中华全科医学

Identification and management of somatic symptoms disorder by general practitioners

FENG Xian, YAO Yuan-long, HUANG Wen-bo, WANG Liu-yi

2022, 20(3): 357-359. doi: 10.16766/j.cnki.issn.1674-4152.002352

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More and more patients with somatic symptoms disorder (SSD) with physical discomfort as the chief complaint are treated in general clinic. These patients are plagued by painful somatic symptoms for years and are treated in various specialties or general clinic of general hospitals, but they cannot be correctly identified and dealt with. In most western countries, general practitioners provide most mental health services. General practitioners have an important role to play in the identification of such diseases, and earlier detection and management can reduce the burden on patients and clinicians. Therefore, it is a challenge for general practitioners to correctly identify patients with psychological disorders who complain of physical discomfort and provide them with continuous, comprehensive and individualized management. General practitioners as "gatekeeper" of most of the patients health, how to use "biological-psychological-social" comprehensive model to help somatization disorder to understand the importance of its symptoms, and through their own learning knowledge about mental illness, correct selection and use of all kinds of tools, such as psychological scale to improve the recognition of SSD patients, in view of the patient's discomfort to take effective relief measures, and in the process of medication treatment, auxiliary necessary psychological treatment, etc. With the deepening of China's medical reform system and the implementation of the hierarchical diagnosis and treatment system, general practitioners and psychiatrists work together to improve the diagnosis and treatment effect of SSD. Therefore, this article from the body symptoms of disorders of the epidemiology and the present situation, the etiology, clinical manifestation and diagnosis, general practitioners in the face of such patients clinical thinking, to do a review, so as to improve the identify of general practitioners' right is complained of mental disorder patients with body discomfort, and provide a continuous, comprehensive, individualized management.

Clinical Reasoning in Primary Care in the United Kingdom(to be continued)

Rodger Charlton, XIE Wan-ling, LIU Man-ling

2022, 20(3): 360-361.

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Screening and intervention of sarcopoenia in elderly patients with chronic heart failure

MA Lu-yao, LIN Ping, WANG Qin, REN Qian

2022, 20(3): 419-423. doi: 10.16766/j.cnki.issn.1674-4152.002367

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Objective To screen the incidence of sarcopoenia in elderly inpatients with chronic heart failure (CHF) and to evaluate the effect of exercise training and nutritional support in combination with standard heart-failure treatment on the improvement in sarcopoenia and cardiac function in elderly inpatients with CHF. Methods Two hundred elderly inpatients with CHF who were in the Hangzhou Third People's Hospital from January 2018 to February 2020 were collected to be screened for sarcopoenia. The differences of cardiac function, sarcopoenia, in the 200 selected patients were observed. The selected patients with CHF combined with sarcopoenia were randomly divided into control (standard heart-failure treatment, 33 cases) and observation (exercise training+nutritional support+standard heart-failure treatment, 33 cases) groups. After two months of treatment, the improvement in sarcopoenia and cardiac function were compared between the two groups. Results (1) The incidence of sarcopoenia in elderly inpatients with CHF was 33%. (2) In patients with CHF complicated with sarcopoenia and those who without sarcopoenia, NT-proBNP levels were (1 559.59±485.95) pg / mL vs. (1 362.60±336.75) pg / mL, the LVEFs were (45.56±4.25) % vs. (46.98±3.12) %, and the proportions of cardiac function Ⅲ were 37(56.06%) vs. 53(39.55%), the difference was statistically significant respectively. (3) After treatment, between two groups, the 6 min walking distance, appendicular muscle mass, grip strength, and GDF-11 level of the observation group were all higher; GDF-15 level was lower in the observation group (all P < 0.05). The LVEF and NYHA cardiac-function grading in the observation group also improved compared with that of the control group (all P < 0.05). (4) Multiple linear-regression analysis showed that the GDF-15 level was inversely correlated with appendicular muscle mass and 6 min walking distance (β=-0.449, -0.708, all P < 0.05), GDF-11 level was positively correlated with appendicular muscle mass and grip strength (β=0.537, 0.759, all P < 0.05). Conclusion Sarcopoenia has a high incidence in elderly inpatients with CHF. Exercise training and nutritional support combined with standard heart-failure treatment can improve sarcopoenia and cardiac function in elderly patients with CHF complicated with sarcopoenia. GDF-15 and GDF-11 can be used as clinical-observation indices in patients with sarcopoenia.

Effect of geriatric syndrome on physical function and fall risk in elderly patients with type-2 diabetes

QI Qian-qian, XIN Hong-ju, ZHOU Zhou-Wei, RUAN Chun-yan, ZHAO Jing

2022, 20(3): 424-427. doi: 10.16766/j.cnki.issn.1674-4152.002368

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Objective To investigate the effects of geriatric syndrome on the physical function and the risk of fall in elderly patients with type-2 diabetes. Methods A total of 165 elderly patients with type-2 diabetes who were treated or hospitalised in our hospital from February 2019 to February 2020 were selected as the research subjects. According to the type and quantity of geriatric syndrome, the patients were divided into 0-1 type group (n=36), 2-3 type group (n=73), and 4-6 type group (n=56). The effects of geriatric syndrome on physical function and fall risk in elderly patients with type-2 diabetes were compared and analysed. Results The proportion of age, proportion of divorce/widowed, proportion of fear of falling, use rate of assistive devices, incidence of falling history in the past 1 year, incidence of high risk of falling, impairment of daily living and decline of balance gait in 4-6 groups were significantly higher than those in 0-1 group and 2-3 group (all P < 0.05). Univariate and multivariate logistic regression analysis showed that fattening was the only risk factor for impairment of daily living ability, decline in balance and gait function, and fall in recent 1 year in elderly patients with type 2 diabetes (all P < 0.01). Cognitive decline was an independent risk factor for increased risk of fall, decreased balance and gait function, and the occurrence of fall in the past 1 year (all P < 0.01). Malnutrition was an independent risk factor for daily living impairment, increased risk of falls, reduced balance and gait function, and falls in the past 1 year (all P < 0.01). Conclusion Geriatric syndromes such as frailty, malnutrition, and cognitive decline, can lead to decreased physical function and increased fall risk in elderly patients with type-2 diabetes. Comprehensive geriatric assessment and intervention measures should be taken to improve the quality of life of elderly patients with this disease.

Infection characteristics of 11 juvenile cases of COVID-19 in BoZhou City, Anhui Province

ZHAO Feng, SUN Fang, WEI Guang-you, HE Hong-liang

2022, 20(3): 428-430. doi: 10.16766/j.cnki.issn.1674-4152.002369

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Objective To study the epidemiological and clinical characteristics of juvenile patients with coronavirus disease 2019 (COVID-19) in BoZhou City, Anhui Province. Methods We conducted a retrospective study focusing on 11 juvenile patients diagnosed with COVID-19 in BoZhou City, Anhui Province from 24 January 2020 to 12 February 2020. Epidemiological, demographic, clinical, laboratory, radiological and treatment data were collected and analysed. Results Amongst the hospitalised juvenile patients with COVID-19, the median age was 10.54(7.5, 13.0) years, and 6(54.5%) were male. All 11 patients were detected by real-time RT-PCR, and at least 1 family members were infected with COVID-19. Patients had clinical manifestations of fever [4(36.3)% patients], mild upper respiratory tract symptoms [8(72.7%) patients], cough [2(18.2%) patients], muscle ache [1(9.1%) patients], sore throat [2(18.2%) patients] and nasal congestion [4(36.4%) patients]. One patient (9.1%) showed significant gastrointestinal symptoms and other clinical manifestations 1-2 days before the diagnosis of COVID-19. Eight patients (72.7%) had decreased lymphocyte counts, 9(81.8%) had elevated c-reactive protein levels, 3(27.2%) had elevated ALT and AST, and 4(36.4%) had normal white blood cell counts. According to imaging examination, 3(27.2%) patients showed bilateral pneumonia, and 5(45.5%) patients showed multiple mottling and ground-glass opacity. Conclusion Compared with adults, there are not many cases of juvenile patients, and relevant studies are insufficient. The above information provides valuable guidance for the effective management and accurate treatment of this disease.

Clinical characteristics and risk factors of feeding intolerance in preterm infants

FAN Min, CHEN Xin, ZHANG Zhen, JIA Wen-ting

2022, 20(3): 431-434. doi: 10.16766/j.cnki.issn.1674-4152.002370

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Objective To analyse the clinical characteristics and related factors of feeding intolerance (FI) in preterm infants. Methods A total of 589 preterm infants hospitalised in the first and second affiliated hospitals of Bengbu Medical College from November 2020 to November 2021 were divided into the feeding tolerance (FT) group and FI group. They were divided into < 32 weeks group and ≥32 weeks group according to gestational age. They were divided into groups of < 1 500 g and ≥1 500 g according to birth weight. General information (gender, gestational age, birth weight, asphyxia and medication) and FI (occurrence time, duration and disappearance time) were recorded in detail in the FI group, clinical characteristics of FI were summarised, and risk factors of FI were analysed. Results (1) FT accounted for 68.59%, and FI accounted for 31.41%. (2) The main symptoms of FI were abdominal distention, gastric retention and vomiting. (3) The appearance of FI in the group with gestational age < 32 weeks appeared later (P < 0.001), lasted longer (P < 0.001), and disappeared later (P=0.002) than the group with gestational age ≥32 weeks. The difference was statistically significant (P < 0.05), but the difference of main symptoms was not statistically significant (P>0.05). Compared with the ≥1500g group, FI clinical manifestations appeared later (P=0.002), lasted longer (P=0.004) and disappeared later (P < 0.001) in < 1 500 g group. However, the vomiting of premature infants in the ≥1 500 g group was significantly higher than that in the < 1 500 g group (P=0.034). All had statistical significance (P < 0.05). (4) Gestational age and birth weight were protective factors of FI, whereas intrauterine infection and neonatal respiratory distress syndrome were independent risk factors of FI (all P < 0.05). Conclusion The younger the gestational age and the lighter the birth weight, the later the occurrence and disappearance time and the longer the duration of FI. Low birth weight and intrauterine infection are independent risk factors of FI.

Analysis of prepregnancy body quality control and its influencing factors in overweight/obese infertility patients

JIAO Xiao-ke, CAO Hong-xia, WANG Dan-dan, XING Jin-fang

2022, 20(3): 435-437. doi: 10.16766/j.cnki.issn.1674-4152.002371

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Objective To investigate the prepregnancy body quality control status of overweight/obese infertility patients and analysed the influencing factors. Methods A total of 116 cases of overweight/obese infertility patients who were treated in the Outpatient Department of the Reproductive Medicine Center of our hospital from June 2019 to June 2020 were selected as the research objects. General clinical data and relevant data before and after body weight control were collected, and relevant factors influencing the effect of body weight control were analysed. Results The time of body mass control was 8-24 weeks. The weight loss was 0-25 (7.43±0.62) kg on average, and the weight loss accounted for 0-26.83% of the original body weight. A total of 45 patients (38.79%) had weight loss/original body weight ≥10%. Whether the patients had controlled the body mass in the past, the way of body mass control in the past, basic metabolism, body mass control time, original BMI and general self-efficacy score had significant effects on the effect of body mass control (all P < 0.05). Multivariate logistic regression analysis showed that basic metabolism, body mass control time, BMI and general self-efficacy were the influential factors of body mass control effect. Conclusion The effect of body mass control in overweight/obese infertile patients is poor and needs to be further improved. Basal metabolic rate, lower BMI reduce, general self-efficacy scores are independent risk factors affecting the effects of patients' body quality control, weight control patients with longer belong to the protection of the body quality control effect factors, clinical should be aimed at the above factors intervention measures to improve the patients' body quality control effect, improve the pregnancy outcome.

Incidence of insulin resistance in obese school-age children and its correlation with autonomic nerve function

XU Jun

2022, 20(3): 438-440. doi: 10.16766/j.cnki.issn.1674-4152.002372

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Objective To investigate the incidence of insulin resistance (IR) in obese school-age children and its correlation with heart rate deceleration capacity (DC), heart rate acceleration capacity (AC) and heart rate variability (HRV). Methods A total of 122 obese school-age children were admitted to our hospital between May 2018 and May 2019 as the research objects, and they were divided into the IR group (69 cases) and non-IR group (53 cases) on the basis of the IR index (IRI) calculation results. The general conditions of both groups were recorded. The results of DC, AC and HRV in both groups were compared, and the Pearson correlation coefficient was analysed to determine the correlation between IRI indicators and results of DC, AC and HRV. Results The IR group had lower DC, SDNN, SDANN and HF (P < 0.05) and higher AC than the non-IR group (P < 0.05). The two groups were negatively correlated with DC, SDNN, SDANN, RMSSD, LF and HF (r=-0.390, -0.451, -0.290, -0.215, -0.259, -0.324, all P < 0.05) and positively correlated with AC (r=0.584, P < 0.05). In the IR group, IRI indicators were negatively correlated with SDNN, RMSSD and LF (r=-0.517, -0.370, -0.355, all P < 0.05) and positively correlated with AC (r=0.519, P < 0.05). In the non-IR group, IRI indicators were negatively correlated with RMSSD and HF (r=-0.343, -0.344, all P < 0.05). Conclusion The heart autonomic nerve function of obese school-age children with IR is severely damaged, as evidenced by a decrease in DC-and HRV-related indicators and an increase in AC level. Moreover, the higher the degree of IR in the child, the more severe the damage of autonomic nerve function.

Strategy research on improving the quantity and quality of general practitioner contract based on general practitioner contract decision model

ZHU Chun, LI Dong-hua, ZHANG Xing-na, SHEN Ao, GU Hui-ying, ZHU Hui-rong

2022, 20(3): 441-445. doi: 10.16766/j.cnki.issn.1674-4152.002373

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Objective Study the strategies to improve the service level of general practitioners (GPs) which can provide theoretical basis for solving questions like "What is the key problems in improving family doctor contract service? What can be done?" Methods From May 4 to May 25, 2018, on the basis of convenience sampling, 25 community health service centres were involved. A questionnaire survey was performed on GPs who participated in contracted services and were willing to join the study. The main contents of the survey included demographic and sociological characteristics, ability to work, characteristics of contracted residents, practical environment and contract status. Data analysis was performed in SPSS 24.0 and AMOS 24.0. Results In the correlation analysis, the correlation coefficients of work ability, characteristics of contracted resident 1, characteristics of contracted resident 2, practice environment and contracted object's fit were 0.456, 0.376, 0.505 and 0.430, respectively, and they were statistically significant (all P < 0.01). In the structural equation, the characteristic of contracted resident 1 had direct and indirect effects on the contracted object's fit. The effect values were 0.479 and 0.218, respectively, and the total effect value was 0.697. Contracted resident 2 had no effect on the contracted object's fit. Work ability had direct impact on the contracted object's fit, with an effect value of 0.359. The practice environment had no effect on the fit of the contracted object. Conclusion To increase the signature rate, the GPs' clinical ability and ability to use electronic medical information should be cultivated. At the same time, it is necessary to spread propaganda of the family doctor contract service amongst residents and bring performance appraisal and incentive mechanism to completion.

Mental health status of home isolation people during the prevalence of COVID-19

ZHOU Yi-jiang, LI Shu-guang, MO Qiu-yan, MO Yan, LU Li-ming, QIN Zhi-ming

2022, 20(3): 446-449. doi: 10.16766/j.cnki.issn.1674-4152.002374

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Objective To explore the mental health status and influencing factors of home isolation people during the prevalence of coronavirus disease 2019 (COVID-19) and understand the mental health needs and appropriate interventions to provide psychological intervention for the masses in public health emergencies. Methods Using convenience sampling, 859 home isolation people aged 18-80 years old were surveyed using a questionnaire. Chi-Square test and Fisher's exact test were used to compare between groups, and stepwise multiple logistic regression was used to investigate the factors influencing mental health status. Results A total of 832 subjects were included, including 773 general home isolation people and 59 key home isolation people. The proportions of anxiety, depression and stress were 76.27% (45/59), 84.75% (50/59) and 84.75% (50/59) among the key home isolation people and 70.38% (544/773), 76.46% (591/773) and 74.46% (591/773) among the general home isolation people, respectively. The difference was not statistically significant (all P>0.05). The most preferred psychological assistance of the two groups was WeChat or QQ counselling and how to ease psychological stress. Stepwise multiple logistic regression showed that female, difficulty falling asleep, difficulty maintaining sleep and early waking were risk factors for anxiety (all P < 0.05). Female, difficulty falling asleep and difficulty maintaining sleep were risk factors for depression (all P < 0.05). Compared with the 18-39 age group, the 40-59 age group was less prone to depression (OR=0.590, 95% CI: 0.420-0.840). Compared with those in the 18-39 age group, those with junior high school education and below and those who have difficulty falling asleep, those in the 40-59 age group, those with a master's degree and above and those who have difficulty falling asleep were less likely to experience psychological stress. Conclusion During the prevalence of COVID-19, large-scale isolation measures have a large impact on the mental health of the people. Gender and sleeping quality are important factors influencing psychological stress, and psychological crisis intervention should be targeted to the population.

Correlation between serum indexes and cognitive function in elderly patients with depression

CHEN Shou-lin, ZHU Sheng-zhi, YU Chang, XIE Shu-guang, ZHENG Cheng-ying

2022, 20(3): 450-453. doi: 10.16766/j.cnki.issn.1674-4152.002375

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Objective To explore the correlation between serum index and cognitive function in elderly patients with depression and provide reference for clinical diagnosis of senile depression. Methods From June 2018 to June 2019, 50 elderly patients with depression in Ningbo Kangning Hospital were selected as the depression group, and 50 healthy people were selected as the control group. The cognitive function, depression degree and serum indexes were compared between the two groups. Pearson method was used to analyse the correlation between serum indicators and cognitive function in depression group. Results The Hamilton depression scale (HAMD) score of the depression group was (25.44±4.68) points, which was significantly higher than that of the control group [(4.52±2.24) points, P < 0.05], and the mini-mental state examination (MMSE) score was (22.36±2.83) points, which was significantly lower than that of the control group [(27.02±2.35) points, P < 0.05]. There was a negative correlation between HAMD score and MMSE score in the depression group (r=-0.420, P < 0.05). The levels of 5-hydroxytryptamine (5-HT), dopamine (DA) and norepinephrine (NE) in the depression group were significantly lower than those in the control group (all P < 0.05), were negatively correlated with HAMD score (r=-0.532, -0.477, -0.494, all P < 0.05) and positively correlated with MMSE score (r=0.525, 0.476, 0.506, all P < 0.05). The levels of homocysteine (Hcy), Cystatin-C (Cys-C), interleukin (IL)-1β and IL-18 were significantly higher than those in the control group (all P < 0.05), were positively correlated with HAMD score (r=0.444, 0.457, 0.575, 0.540, all P < 0.05) and negatively correlated with MMSE score (r=-0.404, -0.372, -0.594, -0.419, all P < 0.05). Conclusion The level of serum indexes in elderly patients with depression is closely related to the degree of depression and cognitive function. With the increase of depression degree and the decrease of cognitive level, the levels of 5-HT, DA and NE gradually decrease, whereas the levels of Hcy, Cys-C, IL-1β and IL-18 gradually increase.

Quantitative detection method for diagnosis and prognosis evaluation of postpartum stress urinary incontinence in women

YAN Jing, QIAN Chen-feng, ZHOU Yi-bo

2022, 20(3): 454-457. doi: 10.16766/j.cnki.issn.1674-4152.002376

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Objective To observe the clinical effect of pelvic floor ultrasound and urodynamic test in the diagnosis and prognosis evaluation of female postpartum stress urinary incontinence. Methods One hundred cases of postpartum stress urinary incontinence patients and 300 cases of normal postpartum women were studied. All subjects were tested by pelvic floor ultrasound and urodynamics. The patients with postpartum stress incontinence were trained with pelvic floor muscle rehabilitation and biofeedback electrical stimulation to evaluate the efficacy level. The changes in pelvic floor ultrasound and urodynamic indexes between patients with postpartum stress incontinence and normal postpartum women and patients with different therapeutic levels were compared. Results The ultrasonic detection values of bladder neck movement distance and urethral rotation angle in patients with postpartum stress urinary incontinence were significantly higher than those in normal postpartum women (t=32.768, 28.960; all P < 0.001), the rate of intraurethral funnel formation in patients with postpartum stress urinary incontinence (88.00%) was significantly higher than that in normal postpartum women (11.33%, χ²=207.965, P < 0.001), and the urodynamic parameters such as maximum urethral closure pressure, functional urethral length and maximum urethral pressure in patients with postpartum stress urinary incontinence were significantly lower than those of normal postpartum women (all P < 0.001). The total effective rate of floor muscle rehabilitation training and biofeedback electrical stimulation for patients with postpartum stress urinary incontinence was 83.00%. The pelvic floor ultrasound indexes of patients with postpartum stress urinary incontinence after effective rehabilitation treatment were significantly lower than those of patients with ineffective treatment (t=5.760, 8.323; all P < 0.001), the rate of intraurethral funnel formation (18.07%) was significantly lower than that of patients with ineffective treatment (76.47%, χ²=21.060, P < 0.001), and the urodynamic indexes were significantly higher than those in patients with ineffective treatment (all P < 0.001). Conclusion Pelvic floor ultrasound and urodynamic detection can effectively identify the changes of pelvic floor tissue structure and urethral physiological function in patients with postpartum stress urinary incontinence, which has high clinical application value for early diagnosis and prognosis evaluation of postpartum stress urinary incontinence.

Clinical effect of colour Doppler ultrasonography combined with contrast-enhanced ultrasound in the differential diagnosis of renal parenchymal tumour

LIU Xue, YANG Chong-yi, YANG Feng-qiang, GAO Yin, HU Zeng-gang, LI Guang-yin

2022, 20(3): 458-460. doi: 10.16766/j.cnki.issn.1674-4152.002377

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Objective To observe the clinical effect of colour Doppler ultrasonography (CDUS) and contrast-enhanced ultrasound (CEUS) in qualitative differential diagnosis of renal parenchymal tumour. Methods A total of 126 patients with renal parenchymal tumours in our hospital from January 2017 to August 2021 were selected as the research objects. All cases underwent CDUS and CEUS examination to analyse renal tumours with different properties. The histopathological test results were used as the gold standard to statistically analyse the difference in the diagnostic efficacy of the two detection methods in the differential diagnosis of renal tumours with different pathological types and different lesion sizes. Results In terms of CDUS imaging signal characteristics, malignant renal parenchymal tumours mostly protruded outside the renal contour, and most of them had pseudocapsule. Conversely, benign renal parenchymal tumours mostly did not protrude outside the renal contour, and most of them did not have a pseudocapsule. In terms of CEUS signal characteristics, malignant renal tumours were mainly characterised by fast perfusion, high intensity, uneven enhancement of the lesion and annular enhancement around the lesion, whereas benign renal tumours were mainly characterised by synchronous or slow perfusion, medium and low intensity, uniform enhancement of the lesion and no annular enhancement around the lesion. The sensitivity (91.67%), specificity (87.04%) and accuracy (89.68%) of CEUS were significantly higher than those of CDUS (72.22%, 68.52% and 70.63%; χ²=9.199, P=0.002; χ²=5.357, P=0.021; χ²=14.371, P < 0.001). The Kappa value and area under ROC curve of CEUS for the qualitative diagnosis of small renal tumour (0.789 and 0.894) were higher than those of CDUS (0.405 and 0.704). Conclusion CEUS is superior to CDUS in the qualitative differential diagnosis of small renal tumours. The combined application of CEUS and CDUS can improve the diagnostic efficiency of renal parenchymal tumours and is worthy of clinical application.

Comparison of MSCT three-dimensional reconstruction and MRI in the diagnosis of mandibular condylar fracture

HUANG Hong, XU Xu, YAN Qin, FANG Xin

2022, 20(3): 461-463. doi: 10.16766/j.cnki.issn.1674-4152.002378

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Objective To observe the differential diagnosis effect of MSCT three-dimensional reconstruction and MRI on mandibular condylar fracture with different characteristics. Methods A total of 150 patients with mandibular condylar fracture treated at Quzhou Hospital of Traditional Chinese Medicine and the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2019 to June 2021 were studied. All patients underwent multi-slice spiral CT(MSCT) scanning, three-dimensional reconstruction and MRI before operation. The sensitivity, specificity and accuracy of the two methods in the diagnosis of mandibular condylar fracture types and fracture displacement, as well as the diagnostic coincidence of soft tissue injury, were investigated. Results There was no significant difference in the sensitivity, specificity and accuracy of MSCT three-dimensional reconstruction and MRI in the diagnosis of different types of mandibular condylar fractures, such as condylar head fracture, condylar neck fracture and subcondylar fracture (all P>0.05). There was no significant difference in the sensitivity, specificity and accuracy of MSCT three-dimensional reconstruction and MRI in the diagnosis of different mandibular condylar fracture displacement, such as in situ bone fracture, bending displacement and dislocation fracture (all P>0.05). The diagnostic accuracy of MRI for ligament tear and condylar surface cartilage injury[81.97%(50/61) and 80.49%(66/82)] was significantly higher than that of MSCT scanning three-dimensional reconstruction[63.93%(39/61) and 65.85%(54/82)], χ²=5.587, 4.473; P=0.018, 0.034. Conclusion The diagnostic ability of MSCT scanning three-dimensional reconstruction for the type and displacement of mandibular condylar fracture is comparable to that of MRI, whereas MRI has better diagnostic ability for soft tissue injury. Clinically, the two methods can be combined to improve the comprehensive diagnostic efficiency of mandibular condylar fracture and surrounding soft tissue injury.

Cell derivatives in heart injury repair progress and application prospects

LI De-min, LU Yong-zheng, QIN Zhen, XU Yan-yan, ZHANG Li, ZHANG Jin-ying, TANG Jun-nan

2022, 20(3): 464-467. doi: 10.16766/j.cnki.issn.1674-4152.002379

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Acute myocardial infarction (AMI) is still the leading cause of death in patients with coronary heart disease. New treatment strategies for repairing the damaged heart after AMI need to be developed. The latest research shows that cell derivatives exhibit great potential in the repair of heart damage, which is a hot spot in current medical research. Cell derivatives include extracellular vehicles (EVs), non-coding RNA, and growth factors. Combined with the latest research progress, this review shows the changes and functions of EVs derived from cardiomyocytes, endothelial cells and immune cells after AMI. The changes and effects of microribonucleic acid, long non-coding ribonucleic acid and circular ribonucleic acid in preclinical and clinical research after AMI are summarised. The focus is on the changes and effects of vascular endothelial growth factor and fibroblast growth factor after AMI. Finally, from the perspective of clinical application, the research on EVs, non-coding RNA, growth factors as biomarkers for the diagnosis and prediction of clinical disease progression, and the use of these cell derivatives as treatment methods for AMI are summarised. In short, cell derivatives have great potential in the repair of heart damage and are worthy of in-depth study.

Clinical research progress related to massive blood transfusion in obstetrics

DING Jie-lan, FENG Juan, CHEN Jie-feng, PAN Hai-tao

2022, 20(3): 468-472. doi: 10.16766/j.cnki.issn.1674-4152.002380

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In obstetrics, obstetric mass transfusion requires extensive coordination amongst obstetric, anaesthesia and blood bank teams. In the clinical process, obstetric haemorrhage is one of the most common causes of obstetric morbidity and mortality. Intraoperative and postpartum haemorrhage will pose a certain threat to the puerpera and bring great challenges to clinicians. Therefore, timely identification of risk factors for obstetric massive transfusion can bring more opportunities for treatment and improve the survival rate of puerpera. Blood transfusion is still the most important treatment in the rescue of obstetric haemorrhage, but careless blood transfusion will bring serious consequences. Massive transfusion protocols (MTP) is a predictive blood transfusion protocol, which is used to correct the coagulation dysfunction by adding plasma, clotting factors and platelets, even when red blood cells are added in response to massive blood loss in obstetrics. MTP not only includes the amount of input, but also is an emergency linkage mechanism. Reasonable allocation of blood components and clear management rules for various matters in blood transfusion have been formulated to make the supply of blood components more effective. In the process of the rescue, staff should follow the specification, standard blood transfusion strategy, timely grasp the obstetric numerous transfusions start time, quick to adopt appropriate proportion of rapid blood transfusion, deal with a large number of blood transfusions of critical condition, recovery quickly promote maternal blood volume. This is the important link in the process of treatment, which is of extremely important significance to improve the success rate of rescue.

Medication rule of Professor Cui Yun in treating oligoasthenozoospermia based on data mining

XU Wen-li, CUI Yun, FANG Teng-duo

2022, 20(3): 473-477. doi: 10.16766/j.cnki.issn.1674-4152.002381

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Objective To investigate the medication rule, prescription experience and clinical ideas of Professor Cui Yun in treating oligoasthenozoospermia. Methods The first prescriptions of 200 oligoasthenozoospermia patients who were treated by Professor Cui Yun between January 2019 and December 2019 in Ningbo TCM Hospital were collected and extracted. The database was established. The nature, taste, meridian tropism and efficacy of drugs were analysed by descriptive statistics, and the drug combinations and prescriptions commonly used by Professor Cui Yun in the treatment of oligoasthenozoospermia were analysed use cluster analysis. Results There were 87 herbs and 2 425 frequencies in the 200 prescriptions. The frequency of the top 50 herbs was up to 95.46%, and the top five herbs were energy-restoring herbs, heat-clearing herbs, urine-promoting herbs, blood circulation-promoting herbs and astringent herbs. The properties were cold, warm and neutral, and never great cold or hot herbs. The tastes were bitter, sweet and acrid. The main meridian entries were spleen, kidney and liver. The cluster analysis showed that the common prescriptions of Professor Cui Yun in treating oligoasthenozoospermia were Liu wei Di huang Soup, Huoxue Prescription, Dang gui Liu huang Soup, Dang gui Buxue Soup, Tuomin Soup and Erzhi Pills, and the common drug groups were Guya and Maiya, Maidong and Wuweizi, Shengdiyu and Huzhang, Xiqiancao Guanzhong and Shengma. Conclusion The medication rule of Professor Cui Yun in treating oligoasthenozoospermia complies with the pathological mechanism of kidney deficiency, damp heat and stasis toxin. The prescription is based on supporting weakness, taking clearing away heat and urine, activating blood circulation into account, and attaching importance to spleen and kidney, or liver and kidney. On the other hand, the data mining of the herbs' property reflects the equal stress on coldness and warmness, removing and tonifying, the prescription is gentle and flexible in brief.

Clinical effect of midnight-noon ebb-flow of ear acupoint pressing bean on improving yang-deficiency constitution and clinical curative effect of early threatened abortion with kidney-deficiency syndrome

LI Jing-ying, ZHOU Jian-ping

2022, 20(3): 478-481. doi: 10.16766/j.cnki.issn.1674-4152.002382

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Objective To evaluate the effect of midnight-noon ebb-flow on Yang deficiency constitution and TCM syndrome score of patients with early threatened abortion of kidney deficiency type, observe its clinical effect and provide evidence-based basis for clinical practice. Methods Seventy patients with early threatened abortion with yang and kidney deficiency who were admitted at the Department of Gynecology of Ningbo Municipal Hospital of TCM from January 2020 to September 2020 were selected. Random numbers were generated by SPSS according to the admission sequence number, and patients were randomly divided into the control group (35 cases) and study group (35 cases). The control group was given conventional Chinese and Western medicine treatment (Western medicine: 20 mg progesterone injection or 40 mg intramuscular injection+Chinese medicine Shoutaiwan plus or minus oral), and the study group was given midnight-noon ebb-flow of ear acupoint pressing bean on the basis of conventional Chinese and Western medicine treatment. The scores of Yang deficiency constitution on the TCM Physique Identification Scale, the scores of TCM syndromes of early threatened abortion, the improvement rate of yang deficiency physique and the effective rate of treatment were compared between the two groups before and after treatment. Results The Yang deficiency constitution score of the study group was (26.77±12.52) points, which was significantly lower than that of the control group (38.54±13.94) points (t=3.717, P < 0.01), the median and quartile of TCM syndrome in the study group were 0 (0, 1), which were lower than those in the control group [1(0, 2), Z=-2.543, P < 0.05]. The improvement rate and total effective rate of Yang deficiency physique in the study group were 62.86% and 91.43% respectively, which were significantly higher than those in the control group (28.57% and 65.71%, χ²=8.289 and 6.873, both P < 0.01). Conclusion Midnight-noon ebb-flow of ear acupoint pressing bean at the selected time can improve the constitution of yang deficiency and reduce the clinical symptoms of patients with early threatened abortion of kidney deficiency type. It can be used and promoted as an external treatment method of Chinese medicine.

Supervision of online theory courses of clinical medicine in the context of the COVID-19 epidemic

TONG Lin, ZHANG Liang-qing, ZHOU Zhong-you, LIN Qiao-ling, YAO Wei-min

2022, 20(3): 482-486. doi: 10.16766/j.cnki.issn.1674-4152.002383

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Objective To investigate the new supervision scheme on online theory courses of clinical medicine (OTCCMs) in the context of the COVID-19 epidemic, so as to provide a guarantee for improving the quality of online teaching of clinical medicine. Methods From March 2020 to May 2020, 19 OTCCMs (18 professional courses and 1 elective course) of the First Clinical College of Guangdong Medical University (GDMU) were taken as the research objects. The characteristics of OTCCMs were prospectively analysed through investigation and research. The suitability and applicability of the traditional teaching supervision (TTS) mode were analysed retrospectively. In view of the objectives and requirements of the current online teaching supervision (OTS), the strategies linking the TTS mode with the OTS mode were analysed through a series of investigations, and formative evaluation method was applied. Then, the framework of the new OTS mode was established and improved. Students' recognition degree on the teaching effect under the new teaching supervision mode was evaluated through questionnaires. Results There were many new changes and differences in the OTCCMs due to the adoption of three-stage teaching. The TTS model had solidified, and no longer matched and connected the online theory teaching models in the context of the COVID-19 epidemic. The new teaching supervision framework of OTCCMs in the First Clinical College of GDMU was established initially, which basically solved the basic problems faced by current teaching supervision. The effect of the new OTS mode on the teaching effect was recognised by most students. Through the preliminary practical application of the new teaching supervision mode, the basic data for the reform and improvement of the follow-up teaching supervision work were obtained. Conclusion The new supervision mode established by the First Clinical College of GDMU is basically suitable for the current teaching needs of OTCCMs, and can meet the requirements of effective supervision of online teaching and guarantee the teaching quality.

Construction of survival and prognosis nomogram for elderly nasopharyngeal carcinoma (≥ 60 years) based on SEER Database

CHEN Zi-hong, ZHONG Qiang, GAO Jian-quan, WEI Cui

2022, 20(3): 487-492. doi: 10.16766/j.cnki.issn.1674-4152.002384

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Objective To establish a nomogram to predict the overall survival (OS) rate of elderly patients with nasopharyngeal carcinoma (≥ 60 years) by utilising the database of the Surveillance, Epidemiology and End Results (SEER) program. Methods The data of 1 366 elderly patients with nasopharyngeal carcinoma who were diagnosed between 2004 and 2015 from the SEER database were obtained. These patients were randomly divided into training (n=954) and validation (n=412) cohorts. The Cox Proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on OS. Significant prognostic factors were combined to build a nomogram. The predictive performance of the nomogram was evaluated via internal (training cohort data) and external validation (validation cohort data) by calculating the index of concordance (C-index) and plotting calibration curves. Results In the training cohort, the results of Cox proportional hazards regression model showed that age at diagnosis, married status, race, grade, histologic type, TNM stage, radiation and chemotherapy were significantly associated with the survival prognosis (P < 0.05). These factors were used to establish the nomogram. The nomogram showed good accuracy in predicting OS rate, with a C-index of 0.732 (95% CI: 0.708-0.756) in internal validation and a C-index of 0.762(95% CI was 0.729-0.795) in external validation. All calibration curves showed excellent consistency between prediction by nomogram and actual observation. Conclusion A novel nomogram for elderly patients with nasopharyngeal carcinoma is established to predict OS in our study and shows good prognostic significance. It can provide medical personnel with accurate and practical predictive tools which can quickly and accurately assess the survival prognosis of patients individually and guide medical personnel in the follow-up treatment of patients.

Influencing factors of hypoglycaemia in post-operative total parenteral nutrition therapy for gastric cancer

YAN Yan-yan, WU Wan-ying, FU Huan-ying, YU Peng-fei

2022, 20(3): 493-497. doi: 10.16766/j.cnki.issn.1674-4152.002385

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Objective To explore the related factors of hypoglycaemia in patients with gastric cancer during total parenteral nutrition therapy and to provide a theoretical basis for reducing the incidence of hypoglycaemia in clinical treatment and for medical staff to formulate effective prevention and intervention measures. Methods A retrospective study was used to collect information on 974 patients who underwent radical gastric cancer surgery in the Department of Abdominal Surgery of the Tumor Hospital of the University of Chinese Academy of Sciences from January 1, 2018 to December 31, 2019. According to whether or not hypoglycaemia occurred, they were divided into hypoglycaemia group and non-hypoglycaemia group. The hypoglycaemia group was the observation group (126 cases), and the non-hypoglycaemia group was the control group (848 cases). The two groups compared their age, gender, past history, BMI, surgical methods, medication status and biochemical indicators. Univariate analysis was performed using t test and χ² test. Multivariate analysis adopted binary logistic regression analysis. Results A total of 974 patients were enrolled in this study, including 660 males (67.8%) and 314 females (32.2%), with an average age of (61.2±10.5) years. A total of 126 cases of hypoglycaemia were reported, with an incidence of 12.9%. Binary logistic regression analysis showed that gender, BMI, previous diabetes history, insulin and glucose ratio were related to the occurrence of hypoglycaemia during total parenteral nutrition therapy in patients after gastric cancer surgery. Conclusion In nursing care, attention should be paid to high-risk groups, and targeted measures should be taken to improve the nutritional status of patients, use drugs safely and rationally, reduce post-operative stress and fasting time and reduce the incidence of hypoglycaemia.

Talent demand of Shaanxi township health centres and its situation research on basic career status and job satisfaction

LIU Jun-lin, FENG Gong, DU Zhi-qian

2022, 20(3): 498-502. doi: 10.16766/j.cnki.issn.1674-4152.002386

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Objective To understand the current situation and job satisfaction of a talent team in township health centres in Shaanxi Province, explore existing problems and reasons and propose scientific suggestions for the construction of a talent team in township health centres. Methods From December 2019 to August 2020, 1 736 staff members from 193 township health centres in Shaanxi Province were selected using empirical research. The content of the survey included the demand for talents, basic occupation information and job satisfaction. Single-factor (chi-square test) and multiple-factor (binary logistic regression) statistical methods were used to analyse the relationship between basic career information and job satisfaction. Results In total, 1 727 questionnaires were effective, and the effective recovery rate was 99.48%. Total 86.01% (166/193) of health centre managers reported a serious shortage of talents, unreasonable structure or unstable team. In health centres, 53.04% (916/1 727) had a college degree or below, and 67.81% (1 171/1 727) had junior or no professional title. The average score of job satisfaction was (1.98±0.45) points. Single-factor results showed that gender, age, education background, qualification certificate, professional title, job position and monthly income were the factors influencing job satisfaction (P < 0.05). Results showed that gender (OR=1.383, 95% CI: 1.212-1.465), educational background (OR=1.634, 95% CI: 1.566-1.689), employment qualification certificate (OR=0.884, 95% CI: 0.766-0.911) and monthly income (OR=1.168, 95% CI: 1.088-1.215) were the independent factors influencing job satisfaction (all P < 0.05). Conclusion Problems in Shaanxi township health centre include low education background, professional title and income, unreasonable qualification structure and low job satisfaction. This study suggests the need to increase the strength of talent introduction, optimise the structure of talent introduction, improve the mechanism of talent retention and increase the channels of talent training.

Influence of perceived organisational support on overqualification in postgraduate nurses

YAO Hai-xin, LI Wen-yu, XU Xiao-wei, CHEN Yu

2022, 20(3): 503-506. doi: 10.16766/j.cnki.issn.1674-4152.002387

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Objective To explore the current status of overqualification, perceived organisational support and equity sensitivity and their relationship in postgraduate nurses, and to provide a certain reference for the management of graduate nurses. Methods A total of 206 graduate nurses with master's degree or above were selected from five tertiary hospitals in Zhejiang Province between May and September 2020 by convenience sampling. The basic data questionnaire, 9-item Scale of Perceived Overqualification, Perceived Organizational Support Scale for Nurses and Equity Preference Questionnaire were used in the investigation. Multiple linear hierarchical regression was used to analyse the moderating effect of equity sensitivity between perceived organisational support and overqualification. Results The scores of overqualification and perceived organisational support were (31.11±6.79) points and (49.29±9.68) points, with dimension score from high to low are emotional and instrumental support, and the scores of equity sensitivity was (56.22±11.17) points, with dimension score from high to low are dedication and reward. The income satisfaction, the highest degree cultivation model and age in the basic data could affect the overqualification. The equity sensitivity had a moderating effect in the relationship between organisational support and overqualification (β=0.186, ΔR²=0.075, P < 0.001). Conclusion Hospital managers should improve the organisational support system, implement individualised management of graduate nurses, provide them with more opportunities for display and study, let nurses who prefer rewards feel more benign support and positive evaluation from organisations and leaders, and reduce their sense of overqualification.

Effect of individualised dietary guidance on nutritional status and quality of life of liver cancer patients after TACE

TAO Min-jie, LEI Yu, JIN Jun, TANG Gui-fang, WANG Li

2022, 20(3): 507-510. doi: 10.16766/j.cnki.issn.1674-4152.002388

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Objective To investigate the effect of individualised diet guidance on nutritional status and quality of life of liver cancer patients after transcatheter arterial chemoembolisation (TACE). Methods Total 120 patients who underwent TACE in Hangzhou first people's Hospital Affiliated to the Medical College of Zhejiang University from March 2019 to March 2020 were selected as the research objects. They were divided into observation group (62 cases) and control group (58 cases) according to the order of admission. The control group was given routine dietary intervention after surgery, and the observation group was given individualised dietary guidance on the basis of routine nutrition after surgery. The preoperative and postoperative nutritional status of the two groups was compared, and their preoperative and postoperative nutritional risk was evaluated. Results On the 7th day after surgery, the ALB level in both groups was higher than that before surgery (all P < 0.05). Three months after operation, the ALB level in both groups was significantly higher than that before operation and 7 days after operation (all P < 0.05), and the ALB level in the observation group was significantly higher than that in the control group (P < 0.05). At 7 days after surgery, PALB indexes in both groups were decreased compared with those before surgery (all P < 0.05), but the observation group had significantly higher indexes than the control group (P < 0.05). Three months after surgery, the PALB level in both groups was significantly higher than that before surgery and 7 days after surgery (all P < 0.05). The PALB level in the observation group was significantly higher than that in the control group (P < 0.001). Three months after operation, the proportion of lean weight in the observation group was significantly lower than that in the control group[8(12.91%) vs. 16(27.59%), P < 0.05]. Three months after operation, the incidence of nutritional risk in the observation group was significantly lower than that in the control group[16(25.81%) vs. 26(44.83%), χ²=4.766, P=0.029]. Three months after operation, the scores of EORTC QLQ-C30 in the observation group were significantly higher than those in the control group (all P < 0.001). Conclusion Individualised dietary guidance can effectively improve the nutritional status of liver cancer patients after TACE, reduce the incidence of malnutrition risk and improve the quality of life of patients, which is worthy of clinical promotion and use.

Analysis of the incidence and risk factors of cerebral infarction on maintenance haemodialysis patients

WU Xiao-li, NI Jue-min, CHEN Jian-e, WANG Jian, KONG Xiang-dong

2022, 20(3): 511-513. doi: 10.16766/j.cnki.issn.1674-4152.002389

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Objective To understand the incidence of cerebral infarction in maintenance haemodialysis (MHD) patients and analyze its influencing factors. Methods Total 208 uremic patients treated with MHD in the Blood Purification Center of the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2020 were selected as the research objects. Patients were divided into the ischemic cerebral infarction group (n=23) and non-cerebral infarction group (n=185) according to whether cerebral infarction occurred during treatment. General clinical data were compared between the two groups, and risk factors for ischemic cerebral infarction in MHD patients were analysed. Results The incidence of ischemic cerebral infarction was 11.06% in 23 of 208 patients. Comparing the clinical indexes of the two groups of patients, the results showed that ischemic cerebral infarction patients in diabetes, coronary heart disease, atrial fibrillation, systolic pressure, diastolic blood pressure before dialysis before dialysis, uric acid were significantly higher than that of the patients in non-cerebral infarction group (all P < 0.05), and two groups of patients in the frequency of sex, age, duration of dialysis, dialysis, hyperlipidaemia, smoking history, glomerular filtration rate, oral aspirin, oral statin drugs, blood phosphorus, haemoglobin and albumin were not statistically significant (P > 0.05). Logistic regression analysis showed that coronary heart disease, diabetes mellitus, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA were independent risk factors for cerebral infarction in MHD patients. Conclusion The proportion of MHD patients with ischemic cerebral infarction is relatively high, amongst which coronary heart disease, diabetes, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA are independent risk factors for the occurrence of ischemic cerebral infarction in MHD patients, and corresponding prevention and treatment measures should be given in the treatment of MHD patients to reduce the risk of cerebral infarction.

Analysis of the influence of Orem's self-nursing theory on patients with malignant obstructive jaundice undergoing percutaneous transhepatic cholangial drainage

LI Ling-yan, WANG Hong-yu, LIU Shuang-chi, XU Wen-qing, ZHANG Yan-fang, TAN Yi

2022, 20(3): 514-518. doi: 10.16766/j.cnki.issn.1674-4152.002390

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Objective To explore the effect of the nursing method of Orem's self-care theory on the self-care ability, nursing satisfaction rate and disease-related knowledge of patients with percutaneous transhepatic cholangial drainage (PTCD). Methods Ninety-three patients who underwent PTCD treatment for malignant obstructive jaundice in a third-class hospital in a city from May 2020 to March 2021 were divided into the experimental group (47 cases) and control group (46 cases) according to the random number table. The observation group was given routine nursing care, and the experimental group was given nursing intervention based on self-care theory. The intervention period was one month. The two groups of patients were compared for their self-care ability, nursing satisfaction rate and disease knowledge mastery. Results After one month of intervention, the four dimensions of self-care ability in the experimental group were (25.71±2.38) points, (16.29±2.87) points, (35.79±3.84) points and (47.45±4.76) points, and those in the control group were (23.06±3.42) points, (13.75±3.11) points, (32.68±4.12) points and (38.26±3.49) points. The difference was statistically significant (all P < 0.05). The nursing satisfaction rate of the experimental group was 95.7%, and that of the control group was 77.3%. The difference was statistically significant (χ²=6.574, P=0.010). There were statistically significant differences in the scores of wound observation, PTCD tube nursing, complication observation and nursing, diet knowledge and activity knowledge between the two groups (all P > 0.05). Conclusion The application of self-care theory to patients undergoing PTCD can improve patients' self-care ability and nursing satisfaction rate, and promote patients to better grasp disease knowledge.

Influence of anaesthesia recovery nursing based on enhanced recovery after surgery on post-operative delirium in elderly patients under general anaesthesia for hip fracture surgery

ZHU Hong-yan, XU Wei-fang

2022, 20(3): 519-522. doi: 10.16766/j.cnki.issn.1674-4152.002391

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Objective To investigate the influence of anaesthesia recovery nursing based on enhanced recovery after surgery (ERAS) on postoperative delirium (POD) in elderly patients undergoing general anaesthesia for hip fracture surgery. Methods A total of 100 elderly patients who underwent elective hip fracture surgery in our hospital from January 2017 to December 2019 were selected, and they were randomly divided into the control group (n=50) and the observation group (n=50). The patients in the control group received routine nursing, whereas those in the observation group received anaesthesia recovery nursing based on ERAS. The occurrence of POD and delirium-related adverse events, post-operative recovery and nursing satisfaction were compared between the two groups. Results The incidence rates of POD in the observation and control groups were 12.00% and 30.00%, respectively, and with delirium durations of (3.42±1.09) h and (4.74±1.31) h, respectively (all P < 0.05). The incidence of POD-related adverse events including fall/bed fall, unplanned extubation and stress injury were lower than the control group, which were statistically significant (all P < 0.05).In the postoperative recovery of the observation group, extubation time, residence time after anesthesia recovery room (PACU), directional force recovery time and postoperative hospitalization time were shorter than the control group, all statistically significant (all P < 0.05). The nursing satisfaction of the observation group was higher than that of the control group (P < 0.05). Conclusion Anaesthesia recovery nursing based on ERAS can effectively prevent the occurrence of POD and promote post-operative recovery in elderly patients undergoing general anaesthesia surgery for hip fracture.

Application of kangaroo nursing in infants with very low birth weight

LU Ping, LI Jian-ying, ZHOU Ying-chun, XIA Fang-qin, LYU Jun-ying, WANG Jian-ping

2022, 20(3): 523-526. doi: 10.16766/j.cnki.issn.1674-4152.002392

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Objective Clinical nursing and treatment of infants with very low birth weight is always the focus and difficulty in clinical diagnosis and treatment. This article aims to study the application effect of kangaroo nursing in infants with very low birth weight. Methods A total of 160 patients with very low birth weight hospitalised in the Department of Neonatology, Yuying Children's Hospital, Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects and randomly divided into the intervention group (n=80) and the control group (n=80). The control group adopted routine care for premature infants, and the intervention group adopted kangaroo nursing intervention on the basis of the control group. The length of hospitalisation, hospitalisation expenses, growth and development of the children, the rate of exclusive breastfeeding during hospitalisation, the occurrence of complications during hospitalisation, the psychological and emotional status of the mother, the mastery of basic nursing knowledge for infants with very low birth weight and the satisfaction of nursing care were observed and recorded, and then a comparative analysis between groups was performed. Results Significant differences in hospitalisation time, hospitalisation expenses, weight gain, body length gain, head circumference gain and the rate of exclusive breastfeeding during hospitalisation were found between the two groups (all P < 0.05). During hospitalisation, the incidence rates of neonatal necrotising enterocolitis (0 vs. 7.50%), pneumonia (8.75% vs. 22.50%), sepsis (6.25% vs. 18.75%) and feeding intolerance (28.75% vs. 53.75%) were significantly lower in the intervention group than in the control group (P < 0.05). The Self-Rating Anxiety Scale [(33.77±1.15) points vs. (38.26±1.20) points], Self-Rating Depression Scale [(31.34±1.33) points vs. (44.29±2.06) points], satisfaction (96.25% vs. 78.75%) and basic nursing common sense score [(90.55±2.30) points vs. (78.42±1.65) points] showed significant statistical differences between groups (all P < 0.05). Conclusion Kangaroo nursing can help promote the growth and development of infants with very low birth weight, reduce hospitalisation costs and time, improve the psychological and emotional state of the mothers and increase the quality and satisfaction of diagnosis and treatment.

Effect of evidence-based precision nursing model on perioperative psychological stress and postoperative complications in patients with liver cancer undergoing interventional therapy

LIU Li-xia, MAO Jian-ting, HUANG Xu-fang, WU Qiao-hong

2022, 20(3): 527-530. doi: 10.16766/j.cnki.issn.1674-4152.002393

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Objective To explore the effects of evidence-based precision nursing mode on peri-operative psychological stress and post-operative complications in patients undergoing liver cancer undergoing intervention therapy. Methods Before the implementation, 50 patients from April to December 2019 were included in the control group, and 46 patients after the implementation from January to August 2020 were included in the observation group. Both groups received hepatic arterial chemoembolization, and the control group received conventional perioperative surgery. The observation group adopted evidence-based precision nursing. The scores of psychological stress response, psychological status, compliance, post-operative complications and nursing satisfaction were compared between the two groups. Results At 3 days after surgery, the scores of yielding and avoiding status in the medical coping modes questionnaire of the observation group were (7.18±1.77) points and (11.87±2.38) points, which are significantly lower than the (10.48±1.89) points and (13.29±2.33) points of the control group, whereas the score of coping status was (20.64±2.72) points, which is significantly higher than the (18.85±2.93) points of the control group (all P < 0.05). Before discharge, scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were significantly lower in the observation group than in the control group (all P < 0.05). The incidence of hypoproteinaemia and gastrointestinal reactions was significantly lower in the observation group than in the control group (all P < 0.05). After surgery, the number of cases with proper exercise and diet control in the observation group was significantly greater than that in the control group (all P < 0.05). The scores of satisfactions with communication ability, operating skills and medical-nursing cooperation of nursing staff in the observation group were higher than those in the control group (all P < 0.05). Conclusion The evidence-based precision nursing mode is beneficial to improve psychological stress status and negative emotions of patients undergoing liver cancer intervention therapy and reduce post-operative complications, with high nursing satisfaction.

Clinical application effect of rapid rehabilitation surgical nursing technology in elderly patients undergoing ERCP

CHENG Shang-mei, LUO Yan-ling, HUO Rui

2022, 20(3): 531-534. doi: 10.16766/j.cnki.issn.1674-4152.002394

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Objective To investigate the effect of rapid rehabilitation surgical nursing on elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods A total of 110 elderly patients (aged ≥ 60 years) with common bile duct stones who were admitted and underwent ERCP at Maanshan People's Hospital from January 2018 to December 2020 were included in this study. The patients were randomly divided into the control and experimental groups. A total of 55 cases in the control group received routine nursing, and 55 cases in the experimental group received rapid rehabilitation surgical nursing. The differences of clinical indicators such as operation success rate, operation time, hospital stay, incidence of operation complications, postoperative pain score and satisfaction rate of clinical nursing service in both groups were compared. Results The operation time[(34.5±8.2) min], hospitalisation time[(8.5±2.0) days] and postoperative pain score [(2.02±0.76) points] in the experiment group were significantly shorter than those in the control group[(39.5±10.5) min, (9.9±2.5) days and (2.56±0.78) points, respectively, all P < 0.05]. The experiment group had higher surgical success rate and lower operative complications than the control group (96.4% vs. 90.9%, 7.3% vs. 16.4%, respectively, all P > 0.05). The satisfaction rate of clinical nursing service in the experimental group (94.5%) was higher than that in the control group (80.0%), and the difference was statistically significant (P < 0.05). Conclusion Rapid rehabilitation surgical nursing can ensure the success rate of ERCP in elderly patients, reduce postoperative pain score, shorten operation time and hospital stay, and comprehensively improve the satisfaction rate of clinical nursing service and the quality of nursing management.

2022, 20(3): 535-538. doi: 10.16766/j.cnki.issn.1674-4152.002395

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Abstract:

Level of autophagy-related factors in colorectal adenocarcinoma and its relationship with clinical pathological characteristics

XUE Jian-feng, WEI Na, WANG Xi-jiao, YANG Chun

2022, 20(3): 362-365. doi: 10.16766/j.cnki.issn.1674-4152.002353

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Objective To investigate the expression of autophagy-related factors Unc-51 like autophagy activating kinase 1(ULK1), B cell lymphoma-2-interacting protein(Beclin1) and autophagy marker light chain 3(LC3) in colorectal adenocarcinoma and their correlation with clinicopathological features. Methods A total of 63 cases with complete data of radical resection of colorectal cancer from January 2020 to December 2020 in the Department of Pathology of the Affiliated Hospital of Guizhou Medical University were collected. Immunohistochemical EnVision method was used to detect the expression of autophagy-related factors ULK1, Beclin1 and LC3 in tumour tissues and corresponding precancerous tissues. The correlation between autophagy-related protein expression and clinicopathological data such as age, sex, primary location, nerve invasion, differentiation and lymph node metastasis were analysed. Results Autophagy related proteins ULK1, Beclin1 and LC3 were mainly expressed in cytoplasm. Compared with normal tissues, the protein expression levels of ulk1 (71.43% vs. 44.44%), Beclin1 (66.66% vs. 47.61%) and LC3 (55.55% vs. 30.15%) in intestinal adenocarcinoma were significantly higher (all P < 0.05). ULK1 was correlated with tumor differentiation (P < 0.05), while Beclin1 and LC3 showed no significant difference between tumor tissue and normal tissue (all P>0.05). There was no significant correlation with age, sex, primary site, gross type and nerve invasion. In addition, ULK1 and LC3 were correlated with lymph node metastasis (all P < 0.05), while Beclin1 was not significantly correlated with lymph node metastasis (P>0.05). Conclusion The expression level of autophagy-related protein is increased in colorectal cancer, which is related to the degree of tissue differentiation. The expression level of some proteins was related to lymph node metastasis. The increased expression of autophagy in colorectal cancer may be one of the mechanisms of carcinogenesis and metastasis. Interventions targeting the autophagy pathway in tumour tissues may solve some problems of recurrence and metastasis of colorectal cancer.

Clinical study of laparoscopic radical resection of rectal cancer with preservation of left colonic artery dissection

WANG Yong-sen, XIE Yi-xiang, WANG Chuan-si, HUANG Hong-wu, GE Si-tang

2022, 20(3): 366-370. doi: 10.16766/j.cnki.issn.1674-4152.002354

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Objective To evaluate the safety and efficacy of laparoscopic radical resection of rectal cancer with left colonic artery (LCA) preservation and group 253 (253rd group) lymph node dissection. Methods From April 2017 to February 2021, 80 patients who underwent laparoscopic radical resection of rectal cancer in the Colorectal Surgery Department of Lu'an People's Hospital were selected and randomly divided into the observation group and control group (40 cases in each group). The observation group was given LCA preservation, and the 253rd group lymph nodes were cleaned. In the control group, LCA was not retained, but the inferior mesenteric artery was severed. The intraoperative and postoperative conditions of both groups were compared. Results Intraoperative conditions: the pressures of colonic marginal artery arch in the observation group and the control group were (47.00±9.02) mm Hg (1 mm Hg=0.133 kPa) and (37.40±7.52) mm Hg, respectively. The difference between the two groups was statistically significant (P < 0.05). In the observation group, LCA was temporarily clamped during operation, and the pressure of colonic marginal artery arch was (36.00±8.37) mm Hg. The difference before and after clipping was statistically significant (P < 0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in operation time, intraoperative blood loss, number of lymph nodes removed in 253rd group lymph node dissection and mesenteric lymph node dissection between the two groups (all P>0.05). There was significant difference in free spleen curvature and preventive stoma rate between the two groups (all P < 0.05). Postoperative situation: there were significant differences in the incidence of anastomotic leakage and the first anal exhaust time between the two groups (all P < 0.05). Conclusion Preserving LCA and 253rd group lymph node dissection can ensure thorough dissection without increasing complications, significantly increase the pressure of proximal colonic artery arch, reduce the rate of ileostomy prevention and splenic flexure dissociation, and reduce the incidence of postoperative anastomotic leakage. It is a safe and reliable operation.

Relationship between serum B-cell activating factor expression and carotid atherosclerosis and its related factors in patients with systemic lupus erythematosus

FANG Ru-meng, DI Ning-ning, ZHENG Qian-qian, XIE Chang-hao, LI Zhi-jun

2022, 20(3): 371-374. doi: 10.16766/j.cnki.issn.1674-4152.002355

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Objective To explore the relationship between serum B-cell activating factor (BAFF) expression level and carotid atherosclerosis in patients with systemic lupus erythematosus (SLE) and its related factors. Methods A total of 103 SLE patients who met the inclusion criteria and were admitted to our department from October 2020 to June 2021 were selected. According to the results of carotid colour Doppler imaging, 103 SLE patients were divided into three groups: group A with arterial plaque formation (32 cases), group B with intima thickening (31 cases) and group C with no arterial disease (40 cases). At the same time, serum samples of healthy people (group D, 40 cases) were selected as the control group. The expression levels of serum BAFF in four groups were detected by enzyme-linked immunosorbent assay. The correlation between BAFF and clinical and laboratory indicators was analysed. Results The expression level of BAFF in SLE patients was significantly higher than that in healthy controls [5.73(2.02, 7.89) ng/mL vs. 1.01(0.76, 1.31) ng/mL, Z=-9.265, P < 0.001]. The expression of BAFF in SLE patients in group A was higher than that in groups B and C [14.55(11.44, 20.18) ng/mL vs. 6.33(5.81, 7.45) ng/mL vs. 5.26(4.22, 6.93) ng/mL, Z=55.767, P < 0.001]. Correlation analysis showed that the expression level of BAFF was positively correlated with the course of disease, age, SLEDAI2000, ESR, anti-dsDNA quantisation and IgA and negatively correlated with complement C3 (r=-0.309). Conclusion The expression level of serum BAFF in SLE patients is correlated with the occurrence of carotid atherosclerosis, which may be an important factor promoting the formation of atherosclerosis in SLE patients. Serum BAFF level in SLE patients was significantly correlated with SLEDAI and other disease activity indicators, which could be used as a reference indicator to judge the disease activity.

Clinical observation of DSA combined with ultrasound-guided treatment of body superficial venous malformation

LU Yao, ZHANG Li, QIAN Jing-yu, SHI Ao, GE Yu-yao

2022, 20(3): 375-378. doi: 10.16766/j.cnki.issn.1674-4152.002356

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Objective To compare the efficacy and safety of digital subtraction angiography (DSA) combined with ultrasound-guided therapy in the treatment of superficial venous malformations. Methods Thirty cases of superficial venous malformation admitted to the Department of Orthopaedics of the First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2020 were retrospectively treated with ultrasound-guided direct percutaneous puncture injection of sclerotherapy. According to the results of ultrasound and magnetic resonance examination, the patients were divided into group A and group B. Group A had cavitary lesion with no important peripheral blood vessels and nerves. In group B, the lesions were dilated, which were deeper or adjacent to important neurovascular and skeletal lesions. A total of 19 patients, including 6 males and 13 females, with an average age of 25 (6, 32) years, were enrolled in group A. In group B, 11 patients, including 4 males and 7 females, with an average age of 17 (11, 54) years, were treated with DSA combined with ultrasound guidance. After treatment, the patients were followed up for 3-12 months to compare the clinical effects and postoperative adverse reactions between group A and group B. Results In group A, 3 cases were cured, 10 cases had significant remission, 5 cases had partial remission, and 1 case was ineffective. The total effective rate was 94.7%(18/19), and the cure rate 15.79%(3/19). An average of 2.40 injections were given. In group B, 6 cases were cured, 2 cases had significant remission, 3 cases had partial remission, and 0 cases were ineffective. The effective rate was 100.00%, and the cure rate was 54.55%(6/11). Each patient was injected 1.37 times on average. The main adverse reactions were local soft tissue swelling and pain. After symptomatic treatment, such as local ice compress, improvement of microcirculation and intravenous dexamethasone, the symptoms were relieved. No serious complications such as pulmonary embolism or cardio-cerebrovascular accident were found, and no gross haematuria or haemoglobinuria was found. Conclusion Under imaging guidance, the application of lauromacrogol combined with pingyangmycin in the treatment of somatic venous malformations is a safe and effective method. For malformed veins with the largest diameter of the lesion >5 cm, DSA-guided treatment can result in higher cure rate.

Effect of recombinant human brain natriuretic peptide combined with levosimendan in patients with septic heart failure

WANG Bin, CAI Xue-fang, LIN Le-qing

2022, 20(3): 379-383. doi: 10.16766/j.cnki.issn.1674-4152.002357

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Abstract:
Objective To explore and analyse the efficacy and safety of recombinant human brain natriuretic peptide (rh-BNP) combined with levosimendan in the treatment of septic heart failure, and analyse its effect on miR-132 and miR-31 levels in patients' peripheral blood. Methods A total of 117 patients with sepsis and heart failure who were admitted at the Affiliated Hospital of Hangzhou Normal University from March 2017 to June 2019 were selected. The random number table method was used to divide the observation group (61 cases) and the control group (56 cases). The control group was treated with levosimendan, and the observation group was treated with levosimendan combined with rh-BNP. The APACHE Ⅱ score, cardiac function indexes, myocardial enzyme spectrum, peripheral blood miR-132 and miR-31 and adverse reactions were compared between the two groups. Results After treatment, the APACHE Ⅱ score of the observation group[(14.62±1.74) points] was lower than that of the control group[(16.96±2.73) points, t=5.575, P < 0.05]. The LVEDD[(48.93±4.28) mm], LVESD[(39.42±4.16) mm] and LVFS[(22.31±1.75)%] of the observation group were lower than those of the control group[(52.18±3.95) mm, (42.28±3.74) mm, (24.97±1.89)%, respectively, t=4.257, 3.898, 7.905, all P < 0.05]. The serum LDH, CK and CK-MB levels in the observation group were lower than those in the control group (all P < 0.05). The relative expression of miR-31 in the peripheral blood of patients was positively correlated with LVEDD, LVESD, LDH, CK and CK-MB (all P < 0.05). Conclusion rh-BNP combined with levosimendan in the treatment of septic heart failure can effectively improve the clinical symptoms and cardiac function, and it can also improve the expression of miR-132 and miR-31 in the peripheral blood of patients.

Dental support surgical template for implant placement in the aesthetic area of maxillary anterior region

LU Xiao-miao, TIAN Rui-xue, ZHANG Kai

2022, 20(3): 384-387. doi: 10.16766/j.cnki.issn.1674-4152.002358

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Objective To research the accuracy and position of implant placement between the and the simple template, and analyse the factors which affect the accuracy of implant placement. Methods Thirty patients were selected from January 2019 to January 2020 in the First Affiliated Hospital of Bengbu Medical College, who were randomly divided into groups A and B (15 patients in each group). Cone beam computed tomography (CBCT) images were taken before surgery, and Tooth Implant software was used to design the pre-operative plan. Implants were placed in group A using the digital surgical template, and implants were placed in group B using the simple template. All patients in the two groups were subjected to CBCT after the operation. Pre-operative and post-operative CBCT images were matched, and the deviations between the placed position and the planned were measured, including shoulder deviation, apical deviation, depth deviation and angle deviation. Final repair work was performed after 6 months, and the pink esthetic score (PES) and white aesthetic scores were given. Results We placed 51 implants in the 30 patients. Patients in group B received 25 implants. The deviation in group A was (0.57±0.11) mm in the shoulder, (0.78±0.35) mm in the apex, (0.36±0.19) mm in depth and (2.37±1.13)° in angle. The deviation in group B was (1.32±0.23) mm in the shoulder, (1.04±0.15) mm in the apex, (0.86±0.35) mm in depth and (7.24±1.37)° in angle. A significant difference in deviation index was found between the two groups (all P < 0.05). The PES in group A [(9.19±0.74) points] was significantly different from that in group B [(7.95±0.76) points] after 6 months (P < 0.05). Conclusion The digital surgical template for implant surgery may improve the precision of implantation in the anterior maxilla and the aesthetic restoration result. digital surgical template for implant surgery.

Prognostic factors of pineal region tumors resected by the modified Poppen approach

PENG Nan, CHENG Chuan-dong, JI Ying, WU Jin-long, RU Xiao-yu, TU Yang, ZHENG Wei-nan

2022, 20(3): 388-390. doi: 10.16766/j.cnki.issn.1674-4152.002359

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Objective To investigate the factors influencing the prognosis of adult pineal region tumors after microresection via the modified Poppen approach, so as to identify the related factors leading to poor prognosis and improve clinical prognosis of patients. Methods Clinical data of adult patients admitted to the Neurosurgery Department of the Provincial Hospital affiliated to the University of Science and Technology of China from June 2015 to July 2020 who underwent microresection of pineal region tumors via the modified Poppen approach were collected and retrospectively analyzed. Results A total of 48 patients were collected. The patients received Karnofsky performance score (KPS) index score 1 month after surgery, and were divided into two groups according to the results of KPS score. Those with a KPS score of 70 or above were considered to have a good prognosis, while those with a KPS score of 70 or below were considered to have a poor prognosis, because effective anti-tumor regimens could not be implemented for patients with a KPS score of 70 or below. There were 29 patients with good prognosis and 19 patients with poor prognosis. The results of univariate analysis showed that the amount of blood loss in the poor prognosis group [(466.84±182.18) mL] was higher than that in the good prognosis group [(364.14±123.42) mL]. The incidence of postoperative occipital lobe injury in the poor prognosis group (57.89%, 11/19) was higher than that in the good prognosis group (24.14%, 7/29). However, the results of multivariate Logistic regression analysis showed that postoperative KPS score was only correlated with postoperative occipital lobe injury (OR=4.887) and the relationship between the lesion and the parietal capsule (OR=5.870), but not related to the preoperative KPS score and intraoperative blood loss. Conclusion Microresection of brain tumors using the modified Poppen approach can improve the prognosis of patients. The poor prognosis of some patients is related to tumor location, postoperative occipital lobe injury and the amount of blood loss. Excessive traction should be avoided in operation to reduce the possibility of occipital lobe injury. For patients whose tumors are located in front of the parietal cap, the surgical methods should be replaced. Intraoperative reduction of total blood loss may improve patient outcomes.

Application of meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block in perioperative period of radical thyroidectomy patients

ZHU Guang-liang, SHEN Jun, LI Xiao-ming, CHEN Ben-xin

2022, 20(3): 391-394. doi: 10.16766/j.cnki.issn.1674-4152.002360

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Objective To observe the effect of meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block in patients with radical thyroidectomy. Methods Seventy-six thyroid cancer patients admitted at the Affiliated Hospital of West Anhui Health Vocational College from December 2019 to February 2021 were selected and randomly divided into group M and group C, with 38 cases in each group. Group M was pretreated with meloxicam before operation, and group C was treated with placebo. Group M was given ultrasound-guided internal branch of superior laryngeal nerve block combined with general anaesthesia, whereas group C was given general anaesthesia. The hemodynamic indexes, postoperative VAS score, stress reaction, postoperative recovery and adverse reactions of the two groups were observed. Results The mean arterial pressure (MAP) and heart rate (HR) at T2, T3 and T4 in group M were lower than those in group C (all P < 0.05). The VAS score 2, 4, 12, 24 and 48 h after operation in group M were significantly lower than in group C (all P < 0.05). The levels of norepinephrine (NE), hs-CRP and IL-1β 24 h after operation in group M were significantly lower than those in group C (all P < 0.01). The levels of β Endorphins (β-EP) 24 h after operation in group M were significantly higher than those in group C (P < 0.01). The time of first intake, bedside activity time and length of hospital stay [(5.6±1.3) h, (16.2±4.7) h and (11.5±2.2) days] in group M were significantly lower than those in group C [(6.8±1.7) h, (18.9±5.3) h and (12.7±2.8) days], all P < 0.05. The incidence of coughing during emergence, antiemetic rescue and postoperative sore throat (7.9%, 13.2% and 13.2%) in group M were significantly lower than those in group C (39.5%, 42.1% and 39.5%, all P < 0.01). The incidence of nausea and vomiting (5.3%) in group M was significantly lower than that in group C (23.7%, P < 0.05). Conclusion Meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block effectively inhibits perioperative stress response, effectively relieves postoperative sore throat and promotes postoperative rehabilitation in patients with radical thyroidectomy.

Prognostic analysis of different treatments for locally advanced cervical cancer

GAO Long-fei, LIU Jian

2022, 20(3): 395-398. doi: 10.16766/j.cnki.issn.1674-4152.002361

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Objective To investigate the effect of neoadjuvant chemotherapy and radical surgery (NACT+RS) and surgery alone (radical surgery, RS) on the prognosis of locally advanced cervical cancer. Methods From January 2013 to December 2015, 119 patients with locally advanced cervical cancer were divided into the NACT+RS group (n=74) and the RS group (n=45). According to the curative effect of chemotherapy, the NACT+RS group was divided into an effective group (n=45) and an ineffective group (n=29). The operation time, intraoperative blood loss, post-operative pathological features and 5-year survival between the NACT+RS and RS groups were compared, and the post-operative pathological features and 5-year survival between the NACT effective group and the RS group were compared to evaluate the effect of NACT combined operation on patient survival. Results No significant difference in intraoperative blood loss, operation time, lymph node metastasis, myometrial invasion and 5-year survival rate was found between the NACT+RS and RS groups. The amount of intraoperative blood loss in NACT+RS group was significantly less than that in RS group (P < 0.05). Compared with that in the NACT effective group, the positive rate of lymph node metastasis in the RS group was 4.4% and 17.8%, respectively, and the difference was statistically significant (χ²=4.050, P=0.044). In addition, the deep muscle infiltration rate was 20.0%, 55.6%, respectively, and the difference was statistically significant (χ²=12.101, P=0.001). The 5-year survival rate of the NACT effective group was 93.3%, whereas that of the RS group was 73.3% (χ²=6.480, P=0.011). Conclusion Compared with simple operation, neoadjuvant chemotherapy combined with surgery can reduce lymph node metastasis and myometrial invasion and improve the long-term prognosis of patients.

Clinical effect observation of thoracoscopic lobectomy and segmentectomy in the treatment of early non-small cell lung cancer

ZHANG Bing-tai, ZHANG Lei, LIU Jun, LI Hong-lin, LIU Xue-gang

2022, 20(3): 399-402. doi: 10.16766/j.cnki.issn.1674-4152.002362

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Objective To observe the clinical efficacy of thoracoscopic lobectomy and segmental lung resection in the treatment of patients with early stage non-small cell lung cancer (NSCLC), and analyse the differences between the two groups. Methods Sixty patients with early NSCLC who were admitted to the Department of Cardiac Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2019 were selected. According to surgical methods, they were divided into the observation group (thoracoscopic segmentectomy) (n=30) and control group (thoracoscopic lobectomy) (n=30). Perioperative related indicators and postoperative complications were compared between the two groups, and preoperative and postoperative lung function and quality of life were analysed. Results Compared with the control group, the observation group had longer operation time[(140.32±12.31) min vs. (109.82±14.52) min], shorter postoperative drainage time and hospitalisation time[(5.12±1.07) days vs. (5.89±0.95) days, (7.89±1.24) days vs. (9.18±1.32) days], and lesser intraoperative blood loss[(65.09±15.45) mL vs. (86.46±17.87) mL, all P < 0.05]. The incidence of pulmonary air leakage was higher in the observation group, and no statistical significance was observed in the incidence of postoperative complications between the two groups (P>0.05). No significant difference was observed in preoperative lung function indexes (FEV₁, FVC) between the two groups (all P>0.05). Statistically significant differences were observed in lung function indexes between the two groups and within the two groups at different time points after operation (all P < 0.05). An interaction was observed between group and time (F_interaction=65.982, 61.374, all P < 0.05). No significant difference was observed in preoperative KPS scores between the two groups (P>0.05). Statistically significant differences were observed in the KPS scores between the two groups and at different time points within the group after surgery (all P < 0.05). An interaction was observed between group and time (F_interaction=50.233, P < 0.05). Conclusion The overall effect of thoracoscopic pulmonary segmentectomy in the treatment of patients with early NSCLC is better than that of lobectomy, with lesser intraoperative bleeding, faster postoperative recovery and little impact on lung function, which has important clinical application value.

Detection and significance of plasma exosomes miR-21 and lncRNA MALAT1 in patients with atopic dermatitis

CAI Bao-xiang, ZHU Jian-wei, CHEN Yan, JIN Ying-kai

2022, 20(3): 403-406. doi: 10.16766/j.cnki.issn.1674-4152.002363

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Objective To analyse the expression levels of plasma exosome microRNA-21 (miR-21) and long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in patients with atopic dermatitis (AD) and to explore their clinical significance. Methods A total of 118 patients with AD in the Dermatology Department of Ningbo Medical Center Li Huili Hospital from January 2018 to May 2020 were selected and divided into 41 cases of mild, 38 cases of moderate and 39 cases of severe according to the scoring atopic dermatitis index (SCORAD). At the same time, 120 healthy people were selected as the control group. Plasma exosomes were extracted and identified. The levels of miR-21 and lncRNA MALAT1 in plasma exosomes were measured by real-time fluorescence quantitative polymerase chain reaction. The Pearson method was used to analyse the correlation among miR-21, lncRNA MALAT1 and SCORAD score, and multiple linear stepwise regression model was used to analyse the risk factors of increased SCORAD score in patients with AD. Results The extracted samples had the characteristics of exosomes. The levels of serum miR-21, lncRNA MALAT1 and SCORAD score in the mild, moderate and severe patients in the AD group were significantly higher than those in the control group and increased with the increase in disease severity (F=91.160, 206.502, 246.615, all P < 0.001). The levels of miR-21 and lncRNA MALAT1 in plasma exosomes were positively correlated with SCORAD score (r=0.631, 0.528, all P < 0.05). The high levels of plasma exosomes miR-21 and lncRNA MALAT1 were the risk factors for the increase in SCORAD score in patients with AD (all P < 0.05). Conclusion The abnormally high expression levels of plasma exosomes miR-21 and lncRNA MALAT1 may be related to the occurrence and development of AD and closely related to disease severity. Monitoring the levels of miR-21 and lncRNA MALAT1 may be important for further targeted prevention and treatment of AD.

Relationship between coagulation and fibrinolysis imbalance and severity of craniocerebral injury and its predictive value for acute traumatic coagulopathy

MAO Xiao-qiang, JIN Jing, YU Guo-feng

2022, 20(3): 407-410. doi: 10.16766/j.cnki.issn.1674-4152.002364

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Objective To analyse the relationship between coagulation and fibrinolysis imbalance and the severity of craniocerebral injury and its predictive value in acute traumatic coagulopathy. Methods A total of 145 patients with craniocerebral injury admitted to our hospital from January 2017 to October 2020 were selected as subjects. The severity of the patients was evaluated by Glasgow Coma Scale (GCS), and patients were divided into the severe group and non-severe group. The ratio of thrombin-antithrombin complex (TAT)/plasminolysin-α2 plasminolytic inhibitor complex (PIC) was used to evaluate the degree of coagulation-fibrinolytic imbalance. The coagulation function indexes and the ratio of TAT/PIC were compared between the two groups. The predictive effect of TAT/PIC ratio on acute traumatic coagulopathy was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). Results The activated partial thromboplastin time (APTT) in the severe group was longer than that in the non-severe group[(33.69±8.16) s vs. (25.43±5.87) s], the level of D-dimer was higher than that in the non-severe group[(3.57±1.23) mg/L vs. (1.47±0.47) mg/L], and the TAT/PIC ratio was lower than that in the non-severe group[(0.75±0.11) ×10^-3 vs. (1.77±0.24) ×10^-3], the difference was statistically significant (P < 0.05). Pearson correlation analysis showed that the TAT/PIC ratio was positively correlated with GCS score (P < 0.05). Amongst 145 patients with craniocerebral injury, 21 cases (14.48%) had acute traumatic coagulopathy. The TAT/PIC ratio of the acute traumatic coagulation disease group was significantly decreased after admission, and the TAT/PIC ratio at 12 and 24 h after admission was significantly decreased compared with that at admission, the difference was statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that the TAT/PIC ratio, APTT and D-dimer were independent predictors of acute traumatic coagulation disease (all P < 0.05). Using ROC curve analysis, the AUC of the TAT/PIC ratio in predicting acute traumatic coagulopathy was 0.918. Conclusion Coagulation-fibrinolysis imbalance is positively correlated with the severity of craniocerebral injury, and the decrease of TAT/PIC ratio indicates a greater risk of acute traumatic coagulopathy.

Association between matrix metalloproteinase inhibitor-2 gene -418G/C polymorphisms and cerebral infarction with atrial fibrillation

LI Wei-ling, JIN Xiao-ping, YU Dan, SHEN Yu-guang

2022, 20(3): 411-414. doi: 10.16766/j.cnki.issn.1674-4152.002365

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Objective Cerebral infarction caused by atrial fibrillation is a principal cause of high mortality in patients with ischaemic stroke. Considering the important role of matrix metalloproteinase inhibitor (TIMP) in the myocardial dimension process of atrial fibrillation, this study investigates the relationship between promoter region polymorphism (-418G/C) of TIMP-2 and cerebral infarction caused by atrial fibrillation. Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect TIMP-2 gene promoter region -418G/C site polymorphism in 204 cases of cerebral infarction of atrial fibrillation (case group) and 248 cases of noncardiogenic cerebral infarction (control group) with first admission between January 2016 and June 2018. The general, genotype and all of the groups were compared. Results No significant differences in gender, age, tobacco and alcohol habits, systolic and diastolic blood pressure at admission, fasting glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, fibrinogen and homocysteine were found between the case and control groups (all P>0.05). A total of 94 cases of the case group in GC+CC genotype accounted for 46.1%, and 90 cases of the control group in GC+CC genotype accounted for 36.3%; the difference between the two groups was statistically significant (P=0.043, 95% CI: 1.017-1.585). On the time, there were 115 cases of the case group in C allele, accounting for 28.2%, while 106 cases of the control group, accounting for 21.4%. The difference between the two groups was statistically significant (P=0.020, 95% CI: 1.049-1.658). Conclusion The TIMP-2 (-418gG/C) polymorphism may be associated with genetic susceptibility in cerebral infarction with atrial fibrillation.

Characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy

YU Hong-xia, CHEN Xiao-rong

2022, 20(3): 415-418. doi: 10.16766/j.cnki.issn.1674-4152.002366

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Objective To analyse the characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy. Methods A total of 185 patients with type 2 diabetic nephropathy treated in our hospital from January 2019 to April 2020 were selected as the observation group and divided into an anaemia group (n=52) and a non-anaemia group (n=133). A total of 105 patients with type 2 diabetes mellitus with normal urinary protein were selected as the control group. The characteristics and influencing factors of anaemia in patients with type 2 diabetic nephropathy were analysed. Results The incidence of anaemia in the observation group (28.11%) was significantly higher than that in the control group (3.81%, P < 0.01). In addition, 88.46% of the patients with anaemia had positive cell orthochromatic anaemia, 23.08% of the patients with anaemia had glomerular filtration rate (EGFR)>90 mL/(min·1.73 m²), 34.62% of the patients with anaemia had anaemia at the normal level of serum creatinine (SCR). The levels of SCR and cystatin C (Cys C) in the anaemia group were significantly higher than those in the non-anaemia group (all P < 0.01), whereas the levels of haemoglobin, EGFR, albumin (ALB) and prealbumin (PLB) in the anaemia group were significantly lower than those in the non-anaemia group (all P < 0.05). Elevated SCR, Cys-C, decreased EGFR, ALB and PLB were independent risk factors for anaemia in patients with type 2 diabetic nephropathy. Conclusion Patients with type 2 diabetic nephropathy have a high incidence of anaemia, mainly positive cell and positive pigment anaemia, and many patients have anaemia before the decrease of EGFR and when SCR is normal. Elevated SCR, Cys-C, decreased EGFR, ALB and PLB are independent risk factors for anaemia in patients with type 2 diabetic nephropathy.

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2022 Vol. 20, No. 3

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