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2025 Vol. 23, No. 8

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General Practice Forum
Investigation on the working status of rural oriented general practitioners and their willingness to stay after service expiration
REN Wen, FU Jinchao, QIN Hongli, REN Jingjing
2025, 23(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.004112
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  Objective   To investigate the willingness of rural oriented general practitioners to stay after service expiration and the influencing factors, and provide scientific advices for the formulation of the policy of Zhejiang Province.   Methods   In August 2024, the convenient sampling method was used to conduct a questionnaire survey (investigation on the working status of rural oriented general practitioners and their willingness to stay after service expiration) on the oriented general undergraduate students enrolled in Zhejiang Province in 2012. A total of 105 valid questionnaires were collected.   Results   In this study, a total of 105 general practitioners were surveyed. Among them, 89.5% (94 people) returned to the contracted community hospital after graduation. After graduation, the vast majority of them worked in township health centers (47.6%, 50 people) and community health service centers (32.4%, 34 people), among which 62.9% (66 people) were engaged in general practice. 45.7% (48 people) were willing to continue working in the contracted community hospital after completing their service, and 16.2% (17 people) oriented general practitioners were unwilling to continue working in the contracted community hospital. The top three reasons for being willing to stay in the contracted community were proximity to home (68.8%, 33 people), less pressure (45.8%, 22 people), and professional identification (35.4%, 17 people). The top three reasons for not wanting to stay in the contracted community hospital were the available development space is limited (82.4%, 14 people), low income (76.5%, 13 people) and cumbersome work content (58.8%, 10 people). Logistic regression analysis found that the community hospital ' s emphasis on general practice and the attitude of general practitioners towards career prospects had a significant impact on whether general practitioners were willing to stay after the service expiration (P < 0.05).   Conclusion   The willingness of oriented general practitioners to remain on the job after the completion of their service period is relatively low. The difficulty in career development is the primary reason affecting the willingness to remain on the job after the service period.
Special Topic/Stroke Rehabilitation
Effect of exercise training combined with wrist and ankle acupuncture on lower limb motor function and balance in patients with hemiplegia after stroke
YANG Jie, ZHU Yongmei, NIU Yang, ZHANG Tianning, WANG Long
2025, 23(8): 1271-1274. doi: 10.16766/j.cnki.issn.1674-4152.004113
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  Objective   To explore the effect of exercise training combined with wrist and ankle acupuncture on lower limb motor function and balance in patients with hemiplegia after stroke.   Methods   From January 2020 to January 2023, 80 patients were divided into two groups by the random number table method: 38 patients in the reference group and 42 patients in the combination group. The reference group received wrist and ankle needle therapy alone, while the combination group received exercise training combined with wrist and ankle needle therapy. Plasma viscosity (PV), whole blood viscosity (BV), fibrinogen (FIB), angiopoietin-1 (Ang-1), vascular endothelial growth factor (VEGF), peak hip flexion, knee flexion, and stride frequency were measured. Berg balance scale (BBS), Fugl-Meyer scale (FMA), and stroke rehabilitation assessment of monvement (STREAM) were used to compare the clinical treatment effect.   Results   After treatment, the levels of PV, BV, and FIB in the combination group were lower than those in the reference group (P < 0.05). The levels of Ang-1, VEGF, peak hip flexion, peak knee flexion, step frequency, BBS, FMA and STREAM in the combined group were all higher than those in the reference group (P < 0.05). The total effective rate of the combination group [92.86%(39/42)] was higher than that of the reference group [71.05% (27/38), χ2=6.570, P=0.010].   Conclusion   Exercise training combined with wrist and ankle acupuncture therapy significantly improves hemorheology parameters, kinematic parameters, and vascular activity in the treatment of patients with hemiplegia after stroke, resulting in enhanced lower limb motor function and balance. The therapeutic efficacy of the combined intervention is notably superior to acupuncture alone.
Construction and validation of a malnutrition risk prediction model for patients recovering from stroke
RAO Zhenzhen, LI Yaling, SUN Yinxia, YUAN Jie, ZHAN Yan, LI Jiuhu, CHEN Lei
2025, 23(8): 1275-1279. doi: 10.16766/j.cnki.issn.1674-4152.004114
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  Objective   Analyzing risk factors for malnutrition in patients recovering from stroke, constructing a nomogram model, and validating its predictive effect.   Methods   A total of 254 stroke recovery patients were admitted to Taihe hospital in Shiyan City from December 2021 to November 2022. Among them, 178 cases from December 2021 to July 2022 were used as the modeling group, and 76 cases from August to November 2022 were used as the validation group. The data in the modeling group were analyzed using one-way analysis and logistic regression analysis to determine the malnutrition risk factors in patients recovering from stroke. Constructed a column-line diagram model and verified the effect.   Results   The incidence of malnutrition risk in patients recovering from stroke was 60.24% (153/254). The incidences of malnutrition risk were 61.80% (110/178) and 56.58% (43/76) in the modeling and validation groups, respectively. The age (OR=1.086, P < 0.001), mRS score (OR=1.756, P=0.001), and ALB level (OR=0.842, P=0.012) were independent influencing factors for the risk of malnutrition in patients recovering from stroke. The model was constructed as follows: Logit(P)=0.402+0.083×age+0.563×mRS score-0.172×ALB level. The AUCs of the modeling and validation group models were 0.844 (95% CI: 0.788-0.900) and 0.831 (95% CI: 0.740-0.921), respectively.   Conclusion   The older the age, the higher the mRS score, and the lower the ALB level, the greater the risk of malnutrition in patients recovering from stroke. This risk prediction model constructed in this study has good discrimination and calibration, and can be used as a reference tool to facilitate early identification of malnutrition risk in patients recovering from stroke by clinical health care professionals.
Based on the model of double difference method, this paper analyzes the influence of Tiaoren Tongdu acupuncture on patients with cognitive impairment after stroke
ZOU Yitong, CHENG Yisheng, WANG Peipei
2025, 23(8): 1280-1283. doi: 10.16766/j.cnki.issn.1674-4152.004115
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  Objective   To evaluate the therapeutic effect of Tiaoren Tongdu acupuncture combined with hyperbaric oxygen on patients with post-stroke cognitive impairment (PSCI), and to analyze the influence on cognitive function of patients by the double difference method (DID) model.   Methods   According to the random number table method, 126 patients with PSCI admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2020 to July 2023 were divided into two groups. The routine group (n=57) was given hyperbaric oxygen therapy, and the combined group (n=59) was Tiaoren Tongdu acupuncture therapy on the basis of the routine group. After the treatment, the clinical efficacy, inflammatory factor level, cerebral blood flow perfusion, and cognitive function were compared between the two groups.   Results   The total effective rate of the combined group (93.22%, 55/59) was higher than that of the routine group (80.70%, 46/57, P < 0.05). After two months of treatment, the levels of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and IL-10 in the combined group were lower than those in the conventional group (P < 0.05). The cerebral blood flow (CBF) and cerebral blood volume (CBV) in the combined group were higher than those in the routine group, while the mean transit time (MTT) and time to peak (TTP) were lower than those in the routine group (P < 0.05). After 1 week of treatment, 1 month of treatment, 2 months of treatment, and the end of follow-up, the Montreal cognitive assessment score in the combined group was higher than that in the routine group (P < 0.05). The DID regression model showed that after treatment, the cognitive function of patients increased by 1 134.2% respectively (P < 0.05).   Conclusion   The Tiaoren Tongdu acupuncture combined with hyperbaric oxygen can reduce neuroinflammatory reaction, regulate cerebral blood flow, improve cognitive function, and relieve clinical symptoms in patients with cognitive impairment after stroke.
General Practice Research
Correlation between blood test indexes including triglyceride glucose index, atherogenic index of plasma, and prediabetes
ZHENG Xudong, WANG Fang, NI Xiang, XU Ming, KANG Dongmei
2025, 23(8): 1284-1288. doi: 10.16766/j.cnki.issn.1674-4152.004116
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  Objective   To explore the role of multiple indicators, including triglyceride glucose index (TyG), triglyceride glucose body mass index (TyG-BMI), atherosclerotic index of plasma (AIP), triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C), and aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), in assessing the risk of prediabetes.   Methods   A total of 15 371 individuals from the South District Health Management Center of the First Affiliated Hospital of University of Science and Technology of China from October 2019 to April 2022 were included in the study. The follow-up data were collected from February 2020 to January 2024. Pre-diabetes was diagnosed based on the criteria of WHO and ADA. The differences of blood test indicators such as triglyceride glucose index, triglyceride glucose body mass index, plasma arteriosclerosis in prediabetes population and non-prediabetes population were compared and statistically analyzed (P < 0.05).   Results   The levels of TyG-BMI, TyG, AIP, and TG/HDL-C in patients with prediabetes were significantly higher than those in the normal control group (P < 0.05), while the AST/ALT ratio was lower than those in the normal control group (P < 0.05). The AUC values for identifying prediabetes ranked from highest to lowest were: TyG-BMI, TyG, AIP, TG/HDL-C, and AST/ALT. The AUC values of TyG-BMI were 0.916 (ADA criteria) and 0.933 (WHO criteria), indicating that both TyG and TyG-BMI were independently and positively correlated with prediabetes and served as the most effective individual predictors.   Conclusion   Blood biomarkers such as TyG index, TyG-BMI, AIP, AST/ALT ratio, and TG/HDL-C ratio have predictive value for prediabetes patients. These indicators not only aid in early screening but also provide insight into the risk of vascular sclerosis, cardiovascular and cerebrovascular diseases, and metabolic disorders. The combined use of these biomarkers offers a more scientific and reasonable rational basis for the prevention and treatment of prediabetes patients.
Correlation between Child-Pugh classification and electrocardiogram variation in patients of Wilson ' s disease with cirrhosis
DU Jiang, WANG Meixia, TAO Zhuang, HAO Wenjie, WANG Fei, ZHANG Yu, YANG Pingping
2025, 23(8): 1289-1291. doi: 10.16766/j.cnki.issn.1674-4152.004117
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  Objective   To compare the related parameters of Child-Pugh classification and cardiac function in patients with hepatolenticular degeneration and cirrhosis, and to explore the variation of electrocardiogram in the very early stage of these patients.   Methods   A total of 98 patients with hepatolenticular degeneration and cirrhosis admitted to Anhui Provincial Hospital of Traditional Chinese Medicine from June 2022 to July 2023 were selected as the observation group. The Child-Pugh score was calculated and divided into three subgroups: A, B and C according to its classification. A total of 98 cases of physical examination in the hospital during the same period were selected as the control group. The electrocardiogram parameters of the two groups were collected and compared to explore the correlation between Child-Pugh classification and electrocardiogram variation in WD patients.   Results   (1) The abnormal rate of electrocardiogram in the observation group (84.69%) was higher than that in the control group (25.51%), and the difference was statistically significant (P < 0.05). (2) Compared with the control group [(68.11±3.95) times/min, (91.09±4.55) ms], the heart rate and QRS duration of the observation group [(75.57±6.56) times/min, (102.23±7.98) ms] were prolonged, and the difference was statistically significant (P < 0.01). (3) Compared with subgroup A, the heart rate of subgroup B and subgroup C was accelerated, the QRS duration, QT and QTc interval were prolonged, and the difference was statistically significant (P < 0.01). (4) Spearman correlation analysis showed that Child-Pugh classification was positively correlated with heart rate (r=0.740, P < 0.001), QRS duration (r=0.495, P < 0.001), QT interval (r=0.442, P < 0.001), QTc interval (r=0.490, P < 0.001), and negatively correlated with P-R interval (r=-0.433, P < 0.001).   Conclusion   Patients with hepatolenticular degeneration and cirrhosis are more likely to have non-specific ECG abnormalities than normal people. There is a certain relationship between the severity of liver cirrhosis and its electrocardiogram variability.
Significance and mechanism of neuroultrasound combined with neuromagnetic resonance imaging in the diagnosis and treatment of Guillain-Barré syndrome
SHI Peng, WU Xinyu, HUAI Yushui, SONG Hongwei, NIAN Di
2025, 23(8): 1292-1297. doi: 10.16766/j.cnki.issn.1674-4152.004118
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  Objective  To explore the significance and mechanism of neuroultrasound and neuromagnetic resonance imaging in the diagnosis of Guillain-Barré syndrome (GBS).  Methods  A total of 43 GBS patients who were first diagnosed at the First Affiliated Hospital of Bengbu Medical University from October 2021 to February 2025 were enrolled, and 24 patients with normal physical examination were enrolled as control group. Based on neurophysiological examinations, the GBS were classified into two subtypes: acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). Neuroultrasound and neuromagnetic resonance imaging were performed on all subjects. The cross-sectional area of the cervical nerve roots and peripheral nerves (CSA) was measured by neuroultrasound, and the CSA of the cervical nerve root and lumbar sacral nerve root was measured by neuromagnetic resonance imaging. The degree of neurological impairment in GBS was assessed using the GBS disability scale scores (GDSS), and the correlation between CSA values and the degree of neurological deficit was evaluated. Peripheral venous blood was collected, and the levels of pyroptosis-related inflammatory factors in peripheral blood were measured using ELISA.  Results  Compared with the control group, the nerve roots and peripheral nerves of the limbs in the AIDP group and the AMAN group were thickened, and the CSA value was increased. Among them, nerve ultrasound showed that there were statistically significant differences in C5 and C6 among the three groups (H=20.216, P < 0.001; H=12.452, P=0.002), and the magnetic resonance imaging results showed that compared with the AMAN group and the healthy control group, the CSA values of C4-C8 and L3-S1 in the AIDP group were significantly increased, and the differences were statistically significant (P < 0.01). The CSA value of peripheral nerves was positively correlated with the degree of neurological deficit (P < 0.05). Pyroptotic inflammatory factors were higher than those in the control group, and the difference was statistically significant (P < 0.05).  Conclusion  The elevated CSA values of nerve roots and peripheral nerves, as well as neurological deficits in GBS, may be associated with the inflammatory cascade triggered by pyroptosis pathway activation. The detection of peripheral blood inflammatory cytokines combined with neuroimaging may facilitate early diagnosis of GBS and provide novel insights for its clinical management.
Analysis of PTH compliance and related influencing factors in MHD patients in Huainan area
HAN Shu, DAI Rong, XIE Weinan, WANG Baojia, DI Jiamei
2025, 23(8): 1298-1302. doi: 10.16766/j.cnki.issn.1674-4152.004119
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  Objective  To understand the compliance of parathyroid hormone (PTH) quality control indicators and related influencing factors in maintenance hemodialysis (MHD) patients in Huainan area through the analysis of general clinical data and clinical quality control data of MHD patients in Huainan area from 2021 to 2023, so as to provide a basis for finding more effective prevention and treatment measures.  Methods  The patients who underwent MHD in 18 hemodialysis units in Huainan area from January 2021 to December 2023 were selected as the research objects, and the general clinical data and related laboratory indicators of all patients were collected. The compliance of PTH related clinical indicators in MHD patients in Huainan area was analyzed, and the related factors affecting PTH compliance were explored.  Results  A total of 4 409 MHD patients from 18 hemodialysis units in Huainan area were included in this study, including 2 740 males and 1 669 females, with an average age of (58.23±12.71) years and an average dialysis age of 60.00 (36.00, 97.00) months. The laboratory test results of all subjects showed that the compliance rates of serum calcium, serum phosphorus, ALP and PTH were 63.1%, 46.7%, 75.3%, and 59.2%, respectively. There were statistically significant differences in the distribution of blood phosphorus compliance rate and PTH compliance rate in 2021, 2022 and 2023 (χ2=8.765, 10.917, P=0.012, 0.004). There were statistically significant differences in the distribution of PTH compliance among subjects with different ages, primary diseases, blood phosphorus compliance rate and ALP compliance rate (P < 0.05).  Conclusion  The indicators of MHD patients in Huainan area still need to be further improved, and the compliance rate of blood phosphorus and PTH increased year by year from 2021 to 2023. The age, hypertension, serum phosphorus and ALP are all related factors affecting PTH compliance.
Efficacy of KDB ab-interno trabeculectomy for glaucoma
LIN Leilei, DONG Nannan, WEI Liqing, PAN Weihua, CHEN Ding
2025, 23(8): 1303-1307. doi: 10.16766/j.cnki.issn.1674-4152.004120
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  Objective  To explore the safety and efficacy of internal trabeculectomy with double-blade trabeculectomy net (KDB) in glaucoma, and to provide a reference for the selection of glaucoma treatment methods.  Methods  From December 2019 to August 2021, 28 patients who underwent KDB internal trabeculectomy at the Eye Hospital of Wenzhou Medical University were divided into 22 patients with open-angle glaucoma (OAG) according to the types of glaucoma (OAG group). There were two groups: 23 eyes and 6 patients after phacoemulsification and cataract extraction combined with anterior chamber angle separation (Phaco-GSL) for angle-closure glaucoma (ACG group, 7 eyes). Compare the intraocular pressure, visual acuity, types of intraocular pressure-lowering drugs used, complications, postoperative visual field changes and anterior chamber angle adhesions, and success rates (complete, conditional success rate, strictly complete, strict conditional success rate) between the two groups.  Results  The postoperative visual acuity in the OAG group (0.28±0.05) was superior to 0.61±0.12 that in the ACG group (F=9.358, P < 0.05). The percentage of affected eyes with intraocular pressure drop ≥20% from baseline, percentage of affected eyes with intraocular pressure≤18 mmHg (1 mmHg=0.133 kPa), and percentage of affected eyes without using antiglaucoma drugs were significantly higher in the OAG group than those in the ACG group (P < 0.05). The mean deviation (MD) and visual field index (VFI) were significantly reduced compared to baseline values, with statistical differences (P < 0.05). No statistical differences were exhibited in the incidence rates of four kinds of complications between groups (P>0.05).  Conclusion  KDB ab-interno trabeculectomy for glaucoma can effectively reduce intraocular pressure, reduce the types of antiglaucoma drugs, and improve the visual field defects.
Clinical application effect of digital impression technology in robot-assisted implant crown restoration
LI Ping, ZOU Xiaosong, ZHANG Xing, TIAN Ruixue, LU Xiaomiao
2025, 23(8): 1308-1311. doi: 10.16766/j.cnki.issn.1674-4152.004121
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  Objective  To explore the advantages of digital impression technology and its adaptability in clinical application following single tooth implantation assisted by a manipulator.  Methods  A total of 30 patients with single tooth loss were selected from the Department of Stomatology at the First Affiliated Hospital of Bengbu Medical University from February 2023 to September 2024. Three months after undergoing implant surgery, the patients were randomly divided into a digital printing module (n=15) and a traditional printing module (n=15) by random number table method. The clinical effects of the two impression techniques were evaluated by analyzing the impression operation time, visual analogue scale (VAS), and the clinical suitability of the restoration crown. Additionally, patients were categorized based on the position of dental implants into anterior teeth, premolar, and molar groups. This was done to compare the clinical work efficiency differences between two impression techniques across various restoration areas.  Results  Compared to traditional impression technology [23.15 (18.93, 28.00) min], digital impression technology saved more time [19.72 (13.00, 25.02) min], and the difference was statistically significant (U=49.000, P < 0.01). In terms of nausea/vomiting, comfort level and convenience of operation, digital impression technology received higher patient satisfaction (P < 0.05). A majority (83.33%, 25/30) of patients preferred the digital impression method. While both impression techniques could achieve satisfactory crown abutment relationships, the digital group had a significantly shorter occlusal adjustment time [10.17 (3.15, 16.72) min] compared to the traditional group [18.07 (9.17, 24.60)min, U=27.500, P < 0.01]. Furthermore, compared to premolars or molars, anterior teeth required longer impression time, yet the occlusal adjustment time was significantly reduced (P < 0.05).  Conclusion  For single implant assisted by manipulator, digital impression technology can effectively restore the spaces of missing tooth. However, digital impression technology requires less time for occlusal adjustment of implant-supported crowns, particularly in the anterior teeth area. Additionally, patient satisfaction with digital impression technology is higher than with traditional methods.
The application of multidisciplinary team diagnosis, treatment, and long-term management in medically unspecified disease
ZHAO Lihua, CHEN Xiaoyong, REN Jingjing, KONG Yanhua, LIN Ziwei, LIANG Yan, ZHAO Jialong, CUI Manman, YAN Shanshan
2025, 23(8): 1312-1315. doi: 10.16766/j.cnki.issn.1674-4152.004122
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  Objective  To analyze the clinical characteristics of inpatients with medically unspecified disease (MUD), compare the diagnosis and treatment of MUD-multi-disciplinary team (MUD-MDT) in general practice versus specialties, and evaluate the long-term management effectiveness in tertiary hospital.  Methods  Clinical data were collected from patients with common MUD and MDT application in Bozhou People' s Hospital from September 2022 to September 2023. A total of 234 cases were included for statistical analysis. Among them, 100 patients without definitive organic or psychiatric diagnoses were selected for further analysis. Of these, 50 MUD patients received long-term community management for one year following discharge, while the other 50 MUD patients did not receive such management after discharge. The basic information of the patients was collected and analyzed statistically.  Results  Among the 234 MUD inpatients, females outnumbered males. The age range was 18-99 years old, with an average age of (64.57±16.28) years. Compared with specialty departments, MUD-MDT treatment in general practice demonstrated a higher definitive diagnosis rate, greater clinical improvement, shorter hospitalization, and lower total hospitalization cost. Regarding management modes, the self-management scores of MUD patients without long-term community management were lower than those with long-term community management, with a statistically significant difference (P < 0.001). The scores of depression and anxiety in MUD patients without long-term community management were higher than those with long-term community management (P < 0.05).  Conclusion  In the diagnosis and treatment of undifferentiated diseases, MUD-MDT in general practice is more effective and cost-effective than that in specialty departments. The establishment of "general-specialty-community" multidisciplinary team model for diagnosis, treatment, and long-term management of undifferentiated diseases can improve the self-management ability of MUD patients and reduce the occurrence of mental diseases.
Analysis of risk factors for early recurrence of pediatric intussusception after ultrasound-guided warm saline enema reduction
ZHOU Kai, LIU Xingyu, DUAN Jinjiang, LI Yang
2025, 23(8): 1316-1319. doi: 10.16766/j.cnki.issn.1674-4152.004123
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  Objective  To investigate the independent risk factors for early recurrence after ultrasound-guided warm saline enema reduction in children with intussusception, and to provide evidence for optimizing clinical treatment strategies.  Methods  A retrospective cohort study design was adopted, including 209 children with acute intussusception admitted to the First Affiliated Hospital of Bengbu Medical University from December 2018 to December 2024. All cases were diagnosed by ultrasound and treated with ultrasound-guided warm saline enema reduction. Clinical data such as the onset time of the disease, dehydration status, location and type of intussusception were recorded. Univariate and multivariate logistic regression model was used to analyze the independent risk factors for recurrence within 48 hours after reduction.  Results  Among the cases, 194 (92.82%) achieved successful reduction, while 15 (7.18%) experienced recurrence within 48 hours. Multivariate analysis revealed that duration of symptoms >24 hours (OR=3.168, 95% CI: 1.570-6.393, P=0.001), dehydration (OR=5.324, 95% CI: 1.090-26.012, P=0.039), initial intussusception head located at the splenic flexure and distal descending colon (OR=6.951, 95% CI: 1.519-31.813, P=0.012), and ileo-ileocolic type intussusception (OR=3.848, 95% CI: 1.003-14.760, P=0.049) were independent risk factors for early recurrence after reduction (all P < 0.05). Abdominal distension (OR=2.305, 95% CI: 0.591-8.993, P=0.229) and bloody stool (OR=2.331, 95% CI: 0.585-9.297, P=0.230) showed no significant association.  Conclusion  The key risk factors for early recurrence after ultrasound-guided warm saline enema reduction are onset time of illness >24 hours, dehydration, initial intussusception head located at the splenic flexure and beyond the descending colon, and ileo-ileal type of intussusception. Clinically, individualized interventions should be developed targeting these factors, including shortening the time window from diagnosis to treatment, correcting dehydration status, and optimizing the reduction technique, in order to reduce the risk of recurrence.
Correlation between KRAS, NRAS, BRAF, and PIK3CA gene mutations and the clinicopathological features of colorectal cancer
GUO Zhiqin, YANG Hongjie, YUAN Linna, CHEN Xiangyi, WU Wanxin
2025, 23(8): 1320-1323. doi: 10.16766/j.cnki.issn.1674-4152.004124
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  Objective  To analyze the mutation of KRAS, NRAS, BRAF, and PIK3CA in colorectal cancer, and explore the relationship with clinical pathological characteristics, providing an important reference for clinical individualized treatment.  Methods  The clinicopathological data of 524 patients in the Affiliated Hospital of Jiaxing University from January 2019 to December 2022 were reviewed. The mutation status of KRAS, NRAS, BRAF, and PIK3CA genes in FFPE tissues was detected by using ARMS-PCR method, and the association between gene mutation status and clinicopathological characteristics was analyzed.  Results  (1) The total gene mutation rate in this study was 53.4% (280/524), and the mutation rates of KRAS, NRAS, BRAF, and PIK3CA were 46.6% (244/524)、3.2% (17/524)、3.8% (20/524) and 2.7% (14/524), respectively. 3.6% (19/524) of patients had co-mutations in different genes. (2) The mutation of KRAS gene was mainly concentrated in exon 2 (43.1%, 226/524), which was more common in female and patients with mucinous adenocarcinoma (P < 0.05). (3) The mutation rates of NRAS gene in exons 2 and 3 were 1.3% (7/524) and 1.9% (10/524). NRAS gene mutation was prone to occur in patients with tumor diameter﹤5 cm (P < 0.05). (4) BRAF gene mutation was more frequent in patients with tumor diameter ≥5 cm, infiltrative type, poorly-differentiated, mucinous adenocarcinoma and vascular invasion (P < 0.05). Besides, BRAF gene mutation mainly occurred in the right-side colon cancer (P < 0.05). (5) The mutation rate of PIK3CA gene was higher in patients with mucinous adenocarcinoma [6.3% (5/79) vs. 2.0% (9/445), χ2=4.785, P=0.029].  Conclusion  KRAS gene mutation rate is higher in colorectal cancer, mainly occurred in exon 2, while NRAS, BRAF, and PIK3CA gene mutations are relatively lower. Mutations in the KRAS, NRAS, BRAF, and PIK3CA genes are associated with different clinicopathological characteristics. Combined detection of the above gene mutation can help to evaluate prognosis and develop individualized precision treatment plan.
General Clinical Research
The effect of quantitative rehabilitation training guided by the concept of empowerment on postoperative rehabilitation in patients with osteoporotic hip fracture
HUANG Li, LI Min, HUANG Mi, ZHANG Chen
2025, 23(8): 1324-1327. doi: 10.16766/j.cnki.issn.1674-4152.004125
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  Objective  To explore the effects of quantitative rehabilitation training guided by the concept of empowerment on the postoperative rehabilitation of patients with osteoporotic hip fracture, in order to provide reference for patients with rapid postoperative rehabilitation.  Methods  The relevant data of 120 patients with osteoporotic hip fracture who underwent total hip arthroplosty in Wuhan First hospital from June 2022 to June 2024 were collected and divided into the control group (n=57, quantitative rehabilitation training) and the study group (n=63, quantitative rehabilitation training + rehabilitation training guidance based on the concept of empowerment) according to different intervention method. Fear-avoidance belief, self-efficacy, hip function, and quality of life were compared between the two groups.  Results  After intervention, the study group had lower scores of physical activity and work-fear avoidance belief than the other group [(11.07±3.12) points and (20.88±4.82) points vs. (17.21±3.64) points and (31.84±5.39) points, F=787.801, 931.311, P<0.001], while higher scores of coping and physical exercise self-efficacy [(44.62±4.39) points and (42.83±3.05) points vs. (36.17±6.01) points and (35.11±3.81) points, F=701.077, 974.633, P<0.001]; The scores of hip joint function in the study group were higher, and the scores of quality of life were also higher (P<0.05).  Conclusion  Quantitative rehabilitation training guided by the concept of empowerment can significantly reduce the fear avoidance belief of patients with osteoporotic hip fracture after total hip arthroplosty, and promote the rehabilitation of joint function.
Association between intestinal flora metabolite trimethylamine oxide and 2-year cardiovascular event risk in STEMI Patients after PCI
HE Ming, HE Chaojie, LIU Jintao, HU Yanyan, ZHU Yongjin
2025, 23(8): 1328-1332. doi: 10.16766/j.cnki.issn.1674-4152.004126
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  Objective  Trimethylamine oxide (TMAO), a metabolite of intestinal flora, has been shown to be closely associated with the occurrence of cardiovascular disease (CVD). This study further investigated the association between TMAO and major adverse cardiovascular events (MACE) at 2 years after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).  Methods  A total of 158 STEMI patients who successfully underwent PCI treatment at Jiaxing Hospital of Traditional Chinese Medicine from June 2021 to December 2022 were prospectively selected and recorded (STEMI group). During the 2-year follow-up period after PCI, those with MACE and those without MACE were respectively classified as the MACE group and the No-MACE group. Another 40 healthy volunteers of the same age were selected and recorded as the control group. The plasma TMAO level was compared between different groups, and the relationship between plasma TMAO and MACE occurrence 2 years after PCI in STEMI group was analyzed by logistic stepwise analysis and ROC curve.  Results  Plasma TMAO [4.81 (4.12, 7.48) μmol/L vs. 2.25 (1.48, 2.60) μmol/L] in STEMI group was higher than that in control group (Z=14.057, P<0.001). There were 48 cases in the MACE group and 102 cases in the No-MACE group, respectively. Age, diabetes history, serum soluble growth stimulation expression factor 2 (sST2), N-terminal brain natriuretic peptide precursor (NT-proBNP) and TMAO in MACE group were higher than those in No-MACE group, and the differences were statistically significant (P<0.05). After modifying the collinearity of independent variables, stepwise logistic analysis showed that diabetes history and higher age, sST2, TMAO were independent risk factors for MACE 2 years after PCI in STEMI group (P<0.05). The predicted cutoff value of TMAO was 5.13 μmol/L, and the area under the curve (AUC) was higher than that of sST2 (P<0.05).  Conclusion  The plasma TMAO level of STEMI patients is abnormally elevated, and those with a higher level of TMAO have a higher risk of MACE occurrence. The plasma TMAO level has a good predictive value for MACE 2 years after PCI.
Diagnostic value of ESM-1 and PTX3 in elderly patients with diabetic nephropathy complicated with pulmonary infection
WANG Xiaohua, WANG Jun, LI Li, GAO Qian
2025, 23(8): 1333-1336. doi: 10.16766/j.cnki.issn.1674-4152.004127
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  Objective  To analyze the diagnostic value of endothelium-specific molecule-1 (ESM-1) and pentamerin-3 (PTX3) in elderly patients with diabetic nephropathy (DN) complicated with pulmonary infection, and to provide more valuable prognostic indicators for the improvement of patient prognosis.  Methods  A total of 81 patients with DN admitted to the Affiliated Hospital of Shaoxing University of Arts and Sciences from October 2020 to October 2023 were selected and divided into DN group with pulmonary infection (n=36) and DN group (n=45) according to whether they had pulmonary infection. Serum ESM-1 and PTX3 levels of the patients were detected. ROC curve was drawn to evaluate the diagnostic value of ESM-1 and PTX3 in elderly patients with DN complicated with pulmonary infection.  Results  The levels of serum ESM-1 and PTX3 were (5.64±1.24) ng/mL and (203.57±44.86) ng/mL in the DN group complicated with pulmonary infection. They were higher than those in DN group [(3.91±1.11) ng/mL, (148.44±39.95) ng/mL, t=6.616, 5.843, P<0.001]. The results of multivariate logistic regression analysis showed that long duration of DM, high fasting blood glucose level, low serum albumin level, high HbA1c value, history of COPD, maintenance hemodialysis, renal decompensation, high ESM-1 level and high PTX3 level were independent risk factors for pulmonary infection in elderly patients with DN (P<0.05). ROC curve analysis indicated that the AUCs of ESM-1 and PTX3 in the diagnosis of pulmonary infection in elderly DN patients were 0.834 and 0.862 respectively, and the AUC of combined diagnosis was 0.929.  Conclusion  Serum ESM-1 and PTX3 levels in elderly patients with DN complicated with pulmonary infection are significantly increased. The detection of the two levels is helpful to the diagnosis of pulmonary infection in elderly patients with DN.
Analysis of diagnostic efficacy of different sarcopenia diagnostic tools in senile comorbid patients with normal nutrition and malnutrition
NING Chuanrong, LI Qian, ZHANG Yan, FANG Shitong, HUANG Changbao, WANG Jingjing
2025, 23(8): 1337-1339. doi: 10.16766/j.cnki.issn.1674-4152.004128
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  Objective  To analyze the diagnostic efficacy of different sarcopenia examination tools in the nutritional assessment of elderly patients with comorbidities. The results of this study will provide a reference for clinical selection of a faster and simpler nutritional assessment scheme.  Methods  A total of 242 elderly patients suffering from multiple chronic conditions were selected for inclusion in the study. These patients were admitted to Ma'anshan People's Hospital between August 2021 and April 2024. The mini nutritional assessment (MNA) diagnostic results were utilized as the gold standard for the evaluation of nutritional status, and the patients were categorized into two groups based on their nutritional status: a normal nutrition group and a malnutrition group. Three commonly used sarcopenia screening tools were employed to investigate the nutritional status of the patients: the modified 5-item scale (SARC-CalF) questionnaire, the simple sarcopenia screen (SARC-F) questionnaire, and the Ishii score. The present study sought to analyze the diagnostic value of these three different sarcopenia screening tools in assessing the nutritional status of elderly patients with multiple chronic conditions.  Results  The nutritional status of 242 senile patients with comorbidities was evaluated by means of the MNA. Among the subjects, 98 exhibited signs of malnourishment, while 144 demonstrated a healthy nutritional status. The utilization of the MNA questionnaire as the diagnostic criteria revealed the diagnostic sensitivity of the SARC-CalF questionnaire, SARC-F questionnaire and Ishii score for the nutritional status of elderly comorbidities was to be 83.5%, 73.7%, and 77.0%, respectively. Concurrently, the respective specificities were determined to be 94.7%, 89.1%, and 91.5%. The accuracy of the model was 89.7%, 81.8% and 84.7%, respectively. The consistency test demonstrated that the Kappa values of the SARC-CalF questionnaire, the SARC-F questionnaire, the Ishii score, and the gold standard were 0.789, 0.632, and 0.690, respectively. The diagnostic efficacy of SARC-CalF in senile comorbidities was marginally superior to that of the other two SARC-CALF diagnostic tools.  Conclusion  The SARC-CalF, SARC-F and Ishii score are three commonly used diagnostic tools for the nutritional assessment of senile comorbidities. The SARC-CalF demonstrates relatively higher sensitivity and specificity for the nutritional assessment of senile comorbidities.
Analysis of the prognosis and related influencing factors in children with severe pneumonia combined with respiratory failure
HE Shijia, LIANG Ying, ZHU Hongtao
2025, 23(8): 1340-1342. doi: 10.16766/j.cnki.issn.1674-4152.004129
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  Objective  To analyze the clinical characteristics of children with severe pneumonia complicated with respiratory failure, find out the influencing factors of poor prognosis, and reduce its occurrence.  Methods  A total of 110 children with severe pneumonia complicated with respiratory failure admitted to the First Affiliated Hospital of Xinjiang Medical University from December 2020 to December 2022 were divided into a good prognosis group (82 cases) and a poor prognosis group (28 cases) according to the prognosis. The clinical data of children were collected, and the influencing factors of poor prognosis were analyzed by logistic regression.  Results  Pulmonary function decreased and arterial blood gas worsened in the poor prognosis group. Logistic regression analysis showed that age ≤3 years (OR=1.292, 95% CI: 1.068-1.516), repeated respiratory tract infection (OR=3.904, 95% CI: 3.414-4.394), acute physiology and chronic health evaluation-Ⅱ score (APACHE Ⅱ) score ≥18 points (OR=4.702, 95% CI: 4.024-5.380), non-ventilation therapy (OR=2.004, 95% CI: 1.594-2.414), persistent pulmonary hypertension (OR=4.600, 95% CI: 3.884-5.316), malnutrition (OR=5.212, 95% CI: 4.548-5.876), hypoxemia (OR=5.557, 95% CI: 4.715-6.399), repeated intubation (OR=5.114, 95% CI: 4.450-5.778), hypercapnia (OR=3.501, 95% CI: 2.897-4.105), immunosuppression (OR=3.789, 95% CI: 3.065-4.513) were the risk factors for poor prognosis (P<0.05).  Conclusion  Respiratory failure in children with severe pneumonia can damage their lung function. Clinical analysis of its risk factors and intervention can improve its prognosis.
Study on the status and influencing factors of self-regulation fatigue in pregnant women with gestational diabetes
CAI Fengcheng, XU Mengyan, LIU Bei, WU Yingying
2025, 23(8): 1343-1345. doi: 10.16766/j.cnki.issn.1674-4152.004130
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  Objective  To understand the factors influencing self-regulation fatigue in pregnant women with gestational diabetes mellitus (GDM) and provide a reference for their health management.  Methods  The GDM pregnant women registered at Hangzhou Obstetrics and Gynecology Hospital from January to June 2024 were selected as the research objects. Demographic information was collected using a general data questionnaire. The self-regulatory fatigue was assessed using the self-regulatory fatigue scale (SRF-S). The general self-efficacy scale (GSES), psychological resilience scale (CD-RISC), and social support rating scale were used to assess self-efficacy, resilience, and social support in pregnant women with GDM, respectively. Univariate analysis and multiple linear regression models were used to identify factors affecting self-regulatory fatigue in pregnant women with GDM.  Results  SRFS score was (47.20±8.53) points, GSE score was (23.60±4.15) points, and CD-RISC score was (59.70±11.66) points. GSES score and CD-RISC scores were negatively correlated with SRFS (r=-0.509, -0.487, respectively). Multiple linear regression analysis indicated that education level (college degree or above, β=-0.196), per capita monthly household income (>5 000 yuan, β=-0.214), gestational age (≥28 weeks, β=0.259), social support level (medium: β=-0.108; high: β=-0.287), self-efficacy (β=-0.135), and psychological resilience (β=-0.116) were significant factors affecting self-regulation fatigue (P<0.05).  Conclusion  GDM have a high level of self-regulation fatigue. Attention should be formulated to enhance self-efficacy and social support, thereby reducing their self-regulation fatigue.
Analysis of the status quo of the perceptions and challenge of general practitioner in rare disease management
HU Bolin, XUAN Jinyan, SHEN Jiaying, HUANG Zhenhua, SUN Junsheng, REN Jingjing
2025, 23(8): 1346-1349. doi: 10.16766/j.cnki.issn.1674-4152.004131
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  Objective  To study the perception status of general practitioners about rare disease management, analyze the views about rare disease management of general practitioners, clarify the current status of the recognition and challenges of general practitioners in rare disease management, and provide reference opinions for improving the ability of general practitioners to manage rare diseases.  Methods  After literature review and expert consultation, preliminary items of the scale were determined. The questionnaire was then subjected to reliability and validity analysis to form the final questionnaire, targeting general practitioners and using the Questionnaire Star platform for completion. Analyzed using SPSS 27.0 statistical software.  Results  The scale was preliminarily determined to consist of 25 items in 3 dimensions, including basic information, cognitive status, and opinions on rare disease management, with a Cronbach's α coefficient of 0.895. Confirmatory factor analysis indicated good model fit. A total of 434 questionnaires were confirmed to be valid. Only 28.57% (124/434) passed, and there was no statistically significant difference in the cognition of rare diseases among general practitioners with different demographic characteristics (P>0.05). In their views on the management of rare diseases, the respondents believed that the difficulty of general practitioners in managing patients with rare diseases was to establish a diagnosis, monitor treatment, and support and manage complications. At the same time, the respondents believed that if general practitioners want to do a good job in the comprehensive management of patients with rare diseases, they need to "strengthen the follow-up of patients with rare diseases to ensure medication compliance. The rare disease management team, led by general practitioners, can provide continuous care for patients and help patients communicate with experts, coordinate complex management, and provide psychological support and professional guidance. Closely monitor the changes in the patient's condition, detect complications in time, carry out physical and psychological rehabilitation for patients with rare diseases, and refer patients with rare diseases with changes in their condition in a timely manner."  Conclusion  At present, general practitioners generally have insufficient understanding of rare diseases. The main challenges in rare disease management lie in the diagnosis, treatment, support and management of complications of rare diseases. Training should be strengthened to enhance the ability of general practitioners to manage rare diseases.
Application of IoT-based respiratory rehabilitation in patients with community-acquired pneumonia
XIE Yajing, CHEN Le, WANG Liya, ZHANG Jinjia, ZHAO Wenwen, YE Liyun, WANG Rongying
2025, 23(8): 1350-1355. doi: 10.16766/j.cnki.issn.1674-4152.004132
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  Objective  To investigate the effects of Internet of Things (IoT)-based respiratory rehabilitation training on clinical symptoms, pulmonary function, and laboratory parameters in patients with community-acquired pneumonia (CAP).  Methods  A total of 176 CAP patients admitted to a Level A Tertiary hospital in Hebei Province between July 2023 and December 2024 were enrolled in the study, and assigned to either an experimental group (n=88) or a control group (n=88) using a random number table method. The two groups received standard medical care; however, the experimental group also additionally underwent IoT-based respiratory training with a portable breathing device. A comprehensive evaluation of the clinical outcomes was conducted, encompassing various parameters, such as physiological indicators, the severity of symptoms, laboratory markers, imaging findings, pulmonary function and nutritional status. These outcomes were assessed at three distinct time points: baseline, 7 days post-intervention, and 14 days post-intervention.  Results  At the 7-day follow-up, the experimental group exhibited significant improvements compared to controls in CRP reduction [6.00 (3.00, 11.00) mg/L vs. 6.00 (5.00, 15.00) mg/L], PCT normalization [0.03 (0.02, 0.05) ng/mL vs. 0.03 (0.02, 0.08) ng/mL], forced expiratory volume in the first second [FEV1, 2.56 (1.96, 3.20) L vs. 2.23 (1.03, 2.78) L], maximum inspiratory pressure [MIP, 50 (36, 71) cmH2O vs. 41 (32, 64) cmH2O, 1 cmH2O=0.098 kPa], and cough severity scores [7 (7, 8) vs. 10 (9, 11), P < 0.05]. By day 14, further enhancements were observed in FEV1 [2.83 (2.15, 3.44) L vs. 2.59 (1.84, 3.14) L], forced vital capacity [FVC, 4.10 (3.28, 5.02) L vs. 3.17 (2.38, 4.06) L], MIP [64 (52, 78) cmH2O vs. 60 (46, 72) cmH2O], maximum expiratory pressure [MEP, 88 (76, 117) cmH2O vs. 80 (62, 108) cmH2O] with all comparisons showing statistical significance (P < 0.05). During the intervention period, no adverse reactions occurred in either the experimental group or the control group.  Conclusion  The findings of this study demonstrate that IoT-facilitated respiratory rehabilitation effectively alleviates systemic inflammation, improves pulmonary mechanics, and accelerates clinical recovery in CAP patients.
Analysis of intervention effect of group psychological counseling on emotional intelligence of lower grade students in primary school
CHENG Bo, ZHANG Wencai
2025, 23(8): 1356-1359. doi: 10.16766/j.cnki.issn.1674-4152.004133
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  Objective  To explore the effects of a group counseling emotional program-on the emotional intelligence of 7-9-year-old lower grades elementary school students to provide lessons for enhancing children's social-emotional competence and reducing behavioral problems.  Methods  Using the convenience sampling method, 65 lower primary school students enrolled in an off-campus educational institution in Beijing from April to June 2023 were selected as the study subjects and divided into an intervention group and a control group according to the enrolled courses. Each group was enrolled in 1 session per week for 90 minutes for a total of 11 sessions. Emotional intelligence was measured in both groups before and after the intervention, using the National Elementary School Children's Emotional Intelligence Scale for student self-assessment and the social competence and behavior evaluation-30 for parent other-assessment. Ultimately, 25 students in the intervention group and 35 in the control group were included in the study, and 24 parents in the intervention group and 34 in the control group were included in the study.  Results  For students' self-assessment, the intervention group's self-emotional management scores were significantly higher than the pre-intervention scores after the intervention [(14.44±3.90) points vs. (12.24±4.23) points], and the difference was statistically significant (t=-2.400, P=0.024); the self-motivation scores of the intervention group after the intervention [(19.60±5.12) points vs. (17.72±5.07) points], and the difference was statistically significant (t=-2.656, P=0.014). For the parent-other assessment, analysis of covariance showed that the difference between the post-intervention anger aggression intervention group [(25.92±5.76) points], controlling for the pre-intervention level, and the control group [(21.00±6.15) points], was statistically significant (F=9.264, P=0.004).  Conclusion  Group counseling is more effective in improving students' self-emotion awareness and self-emotion management and reducing anger aggression levels.
The impact of online and offline peer education based on the IMB model on loneliness in Alzheimer's disease patients
LUO Ping, LING Yingchun, JIN Mingmin, YAN Rong
2025, 23(8): 1360-1363. doi: 10.16766/j.cnki.issn.1674-4152.004134
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  Objective  Given the prevalence of loneliness among Alzheimer's disease (AD) patients, the objective of this study is to explore the effectiveness of a combination of online and offline peer education interventions based on the information motivation behavioral skills (IMB) model in improving loneliness among this population.  Methods  A total of 182 AD patients admitted to Shaoxing Seventh People's Hospital between February 2023 and June 2024 were enrolled in the study and randomly assigned to either a control group (n=91) receiving standard care or an intervention group (n=91) receiving IMB-based hybrid peer education alongside routine care. The severity of loneliness was assessed prior to and following intervention using the University of California Los Angeles loneliness scale (ULS), the Alzheimer's disease knowledge scale (ADKS), and the instrumental activities of daily living (IADL) scale, respectively. Disease-related knowledge and functional independence were also assessed.  Results  Following a six-month intervention period, the ULS score of the observation group patients was (8.18±2.71) points, which was lower than the control group's (12.85±3.68) points, the difference is statistically significant (P < 0.05); The ADKS score of the observation group was (18.54±3.14) points, which was higher than the control group's (15.72±3.02) points, the difference is statistically significant (P < 0.05);The score of the IADL for the observation group was (11.75±2.58) points, which was higher than that of the control group (9.83±2.46) points, the difference is statistically significant (P < 0.05).  Conclusion  The IMB-model-guided hybrid peer education approach effectively mitigates feelings of loneliness, enhances disease understanding, and promotes functional autonomy in patients with AD.
Nursing effect of MDT model health education combined with out-of-hospital continuous intervention on patients with modified radical mastectomy for breast cancer
SHI Xinru, WANG Fang, MA Xiaolei
2025, 23(8): 1364-1368. doi: 10.16766/j.cnki.issn.1674-4152.004135
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  Objective  To explore the intervention effect of multidisciplinary collaboration (MDT) model health education combined with out-of-hospital continuous intervention on patients with modified radical mastectomy for breast cancer.  Methods  A total of 114 patients with modified radical mastectomy for breast cancer admitted to Zhangjiakou First Hospital from June 2020 to June 2022 were selected as the research objects. The patients were divided into routine group (57 cases, routine health education) and MDT group (57 cases, MDT mode health education) by random number table method. The two groups were followed up for 6 months after discharge, during which continuous intervention outside the hospital was performed. The complications, hospitalization, psychological status, health behavior, health knowledge score, shoulder joint function recovery and compliance behavior were compared between the two groups.  Results  The incidence of postoperative complications in the MDT group (10.53%, 6/57) was lower than that in the conventional group [24.56% (14/57), χ2=9.860, P=0.002]. The hospitalization time of the MDT group was shorter than that of the conventional group, and the hospitalization cost was less than that of the conventional group (P < 0.05). After 6 months of follow-up, the scores of self-rating depression scale (SDS) and self-rating anxiety scale (SAS) in the MDT group were lower than those in the conventional group; the health promotion lifestyle rating scale (HPLS-Ⅱ) and health knowledge score were higher than those in the conventional group (P < 0.05). After 6 months of follow-up, the proportion of patients with normal shoulder joint activity in the two groups was higher than that in the routine group (P < 0.05). During the follow-up period, the scores of compliance behaviors in the MDT group were higher than those in the conventional group (P < 0.05).  Conclusion  MDT mode health education combined with continuous intervention outside the hospital can improve the mastery of health knowledge, compliance behavior and health behavior level of patients with modified radical mastectomy for breast cancer, improve their psychological state, promote the recovery of shoulder joint function, shorten the hospitalization time and reduce the hospitalization cost.
The impact of human functional rehabilitation training on the psychological capital and shame of patients with schizophrenia in remission period
YAO Guoli, CHEN Linxia, MA Lingya
2025, 23(8): 1369-1372. doi: 10.16766/j.cnki.issn.1674-4152.004136
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  Objective  Schizophrenia patients continue to grapple with the repercussions of their condition during periods of remission, they encounter significant challenges in terms of their psychological and social well-being. Conventional rehabilitation methodologies have been found to be ineffective in enhancing psychological capital and reducing feelings of shame. The present study proposes a novel human functional rehabilitation training model, the impact of which on the psychological capital and shame of schizophrenia patients in remission is then analyzed. This analysis provides new intervention methods for schizophrenia rehabilitation.  Methods  The present study selected 197 patients with schizophrenia in remission who were admitted to Shaoxing Seventh People ' s Hospital from January 2023 to December 2024 as subjects for a research study. The subjects were randomly divided into two groups: a control group (n=98) and an observation group (n=99). The control group received routine rehabilitation training, while the observation group received human functional rehabilitation training. Both groups were the recipients of continuous intervention for one month. A comparison should be made of the psychological capital and shame levels of two groups of patients before and after intervention.  Results  Following the implementation of the intervention, both patient groups demonstrated an increase in positive psychological capital scale (PPQ) scores. However, the total score of the observation group was found to be (118.96±12.35) points, which exceeded that of the control group [(102.73±15.42) points]. This discrepancy was found to be statistically significant (F=11.153, P < 0.001); After intervention, the total score of the Chinese version of the shame scale for patients with mental disorders (SSMI-C) in the observation group was found to be (45.67±5.75) points. This result was lower than that of the control group, which was (53.97±8.02) points. The difference between these two groups was statistically significant (F=8.376, P < 0.001).  Conclusion  Human functional model rehabilitation training can significantly alleviate the stigma of schizophrenia patients, and at the same time effectively enhance their positive psychological capital levels such as self-efficacy, hope, resilience and optimism, thereby promoting the comprehensive recovery of patients.
The value of left atrial appendage orifice diameter in predicting peridevice leak after the implantation of WATCHMAN occluder
WANG Zhao, WANG Binhao, CHU Huimin, ZHANG Shengmin
2025, 23(8): 1373-1376. doi: 10.16766/j.cnki.issn.1674-4152.004137
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  Objective  Percutaneous left atrial appendage (LAA) closure has been proved to be effective in preventing ischemic stroke for patients with nonvalvular atrial fibrillation (AF). Peridevice leak (PDL) is an important parameter to determine the successful implantation of the occluder. This study aimed to investigate the value of LAA orifice diameter in predicting PDL after the implantation of WATCHMAN occluder.  Methods  A total of 293 patients with AF who underwent LAA closure with WATCHMAN occluder and finished transesophageal echocardiography (TEE) follow-up in the Arrhythmia Center of First Affiliated Hospital of Ningbo University between January 2015 and December 2020 were included. The study population was divided into two groups due to the PDL detected by TEE: PDL < 3 mm group (n=253) and PDL≥3 mm group (n=40). LAA orifice diameter was compared between groups. The relationship between LAA orifice diameter and PDL≥3 mm was analyzed by multivariable logistic regression. The accuracy of LAA orifice diameter for predicting PDL≥3 mm was evaluated by ROC curve.  Results  LAA maximal orifice diameter in the PDL≥3 mm group was larger than that in the PDL < 3 mm group [(24.4±3.3) mm vs. (22.3±3.7) mm, P=0.001]. Multivariable logistic regression showed that LAA maximal orifice diameter was associated with PDL≥3 mm (OR=1.192, 95% CI: 1.060-1.340, P=0.003). In the ROC analysis, area under the curve was 0.675 (95% CI: 0.590-0.761, P < 0.001). The cut-off value of LAA maximal orifice diameter for predicting PDL≥3 mm was 23 mm, yielding a sensitivity of 72.5% and a specificity of 56.1%.  Conclusion  LAA orifice diameter has a reference value for predicting significant PDL after the implantation of WATCHMAN occluder in patients with nonvalvular AF.
The molecular epidemiology of carbapenem-resistant Citrobacter freundii in Lishui City
GONG Zhiming, HUANG Feiwu, ZHAO Yunan, CHEN Jiaoli, ZHAO Xinmi, XU Jianfen, HUANG Jiansheng
2025, 23(8): 1377-1381. doi: 10.16766/j.cnki.issn.1674-4152.004138
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  Objective  To analyze the resistance mechanisms and molecular epidemiological characteristics of carbapenem-resistant Citrobacter freundii (CRCF), providing laboratory evidence for clinical prevention and treatment.  Methods  CRCF strains collected from January 2016 to December 2022 in Lishui Central Hospital were tested for MIC using the broth microdilution method. PCR was employed to detect carbapenemase genes (blaKPC-2, blaNDM-1, blaIMP-1, blaVIM-1, blaOXA-48), and the genetic background of resistance genes. Conjugation and transformation experiments were conducted to analyze plasmid transferability and plasmid typing. MLST typing was combined with CRCF strains from the PubMed database for phylogenetic analysis.  Results  The resistance rates of 17 CRCF isolates were 100% (17/17) to trimethoprim/sulfamethoxazole; 76.5% (13/17) to ceftazidime, cefepime, and aztreonam; 82.4% (14/17) to meropenem; 64.7% (11/17) to imipenem; 94.1% (16/17) to piperacillin/tazobactam; 58.8% (10/17) to LVX; 47.1% (8/17) to amikacin; 11.8% (2/17) to polymyxin; and the lowest resistance rate was to tigecycline at 5.9% (1/17). Among these strains, 11 carried blaNDM-1, 5 carried blaKPC-2, and 1 carried blaIMP-4. 54.5%(6/11)of blaNDM-1 were located on IncX3 plasmids, while all of blaKPC-2 were located on IncFⅡ plasmids. The strains were classified into 14 ST types, with phylogenetic analysis indicating sporadic distribution.  Conclusion  CRCF in Lishui exhibits high resistance to carbapenem antibiotics, primarily carrying blaNDM-1 and blaKPC-2, presenting a sporadic epidemic pattern.
Ancient and modern studies on acupuncture for anxiety and depression from the perspective of spleen and stomach meridians
FENG Peipei, YU Wei, HE Min, SHEN Zui
2025, 23(8): 1382-1386. doi: 10.16766/j.cnki.issn.1674-4152.004139
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In recent years, the incidence of anxiety and depression has continued to rise, with an increasing number of affected patients seeking treatment in acupuncture departments. Currently, clinical acupuncture treatment for anxiety and depression focused on the Heart Meridian (Pericardium Meridian) and Liver Meridian, aiming to calm the mind and spirit while relieving liver stagnation and depression. However, patients with anxiety and depression in acupuncture department are not experiencing these symptoms for the first-time, rarely, they have endured long-term or recurrent conditions. In light of the principles that "excessive thinking injures the spleen" and "prolonged illness injures the spleen", the clinical treatment of anxiety and depression with acupuncture needs to emphasize the regulation of the spleen-stomach meridians (acupoints). However, relatively little research has investigated the treatment of anxiety and depression from the perspective of the spleen-stomach meridians (acupoints). Traditional Chinese medicine (TCM) has a long-standing understanding of anxiety and depression, although it does not refer to them explicitly as "anxiety" or "depression". Instead, relevant symptoms are dispersed among diseases such as "dian kuang" (mania and delirium) and "yu zheng" (depression syndrome). This article begins by examining records from classical Chinese medical literature to explore the relationship between the spleen-stomach meridians (acupoints) and anxiety and depression from four aspects: the direct correlation with anxiety and depression, the relationship through the regulation of qi and blood, and their indirect connections through the heart/liver with anxiety and depression. It excavates and summarizes the relevance of the spleen-stomach meridians (acupoints) to anxiety and depression within the theoretical framework of TCM theory. Finally, from the perspective of modern biomedical science, the article focuses on the gut microbiota-vagus nerve-brain axis to elucidate the potential material basis and scientific underpinnings of the association between the spleen-stomach meridians (acupoints) and anxiety and depression. In summary, this article aims to deepen the clinical application of acupuncture in the prevention and treatment of anxiety and depression by integrating classical theory with modern research. It provides diagnostic and therapeutic insights and contributes to the development of acupuncture treatment strategies for mental health conditions.
Advances in surgical treatment strategies for common bile duct stones
DING Yihui, XU Haoyu, MA Lu, SHE Zhanfei
2025, 23(8): 1387-1390. doi: 10.16766/j.cnki.issn.1674-4152.004140
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Choledocholithiasis is a common and recurrent biliary disease. It can cause severe abdominal pain due to bile duct obstruction and may even to acute obstructive suppurative cholangitis, posing serious threatens to human health. The treatment standard is complete stone removal upon diagnosis. With the increasing incidence of choledocholithiasis, treatment methods have continuously evolved. Although the ultimate goal of all treatment methods is to achieve complete clearance of stones from the common bile duct, each approach differs in terms of the equipment used, as well as the entry site and pathway into the bile duct. This review provides a detailed overview of the clinical treatments, including: percutaneous transhepatic papillary balloon dilation (PTPBD) via the percutaneous transhepatic route, laparoscopic common bile duct exploration (LCBDE) through direct access to the common bile duct, laparoscopic transcystic common bile duct exploration (LTCBDE) via the cystic duct, T-tube tract stone extraction via a pre-existing sinus tract, and endoscopic retrograde cholangiopancreatography (ERCP) through the endoscopic retrograde pancreatobiliary route.
Exploring the effectiveness of seated knee adjustment method for treating knee osteoarthritis based on anybody simulation technology
LI Jie, SUN Wuquan, CHEN Jintian, ZHENG San, LI Jiangshan, FU Yangyang
2025, 23(8): 1391-1394. doi: 10.16766/j.cnki.issn.1674-4152.004141
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  Objective  To explore the effects of the seated knee adjustment method on lower limb joint forces and muscle forces in patients with unilateral knee osteoarthritis (KOA) and to evaluate its biomechanical characteristics using computer simulation.  Methods  A total of 20 patients diagnosed with unilateral KOA who visited the outpatient clinic of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, from August 2023 to March 2024, were included. The intervention involved the seated knee adjustment method, administered twice weekly for 5 weeks. Gait data were collected using the Vicon Nexus system, and the AnyBody software was used for biomechanical simulation to analyze lower limb joint forces and muscle forces.  Results  The clinical outcomes indicated a total efficacy rate of 100% (20/20 cases) after intervention. Post-intervention VAS pain scores [3.00 (2.00, 3.00)] and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores (34.10±14.14) were significantly lower than pre-intervention VAS scores [5.00 (3.00, 6.25)] and WOMAC scores (42.80±17.49, P < 0.05). Significant differences were observed in the peak relative joint forces on the vertical axis and frontal axis of the affected knee and the vertical axis of the unaffected knee before and after the intervention (P < 0.05). Additionally, the peak relative muscle forces of the vastus lateralis superior, rectus femoris, tibialis anterior, semitendinosus, and tensor fasciae latae of the affected knee, as well as the vastus lateralis superior and rectus femoris of the unaffected knee, showed significant differences before and after the intervention (P < 0.05).  Conclusion  The seated knee adjustment method effectively alleviates knee pain, improves daily functional activities, and optimizes joint force balance while enhancing muscle coordination in patients with KOA.
Investigation and analysis of satisfaction among general practice ordered students in standardized residency training program in Gansu province
LI Yurong, YANG Xiao, YANG Suigang, GAO Chen, WEI Zihui
2025, 23(8): 1395-1398. doi: 10.16766/j.cnki.issn.1674-4152.004142
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  Objective  To investigate and analyze the existing problems in the residency training for general practice ordered students in Gansu Province and propose corresponding suggestions for improvement.  Methods  A questionnaire survey was conducted on the general practice ordered students from the 2020-2021 grade in Gansu Province. A total of 279 questionnaires were distributed, with 223 valid questionnaires were collected. Using SPSS 25.0 software, the factors influencing teaching satisfaction were analyzed by multivariate logistic regression. The satisfaction survey results were analyzed using the chi-square test and Fisher ' s exact test.  Results  The adequacy of teaching equipment, the fulfillment of clinical and community teaching tasks, teaching management quality, and teaching execution significantly influenced the satisfaction of with teaching mentors (P < 0.05). In the satisfaction survey, general practice ordered trainees expressed a strong demand for diversified clinical teaching methods (68.60%, 153/223) and called for improvements in their remuneration and living conditions (74.43%, 166/223). In the residency teaching work, the majority agreed that their overall competencies had improved significantly, especially in their clinical experience (83.41%, 186/223) and practical skills (76.23%, 170/223). However, 81.61% (182/223) of them believed that their learning motivation needs to be further improved. During the investigation, the residents-in-training suggested increasing the rotation in clinical departments and outpatient teaching practice (59.19%, 132/223), increasing electrocardiography and imaging diagnosis (61.43%, 137/223), and improving remuneration and performance-based allocation (60.54%, 135/223).  Conclusion  The overall satisfaction with the general practice residency training in Gansu Province is relatively high. The article focuses on suggestions for feasible recommendations for optimizing rotation schedules of general practice residency training, enriching training content, and diversifying training modes. In order to improve the quality of residency training, it is necessary to strengthen ideological and political education and foster a stronger sense of professional identity among residents.
Research on the practical effect of strengthening implicit competence teaching in standardized training of general practitioners
WANG Shuoshan, YANG Xiansheng, YAN Mei, DING Chan, FU Yue
2025, 23(8): 1399-1403. doi: 10.16766/j.cnki.issn.1674-4152.004143
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  Objective  At present, there is little application of the implicit competence teaching model in the standardized training of residents at home and abroad. This paper aims to explore the practical effect of the implicit competence teaching model in the standardized training of general residents.  Methods  Thirty residents of grade 2022, 2023 and 2024 in the General Practice Department of Foshan First People ' s Hospital who were receiving national standardized training were selected as the research objects, and those candicates were divided into control group and research group by random number table method. The research group adopted the intensive implicit competence teaching mode, while the control group adopted the conventional teaching mode. After a 5-month (July 2024-November 2024) training, the implicit competence and post competence of general practitioners were evaluated.  Results  The results of the repeated measurement data subject internal effect test showed that there were statistically significant differences in the implicit competence and post competence scores of the two groups of general practitioners at different measurement time points (P < 0.001). There were significant differences in the implicit competency scores between the two groups at the third month and the fifth month [(54.60±3.18) points vs. (51.87±2.50) points; (61.07±3.35) points vs. (56.17±5.83) points, P < 0.05]. There were significant differences in post competency scores between the two groups at the third month and the fifth month [(46.70±1.99) points vs. (44.95±1.86) points; (48.52±2.17) points vs. (46.04±2.33) points, P < 0.05]. The estimated marginal means of the research group showed a steeper trend over time compared to the control group.  Conclusion  The effect of enhancing implicit competence is more significant than that of general practitioners with conventional teaching mode.
Meta-analysis of the efficacy and safety of tranexamic acid in the perioperative period of posterior lumbar fusion
Aikebaierjiang·Aisaiti, Abduwupur·Haibeier, GU Wenzhu, Kutiluke·Shoukeer, Shalayiding·Aierxidin, Alimujan·Abudurousuli, LUO Xuefeng
2025, 23(8): 1404-1410. doi: 10.16766/j.cnki.issn.1674-4152.004144
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  Objective  To conduct a meta-analysis assessing the effectiveness and safety of tranexamic acid (TXA) during the perioperative period of posterior lumbar interbody fusion (PLIF), investigating its role in reducing surgical bleeding and promoting patient recovery.  Methods  PubMed, Cochrane Library, EMbase, CNKI, Wanfang, and VIP databases were searched for randomized controlled trials of tranexamic acid in the perioperative period of PLIF, and 22 studies (2 577 patients, 1 300 tranexamic acid group and 1 277 control group) were selected. Endnote X9 was used to organize the literature, Revman 5.3 software was used to analyze the data, and the detection indicators covered intraoperative blood loss, total blood loss, etc.  Results  The application of TXA to PLIF significantly reduced intraoperative and total blood loss and postoperative drainage, shortened the operation time, reduced the blood transfusion rate compared to the control group, and also reduced the postoperative hemoglobin loss and hematocrit, shortened the hospital stay, and did not increase the risk of postoperative complications.  Conclusion  The application of TXA in the perioperative period of PLIF can reduce the related blood loss and blood transfusion rate, shorten the operation time, improve the change of indicators, and does not increase the risk of postoperative complications, which supports clinical promotion.
The Correlation among postoperative infection, coping modes, and quality of life in patients with urinary tract obstruction
ZHAO Yingying, LI Shuang, ZHANG Xin, GAO Xuejun, LI Tao
2025, 23(8): 1411-1414. doi: 10.16766/j.cnki.issn.1674-4152.004145
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  Objective  To analyze the correlation among postoperative infection, coping modes, and quality of life in patients with urinary tract obstruction so as to provide a basis for postoperative management.  Methods  The clinical data of 292 patients with urinary tract obstruction admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from June 2022 to June 2024 were retrospectively analyzed. The postoperative infection, medical coping modes questionnaire (MCMQ), and short form 36 questionnaire (SF-36) were recorded. The relationships among postoperative infection, coping modes, and quality of life were analyzed.  Results  Postoperative infection occurred in 31 (10.62%) of 292 patients with upper urinary tract obstruction. MCMQ scores for confrontation, avoidance, and resignation were (24.12±3.41) points, (21.46±3.18) points, and (15.63±2.99) points, respectively. SF-36 scores of health perception, physical health, mental function, attitude toward material life, and social function were (72.78±7.07) points, (72.80±7.95) points, (73.71±7.84) points, (74.73±7.18) points and (76.11±7.17) points, respectively. Correlation analysis showed that postoperative infection was negatively correlated with quality of life (r=-0.447, P=0.003). Confrontation scores in MCMQ were positively correlated with quality of life, while avoidance and resignation scores were negatively correlated (r=0.351, -0.301, -0.374, respectively, all P < 0.05). The structural equation model showed that postoperative infection directly affected the quality of life of patients with upper urinary tract obstruction, and indirectly affected it through the coping modes of confrontation, avoidance, and resignation. Multivariate analysis showed that age, marital status, family monthly income, comorbidities, co-infection, and coping modes as important factors affecting quality of life (P < 0.05).  Conclusion  Postoperative infection and coping modes of patients with urinary tract obstruction significantly affect the quality of life. Targeted interventions addressing postoperative infection and adverse coping modes of patients are essential for improving their quality of life.
Innovative practice of project-based model to enhance patients' medical experience
LI Xinyi, CHEN Ye, PENG Hong, WU Jiayu
2025, 23(8): 1415-1419. doi: 10.16766/j.cnki.issn.1674-4152.004146
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The enhancement of patient experience constitutes a prerequisite for the advancement of hospitals and signifies a pivotal aspect of hospital public welfare. In recent years, with the advent of personalized and high-quality medical services, the government has promulgated a series of documents encouraging public hospitals to continuously improve medical services and enhance patient experience. A significant number of medical institutions in China have embarked on a systematic exploration of the practice of patient experience management. In light of the prevailing domestic and foreign patient experience management models both domestically and internationally, Shanghai Chest Hospital has pioneered a novel "3 + 3 + 3" patient experience operation management model. This model employs a project-based approach, entailing a three-tiered organizational structure comprising the Patient Experience Management Committee, the Patient Experience Department, and the Work Group. It also involves the coordinated operation of the Management Committee, Functional Departments, and Social Forces, and a three-stage workflow encompassing the identification, analysis, and resolution of issues. Concurrently, the "114" basic project has been initiated to enhance patient experience encompassing the establishment of an experience exchange platform, establishing a set of experience evaluation tools, and the formation of four service teams. The implementation of project leadership, the integration of expertise and practice, and defect management has resulted in a steady increase in patient satisfaction within the hospital over the past several years. According to the findings of a patient satisfaction survey administered by the Shanghai Association for the Promotion of Medical and Health Conduct, outpatient patient satisfaction levels have exhibited an upward trajectory, rising from 96.72% in 2021 to 98.82% in 2023. In contrast, patient satisfaction levels have remained consistently high, maintaining around 99.9% over the observed period. The hospital' s initiatives in patient experience management have yielded commendable outcomes, contributing to the enhancement of medical services and the advancement of the hospital. These efforts have also served as a model and source of inspiration for the patient experience management practices of other medical institutions.
Influence of the motivation of rural-ordered government-funded medical students in Shandong Province on their willingness to fulfill commitments
DING Lili, ZHAO Fei, XIE Ruirui, WU Bingyi
2025, 23(8): 1420-1424. doi: 10.16766/j.cnki.issn.1674-4152.004147
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  Objective  To explore the impact of application motivations on the commitment fulfillment willingness of government-funded medical students in Shandong Province, and provide reference for enhancing their commitment fulfillment willingness and cultivation quality.  Methods  A self-designed questionnaire was used to investigate 2 058 government-funded medical students from grade 2019 to grade 2022 in five medical colleges and universities in Shandong Province. Descriptive statistical analysis, one-way analysis of variance and multiple linear regression model were used to analyze the influence of the motivation of government-funded medical students on their willingness to perform the contract.  Results  The results of one-way analysis of variance showed that there were statistically significant differences in the scores of willingness to fulfill the contract between parents' opinions, government arrangement of work and free study policy (P < 0.001). There were also statistically significant differences in the scores of willingness to implement the policy and whether the place of origin and the place of destination were matched (P < 0.001). The regression results of the willingness of medical students to fulfill the contract showed that the two motivations of government arranged work (P=0.021) and free study policy (P=0.001) had a significant impact on the willingness of medical students to fulfill the contract. Policy identification had a significant effect on the willingness of medical students to perform the contract (P < 0.001). The interaction term between parental opinions and policy identification has a significant impact on willingness to fulfill the agreement (P=0.025).  Conclusion  The examination motivation, policy identification and matching of students' place of origin and orientation of public medical students have an important impact on their willingness to perform the contract.
Quantitative assessment strategy of the impact of intervention strategies on post-operative stigma and self-efficacy in breast cancer patients
JIANG Lin, XIE Wenli, ZHAO Jing, WANG Jing, LIANG Yu, CHEN Xia
2025, 23(8): 1425-1429. doi: 10.16766/j.cnki.issn.1674-4152.004148
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  Objective  To construct a quantitative assessment strategy for breast cancer patients and to explore the application effect of nursing intervention based on this strategy in breast cancer patients. The ultimate aim of this research is to improve the psychological state of breast cancer patients after surgery.  Methods  From January to June 2024, a total of 65 female patients diagnosed with breast cancer were selected for inclusion in the study. All of the patients were undergoing surgical intervention in the Department of Breast Surgery at the First Affiliated Hospital of the University of Science and Technology of China. According to the admission time, 32 patients admitted from January to March 2024 were selected as the observation group. A control group of 33 patients was admitted between April and June 2024. The observation group was administered a quantitative assessment strategy intervention grounded in perioperative routine nursing, while the control group received perioperative routine nursing. The intervention was conducted over a period of four weeks. Prior to the implementation of the intervention and four weeks following its completion, the social impact scale (SIS) and the general self-efficacy scale (GSES) were utilized to assess the levels of stigma and self-efficacy among patients in the two respective groups.  Results  A total of 60 patients participated in the study, with 30 patients belonging to the observation group and 30 patients belonging to the control group. Following the intervention, no statistically significant change in stigma score was observed in the control group when compared with the pre-intervention score (P>0.05). However, a statistically significant decrease in stigma score was noted in the observation group (P < 0.05). Furthermore, the observed stigma score in the observation group was lower than that of the control group, with a statistically significant difference (P < 0.001). The self-efficacy score of the control group demonstrated no significant change in comparison with its value prior to the intervention (P>0.05). Conversely, the self-efficacy score of the observation group exhibited a significant increase (P < 0.05) in comparison with its value prior to the intervention. Furthermore, the self-efficacy score of the observation group was higher than that of the control group, and the difference between these two groups was found to be statistically significant [(28.93±4.93) points vs. (21.60±5.82) points, F=5.167, P < 0.001].  Conclusion  The implementation of a quantitative assessment strategy intervention can reduce postoperative stigma, enhance self-efficacy, improve psychological state and it is worthy of clinical application.
Application of professional hierarchical nursing scheme in patients with severe craniocerebral trauma before operation
XU Xueqin, XU Yanrong, YANG Yongjie
2025, 23(8): 1430-1434. doi: 10.16766/j.cnki.issn.1674-4152.004149
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  Objective  To explore the effect of a professional hierarchical nursing program in the preoperative application of severe traumatic brain injury (sTBI) patients in terms of first-aid effect, first-aid time, nursing quality, and complication rate.  Methods  From January 2023 to December 2024, 82 patients with severe traumatic brain injury (sTBI) were selected from Shanxi Bethune Hospital. Using a random number table method, participants were allocated to either the observation group (n=41) or the control group (n=41). The control group underwent standard nursing protocols, whereas the observation group received a professional hierarchical nursing approach. The first aid effect, first aid time, quality of care, complication rate, Glasgow coma scale (GCS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), and National Institutes of Health stroke scale (NIHSS) scores before and after first aid were compared between the two groups.  Results  The observation group exhibited a significantly higher rescue success rate of 97.56% (40/41) compared to the control group' s 80.49% (33/41, χ2=4.493, P=0.034). The observation group demonstrated shorter emergency response time, rescue duration, examination time, consultation waiting time, and ward handover time than the control group (P < 0.05). Scores across all dimensions of nursing quality were higher in the observation group compared to the control group (P < 0.05). The incidence of complications was lower in the observation group than in the control group (P < 0.05). Post-rescue assessments revealed elevated GCS scores and reduced APACHE Ⅱ and NIHSS scores in both groups compared to pre-rescue baseline values. Between-group comparisons showed the observation group had significantly higher GCS scores and lower APACHE Ⅱ, NIHSS scores than the control group (P < 0.05).  Conclusion  The professional hierarchical nursing scheme applied to sTBI patients before surgery can effectively improve the first-aid effect, shorten the first-aid time, reduce complications, promote the recovery of patients, reduce the severity of the disease and the degree of neurological impairment, and improve the quality of nursing.
Analysis of patient privacy protection behavior and its influencing factors among operating room nurses with high privacy protection cognitive level
YING Xiaoye, YU Ying, MAO Chenjing, LIN Yaqin, GAO Xiaomin, REN Ying
2025, 23(8): 1435-1439. doi: 10.16766/j.cnki.issn.1674-4152.004150
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  Objective  To explore the current situation and influencing factors of patient privacy protection behavior of operating room nurses with high privacy protection cognitive level, and provide some references for the clinical management of operating room nurses.  Methods  A total of 306 operating room nurses who had participated in patient privacy protection training in nearly one year were selected between April and May 2024 by convenient sampling. The basic data questionnaire, patient privacy protection scale, Jefferson empathy scale and ethical sensitivity scale were used in the investigation. The cluster analysis was used to classified nurses' patient privacy protection behavior, and the logistic regression was used to analyze the influencing factors of privacy protection behavior.  Results  The score of patient privacy protection behavior was 108.53±15.67. The operating room nurses were divided into high-level group of 207 nurses (67.6%) and median group of 99 nurses (32.4%) by 104 boundaries. The results of the logistic regression showed that there had been patient privacy-related medical disputes / nurse-patient discord, ethical sensitivity, empathy, operating room workload tolerance and operating room supporting facilities related to privacy protection were the factors affecting the patient privacy protection behavior of operating room nurses with high cognitive level (P < 0.05).  Conclusion  Managers should face up to the gap between cognition and behavior, and can actively explore methods to promote the patient privacy protection behavior through improving the ethical sensitivity and empathy, regularly assessing the operating room nurse' s workload, ensuring the perfection of privacy and applicability of privacy facilities.
The application of a predictive nursing model based on evidence theory in preventing intraoperative acquired pressure injury in elderly patients with transforaminal lumbar interbody fusion
WU Min, XIE Jingyi, LI Wenwen, LI Lanlan, DONG Zhou, CHENG Huimin
2025, 23(8): 1440-1444. doi: 10.16766/j.cnki.issn.1674-4152.004151
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  Objective  To study the application effectiveness of a predictive nursing model based on evidence theory in preventing intraoperative acquired pressure injury (IAPI) in elderly patients with transforaminal lumbar interbody fusion (TLIF).  Methods  A total of 80 elderly patients who underwent TLIF treatment at the First People' s Hospital of Hefei from February 2021 to February 2024 were enrolled and randomly assigned to a control group (n=40, routine nursing intervention) and an observation group (n=40, predictive nursing model based on evidence theory on the basis of the control group) by random number table method. IAPI, complication rates, pain degree (visual analogue scale, VAS), and low back function (Oswestry disability indexes, ODI) were compared between the two groups.  Results  (1) At 72 h after operation, no significant difference in IAPI location was observed between the two groups (P>0.05), however, the incidence rate of IAPI, injury number, injury area, and complication rate in the observation group were lower than those in the control group (P < 0.05), respectively. (2) The proportion of IAPI classified as grade Ⅲ-Ⅳ in the observation group was lower than that in the other group (P < 0.05). (3) VAS scores decreased in both groups at 30 min, 3 d, and 1 week after surgery, with the observation group showing lower scores (P < 0.05). (4) ODI scores decreased in both groups after the intervention, with significantly lower scores observed in the observation group [pain, (3.31±0.59) points vs. (3.67±0.52) points; personal comprehensive function, (8.14±2.26) points vs. (10.05±2.03) points; single function, (9.28±1.84) points vs. (10.53±1.72) points, all P < 0.05].  Conclusion  The application of predictive nursing model based on evidence theory in elderly patients with TLIF can effectively prevent the occurrence, area, and severity of IAPI, and improve lower back function.
A case of gout management in general practice with multiple comorbidities
ZHANG Zhenglu, WU Yihan
2025, 23(8): 1445-1448. doi: 10.16766/j.cnki.issn.1674-4152.004152
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With the development of the social economy, the incidence of gout has been rising year by year and is closely associated with multiple systemic diseases. This poses higher requirements for the reception, comprehensive treatment, and management abilities of general practitioners. This article details the entire diagnosis and treatment process of a gout patient with multiple comorbidities. After elaborating on the patient' s medical history, a process-based diagnosis was carried out using the patient-centered interview concept and Murtagh' s safe diagnostic strategy, and a personalized treatment plan was formulated through comprehensive consideration. In drug treatment, medications were carefully selected and the interactions between them were weighed. Non-drug treatments covered aspects such as diet, exercise, psychological counseling, and community follow-up. This process fully demonstrated the advantages and value of general practice in the comprehensive management of gout, accumulated valuable experience for the clinical treatment of gout and the handling of patients with multiple comorbidities by general practitioners, which is of great significance in improving the diagnosis and treatment level of gout and related comorbidities at the primary level, and also provides a useful reference for improving the quality of life and prognosis of patients.

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