中华全科医学

Confirmation and analysis of critical issues in performance appraisal of family doctors ' contracted services in China

CHEN Hong, ZHOU Rong, SHI Jian-wei, YU Wen-ya, LYU Yi-peng, ZHOU Liang, GAO Xiang, WANG Zhao-xin, HUANG Lei

2022, 20(11): 1813-1817. doi: 10.16766/j.cnki.issn.1674-4152.002709

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Abstract:
Objective To verify the critical issues related to the performance appraisal of family doctors in China and provide suggestions for further optimisation in this field. Methods Policy documents related to the performance appraisal of family doctors ' contracted services issued at the national or regional levels were systematically retrieved and collected by channels such as government websites, information disclosure platforms, and so on, as well as literature before March 1, 2022 was retrieved in the CNKI with the theme of "Family doctors/General doctors/Community health service centres/Contracted services+Performance evaluation/Performance evaluation/Performance evaluation". Then, a total of 55 Chinese documents related to the performance appraisal of family doctors in China were reviewed and analysed, and qualitative and semi-quantitative research on the documents were conducted using literature review and cluster analysis. Results It was found by analysing the 14 main problems that the issues of the performance evaluation system of family doctors ' contracted services in China was mainly focused on structural submodel, among which, "the evaluation system did not reflect the uniqueness of the value of family doctors ' contracted services", "the setting of index weight did not conform to the positioning of the post epidemic normalisation era"and "performance appraisal was a mere formality" were the key issues in the field of performance appraisal of contracted services of family doctors in China. Conclusions The issue system and key issues summarised in this study can help decision-makers and researchers have a deeper understanding of this field, hence, clarifying the focus of future work. However, the problem mainly focuses on the structural submodel. Therefore, the way of performance appraisal should be considered from a strategic and long-term perspective in the future. In addition, under the guidance of policies, improvements should be made from the aspects of index selection, weight setting and appraisal methods of the appraisal system to truly achieve the results of common progress of grass-roots health institutions and personnel.

Development of Additional GP skills in United Kingdom General Practice (the end)

Rodger Charlton, LIU Zi-zhen, LIU Man-ling

2022, 20(11): 1818-1819.

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Abstract:

Study on the relationship between multimorbidity and nutritional status among the community-dwelling elderly people in Guangzhou

LIN Wei-quan, SUN Min-ying, LIU Lan, WANG Chang, LI Yao-hui, YANG Yun-ou, WU Di, LIU Hui, LIN Guo-zhen

2022, 20(11): 1870-1873. doi: 10.16766/j.cnki.issn.1674-4152.002723

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Abstract:
Objective To explore the relationship between multimorbidity and nutritional status, as well as its influence factors among community-dwelling elderly people in Guangzhou. Methods A total of 2 127 residents aged ≥ 65 years who participated in a physical examination in the community health service centre in Guangzhou from January to December 2019 were selected as subjects. Nutritional status included malnutrition and overweight/obesity. The Spearman correlation analysis was used to analyse the relationship between multimorbidity and nutritional status. The multivariate logistic regression analysis was used to explore the influence factors of nutritional status among elderly people. Results The prevalence of multimorbidity, malnutrition and overweight/obesity was 38.08% (810/2 127), 10.81% (230/2 127) and 46.26% (984/2 127), respectively. There was a positive correlation between multimorbidity and overweight/obesity among elderly people (r=0.144, P < 0.05). Logistic regression analysis showed that per 5 years of age increasing, the risk of malnutrition increased (OR=1.369, 95% CI: 1.205-1.555), whereas the risk of overweight/obese decreased (OR=0.885, 95% CI: 0.813-0.965). Meanwhile, unmarried, divorced and widowed were risk factors for malnutrition (OR=1.791, 95% CI: 1.164-2.754). In addition, smoking was a protective factor against overweight or obesity (OR=0.558, 95% CI: 0.408-0.764). After adjusting the general data and health related factors, the risk of malnutrition in the elderly with missing teeth was 1.337 times as that without missing teeth, and the risk of overweight/obesity in the elderly with multimorbidity was 1.849 times as that without multimorbidity. Conclusion The prevalence of multimorbidity, malnutrition and overweight/obesity are high among community-dwelling elderly people in Guangzhou. There is an association between tooth loss and malnutrition, as well as between multimorbidity and overweight/obesity.

Clinical study on the correlation between sarcopenic obesity and hypertension in elderly subjects

ZHAO Xu-ran, GAO Jin-e, NA Ri-song, HAI Rong, ZHANG Peng-fei

2022, 20(11): 1874-1877. doi: 10.16766/j.cnki.issn.1674-4152.002724

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Abstract:
Objective To explore the correlation between sarcopenic obesity and hypertension in the elderly, and to provide reference for clinical prevention and treatment of hypertension in the elderly. Methods Two hundred and ten elderly patients hospitalized in Geriatric Medicine Center of Inner Mongolia People's Hospital from January 2018 to January 2021 were selected. Among them, 134 (63.81%) were hypertensive and 76 (36.19%) were non-hypertensive. Height, body mass, appendicular skeletal muscle mass (ASM), grip strength, blood glucose, blood lipid, liver function and kidney function were measured. Body mass index (BMI) and relative skeletal muscle index (RSMI) were calculated and compared. Results ASM and RSMI in the hypertension group were lower than those in the non-hypertension group [(14.90±3.38) kg vs. (19.41±1.56) kg, P < 0.001; (5.59±1.37) kg/m² vs. (7.11 ±0.84) kg/m², P < 0.001]. The age and BMI of the hypertension group were higher than those of the non-hypertension group [(72.79±7.20) years vs. (70.79±6.51) years, P=0.046; 25.66±3.48 vs. 24.46±2.81, P=0.011]. The prevalence rate of sarcopenia and sarcopenic obesity in the hypertensive group was higher than those in the non-hypertensive group (67.91% vs. 38.16%, P < 0.001; 25.37% vs. 2.63%, P < 0.001). Multivariate logistic regression analysis showed that age, sarcopenia and sarcopenic obesity were the risk factors of hypertension in the elderly. Conclusion ASM is closely related to hypertension, and high ASM is a protective factor of hypertension in the elderly. Sarcopenic obesity and sarcopenia are important risk factors of hypertension in the elderly.

Clinical analysis of coagulation function and platelet count in neonates of different gestational ages

JIA Wen-ting, WANG Ling-zhi, LIU Min-min, ZHANG Zhen

2022, 20(11): 1878-1880. doi: 10.16766/j.cnki.issn.1674-4152.002725

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Abstract:
Objective To explore the coagulation function and platelets of neonates of different gestational ages after birth, and to provide a basis for the diagnosis and treatment of neonates and the evaluation of bleeding tendency. Methods A total of 89 neonates admitted to the Department of Pediatrics of the Second Affiliated Hospital of Bengbu Medical College from October 2019 to April 2022 were selected. Based on the gestational age, there were 11 cases of early preterm infants (28-31⁺⁶ weeks), 17 cases of moderately preterm infants (32-33⁺⁶ weeks) and 26 cases of late preterm infants (34-36⁺⁶ weeks). Meanwhile, there were a total of 35 full-term infants (gestational age 37-41⁺⁶ weeks). The platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D) and international normalized ratio (INR) were measured within 6 hours after admission. In addition, the clinical data, detection indicators, incidence of abnormal coagulation function and incidence of bleeding were compared among the four groups to compare the incidence of disseminated intravascular coagulation (DIC) in preterm infants and full-term infants. Results Serum PT, APTT, TT, D-D and INR of early and moderately preterm infants were higher than those of late preterm infants and full-term infants, and the serum FIB was lower than that of late preterm and full-term infants. Meanwhile, PLT in early preterm infants was lower than that in the other three groups (all P < 0.05). The incidence of bleeding in early, middle, late preterm and full-term infants were 72.73% (8/11), 52.94% (9/17), 30.77% (8/26) and 25.71% (9/35), respectively. Moreover, the incidences of abnormal coagulation function were 81.82% (9/11), 70.59% (12/17), 53.85% (14/26) and 37.14% (13/35), respectively. Furthermore, the incidences of bleeding and abnormal coagulation function in early and moderately preterm infants were higher than those in late preterm infants and full-term infants. The incidence of DIC in preterm infants was 22.22% (12/54), which was higher than that in full-term infants at 2.86% (1/35). Conclusion The lower the gestational age, the more imperfect the coagulation function, and the higher the incidence of bleeding, coagulation dysfunction and DIC.

Detection and clinical value of serum levels of miR-143-3p, miR-222-3p and AMH in patients with polycystic ovary syndrome

LIN Yan-ling, WANG Ying, HUANG Qi, KANG Ling, XING Wei-zhen

2022, 20(11): 1881-1883. doi: 10.16766/j.cnki.issn.1674-4152.002726

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Abstract:
Objective To investigate the expression and clinical value of serum miR-143-3p, miR-222-3p levels combined with anti-Mullerian hormone (AMH) in polycystic ovary syndrome (PCOS). Methods Total 128 patients with PCOS (PCOS group) treated in Sanya Women and Children's Hospital from January 2018 to March 2022 and 50 healthy women (control group) were selected. According to insulin resistance index (HOMA-IR), PCOS patients were divided into insulin resistance group (n=83, HOMA-IR≥2.69) and non-insulin resistance group (n=45, HOMA-IR < 2.69). According to BMI, PCOS patients were divided into obesity group (n=40, BMI≥28) and non-obesity group (n=88, BMI < 28). According to the level of testosterone, they were divided into hyperandrogen group (n=71, testosterone≥0.7 ng/mL) and non-hyperandrogen group (n=57, testosterone < 0.7 ng/mL). The serum levels of miR-143-3p and miR-222-3p were detected by real-time quantitative PCR, and AMH was detected by electrochemiluminescence. The diagnostic value of miR-143-3p, miR-222-3p combined with AMH in PCOS were analyzed by receiver operating characteristic (ROC) curve. Pearson correlation analysis was used for correlation analysis. Results The serum levels of miR-143-3p, miR-222-3p and AMH in PCOS group were significantly higher than those in control group, those in obesity group was significantly higher than that in non-obesity group, those in hyperandrogen group was significantly higher than that in non-hyperandrogen group, and insulin resistance group was significantly higher than that in non-insulin resistance group, with statistical significance (all P < 0.001). ROC curve showed that the combined diagnosis of PCOS by miR-143-3p, miR-222-3p and AMH had the largest area under the curve (AUC=0.910, 95% CI: 0.852-0.974). The serum levels of miR-143-3p and miR-222-3p in PCOS patients were positively correlated with AMH (r=0.842, 0.795, all P < 0.001). Conclusion The serum levels of miR-143-3p, miR-222-3p and AMH were significantly increased in PCOS patients, and the detection of the three items were helpful for the diagnosis of PCOS.

The predictive value of systemic immune-inflammation index for intravenous immunoglobulin resistance in children with Kawasaki disease

CHU An-zhen, ZHANG Lan

2022, 20(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.002727

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Abstract:
Objective To evaluate the predictive value of systemic immune-inflammation index (SII) for intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD). Methods A total of 445 hospitalized children diagnosed with KD and treated with IVIG in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to March 2022 were retrospectively analyzed. According to the presence of IVIG resistance, they were divided into IVIG resistance group and IVIG sensitive group. Stratified analysis was performed according to platelet value. The differences of inflammatory indexes between each group were compared and binary logistic regression was used to analyze the correlation between each inflammatory index and IVIG-resistance in children with KD. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each inflammatory index for IVIG-resistance in children with KD. Results For all children with KD, inflammatory indexes including N, NLR, PLR, SII, and CRP of the IVIG-resistant group were higher than those of the IVIG-sensitive group (all P < 0.05), and L was lower (P < 0.05). For thrombocytopenia KD children, there was no statistical difference in the values of each inflammatory indexes. For non-thrombocytopenia KD children, the levels of N, NLR and SII of the IVIG-resistant group were higher than those of the IVIG-sensitive group (all P < 0.05). Logistic regression analysis showed that both NLR and SII were independent risk factors for predicting IVIG resistance. ROC curve analysis showed that the sensitivity of NLR for predicting IVIG-resistance in allover the KD children was 55%, and the specificity was 67%. The sensitivity of SII for predicting IVIG-resistance in non-thrombocytopenic KD children was 56%, and the specificity was 64%. Conclusion NLR has a strong predictive ability for IVIG-resistance in allover children with KD, and SII has a strong predictive ability for IVIG-resistance in non-thrombocytopenic KD children.

Efficacy of Xingpi Yanger Granule combined with bifidobacterium quadruple viable tablets in the treatment of infantile diarrhea predominant irritable bowel syndrome

ZHAO Jing-li, ZHAO Li-li, CHEN Pu, DING Xian-chun

2022, 20(11): 1889-1892. doi: 10.16766/j.cnki.issn.1674-4152.002728

284 1

Abstract:
Objective To investigate the efficacy of Xingpi Yanger Granule combined with bifidobacterium quadruple viable tablets in the treatment of infantile diarrhoea predominant irritable bowel syndrome (IBS). Methods A total of 104 children with diarrhoea-predominant IBS in Nanyang Central Hospital from October 2018 to October 2020 were selected and equally divided into control and observation groups by the random number table. The control group was treated with bifidobacterium quadruple viable tablets, and the observation group was treated with Xingpi Yanger Granule combined with bifidobacterium quadruple viable tablets. The total effective rate and adverse reactions were compared between the two groups. The traditional chinese medcine syndrome score, T lymphocyte subsets and brain gut peptide indexes of the two groups were compared before and after treatment. Results The total effective rate of the observation group was 90.38% (47/52), which was significantly higher than 75.00% (39/52) of the control group (χ²=4.299, P=0.038). After treatment, the syndrome scores of diarrhea [(1.26±0.32) points vs. (1.87±0.39) points], abdominal pain [(1.28±0.37) points vs. (1.94±0.43) points], fullness in both flanks [(0.74±0.16) points vs. (1.07±0.24) points], nausea [(0.54±0.13) points vs. (0.75±0.19) points], nausea [(0.47±0.18) points vs. (0.82±0.27) points] in the observation group were significantly lower than those of the control group (all P < 0.05). After treatment, the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group were higher than those in the control group (all P < 0.05); the level of CD8⁺ in the observation group was lower than that in the control group (t=4.418, P < 0.05). After treatment, the levels of substance P, neurotensin, motilin and gastrin in the observation group were higher than those in the control group (all P < 0.05). No obvious adverse reaction was found in the two groups. Conclusion Xingpi Yanger Granule combined with bifidobacterium quadruple viable tablets effectively treat infantile-diarrhoea-predominant IBS, can significantly alleviate clinical symptoms and regulates T lymphocyte subsets and brain gut peptide levels.

Effect evaluation of community hypertension patients' management based on chronic disease management pathway

SHI Wei-li, WANG Liu-yi, LI Ming-yan, ZHAO Ying-shuai, GUO Meng-meng, WANG Yong

2022, 20(11): 1893-1896. doi: 10.16766/j.cnki.issn.1674-4152.002729

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Abstract:
Objective To evaluate the effectiveness of health management for hypertension patients in the community based on the chronic disease management pathway. Methods A total of 160 patients with hypertension in two districts of Zhengzhou City from January 2019 to June 2019 were selected and divided into management group and control group by random number table, with 80 cases in each group. They received one-year management based on chronic disease management pathway and community routine management, respectively. After one year, blood pressure control, BMI, hypertension prevention knowledge, drug compliance and patients' acceptance of the management plan were evaluated. Results A total of 154 patients were enrolled, including 78 patients in the management group and 76 patients in the control group. After one year, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups were significantly decreased (all P < 0.05), and the blood pressure compliance rate was significantly improved, while the management group was better than the control group (60.2% vs. 42.1%, P < 0.05). The number of patients in the management group who mastered the knowledge of risk factors and early warning symptoms was higher than that in the control group, with a statistically significant difference (P < 0.05). The drug compliance of the two groups was significantly improved (t=4.463, P < 0.001; t=3.525, P=0.001). The questionnaire survey showed that 88.5% (69/78) of the enrolled patients said that the management scheme had certain practicability, and 94.9% (74/78) of the enrolled people hoped to continue to use the scheme for chronic disease management. Conclusion Comprehensive management based on chronic disease management pathways can improve the blood pressure control rate and compliance rate of community hypertension patients, and help hypertension patients master relevant prevention knowledge.

The influence of family doctors' intensive psychological counseling on the anxiety and depression of patients with essential hypertension contracted by "1+1+1" in the community

YANG Tao, QIU Zhong-min, HUANG Lei, ZHOU Rong, YU Min-jie, TENG Bin, XU Dan-dan, SHAO Dan-dan, WANG Chao-xin

2022, 20(11): 1897-1900. doi: 10.16766/j.cnki.issn.1674-4152.002730

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Abstract:
Objective To explore the effect of family doctors' intensive psychological intervention on anxiety and depression of patients with essential hypertension contracted by "1+1+1" in the community. Methods A total of 116 patients with essential hypertension with anxiety and depression who received the "1+1+1" community contract service from February 2018 to February 2020 were divided into control group (58 cases) and observation group (58 cases) according to the random number table method. The control group was given routine intervention by family doctors, while the observation group was given intensive psychological counseling intervention by family doctors. The symptom checklist 90 (SCL-90), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), and social support revalued scale (SSRS) were used to compare the anxiety and depression of the two groups of patients before the intervention and the 6th and 12th months after the intervention, and the changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups were observed. Results With the extension of time after the intervention, the scores of the SCL-90, HAMD and HAMA of the two groups decreased, and the observation group was always lower than the control group (all P < 0.05), the scores of the two groups of SSRS increased, and the observation group was always higher than the control group (all P < 0.05). With the extension of the intervention time, SBP and DBP of the two groups decreased, and the decrease in the observation group was more obvious than that in the control group (all P < 0.05). Conclusion Family doctors' intensive psychological counseling for patients with essential hypertension contracted by the community "1+1+1" can help control their blood pressure level, and improve their anxiety and depression, improve the quality of life, which has a high clinical value.

Characteristics and community management status of middle-aged and older adults with severe mental disorders in Baoan district, Shenzhen

LU Chu-hong, CHENG Juan, QING Li, LIU Cheng-feng, SU Hai-yun, LIN Wei-quan

2022, 20(11): 1901-1904. doi: 10.16766/j.cnki.issn.1674-4152.002731

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Abstract:
Objective To investigate the characteristics and community management status of middle-aged and elderly patients with severe mental disorders (SMDs) in Bao'an District, Shenzhen City, and explore the related factors affecting management status. Methods The data of middle-aged and elderly patients with severe mental disorders aged ≥ 45 years under management in Bao'an District were extracted from Shenzhen Mental Health Prevention and Control Information Management System as of September 30, 2021. Logistic regression models were used to explore the difference in management indicators (medication compliance and high-risk behaviour) of middle-aged and older adults with SMD. Results A total of 2 096 middle-aged and elderly patients were included in the analysis. Most of the middle-aged and older adults (≥45 years) in Bao'an District, Shenzhen were female, accounting for 59.54% (1 248 cases). Their educational level was low, 76.00%(1 593 cases) of them had a junior high school education or below. Most patients were married, accounting for 77.58% (1 626 cases). Most of them were taken care of by immediate family, accounting for 91.27% (1 913 cases). The main disease type was schizophrenia, accounting for 67.32% (1 411 cases). The rate of regular medication was 74.81% (1 568 cases), and the incidence of high-risk behaviour was 8.78% (184 cases). Low-income (OR=1.608, 95% CI: 1.150-2.249), immediate relatives (OR=2.060, 95% CI: 1.178-3.600) and mental disorders caused by epilepsy (OR=14.012, 95% CI: 5.964-32.923) were positive factors for medication compliance of middle-aged and older adults with SMD. Less than 60 years of age (OR=1.913, 95% CI: 1.275-2.871), being unmarried (OR=1.868, 95% CI: 1.310-2.663), being Low-income (OR=1.607, 95% CI: 1.071-2.411) and being diagnosed with other serious mental disorders (OR=47.838, 95% CI: 10.846-210.986) were risk factors for high-risk behaviours. Conclusion Measures should be adopted according to the characteristics of patients in the management of urban middle-aged and older patients, focusing on middle-aged and elderly patients less than 60 years old, Low-income and unmarried.

Effect evaluation on health knowledge three-dimensional comprehensive intervention of migrant workers in Shanghai

SHI Jia-hua, XU Ting, TAN Zheng, LU Wei

2022, 20(11): 1905-1908. doi: 10.16766/j.cnki.issn.1674-4152.002732

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Abstract:
Objective To understand the current status of health knowledge, evaluate the effect on health knowledge intervention of migrant workers in Shanghai, and explore effective methods for carrying out health education for them. Methods The migrant workers in Shanghai were selected as the research object. The stratified cluster sampling method was adopted. A total of 1 226 migrant workers in various industries were selected in the urban and suburban areas of Shanghai, and health intervention was conducted through a three-dimensional (3D) comprehensive intervention way. Before and after the intervention, the health knowledge, behaviour and ability of the subjects were tested by a questionnaire survey to evaluate the effect of the intervention. Results Through a series of interventions of health knowledge training, the research object in the "human physiological knowledge", "disease and safe medication knowledge", "diet and nutrition knowledge and good living habits", "knowledge of accident rescue and first aid measures" and the overall score had the effect of the intervention (all P < 0.05). The overall mean score increased from 45.0(35.0, 57.5) points before intervention to 70.0(55.0, 87.5) points 6 months after the intervention, and the "qualified" subjects increased from 23.9% (293/1 226) to 69.1% (755/1 092). The difference was statistically significant. Conclusion It is very necessary to pay more attention to migrant workers in Shanghai by relevant departments, who lacking in health knowledge. The 3D comprehensive intervention has a significant effect on improving the health knowledge level of migrant workers in the short term. Therefore, carrying out health education for migrant workers in a planned and methodical way is conducive to the overall improvement of migrant workers' health.

Application of synchronous health education of family members based on rational behavior theory in perioperative period of renal transplantation

ZHANG Rong-bing, WU Xiao-qiang, WANG Xiao-qing, LI Jing, ZHANG Ling-ling

2022, 20(11): 1909-1912. doi: 10.16766/j.cnki.issn.1674-4152.002733

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Abstract:
Objective To explore the effect of synchronous health education for family members based on rational behavior theory in kidney transplantation. Methods Total 120 renal transplant patients admitted to Henan Provincial People's Hospital from March 2017 to May 2020 were selected and grouped according to the principle of matching basic characteristics between groups. The control group (60 cases) received perioperative routine care, and the study group (60 cases) received perioperative routine care plus synchronous health education of family members based on rational behavior theory. The treatment compliance of the two groups of patients was compared. The changes of health behavior, disease uncertainty, social psychological adaptability, quality of life, family care burden and hope were observed before and after intervention. Results After the intervention, the treatment behavior, eating behavior, social psychological behavior, physical activity behavior and total scores of the study group were higher than those of the control group (P < 0.05), and the total treatment compliance of the study group (96.67%) was higher than that of the control group (83.33%, P < 0.05). After intervention, the scores of Mishel uncertainty in illness scale-adult (MUIS-A) in the study group were lower than those in the control group, while the scores of psychosocial adaptability and quality of life scale for patients of renal transplantation (QOL-RT) in renal transplant patients were higher than those in the control group (P < 0.05). The score of Zarit burden scale (ZBI) in the study group was lower than that in the control group, while the score of Herth hope index (HHI) was higher than that in the control group (P < 0.05). Conclusion The effect of family members' synchronous health education based on rational behavior theory in the perioperative period of renal transplantation is obvious. It can not only improve patients' health behavior and quality of life, improve treatment compliance and psychosocial adaptability, reduce the uncertainty of disease, but also reduce the care burden of family members and improve the level of hope.

Correlation analysis of frailty syndrome with cognitive dysfunction and depression among elderly inpatients

HU Yin-tian, HU Xi-wen

2022, 20(11): 1913-1915. doi: 10.16766/j.cnki.issn.1674-4152.002734

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Abstract:
Objective To investigate the correlation between frailty syndrome and cognitive dysfunction and depression in elderly inpatients. Methods A total of 178 cases of hospitalised elderly inpatients were selected in Hangzhou Seventh People's Hospital from February 2019 to February 2020. Based on the Fried scale, the inpatients were divided into non-frailty group (42 cases), pre-frailty group (72 cases) and frailty group (64 cases). The general clinical data of the three groups were compared to analyse the correlation between frailty and cognitive dysfunction and depression as well as to explore the risk factors affecting frailty. Results There was statistical significance found in gender, age, number of chronic diseases, IL-6, CRP and ALB among the three groups (all P < 0.05). The incidence of cognitive dysfunction and depression in the frailty group [43 (59.72%), 31 (43.06%)] was significantly higher than that in the non-frailty group [3 (7.14%), 1 (2.38%)] and the pre-frailty group [21 (32.81%), 15 (23.43%)], all P < 0.017, and the pre-frailty group was significantly higher than that in the non-frailty group (all P < 0.017). Meanwhile, the severity of frailty were significantly positively correlated with cognitive function and the incidence of depression (r=0.138, P=0.017; r=0.163, P=0.004), respectively. Logistic regression analysis showed that age, number of chronic diseases, cognitive dysfunction and depression were independent risk factors for frailty in elderly inpatients. Conclusion The frailty degree of elderly inpatient frailty syndrome is positively correlated with cognitive dysfunction and depression. Therefore, old age, cognitive dysfunction, depression and several chronic diseases are independent risk factors for elderly frailty syndrome.

Application of pelvic floor ultrasound combined with MRI in treating stress urinary incontinence with Fu's subcutaneous needling

SU Jin-zhan, XU Ying-zi, DU Jia, HUANG Xiao-shan, FAN Shu-feng, LI Miao-er

2022, 20(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.002735

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Abstract:
Objective To observe the changes of different indicators before and after the treatment of mild to moderate stress urinary incontinence with Fu's subcutaneous needling using transperineal pelvic floor ultrasound combined with pelvic floor MRI, and provide an objective basis for judging the efficacy of Fu's subcutaneous needling in treating stress urinary incontinence. Methods A total of 100 patients with mild to moderate stress urinary incontinence that were diagnosed in the Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2017 to April 2020 were randomly divided into control group (n=50) and experimental group (n=50). The control group received the Kegel exercise, meanwhile, the experimental group received Fu's subcutaneous needling and Kegel exercise. Patients were examined by pelvic floor ultrasound and MRI before and after treatment. The bladder neck descent (BND), posterior angle of the bladder (Av), the tilt angle of the urethra (θv), rotation angle of the urethra (θ), area of the levator hiatus (Sv) and the opening of the urethral orifice, the continuity and thickness of levator anus and urethral sphincter, the morphology and muscle T₂WI signal values of peri-urethral ligament, para-urethral ligament, pubic urethral ligament, hypospadias ligament of the two groups were compared before and after the treatment. Results Before the treatment, there was no significant difference found in ultrasound and MRI indicators between the two groups (all P > 0.05). Compare the two groups after treatment, there were significant differences in BND [control group (24.71±4.84) mm; experimental group (30.01±6.40) mm], Av, θv, θ, Sv, pubic sphincter thickness [control group (3.19±0.14) mm; experimental group (3.32±0.10) mm], the thickness of urethral sphincter T₂WI signal value and urethral sphincter T₂WI signal value (P < 0.05). Meanwhile, in the resting state, there were statistically significant differences in funnelization of the internal urethral orifice between the two groups [control group 22 cases (44.0%), experimental group 6 cases (13.3%), P < 0.05]. Conclusion After Fu's subcutaneous needling treatment, some parameters and functions of the bladder, urethra and pelvic floor muscle are changed in patients with mild to moderate stress urinary incontinence. Therefore, pelvic floor ultrasound combined with MRI can be used to evaluate the efficacy of Fu's subcutaneous needling therapy.

Mechanism of matrix metalloproteinases and inhibitors, transforming growth factors β1 on the tissue remodelling in chronic rhinosinusitis

CHANG Xue-yan, ZHOU Ling

2022, 20(11): 1920-1924. doi: 10.16766/j.cnki.issn.1674-4152.002736

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The main clinical manifestations of chronic rhinosinusitis (CRS) are nasal congestion, mucous or purulent discharge and headache, which affect quality of life. The pathogenesis of CRS is unclear and accurate and effective treatment methods are lacking. Repeated or combined treatments using multiple methods are needed, which impose large psychological and economic burden. Tissue remodelling theory is an important pathogenesis of CRS. The imbalance between the generation and degradation of extracellular matrix (ECM) is one of the important characteristics of tissue remodelling, and the tissue remodelling mechanisms of different subtypes of CRS are different because the expression levels of matrix metalloproteinases (MMPs) and the tissue inhibitor of metalloproteinases (TIMPs) vary by subtype. MMPs and their inhibitors not only affect the ECM but also affect ECM metabolism through molar ratio and participate in CRS tissue remodelling. Transforming growth factor-β1 (TGF-β1) in addition to directly stimulating various pathways and cytokines to affect tissue remodelling, it can also be used TGF-β1/Smad pathway to affect ECM metabolism, so as to participate in CRS tissue remodelling. MMPs, TIMPs and TGF-β1 structure and the mechanism of CRS tissue remodelling are reviewed.

Progress on the relationship between gut microbiota and female reproductive diseases

XIE Duo, ZHANG Ying, ZHANG Wan-lin

2022, 20(11): 1925-1929. doi: 10.16766/j.cnki.issn.1674-4152.002737

457 24

Abstract:
The formation and proliferation of gut microbiota begin at birth, and its composition changes mainly depending on genetic, nutritional and environmental factors. There are more than thousands of bacteria in the human intestines which are highly diversified. With the development of high-throughput sequencing technology, bioinformatics and culturomics, researchers can deeply explore the composition of the microbiota and their functions. At present, the study on the correlation between gut microbiota and human diseases is booming. Gut microbiota plays an important role in human physiology, metabolism, nutrition and immune function. The delicate balance between gut microbiota and host affects the development of different diseases. An increasing number of studies have focused on the relationship between gut microbiota changes and female reproductive diseases. From animal model research to a human study, various results have shown that the diversity of gut microbiota, the change of species of bacteria abundance and the imbalance of some bacteria proportion, are closely related to female reproductive diseases, such as polycystic ovary syndrome, endometriosis, pregnancy complications and adverse pregnancy outcomes, however, the mechanism is still limited. Targeting specific gut microbiota or its metabolites, results have initially shown effects in the clinical study of diagnosis and treatment of female reproductive-related diseases. Therefore, further mechanism research is needed to clarify the causal relationship between gut microbiota and female reproductive diseases and design more rigorous clinical trials to clarify the standards of effective treatment to provide more basis for the application of gut microbiota in disease prevention, diagnosis and treatment. Thus, this article reviews the research progress on the relationship between intestinal flora and polycystic ovary syndrome, endometriosis and recurrent abortion.

Research progress on the correlation between childhood vaccination and febrile convulsion

YU Dong, SHAO Xiao-li

2022, 20(11): 1930-1933. doi: 10.16766/j.cnki.issn.1674-4152.002738

274 6

Abstract:
At present, Children' s vaccination has been fully popularized in China, and the adverse reaction of vaccination has been constantly appearing, which has been widely concerned by the society. While vaccines provide immunity, very few of them can cause adverse reactions, such as fever, local redness and induration, anaphylactic edema, shock and laryngeal edema. Fever is the most common adverse event, and most children can tolerate vaccine-induced fever, although a small proportion will experience severe adverse events such as febrile convulsion. Febrile seizures (FS) occur in children aged from 3 months to 6 years, which are the main periods of childhood vaccinations. FS was one of the most important factors influencing the popularity of childhood vaccination in China and abroad.Now, studies suggest that FS is mainly caused by multiple factors such as genetics and environmental, and some studies suggest that the occurrence of FS is related to the changes of cytokines in vivo. Vaccine can cause changes of cytokine levels, such as IL-1, IL-6, etc., and the changes of cytokine levels may be different with different vaccines. Fever following vaccination may lead to the onset of some heat-sensitive epileptic syndromes, such as Dravet syndrome. In this paper, the correlation between children' s vaccination and febrile convulsion was reviewed from two aspects of immune and genetic factors, so as to correctly understand the influence of vaccination on the occurrence of febrile convulsion in children, and provide some suggestions and guidance for the preventive inoculation of children with convulsion.

Clinical observation of Chen' s Menstrual Conditioning Soup combined with femostone on premature ovarian failure of liver and kidney Yin deficiency syndrome

ZHANG Wen-yu, WU Huan

2022, 20(11): 1934-1937. doi: 10.16766/j.cnki.issn.1674-4152.002739

271 5

Abstract:
Objective To retrospectively analyses the clinical curative effect of Chen' s Menstrual Conditioning Soup combined with femoston on premature ovarian failure of liver and kidney Yin deficiency syndrome. Methods Forty cases of premature ovarian failure with Yin deficiency of liver and kidney in the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine were retrospectively analysed from January 2019 to January 2021. According to the treatment methods, they were divided into femoston treatment group (control group, n=17) and femoston combined with Chen' s Menstrual Conditioning Soup treatment group (observation group, n=23). The treatment effect was observed after 6 months. Results After treatment, the scores of TCM syndromes in the observation group were lower than those in the control group (all P < 0.05). The therapeutic effect of the observation group was better than that of the control group (Z=-2.455, P < 0.05). The levels of serum follicle stimulating hormone and luteinizing hormone in the observation group were (19.21±4.57) IU/L and (20.44±3.10) IU/L, respectively, which were lower than those in the control group [(22.78±4.69) IU/L, (23.17±3.44) IU/L, all P < 0.05]. The level of estradiol (E₂) in the observation group was (69.22±12.39) pmol/L, which was higher than that in the control group [(60.98±11.22) pmol/L, P < 0.05]. The mean ovarian volume, number of antral follicles and peak systolic blood flow velocity of ovarian artery in the observation group were higher than those in the control group, and the resistance index and acceleration time were lower than those in the control group (all P < 0.05). Conclusion Chen' s Menstrual Conditioning Soup combined with femostone has a remarkable effect on premature ovarian failure of liver and kidney Yin deficiency syndrome, and it can effectively alleviate clinical symptoms, promote the recovery of sex hormone level and improve ovarian function.

The effect of combined training on patients with dysphagia after stroke based on volume viscosity swallowing test

HU Xiao, LIN Hai-yan, CHEN Yan-yan, FU Fang-wang

2022, 20(11): 1938-1940. doi: 10.16766/j.cnki.issn.1674-4152.002740

118 3

Abstract:
Objective To explore the effect of combined training based on the volume viscosity swallowing test (V-VST) on stroke patients with dysphagia, and to provide a basis for clinical rehabilitation training and treatment. Methods A total of 100 stroke patients with dysphagia who were treated in the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to August 2021 were selected and randomly divided into observation group and control group according to the random number table method, with 50 cases in each group. The patients in the control group were given symptomatic treatment and routine care, and the patients were instructed to carry out simple swallowing function training. Patients in the observation group were screened by the V-VST test on the basis of the control group, and the feeding training and swallowing rehabilitation training programs were formulated according to the screening results. The time of gastric tube intubation, hospital stay, incidence of aspiration pneumonia and incidence of aspiration within 1 month of the two groups of patients were recorded. The swallowing function was assessed by the standardized swallowing assessment (SSA) before and after the intervention. The results of the water field drinking test and the treatment effect of dysphagia were compared between the two groups. Results The gastric tube retention time, hospitalization time, aspiration rate, and incidence of aspiration pneumonia in the observation group were significantly lower than those in the control group (all P < 0.05). Before the intervention, the swallowing function scores of the two groups of patients were the same. After the intervention, the swallowing function scores of the two groups were significantly decreased, and the observation group was lower than the control group (all P < 0.05). After the intervention, there were more cases of grades Ⅰ and Ⅱ of the water-field drinking test in the observation group than that in the control group (P < 0.05). The effective rate of treatment for dysphagia in the observation group was 96.00% (48/50), which was higher than that in the control group (74.00%, 37/50, χ²=9.490, P=0.002). Conclusion Combined training based on V-VST can effectively improve the treatment effect of stroke patients with dysphagia, reduce the rate of aspiration during hospitalization and the incidence of aspiration pneumonia, which has good clinical application value.

Application of raining class combing with CBL method based on BOPPPS model in experimental teaching of physical diagnosis

CHENG Cheng, ZHU Ning-jun, LI Meng-li, WANG Tong

2022, 20(11): 1941-1943. doi: 10.16766/j.cnki.issn.1674-4152.002741

236 8

Abstract:
Objective Physical diagnosis is an important subject linking basic and clinical practice. To improve teaching effect and quality, the present study adopted a combination of raining class and case-based learning (CBL) methods based on BOPPPS model in the physical examination of the cardiovascular system. Methods Two classes (62 students) from 2018 Clinical Medicine of Anhui Medical University were randomly divided into control group (32 students) and experimental group (30 students) by drawing lots from February to June 2021 in the Second Clinical College of Anhui Medical University. The control group adopted the traditional teaching mode, whereas the experimental group adopted the combination of raining class and CBL based on BOPPPS model. After the part of the course, two groups of students took written examinations. A questionnaire was used in determining whether the teaching method stimulated study interest, cultivated clinical thinking ability and increased learning time and teaching satisfaction. Results The results showed that the examination score of the experimental group was significantly better than those of the control group [(82.30?.31) points vs. (76.63?.91) points, P=0.005]. Moreover, learning interest (93.3% vs. 62.5%, ?²=8.420, P=0.004), clinical thinking ability (76.7% vs. 40.6%, ?²=8.260, P=0.004), learning time (86.7% vs. 50.0%, ?²=9.526, P=0.002) and teaching satisfaction (93.3% vs. 65.6%, ?² =7.174, P=0.007) in the experimental group were marked superior to those in the control group. Conclusion The combination of raining class and CBL methods based on BOPPPS model in the physical examination of cardiovascular system not only improved teaching effect but also stimulated learning interest, enthusiasm, communication and interaction and increased satisfaction. It is worthy to be further popularised in the teaching of physical diagnosis.

Value of combined application of Mini-CEX and DOPS in teaching evaluation of paediatric interns

RONG Dao-xiang, FANG Shan-shan, ZHOU Rui, WANG Lei, XU Jia-li

2022, 20(11): 1944-1946. doi: 10.16766/j.cnki.issn.1674-4152.002742

215 9

Abstract:
Objective To explore the combined application value of the Mini-clinical evaluation exercise (Mini-CEX) and direct observation of procedural skills (DOPS) scale in the teaching evaluation of paediatric interns, so as to improve the quality of clinical teaching for interns. Methods A total of 30 students majoring in clinical medicine who were practicing paediatrics in Department of Pediatrics of the First Affiliated Hospital of Bengbu Medical College from October 2020 to September 2021 were selected to evaluate the clinical knowledge and clinical operation techniques of the interns with Mini-CEX and DOPS. Each resident was evaluated twice during the 6-week paediatric residency (the beginning and end of the internship). After the assessment of the Mini-CEX and DOPS scale, they learned shortcomings after communicating and giving feedback to the assessment teachers and strengthened self-study and operation practice of relevant theoretical knowledge in a future study. The qualified number of interns and the evaluation time before and after the two evaluations were compared. Results At the beginning and end of the internship, the number of people who passed the Mini-CEX scale assessment were 18 and 25 (Z=4.055, P < 0.001), the assessment time was (13.13±2.56) min and (11.43±2.34) min, and the feedback time were (9.37±1.59) min and (7.63±1.33) min, respectively. There were statistically significant differences in the time spent in the two assessments and feedback (all P < 0.05). Meanwhile, at the beginning and end of the internship, the number of people who passed the DOPS scale assessment were 18 and 26 (Z=4.347, P < 0.001), the assessment time were (18.40±2.81) min and (15.90±2.12) min, and the feedback time were (8.83±1.76) min and (7.33±1.32) min, respectively. There were statistically significant differences in the time spent in the two assessments and feedback (all P < 0.05). Conclusion The using of Mini-CEX and DOPS scale for teaching in paediatric clinical practice can improve the overall professional communication ability and autonomous learning ability of interns, improve the professional skills and professional literacy of interns and achieve good clinical teaching effect. It is worthy of clinical promotion.

Application of discussion teaching of difficult cases in clinical teaching of gastroenterology

LIU Shao-feng, ZUO Xiu-ling, HE Chi-yi, NIU Xiao-ping

2022, 20(11): 1947-1949. doi: 10.16766/j.cnki.issn.1674-4152.002743

232 17

Abstract:
Objective To summarize the experience of discussion teaching of difficult cases in clinical teaching, look forward to its popularization value, and prepare for the application and evaluation of specialist training base. Methods This paper reviewed the practical experience of the discussion teaching of difficult cases in clinical teaching of Department of Gastroenterology of the First Affiliated Hospital of Wannan Medical College over the past 5 years. Then, this paper summarized the teaching preparation, teaching implementation process and feedback results of the teaching effect. Finally, the significance and advantages of this teaching method were analysed and its value prospected. The feedback on the teaching effect was carried out using small teacher-student seminars and anonymous questionnaires. Results The discussion teaching of difficult cases had been continuously improved in the process of practice, and was incorporated into the Department Teaching System for management. The systems formulate detailed requirements for the preparation and process of teaching. The teachers and students agreed that this teaching method could mobilize the students' or residents' learning initiative and enthusiasm, so that they could better master theoretical knowledge and improve their clinical thinking ability. The questionnaire on teaching effect showed that more than 80% of students or residents believed that the ability to diagnose and treat difficult diseases had been significantly improved, more than 90% of the students or residents thought that the role of this teaching method cloud not be replaced by other methods such as teaching rounds. It is agreed that it should be used as a fixed teaching method. Moreover, a small number of students (1.2%) suggested that it should be carried out once every two months to avoid increasing the learning burden caused by excessive frequency. Conclusion The discussion teaching of difficult cases is an important clinical teaching method. It should be carried out and implemented in the teaching base for resident and standardised training hospitals.

Analysis of influencing factors of clinical practice adaptability of nursing students and teaching promotion strategies

YANG Cong-yan, LI Jing, ZHOU Xiao-mei, ZHANG Yan-li, ZHANG Xia-wan, ZHOU Ying

2022, 20(11): 1950-1953. doi: 10.16766/j.cnki.issn.1674-4152.002744

983 50

Abstract:
Objective To know about the status quo of clinical practice adaptability of nursing students in Anhui, explore the factors influencing the adaptability of clinical practice, so discuss the strategies to improve the adaptability of clinical practice from the angle of nursing teaching. Methods A total of 1 210 nursing students from 8 tertiary hospitals in Anhui Province were selected by convenience sampling from July to September 2021. The stress scale, psychological resilience scale and clinical practice adaptation scale were used to investigate. Two sample t-test and ANOVA were used for univariate analysis of clinical practice adaptability. Pearson correlation analysis was used for correlation analysis of stressors, psychological resilience and clinical practice adaptability. Multiple linear regression was used for influencing factors of clinical practice adaptability. Results There were statistically significant difference in the clinical practice adaptation among liking the degree of nursing, employment attitude, personality traits, physical health state, interpersonal communication, whether voluntary choice of nursing profession and willing to work in nursing after graduation of nursing students (all P < 0.01). The total score of stress was negatively correlated with the dimensions and total scores of clinical practice adaptability (r: -0.592 to -0.456, all P < 0.01), while the mental toughness was positively correlated with the dimensions and total scores of clinical practice adaptability (r: 0.415 to 0.592, all P < 0.01). The employment attitude, personality traits, liking the degree of nursing, stress and mental toughness were the influence factors of the clinical practice adaptability. Conclusion Internship stress, mental toughness and clinical practice adaptability are related. Schools and practice hospitals should realize the importance of clinical practice adaptability and implement targeted clinical teaching methods to improve the adaptability, so as to stabilize the nursing team.

A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients

WANG Dao-xin, LIU Nan, SHI Ze-yuan, DING Nan-nan, FENG Chun-qian, ZHAO Wen-li

2022, 20(11): 1954-1959. doi: 10.16766/j.cnki.issn.1674-4152.002745

299 11

Abstract:
Objective To analyse the risk factors of catheter-related infection in ICU patients. Methods Related articles on independent risk factors of central venous catheter-related bloodstream infection in ICU patients were searched in PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, CBM, EBSCO and other databases. Outcomes were combined, and meta-analysis and sensitivity analysis were performed using RevMan 5.3 software. Results A total of 13 studies were included, including 12 283 patients and 773 infected patients. The infection rate was 6.29%. Nine risk factors were as follow: catheter indwelling days ≥7 days (OR=5.30, 95% CI: 3.39-8.27), diabetes mellitus (OR=21.15, 95% CI: 11.45-39.08), antibiotic use before catheterisation (OR=6.63, 95% CI: 5.12-8.58), advanced age (OR=3.01, 95% CI: 2.74-3.31), puncture frequency of >2 times (OR=60.10, 95% CI: 30.63-117.94), high APACHEⅡ score (OR=16.07, 95% CI: 8.97-28.77), femoral vein catheterisation (OR=12.41, 95% CI: 3.82-40.30), male (OR=7.93, 95% CI: 3.69-17.04), emergency surgery (OR=8.12, 95% CI: 3.43-19.19), all P < 0.05. Conclusions The main risk factors for central catheter-related bloodstream infection in ICU patients are catheter indwelling days ≥7 days, diabetes mellitus, antibiotics before catheterisation, age of > 55 years, catheterisation frequecy of >2 times, high APACHEⅡ score, femoral vein as the indwelling site, male and emergency surgery. Clinical attention should be paid to high-risk groups and related risk factors, and effective intervention measures should be taken to reduce the occurrence of central catheter-related bloodstream infection.

Effect of surgical smoke intervention strategy based on Green model on medical staff in operating room

QIU Xiao-dan, WANG Le-jie, ZHANG Min, YAN Lin-zhi

2022, 20(11): 1960-1964. doi: 10.16766/j.cnki.issn.1674-4152.002746

252 3

Abstract:
Objective To investigate and evaluate the protection status of operating room medical staff against surgical smoke using Green mode as theoretical basis, develop and implement intervention strategy according to assessment result, discuss application effect of the strategy, and provide guidance gist to the application of surgical smoke intervention strategy in operating room staff. Methods A total of 78 operating room medical staff from the Second Affiliated Hospital of Wenzhou Medical University were selected as research object according to including and excluding standard. The conventional mode management stage will be adopted from February to May 2021 as the before intervention stage, and the stage of formulating and implementing intervention strategy management based on Greens model from June to September 2021 will be taken as the after intervention stage. The knowledge, attitude and behavior of operating smoke prevention, and self-assessment scores impacted by operating smoke among operating room medical staff before and after intervention were compared. Results After intervention, the scores of surgical smoke prevention knowledge [(14.17±4.36) points], attitude [(72.89±6.11) points] and behavior [(68.34±7.35) points] of medical staff in the operating room were significantly higher than those before intervention [(9.16±3.62) points, (64.78±7.24) points and (52.73±6.48) points]. The self- assessment score of surgical smoke influence [(4.89±1.76) points] was significantly lower than that before intervention [(6.47±2.53) points], the difference was statistically significant (P < 0.05). Conclusion The application of intervention strategy using Green mode as theoretical basis in operating room medical staff can enhance the cognition degree to surgical smoke prevention knowledge, effectively improve their protective attitude, regulate their protective behavior, and decrease their self-assessment score of surgical smoke influence.

Study on the influencing factors of vicarious trauma in oncological medical staff

ZHOU Na, LI Ling, TANG Yu, CUI Yi, MA Hai-ying, SHENG Yue-hong

2022, 20(11): 1965-1968. doi: 10.16766/j.cnki.issn.1674-4152.002747

262 3

Abstract:
Objective To explore the characteristics of vicarious trauma in oncological medical staff and the effects of sleep, coping style and attachment pattern on surrogate trauma. Methods A total of 357 medical staff in the Oncology Ward of Shanghai East Hepatobiliary Surgery Hospital from November to December 2021 were selected as the subjects. Self-designed general information questionnaire, Pittsburgh sleep quality index (PSQI), adult attachment scale (AAS), simplified coping style questionnaire (SCSQ) and vicarious traumatization questionnaire (VTQ) were used as research tools. SPSS 20.0 was used for statistical analysis, and ANOVA, Spearman correlation analysis and multiple linear regression analysis were used for statistical test of influencing factors. Results The total VTQ score of 357 medical staff in the Oncology Ward was (81.70±24.37) points. There were significant differences in the total score of VTQ among medical staff of different gender, position, marital status, education level and whether they had traumatic memory (all P < 0.05). The total score of VTQ was significantly positively correlated with AAS anxiety subscales and SCSQ negative coping subscales (r=0.458, 0.498, 0.354, all P < 0.01), and significant negative correlation with AAS proximity subscale, dependence subscale and SCSQ positive coping subscale (r=-0.457, -0.277, -0.370, all P < 0.01). Multiple linear regression analysis showed that gender, PSQI score, positive coping and negative coping subscales in SCSQ, AAS closeness and anxiety subscale score were the influencing factors of vicarious trauma (decision coefficient R²=0.431; adjusted R²=0.411, F=21.639, P < 0.001). Conclusion The degree of vicarious trauma is higher in oncology medical staff, and female, poor sleep quality, negative coping style and attachment anxiety are the risk factors.

Investigation and risk factors analysis of comorbid anxiety and depression in patients with epilepsy

WU Xue-mei, WANG Hai-yan

2022, 20(11): 1969-1972. doi: 10.16766/j.cnki.issn.1674-4152.002748

254 16

Abstract:
Objective To investigate the status of comorbid anxiety and depression in patients with epilepsy and analyse the risk factors of comorbid anxiety and depression. Methods A total of 285 patients with epilepsy treated in the Seventh People' s Hospital of Hangzhou City from February 2019 to February 2021 were recruited in the stduy. The Chinese version of generalised anxiety disorder-7 (GAD-7) and epilepsy with neurological disorders and depression inventory for epilepsy (NDDI-E) were used in surveying epileptic patients with anxiety and depression status. Single-factor analysis was used in epileptic patients with anxiety, depression and related factors, and then multi-factor logistic regression analysis was performed in examining the independent risk factors of comorbid anxiety and depression. Results Among the 285 epilepsy patients, 47 patients (16.49%) suffered from anxiety, 73 patients (25.61%) suffered from depression and 42 patients (14.74%) suffered from both. Multivariate Logistic regression analysis showed that long disease duration, types of oral drugs, seizure frequency of >2 times per month and seizure type with focal disturbance of consciousness were independent risk factors for comorbid anxiety in epileptic patients (OR_duration=1.514; OR_{types of oral drugs}=1.719; OR_{seizure frequency}=6.455; OR_{type of seizures}=3.083); multiple types of oral drugs, seizure frequency >2 times/month and seizure type with focal disturbance of consciousness were independent risk factors for comorbid depression in epileptic patients (OR_{type of oral drug}=1.773; OR_{seizure frequency}=5.457; OR_{seizure type}=2.399); seizure frequency of >2 times/month, focal with the disturbance of consciousness seizures were independent risk factors for comorbid anxiety and depression in epilepsy patients (OR_{seizure frequency}=7.205; OR_{seizure type}=3.958). Conclusion The prevalence of comorbid anxiety and depression in epileptic patients is high. Clinical measures should be taken according to risk factors, and psychological counselling and counselling should be carried out to reduce the incidence of anxiety and depression in patients with epilepsy.

Investigation of the quality of long-term care insurance service in the central city of Shanghai

XU Juan-juan, BAO Yong

2022, 20(11): 1973-1977. doi: 10.16766/j.cnki.issn.1674-4152.002749

245 6

Abstract:
Objective To evaluate clients' needs and satisfaction with long-term care insurance, and understand whether or not the desired target is achieved after the long-term care insurance service promotion. Methods The research subject came from three communities located in the centre of Shanghai from January to December 2021, and a total of 80 residents who were involved in the corresponding long-term care insurance were randomly selected from each community. The outcomes rank from levels 2 to 6 by evaluating their disabilities. The survey involves two parts: (1) personal information; (2) quality evaluation from long-term care services: based on SERVPERF (Service Performance) model, five dimensions of empathy, reliability, responsiveness, assurance and perception were constructed, and each dimension was designed with 3-5 evaluation indicators, and a total of 20 indicators were used to evaluate the quality of long-term care services. Results A total of 240 people were involved, including 78 males (50.83%) and 162 females (67.50%); among them, 90.42% (217/240) were 70 years old or above; 122 were married (50.83%) and 106 were widows (44.17%); the service location was mainly community home; health situations and self-care ability were mainly including general (49.58%), unhealthy (33.75%), with disability (42.08%) and ability with self-care (34.17%); 58.75% of them were required for level 2-3 care. The overall evaluation score of long-term care service quality in this survey was 4.408, which was in a relatively good and very good range. The five aspects ranked from top to the bottom were responsiveness, reliability, perception, assurance and empathy. Conclusion The overall evaluation outcome stays positive. However, it cannot satisfy the needs of different disability levels of the elderly.

Experience in coordination in thoracic aortic hybrid surgery

ZHANG Yu-yan, FU Qin, DIAO Wen-jie, SHI Chao, YU Chao-wen, LIU Xue-gang

2022, 20(11): 1978-1981. doi: 10.16766/j.cnki.issn.1674-4152.002750

270 1

Abstract:
Objective To explore the key points of cooperation between thoracic endovascular aortic repair (TEVAR) and hybrid cervical vascular bypass+TEVAR, so as to improve the efficiency and safety of the operation. Methods A total of 130 patients with the aortic disease treated in the First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2021 were reviewed, including 101 patients underwent TEVAR surgery alone (the TEVAR group) and 29 patients underwent hybrid cervical vascular bypass+TEVAR surgery (the hybrid operation group). The gender, age, weight, height, complications, as well as the preoperative preparation, intraoperative cooperation and experience of the two different surgical methods were analysed. Results All patients in the two groups completed surgery. In the TEVAR group, the operation time was (116.32±37.15) min, the postoperative hospital stay was (7.45±3.88) days, and there was 1 case of postoperative inguinal incision lymphatic leakage. Meanwhile, in the hybrid operation group, the operation time was (261.07±57.39) min, and the hospital stay was (11.66±6.32) days. There were no serious complications in both groups. Conclusion Hybrid composite operating room nurses to high standards of preoperative preparation, intraoperative and postoperative nursing, and skilled operation coordination can improve the TEVAR and hybrid cervical vascular bypass + TEVAR operation efficiency and operation safety.

Analysis of influencing factors of a partnership between paediatric nurses and parents of ill children

LIN Xiao-min, NI Yong-yong, SUN Li-zhen, HE Jie-xue, PAN Guo-quan

2022, 20(11): 1982-1986. doi: 10.16766/j.cnki.issn.1674-4152.002751

158 6

Abstract:
Objective To explore the status quo of the partnership between paediatric nurses and ill children' s parents, as well as analyse its influencing factors to provide a theoretical basis for nursing management. Methods Using the convenience sampling method, 189 paediatric nurses and 189 parents of ill children from five tertiary hospitals in Zhejiang Province were selected from August to October 2021 as the research objects. The general demographic questionnaire, the Chinese version of the paediatric nurse-parent partnership scale (PNPPS), the nursing organization climate scale and the nurse psychological capital questionnaire were used to conduct the questionnaire survey. SPSS 21.0 statistical software package was used for data statistics and analysis. Results The score of the partnership between pediatric nurses and children' s parents was (141.67±15.73) points, the score of nursing organization atmosphere was (85.13±9.87) points, and the score of psychological capital was (86.52±11.89) points. The results of univariate analysis showed that there were statistically significant differences in the total score of PNPPS (pediatric nurse version) among pediatric nurses, including childbearing, pediatric working years and average monthly income (all P < 0.05). Pearson correlation analysis showed that the total score of PNPPS (pediatric nurse version) was positively correlated with the organizational climate, psychological capital and the total score of PNPPS (children' s parents version, r=0.248-0.598, all P < 0.01). Multiple stepwise regression analysis showed that the influencing factors of the partnership between pediatric nurses and parents were nursing organization atmosphere, childbearing, psychological capital, total score of PNPPS (children' s parents version) and years of pediatric work. Conclusions The partnership between paediatric nurses and children' s parents is at a moderate level. The nursing organizational atmosphere, whether or not to give birth, psychological capital, and the number of years of paediatric work are the influencing factors of paediatric nurses on the parental partnership of children. Therefore, nursing managers should pay attention to the level of nursing organizational atmosphere and psychological capital of paediatric nurses who have not given birth and have low working years, improve the level of psychological capital, improve the partnership between paediatric nurses and children' s parents, and provide the best nursing services for children through creating a harmonious nursing organizational atmosphere.

2022, 20(11): 1987-1991. doi: 10.16766/j.cnki.issn.1674-4152.002752

117 9

Abstract:

2022, 20(11): 1992-1994. doi: 10.16766/j.cnki.issn.1674-4152.002753

147 13

Abstract:

Screening to detect peripheral retinal lesions in myopic eyes using ultrawide field scanning laser ophthalmoscopes in the outpatient general ophthalmology clinics

CHEN Jian-ying, HU Xin-xin, WANG Sheng-zhan, CHEN Ting-ting

2022, 20(11): 1820-1823. doi: 10.16766/j.cnki.issn.1674-4152.002710

340 14

Abstract:
Objective To detect the incidence of peripheral retinal lesions in healthy myopic eyes using ultrawide field scanning laser ophthalmoscopes, and further explore the feasibility and significance of screening to detect peripheral retinal lesions in myopic eyes using ultrawide field scanning laser ophthalmoscopes in the outpatient general ophthalmology. Methods This retrospective study included a total of 210 healthy myopic patients (210 eyes), who had visited the outpatient general ophthalmology clinics of the Affiliated People ' s Hospital of Ningbo University. The eyes were divided into three groups based on the spherical equivalent refraction (SER): low myopia (≤ 3.00 D, 43 cases), moderate myopia (3.00-6.00 D, 98 cases) and high myopia (≥ 6.00 D, 69 cases). An IOL-Master was used to measure the axial length and corneal curvature. The retina was photographed with Optomap Daytona 200T ultrawide field scanning laser ophthalmoscopes and the peripheral retinal lesions was recorded. Results The mean age of the patients was (24.97±7.39) years, and the mean SER was (-5.02±2.11) D. The detection rate was 30.95% (65 cases) in peripheral retinal lesions, 26.19% (55 cases) in white without pressure (WWOP), and 6.67% (14 cases) in the lattice degeneration (LD), respectively. The high myopia group showed the highest detection rate of peripheral retinal lesions (46.38%, 32 cases) and WWOP (39.13%, 27 cases). Meanwhile, low myopia group showed the lowest detection rate of peripheral retinal lesions (11.63%, 5 cases) and WWOP (9.30%, 4 cases). The detection rate of LD in high myopia group [14.49% (10 cases)] were higher than that in moderate myopia group [3.06% (3 cases)] and low myopia group [2.32% (1 cases)]. The detection rate of peripheral retinal lesions, WWOP and LD in myopic eyes were positively correlated with the axial length and absolute values of SER, respectively (all P < 0.05). Conclusion Ultrawide field scanning laser ophthalmoscope is a potentially useful screening tool for the detection of peripheral retinal lesions in myopic eyes. Careful peripheral fundus examinations are needed for better early diagnosis and management regardless of myopia severity.

Effect of preoperative and postoperative intervention of ERAS on rehabilitation effect and quality of life in elderly patients after total knee arthroplasty

ZHAO Zhi, PEI Li-jia, LIU Yang, HUANG Jun-mei, ZHOU Xin-she

2022, 20(11): 1824-1827. doi: 10.16766/j.cnki.issn.1674-4152.002711

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Abstract:
Objective To investigate the effect of preoperative and postoperative intervention of enhanced recovery after surgery (ERAS) on rehabilitation effect and quality of life in elderly patients after total knee arthroplasty (TKA). Methods Forty-two elderly patients who underwent TKA in the First Affiliated Hospital of Bengbu Medical College from July 2019 to December 2020 were divided into two groups according to random number table. The study group received intervention of ERAS, and the control group received routine nursing. The rehabilitation effect and quality of life of the two groups were observed. Results The VAS pain scores of the study group [(4.38±1.12) points, (2.71±1.09) points] were significantly lower than those of the control group [(6.24±1.47) points, (5.87±2.10) points] at 12 and 48 hours after operation (all P < 0.05). The range of motion (ROM) of the two groups increased gradually after operation, and the ROM of the study group [(96.62±7.31)°, (117.83±4.29)°] were significantly higher than that of the control group [(83.28±6.74)°, (108.27±5.28)°] at 2 weeks and 1 month after operation (all P < 0.05). The score of hospital for special surgery knee score (HSS) of patients in the two groups increased gradually after surgery, and the score of the study group [(65.84±7.73) points, (86.74±7.48) points] were significantly higher than that of the control group [(55.28±6.13) points, (75.33±6.13) points] at 1 month and 6 months after surgery (all P < 0.05). Two weeks after operation, the total scores of material life, physical function, psychological function, social function and quality of life in the study group were significantly higher than those in the control group (all P < 0.05). The satisfaction of the study group was 95.24%, which was significantly higher than that of the control group (61.90%, P < 0.05). Conclusion ERAS intervention in elderly patients after TKA can significantly shorten hospitalization time, reduce the incidence of complications, and promote the recovery of knee function.

Application value of resting energy metabolism measurement in nutritional support of postoperative patients with gastric cancer

YANG Ting-ting, GUAN Ke, YANG Yang, WANG Wen, WANG Wei-xiang, BAI Jun-wei, ZHANG Han, ZHOU Yang, LI Jing, GAN Yong, SHEN Li-jun

2022, 20(11): 1828-1830. doi: 10.16766/j.cnki.issn.1674-4152.002712

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Abstract:
Objective To explore the value of nutrition support based on resting energy metabolism measurement in postoperative patients with gastric cancer, and provide a reference for improving postoperative nutritional status and accelerating postoperative rehabilitation. Methods Using the method of retrospective analysis, 36 patients with radical gastrectomy treated in the Department of Gastrointestinal Surgery of Henan Provincial People ' s Hospital from June 2019 to December 2019 and estimated by resting energy metabolism method were included in the study group. In addition, 42 patients with radical gastrectomy treated in the same period and estimated by the Harris-Benedict (HB) formula method were included as the control group. The total protein, albumin, red blood cell, haemoglobin, lymphocyte ratio and C-reactive protein were measured at 1, 3, 5 and 7 days after the operation, and the postoperative infection and hospital stay were compared. Results The resting energy expenditure (REE) of the study group on the first day after operation was (1 557.00±432.65) kcal/d, which was significantly higher than of the control group estimated by the HB formula (1 331.87±149.65) kcal/d (P < 0.05). The levels of total protein and albumin in the study group on the 5th and 7th day after operation were significantly higher than those in the control group (all P < 0.05), and the levels of C-reactive protein were significantly lower than those in the control group (all P < 0.05). The hospital stay in the study group [(10.95±3.99) d] was less than that in the control group [(13.69±2.98) d], with a statistically significant difference (P < 0.05). Conclusion Resting energy measurement method can accurately evaluate the energy changes of postoperative gastric cancer patients, and provide a practical basis for postoperative nutritional support, which is conducive to improving the nutritional status and has important value in promoting postoperative rehabilitation.

Melatonin regulates Nrf2/ARE signal pathway to delay the degeneration of nucleus pulposus mesenchymal stem cells

LI Cai, XU Pan-pan, HU Jie, ZHU Kun, YE Yu-chen, ZHANG Ya-wei, ZHANG Chang-chun

2022, 20(11): 1831-1835. doi: 10.16766/j.cnki.issn.1674-4152.002713

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Abstract:
Objective To explore the effect of melatonin on rat nucleus pulposus mesenchymal stem cells (NPMSCs) under oxidative stress and its regulatory mechanism. Methods Rat nucleus pulposus mesenchymal stem cells were isolated and purified by differential adhesion method. The state of cells was observed under the microscope to identify the differentiation potential of the third generation cells and cell surface immune markers. CCK-8 method was used to detect the effect of different concentrations of hydrogen peroxide and melatonin on the activity of NPMSCs in rats to determine the optimal concentration and experimental grouping. The level of reactive oxygen species in NPMSCs were detected by immunofluorescence and flow cytometry. The expressions of extracellular matrix marker proteins (collagen Ⅱ and glycosaminoglycan) and key proteins (Nrf2, HO-1) in Nrf2/ARE signaling pathway were analyzed by Western blotting. Results Melatonin protected the activity of NPMSCs under oxidative stress, and the protective effect of 1 μmol/L concentration was the most obvious (0.717±0.018, t=7.102, P < 0.01). Melatonin could inhibit the level of reactive oxygen species induced by H₂O₂ (positive rate: 70.0% vs. 32.7%). In addition, melatonin significantly increased the activities of Nrf2 (1.925±0.024, t=13.150, P < 0.01) and HO-1 (1.605±0.019, t=12.940, P < 0.01), and improved the function of NPMSCs. After treatment with melatonin, the expression of Collagen Ⅱ (0.850±0.010, t=25.200, P < 0.01) and glycosaminoglycan (0.335±0.013, t=10.640, P < 0.01) increased. Conclusion Melatonin affects the biological characteristics of NPMSCs degeneration by regulating Nrf2/ARE signal pathway.

Role of EZH2 in endometriosis-related infertility induced by oxidative stress in ovarian granulosa cells

YU Xiao-yan, WANG Lie-hong, YANG Hui-lin, MA Ying-lan, LI Yan-zi

2022, 20(11): 1836-1840. doi: 10.16766/j.cnki.issn.1674-4152.002714

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Abstract:
Objective To explore the role of enhancer of Zeste homologue 2 (EZH2) in ovarian granulosa cells (GCs) and oxidative stress (OS)-induced infertility related to endometriosis (EM). Methods The GCs were collected from 66 patients with deep invasive EM and 63 patients with tubal infertility (control group) in the Department of Reproductive Medicine, Qinghai Red Cross Hospital from April 2019 to November 2020. Flow cytometry was used in analysing the level of ROS in GCs. The COV434 cell model with low EZH2 expression was established in vitro and treated with H₂O₂. Cell senescence was measured by SA-β-gal. A mouse EM model was established, treated with an intraperitoneal injection of the EZH2 inhibitor DZNep and subjected to 6-month fertility test. Results Compared with the control group, the chronic pelvic pain score, dysmenorrhea pain score and serum CA-125 antigen significantly increased in the EM group (all P < 0.001), and the number of cells, average number of 2 PN embryos, average number of high-quality embryos and clinical pregnancy rate per embryo transfer cycle significantly decreased (all P < 0.001). Compared with control GCs, the intracellular ROS in GCs of patients with EM increased significantly (3.62±0.26 vs. 12.25±0.74, P < 0.001), and the expression levels of iNOS and SOD1 in the GCs decreased significantly (all P < 0.05). EZH2 knockdown significantly reversed H₂O₂-induced increase in ROS levels and SA-β-Gal activity (all P < 0.05) and down-regulated the expression of senescence-related proteins (all P < 0.05). The EM lesions in the EM+DZNep group was significantly smaller than those in the EM group [(433±74) mm³ vs. (1 624±182)mm³, P < 0.001], and the mean number of pups per delivery was significantly greater than in the EM group (all P < 0.05). Conclusion EZH2 is involved in EM-related infertility induced by GC cell OS.

The Relationship between HPV E6/E7 mRNA, vaginal environment and cervical diseases

WANG Yan, WANG Ling-ling, WANG Cai-zhi

2022, 20(11): 1841-1844. doi: 10.16766/j.cnki.issn.1674-4152.002715

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Abstract:
Objective To investigate the relationship between the expression of HPV E6/E7 mRNA, vaginal microecological abnormalities and cervical lesions in women of childbearing age. Methods A total of 1 245 patients of reproductive age who were admitted to the outpatient and inpatient Departments of Obstetrics and Gynecology of the First Affiliated Hospital of Bengbu Medical College for cervical cancer screening from December 2019 to August 2021 were enrolled. All patients were examined by colposcopy. According to the results of colposcopy pathology, there were 290 cases in cervical intraepithelial neoplasia (CIN) Ⅰ group, 360 cases in CIN Ⅱ group, 465 cases in CIN Ⅲ group, 130 cases in cervical squamous cell carcinoma group and 150 healthy women in control group. By detecting the expression of HPV E6/E7 mRNA and the pathogen of vaginal secretions, the relationship between HPV E6/E7 mRNA and cervical diseases was compared. Results There was a statistically significant difference in vaginal cleanliness among the groups (χ²=46.123, P < 0.05), among which the detection rate of vaginal cleanliness Ⅲ-Ⅳ in the control group < CIN Ⅰ group < CIN Ⅱ group < CIN Ⅲ group < CECS group. The positive detection rate of Gardnerella in each group was statistically significant (χ²=39.404, P < 0.05). There was no significant difference in the positive rates of candida and trichomonas in each group (P>0.05). The positive detection rate of HPV E6/E7 mRNA in each group was statistically significant (χ²=287.386, P < 0.05). The positive detection rates of HPV E6/E7 mRNA in CIN Ⅰ, CIN Ⅱ, CIN Ⅲ, CECS and control groups were 50.7%, 81.9%, 76.1%, 79.2% and 13.3%, respectively. The positive expression rate of HPV E6/E7 mRNA in CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and CESC groups was correlated with the rate of vaginal microecology disorder (P < 0.05). Logistic regression analysis showed that vaginal cleanliness (Ⅰ- Ⅱ) and lactobacillus were independent protective factors for HPV E6/E7 mRNA expression (OR < 1, all P < 0.05). Conclusion The increased positive rate of HPV E6/E7 mRNA expression, the increased detection rate of vaginal cleanliness (Ⅲ- Ⅳ), and the increased positive detection rate of Gardnerella are all high risk factors for predicting cervical cancer or cervical precancerous lesions.

Clinical effect analysis of curettage and fenestration decompression for treating odontogenic cyst of jaw

ZHOU Gen-xiang, WANG Zhong-hua, GAO Ming-hua, DONG Li-ying, LI Fang-jie

2022, 20(11): 1845-1847. doi: 10.16766/j.cnki.issn.1674-4152.002716

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Objective To evaluate the clinical effect of curettage and fenestration decompression in the treatment of odontogenic cyst of jaw and provide reference for rational selection of surgical techniques in clinical work. Methods A retrospective analysis of 180 patients with odontogenic cyst of jaw from January 2016 to December 2018 in the First Affiliated Hospital of Huzhou Normal University was carried out. Patients were divided into two groups according to different surgical methods, 100 cases underwent cyst curettage and 80 cases fenestration decompression. The percentages of cyst area reduction at 3 and 6 months, clinical effective rate at 6 months postoperatively were compared between the two groups. The clinical effective rate of different types of cysts in the fenestration group were compared. The rate of postoperative infection, bleeding, numbness and recurrence were compared between the two groups. Results The percentage of cyst cavity area reduction in the fenestration group at 3 and 6 months after operation were significantly higher than that in curettage group, and the differences were statistically significant (all P < 0.01). At 6 months after operation, the effective rate of fenestration group was 82.50% (66/80) while that of curettage group was 69.00% (69/100), and the difference was statistically significant (P < 0.05). The total effective rate of fenestration group was 91.25% (73/80), effective rate of keratinizing cyst was better than that of multilocular type (P < 0.05), and there was no significant difference in fenestration effect between different cyst types (P>0.05). In curettage group, the rate of postoperative infection was 2.00% (2/100), the rate of lower lip numbness was 1.00% (1/100) and the recurrence rate was 1.00% (1/100). There was no postoperative complication in the fenestration group. Conclusion Both curettage and fenestration decompression are effective methods for the treatment of odontogenic cyst of jaw. Curettage is more suitable for small jaw cysts or cysts that do not invade important anatomical structures around the jaw. Compared to curettage, fenestration decompression is simpler to operate, less traumatic, and has fewer complications. Fenestration decompression can effectively reduce the cyst cavity and promotes bone regeneration around jaw cysts, which is especially suitable for large-medium-sized cysts, and is conducive to complete curettage in stage Ⅱ surgery to preserve function.

Correlation analysis between serum Lp-PLA2 level and carotid atherosclerotic plaque

TIAN Xue, HUANG Liu, YAO Jing-qing, LI Yun-tao

2022, 20(11): 1848-1851. doi: 10.16766/j.cnki.issn.1674-4152.002717

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Abstract:
Objective To explore the correlation between lipoprotein associated phospholipase A2 (Lp-PLA2) and carotid atherosclerotic plaque. Methods A total of 1 018 patients who underwent carotid artery ultrasound and Lp-PLA2 detection from June 2019 to December 2020 in the Second Affiliated Hospital of Nanjing Medical University were selected. Based on the test results, patients were divided into (1) non-carotid plaque group (31 cases), stable group (376 cases) and unstable group (611 cases); (2) non-carotid plaque group (31 cases), unilateral group (324 cases) and bilateral group (663 cases); (3) no stenosis group (31 cases), mild (932 cases), moderate (26 cases) and severe carotid stenosis (29 cases). The total plaque area, stable plaque area, and unstable plaque area of all patients were calculated. The difference of Lp-PLA2 level among groups and the correlation of plaque area were analyzed. Results Compared with the non-plaque group [139.00 (96.00, 193.00) ng/mL], the Lp-PLA2 level in the unstable plaque group [179.00 (123.00, 281.00) ng/mL] and the bilateral plaque group [181.00 (120.00, 279.00) ng/mL] were significantly increased (all P < 0.05). The level of Lp-PLA2 in patients without carotid stenosis and with mild carotid stenosis were significantly different from that in patients with moderate and severe carotid stenosis (all P < 0.01). Lp-PLA2 was positively correlated with total plaque area and unstable plaque area (all P < 0.05). Lp-PLA2 had high diagnostic value for moderate and severe carotid artery stenosis (AUC=0.710, sensitivity was 43.6%, specificity was 89.7%, P < 0.001, 95% CI: 0.631-0.789). Conclusion Lp-PLA2 is significantly correlated with carotid plaque stability, vascular stenosis, bilateral plaque formation and plaque area, especially unstable plaque area, which can promote the formation and development of carotid atherosclerotic plaque. Lp-PLA2 has high diagnostic value for moderate and severe carotid stenosis, and may be a good indicator for large-scale clinical screening.

Drug resistance of Helicobacter pylori in 120 patients with digestive tract diseases in Northern Anhui Province

CUI Yan-yan, KE Xi-quan, WANG Qi-zhi, YAN Shan-jun, WANG Qiang-wu, WANG Jian-chao, LI Da-peng

2022, 20(11): 1852-1855. doi: 10.16766/j.cnki.issn.1674-4152.002718

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Abstract:
Objective To investigate the drug resistance of Helicobacter pylori (HP) to commonly used antibiotics and its influencing factors in Northern Anhui Province, understand the drug resistance spectrum of HP in this area, and provide a basis for the selection of the best treatment plan for eradication of HP. Methods A total of 120 patients who were positive for both ¹³C-urea breath test (or ¹⁴C-urea breath test) and rapid urease test in the First Affiliated Hospital of Bengbu Medical College from January 2020 to June 2021 were selected. HP was isolated and identified by microaerobic culture. The drug resistance of HP to amoxicillin, clarithromycin, metronidazole, levofloxacin and furazolidone was detected using the HP drug sensitivity detection kit method, and the drug resistance of HP isolated from patients with different genders, ages and disease categories to the above antibiotics was further compared and analysed. Results A total of 55 strains of HP were cultured from 120 patients with a positive rate of 45.83%. There was no significant difference in the HP culture positive rate among patients of different genders and ages (P>0.05), and the positive rate of HP culture in peptic ulcer patients was significantly higher than that in gastritis and gastric cancer patients (P < 0.017). The drug resistance rates of HP to amoxicillin, clarithromycin, metronidazole, levofloxacin and furazolidone were 3.64%, 27.27%, 65.45%, 30.91% and 1.82%, respectively. There were no statistically significant differences in HP resistance levels among different genders, age stages and disease types (all P>0.05). Conclusion The resistance rate of HP strains to metronidazole, clarithromycin and levofloxacin is high in Northern Anhui Province, but the resistance rate to amoxicillin and furazolidone is low. When antibiotics are used to eradicate HP in Northern Anhui Province, sensitive antibiotics are used for empirical treatment as far as possible.

Correlation between condylar anatomical measurement based on digital three-dimensional reconstruction and common symptoms of unilateral temporomandibular joint disorder

ZHANG Kai-xiang, XU Jin-cheng

2022, 20(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.002719

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Abstract:
Objective To retrospectively analyzed the correlation between common clinical symptoms of temporomandibular joint disorders (TMD) and condyle morphology by performing 3D reconstruction and anatomical measurement. Methods A total of 156 patients who were treated in Department of Stomatology, Bengbu Third People ' s Hospital Affiliated to Bengbu Medical College from June 2020 to September 2021 were divided into experimental group (click group, pain group, and mouth opening limitation group) and control group (no TMD symptom group). The patients were all taken in the Department of Radiology for maxillofacial CT, and three-dimensional reconstruction was performed by Mimics software to obtain the mandibular condyle shape and anatomical measurement was carried out. Results Condylar interior-exterior diameter, condylar anteroposterior diameter, condylar anteroposterior angle in the non TMD symptom group were (21.42±1.93) mm, (11.66±1.22) mm, and (105.86±6.67)°, respectively. These three parameters were (21.47±2.38) mm, (10.64±1.10) mm, (97.38±6.76)° in the click group; (21.25±1.04) mm, (12.17±0.81) mm, (104.00±6.73)° in the pain group; (20.48±2.17) mm, (11.55±1.57) mm, (106.79±8.36)° in the mouth opening limitation group. In the patients with joint snapping, the anterior and posterior condylar diameter decreased, and the anterior and posterior condylar angle also decreased. In patients with joint pain, the anteroposterior diameter of the condyle was larger than that of the control group, while the condyle shape of the mouth opening restriction group had no significant difference from that of the control group. Conclusion Condylar anatomical measurements are different in TMD patients, suggesting that anatomical measurements may provide a assist for diagnosis of TMD.

Investigation of clinical characteristics and prognostic factors in patients with non-small cell lung cancer after radical resection

XIE Zhong-hai, LI Hong-wei, ZANG Jin, MIN Wei-wei

2022, 20(11): 1860-1862. doi: 10.16766/j.cnki.issn.1674-4152.002720

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Objective To explore the clinical characteristics and prognostic factors of patients with non-small cell lung cancer after radical resection, and provide a theoretical basis for the formulation of prognostic intervention programs for patients. Methods A total of 514 patients who underwent radical resection of non-small cell lung cancer in Huzhou Central Hospital from January 2013 to December 2016 were selected as the research subjects. The postoperative clinical characteristics of the patients were counted, and the multivariate regression method was used to analyse the factors affecting the prognosis of patients with non-small cell lung cancer after radical resection. Results The clinical characteristics of 514 patients with non-small cell lung cancer after radical resection showed that the lesions were located in the right lung in 292 cases (56.81%) and in the left lung in 222 cases (43.19%). Histological types were mainly adenocarcinoma in 284 cases (55.25%) and squamous cell carcinoma in 206 cases (40.08%). Meanwhile, 305 cases (59.34%) had postoperative distant organ metastasis. Degree of tumour differentiation: 286 cases (55.64%) with low differentiation, 228 cases (44.36%) with moderate/high differentiation. Clinical TNM staging: 418 cases (81.32%) of stages Ⅰ-Ⅱ and 96 cases (18.68%) of stages Ⅲ-Ⅳ. The results of multivariate regression analysis showed that tumour diameter ≥ 3 cm, distant organ metastasis after the operation, medium/well-differentiated tumour, stages Ⅲ-Ⅳ, and no chemotherapy after operation were the prognostic influencing factors for patients with non-small cell lung cancer after radical resection (all P < 0.05). Conclusion Tumour diameter of ≥ 3 cm, distant organ metastasis after the operation, poorly differentiated tumour, stages Ⅲ-Ⅳ, and no postoperative chemotherapy are independent factors affecting the postoperative prognosis of patients with non-small cell lung cancer. Therefore, relevant prevention should be actively carried out in clinical practice to improve the quality of life of patients with non-small cell lung cancer after radical resection.

Effect of reducing paracentric defocusing soft lens on myopia in children and its effect on diopter and axial length

WANG Ying, WU Xiao-lan, ZHOU Lei, JIN Xia, XIN Dan-li, ZHANG Xiao-jin

2022, 20(11): 1863-1865. doi: 10.16766/j.cnki.issn.1674-4152.002721

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Objective To explore the clinical effect of reducing paracentral defocusing soft lens on myopia in children, and analyze its influence on diopter and axial length in children. Methods A total of 100 children with myopia who were admitted to Optometry Clinic of Ningbo Eye Hospital from January 2020 to June 2021 were divided into control group and observation group by random humber table. There were 50 cases in the control group treated with ordinary frame glasses, and 50 cases in the observation group were treated with reduced paracentric defocusing soft lens. The diopter, axial length, naked eye vision, visual quality, clinical efficacy and adverse reactions were observed. Results After treatment, the diopter of the observation group [(-2.23±0.51) D] was lower than that of the control group [(-3.06±0.62) D, P < 0.05]; the axial length in the observation group [(24.14±0.38) mm] was shorter than that in the control group [(26.01±0.55) mm, P < 0.05]; the naked eye visual acuity of the observation group (1.03±0.18) was higher than that of the control group (0.82±0.13, P < 0.05); the objective scattering index of the observation group (0.67±0.11) was lower than that of the control group (0.81±0.14, P < 0.05); and the modulation transfer function and Strehl ratio of the observation group (37.81±5.20, 0.49±0.05) were higher than those of the control group (32.97±4.88, 0.42±0.07, all P < 0.05). The total effective rate of the observation group was 92.0% (46/50), which was higher than that of the control group [74.0% (37/50), P < 0.05]. The incidence of adverse reactions in the observation group was 6.0% (3/50), which was close to 10.0% (5/50) in the control group (P>0.05). Conclusion Reducing paracentric defocusing soft lens is effective in the treatment of myopia in children. It can improve the diopter, axial length, naked eye vision and visual quality of children with fewer adverse reactions, and it is worthy of application.

The application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy

WANG Fang-qing, CHEN Gang, RUAN Wei-min, HU Wei-jian, CHEN Sheng, LI Sheng-ping, WANG Jin-qian

2022, 20(11): 1866-1869. doi: 10.16766/j.cnki.issn.1674-4152.002722

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Objective To explore the effectiveness and safety of the application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy. Methods Total 100 patients underwent thoracoscopic segmentectomy for the treatment of pulmonary nodules in Tongling People ' s Hospital from January 2019 to June 2021 were randomly divided into horseshoe-shaped intersegmental plane incision group with energy equipment (observation group) and intersegmental plane incision group with cutting suture device (control group) according to the random digital table method, with 50 cases in each group. The preoperative and postoperative clinical data was compared and analyzed. The main indexes included the drainage volume within 3 days after operation, the time of pulmonary leakage, arterial blood gas and pulmonary function. Results There was no difference in indexes like intraoperative blood loss, operation time, postoperative drainage volume within 3 days, postoperative drainage tube indwelling time, postoperative pulmonary air leakage time, postoperative hospitalization time and postoperative complications between the two groups (all P>0.05). Hospitalization costs in the observation group were significantly less than those in the control group (P < 0.001). At 1 month after operation, the arterial blood gas and the pulmonary function of the observation group was significantly better than that of the control group (all P < 0.05). The postoperative PaO₂ in the observation group was higher than that of the control group, the postoperative PaCO₂ in the observation group was lower than that of the control group, the postoperative forced vital capacity in the observation group [(2.58±0.43) L] was higher than that of the control group [(2.21±0.34) L], and the postoperative forced expiratory volume in one second in the observation group [(2.32±0.39) L] was higher that of the control group [(1.96±0.32) L]. The differences were statistically significant (all P < 0.05). Conclusion The application of horseshoe-shaped intersegmental plane processing method with energy equipment in thoracoscopic accurate pulmonary nodules segmentectomy is a safe and effective method with better pulmonary expansion and high-value consumables saving, which is worth popularizing.

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2022 Vol. 20, No. 11

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