of degenerative lumbar spondylolisthesis in the future.
Evaluation and implementation of an antimicrobial stewardship checklist in a respiratory ICU ward in a tertiary teaching hospital
WANG Xue, WANG Yu-he, GAO Shan, HOU Ting-ting, HONG Lei, ZHU Yu-lin, ZHANG Yong
2022, 20(10): 1792-1796. doi: 10.16766/j.cnki.issn.1674-4152.002704
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  Objective  To analyse the consumption of antimicrobials in the respiratory intensive care unit (RICU) before and after the implementation of an antimicrobial stewardship checklist and evaluate the clinical application value of the antimicrobial stewardship checklist.  Methods  An antimicrobial stewardship checklist was designed according to RICU working practice. The antimicrobial-related data of all inpatients in the RICU of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2019 were retrospectively analysed. Inpatients before the implementation of antimicrobial checklist management from January 2013 to December 2015 were set as the control group, and the remaining inpatients from January 2017 to December 2019, who were subject to antimicrobial checklist management, were set as the intervention group. The frequency of intensity of antibiotics use density (AUD), pathogenic test results, hospitalization improvement rate and length of RICU stay were calculated and analysed for both groups.  Results  After the implementation of the antimicrobial management checklist, the AUD values of the control group (n=329) and the intervention group (n=550) were 207.51 DDD/(100 people·day) and 146.21 DDD/(100 people·day), respectively. For the control group and the intervention group, the drug use rates were 67.99% (223/328) and 25.83% (124/480, χ2=141.313, P < 0.001), respectively; the combined drug ratios were 94.82% (311/328) and 65.21% (313/480, χ2=97.132, P < 0.001), respectively; and the rates of microbial testing before antimicrobial use were 92.68% (304/328) and 97.50% (468/480, χ2=10.621, P=0.001), respectively. The length of hospital stay decreased from 8 (6, 13) days to 8 (5, 12) days, and the difference was statistically significant (Z=-1.965, P=0.049).  Conclusion  The implementation of an antimicrobial stewardship checklist can help in reducing the intensity of antimicrobial drug use and reduce the frequency of combined use and high-grade use of antimicrobials, which is helpful to standardise the antimicrobial application and has high value in clinical application.
Analysis of anxiety and information needs of patients in preoperative waiting room and its influencing factors
CHENG Lan, DONG Yu-yan, ZUO Li-hong, SHEN Hai-ping
2022, 20(10): 1797-1800. doi: 10.16766/j.cnki.issn.1674-4152.002705
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  Objective  To analyse the current situation of preoperative anxiety and information needs of preoperative waiting room patients and formulate targeted psychological support intervention.  Methods  From January to March 2021, 100 patients who were waiting for surgery in the operating room of Shaoxing Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. The Amsterdam preoperative anxiety and information scale (APAIS) was used to investigate the preoperative anxiety status and information needs of patients, and the related factors affecting the preoperative anxiety and information needs of patients were analyzed by multiple linear regression.  Results  The average anxiety score of the patients waiting for operation was (10.33±3.25) points, and the anxiety score of 51 patients was ≥12 points, that is, 51% of patients were in anxiety state. The average score of patients' information needs was (7.81±2.66) points, and the score of 71 patients' information needs was ≥5 points, that is, 71% of patients were at the level of moderate or above. The results of multiple linear regression analysis showed that gender, age, number of operating tables, type of operation, sleep quality during the night before operation, operation experience and anaesthesia experience were the main influencing factors of anxiety, and the age, operation experience and anesthesia experience were the main factors influencing the information needs of patients during preoperative waiting.  Conclusion  The level of anxiety and information needs of patients in the preoperative waiting room is high. Nurses should pay attention to the psychological support and intervention of patients in the preoperative waiting room. In particular, they should pay more attention to older patients, women, patients who underwent continuous surgery or gynaecological surgery, patients with poor sleep quality in the night before surgery and patients with painful memories of surgery and anaesthesia.
Consistency of self-evaluation and nursing records in patients with cytokine release syndrome after CAR-T cell therapy for haematological tumours
WU Zu-xia, ZUO Qiong, LIU Rui, WANG Xing-bing
2022, 20(10): 1801-1804. doi: 10.16766/j.cnki.issn.1674-4152.002706
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  Objective  To explores the consistency of self-evaluation and nursing records of patients with cytokine release syndrome (CRS) after chimeric antigen receptor T (CAR-T) cell therapy of haematological tumours.  Methods  A total of 39 patients with haematological tumours who developed CRS symptoms requiring clinical intervention after CAR-T cell therapy in the First Affiliated Hospital of University of Science and Technology of China from October 2016 to October 2018 were selected. The self-assessment of symptoms, including nausea, vomiting, dyspnea, myalgia, headache, rash, fatigue and loss of appetite, were summarised using a standardised questionnaire and then compared with the CRS symptom scores in the nursing records using the Wilcoxon rank-sum test and further analysed using an intraclass correlation coefficient (ICC) to explore the consistency between the two.  Results  Except rash (Z=1.388, P=0.165), the self-reported CRS symptoms of patients, nausea, vomiting, dyspnea, myalgia, headache, fatigue and loss of appetite were significantly higher than the data in nursing records (all P < 0.001). Similarly, in the patient self-assessment, except rash, the consistency was appropriate (ICC=0.55, P < 0.001), and the other items were low with the nursing assessment data measurement (0.21 < ICC < 0.40, all P < 0.05).  Conclusion  The nurses ' evaluation of CRS patients after CAR-T cell therapy of haematological tumours is not consistent with the patient ' s self-evaluation, and their nursing evaluation still needs to be further summarised.
Study on the application effect of knowledge, belief and practice nursing model in patients with stress urinary incontinence
LI Hai-yan, WU Rong-rong, ZHENG Jian-qiu, FENG Yao, YE Xiang-xiang
2022, 20(10): 1805-1808. doi: 10.16766/j.cnki.issn.1674-4152.002707
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  Objective  To analyse the effect of knowledge, belief and practice nursing mode in nursing of patients with stress urinary incontinence (SUI) and its influence on quality of life.  Methods  Ninety-eight SUI patients treated in the Department of Urology of the First Affiliated Hospital of Wenzhou Medical University from August 2017 to August 2019 were randomly divided into two groups: 49 patients in the control group adopted traditional nursing, and 49 patients in the observation group adopted knowledge, belief and practice nursing. After 2 weeks of intervention, the daily leakage times, score of international urinary incontinence standard questionnaire (ICIQFLUTS) for female lower urinary tract symptoms and patient satisfaction of the two groups were compared. After 2 months of follow-up, the quality of life scores of the two groups were compared.  Results  After 2 weeks of intervention, differences in the daily urine leakage times of the observation and control groups [(1.52±0.11) times vs. (3.06±0.18) times] and ICIQFLUTS score [(35.12±1.62) points vs. (40.65±2.55) points] were statistically significant (all P < 0.05). Patient satisfaction in the observation group (95.92%, 47/49) was significantly higher than that in the control group (71.43%, 35/49), with a statistically significant difference (P < 0.05). After 2 months of follow-up, the total score of quality of life in the observation group was significantly higher than that in the control group [(82.95±5.49) points vs. (70.16±3.84) points], and the scores of social restrictions [(20.62±3.62) points vs. (14.28±1.64) points], daily life restriction [(35.62±4.85) points vs. (30.16±2.22) points] and psychological impact [(40.52±4.55) points vs. (33.25±2.94) points] in the two groups were statistically significant (all P < 0.05).  Conclusion  The knowledge, belief and practice nursing model can effectively relieve urinary incontinence symptoms of SUI patients, reduce the number of urinary leakage and improve patient satisfaction and quality of life, which is worthy of reference.
Treatment of dysphagia after cholesteatoma of cerebellopontine angle by injection of botulinum toxin type A in circumpharyngeal muscle: A case report
FAN Liu-bo, HAN Wen-sheng, ZHANG Lu-ding, LUO Mi-mi
2022, 20(10): 1809-1812. doi: 10.16766/j.cnki.issn.1674-4152.002708
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Cholesteatoma is called pearl tumor or epidermoid cyst, pathological place is in brain and ear more, can cause the pathological changes such as cholesteatoma of intracranial cholesteatoma, external auditory canal cholesteatoma. This disease is rare in clinical practice, involving the ring pharyngeal muscle cases are rarer. This case was the first time that cholesteatoma of cerebellopontine angle had been found to involve the cricopharyngeal muscle, resulting in the cricopharyngeal muscle dysplasia and severe swallowing dysfunction. In this case, for the first time, we adopt catheter balloon joint ultrasound guided botulinum toxin injections cerebellopontine angle cholesteatoma ring slow pharynx muscle loss, with past measures such as CT, electromyography positioning compared with no radiation, the advantages of the trauma of tiny, precise positioning, in the technical scheme for swallowing disorder accurate treatment research provided important reference basis.
General Practice Research
Establishment of clinical warning tool based on the influencing factors of PICC catheter occlusion in critically ill patients
LI Qin-ling, WANG Yang, DAI Hui, GE Li
2022, 20(10): 1637-1640. doi: 10.16766/j.cnki.issn.1674-4152.002667
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  Objective   To explore the risk factors of peripherally inserted central catheter (PICC) complicated with occlusion in critically ill patients and establish a clinical warning tool.   Methods   Clinical data of 458 critically ill patients admitted to Xinhua Hospital from April 2011 to April 2021 were retrospectively analyzed. The software SPSS 23.0 was used to perform data analysis. The two-sample t test was applied to perform measurement data comparison and the chi-square test was used to perform count data. Binary logistic regression was applied to screen independent risk factors, and R software was used to establish a nomogram warning tool about occlusion.   Results   A total of 458 critically ill patients were included, of which 57 patients (12.4%) in the occlusion groups and 401 patients in the non-occlusion groups. The multivariate binary logistic regression analysis showed that the body mass index (OR=1.084, 95% CI: 1.043-1.126), PICC retention time (OR=1.045, 95% CI: 1.018-1.073), PICC intravenous nutrition (OR=3.025, 95% CI: 1.305-7.014) and PICC blood transfusion (OR=2.773, 95% CI: 1.151-6.683) were independent predictor for occlusion. In addition, the Bootstrap method and calibration curve analysis indicated that the predictive ability of the clinical warning tool for catheter occlusion based on the above independent risk factors was strong and stable.   Conclusion   The risk of PICC occlusion in critically ill patients cannot be ignored. Based on the tool, it could predict the risk of catheter occlusion and provide guidance for avoiding artificial superposition of risk factors.
Impact of combined upper gastrointestinal symptoms on anxiety, depression and quality of life of patients with functional constipation
YU Ting, ZHU Feng, LIN lin, TANG Yu-rong
2022, 20(10): 1641-1644. doi: 10.16766/j.cnki.issn.1674-4152.002668
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  Objective   To explore the effect of combined upper gastrointestinal (GI) symptoms on anxiety, depression and health-related quality of life (HRQoL) in patients with functional constipation (FC).   Methods   According to the Rome Ⅳ diagnostic criteria, patients with FC who were admitted to the Gastrointestinal Motility Center of the First Affiliated Hospital of Nanjing Medical University from October 2016 to October 2019 were included. Gastrointestinal symptom rating scale, ZUNG anxiety and depression self-rating scale (SAS and SDS) and concise health questionnaire (SF-36) were used in assessing upper GI symptoms, anxiety and depression and HRQoL.   Results   Among 156 patients with FC, 95 (60.90%) had upper gastrointestinal symptoms: 11(7.05%) only had acid reflux and heartburn, 23(14.74%) only had upper abdominal distension, 11(7.05%) only had belching, 7(4.49%) had acid reflux, heartburn and upper abdominal distension, 32(20.51%) had belching and upper abdominal distension and 11(7.05%) had belching, acid reflux and heartburn. Compared with FC patients without upper GI symptoms, those who had upper GI symptoms show higher scores of SAS and SDS (all P < 0.05), and lower score of role physical, physical functioning, general health, role emotional and mental health (all P < 0.05). Among patients with upper GI symptoms, patients who had both belching and upper abdominal distension show higher scores of SAS and SDS, and lower scores of physical functioning, social functioning and role emotional. Furthermore, combined with both belching and upper abdominal distension and high score of SAS was predictor of poorer SF-36 total score (all P < 0.05).   Conclusion   Acid reflux and heartburn, upper abdominal distension and belching are the most common upper GI symptoms in patients with FC. The combined upper GI symptoms increases anxiety and depression and reduce the HRQoL in the patients.
Inner ear malformation among 255 cases with severe to extremely severe sensorineural hearing loss in Xinjiang and relevant issues
LU Jin-shan, ABULIKEMU Yiming, WU Mei, WUMAIER Yasen, CHEN Jie, ZHANG Xiao-yu, ZHANG Jin
2022, 20(10): 1645-1649. doi: 10.16766/j.cnki.issn.1674-4152.002669
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  Objective  To investigate the image and surgical characteristics of inner ear malformation in children with severe to extremely severe sensorineural hearing loss, so as to provide better clinical guidance for cochlear implantation.   Methods  From January 2020 to December 2021, children admitted to People's Hospital of Xinjiang Uygur Autonomous Region for screening and cochlear implantation were examined by high-resolution CT of temporal bone and the cases of inner ear malformation were screened out. According to Sennaroglu ' s classification method, they were classified as follows: Michel malformation, cochlea aplasia, common cavity, cochlear hypoplasia types Ⅰ, Ⅱ and Ⅲ, incomplete partition types Ⅰ-Ⅲ (IP-Ⅰ, IP-Ⅱ and IP-Ⅲ), vestibular and semicircular canal malformation, large vestibular aqueduct and internal auditory canal stenosis. Cochlear implantation approaches, electrode types and complications were recorded, and the image characteristics and surgical precautions of various malformations were analysed.   Results  Among 255 patients with severe to extremely severe sensorineural hearing loss, 66 cases (125 ears) had inner ear malformation, in which IP-Ⅱ accounted for 30.30% (20 cases/66 cases) of inner ear malformation cases, large vestibular aqueduct accounted for 19.70% (13 cases/66 cases) and other types were relatively low. A total of 55 children (57 ears) with inner ear malformation received cochlear implantation (CI), including two bilateral CI cases. All cases had been implanted with electrodes through a cochleotomy or round window. Short straight electrodes were implanted in patients with cochlear hypoplasia types Ⅱ and Ⅲ, IP-Ⅰ and IP-Ⅲ. Standard electrodes were implanted in patients with IP-Ⅱ, large vestibular aqueduct and enlarged internal auditory canal. Postoperative CT scans suggested one IP-Ⅱ case were implanted into vestibular cavity, so this case received another operation by cochlear implantation successfully. The incidence of cerebrospinal fluid "gusher" was 29.82% (17 ears/57 ears). There was no complications such as cerebrospinal fluid otorrhea and flap necrosis.   Conclusion  IP-Ⅱ and LVA are the predominant types of inner ear malformations. The incidence of cerebrospinal fluid "gusher" in CI is high in children with inner ear malformation. HRCT and MRI are complementary, which can clearly and comprehensively display the inner ear structure and provide guarantee for cochlear implementation successfully.
Effect of myocardial infarction-associated transcripts on retinoblastoma
JIANG Yu, SUN Xian-tao, SUN Shuang, LU Yue-bing
2022, 20(10): 1650-1653. doi: 10.16766/j.cnki.issn.1674-4152.002670
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  Objective   To explores the effect of lncRNA MIAT targeting miR-145 on the proliferation and apoptosis of retinoblastoma.   Methods   From September 2015 to September 2020, 30 children with retinoblastoma underwent enucleation in Children ' s Hospital of Zhengzhou University were selected, and tumor tissues and adjacent tissues were collected. Human retinoblastoma cells (Y79) were cultured and divided into si-NC, si-MIAT, miR-NC, miR-145, si-MIAT + anti-miR-NC and si-MIAT + anti-miR-145 groups according to the random number table method. RT-qPCR was used in detecting the expression levels of MIAT and miR-145 in the cells. CCK-8 was used in detecting cell proliferation, and flow cytometry was used in detecting cell apoptosis. Cyclin D1, p21, Bcl-2, Bax, p-PI3K and p-Akt protein expression levels were detected with Western blotting, and dual luciferase reporter was used in detecting the targeted relationship between MIAT and miR-145.   Results   Compared with adjacent tissues, the expression of MIAT in retinoblastoma tissue was significantly up-regulated, and the expression of miR-145 was significantly down-regulated (3.61±0.28 vs. 1.05±0.11, 0.33±0.03 vs. 1.03±0.09, all P < 0.05). Compared with the si-NC group, cell viability in the si-MIAT group was significantly down-regulated, mortality rate was significantly up-regulated, and p-PI3K protein and p-Akt protein expression were significantly down-regulated (all P < 0.05). Compared with the miR-NC group, cell viability in the miR-145 group showed significantly down-regulated, apoptosis rate was significantly up-regulated (all P < 0.05). Compared with the si-MIAT + anti-miR-NC group, cell viability was significantly up-regulated in the si-MIAT + anti-miR-145 group, cell apoptosis rate was significantly down-regulated, whereas the expression levels of p-PI3K and p-Akt proteins were significantly up-regulated (all P < 0.05).   Conclusion   The inhibition of MIAT expression and up-regulation of miR-145 expression can promote apoptosis and inhibit the proliferation of retinoblastoma. The mechanism is related to the PI3K/Akt pathway.
The molecular mechanism of sinomenine hydrochloride treat ulcerative colitis through Hedgehog signalling pathway in mice
XU Feng, XU Lin-xia, LIU Wei, WANG Ke-ke, CHEN Cai-feng, Xie Li, KE Xi-quan
2022, 20(10): 1654-1657. doi: 10.16766/j.cnki.issn.1674-4152.002671
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  Objective  To investigate the protective effect and possible mechanism of sinomenine hydrochloride (SH) on ulcerative colitis (UC) in mice.   Methods  Twenty-four mice were randomly divided into 4 groups: normal group, model group, low and high dose SH group (SH 20 mg/kg, 60 mg/kg), with 6 mice in each group. Disease activity index (DAI) and colon histopathology (HI) scores were recorded, and the expression levels of Shh mRNA and related proteins and cytokines were detected.   Results  Compared with the normal group, the DAI score [(3.44±0.27) points vs. 0, P < 0.001] and HI score [(7.67±0.52) points vs. 0, P < 0.001] increased, Shh mRNA (P < 0.05), Shh, Smo, Ptch1 and Gli1 protein (all P < 0.01) decreased, and TNF-α, IL-1β and IL-6 (all P < 0.001) increased in the model group. Compared with the model group, the DAI score [(2.50±0.18) points, (1.89±0.17) points vs. (3.44±0.27) points, P < 0.001], HI score [(5.17±0.75) points, (3.33±0.52) points vs. (7.67±0.52) points, P < 0.001] decreased, Shh, Smo, Ptch1 and Gli1 protein (all P < 0.001) increased, and TNF-α, IL-1β, IL-6 (all P < 0.01) decreased in the SH treatment group.   Conclusion  SH can treat ulcerative colitis in mice. The mechanism may be that it up regulates the activity of Hedgehog signalling pathway, thereby reduces the content of TNF-α, IL-1β, IL-6.
Effect of Mailuoning injection on blood circulation and vascular endothelium in patients with lower extremity arteriosclerosis obliterans
KANG Hai-han, LI Fei, WU Cheng-wen, CUI Wen-jun
2022, 20(10): 1658-1661. doi: 10.16766/j.cnki.issn.1674-4152.002672
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  Objective  To investigate the effect of Mailuoning injection on blood circulation and vascular endothelium in lower extremity arteriosclerosis obliterans (ASO).   Methods  A total of 104 lower extremity ASO patients treated in the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were enrolled and were divided into control group (52 cases) and observation group (52 cases) according to the random number table method. The control group was treated with Alprostadil injection, and the observation group was treated with Alprostadil injection combined with Mailuoning. The blood rheology indexes, adhesion factors and inflammatory factor levels of the two groups were compared before and after treatment, and the short-term clinical efficacy and adverse reactions during the treatment of the two groups were compared.   Results  No significant difference in plasma viscosity, erythrocyte stiffness index, erythrocyte aggregation index and whole blood viscosity was found between the two groups before treatment (all P>0.05). After treatment, the levels of five indicators in the two groups were lower than before treatment, and the observation group was lower in the control group (all P < 0.05). No significant differences in the levels of adhesion factor ET-1 and ICAM-1 in the two groups before treatment (all P>0.05). After treatment, the levels of ET-1 and ICAM-1 in the two groups were lower than those before treatment, and the levels in the observation group were lower than those of control group (all P < 0.05). No significant difference in serum inflammatory factors IL-6, IL-8, TNF-α and hs-CRP was found between the two groups before treatment (all P>0.05). After treatment, the levels of four indicators in the two groups were lower than those before treatment, and the observation group had lower levels than the control group (all P < 0.05). The effective rate of the observation group was higher than that of the control group (92.31% vs. 76.91%, χ2=4.727, P=0.030). No serious adverse reactions were observed in the two groups, and the total adverse reaction rate (11.45% vs. 9.62%) was not statistically significant (χ2=0.102, P=0.749).   Conclusion  Alprostadil combined with Mailuoning injection in the treatment of lower extremity ASO can improve patient ' s hemorheological indexes, regulate the levels of adhesion factors and inflammatory factors without increasing adverse reactions and have high safety and significant efficacy.
Influence on levels of melatonin and oxidative stress in critically ill patients with AECOPD treated by different ways of light
GAI Mei-hua, FU Yan-ping, JIN Ai-xiang, YAO Hui-ping
2022, 20(10): 1662-1665. doi: 10.16766/j.cnki.issn.1674-4152.002673
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  Objective  To discuss the influence on levels of melatonin (Mel) and oxidative stress in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by different ways of light.   Methods  One hundred patients with AECOPD admitted to the Intensive Care Unit (ICU) of Zhejiang Province People ' s Hospital from July 2019 to December 2020 were selected as study subjects and divided into the control group (n=48) and observation group (n=52) according to random number table. The patients of control group were given 24-hour illumination, while the patients of observation group were given intermittent light way. The levels of serum Mel and urine 6-sulfonic melatonin (6-SMT), malondialdehyde (MDA) and superoxide dismutase (SOD) in bronchoalveolar lavage fluid (BALF) were measured, and statistical analysis were carried out.   Results  The levels of serum Mel (7 a.m. and 10 p.m.) were (29.6±5.8) pg/mL, (26.7±6.4) pg/mL and (50.8±8.5) pg/mL, (46.7±9.1) pg/mL respectively at 5 days after admission. The levels of serum Mel (7 a.m. and 10 p.m.) were (35.3±8.2) pg/mL, (24.5±5.7) pg/mL and (55.6±6.6) pg/mL, (44.5±7.5) pg/mL respectively at 10 days after admission. Compared with the control group, the levels of serum Mel (7 a.m. and 10 p.m.) in the observation group showed a gradually increasing trend (all P < 0.05). The levels of urine 6-SMT (7 a.m. and 10 p.m.) in the two groups showed a similar trend. In the observation group, the level of MDA in BALF gradually decreased while the level of SOD gradually increased (all P < 0.05). The success rate of removing ventilator of the observation group was obviously higher than that of the control group, while ICU stay time, the incidence of MODS and 28-day mortality were lower than those of the control group (all P < 0.05).   Conclusion  For critically ill patients with AECOPD, intermittent illumination can obviously increase the level of melatonin and its metabolites in the body, improve the ability of resistance to oxidative stress and improve prognosis.
The mechanism and clinical significance of SPARCL1 down-regulation expression on gemcitabine resistance in gallbladder cancer
HE Hua, LIU Shao-peng, LIU Hai-chao, BAI Ming-hui
2022, 20(10): 1666-1671. doi: 10.16766/j.cnki.issn.1674-4152.002674
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  Objective   To examine the role of cysteine rich acidic secretory glycoprotein analogue 1 (SPARCL1) in gallbladder cancer.   Methods   Gemcitabine resistant human gallbladder carcinoma cell line GBC-SD/GEM cell line was divided into blank control and SPARCL1 overexpression transfection groups. The expression levels of SPARCL1, matrix metalloproteinase-9 (MMP-9), vimentin (VIM) and fibronectin 1 (FN1), and the proliferation ability of each cell was detected after transfection. The expression of SPARCL1 in 50 cases of gallbladder cancer (gemcitabine-resistant group and-sensitive group) and paracancerous tissues operated in Luoyang Central Hospital from January 2014 to January 2017 were detected, and its relationship with the clinicopathologic features and prognoses of patients were analysed.   Results   The expression of SPARCL1 gene (29.12±1.10) and SPARCL1 protein (23.08±2.15) in the transfection group were significantly higher than that in the control group respectively (3.34±0.98, 2.58±0.71, all P < 0.05). The proliferation capacities and expression levels of MMP-9, VIM and FN1 in the SPARCL1 transfection group were 33.09±12.11, 1.69±0.75, 1.78±0.43 and 1.62±0.31, which were all significantly lower than those in the control group (327.15±9.28, 3.81±0.78, 4.12±0.24, 4.69±0.63, all P < 0.05). The expression of SPARCL1 in gemcitabine resistance group, sensitive group and paracancerous tissues were 5.65±2.01, 15.02±1.17 and 28.46±2.53, respectively, the difference between groups was significant (P < 0.05). SPARCL1 expression was independent of gender, age, pathological type, tumour size, CA19-9, CEA and tumour stage (all P > 0.05), but significantly correlated with lymph node metastasis and tumour differentiation (all P < 0.05). Median survival time of patients in the gemcitabine-resistant group was significantly lower than that of the sensitive group (14.77 months vs. 27.28 months).   Conclusion   SPARCL1 is poorly expressed in gallbladder cancer and is associated with gemcitabine chemotherapy resistance and prognosis.
Expression and significance of annexin A1 and S100A16 protein in human glioma
LIAO Qiu-lin, LAI Xu-wen, WU Xiao-li, HAN Li-fang, PENG Da-yun, ZHUANG Jie-na, LIAO Yue-yuan
2022, 20(10): 1672-1674. doi: 10.16766/j.cnki.issn.1674-4152.002675
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  Objective   To investigate the expression level and significance of annexin A1 (ANXA1) and S100A16 protein in glioma.   Methods   A total of 160 glioma cases and 20 dysembryoplastic neuroepithelial tumor (DNT) cases confirmed by Guangdong Clifford Hospital and General Hospital of Southern Theater Command from January 2015 to December 2020 were collected. The expression levels of ANXA1 and S100A16 proteins were detected by immunohistochemistry (IHC).   Results   The detectable rate of ANXA1 in glioma group was 80.6% (129/160), which was higher than that in normal brain tissue by 7.5% (12/160). The detectable rate of S100A16 in the glioma group was 86.3% (138/160), which was higher than that in the normal brain tissue group by 10.0% (19/160). No significant difference in the detectable rates of ANXA1 and S100A16 was found in the WHO grade Ⅰ-Ⅳ gliomas. The detectable rate of annexin A1 in astrocytoma without WHO grade Ⅰ was the highest, reaching 95.0% (76/80), which was much higher than that in oligodendroglioma (42.9%, 15/35). The detectable rate of S100A16 in astrocytoma without WHO grade Ⅰ (83.8%, 67/80) was not statistically significant compared with that in oligodendroglioma (88.6%, 31/35). Significant difference in the detectable rate of ANXA1 was found between the DNT group (100.0%, 20/20) and low-grade glioma group (78.8%, 63/80).   Conclusion   ANXA1 can be used as an auxiliary diagnostic marker for glioma and for the differential diagnosis of complex DNT and oligodendroglioma. Statisical difference in the expression of S100A16 differed between glioma and normal brain tissue, but S100A16 cannot be used as an auxiliary marker in the differential diagnosis of DNT and low-grade glioma.
Sensitization patterns of inhaled allergens in adults self-reported allergic rhinitis in Zhengzhou area
DU Wen-jin, ZHANG Qiu-xing, ZHANG Wen-chao, WANG Si-qin
2022, 20(10): 1675-1677. doi: 10.16766/j.cnki.issn.1674-4152.002676
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  Objective  To investigate the sensitization spectrum of adult self-reported allergic rhinitis (AR) patients in Zhengzhou area, analyze the differences of aeroallergen sensitization rates in different age groups, genders and years, and to provide reference for clinical diagnosis and treatment of AR.  Methods  Seventeen kinds of inhaled allergen reagents were used to conduct skin prick test (SPT), which was performed in 2 305 adult self-reported AR patients from January 2019 to December 2021 in Henan Provincial People' s Hospital. The distribution of allergens in different genders, ages and years was compared, and the positive rate was analyzed.  Results  The positive rate of SPT in 2 305 AR patients was 77.09%, which was often complicated with multiple allergens, among them, 1 137 patients (49.33%) were positive for 4 or more allergens. The top 5 allergen positive rates were pollen of dust mite (42.78%), house dust mite (38.61%), Platanus acerifolia pollen (35.27%), Artemisia pollen (34.27%) and Humulus scandens pollen (31.63%). The SPT positive rate of patients aged 18-30 years was the highest (91.84%), and the positive rate decreased with the increase of age. The positive rate of dust mite, house dust mite, Rape pollen and Humulus scandens pollen were statistically significant differences among different genders (all P < 0.05). From 2019 to 2021, the positive rate of dust mites and house dust mites were increased year by year, while the positive rate of Platanus acerifolia pollen, Artemisia pollen and Humulus scandens pollen were decreased year by year.  Conclusion  AR patients are more likely to be allergic to 4 or more inhaled allergens. The positive rate of SPT was highest in 18-30 years old. Among the common allergens of self-reported AR in adults in Zhengzhou, dust mite, household dust mite, Platanus acerifolia pollen, Artemisia pollen and Humulus scandens pollen are the most common allergens.
General Clinical Research
A retrospective clinical study of 9 cases with autoimmune diseases combined acquired hemophilia A
GAO Fei, TIAN Miao, LI Guang, DU Ming-zhu, ZHOU Zhi-hui, SONG Yan-ping, DONG Chang-hu
2022, 20(10): 1678-1681. doi: 10.16766/j.cnki.issn.1674-4152.002677
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  Objective  To analyze and summarize the clinical features, laboratory examination results, treatment plan and curative effects of patients with autoimmune diseases combined with acquired hemophilia A, so as to improve the understanding of the disease.  Methods  Nine patients with autoimmune diseases combined acquired hemophilia A who were admitted by Xi ' an Central Hospital from January 2012 to December 2020 were selected, and their clinical features, laboratory examination results, treatment plans and curative effects were retrospectively analyzed.  Results  Among the 9 patients, 4 were males and 5 were females. The median age was 60.0 (42.0~72.5) years. Bleeding symptoms were heterogeneous, mainly skin bleeding, but also bleeding from important organs such as gastrointestinal bleeding and corpus luteum hemorrhage. In the treatment of elimination of inhibitors, glucocorticoid monotherapy was used in 4 cases (44.5%), cyclophosphamide and prednisone (CP) regimen in 1 case (11.1%), rituximab combined with CP regimen or cyclophosphamide, vincristine and prednisone (COP) regimen in 3 cases (33.3%), and cyclophosphamide monotherapy in 1 case (11.1%). Among them, 3 cases were complete remission (33.3%), 4 cases were partial remission (44.5%), and 2 cases (22.2%) were not remission, and the total effective rate was 77.8%.  Conclusion  Autoimmune diseases combined acquired hemophilia A have a rapid onset, heavy bleeding and heterogeneity. The use of immunosuppressive therapy is more effective. In some cases, the combination of rituximab on the basis of immunosuppressive therapy can also achieve better results. After immunosuppression and coagulation factor supplementation, the disease can be quickly controlled and the effect is good, but 44.5% of patients only achieved partial remission after one course of treatment, suggesting that to completely remove the inhibitors, systemic treatment is required for the primary disease, and multiple courses of treatment or longer-term immunosuppressive treatment are required.
Study on the clinical effect of Masquelet technique on tibial chronic osteomyelitis and bone defect
HUANG Jian, LI Jian, LIAN Xiao, WANG Rong
2022, 20(10): 1682-1684. doi: 10.16766/j.cnki.issn.1674-4152.002678
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  Objective  To observe the clinical effect and safety of Masquelet technique in the treatment of tibial chronic osteomyelitis and bone defect.  Methods  Five patients with chronic osteomyelitis and bone defects in the tibia treated by Masquelet technology in the Department of Orthopaedics of our hospital from May 2018 to October 2021 were examined. They were followed up to 6 months after operation. Changes in hospital for special surgery (HSS), American orthopedic foot and ankle society (AOFAS) and the MOS item short from health survey (SF-36) scores were compared, the healing of tibial defect lesions was confirmed by imaging examination and the postoperative complications were observed.  Results  Before treatment, the HSS scores was 32-38 (35.60±2.61) points, the AOFAS score was 33-42 (38.40±3.42) points, the SF-36 score was 35-40 (38.40±2.07) points. After six menstrual reexaminations, all patients had good bone healing, the HSS score was 83-90 (85.80±2.68) points, the AOFAS score was 84-89 (86.20±2.17) points, the SF-36 score was 83-90 (85.40±2.70) points, which was significantly higher than that before treatment (t=66.893, 52.802, 57.346; all P < 0.001). Except one patient with delayed suture removal due to infection of bone incision, other patients did not have postoperative complications.  Conclusion  Masquelet technology is highly effective and safe in the treatment of large-scale bone defects caused by tibial osteomyelitis. It has positive significance for improving the lower limb motor function and quality of life of patients, and is worthy of clinical promotion.
Clinical observation of percutaneous radiofrequency ablation of cervical intervertebral disc combined with silver needle in the treatment of cervical vertigo
PI Duo-bo, BAO Jun-kan, CHEN Long, ZHANG Ying
2022, 20(10): 1685-1687. doi: 10.16766/j.cnki.issn.1674-4152.002679
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  Objective  To investigate the clinical effect of percutaneous radiofrequency ablation of cervical intervertebral disc combined with silver needle for cervical vertigo treatment.  Methods  A total of 119 patients with cervical vertigo diagnosed in the Pain Clinic of the Affiliated Hospital of Shaoxing University of Arts and Sciences from June 2019 to June 2021 were collected. The patients were randomly divided into group A (RF + silver needle group, n=41), group B (RF group, n=39) and group C (silver needle group, n=39). Patients in group A were treated with cervical intervertebral disc radiofrequency combined with silver needle, patients in group B were treated with cervical intervertebral disc radiofrequency only, and patients in group C were treated with silver needle only. The maximum systolic blood flow velocity (Vmax) of left vertebral artery (LVA), right vertebral artery (RVA) and basilar artery (BA) in the three groups before intervention and 1 week, 1 month and 3 months after treatment were measured by cranial colour Doppler ultrasound. The vertigo disability rating scale was used in evaluating the degree of vertigo.  Results  After the intervention, the vertebral artery haemodynamics of the three groups improved. After 3 months of intervention, the LVA-Vmax [(45.51 ± 4.73) cm/s], RVA-Vmax [(45.48 ± 4.70) cm/s], BA-Vmax [(45.54 ± 4.76) cm/s] of group A were higher than those of group B [LVA-Vmax, (43.11±4.82) cm/s; RVA-Vmax, (43.01±4.79) cm/s; BA-Vmax, (43.62±3.95) cm/s] and group C [LVA-Vmax, (43.06±4.98) cm/s; RVA-Vmax, (43.08±4.81) cm/s; BA-Vmax, (43.11±3.06) cm/s], the differences were statistically significant (all P < 0.05). After the intervention, all the indicators of the vertigo and disability scores of the three groups decreased, and the three groups had the lowest levels of the indicators after 1 month of intervention, and the differences were statistically significant (all P < 0.05).  Conclusion  The curative effect of cervical disc radiofrequency combined with silver needle in the treatment of cervical vertigo is significantly better than that of cervical disc radiofrequency therapy and silver needle alone.
Effects of paliperidone sustained-release tablets combined with aripiprazole on psychotic symptoms, cognitive function and prolactin in schizophrenia
HUANG Jin, ZHU Cheng
2022, 20(10): 1688-1690. doi: 10.16766/j.cnki.issn.1674-4152.002680
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  Objective  To investigate alleviation of psychotic symptoms and cognitive function of schizophrenia and the effect of prolactin in the combined treatment of paliperidone sustained-release tablets and aripiprazole.  Methods  Ninety-six patients with schizophrenia were recruited at the Fourth People' s Hospital of Jiande from September 2019 to September 2021 and randomly divided into intervention group (n=48) and control group (n=48) with the random number table method. The patients in the intervention group received paliperidone sustained-release tablets combined with aripiprazole at 10 mg/day, and the control group received paliperidone sustained-release tablets. Changes in positive and negative syndrome scale (PANSS), MATRICS consensus cognitive battery (MCCB) and prolactin were observed in both groups after 8 weeks of treatment.  Results  After treatment, the PANSS and MCCB scores improved (all P < 0.001) and prolactin levels increased (P < 0.001) in both groups. The scores of PANSS [intervention group, (65.06±10.47) points, control group, (70.17±6.36) points, P=0.005], information processing speed [intervention group, (55.06±6.48) points, control group, (49.85±4.76) points, P < 0.001], attention/vigilance [intervention group, (54.33±9.37) points, control group, (48.94±5.31) points, P=0.001], working memory [intervention group, (50.33±5.65) points, control group, (45.96±4.65) points, P < 0.001], prolactin levels [intervention group, (46.52±2.59) ng/mL, control group, (65.63±8.32) ng/mL, P < 0.001] in the intervention group were better than the control group. No statistically significant difference in word learning, visual learning, reasoning and problem-solving ability and social cognition was found between the two groups after treatment (all P>0.05).  Conclusion  Paliperidone sustained-release tablets combined with aripiprazole can effectively alleviate psychotic symptoms and cognitive function in schizophrenia. Aripiprazole can reduce the hyperprolactin level caused by paliperidone extended-release tablets.

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