2021 Vol. 19, No. 6

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Expert Forum
International experience and practice of integrated primary care in China
ZHANG Ya-lin, LIAO Xiao-yang, ZHAO Qian, LEI Yi, LI Zhi-chao, TANG Yi-jun, LI Ni
2021, 19(6): 887-891. doi: 10.16766/j.cnki.issn.1674-4152.001942
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With the acceleration of the global aging process and the outbreak of chronic diseases, the demand for health services is increasing, and the "fragmentation" of health services is becoming increasingly prominent. Therefore, integrated health service has become a worldwide trend of health system reform in the 21st century. Many countries and regions have carried out different forms and contents of exploration. Integrated primary care started late and developed rapidly in China, but it still faces some problems. From system level, organizational level, professional level, clinical level, this review analyze the current situation of integrated primary care in China, summarize and draw lessons from typical experience of Kaiser permanente, National Health Service, German Black Forest model. Based on the comparison of international experience, we examine the current situation and sort out China's main problems of integrated primary care in China. Problems include six aspects: policy formulation, standard implementation, inter agency coordination, inter professional cooperation, information construction and comprehensive evaluation. At the same time, we analyze the new trend of integrated primary care: the establishment and improvement of the integration mechanism, the construction of the gridded medical alliance and the specialty-general practice collaboration are the new trends of integrated primary care in China. It is necessary for China to shift service centers from tertiary hospital to primary care, and shift the focus of service from "organizational integration" to "clinical integration". In the future, we should promote and improve policy support, inter agency cooperation, inter professional cooperation mechanism and information integration technology to develop integrated primary care in China.
2021, 19(6): 892-893.
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Mechanism of Portulaca oleracea L. in the treatment of non-alcoholic fatty liver disease based on data analysis
WANG Xin, WU Qiao-min, TANG Yu-xiao, ZHANG Mei-fang, CHEN Jie-wen
2021, 19(6): 950-953. doi: 10.16766/j.cnki.issn.1674-4152.001958
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  Objective  To explore the molecular mechanism of Portulaca oleracea L. in the treatment of non-alcoholic fatty liver (NAFLD).  Methods  With the use of the TCMSP and Drug Bank and Uniprot database, the effective activity of Portulaca oleracea L. was screened out ingredients and their potential targets. The Drug bank, OMMI and GeneCards databases were used in identifying gene targets related to NAFLD and intersection targets. Finally, the DAVID database was used in conducting KEGG and GO enrichment analyses for determining the potential signal pathways of Portulaca oleracea L. for NAFLD treatment.  Results  Portulaca oleracea L. had 10 effective active ingredients, of which quercetin, kaempferol, luteolin, β-sitosterol and β-carotene were the main active ingredients. A total of 85 key targets were identified after matching with NAFLD gene targets, and tumor necrosis factor (TNF), cysteine aspartic protease, Ser/Thr protein kinase and inflammatory chemokines were found to be important targets. DAVID enrichment analysis showed that GO functional analysis were mainly involved in inflammation (P < 0.001), cell hypoxia (P < 0.001), and apoptosis (P < 0.001), identical protein binding (P < 0.001), protein polymerisation activity (P < 0.001) and cytokine activity (P < 0.001). KEGG enrichment analysis mainly related to TNF (P < 0.001), apoptosis (P < 0.001), TLR (P < 0.001) and NF-κB signal pathway (P < 0.001).  Conclusion  This study preliminarily explores the potential targets and related signal pathways of Portulaca oleracea L. in NAFLD treatment and provides a theoretical basis for further revealing mechanisms for developing the functional food of Portulaca oleracea L.
Initiation of antiretroviral treatment among HIV-infected pregnant women and associated factors
HUANG Zhao-hui, ZHANG Yue, GUOLIU Run-nan, HU Lin-feng, FENG Fang, ZHAI Qian, FANG Liang, LIU Kai
2021, 19(6): 954-958. doi: 10.16766/j.cnki.issn.1674-4152.001959
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  Objective  The proportion of antiretroviral treatment among HIV-infected pregnant women is an important evaluation index for the program of china's women development. However, the anticipated goals of such programs are difficult to achieve in Anhui province. This paper aimed to analyse the proportion of antiretroviral treatment among HIV-infected pregnant women and related influencing factors and provide support for promoting the proportion.  Methods  Data were abstracted from an information system for the prevention of mother-to-child transmission (PMTCT) of acquired immunodeficiency syndrome (AIDS), hepatitis B and syphilis from 2004 to 2020. The data included basic information about the husbands or sexual partners of the pregnant women and initiation of antiretroviral treatment (ART). Pearson chi-square test and Poisson regression model were used in analysing the data.  Results  A total of 834 HIV-infected pregnant women were reported in Anhui province, with an average age of 28.65±6.39 years. The initiating ART rate among HIV-infected pregnant women increased from 57% (2004-2010) to 95% (2020), χ2=47.658, P < 0.001. The result of Poisson regression model revealed that the HIV-infected pregnant women diagnosed before pregnancy (95% CI: 2.91-9.13), during pregnancy (95% CI: 2.85-8.97) and during the intrapartum period (95% CI: 1.00-3.64) were less likely to initiate ART than those diagnosed in the postpartum period.  Conclusion  Our results suggest that the confirmed time of HIV can be advanced by strengthening the management of pregnant women and useful in alleviating the effect of the PMTCT of AIDS.
Analysis of influencing factors and pregnancy outcomes of macrosomia among pregnant women with diabetes in a hospital in Zhengzhou City from 2014 to 2018
CHEN Yu-rong, DUAN Xiao-kai, LIU Chun-fan, YANG Xiao, JIANG Yan-li, ZHANG Zhen-xiang, DU Shao-fei
2021, 19(6): 959-963. doi: 10.16766/j.cnki.issn.1674-4152.001960
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  Objective  To analyse the influencing factors and pregnancy outcomes of fetal macrosomia in women with gestational diabetes mellitus (GDM) and discuss effective methods for reducing the incidence of this disease.  Methods  A total of 1 135 single pregnancy women with GDM who were admitted to Zhengzhou First People's Hospital from January 2014 to December 2018 were retrospectively analysed. They were divided into macrosomia group (175 cases with body weight of ≥4 000 g) and non-macrosomia group (960 cases with body weight of < 4 000 g).  Results  The incidence of GDM macrosomia was 15.42%, and this disease was found to be associated with family history of diabetes in pregnant women, pre-pregnancy BMI, gain too much pregnancy weight and high fasting blood glucose (all P < 0.05). The pregnant women in the macrosomia group were with a high incidence of gestational hypertension, surgical delivery and adverse pregnancy outcomes of premature delivery, neonatal hypoglycemia, fetal distress and postpartum haemorrhage, which were significantly higher than those in the non-GDM macrosomia group (all P < 0.05). The risk factors of neonatal hypoglycemia in the GDM macrosomia group was 1.599 times (95% CI: 0.938-2.726), 1.756 times (95% CI: 1.132-2.723) and 2.489 times (95% CI: 1.385-4.471) that in the non-macrosomia group.  Conclusion  GDM macrosomia can increase adverse pregnancy outcomes, such as surgery, preterm delivery, fetal distress, pregnancy hypertension and massive haemorrhage during labour. Pregnant women must be screened for oral glucose tolerance test (OGTT), their traditional diet and lifestyle must be changed, their weight gain and increase in blood sugar levels during pregnancy must be strictly limited and nursing intervention should be implemented during the entire process of intrapartum and puerperium to control the risk factors of GDM. These steps can effectively reduce the incidence of GDM macrosomia and reduce the risk of adverse pregnancy outcomes.
Effect of pelvic floor rehabilitation on pelvic floor function after total laparoscopic hysterectomy
CUI Xia, WANG Wen-yan, LING Lin, ZHAN Lei, WEI Bing
2021, 19(6): 964-968. doi: 10.16766/j.cnki.issn.1674-4152.001961
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  Objective  To investigate the effects of pelvic floor muscle exercise combined with biofeedback electrical stimulation on pelvic floor muscle function and quality of life after laparoscopic total hysterectomy.   Methods  A total of 60 patients who underwent laparoscopic total hysterectomy in the Second Affiliated Hospital of Anhui Medical University from January 2017 to December 2018 for non-prolapsed benign uterine diseases were randomly divided into the experimental and control groups. Each group had 30 patients. The control group was treated with PFMT, whereas the experimental group was treated with biofeedback electrical stimulation combined with PFMT. A perineal muscle testing method was used, and pelvic floor muscle electric parameter was measured 3 months after surgery and 6 months and 12 months after the postoperative evaluation of pelvic floor function. Treatment times for urinary and bowel symptoms were compared using pelvic floor functional impact survey questionnaire (PFIQ-7) with pelvic organ prolapse/incontinence sexual questionnaire (PISQ-12), and the quality of life of patients in both groups were evaluated.   Results  The OR values for muscle strength of class Ⅰ and class Ⅱ were 2.962 and 2.636, respectively. The P time/group/interaction values of slow and fast muscles were < 0.001/0.033/0.024, < 0.001/0.001/0.011 and < 0.001/0.003/0.001. The symptoms of lower urinary tract and intestinal tract in the two groups decreased 6 and 12 months after surgery, compared with those 3 months after surgery, and the improvement of symptoms and quality of life in the experimental group were better than those in the control group, and the differences were statistically significant (all P < 0.05).   Conclusion  Reasonable pelvic floor rehabilitation therapy after laparoscopic total hysterectomy can effectively prevent and improve the functional status of the pelvic floor muscle and enhance quality of life. Pelvic floor muscle exercise combined with biofeedback electrical stimulation has a good therapeutic effect, which is worthy of clinical promotion.
Risk factors of shoulder dystocia during maternal delivery and the evaluation of the intervention effect of posterior shoulder rotation
LU Ying, YOU Ai-jun, WU Jia-han
2021, 19(6): 969-971. doi: 10.16766/j.cnki.issn.1674-4152.001962
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  Objective  To explore the risk factors of shoulder dystocia during maternal delivery and the intervention effect of posterior shoulder rotation.   Methods  Data of 5 812 women who underwent vaginal delivery in Ningbo Women's and Children's Hospital from January 2019 to January 2020 were collected, including 59 women with shoulder dystocia (case group) and 5 753 women without shoulder dystocia (control group). Univariate and multivariate logistic regression analyses were conducted on the risk factors of shoulder dystocia. Among the 59 women with shoulder dystocia, 27 cases received conventional forearm pressure (case group 1), and 32 cases received posterior shoulder rotation (case group 2). The pregnancy outcomes of the groups were compared.   Results  Statistically significant differences in age, body mass index (BMI), gestational diabetes mellitus (GDM), uterine inertia and macrosomia were found between the case and control groups (all P < 0.05). Multivariate logistic analysis showed that BMI>27, GDM, uterine inertia and macrosomia were independent risk factors for shoulder dystocia (all P < 0.05). The total incidence rates of maternal and neonatal adverse outcomes in the case group were 20.34% and 13.56%, respectively, which were higher than those in the control group (6.67% and 0.42%, respectively; all P < 0.05). The total incidence rate of maternal and neonatal adverse outcomes in the case group 1 was 25.93%, which was not significantly different from at in case group 2 (15.62%, P>0.05). The total incidence rate of adverse neonatal outcomes in case group 1 was 25.93%, which was significantly higher than that in case group 2 (3.13%; P < 0.05).   Conclusion  Shoulder dystocia in maternal delivery have numerous risk factors, and thus targeted management is necessary to the prevention of shoulder dystocia. The incidence rates of adverse maternal and infant outcomes when the posterior shoulder rotation method is used are lower than those when the conventional shoulder pressing method is used for treating shoulder dystocia.
Comparison of the effect of different antibiotic treatment regimens on intestinal microecology and peripheral blood T lymphocyte subsets in infants
ZHONG Sheng-fen, ZHOU Wen-can, NI Miao-jun, ZHU Yu-qing, WEN Chao, JIN Ji, YANG Yu
2021, 19(6): 972-974. doi: 10.16766/j.cnki.issn.1674-4152.001963
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  Objective  To investigate the effect of different antibiotic treatment regimens on intestinal microecology and peripheral blood T lymphocyte subsets in infants.   Methods  A total of 72 infants treated with antibiotics in the Maternal and Child Health Hospital of Fuyang District, Hangzhou from January 2019 to December 2019 were selected as the observation group. Meanwhile, 24 healthy infants not administered with antibiotics were selected as the control group. The intestinal microecology and peripheral blood T lymphocyte subsets in both groups were compared. Additionally, the effect of different antibiotic treatment regimens on the above indices in the observation group was compared.   Results  Differences in intestinal microecology and peripheral blood T lymphocyte subsets between the observation and control groups were significant (all P < 0.05). In the observation group, levels of lactobacilli and bifidobacteria were lower in infants treated with β-lactams combined with non-β-lactams antibiotics than those treated with β-lactams or non-β-lactams alone (all P < 0.05). The proportion of normal intestinal microflora in infants treated with β-lactams combined with non-β-lactams antibiotics (8.33%) was significantly lower than that in those treated with β-lactams (58.33%) or non-β-lactams (45.83%) alone (all P < 0.05). Besides, CD8+, CD3+ and CD4+ were lower than in those treated with β-lactams or non-β-lactams alone (all P < 0.05).   Conclusion  Treatment with β-lactams combined with non-β-lactams antibiotics greatly influences intestinal microecology and peripheral blood T lymphocyte subsets in infants.
Analysis of community health service utilisation for young and middle-aged building population in Beiwaitan Street, Shanghai
HUANG Jiao-ling, CUI Ya-qi, HAO Yu, LIU Tie-xin, TAN Xin-chen, YANG Yong-hua, MA Xiao-jun, LIN Jie, YU Wen-ya, WANG Zhao-xin
2021, 19(6): 975-978. doi: 10.16766/j.cnki.issn.1674-4152.001964
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  Objective  To explore the current status of community health service utilisation among young and middle-aged population and analyse the main factors affecting visits to community health service center (CHSC).   Methods  From August to September in 2019, A questionnaire survey was conducted on Beiwaitan Street in Shanghai. A total of 1040 questionnaires were distributed, and 993 valid questionnaires were recovered. After controlling for the characteristics of the sample, this study examined the effects of socioeconomic status, health status, basic medical insurance, family doctor contract status and family doctors' cognitive status of the young and middle-aged population on their CHSC visits.   Results  The proportion of young and middle-aged population who visited CHSC was 40.72%, and the main services used was basic diagnosis and treatment (73.82%). The logistic regression results showed that compared with the population of primary school or below, the visit probabilities of populations with junior school, high school, undergraduate and master education levels were 72.1%, 37.1%, 32.8% and 26.9% (all P < 0.05), respectively. The OR for population without non-communicable diseases was only 38.4% of that for NCD patients (P < 0.05). The probability of community visits was higher for those covered by social medical insurance (OR=2.385, P < 0.05). The probability of community visits for those who were in contract with a family doctor was 3.701 times that of those who did not sign up (P < 0.05). The higher the level of their awareness of family doctor, the higher the probability of community visits (P < 0.05).   Conclusion  Basic outpatient clinics are the mainstay for young and middle-aged population. Socioeconomic status, health status, basic medical insurance, family doctor contract status and family doctors' awareness are significant factors that affected young and middle-aged population's community visits. The attention paid to this population currently is much lower than that paid to key populations such as the elderly. This study recommends that attention and research on the young and middle-aged population should be strengthened and that contract management suitable for this population should be developed.
Association of blood cell parameters with non-alcoholic fatty liver disease in the elderly with hypertension
WANG Cheng-cheng, LIU Huai-lei, GONG Wei-hong
2021, 19(6): 979-981, 1007. doi: 10.16766/j.cnki.issn.1674-4152.001965
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  Objective  This study aimed to investigate the relationship between blood cell parameters and non-alcoholic fatty liver disease (NAFLD) in the elderly with hypertension and provide scientific evidence for the prevention and control of NAFLD in elderly hypertensive patients.   Methods  The cluster sampling method was adopted to select elderly people aged over 60 years who were diagnosed with hypertension from April to July 2018 by taking the village or committee as a unit. After establishing community health examination files, physical examination and laboratory examination were conducted to collect blood cell parameters and other data. Multivariate logistic regression was used to analyse the relationship between blood cell parameters and NAFLD.   Results  The detection rate of NAFLD in elderly patients with hypertension was 63.29% (2 041/3 225). The level of absolute lymphocyte, leukomonocyte, absolute monocyte, absolute neutrophil count, white blood cell count, red blood cell count, haematocrit, haemoglobin, mean corpuscular haemoglobin concentration and platelet count in the NAFLD group was higher than that in the normal group (all P < 0.05). The level of neutrophile granulocyte, red blood cell distribution width and mean corpuscular volume in the NAFLD group was lower than that in the normal group (all P < 0.05). After adjusting for gender, age, BMI and fasting glucose, red blood cell distribution width was negatively associated with NAFLD, and absolute lymphocyte, absolute monocyte, haemoglobin and red blood cell count were positively associated with NAFLD (all P < 0.05).   Conclusion  Our results suggest that red cell distribution width, absolute lymphocyte, red blood count, absolute monocyte and haemoglobin were associated with NAFLD, which may provide a new way to prevent and control NAFLD in elderly hypertensive patients.
The mediating effect of psychological capital on perceived social support and intent to stay in midwives
SHI Wei-hui, ZHU Xiao-ping, YUAN Xiao-yu, WANG Ling, QIU Chang-cui, SHI Yan
2021, 19(6): 982-985. doi: 10.16766/j.cnki.issn.1674-4152.001966
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  Objective  To explore the mediating effect of psychological capital on the perceived social support and the intent to stay in midwife.   Methods  Using the method of convenience sampling, midwives from secondary and tertiary hospitals in Shanghai were selected from January to march in 2020. A total of 264 midwives were investigated with general information questionnaire, psychological capital questionnaire (PCQ), scale of perceived social support and retention intention scale.   Results  The total score of perceived social support was (58.24±15.65) points, and the total score of intent to stay was (22.05±6.13) points. Univariate analysis showed that marriage, position, length of service, the permanent staff or not, and public or private hospitals had significant influence on the total score of willingness to stay on duty (P < 0.05). Pearson correlation analysis showed that the total score of psychological capital was positively correlated with the willingness to stay in work (r=0.802, P < 0.05). The total score of perceived social support was positively correlated with the willingness to stay in work (r=0.747, P < 0.01), and the support at family level, friends' level and other levels was positively correlated with the intention to stay. Multiple hierarchical regression analysis showed that psychological capital played a significant role in predicting the willingness to stay on duty, and the explanatory variation increased by 76.3%. After introducing psychological capital into the regression equation, the regression coefficient of family support decreased to 0.284, indicating that psychological capital played a partial mediating role in the contribution of family support to the intention to stay in work.   Conclusion  There is large space for improvement in the willingness of midwives to stay. Managers should make appropriate career development strategies based on the situation of local mothers, and improve the psychological capital of obstetric nurses, so as to help the midwives stay on duty.
Effect of home nutrition support on nutritional status and psychological pain of patients with gastric cancer after surgery
ZHU Jin-cheng, HUANG Hong, ZHANG Hao-ran, ZHAO Cun-xi
2021, 19(6): 986-989. doi: 10.16766/j.cnki.issn.1674-4152.001967
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  Objective  To investigate the status of malnutrition and psychological distress in patients with gastric cancer after operation and observe the effect of family nutritional support on postoperative nutritional status and psychological distress of patients with gastric cancer.   Methods  A total of 166 patients undergoing gastrectomy in the Department of Oncology and Gastrointestinal Surgery of the First Affiliated Hospital of Bengbu Medical College from September 2019 to August 2020 were collected as the study subjects and randomly divided into experimental group and control group. The patients in the control group were given conventional anti-tumor treatment and patients in the experimental group were given additional home nutrition support treatment on the based on the treatment of the control group. The family information, nutritional and psychological distress indexes of patients were detected at discharge and 3 weeks after discharge.   Results  The results of Patient-Generated Subjective Global Assessment (PG-SGA) and Psychological Distress assessment showed that the incidence of malnutrition was 79.5% and the overall positive rate of psychological distress was 63.3%. The positive rate of psychological distress in malnourished gastric cancer patients (67.4%) was higher than that in well-nourished gastric cancer patients (47.1%, P < 0.05). There were no significant differences in the levels of total protein (TP), albumin (ALB), prealbumin (PAB), PG-SGA score and detection rate of psychological distress between the two groups at discharge (all P < 0.05). After 3 weeks, the levels of total protein (TP), albumin (ALB) and prealbumin (PAB) in the experimental group were higher than those in the control group, and the incidence of malnutrition in the experimental group (61.4%) was lower than that in the control group (80.7%, P < 0.05). The detection rate of psychological distress in the experimental group (31.3%) was lower than that in the control group (53.0%, P < 0.05).   Conclusion  The incidence of malnutrition and the detection rate of psychological pain in patients with gastric cancer after surgery are high. Family nutrition support can effectively improve the nutritional status of patients and reduce the detection rate of psychological pain.
Expression and clinical diagnostic of serum miR-92a-1 in patients with colorectal cancer
WU Xiao-yu, CUI Fa-cai, HU Min, ZHU Ya, ZHENG Pei-ming
2021, 19(6): 990-993. doi: 10.16766/j.cnki.issn.1674-4152.001968
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  Objective  This study aimed to investigate the expression of serum miR-92a-1 and its clinical diagnostic value in patients with colorectal cancer (CRC).   Methods  The serum samples of 131 patients with CRC and 50 patients with colorectal adenomas (CRA), who were hospitalised from May 2018 to December 2019 at the Henan Provincial People's Hospital, were collected, and 50 healthy controls were selected. The expression of serum miR-92a-1, carcinoma embryonic antigen (CEA) and carbohydrate antigen 199 (CA199) were detected by real-time quantitative PCR and electrochemiluminescence (ECLIA) and compared amongst the three groups. The relationship between serum miR-92a-1 and the clinicopathological characteristics of CRC patients was further analysed, and the receiver operating curves (ROC) were constructed to assess the diagnostic value of miR-92a-1 or combination of CEA and CA199 in CRC.   Results  The expression level of serum miR-92a-1, CEA and CA-199 in CRC patients was significantly higher than those in CRA patients or healthy controls, with statistically significant differences (all P < 0.05). The expression of serum miR-92a-1 in CRC patients was correlated with the degree of differentiation, TNM stage, lymph node metastasis and distant metastasis (all P < 0.05) but not with gender, age, tumour diameter and high risk (all P>0.05). The area under ROC curve (AUC) of miR-92a-1 in the diagnosis of CRC was 0.875 (95% CI: 0.833-0.918), and the sensitivity and specificity were 72.5% and 86%, respectively. The AUC of miR-92a-1 combined with CEA and CA-199 in the diagnosis of CRC was 0.904 (95% CI: 0.865-0.943), and sensitivity and specificity were increased to 80.2% and 91%, respectively.   Conclusion  The high expression of miR-92a-1 in CRC is related to the degree of differentiation, TNM stage, lymph node metastasis and distant metastasis. miR-92a-1 combined with conventional tumour marker detection has a high diagnostic value for CRC.
Study of multimode MRI in the diagnosis of early-stage patellar cartilage injury
WANG Dong-yu, LUO Xiao-ping, LIU Xu-ming, XIANG Jian-yu, HUANG Xu-hao
2021, 19(6): 994-997. doi: 10.16766/j.cnki.issn.1674-4152.001969
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  Objective  To investigate the diagnostic value of diffusion tensor imaging (DTI) and T2*mapping in the evaluation of early-stage patellar cartilage injury.   Methods  Thirty-two cases with patellar cartilage injury and 31 cases with normal patellar cartilage were examined through arthroscopy, and their data recorded from January 2017 to January 2020 were obtained. All the subjects underwent MRI conventional scanning, DTI and T2*mapping examination. The imaging manifestations of DTI and T2*mapping in early-stage patellar cartilage injury and in the control group were analyzed. Differences among quantitative parameters were determined, and the diagnostic efficacy of quantitative parameters in DTI and T2*mapping was analyzed.   Results  The fractional anisotropy (FA), apparent diffusion coefficient (ADC) and T2*value in the early-stage injury group were 0.42±0.08, (1.31±0.17)×10-3 mm2/s and (36.40±8.32) ms, respectively, whereas those in the control group were 0.31±0.09, (1.86±0.27)×10-3 mm2/s and (54.39±8.04) ms, respectively. The differences between the two groups were statistically significant (all P < 0.05). The sensitivity and specificity were 88.3% and 83.6%, and FA threshold was 0.35 in the diagnosis of early-stage patellar cartilage injury. Sensitivity and specificity were 90.6% and 84.2%, respectively, in an ADC threshold of 1.56×10-3 mm2/s and were 85.4% and 80.3%, respectively, in a T2* threshold of 46.88 ms.   Conclusion  The quantitative parameters of multi-modal MRI have a high diagnostic efficiency for early-stage patellar cartilage injury and have clinical values in the diagnosis and evaluation of patellar cartilage injury.
Observe on the clinical effect of MRI in vascular dementia after ischemic stroke
WANG Guo-yu, SHI Yi-ming, WANG Zeng-xian, CHEN Feng
2021, 19(6): 998-1000, 1025. doi: 10.16766/j.cnki.issn.1674-4152.001970
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  Objective  To observe the characteristics of brain magnetic resonance imaging (MRI) in patients with vascular dementia after ischemic stroke and evaluate the value of MRI in the early diagnosis and monitoring of the disease.  Methods  A total of 200 patients with ischemic stroke who were treated in Taizhou Central Hospital from August 2016 to August 2020 were included in the study. Patients without vascular dementia after stroke were included in the control group, whereas patients with vascular cerebral infatuation after stroke were included in the study group. All patients underwent cranial MRI detection. Infarct size was observed, and the apparent diffusion coefficient (ADC) of the white texture region of interest was measured.  Results  In all 200 patients with acute ischemic stroke, the incidence of vascular cerebral infatuation was 26.50%. The proportions of patients with large and medium cerebral infarction in the study group (50.94% and 56.60%) were significantly higher than those in the control group (21.76% and 23.81%; χ2=15.943, 19.097; all P < 0.001). The volumes of the left and right hippocampi and the left and right cerebral diameters of the study group were significantly lower than those in the control group, and the distance between the uncinate gyrus of the temporal lobe in the study group was significantly higher than that in the control group (all P < 0.001). The ADC values of the white matter in the frontal area of the frontal lobe, posterior area of the frontal lobe, anterior horn of the lateral ventricle, posterior horn of the lateral ventricle, semioval centre and hippocampus were significantly lower in the study group than in the control group (all P < 0.001).  Conclusion  Patients with vascular dementia after ischemic stroke have the characteristics of cortical atrophy, widened sulcus, large infarct area and sparse white matter. MRI examination can effectively diagnose the clinical features of vascular dementia after ischemic stroke and has a clinical value for early treatment and prognosis evaluation.
Mechanisms of Osteoarthritis Pain
QIN Xi-ru, ZHANG Li-zhi
2021, 19(6): 1001-1007. doi: 10.16766/j.cnki.issn.1674-4152.001971
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Osteoarthritis (OA) is the most common joint disease, and its incidence is increasing by years. Currently, there is no effective cure, yet OA is one of the most common causes of functional disability in the elderly. The insufficient knowledge of knee OA and subsequent delayed prevention and treatment of knee OA are the important reasons leading to the increasing morbidity. In clinic, pain is one of the earliest signs in the early stages of OA. Pain is also the main symptom of OA and is one of the most important criteria for diagnosis. Owing to the frequent neglect of early OA pain and insufficient understanding of the cause and mechanism of OA pain, getting satisfactory treatment effect is often difficult. As a result, the incidence of complaints of patients is increasing. Subsequently, progress of the lesions is continuing, which are closely related to the joint disability of patients and eventually joint replacement. Therefore, the causes, characteristics, conduction and perception of pain; the relationship between pain occurrence and development of osteoarthritis and the pathophysiological mechanism of OA pain must be identified. Studies show that OA-related pain has a complex pathophysiologic mechanism, and it is not only a kind of joint injurious pain depending on abnormal stress and biological interplay but also closely related to local inflammation, peripheral and central neuropathy and regulated by a variety of factors (e.g. spirit, gene, weather, etc). Furthermore, clinical findings emphasize that OA is not a stable and linear condition. Pain experience is independent of structural modifications, and it occurs to varying degrees in a patient- and time-specific manner. Therefore, this review covers studies on the mechanisms of OA pain. The review is expected to be helpful for physicians to find the cause of poor curative effect and improve them, for researchers to make transformation from basic study to clinical work, for patients to acquire an optimal management relieving OA-related pain in the future.
Research progress of triglyceride glucose index in coronary atherosclerotic heart disease
WANG Shuo-shan, WU Jing-guo, JING Xiao-li, ZHANG Yong-wei, TANG Hao
2021, 19(6): 1008-1012. doi: 10.16766/j.cnki.issn.1674-4152.001972
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Coronary heart disease (CHD) is still one of the main diseases threatening human health. With the development of economy, and the improvement of our living standards, the incidence of insulin resistance is increasing. Insulin resistance is closely related to the occurrence and development of CHD. The study of the internal relationship between insulin resistance and the pathophysiological process of CHD is of great importance for the early prevention, treatment and follow-up of CHD. The traditional testing method for insulin resistance is complicated, time-consuming and expensive, so it is not suitable to be carried out in community hospitals, cannot be promoted in large-scale populations. In recent years, triglyceride-glucose index (TyG index) as a simple insulin resistance replacement index has been paid more and more attentions. At present, many studies have confirmed that TyG index response insulin resistance is reliable, efficient and simple compared with traditional indicators of insulin resistance. Many studies have found that elevated TyG index is positively correlated with the severity of CHD and poor cardiovascular prognosis. This paper summarizes the relationship between insulin resistance and CHD, the research progress of insulin resistance detection index, and the relationship between TyG index and CHD. This article aims to improve the understanding of TyG index by general practitioners and provide more theoretical basis for them to use this insulin resistance indicator. We hope that we can use the simple marker of TyG index in the screening coronary heart disease risk groups and follow-up work for CHD, and reduce the incidence rate and mortality of CHD.
Research progress of MicroRNA-429 in gynecological malignant tumors
LI Li-yang, XU Peng, WANG Bei-di, GAO Shuang, GUO Yu, KUANG Ye
2021, 19(6): 1013-1016,1034. doi: 10.16766/j.cnki.issn.1674-4152.001973
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Gynecological malignant tumors is a problem that threatens women's health, of which early diagnosis and treatment are of great significance to the prognosis. MicroRNA (miRNA) is a small non-coding RNA involved in post-transcriptional regulation of cells, which plays a key role in the normal physiological processes of cells and the development of tumors. MicroRNA-429 (miR-429) can inhibit the expression of zinc E-box-binding homobox 1 (ZEB1) and ZEB2, which affects tumor progression and metastasis, and regulates Slug Gene expression in order to affects the expression of E-cadherin and Snail protein, and regulates the epithelial-mesenchymal transition (EMT) in tumors, which affects tumor migration, invasion, prognosis, and drug sensitivity. MiR-429 plays a tumor-promoting role in ovarian cancer and is not conducive to the prognosis, but its low expression is associated with low patient survival rates, and the differential expression of miR-429 was found in the ascites of ovarian cancer patients, which has potential clinical diagnostic significance. It plays a role in tumor suppression in cervical cancer role; plays a tumor-promoting role in endometrial cancer, and may have potential diagnostic value in endometrial cancer.The related literature on miR-429 and it's role in gynecological malignancies is reviewed, combined with tumor occurrence, invasion and other factors to discuss, comprehensively analyze the significance of miR-429 in gynecological malignancies, and for the further study significance in clinical application provides reference.
Effect of Yiwei Fuzheng Decoction on Qi deficiency and blood stasis type precancerous lesion and its related mechanism
WU Xian, WANG Hai-bo, LOU Chao-sheng, ZHANG Yin, YE Le-chi
2021, 19(6): 1017-1021. doi: 10.16766/j.cnki.issn.1674-4152.001974
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  Objective  To investigate the effect of Yiwei Fuzheng Decoction on qi deficiency and blood stasis precancerous lesion (PLGC) and its effect on the expression of gastric mucosal histone kinase B/rapamycin target protein (AKT/mTOR) pathway.  Methods  There were 88 patients with qi-deficiency and blood stasis type PLGC who were treated in our hospital from March 2017 to October 2018. The patients were divided into study group and control group according to the random number table method, and 44 cases in each group. Patients in the control group were treated with Weifuchun tablets. Patients in the study group were treated with Yiwei Fuzheng Decoction. The clinical efficacy, pathological score, clinical symptom score and adverse reactions of the two groups were compared. Serum tumor markers were detected by electrochemical chemilescence immunoassay, and the expressions of p-AKT and p-mTOR in gastric mucosal tissues before and after treatment were observed by immunohistochemistry.  Results  After treatment, the total effective rate of the study group (86.36%) was higher than that of the control group (68.18%, P < 0.05). Mucosal inflammation, inflammatory activity, gland atrophy, intestinal metaplasia, dysplasia and other pathological scores in the two groups were significantly reduced, and the pathological scores in the study group were lower than those in the control group (all P < 0.05). The symptom scores of patients in the two groups were significantly reduced after treatment, including full distension, stomachache, fatigue, poor appetite, loose stools in stool, and belching regurgitation, etc., and the pathological scores in the study group were all lower than those in the control group (all P < 0.05). After treatment, the levels of serum CEA, CA19-9 and CA125 in the study group were lower than those in the control group (all P < 0.05). After treatment, the positive expression rates of p-AKT and p-mTOR in gastric mucosa of the study group were lower than those in the control group (all P < 0.05). There was no obvious adverse reaction in both groups.  Conclusion  Yiwei Fuzheng Decoction may treat qi deficiency and blood stasis type PLGC by regulating AKT/mTOR pathway.
Application value of comprehensive myopenia training intervention in stroke rehabilitation training and its preventive effect on myopenia
HONG Jing, RAO Su-yu, ZHOU Hai-tao, XUE Yang-jing
2021, 19(6): 1022-1025. doi: 10.16766/j.cnki.issn.1674-4152.001975
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  Objective  To study the application value of rehabilitation training in stroke and its preventive effect on myopenia.  Methods  A total of 100 inpatients who suffered from stroke and admitted from July 2020 to December 2020 were divided into the control and observation groups of 50 cases each. The control group underwent routine rehabilitation training, whereas the observation group underwent routine rehabilitation training combined with comprehensive myopenia training intervention. The thickness of the anterior tibial flexor and biceps brachii, grip strength of healthy and affected sides, Hamilton Anxiety Scale (HAMA), depression scale (HAMD), quality of life scale (SF-36) and incidence of myopenia were compared between the two groups.  Results  The incidence rate of myopenia in the observation group (4%) was lower than that in the control group (18%; P < 0.05). After the intervention, the M-US values of the anterior tibial flexor muscle in the control group and the observation group were (1.78±0.36) cm and (2.06±0.48) cm, and the difference were significant (all P < 0.05). The M-US values of the biceps brachii were (2.36±0.58) cm and (2.64±0.63) cm, respectively, and the difference was significant (P < 0.05). After the intervention, the grip strength of the healthy side and that of the affected side in the observation group was higher than those in the control group (P < 0.05). After the intervention, the observation group had a lower HAMA score [(4.62±0.73) points] than the control group [(5.03±0.84) points], lower HAMD score [(4.73±0.82) points] than the control group [(5.19±0.87) points] and higher SF-36 score (all P < 0.05).  Conclusion  The comprehensive intervention of myopenia training in patients with stroke can reduce the incidence of myopenia, improve their skeletal muscle thickness and grip strength, alleviate their negative emotions and improve their quality of life.
Application of DOPS as formative evaluation in basic health services in graduation practice
HE Yi-ni, QI Dian-jun, CHEN Xin-yue, ZHU Liang-liang, QI Hui-meng, WANG Shuang, YU Xiao-song
2021, 19(6): 1026-1028, 1052. doi: 10.16766/j.cnki.issn.1674-4152.001976
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  Objective  To discuss the effect of direct observation of procedural skills (DOPS) as formative evaluation in basic health services in graduation practice.  Methods  Total 62 fifth-year undergraduates from The Clinical Medicine Major University of China Medical University were selected as study subjects In June 2018. Using random number table method, 62 medical undergraduates were divided into experimental group and control group, 31 persons in each group. DOPS was added as formative evaluation in the clinical operation skill training of the experimental group, while the control group still carried out clinical operation skill training with traditional teaching methods. The effect was evaluated at the end of the training.  Results  The physical examination scores of the experimental group [(80.66±6.53) points] were higher than those of the control group [(76.13±7.99) points], and the results were statistically significant (P < 0.05). The test scores of ECG operation in the experimental group [(78.50±9.06) points] were higher than those of the control group [(73.30±8.80) points], and the results were statistically significant (P < 0.05). The written test scores of students in the experimental group [(74.43±7.96) points] were higher than those of the control group [(73.28±9.32) points], but the results were not statistically significant (P>0.05). In the Mini-CEX test scores, the experimental group's medical history collection [(6.53±1.24) points], physical examination [(6.28±1.57) points], humanistic care [(6.21±1.31) points], communication skills [(6.44±1.48) points] and overall performance [(6.31±1.15) points] scores, were significantly higher than the control group [(5.87±1.17) points, (5.40±1.30) points, (5.37±1.45) points, (5.57±1.36) points and (5.60±0.89) points, respectively], and the results were statistically significant (all P < 0.05). There was no statistically significant difference between the experimental group and the control group in the clinical diagnosis and treatment and organizational effectiveness items in the Mini-CEX test scores (all P>0.05).  Conclusion  Carrying out DOPS as formative evaluation in the basic health services in graduation practice could improve the teaching effect effectively.
The efficacy of high-flow nasal cannula oxygen therapy for patients after extubation: an overview of systematic reviews
LIU Qin, XIE Xiang-mei, LUO Jia-jia, JIAO Fan, HU Xiao-ying
2021, 19(6): 1029-1034. doi: 10.16766/j.cnki.issn.1674-4152.001977
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  Objective  The aim of this paper was to evaluate the methodological quality and of evidence level for the best evidence, to compare the efficacy and safety of high-flow oxygen therapy with other therapy methods in patients after extubation, and provide reference for the future research priorities of high-flow oxygen therapy in critically ill patients through retrieving systematic review or meta-analysis of patients who were treated with high-flow nasal cannula oxygen therapy after extubation.  Methods  The Cochrane Library, PubMed, Medline, CNKI, CBM, WANFANG and VIP databases were electronically searched to collect systematic reviews or meta-analysis on the application of high-flow nasal cannula oxygen therapy for the patients after extubation. The retrieval time is limited to February 2020 from the time of database construction. Two researchers independently screened literature, and extracted data AMSTAR 2 scale and GRADE system were used to evaluate the methodological quality and evidence quality of the included literature.  Results  A total of 11 systematic reviews/meta-analyses were included. Eight articles compared high-flow oxygen therapy with non-invasive positive pressure ventilation and traditional oxygen therapy, and three articles compared the efficacy of high-flow oxygen therapy with traditional oxygen therapy only. The methodological quality evaluation by AMSTAR 2 was generally low, one study was low and 10 was extremely low. GRADE evaluation results showed that among the 78 evidence level outcome, 6 were high quality, 37 were intermediate quality, 29 were low quality and 6 were extremely low quality. Most studies have shown that the rate of re-intubation in patients with extubation using nasal high-flow oxygen therapy is lower than that of traditional oxygen therapy and similar to non-invasive positive pressure ventilation.  Conclusion  High-flow nasal cannula oxygen therapy can reduce the reintubation rate of patients after extubation and can be used as an alternative to non-invasive positive pressure ventilation under certain conditions. However, the quality of the methodology included in the study is low, and the quality of evidence is average. Therefore, it is recommended to carry out higher quality studies to explore the application of high-flow oxygen therapy in critically ill patients.
Analysis of related metabolic indexes of non-alcoholic fatty liver disease in the elderly popluation of public institutions in Nanjing
SUN Hui-wen, ZHAN Yi-yang, CHEN Min-min, JIANG Min, WANG Chun, WANG Qin, ZHENG Wen
2021, 19(6): 1035-1038. doi: 10.16766/j.cnki.issn.1674-4152.001978
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  Objective  To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in the elderly physical examination population in institutions in Nanjing in 2016 and to analyse the correlation between NAFLD and metabolic indicators, such as triglyceride glucose product index (TyG index).  Methods  Elderly subjects who were admitted to Nanjing Public Institutions from January 2016 to January 2017 and underwent physical examination in the physical examination center of Nanjing Drum Tower Hospital were included in the study. Demographic characteristics, biochemical tests, b-ultrasound examination results, calculate body mass index (BMI) and TyG index were analysed. Differences in metabolism-related indicators between the NAFLD and non-NAFLD groups were determined, and the correlation between TyG and metabolic indexes was analysed. Logistic analysis was used in analysing the independent influencing factors of NAFLD, and ROC was used in evaluating the predictive values of different indicators for NAFLD.  Results  The prevalence rate of NAFLD in 2 712 elderly patients who underwent physical examination was 24.52%, and the prevalence rate of NAFLD in males was significantly higher than that in females (25.86% vs. 17.78%; χ2=13.254, all P < 0.05). Logistic regression analysis showed that BMI, DBP, FPG, HbA1c, TC, TG, LDL-C, HDL-C, TyG index, UA were independent influencing factors for NAFLD. Correlation analysis results showed that TyG index level in elderly physical examination subjects was significantly positively correlated with BMI, SBP, DBP, FPG, HbA1c, TC, TG, LDL-C and uric acid (r=0.324, 0.139, 0.110, 0.484, 0.414, 0.246, 0.846, 0.172, 0.172; all P < 0.05) and significantly negatively correlated with HDL-C level (r=-0.44, P < 0.05). The area under the curve (AUC) values predicted using BMI, DBP, UA and TyG index were 0.71, 0.60, 0.60 and 0.74, respectively.  Conclusion  NAFLD had a high prevalence rate in elderly people who underwent physical examination in public institutions in Nanjing. BMI, DBP, FPG, HbA1c, TC, TG, LDL-C, HDL-C, TyG index, and UA were independent influencing factors for NAFLD, and the TyG index was a simple synthetic indicator for IR assessment and thus has a good predictive value for NAFLD.
Awareness of adult calcium supplement and its influencing factors among general practitioner in Zhejiang Province
YANG Chen-bin, LI Yan-mei, LI Zhang-ping, NI Yun-chao, WU Hui-lei
2021, 19(6): 1039-1042. doi: 10.16766/j.cnki.issn.1674-4152.001979
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  Objective  To investigate and analyze the cognition and influencing factors of general practitioners on adult calcium supplementation in Zhejiang province, and to provide the decision-making basis for targeted education.  Methods  A questionnaire was designed, including the basic information, the knowledge of calcium supplementation and the ways to obtain it. The general practitioners in Zhejiang Province were selected by random number method and the questionnaire was conducted. Univariate and multivariate logistic regression were used to analyze the cognition and influencing factors of calcium supplementation among general practitioners in Zhejiang Province.  Results  Total 780 questionnaires were sent out and 760 were effectively received with an effective rate of 97.4%. 59.7% of respondents were male and 40.3% female. 73.4% of respondents were < 40 years old, and 26.6% were ≥ 40 years old. In terms of educational background, 14.9% had a college degree or below, 80.5% had a bachelor's degree, and 4.6% had a master's degree or above. In terms of titles, 54.9% were primary or below, 34.6% were intermediate, and 10.5% were advanced. In terms of working units, 5.3% were in village clinics, 74.2% in community health service centers, and 20.5% in county-level hospitals. In terms of working years, 60.1% have 10 years or less, 31.2% have 11 to 20 years, and 8.7% have more than 20 years. In terms of acquiring calcium supplement knowledge, pure traditional type (43.7%), simple new media type (17.5%) and compound type (38.8%) were selected. The results showed that the qualified rate of the surveyed doctors was 30.4%, and the longer working years had a negative impact on the qualification of calcium supplements knowledge. From the perspective of access, compared with the traditional type, the simple new media type had a negative impact on the qualification of calcium supplements knowledge, while the complex type had a positive impact on the qualification of calcium supplements knowledge.  Conclusion  General practitioners in Zhejiang Province have insufficient awareness of calcium supplements, especially those who have long working years and only use new media to acquire knowledge, so it is necessary to strengthen the study of calcium supplements knowledge among general practitioners, and it is suggested to acquire knowledge by traditional combined with new media.
Epidemiological investigation and clinical symptom analysis of influenza among children in a hospital of Bengbu City from 2018 to 2019
WANG Le-le, HAN Xu, ZHANG Qi, CHEN Xin
2021, 19(6): 1043-1045,1064. doi: 10.16766/j.cnki.issn.1674-4152.001980
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  Objective  To analyse the epidemiological characteristics and clinical symptoms of influenza among children in a hospital of Bengbu City from 2018 to 2019 so as to provide basis for the prevention and treatment of influenza.  Methods  A total of 528 children diagnosed with influenza and hospitalised in the First People's Hospital in Bengbu from January 2018 to December 2019 were selected as the research objects. The medical history data of the children were reviewed and statistically analysed along with the epidemiological characteristics, clinical symptoms and laboratory tests.  Results  Among the 528 children with influenza, 21.3% had influenza A, 55.6% had influenza B and 23.1% had influenza A combined with influenza B. The peak age of influenza was 1-7 years old and 7-14 years old, and the lowest was among the 0-1 year old infants. Among them, the incidence rate of influenza increased with age, regardless of gender. No significant difference was noted in the incidence rate (P=0.326). The high incidence season of influenza among children was from November to December to March of the next year. The high incidence age of school-age children was 3-7 years old. The clinical symptoms of fever, sore throat, diarrhoea, headache and other clinical symptoms of children with influenza A were severe, the hospitalization time was long, the fever lasted for a long time and the complications were more. In addition, the test indexes of white blood cell, calcitonin and C-reactive protein were significantly increased (all P < 0.05).  Conclusion  The influenza outbreak of children in Bengbu City is seasonal. The number of patients with influenza B is more than those with influenza A and influenza A combined with influenza B. The clinical symptoms and organ damage of children with influenza A are significantly more serious than those with mixed influenza A and B. The hospitalization time and fever duration of children with influenza A are longer than those with influenza B and mixed infection.
Nursing care of elderly patients with maxillary sinus lifting and simultaneous implant implantation
ZHU Li, YU De-dong, XU Yun-xia
2021, 19(6): 1046-1048. doi: 10.16766/j.cnki.issn.1674-4152.001981
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  Objective  To explore the nursing effect of targeted nursing on elderly patients with maxillary sinus simultaneous implantation.  Methods  A total of 42 elderly patients with maxillary posterior tooth loss treated with implant prosthesis admitted to the Second Outpatient Department of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February 2015 to May 2018 were included in the present study. The patients were randomly divided into observation and control groups of 21 patients each. The control group received routine nursing, whereas the observation group received targeted nursing. Differences in negative emotion, satisfaction and self-efficacy before and after the intervention were compared in both groups.  Results  SAS and SDS scores significantly decreased (35.38±5.84 vs. 30.67±5.55 and 32.52±5.01 vs. 29.24±5.10, respectively) in the control and observation groups after intervention (both P < 0.01), but the decrease was more significant in the observation group (P < 0.05). Similarly, functional restoration, aesthetic improvement and comfort (4.46±0.25 vs. 4.66±0.29, 4.27±0.77 vs. 4.61±0.29 and 4.29±0.60 vs. 4.72±0.31, respectively) significantly improved in both groups, and the observation group showed a higher degree of improvement (all P < 0.05). After intervention, the self-efficacy scores of both groups significantly increased (30.19±5.14 and 35.02±5.59), and the increase in the observation group was more obvious (P < 0.05).  Conclusion  Targeting nursing can significantly alleviate negative emotions of elderly patients with concurrent maxillary sinus implantation and improve their satisfaction and self-efficacy.
Application of cluster nursing management to the treatment of orthopaedic trauma with infection through vacuum sealing drainage
CHEN Zhi-hui, ZENG Zhong-you, QIAN Jin-feng
2021, 19(6): 1049-1052. doi: 10.16766/j.cnki.issn.1674-4152.001982
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  Objective  To investigate the application of cluster nursing management to the treatment of orthopaedic trauma patients with infection through vacuum sealing drainage and provide novel methods for clinical nursing.  Methods  A total of 150 patients with trauma infection who were hospitalized in the Department of Orthopaedics of The Coast Guard Headquarters Hospital of the Chinese People's Armed Police Force from July 2019 to July 2020 were divided into the intervention and control groups with a convenience sampling method. Each group included 75 patients. Both groups received VSD treatment, but the control group received routine care, whereas the intervention group was subjected to cluster nursing management preventing orthopaedic trauma. VSD failure rate, wound healing time, negative emotional symptoms (depression and anxiety self-rating scale, SDS/SAS), pain (visual analogue scale, VAS) and nursing satisfaction were compared between the two groups.  Results  The VSD failure rate in the intervention group was 8.00%, which was significantly lower than that in the control group (20.00%; P < 0.05). Wound healing time in the intervention group was significantly shorter than that in the control group (P < 0.05) before the intervention, and no significant changes in the SDS, SAS and VAS scores of the intervention group (P>0.05) were found after the intervention. The SDS and SAS scores of the intervention group were significantly lower than those of the control group (P < 0.05) after treatment. The VAS scores of patients in the intervention group were significantly lower than those in the control group [(2.11±0.97) points vs. (4.22±1.02) points; P < 0.05]. Nursing satisfaction rate was 96.00% in the intervention group, significantly higher than that of the control group (66.66%; P < 0.05).  Conclusion  The implementation of cluster nursing management to prevent infection in patients with orthopaedic trauma can effectively improve the therapeutic effect of VSD treatment.
Application of risk nursing combined with continuous quality improvement in the safety management of intravenous drug use in daytime chemotherapy
BO Li-mei, WEI Yun-hai, BIAN Yuan-yuan
2021, 19(6): 1053-1056. doi: 10.16766/j.cnki.issn.1674-4152.001983
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  Objective  To improve the safety management of drug use in patients undergoing daytime chemotherapy, this study used risk nursing combined with continuous quality improvement on the basis of routine nursing to evaluate the nursing value and significance of the strategy.  Methods  A total of 140 patients who received intravenous chemotherapy in our hospital from May 2019 to December 2019 were included in the control group through convenient sampling. They underwent routine nursing quality management. A total of 150 patients admitted to the Cardiology Department of our hospital were included in the observation group and subjected to risk nursing, which was combined with continuous quality for the improvement of nursing management. Nursing quality and drug literacy scores, incidence of nursing adverse events and nursing satisfaction were compared between the groups.  Results  The scores and total scores of nursing quality in the observation group were higher than those in the control group (P < 0.05). Before nursing intervention, there was no significant difference in drug literacy score between the two groups (P>0.05). After the nursing intervention, the scores of the two groups were increased, but the scores of the observation group were significantly higher than those of the control group (P < 0.05). The nursing satisfaction of the observation group was 94.7% (142/150), and that of the control group was 87.1% (122/140), the difference was statistically significant (P < 0.05).  Conclusion  Risk nursing combined with continuous quality improvement can effectively reduce the risk of intravenous drug use in patients undergoing daytime chemotherapy on the basis of routine treatment and nursing, reduce the occurrence of adverse nursing events, effectively improve the patient's drug literacy and nursing satisfaction. This strategy is of great significance to the safety management of intravenous drug use in daytime chemotherapy.
Effect of evidence-based clinical nursing pathway on emergency thrombolytic therapy in patients with acute cerebral infarction
WANG Fu-qin, ZHU Wei-li, YUAN Ming, MA Li-na, XU Min
2021, 19(6): 1057-1060. doi: 10.16766/j.cnki.issn.1674-4152.001984
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  Objective  Acute cerebral infarction (ACI) has high disability and mortality rates. To improve the nursing quality of patients with ACI, this study used an evidence-based clinical nursing pathway and analysed its effect.  Methods  A total of 126 patients with ACI who received emergency Emergency thrombolytic therapy in Shengzhou Hospital of Traditional Chinese Medicine from May 2018 to April 2020 were selected with a convenience sampling method. With a stochastic digital meter, the patients were divided into control and observation groups (n=63). Both groups of patients received the conventional nursing mode of adjuvant treatment intervention. The observation group recieved addtional emergency thrombolytic therapy according to the evidence-based theory of clinical nursing path. The efficacy indexes of thrombolytic nursing (pre-hospital treatment time, The time from admission to doctor orders, examination time, DNT time and total time), neurological function [stroke scale (NIHSS)] and daily activity ability (Barthel index) before and after nursing were compared between the 2 groups, and the nursing satisfaction of patients in the 2 groups was statistically analysed.  Results  All the indicators of the thrombolysis time effect in the observation group was shorter than those in the control group (P < 0.05). After nursing, nerve function and ability to conduct daily activities in the observation group were higher than those in the control group, and the nursing satisfaction level of the observation was 98.4% (62/63), superior than 76.2% (48/63, P < 0.05).  Conclusion  A clinical nursing path intervention mode based on an evidence-based theory can shorten treatment time for patients with ACI on the basis of routine treatment and nursing, the neurological function and daily nerve function and daily life ability of patients and provide a reference for clinical nursing.
2021, 19(6): 1061-1064. doi: 10.16766/j.cnki.issn.1674-4152.001985
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2021, 19(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.001986
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General Practice Research
Clinical characteristics and risk factors of heart failure patients after hematopoietic stem cell transplantation treatment
XUE Lu-xin, LI Xiao-yang, WANG Jing
2021, 19(6): 894-897. doi: 10.16766/j.cnki.issn.1674-4152.001943
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  Objective  To explore the clinical characteristics and risk factors of patient with heart failure after haematopoietic stem cell transplantation(HSCT), improve methods for the early recognition and intervention for patients with heart failure after haematopoietic stem cell transplantation and improve the prognoses of patients.  Methods  From July 2017 to July 2019, a total of 200 cases of bone marrow and peripheral blood stem cell transplantation were obtained. On the basis of the N terminal value of b-type natriuretic peptide precursor (NT-proBNP) and heart failure symptoms, patients were divided into the heart failure group (patients with symptoms of heart failure and the NT-proBNP>125 pg/mL) and heart failure group, and clinical features and possible risk factors of the patients in the two groups were compared.  Results  The incidence rate of heart failure after HSCT was 22.50%. The haematopoietic stem cell transplantation group before transplantation in patients with heart failure in the aftermath of the NT-proBNP value, pulmonary infection, cord blood combined rate of peripheral blood haematopoietic stem cell transplantation, not in all matches, whether for recurrence of the pretreatment of refractory, cyclophosphamide or anthracycline-based combined with cyclophosphamide solution rate and spore. The anti-thymocyte immunoglobulin+ring anti-rejection scheme selection rate was higher, and haemoglobin value of the haematopoietic stem cell transplantation group was lower than those of the heart failure group, the difference statistically significant (all P < 0.05); Logistic regression analysis showed a high NT-proBNP value before transplantation and high NT-proBNP value one month after transplantation, combined with pulmonary infection and umbilical cord blood combined with haematopoietic stem cell transplantation were independent risk factors for heart failure after hematopoietic stem cell transplantation (OR=1.184, 1.154, 1.091, 0.217).  Conclusion  High NT-proBNP value before transplantation, high NT-proBNP value one month after transplantation, combined with pulmonary infection and umbilical cord blood combined with peripheral blood haematopoietic stem cell transplantation are independent risk factors for heart failure after haematopoietic stem cell transplantation. Special attention should be given to such patients in clinical practice for early intervention, reduction of the risk of heart failure and improvement of prognosis.
Influencing factors of hemorrhagic transformation in non-thrombolytic patients after acute large area cerebral infarction
LIU Li-jun, LIU Xue-yun, WU Xiao-san, QIU Ju, WU Tong, HAN Yong-sheng, WANG Xun
2021, 19(6): 898-900,907. doi: 10.16766/j.cnki.issn.1674-4152.001944
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  Objective  This study was aimed to explore the influencing factors of hemorrhagic transformation (HT) in non-thrombolytic patients with acute massive cerebral infarction by analyzing the differences in factors between the massive cerebral infarction hemorrhage transformation group and the non-hemorrhage transformation group, and the basis for prognosis judgment was provided.  Methods  Count patients with acute massive cerebral infarctions and did not receive thrombolysis in the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University from January 2018 to December 2019, we collected general information of patients, risk factors of stroke, the levels of blood calcium and magnesium on admission, and analyze the difference between the hemorrhage transformation group and the non-hemorrhage transformation group.  Results  A total of 114 patients were enrolled in this study, of which 88 were in the group without hemorrhage transformation and 26 were in the group with hemorrhage transformation. Univariate analysis showed that the patients with hemorrhage transformation combined with atrial fibrillation were significantly more than those without hemorrhage transformation (P < 0.05), and the levels of low-density lipoprotein cholesterol, blood calcium, and magnesium were also significantly lower than those in the hemorrhage transformation group (all P < 0.05). Multivariate logistic analysis showed that atrial fibrillation was positively correlated with hemorrhagic transformation in non-thrombolytic patients with massive cerebral infarction (OR=4.731, 95% CI: 1.594-14.044, P=0.005), and There was an negative correlation between serum magnesium and hemorrhagic transformation in non-thrombolytic patients with cerebral infarction (OR=0.000, 95% CI: 0.000-0.095, P=0.006).  Conclusion  Atrial fibrillation and hypomagnesemia may be independent risk factors for hemorrhagic transformation of acute massive cerebral infarction.
Safety and effectiveness of tranexamic acid in patients combined with high risk comorbidities for postoperative venous thromboembolism during total knee arthroplasty
ZOU Chun-yu, YUE Chen, YANG Lan-bo, MI Yu-fei, WANG Zhan-chao
2021, 19(6): 901-903. doi: 10.16766/j.cnki.issn.1674-4152.001945
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  Objective  To assess the safety and efficacy of tranexamic acid (TXA) in patients with high risk comorbidities for venous thromboembolic events (VTE) during total knee arthroplasty (TKA).  Methods  We chose eight risk factors for postoperative VTE during TKA. Patients in Luoyang Orthopedic Hospital of Henan Province were reviewed from January 2010 to December 2019 and were divided into control, intravenous TXA, and topical TXA group. The safety outcomes were identified as the incidence of VTE, and the efficacy outcome was limited to transfusions.  Results  Through a comprehensive review of 7 836 consecutive TKA cases from 2010 to 2019, 781 cases were included according to the inclusion criteria. Of them, 341 cases didn't receive TXA, 163 patients received intravenous TXA and 277 patients received topical TXA. The incidence of VTE was not significant difference across these three groups (8.50% vs. 9.82% vs. 7.94%), and the transfusion rate was significantly lower in the intravenous and topical TXA groups than the control group (31.67% vs. 18.40% vs. 22.38%, P=0.002).  Conclusion  This study preliminary showed that TXA was effective to decrease transfusions without sacrificing the safety in patients with high risk comorbidities for VTE during TKA.
Effects of epidural labour analgesia on delivery process, delivery mode and postpartum depression
SONG Yu-rong, ZHAN Lei, SUN Li
2021, 19(6): 904-907. doi: 10.16766/j.cnki.issn.1674-4152.001946
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  Objective  To analyse the effects of epidural labor analgesia (LA) on the process and mode of delivery and the risk of postpartum depression (PPD) by comparing labour-related indicators and postpartum depressive symptoms between LA-treated and non-analgesia groups.  Methods  In the prospective cohort study, 556 full-term parturient women admitted to the Second Affiliated Hospital of Anhui Medical University from November 2019 to February 2020 were included in the study. Their socio-demographic and delivery-related data were collected. Depressive symptoms were evaluated using the Edinburgh Postpartum Depression Scale (EPDS) 42 days after delivery. The first and second stages of labour, mode of delivery, forceps delivery, use of oxytocin, amount of postpartum hemorrhage two hours after delivery and neonatal Apgar and EPDS scores were compared among the early stage (A1), late stage (A2) epidural analgesia and non-analgesia (C) groups.  Results  The times of the first and second stages of labour and the proportion of the use of the Caesarean section and oxytocin in groups A1 and A2 were significantly higher than those in group C (all P < 0.05). Maternal blood loss in groups A1 and A2 was lower than that in group C (all P < 0.05). The EPDS scores and the prevalence rate of PPD in groups A1 and A2 were lower than those in group C (all P < 0.05). After Bonferroni correction, there was no significant difference in cesarean section rate between A1 group and C group (P>0.017), but there was still significant difference between any other two groups (all P < 0.017). Multivariate logistic regression analysis showed that LA was a protective factor for the occurrence of PPD after pregnancy-related confounding factors were controlled (OR=0.447, 95% CI: 0.245-0.818; P=0.009).  Conclusion  Epidural LA can prolong the stages of labour in parturient women but can reduce the risk of 6 week PPD. Overall, this treatment mode is safe for mothers and newborns and suitable for clinical use.
Correlation between stress hyperglycaemia ratio and early cognitive dysfunction in patients with anterior circulation perforator arteriosclerotic cerebral infarction
WANG Jing-yue, SUN Bo, PENG Yan-bo, CHAI Hai-xia, FAN Hai-yan, BIAN Zhe
2021, 19(6): 908-912. doi: 10.16766/j.cnki.issn.1674-4152.001947
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  Objective  To discuss the effects of high blood sugar stress ratio on early cognitive dysfunction of patients with Anterior circulation perforator arteriosclerotic cerebral infarction.  Methods  From December 2014 to December 2019, patients with anterior circulation perforator arteriosclerotic cerebral infarction who were hospitalised in neurology department of Affiliated Hospital of North China University of Science and Technology were selected as the observation objects. According to the 90-day Montreal Cognitive Assessment (MoCA) score, all the patients were divided into two groups: cognitive dysfunction group(145 cases) and normal cognitive function group(187 cases). Data were collected to analyse the correlation between stress hyperglycaemia rate (SHR) and 90 day MoCA and A Mini-Mental State Examination (MMSE) scores. Receiver Operator Characteristic (ROC) curve was used to evaluate the effectiveness of SHR-related indicators in predicting cognitive impairment.  Results  In this study, the incidence of early cognitive impairment was 43.67%. The single-factor analysis showed that the differences in age, hypertension, diabetes history, education level, The NIH Stroke Scale (NIHSS) score, random blood sugar and SHR in the two groups were statistically significant. The Multivariate logistic regression analysis showed that age (OR=1.144, 95%CI: 1.097-1.193, P < 0.001), NIHSS score (OR=2.455, 95%CI: 1.254-4.804, P=0.009), SHR (OR=2.087, 95%CI: 1.053-4.137, P=0.035)and random blood glucose (OR=1.008, 95%CI: 1.001-2.012, P=0.047)were independent risk factors for early cognitive impairment after anterior circulation perforator arteriosclerotic cerebral infarction. Correlation analysis showed a negative correlation between SHR and MoCA and MMSE scores for 90 days. The area under ROC curve of SHR and admission random blood glucose in predicting the early cognitive impairment of patients with anterior circulation perforator arteriosclerotic cerebral infarction was 0.795 and 0.626, respectively, and the difference in area under the two sets of ROC curves was statistically significant.  Conclusion  SHR is an independent risk factor of cognitive dysfunction in the early stage of patients with anterior circulation perforator arteriosclerotic cerebral infarction. SHR can be used as an important reference index to predict cognitive prognosis.
Multiple methods to establish rat endometrial deep injury model
ZHANG Yi, HU Xiu-juan, DAI Zhi-jun, LIU Chao, HONG Ming-yun
2021, 19(6): 913-916,1012. doi: 10.16766/j.cnki.issn.1674-4152.001948
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  Objective  To establish an animal model of rat endometrial deep injury, and to provide a basis for subsequent treatment of endometrial injury with endometrial stem cells combined with biological scaffolds.  Methods  Fifteen healthy female rats with normal oestrous cycle were randomly divided into the following two groups: 5 rats in the sham operation group and 10 rats in the model group. The female rats in the sham operation group only performed laparotomy without uterus operation. After laparotomy, the left uterus of each rat in the model group received mechanical endometrial scratching, injection of lipopolysaccharide solution and uterine ischemia. The right uterus received surgical incision without any other treatment. After two oestrus cycles, oestrus laparotomy uterine tissues were collected from control group and model group rats. HE and Masson staining and immunohistochemical detection were used for the lining of Collagen Ⅰ; the expression of CK18, Vimentin, PECAM-1 and the damage area ratio of the number of endometrial glands and fibrosis. The expression levels of lining collagen Ⅰ, CK18, Vimentin and PECAM-1 were used for statistical analysis.  Results  Pathological observation showed that the endometrium in the model group was significantly thinner, the number of glands decreased, the structure was disordered, the interstitial fibrous tissue increased and collagen aggregation and fibrosis were obvious. In the immunohistochemical results, the expression level of Collagen Ⅰ in the model group was higher than that in the sham group, whereas the expression levels of CK18, Vimentin and PECAM-1 were lower than that in the sham group, with statistically significant differences (all P < 0.05).  Conclusion  The deep injury model of rat endometrium can be established by mechanical injury, bacterial lipopolysaccharide injection and triple injury after ischemia.
Sestrin 2 extenuates neuronal ferroptosis induced by sevoflurane through the Nrf2/xCT pathway
LI Fu-jun, JIANG Tao, GUO Li-jia, WANG Shun
2021, 19(6): 917-920,. doi: 10.16766/j.cnki.issn.1674-4152.001949
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  Objective  To explore the role of Sestrin 2 (SESN2) in neuronal ferroptosis induced by sevoflurane (SEV) and its possible mechanism.  Methods  Mouse hippocampal neuron cells HT22 were treated with 0%, 1%, 2% or 4% sevoflurane and iron death inhibitor Ferrostatin-1 (FER-1) for 6 h. SESN2 overexpression vector (SESN2-OE) and corresponding control (NC) were transfected into HT22 cells. The CCK-8 assay was used in detecting cell viability, and the corresponding kit was used in detecting the levels of iron, reactive oxygen species (ROS), malondialdehyde (MDA) and glutathione (GSH). The expression levels of genes and proteins were detected through real-time quantitative PCR (qPCR) and western blot assay.  Results  qPCR and western blot results showed that SEV treatment significantly inhibited the expression of SESN2 mRNA and protein (t=22.904, 37.432; P < 0.05), whereas transfection with SESN2-OE significantly increased the expression levels of SESN2 mRNA and protein in SEV-treated HT22 cells (t=12.703, 11.687; P < 0.05). SEV treatment significantly increased the levels of iron, ROS and MDA in the HT22 cells (t=29.031, 18.819, 28.054) but significantly reduced the levels of GSH, Nrf2 and xCT (t=14.617, 34.513, 13.836; all P < 0.05). Transfection with SESN2-OE significantly reduced the levels of iron, ROS and MDA in SEV-treated HT22 cells (t=8.342, 9.373, 7.381) but significantly increased the levels of GSH, Nrf2 and xCT (t=12.718, 10.102, 9.814; P < 0.05).  Conclusion  Sestrin 2 inhibited sevoflurane-induced HT22 neuronal ferroptosis by activating the Nrf2/xCT pathway.
Expressions of TLR9 and STAT3 and their correlation with IL-10 in patients with ulcerative colitis
ZHANG Wen-ting, GU Lin, KE Xi-quan, WANG Qi-zhi, WANG Qiang-wu, WANG Jian-chao, LI Da-peng
2021, 19(6): 921-924. doi: 10.16766/j.cnki.issn.1674-4152.001950
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  Objective  The expression levels of toll-like receptor 9 (TLR9), signal transduction and transcriptional activator factor 3 (STAT3) and interleukin-10 (IL-10) in peripheral blood and intestinal mucosal tissues of patients with ulcerative colitis (UC) were detected to explore their roles in the pathogenesis of UC and their correlation.  Methods  Thirty-two patients with UC treated in the First Affiliated Hospital of Bengbu Medical College from July 2019 to July 2020 were selected as the experimental group; and 30 healthy subjects according to the results of physical examination were included in the normal control group. The experimental group was further divided into mild group (n=10), moderate group (n=14) and severe (n=8) group. The expressions of TLR9 and STAT3 mRNA in peripheral blood mononuclear cells, serum IL-10 levels and TLR9, as well as levels of STAT3 and IL-10 proteins, in intestinal mucosal tissues were detected.  Results  The expression levels of TLR9 mRNA and STAT3 mRNA in the experimental group were both higher than those in the control group (all P < 0.05). The expression level of IL-10 in serum in the experimental group was significantly lower than that in the normal control group (P < 0.05). The expression levels of TLR9 and STAT3 in intestinal mucosal tissues were all higher than that in the normal control group (all P < 0.05). By contrast, the expression levels of IL-10 in the experimental group were lower than that in the normal control group (P < 0.05). Expressions of TLR9 mRNA and STAT3 mRNA and TLR9 and STAT3 mRNA were positively correlated. Serum IL-10 was negatively correlated with TLR9 and STAT3 mRNA expression levels. Intestinal mucosal IL-10 was negatively correlated with TLR9 and STAT3 protein expression levels.  Conclusion  TLR9, STAT3 and IL-10 are jointly involved in the occurrence and development of UC. TLR9 and STAT3 may be involved in the expression and regulation of IL-10 in the pathogenesis of UC.
Application effect of Angong Niuhuang Pills in patients with cardiac arrest after cardiopulmonary resuscitation
LYU Xin, ZHANG Ying, TANG Wen-xue
2021, 19(6): 925-928,1038. doi: 10.16766/j.cnki.issn.1674-4152.001951
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  Objective  To observe the application value of Angong Niuhuang Pills in patients with emergency cardiac arrest (CA) after cardiopulmonary resuscitation (CPR).  Methods  Total 90 patients with CA and return of spontaneous circulation (CA-ROSC) who were admitted to the General Intensive Care Unit (GICU) of Affiliated Hospital of Hangzhou Normal University from August 2017 to June 2019 were equally divided into observation groups (n=45) and the control group (n=45) by random number table method. The control group was treated with intravenous drip of naloxone immediately after ROSC, while the observation group was treated with Angong Niuhuang Pills based on the treatment of control group. Both groups were treated for 1 week. The cerebral metabolic rate for oxygen (CMRO2), oxidative stress injury, serum S100β and matrix metalloproteinase-9 (MMP-9) levels and prognosis were compared between the 2 groups.  Results  At 3 d and 7 d after treatment, CMRO2 of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, superoxide dismutase [(96.45±9.47) U/mL] and glutathione peroxidase [(82.58±11.49) U/L] of observation group were significantly higher, while malondialdehyde [(9.52±1.88) nmol/mL] was significantly lower, compared with those of the control group [(84.25±8.87) U/mL, (73.60±10.75) U/L, (11.03±3.06) nmol/mL, all P < 0.05]. After treatment, S100β and MMP-9 were significantly lower in the observation group than those in the control group. The proportion of successful cerebral resuscitation in the observation group was significantly higher than that in the control group, and successful cerebral resuscitation time was significantly shorter than the control group. After treatment, the Glasgow Coma Scale (GCS) scores of observation group were significantly higher but the Glasgow-Pittsburgh cerebral performance categories (CPC) scores were significantly lower, compared with the control group (all P < 0.05).  Conclusion  Angong Niuhuang Pills can effectively improve cerebral oxygen metabolism and reduce oxidative stress injury and brain injury in patients with CA after CPR, which is conductive to the prognosis.
Application of extraperitoneal oblique tunnel sigmoidostomy in laparoscopic Miles operation
JIA Wei, LIU Mu-lin, ZHU Bing, LUO Jie
2021, 19(6): 929-931,1060. doi: 10.16766/j.cnki.issn.1674-4152.001952
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  Objective  To investigate the clinical effect of extraperitoneal oblique tunnel sigmoidostomy in laparoscopic abdominoperineal radical resection of rectal cancer.,  Methods  The clinical data of 104 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection (Miles) from January 2015 to December 2017 in the First Affiliated Hospital of Bengbu Medical College were analysed retrospectively. Among them, 52 patients in the observation group were treated with laparoscopic Miles operation combined with extraperitoneal oblique tunnel sigmoidostomy, and 52 patients in the control group were treated with laparoscopic Miles operation combined with intraperitoneal sigmoidostomy. Follow-up was conducted for 24-60 months wherein the first time to exhaust time, the first defecation time, postoperative hospital stay, short-term complications (stoma separation, stoma edema, stoma ischemia or necrosis, stoma intestinal rupture, stoma intestinal obstruction), long-term complications (stoma retraction, stoma stenosis, parastomal hernia, stoma prolapse) and defecation feeling in the sixth month after operation) were statistically analysed.  Results  The first exhaust time [(3.31±0.42) d] and the first defecation time [(4.18±0.55) d] in the observation group were higher than those in the control group [(3.04±0.30) d] and [(3.93±0.42) d], and the difference was statistically significant (all P < 0.05). However, no significant difference was noted in postoperative hospital stay between the observation group [(11.96±1.62) d] and the control group [(11.64±2.32) d], P>0.05. No significant difference was observed in the short-term complication rate of stoma (15.385% vs. 17.308%) between the two groups (P>0.05) as well, but significant differences were noted in the long-term complication rate of stoma (5.769% vs. 32.692%) and the rate of defecation feeling in the sixth month after operation (86.538% vs. 40.385%) between the two groups (all P < 0.05).  Conclusion  Using extraperitoneal oblique tunnel sigmoidostomy in laparoscopic Miles operation is safe and feasible for patients with low rectal cancer. This approach can significantly reduce the incidence of long-term complications after stoma and increase the rate of defecation.
Protective effects of Panax notoginseng saponins on P13K/Akt/mTOR signalling pathway and neuronal apoptosis in hippocampus of rats with traumatic brain injury
LIN Chen, CHEN Chuang
2021, 19(6): 932-935. doi: 10.16766/j.cnki.issn.1674-4152.001953
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  Objective  To investigate the protective effects of Panax notoginseng saponins on the P13K/Akt/mTOR signalling pathway and neuronal apoptosis in the hippocampus of rats with traumatic brain injury (TBI).  Methods  Forty-five SPF SD rats were randomly divided into normal, model and Panax notoginseng saponin groups, and each group contained 15 rats. The Normal group and model group were intraperitoneally injected with the same dose of normal saline, whereas the Panax notoginseng saponin group was intraperitoneally injected with 1% Panax notoginseng saponins (50 mg/kg) once a day for 14 days.  Results  The escape latency of the rats in the Panax notoginseng saponin group [(21.27±3.29)s] was shorter than that in the model group [(28.42±3.87)s], and the number of times they passed the original platform position was (9.73±2.34) times that of the model group [(5.67±1.20) times, all P < 0.05]. The neurobehavioural scores (10.63±2.65) and motor function scores (7.84±2.12) of the rats in the Panax notoginseng saponin group were higher than those in the model group (6.52±1.37 and 4.92±1.35; all P < 0.05). P13K mRNA (0.87±0.18), Akt mRNA (0.92±0.17) and mTOR mRNA (1.02±0.18) levels in the Panax notoginseng saponin group were higher than those in the model group (0.56±0.13, 0.48±0.10 and 0.67±0.21, respectively; all P < 0.05). The Bax protein expression levels (1.57±0.38) in the Panax notoginseng saponins group were lower than those in the model group (3.24±0.54), whereas the Bcl-2 protein expression levels (2.78±0.78) were higher than those in the model group (1.26±0.45; all P < 0.05).  Conclusion  Panax notoginseng saponins have protective effects against neuronal apoptosis in TBI rats, and the mechanism may be related to the upregulation of the P13K/Akt/mTOR signalling pathway and Bcl-2 expression and downregulation of Bax expression.
General Clinical Research
Application of 3D-CTA in peroneal artery perforator flap for repairing postoperative soft tissue defect of tongue carcinoma
XU Cao, WANG Shu-qin, HU Kai, SONG Pei-jun, WU Zhi-gang, CHEN Mo, SUN Yue, LI Jian-cheng
2021, 19(6): 936-939,978. doi: 10.16766/j.cnki.issn.1674-4152.001954
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  Objective  With the development of imaging technology, the visual perforator flap is becoming more and more mature. By analyzing the clinical application effect of 3D-CTA in the peroneal perforator flap to repair the soft tissue defect after tongue cancer surgery, it provides the basis for the design and clinical application of the peroneal perforator flap.  Methods  Total 12 patients with tongue squamous cell carcinoma (8 males and 4 females, aged 36-73 years) were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from January 2019 to June 2020. The peroneal artery perforators were measured according to the CTA results after three-dimensional reconstruction before operation, and the perforators that met the transplantation conditions were selected. According to the preoperative data, the peroneal artery perforator flap was used to repair the soft tissue defect of the tongue. Follow-up was conducted on time and regularly after the operation to evaluate the functional recovery of patients at the operative and donor sites by observing whether there was tumor recurrence, metastasis, and the calf motor function at the donor site.  Results  The peroneal artery perforator flaps of 12 patients were successfully located and operated. All the grafted perforator flaps survived. One patient's skin flap oozed blood after operation, and recovered well after emergency investigation and hemostasis. The average preparation time of the grafted skin flap was 47 min, and the average length of the vessel pedicle was 6.2 cm. After 9 months, 12 patients with open mouth Ⅲ degrees, chewing and speech basic returned to normal. Twelve months after the operation, the lower leg of 12 patients in the lower limb donor area recovered well without obvious movement discomfort.  Conclusion  Preoperative 3D-CTA can accurately provide the anatomical characteristics of peroneal artery perforator, provide good imaging support for the preparation of peroneal artery perforator flap, and achieve good results in the application of peroneal artery perforator flap to repair postoperative soft tissue defects of tongue cancer.
Retrospective analysis of ultrasound-guided and blind central vein catheterisation
HUANG Lei, DI Jia-mei, ZOU Bao, DUAN Bing-hui, LIU Zhi, ZHANG Chao-xue
2021, 19(6): 940-943. doi: 10.16766/j.cnki.issn.1674-4152.001955
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  Objective  Retrospective analysis of the effect of ultrasound guidance and traditional blind puncture in different regions of central venous catheterisation.  Methods  A total of 117 patients with renal failure who were hospitalised in the Department of Nephrology of the First Affiliated Hospital of Anhui University of Technology and Hainan First People's Hospital from March 2017 to March 2020 were selected and divided into ultrasound guided and blind puncture groups by catheterisation method. The ultrasound-guidedgroup was then divided into Cervical vein catheterization group and femoral vein catheterization group, components were the jugular vein catheterisation and femoral vein catheterisation groups, which were finally divided into internal plane median group and out- plane low group of jugular vein by ultrasound-guided jugular vein insertion method. Incidence of complications and dialysis blood flow after catheterisation and puncture time, catheterisation time and puncture and catheterisation success rates were compared between the ultrasound guided group and blind puncture group in the blind puncture; ultrasound-guided jugular vein catheterisation; femoral vein catheterisation and ultrasound-guided jugular vein in-plane median and out-of-plane low group groups were considered.  Results  The age range of the patients in the ultrasound-guided group was significantly higher than that in the blind-puncture group (P < 0.05). Puncture time and puncture success rate in the ultrasound-guided group were significantly higher than those in the blind-puncture group. The incidence of complications in the ultrasound-guided group (3.45%) was significantly lower than the blind puncture group (18.33%), and the difference was statistically significant (all P < 0.05). Puncture time in the ultrasound-guided jugular vein catheterisation group was significantly shorter than that in the femoral vein catheterisation group (P < 0.05). No significant differences in the success rates of puncture and catheterisation were observed. Catheterisation time and blood flow in the ultrasonograph-guided jugular vein out-of-plane low-position group were significantly better than those in the ultrasound-guided jugular vein-in-plane median group (P < 0.05).  Conclusion  Compared with traditional blind puncture, ultrasound-guided central venous catheterisation has shorter puncture and catheterisation times, higher puncture success rate and fewer complications and is safer. An ultrasound-guided jugular vein out-of-plane catheter can effectively reduce the rate of insufficient blood volume and is thus worth promoting in clinics.
Effect of pressure controlled ventilation on postoperative delirium in elderly patients with spinal tuberculosis
WANG Shun, WAN Hai-fang, NI Yan-hua
2021, 19(6): 944-946,968. doi: 10.16766/j.cnki.issn.1674-4152.001956
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  Objective  To explore the effect of pressure-controlled ventilation (PCV) mode on postoperative delirium (POD) in elderly patients with spinal tuberculosis.  Methods  A total of 72 elderly patients suffering from spinal tuberculosis and admitted to a hospital from September 2018 to September 2019 were included in the study. They were randomly divided into observation and control groups with a simple random number table method, and each group contained 36 patients. Patients in the observation group received PCV mode ventilation [initial parameters: VT=8 mL/kg, oxygen flow=2 L/min, RR=12 times/min, FiO2=60%, I∶E=1∶1.5. FiO2; were maintained during the operation; I∶E was unchanged, VT was adjusted to 6 mg/kg+5 cm H2O (1 cm H2O=0.098 kPa) and PetCO2 was maintained at 33-36 mm Hg (1 mm Hg=0.133 kPa) level). The control group received conventional positive pressure ventilation (VT=8 mL/kg, RR=12 times/min, I∶E=1∶2, PEEP=0 cm H2O). Within 1 week after surgery, the rate of postoperative delirium in both groups was evaluated with the consciousness confusion assessment method. For patients with POD after symptomatic treatment, no case of death due to POD was recorded, and the outcome of delirium in the two groups was analysed.  Results  The incidence rate of POD in the observation group was 19.44%(7/36), lower than that in the control group (41.67%, 15/36). The difference was statistically significant (χ2=4.189, P=0.041). POD continued despite that the time was shorter than that in the control group, and the difference was not statistically significant (t=1.504, P=0.137). The POD outcome of the observation group was better than that of the control group, and the difference was statistically significant (Z=-2.799, P=0.005). The outcome of the observation group was 100.00% (7/7), better than that of the control (53.33%, 8/15). Statistically significant differences were found (χ2=4.791, P=0.029).  Conclusion  Pressure control ventilation during the operation of elderly patients with spinal tuberculosis can help reduce the incidence of postoperative delirium and increase the postoperative delirium outcome rate and is thus suitable for clinical application.
Correlation of serum inflammatory factors and pulmonary function with the severity of OSAHS
YAN Xian-ting, HUANG Qing-dong, TANG Ting-yu, WANG Yan-hong, LU Xiao-ling
2021, 19(6): 947-949. doi: 10.16766/j.cnki.issn.1674-4152.001957
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  Objective  To investigate the correlation between inflammatory factors and lung function and the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) to provide reference for clinical treatment.  Methods  The 179 OSAHS patients from Zhejiang Hospital from March 2018 to March 2020 were selected; 80 patients with healthy physical examination during the same period were selected as the control group. The levels of IL-6, IL-18 and TNF-α were measured by enzyme-linked immunosorbent assay, the tidal volume (VT), maximum vital capacity (VCmax), forced vital capacity (FVC) and forced expiratory volume (FEV1) were measured by pulmonary function instrument, and the sleep quality was evaluated by Pittsburgh sleep quality index (PSQI).  Results  The levels of serum IL-6, IL-18 and TNF-α in mild to moderate group [(28.21±5.12)pg/mL, (22.35±4.12)ng/L and (187.46±37.23)ng/L] and severe group [(45.17±6.71)pg/mL, (42.10±5.62)ng/L and (297.42±30.19) g/L] were higher than those in control group [(11.82±3.27)pg/mL, (9.65±2.19) ng/L and (108.91±25.26)ng/L, P < 0.05]. The VT, VCmax, FVC and FEV1 in mild to moderate group and severe group lower than those in control group (all P < 0.05). IL-6, IL-18 and TNF-α were positively correlated with severe OSAHS, while VT, VCmax, FVC and FEV1 were negatively correlated with severe OSAHS.  Conclusion  OSAHS patients have inflammatory reaction, decreased pulmonary function, and the more obvious the inflammatory reaction is, the more obvious the pulmonary function.

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