中华全科医学

Quantitative research on general practitioner policies in China based on a three-dimensional analysis framework on a three-dimensional analysis framework

QI Li, WU Shuang, BAI Hairong, SUN Yu

2023, 21(11): 1813-1817. doi: 10.16766/j.cnki.issn.1674-4152.003231

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Objective To analyze the text of China' s general practitioner training policy, explore the problems in the policy, and provide references and suggestions for the policy improvement. Methods Retrieve policy documents related to the general practitioner cultivation from the websites of the State Council and relevant ministries and institutions, and extract and code policy texts from the perspective of policy tools. Based on the three-dimensional analysis framework of policy tools, cultivation system, and policy effectiveness, apply research methods such as content analysis and PMC index model to analyze the 35 retrieved general practitioner cultivation policies retrieved. Results After encoding 35 policy texts, a total of 165 policy codes were obtained. Among the 165 policy codes, authoritative, motivational, symbolic and dissuasive, capacity building, and systemic transformational tools accounted for 41.82% (69/165), 6.67% (11/165), 7.27% (12/165), 25.45% (42/165) and 18.79% (31/165), respectively. Among the 127 policy codes in the Y dimension, the proportion of policy instruments used at the three levels of institutional education, postgraduate education, and continuing education are 21.26% (27/127), 41.73% (53/127), and 37.01% (47/127), respectively. The four representative general practitioner training policies selected are labeled as P1 to P4, with PMC index scores of 7.401, 6.201, 7.334 and 6.001, respectively. The average PMC index score of the four policy texts is 6.734. Based on the PMC index score and policy level, policy effectiveness P1>P3>P2>P4, the policy effectiveness levels P1 and P3 are excellent and the policy effectiveness levels P2 and P4 are good. Conclusion The use of different policy tools is uneven, and there are significant differences in their use across the three levels of training. The overall effectiveness of general practitioners' policies is at a good level, but there are weaknesses. Propose the rational use of policy tools and strengthen the balance of each policy tool; at the same time, promote the integration of policy tools and training systems to improve their coordination; improve the timeliness, scientificity, and effectiveness of policies for general practitioners.

Analysis of influencing factors of vertebroplasty in the treatment of senile vertebral compression fracture

XU Fei, DOU Qiangbing, LI Xingxing, ZHENG Quan, WANG Qiwei, SUN Liangye

2023, 21(11): 1818-1822. doi: 10.16766/j.cnki.issn.1674-4152.003232

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Objective To analyze the factors affecting the effect of vertebroplasty on senile vertebral compression fracture, in order to estimate the postoperative efficacy of patients and intervene in advance if necessary to improve the effectiveness of treatment. Methods A retrospective study was conducted on 307 elderly patients with vertebral compression fracture who were admitted to the Department of Orthopedics of Lu' an People' s Hospital from January 2015 to June 2022 and received vertebroplasty. Patients were divided into effective group (n=257) and ineffective group (n=50) according to the improvement rate of the Japanese Orthopaedic Association score (JOA score). Gender, age, surgical methods, serum Mg²⁺ concentration, bone cement touch the upper and lower endplates, shape of bone cement, part of bone cement, bone cement covering fracture line and edema area, osteoporosis, and old fracture were summarized and analyzed. Multivariate logistic regression was used to analyze the related factors affecting the curative effect. Results There was a positive correlation between cement not involving the upper and lower endplates, cement being "O" shaped, cement being distributed in the posterior 2/3 of the vertebral body, cement not covering the fracture line and oedema area, and osteoporosis and poor efficacy of vertebral compression fractures treated with vertebroplasty, and the differences were statistically significant (all P<0.05). There were no significant differences of gender, age, decrease in serum Mg²⁺ concentration, old fracture or not (all P>0.05). Cement not involving the upper and lower endplates (OR=9.188, P=0.034), cement being "O" shaped (OR=29.274, P<0.001), cement being distributed in the posterior 2/3 of the vertebral body (OR=24.928, P=0.001), and cement not covering the fracture line and oedema area (OR=16.357, P=0.045) were independent risk factors affecting their efficacy. Conclusion Bone cement don' t touch the upper and lower endplates, "O" type of bone cement, distribution of bone cement in the posterior 2/3 of the centrum, and the failure of bone cement to cover the fracture line and edema area are independent risk factors for therapeutic effect.

Efficacy of percutaneous unilateral balloon kyphoplasty combined with small-needle knife in the treatment of postoperative pain from single-level osteoporotic thoracolumbar vertebral compression fractures

ZHOU Wenjing, LI Huajie, SUN Huan, MIN Youbao, LIU Lei, ZHOU Pinghui

2023, 21(11): 1823-1826. doi: 10.16766/j.cnki.issn.1674-4152.0033233

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Objective To evaluate the clinical efficacy of percutaneous unilateral balloon kyphoplasty combined with small-needle knife treatment in the management of postoperative pain in patients with single-level osteoporotic thoracolumbar compression fractures. Methods A total of 46 patients with single-level osteoporotic thoracolumbar compression fractures who were admitted to the second orthopaedic department of our hospital, Chuzhou Integrated Chinese and Western Medicine Hospital, from July 2017 to March 2019, and met the inclusion and exclusion criteria were selected for this study. General information such as age, sex, and vertebral segment was recorded. The VAS scores were recorded pre-operatively, 24 hours pre-operatively, after needle-knife treatment and at 6 months post-operatively. The Cobb angle before and after surgery and the occurrence of neurological symptoms and recurrent compression fractures within 6 months, were also recorded. Results Post-operative pain was significantly improved compared to pre-operative pain in all 46 patients. The differences in VAS scores and Cobb angles before and after surgery were statistically significant [(2.63±0.74) points vs. (7.30±0.66) points, (8.78±0.16) ° vs. (15.52±0.27) °, all P<0.05]. One case of bone cement overflow occurred and there were no complications such as cardiopulmonary system or lower extremity thrombosis or deaths. Conclusion Percutaneous unilateral balloon kyphoplasty combined with small-needle knife treatment is effective in reducing pain and improving the quality of life in elderly patients with single-level osteoporotic compression fractures. It is considered a safe procedure.

GE Yu, YU Haiyang, LIANG Chengmin, ZHAI Yunlei, CUI Xilong, ZHENG Guohui, JIANG Jishi

2023, 21(11): 1827-1829, 1927. doi: 10.16766/j.cnki.issn.1674-4152.003234

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Objective To investigate the relevant factors influencing the improvement of local kyphotic deformity in individuals afflicted with osteoporotic vertebral compression fractures (OVCF) following percutaneous kyphoplasty (PKP) combined with positional reduction intervention. Methods The data of OVCF patients treated with PKP in Fuyang People' s Hospital from March 2019 to January 2021 were retrospectively analyzed. Patients were treated with PKP procedure combined with postural repositioning. Independent variables included gender, age, body mass index, bone mineral density, vertebral segments, vertebral height, fracture duration, and local kyphotic Cobb angle. Correlation analysis and multiple linear regression analysis were employed to discern the factors impacting the enhancement of local kyphotic deformity and to evaluate the predictive efficacy regarding postoperative Cobb angle improvement. Results Statistically significant differences were observed in the local kyphosis cobb angle, VAS score and Oswestry dability index(ODI) scores at the preoperative, postoperative and last follow-up (all P<0.001). There was a significant difference between the postoperative local kyphosis Cobb angle [(10.9±7.4) °] and the preoperative angle [(15.0±7.6) °, P<0.05]. Postoperative VAS and ODI scores showed significant improvement compared to the preoperative scores (all P<0.05). Preoperative vertebral height, bone density, and fracture duration were negatively correlated with the improvement of kyphotic deformity (r=-7.523, -3.406, -0.489, all P<0.05). The local kyphosis Cobb angle (preoperative) was positively correlated with the improvement of postoperative kyphosis deformity (r=0.141, P<0.05), multiple linear regression analysis showed improvement of kyphosis Cobb angle = 5.016-3.406×bone density-7.523×injured vertebral height value (preoperative) + 0.141×local kyphosis Cobb angle (preoperative) -0.489×course of injured vertebral fracture. Conclusion The improvement of kyphosis after PKP is correlated with the preoperative local kyphosis Cobb angle, the height of injured vertebra, bone density, and fracture course, positively correlates with the preoperative local kyphosis Cobb angle, and negatively correlates with the course of fracture, bone density and injured vertebra height.

Application of quantitative goal exercise combined with whole process refined nutrition management in patients with hematological disease chemotherapy

ZHU Li, TANG Hailong, HU Lei, ZHAO Yinli, GUO Sijin

2023, 21(11): 1830-1833. doi: 10.16766/j.cnki.issn.1674-4152.003235

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Objective To explore the effect of quantitative targeted exercise (QGE) combined with whole process refined nutrition management (WP-RNM) on the clinical results of patients with hematologic diseases undergoing chemotherapy, and to provide evidence for improving the quality of rehabilitation management of patients with hematologic diseases after chemotherapy. Methods A total of 126 patients with hematologic diseases treated with chemotherapy in First Affiliated Hospital of Air Force Military Medical University from February 2019 to June 2021 were selected and randomly divided into observation group and control group with 63 patients in each group by random number table sampling method. The control group was treated with routine intervention, and the observation group was treated with QGE combined WP-RNM intervention program on the basis of routine intervention. The nutritional status, immune function and life quality of the two groups were compared before and after intervention. Result After intervention, the scores of hemoglobin (Hb), plasma prealbumin (PAB), albumin (Alb), transferrin (TRF) and scored patient-generated subjective global assessment(PG-SGA) in the observation group were significantly higher than those in the control group (all P<0.001). The PG-SGA score was significantly lower than that of the control group [(1.92±0.72) points vs. (4.26±0.81) points, t=17.138, P<0.01]. After intervention, the scores of quality of life questionnaire-C30 (QLQ-C30) in the observation group were significantly lower than those in the control group (all P<0.001). After intervention, serum IgG antibody (IgG), IgA antibody (IgA), IgM antibody (IgM), percentage of CD3⁺T cells and CD4⁺T cells in the observation group were significantly higher than those in the control group (t-values: 28.857, 6.683, 9.191, 20.013 and 12.798, respectively, all P<0.01). Conclusion QGE combined with WP-RNM can effectively improve the nutritional intake and immune function of patients with hematological diseases and improve the quality of life of patients.

Efficacy of sildenafil citrate in treating pulmonary hypertension associated with connective tissue disease

LI Xueling, WANG Luyao, ZUO Zhengcai, WANG Guihong

2023, 21(11): 1834-1836. doi: 10.16766/j.cnki.issn.1674-4152.003236

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Objective To investigate the changes of hemodynamic parameters and exercise ability in patients with pulmonary hypertension associated with connective tissue disease (CTD-PAH) before and after oral sildenafil citrate treatment, in order to evaluate its clinical efficacy. Methods Twenty-six CTD-PAH patients who visited the Outpatient and Ward of Rheumatology and Immunology Department of Anqing Medical Center of Anhui Medical University (Anqing Municipal Hospital) from January 1, 2022 to March 1, 2023 were selected as research objects. Enrolled patients were given oral sildenafil citrate for 12 weeks. The changes of 6-min walking test (6MWT), pulmonary artery systolic blood pressure (PASP) and N-terminal B-type natriuretic peptide (NT-proBNP) before and after treatment were observed. The changes of laboratory indexes, blood pressure and heart rate were followed up. Results (1) After treatment, the 6MWT distance of patients increased from (271.231±34.386) m to (423.310±44.909) m. PASP decreased from (103.080±8.309) mmHg (1 mmHg=0.133 kPa) to (69.058±4.995) mmHg. Plasma NT-proBNP decreased from (1 983.650±46.175) pg/mL to (937.458±203.686) pg/mL. The three indexes were statistically significant before and after treatment (all P < 0.05). (2) Adverse reactions: after follow-up observation, there were no significant differences in blood pressure, heart rate, liver and kidney function before and after treatment (all P>0.05). Conclusion Sildenafil citrate treatment in patients with CTD-PAH can significantly improve the physical fitness of patients, significantly reduce SPAP, improve cardiac function and have no significant adverse effects on blood pressure, heart rate, liver and kidney function, with good safety.

Evaluation of the agreement between the anaerobic threshold and heart rate reserve methods of target exercise heart rate in a population with coronary artery disease

HAN Ling, LIU Qiang, LIU Yefa, FAN Xiaomian, XU Di, HOU Yonghong, WANG Dongwei, DING Rongjing

2023, 21(11): 1837-1840. doi: 10.16766/j.cnki.issn.1674-4152.003237

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Objective To compare the anaerobic threshold target heart rate obtained from cardiopulmonary exercise test (CPET) with the target heart rate obtained from the heart rate reserve method to test the consistency of target heart rates obtained from different methods and to guide the formulation of exercise prescriptions. Methods A total of 324 patients with coronary heart disease diagnosed in Zhengzhou Central Hospital and Peking University People' s Hospital from January 2013 to January 2020 were included. Data of anaerobic threshold corresponding heart rate, resting heart rate and measured maximum heart rate as measured by CPET were collected. The intraclass correlation coefficient (ICC) and the Bland-Altman method was used to compare the agreement between exercise target heart rate obtained by the anaerobic threshold method and that calculated by heart rate reserve method. Results The target exercise heart rate by the anaerobic threshold method of 324 patients was (101.1±15.8) beats/min, and the target exercise heart rates at 50%, 60%, 70% intensity by heart rate reserve method were (102.2±13.5) beats/min, (109.1±14.2) beats/min, (113.6±15.1) beats/min, respectively. There was no significant difference between exercise heart rate using the anaerobic threshold method and 50% intensity heart rate reserve method (P=0.183). The ICC value of consistency test of exercise THR by anaerobic threshold method and 50% intensity heart rate reserve was 0.781, 95% CI: 0.727-0.824, P<0.001; the evaluation results of the Bland Altman method showed that ratio of the above two was 0.99±0.12, and 95% limits of agreement (LOA) was 0.755-1.220. According to gender, age (≥ 65 years and<65 years), whether myocardial infarction occurred (myocardial infarction group and angina pectoris group), whether β-blockers were applied, and whether complete revascularization was performed, further subgroup analysis showed that ICC values ranged (0.737-0.811, all P<0.001), and results showed consistency of each group was good. Conclusion In patients with coronary artery disease, the 50% intensity heart rate reserve method has good agreement with that anaerobic threshold method, which can be used as an alternative approach when cardiopulmonary exercise testing is not available in clinical practice.

Pharmacokinetic study of single-dose fosaprepitant dimeglumine (150 mg) in healthy Chinese volunteers

LI Hongtao, HE Cuixia, ZHOU Huan, WANG Huaxue

2023, 21(11): 1841-1844. doi: 10.16766/j.cnki.issn.1674-4152.003238

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Objective To study the time course of blood concentration after single-dose intravenous infusion of fosaprepitant dimeglumine for injection manufactured by Jiangsu Aosaikang Pharmaceutical Co., Ltd. in healthy Chinese subjects and to estimate the corresponding pharmacokinetic parameters. To evaluate the safety of fosaprepitant dimeglumine for injection in healthy Chinese subjects. Methods This was a single-centre, single-dose, single-dose study. Twelve subjects were enrolled under fasting conditions. Each of them received fosaprepitant dimeglumine for injection 150 mg for (30±2) min. The concentrations of fosaprepitant and its metabolite aprepitant in human plasma were determined by liquid chromatography tandem-mass spectrometry. WinNonlin6.4 pharmacokinetic software from Phoenix was used for pharmacokinetic calculation and SAS 9.4 for statistical analysis. Results In healthy volunteers, fosaprepitant dimeglumine (150 mg) was administered intravenously for (30±2) min and plasma fosaprepitant peaked and was rapidly cleared. The main pharmacokinetic parameters were as follows: T_max was 0.333 h; C_max was 4.316 μg/mL; AUC_0-t is 2.090 h·μg·mL^-1; AUC_0-∞ is 2.098 h·μg·mL^-1. Fosaprepitant is rapidly converted to aprepitant in the body and its blood concentration peaks at the end of the infusion. Key pharmacokinetic parameters were as follows: T_max was 0.583 h; C_max was 4.888 μg/mL; AUC_0-t was 49.483 h·μg·mL^-1; AUC_0-∞ was 54.658 h·μg·mL^-1. Aprepitant was slowly eliminated in vivo with a mean elimination half-life of 19.3 h. The plasma exposure of aprepitant was much higher than that of the originator drug fosaprepitant, approximately 25.7 times that of fosaprepitant. There were no unexpected adverse events, serious adverse events or adverse events leading to subject withdrawal throughout the study. Conclusion After a single intravenous infusion of fosaprepitant dimeglumine (150 mg) for injection, the pharmacokinetic parameters of fosaprepitant and aprepitant were consistent with those reported in the original research, and they were well tolerated in healthy Chinese volunteers.

Correlation between inflammatory response and peripheral blood platelet-lymphocyte ratio and vitelliform degeneration in human carotid atherosclerotic plaques

XING Benyuan, DAI Xinyu, DING Hong, NIAN Fujia, PENG Gang, LI Yuntao

2023, 21(11): 1845-1848. doi: 10.16766/j.cnki.issn.1674-4152.003239

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Objective To investigate the correlation between inflammatory response and peripheral blood platelet-lymphocyte ratio (PLR) and vitreous degeneration in human carotid atherosclerotic plaques, and to provide a new basis for further diagnosis and treatment of atherosclerosis. Methods Thirty-nine patients with atherosclerosis of the internal carotid artery system treated by carotid endarterectomy in the Department of Neurosurgery, the Second Affiliated Hospital of Nanjing Medical University from October 2018 to April 2022 were retrospectively and consecutively included. The 39 resected carotid atherosclerotic plaque specimens were examined by histopathology, and the patients were divided into inflammatory response group and non-inflammatory response group, and vitreous degeneration and non-vitreous degeneration groups, and the patients' peripheral blood lymphocyte and platelet counts were recorded, and routine blood examination indices such as PLR were calculated to analyze the relationship between the inflammatory response in carotid atherosclerosis and PLR and the degree of vitreous degeneration. Results A total of 39 patients were included, including 23 patients with carotid atherosclerotic plaque with inflammatory response and 32 patients with hyaline degeneration. Compared with the general information for the non-inflammatory response group, the PLR value of the inflammatory response group [135.93 (124.24, 169.15)] was significantly higher than that of the non-inflammatory response group [112.53 (101.95, 123.39)], and the difference between the two groups was statistically significant (P=0.002); the difference between plaque inflammatory response and hyaline degeneration is statistically significant (P=0.035). Conclusion In carotid atherosclerosis, the PLR is increased in patients with high plaque inflammatory response, and there is a positive correlation between intraplaque inflammatory response and plaque vitreous degeneration. Therefore, measuring PLR levels in patients' blood and monitoring changes in both intraplaque inflammatory response and plaque vitreous degeneration levels may provide a new basis for clinical diagnosis, treatment and prevention of atherosclerosis.

Expression and significance of peripheral blood lymphocyte subsets in non-small cell lung cancer

ZHAO Hao, QI Xueyuan, WANG Junbin, ZHANG Xiaofeng, TAO Lu, YU Liang

2023, 21(11): 1849-1851. doi: 10.16766/j.cnki.issn.1674-4152.003240

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Objective To investigate the dynamic changes and significance of lymphocyte subsets in peripheral blood of non-small cell lung cancer (NSCLC) patients with different pathological types and clinical stages, and to compare the immune status of non-small cell lung cancer patients with healthy people. Methods Peripheral blood lymphocyte subsets of non-small cell lung cancer patients admitted to the Respiratory and Oncology Departments of the First Affiliated Hospital of Bengbu Medical College from May 2020 to February 2023 were detected by flow cytometry, including 55 cases of lung squamous cell carcinoma and 49 cases of lung adenocarcinoma, and 25 healthy adults from the health examination center during the same period were screened as controls. Results Compared with the control group, the proportions of CD3⁺ cells and CD4⁺ cells in NSCLC group were (67.43±9.01) % and (37.34±9.15) %, the ratio of CD4⁺/CD8⁺ was 1.57±0.80, which were lower than that in the control group; The proportion of NK cells was (21.22±8.06) %, which was significantly higher than that of the control group; The differences were statistically significant (all P < 0.05). There was no significant difference between squamous cell carcinoma and adenocarcinoma. In Ⅲ - Ⅳ period, the proportion of CD3⁺ cells and CD4⁺ cells were (66.33±9.52) % and (36.01±9.44) %, below Ⅰ - Ⅱ period; The proportion of NK cells was (22.81±8.43) %, which was significantly higher than that in stage Ⅰ- Ⅱ; The differences were statistically significant (all P < 0.05). Conclusion During the occurrence of NSCLC, the immune function of patients is inhibited, and this inhibition is further aggravated with the progression of the disease. It has certain clinical significance to detect the proportion of T lymphocyte subsets, B cells and NK cells in peripheral blood of NSCLC patients to understand the immune status of the body, evaluate the disease and guide the treatment.

Antimicrobial resistance of common pathogens and their special types in urinary tract infection

ZHENG Siqiang, LIU Lin, FAN Shendong, SUN Wenbo, CHEN Bin, HE Qiang

2023, 21(11): 1852-1855. doi: 10.16766/j.cnki.issn.1674-4152.003241

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Objective To investigate the antimicrobial resistance of common pathogenic bacteria and their special types in urine culture of urinary tract infection (UTI) patients, and to provide reference for clinical workers in the empirical treatment of urinary tract infection. Methods The urine culture results and drug resistance were collected from the information system database of Zhejiang Provincial People's Hospital from January 2020 to December 2021, and 3 770 UTI patients were eventually included. The isolated pathogens and their drug susceptibility results were statistically analyzed. Results A total of 4 284 non-duplicate strains were isolated in this study. There were 2 746 strains (64.10%) of Gram-negative bacteria, 875 strains (20.42%) of Gram-positive bacteria, 385 strains (8.99%) of fungi and 278 strains (6.49%) of mycoplasma. The top four isolates were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium and Enterococcus faecalis. Among them, the drug resistance rate of the bacteria producing extended-spectrum β-lactamases and carbapenem resistant bacteria was significantly higher than that of common pathogens. The resistance rate of the former to β-lactam and quinolone antibacterial drugs was significantly higher than that of common pathogens, and it maintained good antibacterial activity against antibiotics and carbapenems with enzyme inhibitors. The latter only showed good sensitivity to tigecycline and amikacin. Conclusion The most common pathogen in urinary tract infection is still gram-negative bacteria. Drug-resistant bacteria such as producing extended-spectrum β-lactamases and carbapenem resistant bacteria are more than before. Clinical initial use of antibacterial drugs can refer to the results of this study for empirical treatment, and antibacterial drugs can be changed according to the drug resistance of pathogenic bacteria after the results of urine culture are available.

Expression levels of serum Krebs von den Lungen-6 and interleukin 33 in rheumatoid arthritis patients and their clinical significance

HUANG Yue, WEI Xiaosong, JIANG Chao, WU Hanxia, WANG Tao, LI Zhijun

2023, 21(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.003242

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Objective To understand the expression levels of serum Krebs von den Lungen-6 (KL-6) and interleukin 33 (IL-33) in patients with rheumatoid arthritis (RA), and to investigate the diagnostic value of detecting serum KL-6 and IL-33 in RA-associated interstitial lung disease (RA-ILD). Methods A total of 88 patients diagnosed with RA who were admitted to the Rheumatology Department of the First Affiliated Hospital of Bengbu Medical College and the First Affiliated Hospital of Anhui Hospital of Science and Technology from May 2022 to February 2023 were selected. They were divided into general RA group (40 cases) and RA-ILD group (48 cases) according to the presence of interstitial lung disease (ILD) on lung CT. Serological indicators of RA, such as serum rheumatoidfactors (RF), erythrocytesedimentationrate (ESR) and anticyclic citrullinated peptide antibody (anti-CCP) were found in all patients. At the same time, the levels of serum KL-6 and IL-33 in the above patients were determined, the correlation between each index and ILD was analyzed, and the diagnostic efficiency of each index for RA-ILD was analyzed by receiver operating characteristic (ROC) curve. Results Serum KL-6 and IL-33 levels were significantly increased in RA-ILD group; serum KL-6 was positively correlated with ESR, CRP, and D-dimer, and serum IL-33 was positively correlated with IgG and globulin. After ROC analysis, the area under the curve (AUC) of each index for diagnosing RA-ILD was RF (0.678), ESR (0.667), CRP (0.716), D-dimer (0.702), IgA (0.666), KL-6 (0.773) and IL-33 (0.705). The AUC of combined detection of KL-6 and IL-33 in diagnosing RA-ILD was 0.816, both of which were superior to individual detection. Conclusion The combined detection of serum KL-6 and IL-33 in RA patients has a high reference value for the early diagnosis of RA-ILD and the assessment of disease severity.

Establishment and validation of model for the risk of Carbapenem-Resistant Enterobacteriaceae infection in elderly patients with pulmonary infection

ZHAO Shiqi, WANG Shu, ZHANG Ying, WANG Shasha, TANG Wenjuan, LI Jing, ZHANG Xuemin, LI Fang

2023, 21(11): 1860-1864. doi: 10.16766/j.cnki.issn.1674-4152.003243

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Objective To analyze and screen the high-risk factors for CRE infection in elderly people with pulmonary infection, and to construction and validate a risk nomogram prediction model. Methods Clinical data of a total of 894 elderly (≥60 years old) hospitalized patients with pulmonary infection cultured by Enterobacteriaceae bacteria in Anhui Province were retrospectively collected. Two hospitals were selected as verification group (250 cases), and the rest were used as training group(644 cases). Univariate Lasso regression and multivariate logistic regression analysis were used to analyze the modeling group data to identify independent risk factors for CRE infection. Construct a Nomogram prediction model and verify the model in multiple centers. Results The independent risk factors of CRE infection in the elderly were endotracheal intubation≥72 h, long-term bed rest, ≥2 types of antibiotics, cerebrovascular disease and malnutrition. Based on the above five independent risk factors, a Nomogram model for predicting risk was established, and the AUC values of the training group and verification group were 0.862 and 0.858. The Hosmer-Lemeshow test shows that the training group P=0.761 and the verification group P=0.339. Decision curve analysis shows that the model has good benefit within large thresholds. Conclusion The construction of a risk prediction model for the risk of CRE infection in the lungs of elderly people have some clinical significance, allowing early individualized intervention according to controllable factors.

Effects of alfentanil on traction pain and shivering during combined spina-epidural anesthesial for cesarean section

GAO Zongbin, YANG Guang, SHI Zhou, HU Jun, WANG Ping

2023, 21(11): 1865-1867. doi: 10.16766/j.cnki.issn.1674-4152.003244

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Objective To investigate the effect of alfentanil on the prevention of traction pain and shivering in puerperae during combined spina/epidural anesthesia (CSEA) cesarean section, to provide a reference for clinical work. Methods A total of 62 parturients who underwent cesarean section under combined spinal-epidural anesthesia at Tongling People's Hospital from January to December 2022 were selected and randomly divided into two groups using a random number table: alfentanil group (group A) and control group (group C), 31 cases per group. After anesthesia, the level of anesthesia sensation was adjusted to T_6-8.After delivery of the umbilical cord, alfentanil 3 μg/kg was injected intravenously, then continuous intravenous infusion alfentanil at 0.125 μg/(kg·min); Group C puerperae were given the same dose of normal saline after delivery of the umbilical cord clamping until the end of the operation. We recorded the general situation, intraoperative traction pain, shivering, skin itching, nausea, vomiting and meionectic blood rates in the groups, mean arterial pressure (MAP) and heart rate (HR) of puerperaeat at each time point. Results There was no significant difference in general condition between the two groups of parturients (P > 0.05), There was a significant difference in the incidence of traction pain between the two groups [22.58%(7/31) vs. 56.67%(17/30), P < 0.05]. Group A had no moderate to severe traction pain, and the incidence of tremor in Group A (6.5%, 2/31) was significantly lower than that in Group C (33.3%, 10/30, χ²=6.972, P < 0.05). There was no significant difference in the incidence of pruritus, nausea, and vomiting between the two groups of parturients (P > 0.05). There was no significant difference in MAP and HR at different time points between the two groups of parturients (MAP: F_interblock=0.142, P=0.708; HR: F_interblock=0.006, P=0.937), there was a statistically significant difference at different time points within the group (MAP: F_time=24.434, P < 0.001;HR: F_time=11.045, P < 0.001), and there was no interaction between the group and time (MAP: F_interaction=1.107, P=0.355; HR: F_interaction=0.616, P=0.659). Conclusion Alfentanil can effectively prevent traction reaction and shivering in cesarean section under CSEA.

Study on the effect of ultrasound-guided stellate ganglion block for preventing cognitive impairment after hip fracture surgery in the elderly

WANG Binhong, QIN Jinling

2023, 21(11): 1868-1871. doi: 10.16766/j.cnki.issn.1674-4152.003245

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Objective Elderly patients have a higher risk of postoperative cognitive dysfunction (POCD), and this study investigates the improvement effect of ultrasound-guided stellate ganglion block (SGB) on cognitive function after hip fracture surgery in the elderly in order to improve the patient's prognosis. Methods A total of 170 elderly patients who underwent hip fracture surgery at Xinchang Hospital Affiliated to Shaoxing University of Arts and Sciences from May 2019 to May 2023 were randomly divided to a control group (85 cases) and a study group (85 cases) by random number table method. The control group underwent total hip replacement surgery under general anesthesia, and the study group received ultrasound guided SGB intervention before anesthesia induction. The surgical and anesthesia recovery indicators were recorded. The changes in hemodynamic indicators during anesthesia were monitored. The brain oxygen metabolism indicators and brain injury biochemical indicators were analyzed, and the occurrence of POCD 3 days after surgery were calculated. Results There was no statistically significant difference in intraoperative bleeding volume, surgical duration, postoperative recovery time, and extubation time between the two groups (all P > 0.05). The heart rate (HR), mean arterial pressure (MAP) values during skin incision and 60 minutes after surgery in both groups were significantly lower than those after admission (all P < 0.001). Immediately after surgery, the cerebral oxygen uptake rate values in the study group [(28.93±2.79)%] were significantly lower than that in the control group [(31.29±2.56)%], while the cerebral venous oxygen content, regional cerebral oxygen saturation and cerebral blood flow/cerebral metabolic rate of oxygen values [(110.78±5.66) mL/L, (61.94±3.78) min, 16.22±1.16] were significantly higher than those in the control group [(104.39±5.92) mL/L, (57.62±3.64) min, 15.09±1.03, all P < 0.001]. The content of serum S-100β and neuron specific enolase at 3 days after surgery in the study group were significantly lower than the control group (all P < 0.001). The incidence of POCD at 3 days after surgery in the study group (8.24%, 7/85) was significantly lower than that in the control group (22.35%, 19/85, χ²=6.538, P=0.011). Conclusion Ultrasound guided SGB can improve brain tissue oxygen supply and metabolic function in elderly patients undergoing hip fracture surgery, alleviate brain injury, and reduce the risk of POCD.

Evaluation of the association between disease perception and medication adherence in patients with drug-resistant pulmonary tuberculosis using the propensity score method

ZHENG Zhenhui, JIANG Qiaomin, ZHANG Zunjing

2023, 21(11): 1872-1875. doi: 10.16766/j.cnki.issn.1674-4152.003246

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Abstract:
Objective The issue of medication adherence in patients with multi drug-resistance tuberculosis (MDR-TB) has received much attention. This study used propensity score matching (PSM) to explore the relationship between disease perception and medication adherence. Methods From June 2019 to October 2022, 172 patients with MDR-TB admitted to the tuberculosis department of Lishui Hospital of Traditional Chinese Medicine, and were divided into a good compliance group (n=103) and a poor compliance group (n=69) according to the Morisky medication adherence scale (MMAS-8). The relevant data between groups and the scores of the brief illness perception questionnaire (BIPQ) were compared, and the factors influencing MDR-TB patients' medication adherence were analyzed logistically. The PSM method performs balanced 1∶1 matching between groups and compares data between groups after PSM matching. To analyze the correlation between MMAS-8 and BIPQ scores in MDR-TB patients before and after PSM matching. Results Before PSM matching, the proportion of the good compliance group with age < 60 years, disease duration < 2 years, education level of high school or above, family monthly income ≥6 000 yuan, and family supervised medication use was higher than that of the poor compliance group (all P < 0.05); the proportion of medical expenses, adverse drug reactions, and BIPQ score were lower in the poor compliance group (all P < 0.05). Age, disease course, level of education, family economic level, method of medical payment, adverse drug reactions and BIPQ scale scores were independent predictors of drug adherence in MDR-TB patients (all P < 0.05). After 48 pairs of PSM were successfully matched, the BIPQ of the good compliance group was still significantly lower than that of the poor compliance group [(35.17±5.78) points vs. (43.22±6.25) points, t=6.551, P < 0.05]. There was a moderate negative correlation between BIPQ and MMAS-8 scores in MDR-TB patients before and after PSM matching (r=-0.674, -0.574, all P < 0.05). Conclusion There are many factors influencing drug adherence in MDR-TB patients, and their level of disease perception is strongly negatively correlated with drug adherence.

The effect of Shexiang Baoxin Pills combined with recombinant human brain natriuretic peptide in the treatment of ischemic heart failure

XIA Yi, LI Xuelong, QIAO Fengjie, DONG Wenbin

2023, 21(11): 1876-1879. doi: 10.16766/j.cnki.issn.1674-4152.003247

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Abstract:
Objective To explore the clinical efficacy of Shexiang Baoxin pills combined with recombinant human brain natriuretic peptide in the treatment of ischemic heart failure, in order to provide reference for the treatment of ischemic heart failure patients. Methods A total of 100 patients with ischemic heart failure admitted to Fuyang District Hospital of Traditional Chinese Medicine in Hangzhou from January 2022 to January 2023 were selected as study subjects and randomly divided into two groups by random number table method. Patients in control group (n=50) received recombinant human brain natriuretic peptide therapy on the basis of conventional treatment, and patients in observation group (n=50) received combined therapy with Shexiang Baoxin Pills on the basis of control group. The overall response rate, pre-and post-treatment cardiac function (left ventricular ejection fraction, left ventricular end-diastolic diameter and left ventricular end-systolic diameter), traditional Chinese medicine (TCM) syndrome score and adverse drug reactions were compared in both groups. Results Compared with the control group, left ventricular Ejection fraction was significantly increased in the observation group [(50.25±5.64)% vs. (45.58±5.47)%, t=4.203, P < 0.001], the left ventricular end diastolic diameter [(52.64±4.44) mm vs. (55.38±4.07) mm, t=3.217, P=0.002], left ventricular end systolic diameter [(38.21±4.16) mm vs. (42.38±4.58) mm, t=4.766, P < 0.001], and the TCM syndrome score was significantly reduced [(8.39±2.66) points vs. (11.67±2.95) points, t=5.839, P < 0.001]; The overall effect of TCM syndrome in the observation group was better than that in the control group (Z=-2.289, P=0.022). There were no significant differences in the overall efficacy rate and the incidence of adverse reactions between the two groups (all P>0.05). Conclusion The combined use of Shexiang Baoxin Pills and recombinant human brain natriuretic peptide on the basis of conventional heart failure treatment can significantly improve the clinical efficacy and cardiac function of patients with ischemic heart failure, which is superior to the use of recombinant human brain natriuretic peptide alone.

Construction of a driving factor model of hypertension among physical examination middle-aged and elderly people in a top three hospital in Jiaxing City

DI Junjun, SHEN Liang

2023, 21(11): 1880-1883. doi: 10.16766/j.cnki.issn.1674-4152.003248

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Abstract:
Objective To investigate the prevalence of hypertension among middle-aged and elderly people in a Level A Tertiary Hospital in Jiaxing City and to build a driving factor model for the development of preventive measures. Methods A total of 5 155 middle-aged and elderly people who underwent a physical examination in Hospital of the Chinese People' s Armed Police Force Maritime Safety Bureau from December 2019 to June 2022 were retrospectively selected for this study. According to the occurrence of hypertension, the subjects were divided into the hypertension group (2 327 cases) and the non-hypertension group (2 828 cases). Hypertension in middle-aged and elderly people was investigated, through the single-factor analysis and multifactor logistic regression analysis, the risk factors of middle-aged and elderly people, construction of driving factor model was established, and draw the receiver operating characteristic (ROC) curve analysis driven model predictive value for hypertension in middle-aged and elderly people. Results There were 2 327 cases of hypertension among 5 155 middle-aged and elderly people, the incidence of hypertension was 45.14%. The results of multivariate logistic analysis showed that age ≥60 years old, BMI >24, smoking, high salt diet, central obesity, no regular exercise, diabetes, family history of hypertension were the risk factors for hypertension in middle-aged and elderly people (all P < 0.05). Including the above factors in the driver model: logit (P) =-14.158+age≥60 years old ×0.542+BMI>24×0.803+smoking×0.609+ high salt diet ×0.774+ central obesity×0.668+ no regular exercise ×0.794+ diabetes ×0.545+ family history of hypertension ×0.676. The results of the ROC curve showed that when logit (P) >16.81, the area under the curve (AUC) was 0.855. Conclusion The incidence of hypertension in physical examination middle-aged and elderly people in a top three hospital in Jiaxing City could reach 45.14%, the risk factors for hypertension include many factors, it was of high value to build a driving factor model to predict the occurrence of hypertension in middle-aged and elderly people.

Retrospective analysis of comorbidities and distribution differences in 511 patients with rheumatoid arthritis

WANG Qingsong, CAO Yunxiang, XU Yu, ZHANG Jinshan, RUAN Liping, WANG Rui

2023, 21(11): 1884-1887. doi: 10.16766/j.cnki.issn.1674-4152.003249

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Abstract:
Objective To investigate the comorbidities of patients with rheumatoid arthritis (RA) and their distribution differences in different age, gender and course of disease, and to provide reference for better comprehensive prevention and treatment of RA and comorbidities. Methods Retrospective analysis was performed on 511 inpatient medical records of RA filed in the Rheumatology Department of Taihe County Hospital of Traditional Chinese Medicine from December 2019 to October 2022, statistical data of comorbidities were collected, and the differences in the distribution of comorbidity in rheumatoid arthritis cases with different ages, genders and course of disease were analyzed. Results (1) The comorbidities of 511 RA patients involved multiple systems and the highest constituent ratio was cardio-cerebrovascular system diseases in 332 cases (64.97%), followed by motor system diseases in 318 cases (62.23%), hematological diseases in 229 cases (44.81%) and endocrine system diseases in 112 cases (21.92%), respiratory diseases in 81 cases (15.85%), other rheumatic diseases in 24 cases (4.70%) and infectious diseases in 9 cases (1.76%). (2) Compared with the male group, the incidence of osteoarthropathy, interstitial pneumonia, cerebral infarction and anemia in the female group was significantly increased (P<0.05). (3) Compared with<60 years old group, the incidence of interstitial pneumonia, osteoporosis, hypertension, coronary heart disease, heart failure, cerebral infarction, type 2 diabetes mellitus, anemia and lumbar disc herniation in ≥60 years old group was significantly increased (all P<0.05). (4) Compared with<1 year group, the incidence of osteoporosis, anemia and lumbar disc herniation in 1-3 years group and > 3 years group were significantly increased (all P<0.05). Compared with the 1-3 years group, the incidence of osteoporosis, hypertension, cerebral infarction, anemia and cervical spondylosis in the > 3 years group was significantly increased (all P<0.05). Conclusion More RA patients have comorbidities, often involving multiple systems; and their distribution differences in different in different age, sex and duration of disease.

Clinical Observe of on maternal participation in kangaroo care during non-invasive ventilation therapy for low birth weight premature infants with RDS

ZHOU Peiyan, LUO Feixiang

2023, 21(11): 1888-1890. doi: 10.16766/j.cnki.issn.1674-4152.003250

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Abstract:
Objective Low weight premature infants have a higher risk of developing respiratory distress syndrome (RDS), and the scientific and reasonable care methods directly affect the prognosis of the children. Therefore, the clinical effect of implementing mother' s participation in kangaroo care (KMC) during invasive ventilation treatment for the children is explored. Methods A total of 156 cases of low weight RDS preterm infants (weight<2 000 g) admitted to the neonatal intensive care unit (NICU) of Jinhua People' s Hospital from January 2019 to December 2022 were taken as the research objects, and they were divided into control group (n=78) and study group (n=78) according to the random number table. Both groups were given non-invasive ventilation treatment. During this period, the control group was given routine care, and the study group was given KMC participated by mothers. The difference of arterial blood gas between before intervention and after weaning were compared. The duration of noninvasive ventilation, repeated use of pulmonary surfactant (PS), and midway conversion to invasive mechanical ventilation were recorded. The complications related to ventilator ventilation during non-invasive ventilation intervention were observed. Results The PaCO₂ values of the two groups were significantly lower than those before the intervention, while the PaO₂, SaO₂ and pH values were significantly higher than those before the intervention (all P<0.05), while the arterial blood gas values of the two groups were not significantly different (all P>0.05); The duration of noninvasive ventilation of RDS premature infants in the study group was significantly shorter than that in the control group [(7.41±0.62) d vs. (8.35±0.71) d, t=8.807, P<0.001], and the repeated use rate of PS and the rate of midway invasive mechanical ventilation were significantly lower than those in the control group (all P<0.05). The overall incidence of complications during noninvasive ventilation of RDS premature infants in the study group (8.97%, 7/78) was significantly lower than that in the control group (23.08%, 18/78, χ²=5.764, P=0.016). Conclusion Implementing KMC with mother involvement during non-invasive ventilation treatment for low weight RDS premature infants can effectively shorten non-invasive ventilation time, reduce PS dosage, and reduce the risk of non-invasive ventilation failure and related complications.

Analysis of psychological factors and intervention of women with abnormal fetal induction of labor

HE Yan, YU Xiaoyan, YU Youfen, AN Jingna

2023, 21(11): 1891-1893. doi: 10.16766/j.cnki.issn.1674-4152.003251

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Abstract:
Objective Abnormal fetal induction of labor not only causes damage to the mother' s physiology, but also causes great psychological trauma. The purpose of this study is to explore the factors analysis of maternal depression and anxiety caused by abnormal fetal labor induction, and to study the clinical effect of psychological intervention. Methods Using convenience sampling method, 142 cases of women with abnormal fetal labor induction admitted to Zhoushan Women and Children's Hospital from October 2019 to October 2022 were selected as research objects. Edinburgh postpartum depression scale was used to investigate the scores of women with abnormal fetal labor induction, analyze the main factors leading to anxiety and depression after labor induction, and explore the clinical effect of psychological intervention. Results The incidence of depression in women with abnormal fetal induction was 44.37% (63/142). After psychological intervention, the score of Edinburgh postnatal depression scale decreased from (10.86±2.86) points before intervention to (9.18±3.08) points, and the difference was statistically significant (P<0.05). Univariate analysis showed that there were statistically significant differences in the scores of Edinburgh postnatal depression scale among women with different education levels, number of previous abortions and social support scores (all P<0.05). The average score of social support was 45.33 points. Logistic multivariate regression analysis showed that educational level, previous number of abortions and social support were the main influencing factors of anxiety and depression after induction of labor. Conclusion The incidence of depression and anxiety is higher in women with abnormal fetal labor induction. The educational level, the number of previous abortions and social support are the influencing factors of anxiety and depression after labor induction. Psychological intervention can effectively reduce the level of anxiety and depression in women with abnormal fetal labor induction.

Observation study of the therapeutic effect of sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training on chronic pelvic pain in women

ZHOU Xiaohong, ZHANG Lin, SU Aifang

2023, 21(11): 1894-1897. doi: 10.16766/j.cnki.issn.1674-4152.003252

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Abstract:
Objective The use of sacral nerve intervention targets in chronic pelvic pain (CPP) has received much attention. This study aims to investigate the effectiveness of sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training in the treatment of female CPP. Methods A total of 92 female patients with chronic pelvic pain admitted to the pelvic floor clinic of Jinhua Maternal and Child Health Hospital from June 2022 to April 2023 were selected and randomly divided into a control group and a study group using a random number table method, with 46 cases each. The control group received myofascial manipulation combined with biofeedback pelvic floor muscle rehabilitation training, and the study group received sacral nerve magnetic stimulation combined with pelvic floor muscle rehabilitation training. Modified Oxford muscle strength grading (MOS), pelvic floor muscle tenderness examination, pelvic floor surface electromyography Glazer assessment and adverse reactions were compared between the two groups before and after treatment. Results After treatment, the MOS grading of the pelvic floor muscles was significantly improved in both groups compared with before treatment (all P<0.05), and the visual analogue pain score (VAS) of the pelvic floor myofascial trigger point (MTrP) was significantly reduced compared with before treatment (all P<0.05). In addition, the MOS grading of the pelvic floor muscles and the VAS score [(2.38±0.74) points vs. (3.51±1.16) points, t=5.570, P<0.001]in the study group were better than those in the control group. After treatment, the average pre resting electromyographic value, post resting average electromyographic value and rapid contraction relaxation time in both groups decreased compared to before treatment, while the maximum electromyographic values of the fast muscles and the average electromyographic values of the slow muscles increased compared to before treatment (all P<0.05). After treatment, the above pelvic electromyographic indicators were better in the study group than in the control group (all P<0.05). No significant side effects were observed in either groups. Conclusion Sacral nerve magnetic stimulation combined with pelvic floor rehabilitation training can significantly reduce pain, improve pelvic floor muscle strength and electrophysiological indicators in female patients with CPP and is a significant and safe rehabilitation treatment plan.

Research on the quality of life in patients with stable coronary artery disease under standardized management in community

YANG Ling, DU Xueping

2023, 21(11): 1898-1902. doi: 10.16766/j.cnki.issn.1674-4152.003253

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Abstract:
Objective To analyze the difference of the quality of life of patients with stable coronary artery disease with different demographic characteristics and different behavior characteristics under standardized management in community, and put forward targeted measures to improve their quality of life. Methods A total of 980 patients under 75 years of age with stable coronary artery disease and standardized management were selected from Yuetan Community Health Service Center in Xicheng District, Beijing from June 2021 to June 2022 by means of purposive sampling. A self-designed questionnaire was used to collect subjects' general data, complications, compliance, risk factor control, exercise and other information. The subjects' quality of life was scored using the MOS item short from health survey (SF-36). To compare and analyze subjects quality of life of different demographic characteristics and behavioral characteristics. Results The average score of SF-36 physical component summary (PCS) of patients with stable coronary artery disease under standardized management in community was 84.25 (75.25, 90.50) points, and the average score of mental component summary (MCS) was 84.50 (76.11, 92.72) points. There was statistical significance in MCS with or without PCI (Z=-3.610, P<0.001). There were statistically significant differences in PCS and MCS of smoking, calcium antagonists, anti-platelet aggregation drugs, regular medication, blood pressure, blood glucose, low density lipoprotein cholesterol (LDL-C) whether reach the standard or not, recent angina pectoris, exercise and with or without exercise instruction (all P<0.05). Conclusion General practitioners should improve the quality of life of patients with stable coronary artery disease by urging them to quit smoking, regularly take secondary preventive drugs for coronary artery disease, control risk factors such as blood pressure, blood sugar, blood lipids, and guiding exercise.

Analysis of the current situation of demand for community home medical care with pension services and its influencing factors for the urban elderly

FU Youxing, CHENG Xia, LIU Jiayang, LIN Lin

2023, 21(11): 1903-1906. doi: 10.16766/j.cnki.issn.1674-4152.003254

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Abstract:
Objective To investigate the current situation of the demand for community home medical care with pension services for the elderly in Chengdu, and to explore the influencing factors of the elderly' s choice of elderly care services, in order to provide reference for the construction of a demand-oriented model of home care services. Methods From November 2022 to February 2023, 606 elderly people in four urban areas of Chengdu were selected as the research subject using the convenience sampling method, survey was conducted by general information questionnaire, social support revalued scale, and the questionnaire on the demand for community home medical care with pension services for the urban elderly. The current situation of the demand for and influencing factors of the demand for community home medical care with pension services for the urban elderly were analyzed. Results The total demand for community home medical care with pension services for the urban elderly was scored (158.31±35.03) points, with a mean score of (3.68±0.81) points, which was at a relatively high level, with the highest score for psychological and spiritual needs services among the dimensions [(3.81±0.85) points]. The results of the multiple linear regression analysis showed that the monthly affordable cost of elderly care services (P=0.001), level of social support (P=0.006), presence of chronic diseases (P=0.001), health status (P=0.023), level of awareness of community-home medical care with pension services (P=0.035) and the willingness to participate (P<0.001) were the factors influencing the demand for services. Conclusion The demand for community home medical care with pension services is high among the urban elderly, especially in terms of services for psychological and spiritual needs. The service needs of the urban elderly are affected by a variety of factors. It is proposed to build an elderly service system with regional characteristics based on the characteristics of the service needs of the elderly and to serve them precisely.

Social participation status and its related factors in patients with mild to moderate Parkinson's disease: a 275-case study

WANG Hong, XU Fanglei, TANG Ailing, ZHANG Yue, GUAN Qiang, GONG Haiyan

2023, 21(11): 1907-1911. doi: 10.16766/j.cnki.issn.1674-4152.003255

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Abstract:
Objective To investigate the social participation status of people with mild to moderate Parkinson's disease (PD), and to analyze the factors associated with it, in order to provide a reference for intervention. Methods A total of 275 patients with mild to moderate PD who visited the clinic of the Department of Neurology in Shanghai Tongji Hospital from January to December 2021 were selected using convenience sampling.The patients were assessed using a general information questionnaire, the impact on participation and autonomy questionnaire (IPA), the exercise of self-care agency scale (ESCA), the unified Parkinson's disease rating scale part Ⅲ(UPDRS-Ⅲ), and the perceived social support scale (PSSS). Results The mean total score of social participation in mild to moderate PD patients was (65.25±28.78) points.Multivariate regression analysis showed that education level (t=10.562, P < 0.001), disease stage (t=10.601, P < 0.001), self-care ability (t=3.212, P < 0.01), motor dysfunction (t=2.121, P < 0.05) and perceived social support (t=3.562, P < 0.001) were the factors most associated with social participation in mild to moderate PD patients. Conclusion The level of social participation in mild to moderate PD patients was related to many factors.More social attention should be paid to these patients and interventions should be provided based on the factors involved to improve their ability to participate in society and their quality of life.

Applied research of acceptance and commitment therapy in women with termination of pregnancy for fetal abnormality

TAO Lei, ZHANG Fengying, ZHOU Lihua, CHEN Jiayun, KUANG Ling, YANG Wenling

2023, 21(11): 1912-1915. doi: 10.16766/j.cnki.issn.1674-4152.003256

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Abstract:
Objective To investigate the effectiveness of acceptance and commitment therapy (ACT) in women who have had an abortion because of a fetal abnormality. Methods A total of 139 eligible participants were recruited from a tertiary A hospital in Anhui province, China, and were divided into two groups based on the temporal sequence of pregnancy termination: an experimental group (70 subjects) and a control group (69 subjects).The experimental group received 6 treatment sessions based on an acceptance and commitment therapy protocol, and the control group received routine psychological care.The generalized anxiety disorder (GAD-7), the Edinburgh postnatal depression scale (EPDS), and the family adaptability and cohesion evaluation scale (FACES-Ⅱ-CV) were used to assess the participants.Data were analyzed using SPSS. Results Before the intervention, there was no significant difference in the GAD-7 and FACES-Ⅱ-CV scores between the two groups (all P>0.05), and there was no significant difference in the incidence of postpartum depression between the two groups (P>0.05).In the experimental group, the mean score of GAD-7 after the intervention (6th week) was significantly lower than in the control group[2.00(1.00, 6.00) points vs.4.00(2.00, 7.00) points, P < 0.05], the average score of FACES-Ⅱ-CV was higher than the control group[(71.84±5.96) points, (61.87±5.31) points vs.(66.41±8.88) points, (56.83±5.12) points, all P < 0.05]. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention to reduce the symptoms of women who terminate pregnancy for fetal abnormality and to help them improve psychological flexibility, family cohesion and adaptability.These findings may help guide effective interventions to improve the mental state of women who terminate pregnancy for fetal abnormality.

Correlation analysis between maternal postpartum depression and early motor development in high-risk infants

WANG Lijuan, WANG Hui, TONG Lian, WANG Jun, ZHANG Yaping, HAN Qian, WANG Yueying, ZHANG Qing

2023, 21(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.003257

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Abstract:
Objective To explore the influence of maternal postpartum depression on early motor development of high-risk infants, and put forward health care measurements for high-risk infants from the perspective of mothers, with a result of improving early intervention, health management programs for enhancing life quality of high-risk infants. Methods A total of 227 high-risk infants born in Meilong Town, Minhang District, Shanghai from March 2020 to February 2021 were enrolled, including 124 boys (54.63%) and 103 girls (45.37%).We investigated demographic and health-related information, and then chose the ages and stages questionnaires-third edition (ASQ-3) for development assessment 6 months after correcting gestational age.The mothers of high-risk infants performed health assessment with the self-rating depression scale (SDS).Logistic regression was used to analyze the impact of maternal postpartum depression on early development of high-risk infants. Results The detection rate of abnormal development by ASQ-3 was respectively 1.76% for communication ability, 25.11% for gross motor skill, 3.96% for fine motor capacity, 5.73% for problem-solving ability, and 11.01% for personal social skill.In all, we collected 227 SDS questionnaires, among which 157(69.16%) mothers had no depressive symptoms while 70(30.84%) mothers showed signs of depression.We performed a univariate analysis of the results of each part of ASQ-3 and maternal postpartum depression in high-risk infants.The results showed that there was significant difference between the results of gross motor skill of high-risk infants and the self-assessment results of mothers (χ²=3.416, P=0.044).In addition, we observed statistical difference in the gross motor ability of boys in the gender stratification of high-risk infants (χ²=6.093, P=0.017).After adjusting the confounding factors, we analyzed the data with logistic regression and found that the risk of early motor dysplasia in boys with maternal depression was 3.49 times higher than that with normal maternal status (P=0.045). Conclusion Maternal postpartum depression has an impact on early gross motor dysplasia in high-risk boys.Therefore, it is necessary to pay special attention to maternal postpartum depression and take some measures to help these mothers.Furthermore, according to the gender differences of high-risk infants, it is important to strengthen the health management and enhance the life quality of high-risk infants.

Application of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy

HE Jia, LIU Ning, YU Tianqiang, SHI Kaiyuan, DUAN Yue

2023, 21(11): 1920-1923. doi: 10.16766/j.cnki.issn.1674-4152.003258

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Abstract:
Objective To study the application effect of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy, aiming to improve the puncture positive rate, reduce patient pain, and provide a basis for clinical diagnosis and treatment. Methods A total of 150 patients with elevated prostate specific antigen (PSA) and prostate nodules admitted to the Rongjun Hospital of Zhejiang Province from July 2019 to December 2022 were selected and divided into control group (75 cases) and observation group (75 cases) according to the random number table method.Both groups underwent transrectal prostate biopsy, the control group undergoing routine ultrasound guided puncture, while the observation group undergoing precise ultrasound contrast-enhanced puncture.Each group was divided into four intervals based on PSA values, the first group: 4 ng/mL < PSA≤ 10 ng/mL; the second group: 10 ng/mL < PSA≤20 ng/mL; the third group: 20 ng/mL < PSA≤40 ng/mL; the fourth group: PSA>40 ng/mL.The related indicators (number of puncture needles, number of positive needles, Gleason score), incidence of adverse reactions (slight hematuria, fever, rectal bleeding, urinary retention, dysuria), and malignant detection rate of biopsy pathology in four regions were compared between the two groups. Results The number of puncture needles in the observation group was similar to that in the control group (P>0.05).The number of positive needles[(1.84±0.52) needles]and Gleason score[(7.25±1.22) points]were higher than those in the control group[(1.56±0.41) needles, (6.32±1.06) points, both P < 0.05].The incidence of adverse reactions in the observation group (9.33%, 7/75) was lower than that in the control group (46.67%, 35/75, P < 0.05).The malignant detection rate in the observation group (52.00%, 39/75) was higher than that in the control group (34.67%, 26/75, P < 0.05).The difference in malignant detection rate of puncture biopsy pathology between different zones in the 2 groups was statistically significant (P < 0.05). Conclusion The application of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy has a good effect, can improve the positive rate of puncture and the detection rate of prostate cancer, and can reduce adverse reactions, which is worthy of application.

Clinical value of HE4 as a molecular marker for renal fibrosis

LI Hong, LI Geng, LIU Xing, YU Hong

2023, 21(11): 1924-1927. doi: 10.16766/j.cnki.issn.1674-4152.003259

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Abstract:
Objective To investigate the changes of serum human epididymis protein 4(HE4) in patients with chronic kidney disease (CKD) and its diagnostic value for renal fibrosis. Methods A total of 159 patients with CKD who were treated in Wuhan Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were selected and divided into CKD 1-5 stage groups, and 39 healthy subjects were selected as the control group.The levels of serum HE4, creatinine (Crea), blood urea nitrogen (Bun) and urine β2-microglobulin (β2-M) in each group were compared.The receiver operating characteristic (ROC) curve was used to evaluate the value of HE4 in the auxiliary diagnosis of CKD.The relationship between HE4 and renal fibrosis was analyzed by GEO database. Results Serum HE4 levels in CKD 1-5 stage patients were (84.36±7.53) pmol/L, (148.90±16.46) pmol/L, (259.80±36.93) pmol/L, (438.80±81.92) pmol/L, and (1 002.34±68.55) pmol/L, respectively, were all higher than that of control group[(33.80±1.99) pmol/L, all P < 0.05].With the progression of CKD, serum HE4 increased gradually.The areas under the curve of serum HE4, Crea, Bun and urine β2-M for predicting CKD were 0.998, 0.801, 0.748 and 0.826, respectively (all P < 0.05).The sensitivity and specificity of HE4 for the diagnosis of CKD were 0.983 and 0.949, respectively.GEO database analysis showed that HE4 gene WFDC2 was closely related to renal fibrosis, and WFDC2 gene expression was significantly increased in renal fibrosis models induced by different diseases (all P < 0.05). Conclusion Elevated serum HE4 level is associated with renal fibrosis and has a high clinical value for chronic renal insufficiency caused by renal fibrosis.

Research on the evaluation index of emergency response capacity of major pandemic

WANG Jiaxin, WU Hao, ZHAO Jingwei, ZHAO Yali

2023, 21(11): 1928-1931. doi: 10.16766/j.cnki.issn.1674-4152.003260

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Abstract:
Emergency management system and capacity are important parts of national governance systems and capacities. The construction of public health emergency management system is the key factor to deal with public health emergencies. In the context of the COVID-19, it is of great significance to improve health system emergency response capacity. While summarizing the experience of public health emergencies such as major infectious diseases, countries around the world are constantly exploring the evaluation system of health emergency capacity. Public medical institutions are the core force of health emergency system, and their emergency capacity directly affects the efficiency and effect of public health emergencies. Primary medical institution is the first line of defense in epidemic prevention and control. Scientific evaluation of the emergency response capacity of primary medical institutions and strengthening the construction of emergency response system for public health emergencies are not only an important part of the Healthy China Strategy, but also an important symbol to test the level of public management of the government and the administrative capacity of the health system. In the face of major infectious disease, primary medical and health institutions need to realize "dual online" in peace time and emergency response, and "dual management" of infectious diseases and common diseases. At present, improving the resilience of community governance has become an important topic in the modernization of community governance. As an important part of improving the resilience of community governance, it is particularly important for primary medical institutions to have emergency response capacity and resilience. This paper reviews the current situation of health emergency response capacity assessment of representative foreign countries or organizations and domestic major infectious diseases, including the system and institution. This paper further proposes to integrate the concept of resilience into the whole process of emergency management and provides the thoughts and references for constructing the index of emergency ability evaluation of primary medical health institutions.

Research progress on molecular biological characteristics of IgG subclasses and its clinical application in related diseases

ZHANG Sheng, CAO Jun, JIN Jieyu, LIANG Yuting

2023, 21(11): 1932-1935. doi: 10.16766/j.cnki.issn.1674-4152.003261

188 29

Abstract:
Immunoglobulin (Ig) is a glycoprotein secreted by the adaptive immune system, which plays an important role in humoral immunity, including immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), and immunoglobulin D (IgD). Among them, IgG is the main component of immunoglobulin in serum, and it is the type of immunoglobulin with the highest content and longest half-life in human serum and extracellular fluid. IgG is the most important antibody in the human body, which has the functions of antibacterial, antiviral infection, neutralizing toxin and immune regulation. It is also the only type that can pass the placenta and play an important role in neonatal anti-infection. According to the number of heavy chain antigenicity and disulfide bond, IgG points IgG1, IgG2, IgG3, IgG4 four subgroups, the structure of the different subtypes is similar, but the combination of helpers and receptors important structural differences can produce different biological functions, such as recognition of antigen-antibody, complement activation and cell surface receptor specificity combined. In view of the different amino acid sequences in the hinge region of the heavy chain of each IgG subclass, the four IgG subclass antibodies play different functions in different clinical disease progression. At present, relevant studies have shown that IgG subclasses have important clinical application value in autoimmune diseases, infectious diseases, allergic diseases and other diseases. Therefore, this article reviews the molecular characteristics and biological effects of IgG subclasses and their correlation with clinical diseases. It provides new ideas and perspectives for the study of pathogenesis, diagnosis, treatment and prognostic monitoring of clinically related diseases.

Evaluation and management of tall stature in children

MU Jialin, CHEN Zhihong

2023, 21(11): 1936-1940. doi: 10.16766/j.cnki.issn.1674-4152.003262

104 12

Abstract:
Tall stature is defined as a height more than two standard deviations (SD) above the mean for the same race, age and sex; or greater than the 97th percentile. It is also defined as the height exceeds the midparental height by more than 2 SD. There has been a high degree of acceptance for tall stature in the society, and people with tall stature even have an obvious sense of superiority. Both of above lead to a far less clinical attention to tall stature than that of short stature. Similar to short stature, tall stature can occur in various periods of growth, and mostly belong to benign process. In some cases, it can be a variation of normal growth pattern or endocrine disorder. Yet in some cases, it can be one of the clinical manifestations of overgrowth syndrome, accompanied by multiple developmental abnormalities and even high risk of cancer. Therefore, the clinician should pay attention to tall stature. Detailed history taking, general examination and relevant ancillary tests are essential to assess the cause of tall stature in children. Currently, relevant research reports in this field are seldom at home and abroad, and there is a lack of intervention indications and measures, mostly aimed at reducing excessive lifetime height and improving psychological anxiety. Oral sex hormones or epiphysiodesis are the main treatments to slow down growth. This paper devotes to make an overall review of the evaluation and management of tall stature in children, to provide appropriate guidance and intervention, to avoid anxiety associated with impaired adult lifetime height and excessive growth, and especially to reduce the risk of tumor development.

Observation on the curative effect of Baihui penetrating Qubin acupuncture combined with suspension therapy in the treatment of complex regional pain syndrome type Ⅰ after stroke

WANG Jing, WANG Ruiping, XUE Yang, SONG Yujin, GU Yujing, ZHU Lin

2023, 21(11): 1941-1945. doi: 10.16766/j.cnki.issn.1674-4152.003263

81 4

Abstract:
Objective To observe the effects of Baihui penetrating Qubin acupuncture combined with suspension therapy on pain, upper limb function, shoulder joint movement, hand swelling, and activities of daily living in patients with complex regional pain syndrome type Ⅰ (CRPS-Ⅰ) after stroke. Methods A total of 120 patients with post-stroke CRPS-Ⅰ admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from July 2021 to December 2022 were selected and divided into control group, head acupuncture group, suspension group and combination group according to the random number table method, with 30 cases in each group. The control group received routine rehabilitation training, and the head acupuncture group, suspension group and combination group received Baihui penetrating Qubin acupuncture, suspension therapy and the combination treatment, respectively, and the pain score (VAS), upper limb function score Fugl-Meyer (FMA-UE), hand swelling degree, passive shoulder motion angle (PROM) and modified Barthel index (MBI) were compared before and after treatment. Results Before treatment, there were no significant differences in VAS score[(8.14±1.06) points, (8.07±1.01) points, (8.11±1.10) points, (8.06±1.13) points, F=0.082, P=0.756], FMA-UE score, hand swelling degree, PROM and MBI score among all groups (all P>0.05). At 2 weeks and 4 weeks after treatment, the VAS score and hand swelling degree of all groups were lower than before treatment, and the intergroup comparison showed that the head acupuncture group, suspension group and combined group were lower than the control group, and the combined group was lower than the head acupuncture group and suspension group, with statistical significance (all P < 0.05). The FMA-UE score and MBI score at 2 and 4 weeks after treatment and PROM at 4 weeks after treatment were all higher than before treatment, and the head acupuncture group, suspension group and combined group were higher than the control group, and the combined group was higher than the head acupuncture group and suspension group, the difference was statistically significant (all P < 0.05). Conclusion Baihui penetrating Qubin acupuncture combined with suspension therapy can improve complex regional pain in post-stroke CRPS-Ⅰ patients, improve the degree of joint mobility, reduce hand swelling and improve life ability, which is worth promoting.

Application of rehabilitation training based on information-motivation-behavioral skills model in postpartum pelvic floor muscle repair

HU Lingbo, PAN Chengyao, YANG Sujuan, MA Binbin, WANG Rongyue

2023, 21(11): 1946-1950. doi: 10.16766/j.cnki.issn.1674-4152.003264

82 7

Abstract:
Objective To explore the effect of rehabilitation training intervention based on the information-motivation-behavioral skills model on the repair of pelvic floor function in parturients. Methods One hundred and thirty-five women who underwent pelvic floor muscle screening at 42 d postpartum and diagnosed with pelvic floor dysfunction in the Postpartum Rehabilitation Clinic of the Second Affiliated Hospital of Wenzhou Medical University from October 2021 to October 2022 were selected as the study subjects, and were divided into an observation group (68 cases) and a control group (67 cases) according to a random number method. The control group was treated with PHENIX USB 4 pelvic floor rehabilitation instrument. The experimental group was additionally given rehabilitation training based on the information-motivation-behavioral skills model, including knowledge and information education of postpartum pelvic floor muscle repair, motivation intervention of active participation in rehabilitation training, and behavioral skills intervention of rehabilitation training. Pelvic floor muscle strength, urinary incontinence scores, pelvic organ prolapse, and pelvic floor muscle exercise self-efficacy scores were compared between the 2 groups at 42 d postpartum and 3 months postpartum. Results In the experimental group, the scores of type Ⅰ and Ⅱ pelvic floor muscle strength, urinary incontinence and self-efficacy of pelvic floor muscle exercise were (4.35±0.46) grades, (4.68±0.54) grades, (2.81±0.97) points, and (182.81±10.16) points, respectively. The incidence of pelvic organ prolapse was 32.4% (22/68). The results were better than those in the control group [(3.15±0.33) grades, (3.24±0.17) grades, (4.01±1.02) points, (164.74±11.09) points, 50.7% (34/67), all P < 0.05]. Conclusion Rehabilitation training based on the information-motivation-behavioral skills model can enhance the pelvic floor muscle strength, improve the symptoms of urinary incontinence and pelvic organ prolapse, and improve the pelvic floor muscle exercise self-efficacy.

Analysis of the first national outpatient teaching competition for general practitioners in Sichuan Province

LIANG Lingbo, SHI Yi, LU Wenting, BI Mingshua, ZENG Yongqiu, SU Qiaoli

2023, 21(11): 1951-1953. doi: 10.16766/j.cnki.issn.1674-4152.003265

94 6

Abstract:
Objective To improve the outpatient teaching skills of general practitioners, the Chinese Medical Doctor Association organized the first national outpatient teaching competition to standardize the training of general practitioner residents. This study analyzed the competition and self-assessment results of the 34 participating hospitals in Sichuan Province. Methods Teaching videos were recorded by the participating hospitals and evaluated by experts organized by the Sichuan Provincial Health Commission, self-evaluation was carried out according to the same evaluation standards. Patient and disease selection, competition scores and self-assessment scores were obtained from the Medical Sciences and Technology Education Centre of Sichuan Province. Differences between participating hospitals were analyzed by selecting different patients and diseases. The correlation between competition scores and self-rated scores was analyzed. Results The mean score of the participating hospitals was (79.9±9.6) points. The mean score of the self-evaluation was (89.9±5.4) points. The mean score of the self-evaluation was significantly higher than that of the expert evaluation [(89.9±5.4) points vs. (79.9±9.6) points, t=7.517, P < 0.001]. No correlation was observed between the self-assessment score and the expert assessment score (r=0.312, P=0.072). The top five items with demerit points were "lack of training in clinical thinking", "weak awareness of hospital infection control", "lack of introduction of latest disease progress", "no guidance or modification of the SOAP records" and "neglect of training in doctor-patient communication". Conclusion The study objectively analyzes the quality of outpatient teaching in the participating hospitals in Sichuan Province, shows the current shortcomings of outpatient teaching of general practice, and the evaluation and promotion effect of the competition on the teaching ability of general practice teachers.

Study on effect of PRECEDE-PROCEED model on improving diabetes management ability of internship nursing students

CHEN Na, SHI Guanhua, YANG Lijuan, LEI Tingting, ZHOU Jing, CHEN Yongxia

2023, 21(11): 1954-1957. doi: 10.16766/j.cnki.issn.1674-4152.003266

105 6

Abstract:
Objective To explore the effects of diabetes management education project based on PRECEDE-PROCEED model on improving the diabetes management ability of internship nursing students. Methods Convenience sampling was used to select 180 internship nursing students who practiced in a hospital as the research object from August 2020 to December 2021. All students were divided into experimental group and control group according to the random number table, with 90 students in each group. The experimental group adopted PRECEDE-PROCEED mode as the framework of the training program, and the control group adopted the conventional path training program. The scores of theoretical knowledges of diabetes, general self-efficacy, blood glucose monitoring skills and insulin injection skills were compared between the two groups before and 1 month after training. Results After 1 month of training, the scores of theoretical knowledge of diabetes, general self-efficacy, blood glucose monitoring skills and insulin injection skills of internship nursing students in both groups were improved compared with those before training (all P < 0.01), and the scores of nursing students in PRECEDE-PROCEED group were higher than those in control group [theoretical knowledge of diabetes: (86.91±4.45) points vs. (75.24±7.09) points; self-efficacy: (3.14±0.41) points vs. (2.81±0.47) points; blood glucose monitoring skills: (95.81±1.87) points vs. (92.62±2.95) points; insulin injection skills: (93.69±4.11) points vs. (90.23±3.90) points], the differences were statistically significant (all P < 0.01). Conclusion The diabetes management education program based on PRECEDE-PROCEED model improves the diabetes theoretical knowledge and self-efficacy of internship nursing students, standardizes their blood glucose monitoring and insulin injection behaviors, and improves their abilities to manage diabetes.

An example of medical molecular biology course based on curriculum ideology and politics

WANG Yajuan, CHENG Yuanfang, YANG Quanzhong, WANG Xiaoyin

2023, 21(11): 1958-1962. doi: 10.16766/j.cnki.issn.1674-4152.003267

116 10

Abstract:
The integration of ideological and political education into the curriculum of professional courses is a key focus of current curriculum reform. In the training of medical students, while imparting medical knowledge, attention should also be paid to their ideological and political education, integrating professional education with students' political beliefs, strengthening their awareness of life, and improving their professional ethics. Medical colleges and universities shoulder the important mission of cultivating future medical talents for the country, the core of their connotative development is to cultivate guardians of the people ' s health with noble medical ethics and profound medical skills. Therefore, in medical colleges and universities, the significance of carrying out ideological and political education in professional courses is of great importance. Medical molecular biology is a compulsory basic course for medical majors, which is closely related to clinical medicine, life, health, and other fields, and rich in ideological and political elements, which can provide a large number of cases and materials for ideological and political education. However, research has found that many colleges and universities currently incorporate little ideological and political education into the medical molecular biology, resulting in a lack of ideological and political functions. Integrating ideological and political education into the medical molecular biology can promote the organic integration of professional education and ideological and political education, enhance medical students' cultural confidence, national pride, and professional identity, and achieve the fundamental task of cultivating virtue and nurturing people. This paper takes "gene diagnosis and gene therapy" as an example to actively explore specific measures for ideological and political integration in the medical molecular biology course, deeply excavate ideological and political elements in the course, and naturally integrate ideological and political elements into the teaching of medical molecular biology. Through case teaching method, elicitation method, and discussion method, so as to guide students to establish a correct outlook on life, values, world view and outlook on life while teaching knowledge, achieve the organic unity of teaching and educating.

Analysis of health literacy status and related factors in patients with chronic atrophic gastritis

SU Bochao, FENG Bojunhao, LI Yunshan, SUO Baojun, WU Yibo, ZHANG Jintai

2023, 21(11): 1963-1966. doi: 10.16766/j.cnki.issn.1674-4152.003268

110 8

Abstract:
Objective To explore the status and influencing factors of health literacy in patients with chronic atrophic gastritis and to provide suggestions for health education for patients with chronic atrophic gastritis. Methods Investigators were recruited to distribute and collect questionnaires in the wards or outpatients of 3 tertiary hospitals (2 in Shandong Province, 1 in Beijing), 4 secondary hospitals (1 in Xinjiang Uygur Autonomous region, 1 in Shanxi Province, 1 in Hubei Province and 1 in Guangdong Province) and 3 primary hospitals (1 in Shanxi Province, 1 in Guangdong Province and 1 in Henan Province) from May 6, 2020 to January 24, 2021. SPSS 26.0 was used for descriptive statistics, χ² test and logistic linear regression analysis. Results A total of 602 effective samples were obtained and the proportion of patients with chronic atrophic gastritis with health literacy was 36.9% (222 cases). The proportion of chronic atrophic gastritis patients with functional, critical and interactive health literacy were 41.7% (251 cases), 50.7% (305 cases) and 55.5% (334 cases), respectively. In terms of total health literacy, there were statistical significance in urban and rural areas (χ²=9.823, P < 0.05), age (χ²=17.815, P < 0.05), education (χ²=43.044, P < 0.05), occupation (χ²=21.583, P < 0.05) and so on. The results of multifactorial logistic regression analysis showed that education below elementary school (OR=0.162, 95% CI: 0.044-0.585), junior high school education (OR=0.270, 95% CI: 0.106-0.687), high school/vocational high school/secondary school education (OR=0.248, 95% CI: 0.105-0.583), and college/bachelor ' s degree (OR=0.430, 95% CI: 0.189-0.977) were unfavorable for health literacy development compared to graduate and higher degrees. Conclusion The level of health literacy of patients with chronic atrophic gastritis is low, and the influence of education on the health literacy of patients with chronic atrophic gastritis is statistically significant.

Analysis of FN1, COL4A1, COL4A2 genes expression and significance in gastric cancer based on database mining

LEI Xinyi, SONG Danjun, DAI Gaiguo, ZHANG Yunli, YANG Litao

2023, 21(11): 1967-1971. doi: 10.16766/j.cnki.issn.1674-4152.003269

98 12

Abstract:
Objective To identify the potential hub genes for the prognosis and targeted therapy of stomach cancer. Methods GSE33651 and GSE118916 datasets were selected from gene expression omnibus (GEO, study periods were from November 2011 to August 2019). The differentially expressed genes (DEGs) were identified by GEO2R. Gene ontologty (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses of DEGs was performed in DAVID database. Protein-protein interaction (PPI) network was constructed using STRING database and Cytoscape software. DEGs with Degree >10 were considered as hub genes. Based on gastric adenocarcinoma data from the cancer genome atlas (TCGA), survival and expression analyses of hub genes were performed in OncoLnc and UALCAN databases, respectively. Immune infiltration analysis of hub genes was performed using TIMER database. Results A total of 80 up-regulated and 34 down-regulated DEGs were identified, enriched in 69 GO terms and 7 KEGG pathways.Fourteen hub genes were screened from the PPI network. The expression levels of FN1, COL4A2 and COL4A1 in gastric cancer tissue were higher than those in normal gastric tissues, and showed excellent prognostic values in gastric cancer. FN1, COL4A2 and COL4A1 were closely associated with immune cell infiltration, which might be involved in the immune response of gastric cancer. Conclusion FN1, COL4A2 and COL4A1 are the hub genes of gastric cancer, which may be potential prognostic biomarkers and therapeutic targets for gastric cancer.

Study on nursing care of schizophrenia patients with diabetes by individualized intervention based on recovery concept

LIN Ling, ZHANG Yi, HE Mei

2023, 21(11): 1972-1976. doi: 10.16766/j.cnki.issn.1674-4152.003270

81 7

Abstract:
Objective The nursing of schizophrenia complicated with diabetes should be paid more attention. This study discusses the application effect of individualized nursing intervention based on the concept of rehabilitation. Methods A total of 122 patients with schizophrenia combined with diabetes admitted to Shanghai Mental Health Center from September 2020 to August 2022 were selected and divided into control group and observation group by random number table method, with 61 cases in each group. The control group implemented routine nursing intervention, while the observation group implemented individualized nursing intervention based on recovery theory. Both groups were intervened for 6 months, and their self-awareness and treatment attitude [insight and treatment attitude questionnaire (ITAQ)], stigma [internalized stigma of mental illness inventory (ISMI)], treatment compliance, clinical psychiatric symptoms [positive and negative syndrome scale (PANSS)], blood glucose indicators [fasting blood glucose (FPG), glycated hemoglobin (HbAlc) and 2 hour postprandial plasma glucose (2hPG)] were compared before and after the intervention, and the blood glucose level after 6 months of intervention in both groups were recorded, as well as the recurrence of schizophrenia during the intervention period. Results After intervention, the ITAQ scale score in the observation group was higher than that in the control group (P < 0.05), while the ISMI scores and total scores in all dimensions were lower than those in the control group (P < 0.05). The excellent and good compliance rate in the observation group was 91.53% (54/59), which was higher than 77.97% (46/59) in the control group (P < 0.05). After intervention, the PANSS scores in all dimensions and total scores in the observation group were lower than those in the control group (P < 0.05), and the levels of FPG, 2 h PG, and HbA1c were lower than those in the control group (P < 0.05). After 6 months of intervention, the blood glucose compliance rate in the observation group was higher than that in the control group [74.58% (44/59) vs. 55.93% (33/59), P < 0.05]. Conclusion Individualized intervention based on the concept of recovery can improve the insight of schizophrenic patients with diabetes, reduce their sense of shame, and facilitate their mental rehabilitation and blood sugar stability.

Application effect of a continuous nursing care centered on timing theory in patients with depression

CHEN Xinxia, ZHOU Suming, DONG Qifang, FENG Hong

2023, 21(11): 1977-1981. doi: 10.16766/j.cnki.issn.1674-4152.003271

109 7

Abstract:
Objective To analyze the application effect of the continuity nursing model based on timing theory in patients with depression. To explore its influence on patients' depressive symptoms, self-efficacy, quality of life and medication compliance, and to provide new ideas for clinical nursing. Methods A total of 116 patients with depression who were admitted to the Seventh People's Hospital in Shaoxing from April 2022 to March 2023 were selected as the research subjects. They were divided into a control group and an observation group according to the random number table method, with 58 cases in each group. The control group applied conventional care, and the observation group applied the continuous care model based on the timing theory on the basis of the control group. To compare the depressive symptoms, self-efficacy, quality of life, and medication adherence of two groups of patients before and after intervention. Results After intervention, the Hamilton depression scale (HAMD-24) score of the observation group was (10.15±2.05) points, which was significantly lower than that in control group [(13.28±2.27) points, P < 0.05]. After intervention, the symptom management self-efficacy and disease commonality management self-efficacy scores of the observation group were (18.13±2.16) points and (20.29±1.03) points, respectively, which were higher than those in the control group [(15.62±2.39) points, (16.55±2.74) points, all P < 0.05]. After intervention, the scores of all dimensions of the 36-item short form health survey were higher in the observation group than in the control group (P < 0.05). Medication adherence in the observation group was 94.8% (55/58), which was higher than 81.0% (47/58) in the control group (P < 0.05). Conclusion The continuous care model based on timing theory can improve depression symptoms, increase self-efficacy and quality of life in patients with depression, and have a positive effect on medication compliance.

Invasive Klebsiella pneumoniae liver abscess syndrome in type 2 diabetes mellitus: a case report and literature review

ZHU Xinlin, ZHANG Lin, ZENG Zhengyan, WU Yanan, LI Canhui

2023, 21(11): 1982-1986. doi: 10.16766/j.cnki.issn.1674-4152.003272

160 22

Abstract:
In recent years, invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) has gradually developed in type 2 diabetes mellitus (T2DM). Due to its hidden symptoms, high virulence and susceptibility to metastatic infection, it is particularly difficult to manage such cases in the clinic. The diagnosis, treatment and prognosis of a case of T2DM complicated with invasive Klebsiella pneumoniae liver abscess syndrome were reported and retrospectively analyzed, and the relevant literature was reviewed, in order to improve the knowledge and understanding of IKLAS for medical personnel so that they can achieve early diagnosis and treatment. Improve the clinical treatment effect.

A case of type Ⅰ Kounis syndrome caused by drug allergy

YANG Changlin, CAO Shufeng, QIAO Lian, ZHAO Huimin

2023, 21(11): 1987-1989. doi: 10.16766/j.cnki.issn.1674-4152.003273

96 9

Abstract:
Kounis syndrome is a syndrome of coronary artery spasm and even acute myocardial infarction secondary to anaphylaxis. The elderly patient in this case developed delayed anaphylaxis when using piperacillin sodium and tazobactam sodium for anti-infective treatment of community-acquired pneumonia in hospital, and the antiallergic treatment improved, but the symptoms of chest tightness and breathlessness occurred, the typical arched back of the inferior wall lead is elevated and dynamic on the electrocardiograph, and the myocardial enzyme is normal. Coronary angiography is performed immediately in the catheter room, which shows a spasm of the right coronary artery, and the spasm disappears after local injection of nitroglycerine. This case is type Ⅰ Kounis syndrome. Kounis syndrome is rare in clinical practice, which can easily lead to missed diagnosis and misdiagnosis. Early recognition and appropriate treatment is the key to improving the clinical prognosis.

Severe tsutsugamushi disease complicated with severe pneumonia, ncephalitis and multiple organ dysfunction: a case report

XIE Xiuyin, WANG Kuliang, XIE Youling, WEI Qingfei

2023, 21(11): 1990-1994. doi: 10.16766/j.cnki.issn.1674-4152.003274

94 6

Abstract:
Scrub typhus is an acute natural infectious disease caused by infection with Orientia tsutsugamushi, one of the most easily overlooked infectious diseases today. It is characterized by sudden onset with high fever, skin eschar or ulcer and lymph node enlargement. The basic pathological changes are vasculitis and perivasculitis and the clinical manifestations are varying degrees of organ dysfunction, necrosis and even failure. This paper reports a case of severe tsutsugamushi disease with fever as the first symptom and severe pneumonic encephalitis and multiple organ dysfunction, which was cured and discharged after treatment. By reporting this case and reviewing the literature, this article aims to improve the clinical understanding of Tsutsugamushi disease in order to achieve early diagnosis, early treatment, and individualized treatment.

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2023 Vol. 21, No. 11

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