中华全科医学

Diagnosis and treatment strategies of traditional Chinese and Western medicine with abdominal pain

YANG Xiaojun, CHEN Peng

2023, 21(10): 1631-1635. doi: 10.16766/j.cnki.issn.1674-4152.003186

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Abstract:
Abdominal pain is a common form of disease presentation and is one of the most common symptoms in outpatient and emergency. The causes of abdominal pain are complex and include medical abdominal pain, surgical abdominal pain, gynecological abdominal pain, etc. The atypical nature of the condition and the difficulty in diagnosing are the features of "abdominal pain". Some organic abdominal pains can even be life-threatening. As the gatekeeper to the health of the community, general practitioners, especially those who combine Chinese and Western medicine, are exposed to certain risks in the management of abdominal pain. This study is partly conducted to reduce the risks associated with medical treatment, analyzes and summarizes the common causes of abdominal pain from the perspective of a teacher teaching Chinese and Western general medicine, and sorts out strategies for the diagnosis and treatment of abdominal pain through relevant literature at domestic and international levels, so as to help students studying Chinese and Western general medicine to understand "abdominal pain", understand "abdominal pain", diagnose "abdominal pain", and diagnose abdominal pain at the early stage of their studies. The aim is to help students who study Chinese and Western general medicine understand "abdominal pain". In the diagnosis and treatment of abdominal pain, it is recommended that the condition be assessed through the five examinations of "Observation Auscultation and Olfaction, Inquiry, Pulse Feeling and Palpation and checking". It is important to assess the common causes of abdominal pain and to identify critical illnesses to avoid missing or misdiagnosing abdominal pain. In the case of fatal illnesses manifested by abdominal pain, symptomatic management is required to ensure the patients' safety and referral to a higher level hospital as soon as possible. It is recommended that a mind map be created based on the presentation of the patient with abdominal pain, and that the disease be diagnosed according to a combination of Chinese and Western medicine, with both Chinese and Western medicine, and with both Chinese and Western medicine. We should communicate with patients about the causes of their abdominal pain, treatment options, prognosis and care, in order to reduce patients ' worries and establish a trusting and harmonious doctor-patient relationship with them.

Study on sleep health of convalescent population based on intelligent senseless sleep monitoring system

MA Qian, ZHANG Pingshu, WANG Lianhui, XUE Jing, OU Ya, YUAN Xiaodong

2023, 21(10): 1636-1639. doi: 10.16766/j.cnki.issn.1674-4152.003187

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Abstract:
Objective To analyze the sleep structure and main sleep disorders of healthy people in nursing homes using the intelligent senseless sleep monitoring technology. Methods A total of 51 volunteers admitted to Jinggezhuang Medical Center and Fangezhuang Old-age Center in Kailuan from August to December 2021 were selected. The intelligent mattress sleep state monitoring platform system (IMSMPS, SC-500) was used to continuously monitor the sleep state at night (17:00-06:00). The data of continuous monitoring for 7 days were analyzed. Results There was significant difference between shallow sleep period and maximum heart rate on day 1 and day 7 in this population [(337.96±66.87) min vs. (318.18±74.05) min; 79 (76, 83) times/min vs. 78 (76, 81) times/min, all P < 0.05], but there was no difference in other sleep monitoring indexes (all P>0.05). The sleep persistence fluctuated between good, fair and bad accounted for 23.53% (12/51), sleep condition fluctuated between good, fair and bad accounted for 39.22% (20/51), sleep efficiency fluctuated between good, fair and bad accounted for only 7.84% (4/51). Conclusion The sleep state of this kind of people has great fluctuation every day, and the incidence of sleep disorder is very high, so only based on the results of a single sleep monitoring is not enough to exclude the diagnosis of sleep disorder.

Analysis of sleep characteristics in elderly patients with insomnia and mild cognitive impairment

SUN Yi, ZHENG Huifen

2023, 21(10): 1640-1642. doi: 10.16766/j.cnki.issn.1674-4152.003188

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Abstract:
Objective To observe the sleep characteristics of elderly patients with insomnia combined with mild cognitive impairment (MCI) and the effect of behavioral cognitive impairment. Methods A total of 56 insomnia patients were selected from the Inpatient Department and Outpatient Department of the Department of Neurology of Jiangsu Geriatrics Hospital from January 2020 to December 2021, including 30 insomnia of normal cognition patients and 26 insomnia patients combined with MCI. The Pittsburgh Sleepiness Quotient Index (PSQI) scale, Self-Assessment Scale for Anxiety (SAS) scale and polysomnography (PSG) monitoring were compared between the two groups. The insomnia combined with MCI group were treated with short-range behavioral cognitive therapy for 4 weeks, and then to observe the therapeutic effect. Results The MoCA score of insomnia combined with MCI group was lower than that of insomnia of normal cognition group [(22.16±1.26) points vs. (26.20±0.53) points, t=16.019, P < 0.001], and the SAS score was higher than insomnia of normal cognition group [(38.22±3.31) points vs. (26.19±5.42) points, t=9.833, P < 0.001]. The scores of PSQI, sleep quality, fall asleep time, sleep time and sleep efficiency of insomnia combined with MCI group were higher than those of insomnia of normal cognition group, and the differences were statistically significant (all P < 0.05). The PSG results showed that the sleep latency was significantly prolonged in the insomnia combined with MCI group, the total sleep time was reduced compared with the insomnia of normal cognition group, and the percentage of NREM light sleep was higher, with statistical significance (all P < 0.05), but the number of awakenings and sleep efficiency were not significantly different compared with the insomnia of normal cognition group (all P>0.05). After intervention, MoCA score of some patients in the insomnia combined with MCI group improved, and SAS scores decreased, the difference was statistically significant. The total score of PSQI decreased compared with that before intervention, and the difference was not statistically significant, but three sub-items of sleep quality, falling asleep time and sleep efficiency were significantly improved compared with that before intervention, and the difference was statistically significant (all P < 0.05). Conclusion Patients with insomnia combined with MCI have significantly longer sleep latency, NREM shallow sleep time, poor subjective perception of sleep quality, and lower overall sleep efficiency. Cognitive behavioral intervention therapy has a good effect.

Relationship between sleep structure, ventilation oxygenation level and interpersonal response, pleasure and cognition in patients with obstructive sleep apnea complicated with subclinical depression

YAN Rong, PAN Yourang

2023, 21(10): 1643-1646. doi: 10.16766/j.cnki.issn.1674-4152.003189

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Abstract:
Objective The sleep structure, ventilation oxygenation level, empathy (interpersonal response), pleasure and cognitive flexibility of patients with obstructive sleep apnea (OSA) and subclinical depression (SD) were evaluated by the scale, and the relationship between sleep data and affective cognitive indicators was explored. Methods Thirty-seven patients with confirmed outpatient or inpatient diagnosis of OSA combined with SD in the Seventh People' s Hospital of Shaoxing City from May 2022 to May 2023 were selected as the OSA combined with SD group, and 65 OSA patients with non-SD during the same period were selected as the OSA group. The patients' sleep structure, sleep ventilation oxygenation status, empathy, pleasure and cognitive flexibility were compared. Pearson (or Spearman) correlation analysis was performed between different sleep indicators and emotional cognitive indicators. Results The sleep efficiency (SE) of OSA patients with SD was significantly negatively correlated with the interpersonal response indicators of personal pain (r=-0.668) and empathic concern (r=-0.579), positively correlated with the abstraction (r=0.664), concrete expected pleasure (r=0.597) and abstract completion pleasure (r=0.770) of pleasure experience, and negatively correlated with the number of error responses (Re) and the number of persistent errors (Rpe) in cognitive flexibility could reach more than 0.5. The sleep latency (SL) was mainly correlated with personal pain (r=0.546) and abstract completion pleasure (r=-0.574). The percentage of rapid eye movement sleep (REM%) were more than 0.5 correlated with personal pain and most pleasure assessment indicators in empathy indicators, and the microarousal index focused on the empathy status of patients (all r>0.5). The apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were correlated with the patient' s emotional and cognitive indicators (|r|>0.5). Conclusion The sleep structure and oxygenation status of OSA patients with SD have a certain impact on their interpersonal response, pleasure and cognitive flexibility, and there is a significant correlation between some indicators.

Analysis of the treatment effect of percutaneous balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

LIU Zhiyu, CAO Chang, CHEN Xi, XU Ruochen, ZHENG Yingying, SHANGGUAN Jiahong, TANG Junnan, ZHANG Jinying

2023, 21(10): 1647-1650. doi: 10.16766/j.cnki.issn.1674-4152.003190

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Abstract:
Objective To evaluate the efficacy and safety of balloon pulmonary angioplasty (BPA) in a cohort of patients with pulmonary hypertension due to chronic thrombotic and/or embolic disease (CTEPH). Methods From October 2019 to June 2022, 8 patients diagnosed with CTEPH at the First Affiliated Hospital of Zhengzhou University underwent BPA surgery. The basic clinical characteristics of the patients were collected, and the hemodynamic indexes, improvement of cardiac structure, and surgical complications were observed. Results There were 5 female and 3 male patients. The mean age at presentation was (55.25±10.45) years, and the mean progressed period of CTEPH was (10.87±6.10) months, and the average follow-up duration was (255.50±149.71) days. A total of 46 BPA operations were performed, with one hemoptysis complication occurred in a patient with Takayasu' s arteritis, and the average number of BPA operations was (5.75±3.57) times. Mean pulmonary artery pressure after BPA decreased from (92.25±33.59) mmHg (1 mmHg=0.133 kPa) to (53.87±27.58) mmHg (P=0.022). NT-proBNP, cardiac output, cardiac index, tricuspid regurgitation velocity, EDV and NYHA were significantly improved (all P < 0.05). When cardiac structural parameters were compared before BPA surgery, before discharge and at follow-up, right ventricular diameter, left ventricular diameter, and right atrial upper and lower diameter were all improved (all P < 0.05). Conclusion BPA is a new surgical technique that can improve hemodynamic indexes and cardiac structure in CTEPH patients with fewer complications.

Clinical and laboratory characteristics of chronic spontaneous urticaria with connective tissue diseases

ZHANG Chengzhong, HUANG Chen, LIU Ja, JI Jie, LU Yan

2023, 21(10): 1651-1653. doi: 10.16766/j.cnki.issn.1674-4152.003191

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Abstract:
Objective To retrospectively evaluate clinical and laboratory characteristics of chronic spontaneous urticaria (CSU) accompanied by connective tissue diseases (CTDs). Methods A total of 400 patients with CSU who were admitted to the Department of Dermatology of the First Affiliated Hospital of Nanjing Medical University from October 2020 to December 2022 were selected. Clinical and laboratory characteristics of CSU in patients with and without CTD were analyzed. Results The male and female proportions of patients with CSU associated with positive Anti-TPO and ANA were 13.8% (22/160), 18.1% (29/160) and 33.3% (80/240), 37.1% (89/240), respectively. Among them, there are 40 female cases and 6 male cases of patients with CTD, mainly including rheumatoid arthritis, Sjogren' s syndrome, and systemic lupus erythematosus. The proportion of serum specific IgE antibody, Anti-TPO and Anti-Tg increased in female patients was significantly higher than that in male patients (all P < 0.05), and the proportion of abnormal levels of IgG, IgM, IgA, complement C3 in five immunological items was significantly higher than that in male patients (all P < 0.05). The proportion of positive ANA in female patients was also significantly higher than that in male patients (P < 0.05). The proportion of serum specific IgE antibody, Anti-TPO, Anti-Tg, RF and ESR increased in patients with connective tissue disease was significantly higher than that in patients without connective tissue disease (all P < 0.05), and the antibody positive rate in patients with connective tissue disease was higher than that in patients without connective tissue disease, there were significant differences in the levels of ANA, Anti-dsDNA, Anti-Sm, Anti-SSA, Anti-SSB, Anti-Jo-1 and Anti-PM-Scl 100 (all P < 0.05). Conclusion The results suggest that CSU is associated with CTDs, especially in female patients. Any patient diagnosed with CSU should be questioned about rheumatic symptoms, and especially in female patients, chronic spontaneous urticaria should be routinely tested for associated antibodies.

Risk factors for ventilator-associated pneumonia after mechanical thrombectomy in acute ischemic stroke

FAN Tingting, LI Rui, ZHU Yuyou, SUN Wen, HU Wei, WANG Guoping

2023, 21(10): 1654-1656. doi: 10.16766/j.cnki.issn.1674-4152.003192

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Abstract:
Objective To investigate the risk factors of ventilator-associated pneumonia (VAP) after mechanical thrombectomy in acute stroke and the predictive value of A2DS2 score scale. Methods From January 2020 to December 2021, the clinical data of 273 patients admitted to the Department of Neurology, the First Affiliated Hospital, University of Science and Technology of China (USTC) for acute cerebral infarction were retrospectively collected. The patients were divided into VAP group (180 cases) and non-VAP group (93 cases). A2DS2 scores were obtained for all patients. Multivariate logistic regression analysis was used to investigate the relationship between various factors and pneumonia. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of the A2DS2 scale for VAP. Results Age, length of hospital stay, history of hypertension, random blood glucose, NIHSS score, neutrophil to lymphocyte ratio (NLR), A2DS2 score were correlated with VAP (all P < 0.05). length of hospital stay and history of hypertension were independent risk factors for VAP (OR=1.112, 95% CI: 1.053-1.173, P < 0.001; OR=1.970, 95% CI: 1.130-3.433, P=0.017); A2DS2≥5 points was an independent risk factor for VAP (OR=2.412, 95% CI: 1.382-4.210, P=0.002). The A2DS2 score scale had predictive value for VAP (AUC=0.651, 95% CI: 0.580-0.721, sensitivity was 0.733, specificity was 0.484, and optimal cut-off value was 5 points). Conclusion Age, hospitalization days, history of hypertension, random blood glucose, NIHSS score, NLR, A2DS2 score were correlated with VAP. Long hospital stay, history of hypertension and high A2DS2 score were independent risk factors for VAP. The A2DS2 score scale has predictive value for stroke combined with VAP.

Analysis of the efficacy of endoscopic submucosal dissection for early gastric cancer and precancerous lesions

WU Yanyan, KE Xiquan, MA Zhenzeng, DENG Min, WANG Meng

2023, 21(10): 1657-1660. doi: 10.16766/j.cnki.issn.1674-4152.003193

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Objective To study the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and precancerous lesions. Methods The clinical data of 110 patients with EGC and precancerous lesions treated with ESD in the Digestive Endoscope Center of the First Affiliated Hospital of Bengbu Medical College from January 1, 2019 to December 31, 2022 were analyzed retrospectively. The observation indexes included the characteristics of the focus, pathology, operative complications, postoperative recurrence and so on, and the difference of pathological results was compared before and after ESD. The data of sex, age, lesion diameter, focus location, intraoperative perforation and postoperative pathological results of patients with delayed hemorrhage after ESD and non-bleeding group were collected, and the risk factors of delayed hemorrhage after ESD were explored. Results In 110 patients treated with ESD, the overall resection rate was 100.0% (110/110), the complete resection rate was 95.5% (105/110), and the curative resection rate was 93.6% (103/110). Postoperative pathology: low-grade intraepithelial neoplasia was 54, high-grade intraepithelial neoplasia was 30, intramucosal carcinoma was 20 and submucosal carcinoma was 6. There was significant difference between preoperative and postoperative pathology (P < 0.05). Delayed bleeding occurred in 6 cases, all of which occurred within 24 hours after operation. Univariate analysis showed that the lesion diameter≥3 cm might be related to delayed bleeding after ESD. There were 3 cases of intraoperative perforation, and no delayed perforation occurred in all patients. Up to February 28, 2023, 110 patients were successfully followed up for 3 to 50 months, with a median follow-up period of 23 months. All patients had no recurrence. Conclusion ESD is a safe and effective surgical procedure for the treatment of EGC and precancerous lesions, but strict indications are required and accurate preoperative evaluation is particularly important.

Role and mechanism of miR-429 in the progression of epithelial ovarian cancer

ZHAO Pingge, ZHANG Yanan, ZHANG Wenya, XU Peng, HUANG Min, LI Meng, TENG Jiaqian, KUANG Ye

2023, 21(10): 1661-1664. doi: 10.16766/j.cnki.issn.1674-4152.003194

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Objective To investigate the expression of miR-429 in epithelial ovarian cancer tissues and its relationship with the proliferation and migration of ovarian cancer cells, and to explore the role of miR-429 target gene DNAJB6 in ovarian cancer. Methods Twenty-seven epithelial ovarian cancer tissues and fourteen normal ovarian tissues obtained by gynecological surgical resection at the Second Affiliated Hospital of Harbin Medical University during the period from September 2019 to February 2022 were selected to detect the expression of miR-429 and DNAJB6 mRNA in the tissues using real-time fluorescence quantitative polymerase chain reaction (RT-qPCR). In human ovarian cancer cell line A2780, miR-429 was knocked down and changes in tumor cell proliferation and migration ability were measured in vitro by using CCK-8 kit, plate clone formation and Transwell cell migration assay. The downstream target genes of miR-429 were predicted by bioinformatics software and its prognostic value in ovarian cancer was analyzed. RT-qPCR and Western blot assays were applied to further confirm the regulatory relationship between miR-429 and DNAJB6. Results Compared with normal ovarian tissues 0.886(0.785, 2.014), miR-429 was highly expressed in epithelial ovarian cancer tissues 2.048(0.830, 5.281), P=0.018, and overexpression of miR-429 could enhance the proliferation and migration of ovarian cancer cells. Compared with normal ovarian tissues (1.290±0.781), DNAJB6 was lowly expressed in epithelial ovarian cancer tissues (0.710±0.456, P=0.004), which was closely related to the prognosis of ovarian cancer patients. Knockdown of miR-429 upregulated DNAJB6 mRNA expression (2.839±0.305, P=0.001) compared to the control (1.020±0.251); knockdown of miR-429 also upregulated DNAJB6 protein expression (P=0.049). Conclusion miR-429 plays a pro-cancer role in epithelial ovarian cancer and can regulate the expression of the target gene DNAJB6, suggesting that miR-429/DNAJB6 may be a new target for ovarian cancer therapy.

Clinical significance of lymphocyte-monocyte ratio in the prognosis of elderly patients undergoing curative chemoradiotherapy for esophageal cancer

GUO Shunan, WANG Gengming, CHEN Man, PAN Quan, ZHOU Yongchun, ZHU Chaomang

2023, 21(10): 1665-1668. doi: 10.16766/j.cnki.issn.1674-4152.003195

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Objective To analyze the prognostic value of lymphocyte to monocyte ratio (LMR) in elderly patients with esophageal cancer (EC). Methods A total of 220 elderly (≥65 years) patients who underwent radical chemoradiotherapy for EC at the Radiation Oncology Department of the First Affiliated Hospital of Bengbu Medical College from January 2014 to December 2017 were enrolled, and the clinical data and laboratory test indexes of the included patients were retrospectively reviewed. By constructing receiver operating characteristic curve, the LMR at the maximum value of Youden index was 4.9, and LMR=4.9 was used as the cut-off value to divide the patients into high LMR group (>4.9, 69 cases) and low LMR group (≤4.9, 151 cases), the survival curves of the two groups were plotted by Kaplan-Meier method, log-rank method to compare the survival status of the two groups, and multivariate analysis was performed by Cox regression model. Results A total of 82 patients were alive in the whole group with a median overall follow-up of 45 months and a median overall survival time of 28 months. The 5-year progression-free survival rates of patients in the high and low LMR groups before radical chemoradiotherapy were 38.6% and 29.8%, respectively (P=0.005), and the 5-year overall survival rates were 47.0% and 26.5%, respectively (P=0.003). By Cox regression model multivariate analysis, the results showed that LMR value before radical chemoradiotherapy was an independent factor affecting the prognosis of elderly EC patients (HR=0.634, 95% CI: 0.422-0.954, P=0.029). Conclusion In elderly EC patients receiving radical chemoradiotherapy, reduced LMR prior to radical chemoradiotherapy was an independent adverse prognostic factor.

Comparison of the efficacy of surgical resection and radiofrequency ablation after chemotherapy for resectable colorectal liver metastases

HU Chao, CHENG Xi, JIN Wangxun, YAO Hongqing, WANG Xinbao

2023, 21(10): 1669-1672. doi: 10.16766/j.cnki.issn.1674-4152.003196

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Objective Systemic chemotherapy followed by local treatment is recommended for patients with colorectal liver metastases (CRLMs). However, there is no consensus on the choice of local treatment for CRLMs after chemotherapy. The research aims to evaluate the efficacy of surgical resection and radiofrequency ablation (RFA) in these patients to provide some information for clinicians. Methods The clinical data of 63 patients with colorectal liver metastases who accepted chemotherapy and underwent local treatment (surgical resection or RFA) at Zhejiang Cancer hospital from January 1, 2017 to December 31, 2017 were retrospectively analyzed. All patients were divided into two groups according to the different methods of local treatment: hepatectomy group and RFA group. The 25 patients in hepatectomy group accepted hepatectomy and the 38 patients in RFA group accepted RFA. The efficacy of surgical resection and RFA in the treatment of colorectal liver metastases (CRLMs) was compared by analyzing local Recurrence-Free Survival time and Recurrence-Free Survival rates of 1 year, 2 years and 3 years. Results There was no significant difference in the number and maximum size of CRLMs between the hepatectomy and RFA groups. Patients were followed for 36 months. Local liver recurrences occurred in 16 patients in the hepatectomy group (64.0%) and 35 patients in the RFA group (92.1%). The median RFS time in the hepatectomy group (24.0 months, 95% CI: 6.0-42.0 months) was significant longer than the RFA group (4.0 months, 95% CI: 3.1-4.9 months, P < 0.05). The 1-year, 2-years and 3-years RFS rates were 64.0%, 52.0% and 36.0% in the hepatectomy group and 21.1%, 10.5%, 10.5% in the RFA group. There were significant differences between the two groups (all P < 0.05). Conclusion For some patients with resectable CRLMs who have accepted chemotherapy, surgical resection may result in a lower rate of local recurrence and longer RFS.

Diagnostic value of CT combined with serum tumor marker in oral squamous cell carcinoma

CAO Wei, LIU Liang, FANG Minjian, QIU Ruolan

2023, 21(10): 1673-1675. doi: 10.16766/j.cnki.issn.1674-4152.003197

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Objective To explore the new diagnostic ideas of oral squamous cell carcinoma, and analyze the diagnostic efficacy and clinical significance of CT combined with tumor markers by observing the CT imaging features of patients and detecting the serum tumor markers of patients. Methods A total of 60 patients who underwent radical operation for oral squamous cell carcinoma in the First Affiliated Hospital of Bengbu Medical College from September 2020 to March 2022 and pathologically confirmed as squamous cell carcinoma were selected as the experimental group. In addition, 60 patients with oral and maxillofacial benign tumors were selected as the control group. Combined with preoperative CT images of patients, the differences in serum tumor markers between the two groups were compared. Postoperative pathological diagnosis was taken as the gold standard. Kappa test was used to compare the consistency between the two groups and pathological findings. Results Serum levels of tumor markers of squamous cell carcinoma associated antigen (SCC-Ag) and carcinoembryonic antigen (CEA) in experimental group were significantly higher than those in control group (all P < 0.05). CT combined with serum tumor marker detection showed high consistency with pathological results (Kappa=0.800, P < 0.001), and its diagnostic efficacy was higher than that of CT alone. CT combined with serum tumor markers had a high diagnostic value (AUC=0.900), serum tumor markers alone had a high diagnostic value (AUC=0.925), and CT alone had a medium diagnostic value (AUC=0.867). Tumor marker testing has the highest diagnostic efficacy, and the combination of the two has higher diagnostic efficacy than CT alone. Conclusion Compared with traditional preoperative CT imaging, serum tumor marker detection has a higher diagnostic accuracy. Considering the importance of patients ' preoperative imaging, CT combined with serum tumor marker detection can be used when necessary. The combined application of the two methods can improve the screening of oral squamous cell carcinoma, and both methods have less harm to patients, so they can be widely used.

Correlation between gut microbiota metabolites and coronary heart disease combined with chronic heart failure and its predictive role in patient prognosis

YANG Xiaoming, ZHENG Xiang, WANG Chaochao

2023, 21(10): 1676-1678. doi: 10.16766/j.cnki.issn.1674-4152.003198

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Objective To explore of the correlation between intestinal microbiota metabolites trimethylamine oxide (TMAO) and phenylacetylglutamine (PAGln) and cardiac function indicators in patients with stable coronary heart disease (SCAD) and chronic heart failure (CHF), and analyze the clinical value of their combined use in predicting major adverse cardiovascular events (MACE) in patients with SCAD and CHF. Methods A total of 200 patients with SCAD combined with CHF and 200 patients with SCAD alone admitted to the Cardiovascular Department of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from April 2018 to April 2021 were selected as the study subjects. The correlation between the contents of TMAO and PAGln and cardiac function indexes in SCAD patients with CHF were analyzed. The diagnostic efficacy of TMAO combined with PAGln in predicting MACE were analyzed. Results The left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), matrix metalloproteinase-9 (MMP-9), brain natriuretic peptide (BNP), TMAO, and PAGln values in patients with SCAD combined with CHF were significantly higher than those in simple SCAD patient, while left ventricular ejection fraction (LVEF) and adiponectin (APN) values were significantly lower than those in patients with simple SCAD (all P < 0.05). TMAO and PAGln in patients with SCAD combined with CHF were positively correlated with LVESD, LVEDD, MMP-9, and BNP detection values (all P < 0.05), while they were negatively correlated with LVEF and APN detection values (all P < 0.05). Serum TMAO and PAGln levels in SCAD patients with MACE combined with CHF were significantly higher than those in non-MACE patients (all P < 0.05). TMAO combined with PAGln predicted the area, sensitivity and specificity under the receiver operating characteristic of MACE in patients with SCAD and CHF (0.964, 91.20% and 93.70%), which were higher than those predicted by both alone. Conclusion The levels of intestinal microbiota metabolites TMAO and PAGln in SCAD combined with CHF patients show an increasing trend, and the combination of the two has high clinical value in predicting MACE in SCAD combined with CHF patients.

Effect of deep muscle relaxation on oxygenation of jet ventilation during rigid bronchoscopy procedures

REN Qiusheng, WANG Yanfang, HUANG Lijun, GU Xiao, WANG Huaying, PENG Weidong

2023, 21(10): 1679-1682. doi: 10.16766/j.cnki.issn.1674-4152.003199

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Objective The optimal condition of jet ventilation during rigid bronchoscopy is still unclear. This study explores the effect of deep muscle relaxation during rigid bronchoscopy on the oxygenation effect of jet ventilation. Methods Sixty-eight patients who received selective treatment for central airway lesions under general anesthesia by rigid bronchoscopy from January 2021 to December 2022 in the Affiliated People's Hospital of Ningbo University were divided into deep muscle relaxation group (group D, n=34) and moderate muscle relaxation group (group M, n=34) by random number table method. After induction of general anesthesia, the patients were inserted rigid bronchoscopy for jet ventilation. Train of four (TOF) stimulation was used to measure the depth of muscle relaxation in group M, and the TOF count was maintained at 1-2. In Group D, the depth of muscle relaxation was measured by post tetanic count (PTC), and the PTC was maintained at 1-2. After operation, atropine and neostigmine antagonized residual muscle relaxation. Results There were no significant differences in the overall operation time and operation time between the two groups (all P>0.05). The anesthesia time in group D was shorter than that in group M (P < 0.01). The recovery time, extubation time and muscle relaxant dosage in group D were longer than those in group M (all P < 0.05). The intraoperative hypoxic events [(2.7±0.6) times/person], the use of hypoxic intervention measures (27/33) and the operation suspension time [(7.6±3.5) min] in group D were lower than those in group M [(8.8±2.6) times/person, 33/33, (19.3±5.6) min], and the surgeon satisfaction score in group D [(9.4±0.5) points] was higher than that in group M [(6.2±1.5) points, P < 0.05]. The arterial oxygen partial pressure in group D was higher than that in group M at 15 and 30 min of jet ventilation (all P < 0.05). The number of cases with postoperative sore throat in group D (18/33) was lower than that in group M (26/33, P=0.037). Conclusion The application of deep muscle relaxation in rigid bronchoscopy procedures can improve the oxygenation effect of jet ventilation, reduce incidence of hypoxemia, operation suspension time and anesthesia time, improve the satisfaction of operators, and has no effect on the total operation time.

Effect of 0.01% atropine eye drops on myopia control and its influencing factors in myopic teenagers

MAO Fangchao, ZHU Ping

2023, 21(10): 1683-1685. doi: 10.16766/j.cnki.issn.1674-4152.003200

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Objective The incidence of myopia in teenagers is gradually increasing, and the M receptor is involved in the whole process of myopia development. Atropine is a typical M receptor blocker. Therefore, the effect of 0.01% atropine eye drops on myopia control in adolescents with myopia and its influencing factors are discussed. Methods A total of 98 myopic adolescents admitted to Haining People's Hospital from March to August 2021 were selected as the research objects, and all received 0.01% atropine treatment. The 82 patients were followed up for 1 year. According to the treatment effect, they were divided into an effective group (50 cases, annual increase of myopia < 0.25 D or decrease of myopia ≥50%) and an ineffective group (32 cases, annual increase of myopia ≥0.25 D). A multivariate logistic regression model was used to analyze the related factors affecting the treatment effect of 0.01% atropine, and a ROC curve was drawn to evaluate the predictive value. Results There were significant differences in age, baseline equivalent spherical mirror SE and naked eye visual acuity between the two groups (all P < 0.05). Multivariate logistic regression analysis showed that age (OR=1.395, 95% CI: 1.023-1.901), naked eye visual acuity (OR=2.134, 95% CI: 1.087-4.187), equivalent spheroscope SE (OR=0.349, 95% CI: 0.183-0.666) were the factors influencing the therapeutic effect of 0.01% atropine (all P < 0.05). The ROC curve showed that the AUCs of age, baseline equivalent spheroscope SE and naked eye visual acuity in predicting the effect of 0.01% atropine were 0.708 (95% CI: 0.597-0.803), 0.799(95% CI: 0.696-0.879) and 0.714 (95% CI: 0.603-0.808), respectively. Conclusion The effect of 0.01% atropine in the treatment of myopic adolescents is significant. Younger age, higher baseline spherical equivalent SE and lower naked eye visual acuity are more likely to benefit from 0.01% atropine.

Rationality analysis of perioperative antibiotics in neurosurgery of a general hospital

DOU Yuxiao, HU Xuefeng, XU Jian

2023, 21(10): 1686-1688. doi: 10.16766/j.cnki.issn.1674-4152.003201

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Objective To evaluate the appropriateness of perioperative prophylactic antibiotic use in neurosurgery department of the Eighth People's Hospital of Hefei. Methods Using the hospital information system, 62 surgical patients admitted to the Department of Neurosurgery from January to December 2022 were randomly selected to evaluate and analyze their perioperative prophylactic antibiotic use. The main evaluation contents included the selection of antibiotics (the first and second generation Cephalosporin or Ceftriaxone, of which the first generation Cephalosporin recommended Cefazolin, and the second generation Cephalosporin recommended Cefuroxime), indications (it is recommended to use prophylactic antibiotics in the perioperative period for patients undergoing craniocerebral surgery, and routine use of prophylactic antibiotics is not recommended for Neurosurgery operations without intracranial access such as facial nerve microvascular decompression, scalp Benign tumor resection, etc.), dosage, timing of first prophylactic drug administration and duration of antimicrobial use. Results The age of 62 patients was (65.52±14.31) years, including 45 males (72.58%) and 17 females (27.42%). Among the 62 patients, 61 cases (98.39%) had Class Ⅰ incision and 1 case (1.61%) had Class Ⅱ incision. Seven patients (11.29%) unnecessarily prolonged the duration of postoperative prophylaxis; 19 patients (30.65%) had an inappropriate timing for the first preventive medication; There were 7 patients (11.29%) without indications for prophylactic use of antibiotics; Of all enrolled patients, only 29 cases (46.77%) were appropriate in all the evaluation indicators of perioperative prophylactic use of antibiotics in neurosurgery. Conclusion There are some deficiencies in the prophylactic use of antibiotics to prevent incision site infection in the neurosurgery department of the Eighth People's Hospital of Hefei. It is necessary to further strengthen the publicity and management of rational use of antibiotics.

Status of disease perception in patients with interstitial pulmonary disease and COPD

LI Jiehong, JIANG Dingyuan, LIN Fang, HUANG Ke, LIU Yu, ZHAO Fan

2023, 21(10): 1689-1692. doi: 10.16766/j.cnki.issn.1674-4152.003202

219 17

Abstract:
Objective To investigate the status quo of disease cognition in patients with interstitial lung disease and chronic obstructive pulmonary disease (COPD), and to provide reference and basis for clinical nursing. Methods A questionnaire survey was used to randomly select 83 patients with COPD and 85 patients with interstitial lung disease from the Department of Respiratory and Critical Care Medicine of China-Japan Friendship Hospital from August 2021 to October 2022. The patients were investigated by disease perception questionnaire (IPQ-R). Results In the dimension of "symptom recognition", the scores of patients with interstitial lung disease and COPD were (5.86±0.83) points, (5.87±0.85) points, t=0.066, P=0.947. In the dimension of "etiological perception", the scores of the two groups were (52.88±0.98) points, (52.80±1.09) points, t=0.545, P=0.587. Compared with COPD, patients with interstitial lung disease perceived their "disease course" to be longer [(18.91±0.85) points vs. (18.18±1.70) points, t=3.485, P=0.001]. In terms of "cyclical recurrence" "disease prognosis" "personal control confidence", patients with interstitial lung disease scored lower than those with COPD [(14.11±1.39) points vs. (15.19±1.36) points, t=5.130; (20.34±0.93) points vs. (20.69±0.46) points, t=3.142; (16.12±1.15) points vs. (16.49±0.67) points, t=2.566, all P < 0.05]. Conclusion Patients with interstitial pulmonary disease have a lower cognition level of disease recurrence and prognosis than patients with COPD. Medical staff should implement targeted clinical nursing interventions according to the level and characteristics of patients' disease perception.

Analysis of factors influencing liver injury caused by long-term use of second-generation antipsychotics in patients with schizophrenia

SHEN Bianhong, WANG Chengpeng, GAO Kerun, ZHANG Kaiyuan, ZHANG Zhiwen, ZHU Chunyan, FANG Ling, TANG Jianping

2023, 21(10): 1693-1697. doi: 10.16766/j.cnki.issn.1674-4152.003203

262 12

Abstract:
Objective A retrospective study was conducted to investigate the risk factors for liver dysfunction associated with long-term use of paliperidone, ziprasidone and other second-generation antipsychotics in patients with schizophrenia. Methods A retrospective study was conducted on 120 patients with schizophrenia who were on long-term second-generation antipsychotics in Hangzhou Seventh People's Hospital from April 2021 to April 2023. They were divided into 2 groups according to whether they had liver injury or not. Thirty-six patients with liver injury were set as the observation group, and 84 patients without liver injury were set as the control group. The risk factors of liver injury were investigated by univariate and multivariate logistic regression analysis. Combined with the results of logistic regression analysis results, R software was used to build a nomogram prediction model for predicting liver injury caused by long-term use of second-generation antipsychotics in schizophrenia patients, and the receiver operating curve (ROC) was plotted, the area under the curve (AUC) was calculated, and the predictive ability of this model was analyzed. Results Logistic regression analysis showed that disease duration >10 years, history of liver disease, history of alcohol consumption, malnutrition, tuberculosis and type of antipsychotic drugs ≥3 were risk factors for long-term use of second-generation antipsychotics in schizophrenia patients (P < 0.05). Hosmer-Lemeshow goodness of fit test, χ²=3.049, P=0.405; C-index=0.910; AUC was 0.910 (95% CI: 0.804-0.946). Conclusion Influencing factors for liver injury induced by long-term use of second-generation antipsychotics in schizophrenia patients were disease duration, and risk factors included liver disease history, alcohol consumption, malnutrition, tuberculosis and type of antipsychotics ≥3 types. The prediction model had a high predictive power.

Early identification and correlation analysis of infectious mononucleosis and acute suppurative tonsillitis in children

HUANG Xiangwei, WANG Hong, XU Xia, WU Dongjing, YANG Xiangchou

2023, 21(10): 1698-1701. doi: 10.16766/j.cnki.issn.1674-4152.003204

232 20

Abstract:
Objective To explore the early differential diagnosis and correlation between pediatric infectious mononucleosis (IM) and acute suppurative tonsillitis (AST), and to provide reference for clinical diagnosis. Methods A total of 130 children with IM (IM group) and 100 children with AST (control group) admitted between January 2021 and June 2022 were selected as study subjects. The clinical data and laboratory indicators of the two groups were analyzed and compared. The receiver operating characteristic curve (ROC curve) was used to analyze the predictive ability of multiple indicators for the early diagnosis of IM. Spearman correlation was used to analyze the correlation between laboratory indicators. Results In terms of clinical manifestations, body temperature < 39 ℃, eyelid edema, neck lymph node enlargement and tonsil secretions were significantly higher in IM group than in the control group, with statistical significance (all P < 0.05). At the early stage of infection, the levels of CRP, neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), CD4⁺/CD8⁺, prealbumin (PA), CRP/PA and C-reactive protein/albumin ratio (CAR) levels were lower in IM group than in the control group, with statistical significance (all P < 0.05). After IM treatment, the levels of CRP, WBC, MLR, CRP/PA and CAR were decreased, while the levels of NLR and PA were increased with statistical significance compared with before treatment (P < 0.05), while the level of ALB was not statistically significant. The ROC curve showed that the AUC of combined detection was 0.988, both higher than that of single detection. NLR was positively correlated with CRP and CAR (r=0.431, 0.433, all P < 0.05). CRP/PA was positively correlated with NLR (r=0.443, P < 0.05), and negatively correlated with PA (r=-0.340, P < 0.05). Conclusion Early identification of IM and AST is difficult and misdiagnosis is easy. Laboratory indicators such as CRP, NLR, MLR, CD4⁺/CD8⁺, PA, CRP/PA, CAR and clinical manifestations (body temperature < 39 ℃, eyelid edema, cervical lymph node enlargement, amygdala secretion) can be evaluated and compared. The combined application has great application value to improve the early diagnosis and efficacy evaluation of IM, and provides clinical assistance.

Expression and clinical significance of miR-374a-5p and RAB10 in cord blood of neonates with hypoxic-ischemic encephalopathy

ZHANG Zhen, ZHUO Feixiang, WU Yumeng, CHEN Xin

2023, 21(10): 1702-1705. doi: 10.16766/j.cnki.issn.1674-4152.003205

163 9

Abstract:
Objective To investigate the expression levels and clinical significance of microRNA-374a-5p (miR-374a-5p) and RAB10 proteins in cord blood of neonates with hypoxic-ischemic encephalopathy (HIE). Methods A total of 75 newborns born in the First Affiliated Hospital of Bengbu Medical College from December 2020 to August 2022 were selected and divided into perinatal asphyxia group (26 cases) and HIE group (27 cases) according to the inclusion and exclusion criteria of HIE and whether the children had asphyxia. There were 14 cases in the mild HIE group, 7 cases in the moderate HIE group, 6 cases in the severe HIE group, and 22 cases in the healthy group. Umbilical cord blood was collected within 30 min after birth, and the expression levels of miR-374a-5p and RAB10 proteins were detected by real-time fluorescence quantification (qRT-PCR). Results There were no significant differences in gender, delivery mode, gestational age and birth weight among all groups (P>0.05). There were significant differences in miR-374a-5p (F=340.618, P < 0.001) and RAB10 (F=100.906, P < 0.001) among the asphyxia group, HIE group and healthy group. The expression level of serum miR-374a-5p in cord blood of neonates in HIE group was lower than that in healthy group, and RAB10 were higher than that in healthy group, the differences were statistically significant (all P < 0.05). The comparison of miR-374a-5p among the three groups with mild, moderate and severe HIE showed statistically significant differences (0.11±0.03, 0.08±0.03, 0.03±0.01, F=39.403, P < 0.001), the expression level of miR-374a-5p in moderate group was lower than that in mild group, and that in severe group was lower than that in mild group and moderate group, the differences were statistically significant (all P < 0.05). There was no significant difference in RAB10 level in cord blood among the three groups with mild, moderate and severe HIE (F=2.309, P=0.121). Conclusion The expression of miR-374a-5p expression is low in HIE children, which is related to the severity of the disease, the more severe the disease, the lower the expression level of miR-374a-5p, which can be used as a reference for early diagnosis and disease evaluation of HIE.

Application value of HINE combined with skull Gesell in early recognition of high risk infants with cerebral palsy

ZHOU Yan, CAI Hefei, TANG Xinglu

2023, 21(10): 1706-1709. doi: 10.16766/j.cnki.issn.1674-4152.003206

154 13

Abstract:
Objective The combined application of the Hammersmith infant neurological examination scale (HINE) and the Gesell developmental scale in early screening of high-risk infants with cerebral palsy aims to develop a more comprehensive and efficient early screening plan. Methods Select Taizhou Women's and Children's Hospital and Taizhou Central Hospital to study 80 high-risk children with cerebral palsy from October 2020 to December 2021; another 50 healthy infants and young children in the same period were selected as the control group. To compare the scores of the HINE scale and the Gesell developmental scale scores between high-risk infants with cerebral palsy and healthy infants; to analyze the early recognition value of HINE combined with Gesell developmental scale in high-risk infants with cerebral palsy. Results The high-risk cerebral palsy group had lower scores in cranial nerves [(12.94±1.81) points], motor [(4.59±1.04) points], posture [(15.91±1.86) points], reflexes and reactions [(12.91±1.94) points], muscle tone [(21.38±2.73) points] and total scale score [(67.71±8.61) points] compared to the control group [(13.62±1.11) points, (5.32±0.62) points, (16.78±1.25) points, (13.96±1.12) points, (23.30±0.88) points, and (72.98±3.36) points], the differences were statistically significant (all P < 0.05). The DQ scores of reaction, fine motor, gross motor, and response were lower in the high-risk cerebral palsy group than control group (all P < 0.05); while the DQ values of language in the high-risk cerebral palsy group had no statistical significance (P>0.05). By receiver operating characteristic analysis, the sensitivity (96.3%) and specificity (96.0%) of HINE combined with Gesell scale for early prediction of high risk infants with cerebral palsy were higher than those of HINE scale (86.3%, 70.0%), Gesell scale (87.5%, 58.0%, P < 0.05). Conclusion HINE combined with the Gesell Scales of Brain Development is of great value in the early recognition of high-risk infants with cerebral palsy and can improve the diagnostic sensitivity and specificity.

Analysis of factors related to microalbuminuria in community populations

QIN Jingjing, PENG Kaiyue, WANG Yue, HAN Qingfeng

2023, 21(10): 1710-1712. doi: 10.16766/j.cnki.issn.1674-4152.003207

180 11

Abstract:
Objective To analyze the factors influencing microalbuminuria in community populations and provide evidence for effective screening of residents with early kidney injury. Methods All residents who underwent regular health examinations in a community in Beijing in October 2021 were selected as the study population, and their examination data were analyzed. Participants were divided into a microalbuminuria group and a normal urine albumin group based on the urinary albumin-to-creatinine ratio. The clinical data between the two groups were compared, and binary logistic regression analysis was performed to determine the factors associated with microalbuminuria. Results The detection rate of microalbuminuria in the study population was 11.9% (122/1 022). There were statistically significant differences (all P < 0.05) in age, metabolic syndrome, history of hypertension, history of diabetes, waist circumference, abdominal obesity, glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, albumin, urea, creatinine, and glomerular filtration rate between the microalbuminuria group and the normal urine albumin group. Binary logistic regression analysis showed that age (OR=1.051, 95% CI: 1.033-1.070) and metabolic syndrome (OR=2.254, 95% CI: 1.425-3.565) were independently associated with microalbuminuria. Among the five components of metabolic syndrome, high blood sugar (OR=2.405, 95% CI: 1.434-4.035) and hypertension (OR=2.082, 95% CI: 1.189-3.674) were positively associated with the detection of microalbuminuria. Conclusion Age and metabolic syndrome are independently associated with microalbuminuria, and diabetes and hypertension among the components of metabolic syndrome have a closer relationship with microalbuminuria.

Research on the method of measuring performance pay of family doctor teams based on hierarchical analysis and key performance indicator design

ZHANG Fang, DAI Huimin, SHAO Jie, HU bing, MA Haiping, SHI Jianwei, HUANG Qian

2023, 21(10): 1713-1718. doi: 10.16766/j.cnki.issn.1674-4152.003208

107 10

Abstract:
Objective To construct a method of measuring performance pay of family doctor teams using analytic hierarchy process and key performance indicator based on the content and characteristics of the work of the family doctor team. Methods Firstly, in-depth interviews were conducted to understand the work content of the current family doctor team, and standardized work items for contracted services under the family doctor team were sorted out. The relative weights of the standardized work items were calculated using the hierarchical analysis method, the salary values of the standardized work items were calculated and quantitative indicators were constructed. Secondly, centralized meetings and discussions were used to set key performance indicators for family doctor signing services based on policy documents and practice base, and quality indicators were constructed. A performance compensation calculation method for family doctor teams was constructed using combining the two. Based on actual business data, the new and old plans were comparatively calculated and verified. Results There were 199 standardized work items for the number of services of family doctor team positions. The average relative standardized value was 6.47±3.32, with the highest relative standardized value for a single project being "home bed visits" and the lowest being "public welfare family planning consultation". The performance and quality indicator system for family doctor contract services included 3 dimensions, 5 first level indicators, and 6 second level indicators, and corresponding assessment methods were set. Based on the existing 3 748 pieces of general medical work data as the basic data, the total performance-based compensation was calculated to be 397 958 yuan according to the standardized value of the original plan. After optimization and adjustment, the calculation result was 405 315.4 yuan (excluding family doctor contract service fees), which was an overall increase of about 1.85% compared to the original plan. Perform DF test showed P < 0.05, which meted the requirements for data smoothness and could ensure the transition of new standardized work values and calculation schemes. Conclusion The method of measuring performance pay of family doctor teams based on analytic hierarchy process and key performance indicators can effectively connect old performance plans and promote the implementation of contract signing services.

A qualitative study of contracted patients' needs of family doctor services and team composition under COVID-19

WANG Jiaxin, SHI Dazhen, MA Wenhan, ZHAO Yali

2023, 21(10): 1719-1723. doi: 10.16766/j.cnki.issn.1674-4152.003209

152 12

Abstract:
Objective To understand the views and needs of contracted patients on contracted family doctor services in urban Beijing under COVID-19, and to understand the team members that can meet their needs, so as to provide reference for the improvement of family doctor contract service quality in the future. Methods Purpose sampling method was used to select one community health service center in each of five urban districts in Beijing, and ten contracted outpatients were selected from each center for face-to-face in-depth personal interviews. A total of 47 contracted residents were interviewed to reach information saturation from June 2021 to July 2021. The interview materials were analyzed by content analysis method. Results (1) The contents of basic services (including 6 basic medical services, 4 basic public health services and 3 other services) and 8 personalized services were delivered for signed patients. The above services were mainly provided by general practitioners and assisted by nurses or assistants. (2) The interviewees' recognition of contracted family doctor services was reflected in the three themes of convenience, continuity and caring. (3) The needs of signed patients for family doctor team services could be summarized into six themes: increasing the variety and supply of drugs, providing home-visit services for the elderly, optimizing the team structure, delivering drugs to the home, organizing health education, and regularly sending health information through mobile phones. Conclusion We should improve the content and methods of contracted family doctor services, optimize the structure of the service team to meet the needs of signed patients under the COVID-19 and continue to improve the quality of contracted family doctor services in public health emergencies.

Effect of psychological intervention based on binary coping on self-management ability and negative emotions in patients with gestational diabetes mellitus

LIU Bei, CAI Fengcheng, CHEN Hong, YE Junhua, XU Mengyan

2023, 21(10): 1724-1727. doi: 10.16766/j.cnki.issn.1674-4152.003210

210 12

Abstract:
Objective To explore the effect of psychological intervention program based on dual coping in gestational diabetes mellitus (GDM) patients, and provide a reference for the health management of pregnant women with GDM. Methods A total of 100 patients with GDM who had established GDM cards from June 2022 to October 2022 in Hangzhou Women ' s Hospital were selected and divided into observation group (50 cases) and control group (50 cases) according to random number table. The control group was given routine antenatal examination and health education in Outpatient Department, and the observation group was given psychological intervention program based on binary coping theory. The self-management ability, negative emotions, fasting blood glucose and 2 h postprandial blood glucose levels were recorded and compared between the two groups before and after the intervention. Results After the intervention, the score of self-management ability of GDM patients in the observation group [(105.29±6.02) points] was higher than that of the control group [(92.49±5.34) points], with statistically significant difference (t=10.955, P < 0.05); Fasting blood glucose [(4.82±0.71) mmol/L] and 2 h postprandial glucose (6.19±1.08) mmol/L in the observation group were lower than those in the control group [(5.20±0.69) mmol/L and (8.01±1.21) mmol/L], and the differences were all statistically significant (t=2.645, 7.738, all P < 0.05). The SAS [(50.77±3.92) points], [SDS (52.50±4.32) points] in the observation group were lower than those in the control group [(58.40±4.34) points, (60.81±4.96) points, t=8.996, 8.713, all P < 0.05]. Conclusion The psychological intervention program based on binary coping can effectively improve the self-management ability of GDM patients, reduce the level of anxiety and depression, and improve the level of blood glucose control.

Preoperative evaluation of gastric cancer differentiation using DCE-MRI parameter histograms

JIN Jianguo, GAO Liyuan, WANG Xiangping, PAN Xiaoben

2023, 21(10): 1728-1731. doi: 10.16766/j.cnki.issn.1674-4152.003211

164 14

Abstract:
Objective To analyze the diagnostic value of quantitative parameters of DCE-MRI histogram in preoperative evaluating the degree of differentiation of gastric cancer. Methods A total of 128 patients with gastric cancer admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from May 2020 to May 2023 were selected as the study objects. DCE-MRI was performed before surgery to obtain the histogram of quantitative parameters of DCE-MRI, including the skewness, entropy, kurtosis, average value and 10%, 90% (P₁₀, P₉₀) of extravascular extracellular space volume ratio (V_e), volume transport constant (K_trans) and rate constant (K_ep). The value of the above parameters in evaluating the differentiation degree of gastric cancer was analyzed. Results The entropy, mean value, P₁₀ and P₉₀ of P₁₀, K_trans and K_ep of V_e in low differentiation group were higher than those in middle differentiation group and high differentiation group (all P < 0.05). The skewness and kurtosis of K_ep in low differentiation group were lower than those in middle differentiation group and high differentiation group (all P < 0.05). Logistic regression analysis showed that abnormal increases in K_trans entropy, mean value, skewness, entropy, mean value, P₁₀, P₉₀ and K_ep levels were risk factors affecting the differentiation degree of gastric cancer (all P < 0.05). ROC results showed that the AUC of K_trans entropy, mean value, P₁₀, P₉₀ and K_ep skewness, entropy, mean value, P₁₀ and P₉₀ in the diagnosis of poorly differentiated gastric cancer were 0.739, 0.806, 0.812, 0.758, 0.714, 0.726, 0.786, 0.761 and 0.749, respectively. Conclusion DCE-MRI quantitative parameter histogram has high diagnostic value in predicting the differentiation degree of gastric cancer, and K_trans P₁₀ has the best diagnostic efficacy.

Significance of excluding anti-screening false negative in blood transfusion patients

YAN Ye

2023, 21(10): 1732-1735. doi: 10.16766/j.cnki.issn.1674-4152.003212

132 6

Abstract:
Objective To investigate the importance of excluding false negative antibody screening in patients to reduce the incidence of adverse transfusion reactions. Methods Screening and identification of irregular antibodies in 1 200 patients who received blood transfusion form January 2019 to June 2021 in Zhengzhou Yihe Hospital; the specific antibody plasma was diluted with AB type plasma, and the corresponding homozygous antigens and heterozygous antigens in the spectrum cells were reacted with the diluted plasma in saline, polybrene, anti-human globulin test card and papain medium, respectively. The highest dilution of plasma with a negative result of heterozygous antigen reaction is used to evaluate the agglutination intensity of the homozygous antigen-positive cell reaction and to measure its titer. Results Anti-human globulin test cards were used to screen positive specimens with irregular antibody results for antibody specificity; negative samples were tested by the salt water method and the coagglutamine method; negative specimens were tested by the papain method. The positive rate of irregular antibody screening in 1 200 patients was 9 cases, the detection rate was 0.75%, and the negative antibody screening results were false negative in 2 cases. The detection rate is 0.17%. Conclusion For dose-dependent antibodies, try to use homozygous cells for antibody detection. Combined use of anti-screening cells with different antigen patterns and various methods to exclude false negatives from irregular antibody screening can prevent errors and reduce the likelihood of adverse transfusion reactions.

Research progress in the pathogenesis and treatment of chronic prostatitis associated with intestinal microbiota dysregulation

XU Xinyu, CUI Yun, WU Jun

2023, 21(10): 1736-1740. doi: 10.16766/j.cnki.issn.1674-4152.003213

470 35

Abstract:
Chronic prostatitis (CP) is a common and frequent disease in urology. Typical performance are mental symptoms (anxiety, depression, cognitive and behavioral abnormalities, lower quality of life), pelvic pain symptoms (urogenital area pain, abdominal and pelvic muscle tenderness, ejaculatory pain, painful urination) symptoms, sexual dysfunction (impotence, low sexual desire, ejaculatory dysfunction), as well as the urinary tract symptoms (frequent urination, urinary urgency, increased nocturia, posturinary leaking, dysuria, etc.). Modern medicine believes that the pathogenesis of CP is closely related to immune disorders, endocrine disorders and local microcirculation disorders, but the core pathogenesis is still unclear. Intestinal microbiota is closely related to human health. In recent years, domestic and foreign scholars have increasingly studied the relationship between gut microbiota and CP, which provides a new perspective for revealing the mechanism of CP. The dysregulation of gut microbiota induces CP mental and psychological symptoms by mediating the increase of inflammatory factors, the hyperactivity of hypothalamic-pituitary-adrenal then disturb hormone level and the abnormal function of neurotransmitters, and induces CP pelvic pain symptoms by inducing the release of inflammatory factors, the sensitization of dorsal root ganglion neurons and the activation of brain glial cells. It can lead to sexual dysfunction symptoms by affecting the levels of testosterone and neurotransmitters, and lead to CP lower urinary tract symptoms by direct infection and affecting the function of pelvic floor muscles. It has become a new direction of CP treatment to restore intestinal microbiota homeostasis by increasing beneficial bacteria and reducing harmful bacteria. At present, probiotics and prebiotics such as oligosaccharides, protein hydrolysates and traditional Chinese medicine polysaccharides are mainly used to regulate intestinal microbiota in the treatment of CP, which has achieved remarkable results and opened up a new direction of CP diagnosis and treatment. This article reviews the pathogenesis and treatment of chronic prostatitis related to intestinal microbiota dysregulation at home and abroad, in order to provide new ideas and basis for urologists to diagnose and treat CP.

Research progress on digital health literacy among older adults

WANG Xinxin, LUAN Wei

2023, 21(10): 1741-1744. doi: 10.16766/j.cnki.issn.1674-4152.003214

1085 84

Abstract:
In recent years, digital technology has developed rapidly and continues to be applied in medical treatment, retirement, health management, and other fields. While the quality of health care products and services has improved, the way older adults acquire and share health knowledge is also changing and a higher level of digital health literacy is required for older adults to adapt to society and promote health. Therefore, it has become an urgent issue to enable older adults to adapt to the digital reform of health services, to motivate them to use digital devices for health management, and to improve their digital health literacy. Digital health literacy (DHL) is an extended concept of health literacy, which refers to the ability of individuals to acquire, process, communicate, and understand health information and services, make effective health decisions, and promote and improve individual and collective health in the context of using digital information and technologies. By reviewing domestic and international studies on DHL in older adults, this paper aims to provide evidence for improving DHL, bridging the digital divide, and promoting health equity in older adults. The findings revealed that factors influencing DHL in older adults could be classified into socio-demographic factors, digital device-related factors, etc. Existing tools to assess DHL in older adults include the Digital Health Literacy Scale, Digital Health Literacy Assessment, etc. For older adults, DHL can affect their quality of life, cognitive health, etc. Existing intervention methods mainly include traditional classroom-based, based on blended learning and interactive technology-based training, etc. In general, research on digital health literacy in older adults is still in its infancy. Further development is warranted, especially with regard to assessment tools and intervention methods.

Progress on medication compliance of patients with multimorbidity in China

CHEN Weier, QIU Yan, PAN Xiaohua, REN Jingjing

2023, 21(10): 1745-1748. doi: 10.16766/j.cnki.issn.1674-4152.003215

450 81

Abstract:
With the acceleration of China's industrialization, urbanization and population aging process, people's production and life style and disease spectrum are constantly changing. The prevalence of chronic diseases represented by cardiovascular and cerebrovascular diseases, diabetes, chronic respiratory diseases and cancer has increased year by year. Chronic diseases have replaced infectious diseases as the major diseases that threaten human life, health and quality of life. The coexistence of chronic diseases is increasingly common in community elderly people. Compared with single chronic diseases, the emergence of comorbidities challenges the basic principles of monmorbidity management, and the interaction of multiple slow traffic diseases also causes greater health harm to the population. The coexistence of chronic diseases often has many problems, such as complex diseases, multiple drugs, and excessive medical treatment, which seriously affect the quality of life and life expectancy of the elderly, increase the economic burden of families and society, increase the national medical expenditure, and cause the waste of health resources. Chronic disease management plays an important role in improving patient health outcomes and improving their quality of life. Drug treatment is an important part of chronic disease management, an important measure to control the condition and reduce complications, and an effective means of patient prognosis and rehabilitation. However, there are differences in China, which increases the difficulty of medical staff to manage comorbid patients. This paper relies on the current situation of medication compliance with chronic diseases patients in China, the social economics, disease, patients, medical team related factors, such as patients' mental health status, cognitive level, medication plan, doctor-patient communication, medical knowledge reserve, drug prices, etc., and then discusses the important measures to improve the comorbid patients' medication compliance, finally provides reference for better management of comorbid patients.

Research progress of glucagon-like peptide -1 in improving cognitive function in patients with type 2 diabetes mellitus complicated with mild cognitive dysfunction

YANG Rong, LU yuan, YU Dehua

2023, 21(10): 1749-1752. doi: 10.16766/j.cnki.issn.1674-4152.003216

243 15

Abstract:
Diabetes mellitus (DM) is not only a global public health issue at present, also has become our country resident common disease, frequently-occurring disease, which can lead to a variety of complications. Mild cognitive impairment (MCI) is a stage in the development of Alzheimer's disease (AD), which is a transitional state between normal and dementia. It can progress to AD. Patients' quality of life is severely affected. Existing research suggests that type 2 diabetes mellitus (T2DM) is closely associated with MCI. Because of the interaction and interdependence between these two diseases, some researchers even refer to AD as "type 3 diabetes". For this reason, more and more attention has been paid to whether T2DM prevention and treatment methods and strategies can have beneficial effects on MCI patients and delay their cognitive decline. In particular, whether hypoglycemic drug therapy can improve the cognitive function in MCI patients has become a research hotspot in recent years, and many animal models and clinical research results have given a positive answer. Recent studies have shown that glucagon-like peptide-1 (GLP-1) can protect neurons and improve cognitive function. Glp-1 receptor agonists and DDP-4 inhibitors, which can increase GLP-1 levels in vivo, have been used in the treatment of diabetes. With the widespread clinical application of these drugs in recent years, there is increasing evidence that the cognitive function in patients with T2DM is significantly improved after the use of these drugs. Therefore, GLP-1 drugs are expected to be ideal drugs for the treatment of T2DM complicated by MCI. This article reviews the improvement of cognitive function in patients suffering from T2DM with MCI by using GLP-1, in order to provide a deeper understanding of T2DM and MCI and to explore new approaches for their treatment.

Advances in immunotherapy in advanced or recurrent endometrial carcinoma

LIU Yixian, CHEN Rong, CHENG Zhongping

2023, 21(10): 1753-1756. doi: 10.16766/j.cnki.issn.1674-4152.003217

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Abstract:
Endometrial cancer (EC) is one of the most common gynecological malignancies, and its incidence is increasing with the increase of obesity and aging population. Although the prognosis of early EC with surgical treatment is generally good, some patients still develop or develop metastatic or recurrent disease. In recent years, immunotherapy has made new progress and plays an important role in the treatment of advanced or recurrent EC. Immunotherapy mainly includes immune checkpoint inhibitors, such as programmed cell death 1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors. Other immunotherapies include chimeric antigen receptor T cell (CAR-T) cell immunotherapy, tumor vaccine, etc. Combined with poly-ADP-ribose polymerase (PARP) inhibitors or targeted drugs is a hotspot, which can improve the objective response rate and produce additional effects or even synergistic effects. Immuno-checkpoint inhibitors are effective in the treatment of microsatellite unstable and mismatch repair defect endometrial carcinoma, but still need to be tested in other tumor types. The combination therapy of CTLA-4 and immunosuppressive checkpoint has its unique advantages, but its safety and efficacy need to be verified in a large number of trials. Combined with PARP inhibitors or targeted drugs, drug types and dosages need to be explored in order to achieve optimal efficacy with minimal side effects. As for cancer vaccine, studies have confirmed that the vaccine can prevent EC recurrence, but its safety and effectiveness still need to be verified. In the future, the study of immune-related biomarkers will also help to predict the prognosis of EC treatment, which is of great significance for the study of immunotherapy.

A systematic review of factors influencing utilization of primary medical service at home and abroad based on the Andersen model

XIANG Tong, LI Wentao, ZHAO Jingwei, HUANG Yafang, WU Hao

2023, 21(10): 1757-1761. doi: 10.16766/j.cnki.issn.1674-4152.003218

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Abstract:
With the promotion of the "Healthy China" strategy, analyzing the factors affecting the utilization of primary healthcare services is crucial for the rational allocation of healthcare resources. At present, there is no review study on the influencing factors of primary healthcare service utilization at home and abroad, and this article is based on Andersen ' s behavioral model of healthcare service utilization to systematically sort out the influencing factors of primary healthcare service utilization. The study finds that the needing factor is the most significant factor influencing the utilization of healthcare services, having chronic diseases, number of chronic diseases, disability and degree of illness significantly influenced the utilization of healthcare services. Among the enabling factors, population health policies, universal health insurance coverage, and increased economic income are positive factors affecting the utilization of healthcare services. Among the predisposing factors, the effect of gender, age, marital status, and education on health service utilization, the findings are inconsistent and may be related to the selection of the study population and the selection of the study area, but each factor has a varying degree of influence on health service utilization. In addition, health behaviors and correct treatment concepts have a positive impact on the use of health services. Previous studies have analyzed and compared healthcare service utilization in terms of geography, economy, healthcare insurance, etc., with fewer factors incorporating patient health outcomes and satisfaction, resulting in insufficient evidence for judgement in analyzing the influencing factors. Moreover, previous studies have paid little attention to the utilization of primary healthcare services, and the data are scarce and incomplete. In future studies, we need to focus on the utilization of primary healthcare services and its influencing factors in different regions of China, and carry out scientific and systematic data analysis, so that we can provide scientific and reliable evidence support and practical policy recommendations for the balanced development of primary healthcare services and precise policy interventions.

Effect of exercise intervention on self-efficacy, abdominal circumference and spacing of rectus abdominis separation in patients with postpartum rectus abdominis separation

ZHAO Rong, WANG Huanhuan, LIANG Wanwan, ZHANG Li, WANG Hongyu, YUE Jianxing

2023, 21(10): 1762-1766. doi: 10.16766/j.cnki.issn.1674-4152.003219

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Abstract:
Objective To explore the effect of exercise intervention on improving self-efficacy, abdominal circumference and separation distance of rectus abdominis in postpartum patients with separation of rectus abdominis, and to provide reference for clinical exercise intervention. Methods Eighty-six patients with postpartum rectus abdominis separation who attended the rehabilitation department of the Second Affiliated Hospital of Bengbu Medical College from August 2022 to March 2023 were selected and divided into a control group (n=43) and an intervention group (n=43) according to the time of consultation; both groups underwent conventional rehabilitation training, and the intervention group underwent exercise intervention on this basis. Patients ' self-efficacy was assessed using the general self-efficacy scale (GSES) before and after the intervention, and abdominal circumference and the separation distance between the rectus abdominis muscles were measured. Results Comparing the two groups of patients before intervention, there was no significant difference in the indicators (all P>0.05). After intervention, the abdominal circumference of patients in both groups was reduced, and the abdominal circumference of the intervention group [(81.67±7.09) cm] was smaller than that of the control group [(84.42±6.72) cm], with statistically significant differences (t=2.071, P=0.045). The separation distance of the three rectus abdominis muscles in both groups decreased (all P < 0.05), and the separation distance of the rectus abdominis muscles 2 cm above the umbilicus [(1.37±0.50) cm], at the flat umbilicus [(1.74±0.50) cm] and below the umbilicus [(1.24±0.53) cm] in the intervention group were smaller than those of the control group [(1.60±0.42), (1.95±0.38) and (1.44±0.37) cm], and the differences were statistically significant (all P < 0.05). The self-efficacy of patients in both groups increased (all P < 0.05), and was better in the intervention group (P < 0.05). Compared the differences in abdominal circumference, rectus abdominis separation distance and self-efficacy score between the two groups before and after intervention, the improvement of the intervention group was better than that of the control group (all P < 0.05). Conclusion Exercise intervention can reduce the abdominal circumference and distance between diastasis recti abdominis in patients with postpartum diastasis and improve maternal self-efficacy, which can effectively promote postpartum recovery and has high clinical promotion value.

Clinical application of supplementing Qi and activating blood in patients with cognitive impairment due to cerebral small vessel disease

CHEN Kelong, SONG Chengcheng, CHEN Ling

2023, 21(10): 1767-1769. doi: 10.16766/j.cnki.issn.1674-4152.003220

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Abstract:
Objective The purpose of this study was to investigate the clinical effect of qi-supplementation and blood-activation therapy with Buyang Huanwu Decoction in the treatment of patients with cognitive impairment due to cerebral small vessel disease, focusing on the effects on cognitive function, attention, executive function and inflammatory factors. Methods A total of 60 patients with cerebral small vessel disease and cognitive impairment admitted to Wenzhou TCM Hospital of Zhejiang Chinese Medical University from February 2022 to May 2023 were selected. The random number table method was used in two groups. The control group (30 cases) was treated with donepezil tablets, and the observation group (30 cases) was treated with Buyang Huanwu decoction for qi-supplementation and blood-activation on the basis of the treatment scheme of the control group. The patients ' cognitive function, attention and executive function were assessed by using Montreal cognitive assessment scale (MoCA), the digit symbol substitution test (DSST) and the trail making test (TMT). Levels of inflammatory factors [blood homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP)] were compared between the two groups. Results Compared before treatment, the MoCA and DSST scores in both groups were significantly increased after treatment (all P < 0.05), and the MoCA and DSST scores in the observation group were significantly higher than those in the control group (all P < 0.05). Compared with before treatment, the TMT time in both groups decreased significantly after treatment (all P < 0.05), and the TMT time in the observation group [TMT-A: (71.10±10.44) s; TMT-B: (222.63±30.84) s] was significantly lower than that in the control group [TMT-A: (77.63±12.44) s; TMT-B: (241.53±38.03) s, all P < 0.05]. After treatment, the levels of Hcy and hs-CRP in both groups were significantly lower than those before treatment (all P < 0.05), and Hcy and hs-CRP in the observation group were significantly lower than those in the control group (all P < 0.05). Conclusion Supplemening Qi and activating blood circulation can significantly improve the cognitive function and executive function of patients with cognitive impairment due to cerebral small vessel disease, and reduce the level of inflammatory factors in patients.

Study on the application of 3D printing technology in clinical teaching of acetabular fracture

WANG Xiaopan, LIU Xiaochen, WU Min, DAI Xiusong, CHEN Xiaotian, ZHANG Pei

2023, 21(10): 1770-1773. doi: 10.16766/j.cnki.issn.1674-4152.003221

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Abstract:
Objective To apply 3D printing technology as an auxiliary teaching tool in clinical teaching activities of acetabular fractures, and explore its application effect. Methods Forty-eight residents who participated in the Orthopaedic training base of the First Affiliated Hospital of Bengbu Medical College from January 2020 to January 2022 were selected as research objects and divided into two groups by random number method, with 24 residents in each group. The resident in experimental group applied the 3D printing technology combined with traditional teaching model to study, while who in control group only accepted traditional teaching to study. After the course, subjective indicators and objective indicators were evaluated and compared for the two groups of residents. The objective indicators were evaluated and compared at multiple time points. Objective and subjective indicators were evaluated for the 2 groups of students respectively after the end of teaching. The objective indicators were mainly the theoretical knowledge examination results, which were evaluated using the evaluation mode of multiple time points; the subjective indicators were evaluated using the anonymous questionnaire mode, which evaluated the differences between the 2 groups of resident trainees in terms of interest in learning, comprehension, content mastery, course participation, case study ability, and satisfaction. Results There was no statistically significant difference in the objective scores of the two groups of resident trainees immediately and 1 week after course (all P>0.05), the objective scores of the experimental group in 1, 2 and 4 months after course were higher than those of the control group [(85.33±3.02) points vs. (82.33±2.60) points, (83.13±2.51) points vs. (79.21±2.75) points, (80.33±2.41) points vs. (75.71±2.82) points, all P < 0.05]. There were differences in the objective scores of resident trainees at different time points, as evidenced by a statistically significant decrease in the objective scores over time (P < 0.05). The decline in the objective scores of resident trainees in the experimental group was gentle, while the decline in the control group was more significant. The experimental group scored higher than the control group in terms of interest in learning, comprehension, content mastery, course participation, case analysis skills, and satisfaction (all P < 0.05). Conclusion In the clinical teaching of acetabular fracture, 3D printing technology is an effective auxiliary tool, which can enhance the teaching effect.

Perceptions and practices of geriatric nutrition among medical staff of various levels in Zhejiang Province

WANG Ange, CHEN Jing, LI Hanyu, ZHANG Qin

2023, 21(10): 1774-1777. doi: 10.16766/j.cnki.issn.1674-4152.003222

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Abstract:
Objective To investigate the nutritional knowledge, nutritional screening, assessment and intervention implementation of medical staff in hospitals at all levels, and to explore the deficiencies of medical staff ' s understanding of nutrition for the elderly, so as to provide reference for continuing education and training. Methods A questionnaire was designed based on the guidelines and consensus on clinical nutrition management for elderly patients. In April 2021, a questionnaire survey was conducted among 248 doctors and nurses who participated in a medical academic annual meeting in Zhejiang Province, so as to understand the understanding and practice of elderly nutrition in hospitals at all levels. Results A total of 237 valid questionnaires were returned, 134 (56.54%) from Level A tertiary hospitals, 65 (27.43%) were from non-Level A tertiary hospitals and 38 (16.03%) from community hospitals. The results showed that primary care physicians tend to underestimate the proportion of older hospitalized patients at risk of malnutrition. There was a significant difference in the frequency of nutritional screening, 86.57% (116/134) Level A tertiary hospitals always or frequently screen patients for malnutrition, while only 10.52% (4/38) primary hospitals do so. The indicators chosen for nutritional screening and assessment are inflexible. Dietary assessment prior to nutritional intervention is less common in community hospitals (47.37%, 18/38) than in Level A tertiary hospitals (86.57%, 116/134). Analysis of questions related to nutritional intervention showed inadequate detection and non-standard nutritional support therapy among community hospitals. Conclusion There was insufficient recognition of the importance of nutrition in older patients among primary care physicians. Nutritional screening and assessment were lacking, and knowledge of nutritional intervention needs to be further improved. Strengthening the training of community physicians in nutritional knowledge and providing the whole process of nutritional screening, assessment and intervention for the elderly will be the focus of our efforts for some time to come.

Association of serum MCP-1 levels with vasculitis: A meta-analysis

HONG Jing, ZHU Qing, CAI Xintian, LIU Shasha, WU Ting, WANG Guoliang, LI Nanfang

2023, 21(10): 1778-1782. doi: 10.16766/j.cnki.issn.1674-4152.003223

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Objective Monocyte chemotactic protein 1 (MCP-1) is a proinflammatory chemokine that is involved in the pathogenesis of vasculitis. The purpose of this meta-analysis is to determine the relationship between serum MCP-1 levels with vasculitis. Methods Articles were identified by searching Web of Science, PubMed, Wanfang, and CNKI databases (up to July 1, 2020). Two independent evaluators screened literature according to inclusion and exclusion criteria, extracted relevant data, and then used Review Manager software (version 5.4.0) and Stata 12.0 software for meta-analysis. Results A total of 13 original articles of vasculitis (1 034 participants) were finally included. The vasculitis group had a higher level of MCP-1 than healthy control (SMD=1.23, 95% CI: 0.48-1.98, P=0.001). Subgroup analysis based on the classification of vasculitis indicated that the serum MCP-1 levels in small vessel vasculitis patients were significantly higher compared to healthy controls, but not in large vessel vasculitis and Behcet ' s disease patients. Conclusion Meta-analysis shows that serum MCP-1 level is significantly higher in patients with vasculitis, especially small vessel vasculitis, than in healthy controls. It suggests that this index has some clinical value for the diagnosis of vasculitis.

Systematic evaluation and meta-analysis of intracoronary injection of epinephrine for preventing no-reflow after PCI

LI Qiuyan, HE Shirong, SU Qiang

2023, 21(10): 1783-1788. doi: 10.16766/j.cnki.issn.1674-4152.003224

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Abstract:
Objective To systematically evaluate the effectiveness and safety of epinephrine in the prevention and treatment of no-reflow after percutaneous coronary intervention (PCI), and to provide a further basis for clinical management. Methods The Cochrane Controlled Trials Database, PubMed, EMbase, China Biology Medicine disc, Wanfang Database and China National Knowledge Infrastructure were searched for relevant literature on no-reflow and slow flow after PCI since the establishment of the database to July 2022, and the inclusion and exclusion criteria were strictly followed to screen, extract, check and final meta-analysis was performed using RevMan 5.3 software. Results A total of 5 studies were selected, with a combined total of 527 patients. The final analysis showed that intracoronary epinephrine injection significantly improved thrombolysis in myocardial infarction trial (TIMI) flow and reduced the incidence of no/slow flow phenomenon (RR=0.52, 95% CI: 0.37-0.72, P < 0.001). Meanwhile, in terms of adverse effects, epinephrine significantly reduced the incidence of intraoperative hypotension during PCI, and the difference between the two groups was statistically significant (P < 0.05). However, for the effects of post-PCI corrected TIMI frame count (CTFC), myocardial blush grade (MBG), incidence of major adverse cardiovascular events (MACEs) during hospitalization and 30 days post-PCI, and post-PCI left ventricular ejection fraction (LVEF), the differences between the two groups were not statistically significant (all P>0.05). A subgroup analysis based on different control groups for TIMI blood flow, CTFC after PCI showed that the results of the difference between epinephrine and different control groups were similar to those before the subgroup analysis and were not statistically significant. Conclusion The results of this systematic evaluation show that intracoronary injection of epinephrine may have the effect of reducing the incidence of no-reflow/slow flow after PCI and that the incidence of intraoperative hypotension is lower than that of drugs such as verapamil and nitroprusside. However, due to the limitations of the study, further confirmation is needed by including randomized controlled trials with larger sample sizes

Development status of General Practitioner with Special Interest in comprehensive hospitals: a survey

WU Jingyi, REN Jingjing, LIU Ying, ZHENG Yuanyuan, CHEN Xiaoyang, YANG Kaichao, LI Kaijun

2023, 21(10): 1789-1792. doi: 10.16766/j.cnki.issn.1674-4152.003225

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Objective The purpose of this study is to understand the development status of General Practitioner with Special Interest (GPwSI) in comprehensive hospitals in China. Methods In April 2022, a questionnaire was sent through the Internet to a large number of general practitioners in comprehensive hospitals in China. The questionnaire included the basic information of general practitioners, the development status of GPwSI in comprehensive hospitals, and the willingness and training needs of general practitioners to develop general specialties, and so on. Results A total of 203 questionnaires were collected, of which 200 were valid, with an effective rate of 98.5%. Among the 200 general practitioners, the mean age was (37.8±9.3) years, 83 (41.5%) were male, 117(58.5%) were female, 24 (12.0%) had participated in general special interests training, and 176(88.0%) had not. Compared with the group who had not participated in any special interest training, the group of general practitioners who had participated in special interest training had longer working years (P < 0.05). Among those who had participated in special interests training, the most important specialty is cardiovascular and cerebrovascular (50.0%, 12/24). While, those who are willing to develop general special interests, the most important is endocrinology (83.5%, 142/170). Regarding the start of general specialty training, compared with the group of assistant chief physician and above, the attending physician and below are more willing to start training, as early as possible (P < 0.05), and prefer self-study (P < 0.05). Conclusion At present, some of comprehensive hospitals in China have GPwSI, however, there is still no complete training system and certification mode. Therefore, we should first establish a general special interest training and certification organization, and determine the certification standards at present. Each region chooses its own training mode.

The mediating effect of positive psychological capital on nurses' perception of organizational atmosphere and combat readiness ability

WANG Ling, XIANG Wei, XUAN Ling, LIU Li, ZHANG Jing, YU Wenxia, SUN Guangjuan, CHENG Lili, ZHU Feng, XU Qiao

2023, 21(10): 1793-1797. doi: 10.16766/j.cnki.issn.1674-4152.003226

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Abstract:
Objective To investigate the current situation of organizational atmosphere perception, positive psychological capital and combat readiness of nurses in military hospitals, and to explore the correlation among the three. Methods A total of 1 139 nurses from 5 military hospitals from October to December 2021 were investigated using the General Data Questionnaire, the Nurses' Organizational Climate Perception Scale, the Positive Psychological Capital Scale, the Combat Readiness Assessment and the Deployment Capability Index Scale. Results The average score of combat readiness of nurses in military hospitals was (3.23±0.78) points, among which the score of leadership and management support was the highest [(3.52±0.88) points] and the score of warrior/survival ability was the lowest [(2.93±0.91) points]. The total average score of organizational climate perception [(3.26±0.58) points] was the highest in team behavior [(3.34±0.61) points] and the lowest in resource security [(3.12±0.66) points]. The total average score of positive psychological capital [(4.72±0.88) points] was the highest for optimism [(5.14±1.17) points] and the lowest for resilience [(4.24±0.86) points]. There was a positive correlation between organizational climate perceptions and positive psychological capital and war readiness ability (r=0.453, 0.472, all P < 0.01). Positive psychological capital was positively correlated with war readiness (r=0.518, P < 0.01). Nurses' perception of organizational climate affects combat readiness through positive psychological capital, and there is a partial mediating effect between positive psychological capital and combat readiness, the mediating effect was 0.174, the proportion of intermediary effect reached 36.86%. Conclusion The combat readiness ability of nurses in military hospitals is at the intermediate level, and positive psychological capital plays a partial mediating role in the nurse' s organizational climate perception and combat readiness ability. It is suggested that managers improve the nurse' s organizational climate perception and enhance the positive psychological capital through psychological intervention measures to improve the combat readiness ability.

The effect of superficial large vessel warming technology combined with warming care in the surgical management of patients with complex trauma

CHEN Xiao, BAO Yingxue, ZHOU Yueqin, WANG Ligang

2023, 21(10): 1798-1801. doi: 10.16766/j.cnki.issn.1674-4152.003227

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Objective To investigate the clinical effect of combined warming technology and warming care for complex trauma patients undergoing surgery, in order to provide a reference for the selection of the warming scheme during surgery. Methods Eighty-four patients who underwent complicated trauma surgery in Xiaoshan District Hospital of Traditional Chinese Medicine from April 2018 to March 2023 were selected. They were randomly divided into the control group and the observation group with 42 cases each. During the perioperative period, the control group was heated by the traditional inflatable warming blanket. The study group was treated with the combination of superficial large vessel heat preservation and warming care. The changes in body temperature and the quality of anesthesia recovery between the two groups were compared at different time points. Results There was no statistically significant difference in body temperature between patients in the observation group at the end of surgery and when entering the anesthesia room and the operating room (P>0.05), while there was a statistically significant difference in body temperature between patients in the control group during surgery and when entering the anesthesia room and the operating room (P < 0.05). There was no statistically significant difference in body temperature between the two groups when entering the operating room. The body temperature of the observation group was higher than that of the control group from the start of surgery to the time of entering the anesthesia room (P < 0.05). The incidence of hypothermia in the observation group was 14.29% (6/42), the incidence of heat injury was 0, and the incidence of shivering was 4.76% (2/42), all of which were lower than the 35.71% (15/42), 16.67% (7/42), and 21.43% (9/42) of the control group (all P < 0.05). The observation group had shorter surgical time, wakefulness time, extubation time, and respiratory recovery time than the control group (all P < 0.05), and less intraoperative bleeding and infusion volume than the control group (all P < 0.05). There was no statistically significant difference in blood pressure and heart rate between the two groups during extubation (all P>0.05). At 10 minutes after extubation, blood pressure and heart rate were lower in the observation group than in the control group (all P < 0.05). Conclusion Superficial large vessels heat preservation technology combined with warming care can effectively improve the intraoperative temperature of patients with complex trauma, reduce temperature fluctuations, improve the quality of anesthesia recovery, ensure the recovery of vital signs after extubation.

Two cases of complicated perianal abscess with systemic lupus erythematosus and literature review

DU Fushuai, XIN Xuezhi, LI Yuantao, PANG Xue

2023, 21(10): 1802-1806. doi: 10.16766/j.cnki.issn.1674-4152.003228

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Patients with perianal abscess complicated by systemic lupus erythematosus have complex conditions, with a wide range of abscesses that are prone to infection and recurrence. This article reviews and analyzes the diagnosis and treatment process of two patients with perianal abscess and systemic lupus erythematosus, summarizes the experience in surgical methods, infection prevention and control, postoperative dressing and care, nutritional regulation, steroid treatment, and other aspects, and reviews relevant literature.

Polar inversion of renal papillary neoplasms: a case report and literature review

LIANG Ke, YUAN Yichu

2023, 21(10): 1807-1809. doi: 10.16766/j.cnki.issn.1674-4152.003229

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Abstract:
Polar inversion of renal papillary tumor (PRNRP) is a newly proposed tumor, tends to be benign or inert papillary tumor, relatively rare in clinic, easy to miss diagnosis and misdiagnosis. The author reported a patient with renal space occupying found on physical examination. The patient received active surgical treatment and a definite diagnosis based on pathology, and recovered well after surgery. After 14 months of follow-up, there was no tumor recurrence and metastasis. In order to improve the level of clinical diagnosis and treatment of the disease, this paper further summarizes and discusses the relevant literature.

Systemic lupus erythematosus with joint involvement as the first symptom: A case report

CHEN Shangtao, LIU Feng, LI Shuangqing

2023, 21(10): 1810-1812. doi: 10.16766/j.cnki.issn.1674-4152.003230

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Abstract:
This paper reported a 67-year-old male patient with a history of lumbar and knee pain for more than 5 years, and no cause was found after various relevant examinations in multiple medical institutions, only with symptomatic pain relief and rehabilitation treatment, the symptoms were not significantly relieved. After admission, skin lesions on both hands and positive antinuclear antibody were found, systemic lupus erythematosus was considered. After the improvement of relevant examinations, the diagnosis was confirmed, after targeted treatment, the patient improved and was discharged. This case suggests that the onset of systemic lupus erythematosus can be insidious, lacking typical manifestations, and it is difficult to make a diagnosis of systemic lupus erythematosus with joint involvement as the initial symptom. It is suggested that clinicians should screen for immune system diseases according to the situation in the face of atypical joint symptoms for early detection, early diagnosis and early treatment.

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2023 Vol. 21, No. 10

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