Table of Content

15 November 2024, Volume 30 Issue 22

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Special Column of Pediatrics

Efficacy of decitabine combined with recombinant human interferon α-2b in children with acute myeloid leukemia

Huan Fangna, Fan Keliao, Wang Hua

2024, 30(22):  3697-3702.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.001

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Objective　To explore the efficacy of decitabine combined with recombinant human interferon α-2b in the treatment of acute myeloid leukemia (AML) in children and its effects on routine blood parameters, immune function, minimal residual disease (MRD) expression, and incidence of adverse reactions. Methods　This study was a randomized controlled trial. A total of 100 children with AML treated at the Department of Oncology and Hematology, Xi'an Children's Hospital from May 2020 to January 2024 were divided into an observation group and a control group with 50 cases in each group according to the random number table method. The control group consisted of 29 boys and 21 girls, aged (9.79±2.60) years. The observation group consisted of 27 boys and 23 girls, aged (9.96±2.35) years. The control group was treated with decitabine at a dose of 15 mg/m² intravenously once a day for 5 days. The observation group was combined with recombinant human interferon α-2b treatment on the basis of the control group: at the same time of decitabine treatment, recombinant human interferon α-2b was given subcutaneous or intramuscular injection at a dose of 3 mIU/m², 3 times a week for 6 weeks. The clinical efficacy, blood routine parameters, immune function, MRD expression, and incidence of adverse reactions were compared between the two groups. χ² test, Fisher exact probability method, and independent sample t test were used. Results　The total effective rate of the observation group was higher than that of the control group [76.00% (38/50) vs. 52.00% (26/50)], with a statistically significant difference (χ²=6.250, P=0.012). Six weeks later, the platelet count, red blood cell count, CD3⁺, and CD4⁺ levels in the observation group were higher than those in the control group [(116.24±12.52) ×10⁹/L vs. (99.20±10.93) ×10⁹/L, (197.12±17.27) ×10⁹/L vs. (169.67±14.64) ×10⁹/L, (58.74±5.40)% vs. (54.94±5.97)%, (34.09±4.26)% vs. (30.37±3.80)%], and the proportion of bone marrow blasts was lower than that in the control group [(9.46±3.13)% vs. (12.90±3.54)%], with statistically significant differences (all P<0.05). There was no statistically significant difference in the rate of MRD positive expression or the incidence of adverse reactions between the two groups (both P>0.05). Conclusion　Decitabine combined with recombinant human interferon α-2b in the treatment of children with AML can effectively improve the clinical efficacy, blood routine parameters, and immune function, with good safety.

Prevention and treatment of engraftment syndrome after non-related umbilical cord blood stem cell transplantation with sivelestat sodium: a case report

Wang Zhaohui, Luo Ronghua, Li Banban, Wang Xudong, Sun Yan, Chang Guangni, Sun Junxia, Liu Yameng, Gao Tingting

2024, 30(22):  3703-3706.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.002

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Construction of an early warning model for poor prognosis of mycoplasma pneumoniae pneumonia with pleural effusion in children based on serum inflammatory markers

Duan Qingqing, Wang Ping, Zhao Ting

2024, 30(22):  3706-3711.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.003

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Objective　To construct an early warning model for poor prognosis of mycoplasma pneumoniae pneumonia (MPP) with pleural effusion in children based on serum inflammatory markers. Methods　The clinical data of 171 children with MPP combined with pleural effusion admitted to Shangluo Central Hospital from July 2021 to December 2023 were retrospectively analyzed, and they were randomly divided into a training set (137 cases) and a validation set (34 cases) according to 8:2. According to the prognosis during hospitalization, the children were divided into a poor prognosis group and a good prognosis group. The clinical data and serum inflammatory markers [interleukin-17A (IL-17A), high mobility group box 1 (HMGB1), procalcitonin (PCT), and serum amyloid A (SAA)] were compared between the poor prognosis group and the good prognosis group in the training set. The influencing factors of poor prognosis in children with MPP combined with pleural effusion were analyzed, and an early warning model for poor prognosis in children with MPP combined with pleural effusion was constructed and verified based on serum inflammatory markers. χ² test and independent sample t test were used. Results　Among the 137 children in the training set, the incidence of poor prognosis was 35.77% (49/137). Among the 34 children in the validation set, the incidence of poor prognosis was 35.29% (12/34). In the training set, there were 29 boys and 20 girls in the poor prognosis group, aged (6.53±1.42) years; there were 45 boys and 43 girls in the good prognosis group, aged (6.99±1.68) years. In the training set, the hospital stay and fever duration of the poor prognosis group were longer than those of the good prognosis group, and the levels of serum D-dimer, IL-17A, HMGB1, PCT, and SAA were higher than those of the good prognosis group (all P<0.05). Logistic regression analysis showed that IL-17A (OR=3.951, 95%CI: 1.737-8.988), HMGB1 (OR=5.339, 95%CI: 2.347-12.145), PCT (OR=4.084, 95%CI: 1.795-9.290), and SAA (OR=4.749, 95%CI: 2.088-10.804) were the influencing factors for poor prognosis in children with MPP combined with pleural effusion (all P<0.05). Using these four influencing factors as predictive variables, a nomogram prediction model was constructed. The sensitivity and specificity of the model in predicting poor prognosis in children with MPP combined with pleural effusion in the training set were 89.80% (95%CI: 76.99%-96.18%) and 92.05% (95%CI: 83.77%-96.47%), and the area under the curve was 0.907 (95%CI: 0.762-0.969); the sensitivity and specificity of the model in predicting poor prognosis in children with MPP combined with pleural effusion in the validation set were 83.33% (95%CI: 50.88%-97.06%) and 90.91% (95%CI: 69.38%-98.41%), and the area under the curve was 0.865 (95%CI: 0.717-0.935). Conclusion　Serum IL-17A, HMGB1, PCT, and SAA are associated with poor prognosis in children with MPP combined with pleural effusion. An early warning model constructed based on serum IL-17A, HMGB1, PCT, and SAA is helpful for early identification of the risk of poor prognosis in children with MPP combined with pleural effusion.

Correlations of HMGB1, PCT, and TGF-β1 levels with the severity and prognosis of neonatal severe pneumonia

Lu Xu, Zhao Yingjuan, Li Danqing

2024, 30(22):  3712-3717.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.004

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Objective　To explore the correlations between high mobility group box 1 (HMGB1), procalcitonin (PCT), and transforming growth factor β1 (TGF-β1) levels with the severity and prognosis of neonatal severe pneumonia. Methods　A total of 90 neonates with severe pneumonia diagnosed and treated in the Department of Neonatology, Xianyang Central Hospital from September 2020 to December 2023 were selected as the study subjects, and were divided into a good prognosis group (64 cases) and a poor prognosis group (26 cases) according to the condition within 30 days of follow-up. Serum HMGB1, PCT, and TGF-β1 levels, Pediatric Critical Illness Score (PCIS), and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score were compared between the two groups on the day of admission (D0) and 1 day after admission (D1), 3 days after admission (D3), 5 days after admission (D5), and 7 days after admission (D7), and the ratio of D7/D1 was calculated (represented as the ratio value). The correlations between the changes of serum indexes and the condition and the influence on prognosis were analyzed. Independent sample t test, χ² test, and Pearson correlation analysis were used. Results　In the poor prognosis group, there were 13 boys and 13 girls, with a gestational age of (37.58±1.13) weeks, aged (11.43±1.47) days. In the good prognosis group, there were 33 boys and 31 girls, with a gestational age of (38.64±1.06) weeks, aged (10.95±1.59) days. The levels of serum HMGB1, PCT, and TGF-β1 and APACHEⅡ score in the poor prognosis group were higher than those in the good prognosis group from D0 to D7, and the PCIS was lower than that in the good prognosis group (all P<0.05). The ratio values of serum HMGB1, PCT, and TGF-β1 were negatively correlated with the PCIS ratio value, and positively correlated with the APACHEⅡ ratio value (all P<0.05). Logistic regression analysis showed that HMGB1-ratio, PCT-ratio, TGF-β1-ratio, PCIS-ratio, and APACHEⅡ-ratio were all influencing factors for poor prognosis in neonates with severe pneumonia (all P<0.05). The areas under the curves of serum HMGB1-ratio, PCT-ratio, and TGF-β1-ratio in predicting poor prognosis in neonates with severe pneumonia were 0.823, 0.820, and 0.923, respectively, and the area under the curve of the combined prediction of the three was 0.977. Conclusions　The levels of HMGB1, PCT, and TGF-β1 in neonatal severe pneumonia are closely related to the severity of the disease and prognosis. The levels of these indicators are higher in the children with poor prognosis, and the ratio values of these indicators can effectively predict the prognosis. The combined prediction of the three indicators has a higher accuracy, which helps to evaluate the condition and prognosis.

Relationships between serum Eotaxin, TNF-α, and LECT2 levels and prognosis in children with bronchial asthma

Zhao Rong, Li Juan, Shen Zheng

2024, 30(22):  3718-3721.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.005

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Objective　To analyze the relationships between serum levels of eosinophilic chemokine (Eotaxin), tumor necrosis factor-α (TNF-α), and leukocyte cell-derived chemokine 2 (LECT2) and prognosis in children with bronchial asthma. Methods　The data of 137 children with bronchial asthma admitted to Shaanxi Provincial Armed Police Corps Hospital from May 2021 to November 2023 were retrospectively analyzed. All the children received conventional treatment, and were followed up for 4 months. They were divided into a good prognosis group and a poor prognosis group according to the prognosis of the children. The clinical data and serum levels of Eotaxin, TNF-α, and LECT2 were compared between the two groups, and the influencing factors of poor prognosis in children with bronchial asthma were analyzed. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive values of serum Eotaxin, TNF-α, and LECT2 levels and their combination for poor prognosis in children with bronchial asthma by using the area under curve (AUC). χ² test and independent sample t test were used. Results　The incidence of poor prognosis was 22.63% (31/137). In the poor prognosis group, there were 14 boys and 17 girls, aged (7.37±1.46) years. In the good prognosis group, there were 42 boys and 64 girls, aged (7.85±1.12) years. The proportions of allergic history and history of recurrent respiratory tract infection in the poor prognosis group were higher than those in the good prognosis group, and the serum levels of LECT2, TNF-α, and Eotaxin in the poor prognosis group were higher than those in the good prognosis group (all P<0.05). Logistic regression analysis showed that history of recurrent respiratory tract infection (OR=4.125, 95%CI: 1.777-9.577), Eotaxin (OR=4.415, 95%CI: 1.902-10.251), TNF-α (OR=3.947, 95%CI: 1.700-9.164), and LECT2 (OR=2.735, 95%CI: 1.178-6.349) were the prognostic factors in children with bronchial asthma (all P<0.05). The areas under the curves of serum TNF-α, Eotaxin, and LECT2 levels and their combination in predicting poor prognosis in children with bronchial asthma were 0.843, 0.799, 0.797, and 0.905, respectively (all P<0.05). Conclusion　Combination of serum LECT2, TNF-α, and Eotaxin has higher prognostic value in children with bronchial asthma.

Advantages of endoscopic kinetic system adenoidectomy + low temperature plasma hemostasis in the treatment of adenoid hypertrophy

Zheng Weichang, Luo Wufeng, Wu Zikai, Lin Yao

2024, 30(22):  3722-3724.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.006

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Objective　To investigate the advantages of transnasal 0° nasal endoscopic adenoidectomy + low-temperature plasma hemostasis in the treatment of adenoid hypertrophy. Methods　The data of 111 children undergoing pediatric snoring surgery were collected from the Department of Otolaryngology, Jieyang Third People's Hospital from April 2021 to April 2023, including 63 boys and 48 girls, aged 2-15 years, with a disease course of 0.3-6.0 years. There were 76 cases with moderate adenoid hypertrophy and 35 cases with severe adenoid hypertrophy. Among them, 56 patients underwent endoscopic kinetic system adenoidectomy + low temperature plasma hemostasis (combined group), and 55 patients underwent low temperature plasma adenoidectomy (low temperature plasma group). The operation time, nasal normal ventilation time, normal activity time, and postoperative nasopharyngeal discomfort were compared between the two groups. χ² test and independent sample t test were used. Results　The operation and prognosis of the two groups were good. After more than 6 months of follow-up, the wound healing and scarring were normal, and the symptoms were completely relieved without complications. There was no statistically significant difference in the blood loss between the combined group [(2.0±1.0) ml] and the low temperature plasma group [(2.0±1.0) ml] (P>0.05). The operation time and nasal normal ventilation time in the combined group were shorter than those in the low-temperature plasma group [(5.0±1.0) min vs. (12.0±3.0) min, (3.0±1.0) d vs. (5.0±1.0) d], with statistically significant differences (both P<0.001). The rate of postoperative nasopharyngeal discomfort in the combined group (2/56) was lower than that in the low-temperature plasma group (10/55), with a statistically significant difference (P<0.05). Conclusion　Compared with simple low temperature plasma adenoidectomy, transnasal 0° nasal endoscopic dynamic system adenoidectomy + low temperature plasma hemostasis has the advantages of shorter operation time, less postoperative nasopharyngeal discomfort, and faster recovery of postoperative nasal ventilation.

Study on relationships between HMGB1, AQP4, 8-OHdG, and APN levels and disease progression and cognitive function in children with epilepsy

Yuan Yanhong, Qi Fengqin, Shi Jing, Peng Fudong, Wang Yuguang

2024, 30(22):  3725-3730.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.007

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Objective　To investigate the relationships between serum high mobility group protein B1 (HMGB1), aquaporin 4 (AQP4), 8-hydroxydeoxyguanosine (8-OHdG), and adiponectin (APN) levels and disease progression and cognitive function in children with epilepsy. Methods　A total of 142 children with epilepsy admitted to the Second People's Hospital of Liaocheng from January 2021 to December 2023 were selected as the study group, including 74 boys and 68 girls, aged (9.08±0.80) years. According to the type of epilepsy, they were divided into a general tonic-clonic seizure group (55 cases) and a focal seizure group (87 cases); they were divided into a cognitive dysfunction group (51 cases) and a normal cognitive function group (91 cases) according to the cognitive function. In addition, 145 normal children who received health checkups during the same period were selected as the control group. The clinical data of the selected children were collected, and serum HMGB1, AQP4, 8-OHdG, and APN levels were detected. Independent sample t test was used to compare serum HMGB1, AQP4, 8-OHdG, and APN levels between the study group and the control group, as well as between children with different types of epilepsy and different cognitive functions. Pearson correlation analysis was used to analyze the correlations between serum HMGB1, AQP4, 8-OHdG, and APN levels and cognitive function in children with epilepsy. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was obtained. The predictive value of serum HMGB1, AQP4, 8-OHdG, and APN alone and in combination for cognitive dysfunction in children with epilepsy was analyzed. Results　The levels of serum HMGB1 [(5.01±1.22) μg/L] and 8-OHdG [(0.43±0.10) μg/L] in the study group were higher than those in the control group [(2.91±0.86) μg/L and (0.29±0.08) μg/L] (both P<0.05), but the levels of serum AQP4 [(56.79±15.02) μg/L] and APN [(6.77±1.45) mg/L] were lower than those in the control group [(163.58±31.27) μg/L and (10.13±2.24) mg/L] (both P<0.05). The levels of serum HMGB1 [(6.14±1.98) μg/L] and 8-OHdG [(0.53±0.15) μg/L] in the general tonic-clonic seizure group were higher than those in the focal seizure group [(3.95±1.10) μg/L and (0.36±0.09) μg/L] (both P<0.05), but the levels of serum AQP4 [(41.43±12.07) μg/L] and APN [(4.64±1.40) mg/L] were lower than those in the focal seizure group [(70.89±21.44) μg/L and (7.98±2.32) mg/L] (both P<0.05). The levels of serum HMGB1 [(6.18±2.04) μg/L] and 8-OHdG [(0.57±0.19) μg/L] in the cognitive dysfunction group were higher than those in the normal cognitive function group [(3.98±1.25) μg/L and (0.38±0.12) μg/L] (both P<0.05), but the levels of serum AQP4 [(46.94±15.15) μg/L] and APN [(4.97±1.55) mg/L] were lower than those in the normal cognitive function group [(71.43±23.59) μg/L and (8.01±2.53) mg/L] (both P<0.05). The levels of serum HMGB1 and 8-OHdG were negatively correlated with cognitive function in children with epilepsy (r=-0.499 and -0.504, both P<0.05), but the levels of serum AQP4 and APN were positively correlated with cognitive function (r=0.531 and 0.527, both P<0.05). The AUC of combined detection of serum HMGB1, AQP4, 8-OHdG, and APN was 0.920, which was higher than that of single detection of each index (0.751, 0.833, 0.817, and 0.848). Conclusions　Serum HMGB1 and 8-OHdG were highly expressed in children with epilepsy, while serum AQP4 and APN were lowly expressed. All four of them were involved in the process of disease progression in children, and were closely related to cognitive dysfunction in children. The combination of all four of them had a higher predictive value for cognitive dysfunction in children with epilepsy.

Efficacy of levetiracetam combined with sodium valproate in the treatment of benign epilepsy with centro-temporal spikes

Ba Jingjing, Lei Yanping, Wang Zhiyong, Wang Jiapeng

2024, 30(22):  3730-3734.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.008

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Objective　To investigate the efficacy of levetiracetam combined with sodium valproate in the treatment of benign epilepsy with centro-temporal spikes (BECT). Methods　A retrospective analysis was performed on 90 BECT children admitted to Weinan Maternal and Child Health Hospital from January 2020 to January 2023, and they were divided into a control group and an observation group with 45 cases in each group according to the treatment methods. In the control group, there were 25 boys and 20 girls, aged (7.52±1.68) years, with a disease course of (2.33±0.54) years. In the observation group, there were 24 boys and 21 girls, aged (7.49±1.71) years, with a disease course of (2.41±0.52) years. The control group was treated with sodium valproate oral solution, the initial dose was 20 mg/(kg·d), divided into 2 times; 1 week later, the dose was adjusted as needed, increasing by 5-10 mg/(kg·d) each time; after that, the dose was adjusted to 30-40 mg/(kg·d), once a day. The observation group was given levetiracetam oral solution on the basis of the control group, the initial dose was 10 mg/(kg·d), divided into 2 times; the dose was increased to 20 mg/(kg·d) in the second week; from the third week to the 24th week, the dose could be increased by 5-10 mg/kg per week up to 30-40 mg/(kg·d). The treatment period of both groups was 24 weeks. The efficacy and frequency of seizures, duration of seizures, and electroencephalographic (EEG) activity before and after treatment were compared between the two groups, and the incidence of adverse reactions was used to evaluate the safety. t test and χ² test were used. Results　After treatment, the total effective rate of the observation group was higher than that of the control group [97.78% (44/45) vs. 80.00% (36/45)] (P<0.05). After treatment, the frequency and duration of seizures of the observation group were (1.01±0.32) times/month and (7.61±1.84) min, which were lower than those of the control group [(1.46±0.47) times/month and (9.14±2.05) min] (both P<0.05). The frequency of α-band in the observation group was (35.46±3.47) Hz, which was higher than that in the control group [(33.01±3.32) Hz], but the frequencies of β-band [(7.14±1.05) Hz vs. (8.61±1.84) Hz], θ-band [(12.55±1.19) Hz vs. (14.92±1.88) Hz], and δ-band [(10.05±1.94) Hz vs. (12.26±2.08) Hz] were all lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　In the treatment of BECT, levetiracetam combined with sodium valproate was more effective in improving the total effective rate, reducing the frequency of seizures, shortening the duration of seizures, and improving the EEG activity.

Effect of acupuncture and massage combined with Huangqi Guizhi Wuwu decoction on spastic cerebral palsy children

Lu Lina, Guo Kai

2024, 30(22):  3735-3739.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.009

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Objective　To explore the value of acupuncture and massage combined with Huangqi Guizhi Wuwu decoction in the treatment of children with spastic cerebral palsy and the improvement of their Gross Motor Function Measure (GMFM) score. Methods　Ninety-six children with spastic cerebral palsy admitted to Xi'an Traditional Chinese Medicine Brain Disease Hospital from January 2021 to December 2023 were selected and were divided into an experimental group (48 cases) and a control group (48 cases) using envelope randomization. In the control group, there were 25 boys and 23 girls, aged (13.42±2.17) months, and the course of disease was (4.53±1.17) months. In the experimental group, there were 27 boys and 21 girls, aged (13.65±2.19) months, and the course of disease was (4.41±1.29) months. The control group was treated with acupuncture and massage (once a day, 6 times/week) on the basis of conventional treatment, and the experimental group was treated with Huangqi Guizhi Wuwu decoction (200 ml of liquid medicine was taken twice in the morning and evening) on the basis of the control group for 12 weeks. The efficacy and GMFM scores, cerebral blood flow velocities, and spasticity indexes before and after treatment were compared between the two groups. t test and χ² test were used. Results　The total effective rate of the experimental group was higher than that of the control group [95.83% (46/48) vs. 83.33% (40/48)] (P<0.05). After treatment, all GMFM scores of the two groups were increased, and the scores of lying and turning, standing, crawling and kneeling, and walking-running-jumping position dimensions of the experimental group were higher than those of the control group (all P<0.05). After treatment, the blood flow velocities of middle cerebral artery (MDA) and anterior cerebral artery (ACA) were increased and the spasticity index was decreased in both groups; the blood flow velocities of MDA and ACA in the experimental group were higher than those in the control group, and the spasticity indexes of muscle tone, tendon reflex, and clonus were lower than those in the control group (all P<0.05). Conclusion　In the treatment of spastic cerebral palsy children, acupuncture and massage combined with Huangqi Guizhi Wuwu decoction has a remarkable effect, which helps to regulate the cerebral blood flow velocity, improve the motor function, and promote the reduction of spasticity index.

One case of pediatric severe burn with mediastinal emphysema, subcutaneous emphysema, and pneumothorax during the perioperative period and literature review

Quan Jin, Jiang Qiuxiang, Liu Shanshan, Yang Xinlei, Zhang Xinhe, Cao Huijuan

2024, 30(22):  3739-3742.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.010

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Objective　To explore the pathogenesis and diagnosis and treatment methods of mediastinal emphysema, subcutaneous emphysema, and pneumothorax in children with severe burn during the perioperative period. Methods　On June 2, 2023, Chengcheng Hospital, Xiamen University admitted a child with severe burn who developed mediastinal emphysema, subcutaneous emphysema, and pneumothorax during the perioperative period. Anesthesia resuscitation and symptomatic management were retrospectively analyzed, and relevant literatures were reviewed. Results　The girl, 6-years-old, with body weight of 26 kg, was diagnosed as 22% of hydrothermal burns, degree Ⅱ-Ⅲ. The wounds were located in the head, face and neck, front and back trunk, right upper limb, and right lower limb. The main causes of mediastinal emphysema after pediatric severe burn were thick and difficult-to-expel sputum and high local alveolar pressure caused by various factors. Perioperative bedside X-ray and CT scans facilitated early diagnosis. The girl underwent perioperative bronchoscopy, bronchoalveolar lavage, and sputum aspiration to reduce airway pressure, and tension subcutaneous emphysema was managed with subcutaneous incision. The girl regained spontaneous breathing and was successfully extubated in the ICU without any anesthesia related complication during follow-up. Conclusions　Early diagnosis of mediastinal emphysema in children with severe burn during the perioperative period, combined with timely application of effective treatment methods, is conducive to a smooth perioperative transition for children.

MRAS gene mutation associated Noonan syndrome: a case report and literature review

Hao Pengkai, Liu Mengnan, Zhu Yingjie, Ren Yaotiao, Zheng Chunling, Teng Xiaoyu, Han Mo

2024, 30(22):  3743-3746.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.011

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Objective　Through molecular genetic diagnosis of a child with Noonan syndrome, this study explored the pathogenesis of gene mutations, prenatal screening, and genetic diagnosis. Methods　Second generation high-throughput sequencing was applied to the child with Noonan syndrome in Altay Maternal and Child Health Hospital, and Sanger sequencing was used to validate the child and their parents. Results　The sequencing results of the child's genes suggested the presence of a heterozygous mutation in the MRAS gene, which was a guanine G mutation at nucleotide 68 to thymine T (c.68G>T), resulting in a mutation of amino acid 23 from Glycine to Valine (p.Gly23Val). Conclusion　According to the American College of Medical Genetics and Genomics (ACMG) variant classification guidelines, this variant is a pathogenic variant, and high-throughput sequencing is helpful for the diagnosis of this complex genetic disease.

Application effect of the modified Newborn Early Warning Score in the disease assessment and treatment intervention of high-risk newborns

Feng Wanping, Cheng Fen, Wang Yuying, Deng Xiaolin, Chen Zhaojin, Liu Shufang, Zhu Guohui, Wen Siqi

2024, 30(22):  3747-3750.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.012

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Objective　To evaluate the application effect of the modified Newborn Early Warning Score (MNEWS) in the disease assessment and treatment intervention of high-risk newborns. Methods　A total of 120 high-risk newborns treated in Dongguan Qishi Hospital from November 2021 to April 2023 were prospectively included and were divided into a control group (60 cases) and an observation group (60 cases) according to the random number table method. In the control group, there were 34 boys and 26 girls, aged 0.41 (0.33, 0.58) h, with a body weight of (3.56±0.31) kg. In the observation group, there were 28 boys and 32 girls, aged 0.41 (0.33, 0.60) h, with a body weight of (3.52±0.33) kg. The control group used the traditional NEWS to assess the conditions and intervention measures for the newborns, while the observation group used the MNEWS. Both groups were continuously intervened until the children were discharged from hospital. The length of hospital stay, incidence of complications, transfer rate, recovery discharge rate, and parental satisfaction were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used. Results　The length of hospital stay in the observation group was (3.62±0.33) d, which was shorter than that in the control group [(5.73±1.12) d], with a statistically significant difference (P<0.001). The incidence of complications of the observation group was lower than that of the control group [33.33% (20/60) vs. 58.33% (35/60)], the transfer rate of the observation group was lower than that of the control group [1.67% (1/60) vs. 15.00% (9/60)], and the recovery discharge rate of the observation group was higher than that of the control group [95.00% (57/60) vs. 71.67% (43/60)], with statistically significant differences (all P<0.05). The parental satisfaction in the observation group was higher than that in the control group [96.67% (58/60) vs. 83.33% (50/60)] (P<0.05). Conclusions　In the evaluation and treatment intervention of high-risk newborns, the MNEWS has a significant effect, which can not only effectively shorten the hospital stay, reduce the incidence of complications and transfer rate, promote the newborns' recovery, and improve the parental satisfaction, but also is suitable for the rapid identification of critically ill and potentially critically ill patients, with clinical promotion value.

New Medical Advances

Molecular pathways of leukemia resistance to treatment with venetoclax

Yan Jiaxin, Yu Wenzheng, Chu Wenhui, Zhang Ziwei

2024, 30(22):  3751-3756.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.013

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Venetoclax is the first BH3 analog approved by the U.S. Food and Drug Administration to target the B cell lymphoma/leukemia (BCL)-2 protein and induce apoptosis in cancer cells by stimulating the mitochondrial apoptosis pathway. It has the potential to enhance cell death in a variety of leukemia treatment regimens and is currently an important component of personalized treatment regimens for leukemia patients. However, with the expansion of the application of venetoclax in recent years, some cases of resistance to venetoclax have emerged, posing a major problem for clinical treatment. Resistance to venetoclax includes both genetic and non-genetic mechanisms, which include increased expression of the anti-apoptotic proteins myeloid leukemia-1 (MCL-1) and B-cell lymphoma-XL (BCL-XL), structural mutations in the BCL-2 family of proteins, mutations and deletions of the BCL-2-associated X-protein (BAX) gene, other oncogenes such as mutations in the gene tumor protein p53 (TP53), amplification of internal tandem duplications (ITD) in FMS-like tyrosine kinase 3 (FLT3), abnormal mitochondrial metabolism in leukemia stem cells (LSCs), alterations in mitochondrial morphology and function, effects of the tumor microenvironment, and venetoclax metabolism that cause the development of drug resistance. In addition, we present concepts and strategies on how to overcome these resistance mechanisms. A series of clinical trials in combination with venetoclax are currently underway, and therefore, understanding the mechanisms of resistance is critical to facilitate the development of new targeted therapeutic strategies as well as furthering our understanding of the biological function of BCL-2 in tumor cells.

Meta Analysis

Effect of exercise interventions on health-related quality of life in patients with lung cancer: a meta-analysis

Zhao Jinpeng, Gao Chengfei, Sun Jianchao

2024, 30(22):  3757-3763.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.014

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Objective　To systematically evaluate the effect of exercise interventions on health-related quality of life in patients with lung cancer. Methods　A literature search was conducted on PubMed, Embase, Cochrane library, Wanfang, and CNKI databases until March 2024 for randomized controlled trials about effect of exercise interventions on health-related quality of life in patients with lung cancer. Data from studies meeting the inclusion criteria were extracted, and a meta-analysis was performed using STATA software. Results　A total of 12 trials involving 333 patients were included. The results of meta-analysis showed that exercise interventions improved the overall health status/quality of life [weighted mean difference (WMD) =6.70, 95% confidence interval (CI): 2.49, 10.90, P=0.002] and physical function (WMD=1.78, 95%CI: 0.22, 3.33, P=0.025) of lung cancer patients, ameliorated dyspnea (WMD=-5.65, 95%CI: -8.62, -2.68, P<0.001) and pain symptoms (WMD=-8.26, 95%CI: -14.66, -1.87, P=0.011), but had no significant effect on patients' fatigue (WMD=-4.04, 95%CI: -8.76, 0.69, P=0.094). Conclusion　Exercise interventions can effectively improve the health-related quality of life in patients with lung cancer, and more randomized controlled trials are needed to confirm these findings.

Treatises

Effect of autologous platelet-rich plasma on LXA4 and p65-RelA in patients with osteoarthritis

Chang Baosheng, Liu Zhihuan, Zhao Chengjin

2024, 30(22):  3764-3769.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.015

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Objective　To investigate the clinical effect of autologous platelet-rich plasma in the treatment of osteoarthritis (OA) and its effect on lipoxin A4 (LXA4) and nuclear factor-κB P65 protein (p65-RelA). Methods　A total of 157 cases of early and middle stage OA patients admitted to Yan'an University Affiliated Hospital from October 2022 to April 2023 were collected as the research objects and were divided into two groups according to the treatment methods. Eighty-one patients in the observation group received autologous platelet-rich plasma therapy, including 54 males and 27 females, aged (67.78±8.86) years; 76 patients in the control group received medical chitin treatment, including 53 males and 23 females, aged (67.59±9.17) years. Both groups were treated continuously for 12 months. The Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), maximum knee range of motion (ROM), bone metabolism level, serum inflammatory factors, LXA4, and glycoprotein salivary lectin (DMBT) contents were compared between the two groups before and after treatment. t test, rank sum test, and χ² test were used. Results　After 12 months of treatment, the WOMAC scores in both groups were lower than those before treatment, and the Lysholm scores and ROM were higher than those before treatment; all the indexes in the observation group were better than those in the control group [(33.71±8.55) points vs. (46.75±9.78) points, (80.10±9.54) points vs. (75.48±9.04) points, (118.61±10.21)° vs. (89.21±9.04)°], with statistically significant differences (t=-8.91, 3.11, and 19.06, all P<0.05). After 12 months of treatment, the levels of osteocalcin (BGP) in both groups were higher than those before treatment, and the levels of type Ⅰ procollagen N-terminal peptide (PINP), type Ⅰ collagen cross-linked C-terminal peptide (CTX), and parathyroid hormone (PTH) were lower than those before treatment; the levels of all the indexes in the observation group were better than those in the control group [(19.74±2.54) μg/L vs. (15.64±2.17) μg/L, (24.68±8.71) μg/L vs. (30.68±9.04) μg/L, (9.78±1.04) μg/L vs. (12.47±1.15) μg/L, (3.74±0.29) pmol/L vs. (4.23±0.36) pmol/L], with statistically significant differences (t=10.84, -4.24, -15.39, and -9.42, all P<0.05). After 12 months of treatment, the levels of LXA4 in both groups were higher than those before treatment, and the levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-17, matrix metalloproteinase (MMP), p65-RelA mRNA, and DMBT were lower than those before treatment; the levels of all the indexes in the observation group were better than those in the control group, with statistically significant differences (t=6.59, -9.99, -3.36, -19.20, -11.85, -14.71, and -9.95, all P<0.05). Conclusion　Autologous platelet-rich plasma can improve the therapeutic effect of OA patients, increase the level of bone formation in bone metabolism, increase the content of LXA4, down-regulate the expression level of p65-RelA, and reduce the inflammatory response of OA.

Clinical application of AI visualization technology in preplanning for complex total hip arthroplasty

Pan Xi'an, Zhang Yuanjin, Zhang Guofu, Li Jun, Sun Farui, Liu Bingxia

2024, 30(22):  3769-3774.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.016

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Objective　To explore the clinical effect of AI visualization technology in preoperative planning of complex total hip arthroplasty. Methods　A retrospective analysis was performed on 62 patients who underwent complex total hip arthroplasty in Huangshi Central Hospital from July 2020 to April 2023. The patients were divided into two groups according to different THA preoperative planning methods: 25 patients undergoing preoperative planning using AI visualization technology were included in the experimental group [12 males and 13 females, aged (67.00±11.34) years], and 37 patients undergoing preoperative planning using traditional two-dimensional X-ray film were included in the control group [18 males and 19 females, aged (66.89±12.98) years]. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, first postoperative exercise time, postoperative length difference between the two lower limbs, Harris Hip Score (HHS) and Visual Analogue Scale (VAS) score before surgery, 3 months after surgery, and 1 year after surgery, and the coincidence rates between the size of the acetabular and femur prostheses actually used during surgery and the size of the preoperative planned prostheses were recorded in both groups. t test and χ² test were used. Results　The operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, and postoperative length difference between the two lower limbs of the experimental group were all better than those of the control group [(81.08±6.31) min vs. (102.35±8.14) min, (408.44±29.83) ml vs. (465.58±72.09) ml, (1.44±0.51) times vs. (2.24±0.64) times, (3.28±0.46) mm vs. (4.24±0.72) mm], with statistically significant differences (t=11.01, 3.75, 5.25, and 5.90, all P<0.05). The HHS scores at 3 months and 1 year after surgery of the experimental group were higher than those of the control group, the VAS scores at 3 months and 1 year after surgery were lower than those of the control group, and the first postoperative exercise time was shorter than that of the control group, with statistically significant differences (t=-7.38, -7.13, 4.24, 4.79, and 3.58, all P<0.05). The coincidence rates between the size of the acetabular and femur prostheses actually used during surgery and the size of the preoperative planned prostheses in the experimental group were higher than those in the control group [88.00% (22/25) vs. 56.76% (21/37), 92.00% (23/25) vs. 54.05% (20/37)], with statistically significant differences (χ²=6.85 and 10.11, both P<0.05). Conclusion　Surgical planning according to AI visualization technology before complex total hip arthroplasty can improve the prostheses size coincidence rate of hip joint on acetabular side and femur side, reduce the operation time, intraoperative blood loss, and fluoroscopy times, improve the hip joint function, and relieve the pain.

Clinical value of combined serum CTRP9 and GDF-15 in predicting ventricular arrhythmia in patients with acute myocardial infarction

Li Nan, Hao Yuanyuan, Shen Yibo

2024, 30(22):  3775-3779.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.017

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Objective　To analyze the clinical value of serum tumor necrosis factor-associated protein 9 (CTRP9) and growth differentiation factor 15 (GDF-15) in predicting ventricular arrhythmia (VA) in patients with acute myocardial infarction (AMI). Methods　This study was a retrospective study. A total of 120 patients with AMI admitted to Xi'an Central Hospital from April 2021 to August 2023 were selected, including 65 males and 55 females, aged 35-74 (55.63±4.86) years. The levels of GDF-15 and CTRP9 were detected by enzyme-linked immunosorbent assay (ELISA) before treatment, and symptomatic treatments such as anti-infection, anticoagulation, thrombolysis, vasodilation, blood sugar control, and diuretics were administered. The patients were divided into an occurrence group and a non-occurrence group based on the presence of VA. The basic data and serological indices of the two groups were compared to analyze the influencing factors of VA occurrence in AMI patients and the predictive value of CTRP9 and GDF-15 for VA occurrence. t test and χ² test were used. Results　After treatment, 26 cases (21.67%) of 120 patients with AMI had VA. The proportion of Killip grade 3-4 in the occurrence group was higher than that in the non-occurrence group [69.23% (18/26) vs. 34.04% (32/94)], with a statistically significant difference (χ²=10.38, P<0.05). The levels of GDF-15 and white blood cell count in the occurrence group were higher than those in the non-occurrence group, but the CTRP9 level was lower than that in the non-occurrence group [(3.24±0.45) μg/L vs. (2.86±0.37) μg/L, (13.22±2.85) ×10⁹/L vs. (11.94±2.63) ×10⁹/L, (8.62±1.78) μg/L vs. (10.57±2.06) μg/L], with statistically significant differences (t=4.42, 2.16, and 4.39, all P<0.05). The results of logistic regression analysis showed that Killip grade (OR=5.486, 95%CI 1.603-18.776), GDF-15 level (OR=10.871, 95%CI 2.345-50.400), WBC level (OR=1.329, 95%CI 1.055-1.647), and CTRP9 (OR=0.607, 95%CI 0.437-0.842) were the influencing factors for VA in AMI patients (all P<0.05). The receiver operating characteristic curve (ROC) analysis showed that the sensitivities of GDF-15, CTRP9, and their combination in the prediction of VA in AMI patients were 60.00%, 63.30%, 90.00%, and the specificities were 73.30%, 66.70%, and 86.70%. The value of combined GDF-15 and CTRP9 in predicting the occurrence of VA in AMI patients was the highest (the area under the curve was 0.894). Conclusion　Changes in GDF-15 and CTRP9 levels are associated with the occurrence of VA in AMI patients, and combined detection can predict the risk of VA in AMI patients early.

Establishment and validation of a prediction model for contrast-induced nephropathy in elderly patients with coronary heart disease undergoing PCI

Yang Tianfen, Li Lei, Zhang Nana

2024, 30(22):  3779-3785.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.018

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Objective　To explore the influencing factors of contrast-induced nephropathy (CIN) in elderly patients with coronary heart disease undergoing percutaneous coronary intervention (PCI), and construct and validate a prediction model. Methods　The medical records of 192 elderly patients with coronary heart disease who underwent PCI in the First People's Hospital of Xianyang from January 2020 to January 2023 were retrospectively analyzed, including 128 males and 64 females, aged 60-80 (71.73±3.59) years. According to the 80/20 law, they were randomly divided into a training set (153 cases) and a validation set (39 cases). According to the changes of serum creatinine (Scr) within 72 h after PCI, the patients were divided into a CIN group and a non-CIN group. The risk factors for CIN related to PCI in elderly patients with coronary heart disease were screened, and a risk prediction model was constructed and validated. χ² test and t test were used; logistic regression model was used to analyze the influencing factors. Results　In the training set, 22 cases (14.38%) of 153 elderly patients with coronary heart disease treated by PCI developed PCI-related CIN. In the validation set, 5 cases (12.82%) of 39 elderly patients with coronary heart disease treated by PCI developed PCI-related CIN. In the CIN group, the proportion of use of diuretics 24 h before PCI, high-sensitivity C-reactive protein (hs-CRP) 24 h after surgery, N-terminal pro B-type natriuretic peptide (NT-proBNP) 24 h after surgery, serum creatinine (Scr) 24 h after surgery, and urinary neutrophil gelatinase-associated lipocalin (NGAL) 24 h after surgery were higher than those in the non-CIN group (all P<0.05), and the estimated glomerular filtration rate (eGFR) was lower than that in the non-CIN group (P<0.05). Use of diuretics 24 h before surgery (OR=3.216, 95%CI 1.472-7.025), hs-CRP 24 h after surgery (OR=2.971, 95%CI 1.360-6.491), NT-proBNP 24 h after surgery (OR=3.341, 95%CI 1.528-7.297), serum Scr 24 h after surgery (OR=3.271, 95%CI 1.497-7.145), and urinary NGAL 24 h after surgery (OR=3.582, 95%CI 1.639-7.826) were risk factors for CIN in elderly patients with coronary heart disease undergoing PCI (all P<0.05), and eGFR (OR=0.253, 95%CI 0.115-0.553) was a protective factor for CIN in elderly patients with coronary heart disease undergoing PCI (P<0.05). The sensitivity, specificity, and area under the curve of the nomogram model for predicting CIN after PCI in elderly patients with coronary heart disease in the training set were 0.815 (95%CI 0.702-0.891), 0.743 (95%CI 0.674-0.856), and 0.834 (95%CI 0.718-0.915). The sensitivity, specificity, and area under the curve of the nomogram model for predicting CIN after PCI in elderly patients with coronary heart disease in the validation set were 0.754 (95%CI 0.662-0.875), 0.772 (95%CI 0.681-0.889), and 0.807 (95%CI 0.743-0.915). Conclusion　The use of diuretics 24 h before PCI, hs-CRP, NT-proBNP, Scr, and urinary NGAL 24 h after PCI, as well as eGFR, are associated with the occurrence of CIN in elderly patients undergoing PCI for coronary heart disease. Developing a risk prediction model helps to forecast the likelihood of CIN in these patients.

Analysis of the prevalence and influencing factors of hypertension among elderly population in rural areas of She ethnic group in Guizhou province

Zhou Xiaoyan, Lin Xianyan, Luo Siyi, Zhang Wan, Huang Wenqiang

2024, 30(22):  3786-3790.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.019

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Objective　To understand the prevalence of hypertension and its influencing factors among elderly population in rural areas of She ethnic group in Guizhou province. Methods　In July 2022, a multi-stage cluster simple random sampling method was used to conduct an epidemiological survey on hypertension among the elderly of the She ethnic group in rural Majiang County. A total of 560 people were investigated, including 222 males and 338 females, aged (72.58±6.59) years. The survey included the incidence, awareness rate, treatment rate, and control rate of hypertension, demographic-related indicators, behavior and lifestyle, and physical examination indicators reflecting body type. The influencing factors were analyzed by χ² test and unconditional logistic regression analysis. Results　The prevalence rate of hypertension among the elderly of the She ethnic group in rural Guizhou province was 55.71% (312/560), and the awareness rate, treatment rate, and control rate of hypertension were 72.44% (226/312), 51.92% (162/312), and 21.79% (68/312). The results of unconditional logistic regression analysis showed that education level (OR=2.020, 95%CI 1.265-3.224), marital status (OR=1.579, 95%CI 1.280-1.947), smoking (OR=2.695, 95%CI 1.578-4.604), alcohol consumption (OR=0.376, 95%CI 0.238-0.593), body mass index (OR=2.051, 95%CI 1.464-2.875), waist-to-hip ratio (OR=1.737, 95%CI 1.125-2.681), family history (OR=1.500, 95%CI 1.223-1.838), and daily salt intake (OR=1.596, 95%CI 1.077-2.366) were the main factors affecting the prevalence of hypertension among the elderly of the She ethnic group in rural Guizhou province (all P<0.05). Conclusions　The prevalence of hypertension among the elderly of the She ethnic group in rural Guizhou province is high, while the treatment and control rates are low. It is necessary to focus on strengthening the education and prevention of hypertension knowledge and controllable factors, change unhealthy living habits, and thereby improve the health level of the elderly.

CT signs and risk factors of treatment outcomes in MDR-PTB patients

Zhang Zhifei, Chen Rui, Cao Zonghua, Zhang Quanwu, Gao Yu, Wang Zhiyong

2024, 30(22):  3790-3795.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.020

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Objective　To analyze the computerized tomography (CT) features in patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB) and the risk factors of treatment outcomes. Methods　The clinical data of 84 MDR-PTB patients treated in Shaanxi Provincial Tuberculosis Prevention and Control Hospital from February 2019 to March 2022 were retrospectively selected, including 53 males and 31 females, aged(38.52±6.70)years, and after standard chemotherapy treatment, they were divided into an effective treatment group (57 cases) and an ineffective treatment group (27 cases) according to clinical treatment outcomes. During the same period, 84 non-MDR-PTB patients were retrospectively selected as the reference group. t test was used to compare the CT signs of the reference group and MDR-PTB group before treatment, χ² test was used to compare the clinical data of MDR-PTB treatment effective and ineffective groups, and multivariate logistic regression analysis was used to analyze the influencing factors of treatment outcomes of the MDR-PTB patients. Results　In the MDR-PTB group, the incidences of thick-walled cavity, multiple cavity, lung damage, pleural thickening, intrapulmonary spread, consolidation, calcification shadow, strip-cord shadow, and lung involvement were 53.57% (45/84), 57.14% (48/84), 9.52% (8/84), 66.67% (56/84), 72.62% (61/84), 58.33% (49/84), 59.52% (50/84), 53.57% (45/84), and 29.76% (25/84), and those in the reference group were 19.05% (16/84), 15.48% (13/84), 1.19% (1/84), 16.67% (14/84), 50.00% (42/84), 30.95% (26/84), 17.86% (15/84), 23.81% (20/84), and 7.14% (6/84), with statistically significant differences between the two groups (all P<0.05). The incidences of plaque, interstitial lesion, and pleural effusion were 69.05% (58/84), 11.90% (10/84), and 60.71% (51/84) in the MDR-PTB group, and 61.90% (52/84), 9.52% (8/84), and 55.95% (47/84) in the reference group, without statistically significant differences between the two groups (all P>0.05). In the effective treatment group, the rates of age <60 years old, initial treatment, initial sputum smear bacterial grade ≤2+, initial sputum culture bacterial grade ≤2+, standardized medication, negative sputum culture after 6 months of treatment, non- multiple cavities, non- thick-walled cavities, non- lung involvement, non- calcification, non- pleural thickness, and non- lung consolidation were 61.40% (35/57), 66.67% (38/57), 70.18% (40/57), 73.68% (42/57), 78.95% (45/57), 71.93% (41/57), 52.63% (30/57), 56.14% (32/57), 87.72% (50/57), 40.35% (23/57), 49.12% (28/57), and 49.12% (28/57), and those in the ineffective treatment group were 25.93% (7/27), 37.04% (10/27), 44.44% (12/27), 33.33% (9/27), 48.15% (13/27), 40.74% (11/27), 22.22% (6/27), 25.93% (7/27), 33.33% (9/27), 15.52% (5/27), 25.93% (7/27), and 22.22% (6/27), with statistically significant differences between the two groups (all P<0.05). Multivariate logistic regression analysis showed that age, retreatment, initial sputum culture bacteria grade 3 or above, multiple cavities, thick-walled cavities, and lung involvement were all risk factors for the treatment outcomes of MDR-PTB patients (all P<0.05), and negative sputum culture after 6 months of treatment and standardized medication were protective factors for the treatment outcomes of MDR-PTB patients (both P<0.05). Conclusions　The CT signs of MDR-PTB patients are characterized by wide lesion distribution and morphological diversity. The treatment outcomes of MDR-PTB patients is affected by many factors, and clinical intervention on related factors should be paid attention to to improve the treatment outcomes.

Study on the diagnostic value of LECT2 and YKL-40 in tuberculosis in HIV/AIDS patients

Fang Shan, Zhao Hu, Wang Xin, Wang Chan, Tan Fangfang, Yang Meng, Yang Huanhuan

2024, 30(22):  3796-3800.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.021

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Objective　To explore the potential value of leukocyte cell-derived chemotaxin 2 (LECT2) and human cartilage glycoprotein-39 (YKL-40) in the diagnosis of tuberculosis in patients with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), assess the performance of these biomarkers in predicting tuberculosis, and provide more precise diagnostic tools for clinical use. Methods　From February 2021 to February 2023, 84 HIV/AIDS patients with tuberculosis admitted to No.215 Hospital of Shaanxi Nuclear Industry were selected as a study group, and 92 HIV/AIDS patients without tuberculosis during the same period were selected as a control group. There were 57 males and 27 females in the study group, aged (47.69±10.59) years. There were 64 males and 28 females in the control group, aged (48.22±9.46) years. Blood samples were collected to measure the levels of LECT2 and YKL-40. The diagnostic value of the two markers for tuberculosis in HIV/AIDS patients was verified by the receiver operating characteristic curve (ROC). Multivariate logistic regression analysis was used to identify independent risk factors for poor prognosis in HIV/AIDS patients with tuberculosis. Results　The level of LECT2 in the study group was lower than that in the control group [(20.65±3.38) μg/L vs. (22.67±3.34) μg/L], and the level of YKL-40 was higher than that in the control group [(159.54±17.56) μg/L vs. (148.74±18.74) μg/L], with statistically significant differences (t=3.995 and 3.935, both P<0.001). The area under the curve (AUC) of combined diagnosis of LECT2 and YKL-40 for tuberculosis in HIV/AIDS patients was 0.739 (95%CI 0.665-0.812), with a sensitivity of 79.8% and a specificity of 58.7%. Multivariate logistic regression analysis showed that anti-HIV treatment, duration of HIV infection, CD4+ T cells, and LECT2 level were important factors for judging the prognosis of HIV/AIDS patients with tuberculosis (all P<0.05). ROC was used to evaluate the prognostic value of LECT2, and the results showed that the AUC of LECT2 was 0.657, with a sensitivity of 64.5% and a specificity of 67.9%. Conclusion　The significant changes in the levels of LECT2 and YKL-40 are closely associated with the state of tuberculosis in HIV/AIDS patients, and can serve as effective biomarkers for auxiliary diagnosis.

Effect of recombinant human brain natriuretic peptide combined with levosimendan in the treatment of acute heart failure

Yang Guanxu, Zhao Yujie, Li Liandong, Yang Xiaoxi, Yang Yibo, Chen Jinfu

2024, 30(22):  3801-3806.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.022

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Objective　To explore the efficacy of the combination of recombinant human brain natriuretic peptide and levosimendan on acute heart failure and the effects on patients' cardiac function recovery and quality of life. Methods　A total of 60 patients with acute heart failure admitted to the Department of Cardiovascular Medicine, Zhengzhou Seventh People's Hospital from February 2023 to July 2023 were selected as the control group by random blind selection method; 60 patients with acute heart failure admitted from August 2023 to February 2024 were selected as the study group. In the control group, there were 29 males and 31 females, aged (67.91±2.63) years, the time from onset to treatment was (4.48±0.47) h, and the cardiac functional classification of New York Heart Association (NYHA) was as follows: grade Ⅱ in 14 cases, grade Ⅲ in 40 cases, and grade Ⅳ in 6 cases. In the study group, there were 22 males and 38 females, aged (67.12±2.84) years, the time from onset to treatment was (4.91±0.42) h, and the NYHA cardiac functional classification was grade Ⅱ in 15 cases, grade Ⅲ in 36 cases, and grade Ⅳ in 9 cases. On the basis of conventional symptomatic treatment, the control group received levosimendan injection with an initial load dose of 12 µg/kg and continued infusion at 0.1 µg/(kg·min) after 10 min of administration. On the basis of the control group, the study group was treated with recombinant human brain natriuretic peptide by intravenous infusion at an initial load dose of 1.5 µg/kg and continued infusion at 0.01 µg/(kg·min) after 2 min of administration. Both groups were administered 30 min after breakfast, once a day. The therapeutic effect was evaluated after 72 h. After discharge, the patients in both groups continued to receive maintenance treatment such as oxygen inhalation, diuresis, and vasodilation for 2 months. The clinical efficacy, cardiac function [left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), heart rate (HR), and cardiac index (CI)], serological indexes [lactic acid (LA), troponin (CTnT), N-terminal B-type natriuretic peptide precursor (NT-ProBNP)], quality of life [Chinese Questionnaire on the Quality of Life Assessment of Cardiovascular Patients (CQQC)], and occurrence of adverse reactions were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the study group was higher than that of the control group [95.00% (57/60) vs. 83.33% (50/60)], with a statistically significant difference (χ²=4.227, P=0.040). After 72 hours and 2 months of treatment, the LVEDD, LVEF, HR, and CI in the study group were (54.26±3.82) mm, (53.15±3.24) mm, (53.23±3.57)%, (55.28±3.69)%, (72.31±6.04) beats/min, (71.19±5.86) beats/min, (3.82±0.34) L/(min·m²), and (3.94±0.41) L/(min·m²), and those in the control group were (56.11±4.06) mm, (55.17±4.12) mm, (48.75±3.29)%, (51.34±3.37)%, (79.62±7.18) beats/min, (76.22±6.34) beats/min, (3.38±0.28) L/(min·m²), and (3.42±0.32) L/(min·m²); the levels of LA, CTnT, and NT-ProBNP in the study group were (1.83±0.65) mmol/L, (1.75±0.43) mmol/L, (0.10±0.04) µg/L, (0.07±0.02) µg/L, (5.12±0.52) µg/L, and (4.28±0.67) µg/L, and those in the control group were (2.39±0.72) mmol/L, (2.04±0.39) mmol/L, (0.18±0.05) µg/L, (0.11±0.03) µg/L, (7.58±0.89) µg/L, and (6.69±0.98) µg/L, with statistically significant differences (all P<0.05). The scores of physical status, medical condition, general life, social and psychological condition, and work condition dimensions of the CQQC in the study group were higher than those in the control group, and the score of disease dimension was lower than that in the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). The re-hospitalization rate within 2 months in the study group was lower than that in the control group [3.33% (2/60) vs. 13.33% (8/60)], with a statistically significant difference (χ²=3.927, P=0.048). Conclusion　The efficacy of acute heart failure applied with levosimendan and recombinant human brain natriuretic peptide synergistically is ideal, which can promote the recovery of patients' cardiac function, improve their serological indexes, and enhance the patients' quality of life.

Clinical Research

Relationships between Treg/Th17 immune imbalance and serum PCT level and risk of acute exacerbation in patients with COPD

Cheng Xudong, Guo Qian

2024, 30(22):  3807-3811.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.023

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Objective　To investigate the relationships between regulatory T cells (Treg) / helper T cell 17 (Th17) immune imbalance and serum procalcitonin (PCT) level and risk of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD). Methods　The clinical data of 80 COPD patients diagnosed and treated in the Second Affiliated Hospital of Xi'an Medical University from June 2020 to June 2023 were analyzed retrospectively. According to their condition, they were divided into stable COPD patients (SCOPD group, 48 cases) and acute exacerbation of COPD patients (AECOPD group, 32 cases). The differences of basic data information between the two groups were observed. Multivariate logistic regression analysis was used to analyze the risk factors of AECOPD. The receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of various serum indexes in evaluating AECOPD. Spearman correlation analysis was used to analyze the relationships between Treg, Th17, Treg/Th17, and PCT levels in the peripheral blood and AECOPD. χ² test and t test were used. Results　In the AECOPD group, there were 20 males and 12 females, aged (59.66±9.17) years, and the course of disease was (9.16±2.52) years. In the SCOPD group, there were 28 males and 20 females, aged (60.13±9.05) years, with a course of disease of (8.98±2.14) years. The levels of Treg and Treg/Th17 in the AECOPD group were lower than those in the SCOPD group [(2.52±0.48)% vs. (3.61±0.73)%, (0.54±0.16) vs. (1.10±0.33)], with statistically significant differences (t=7.435 and 8.913, both P<0.001). The levels of Th17 and PCT in the AECOPD group were higher than those in the SCOPD group [(4.64±0.95)% vs. (3.28±0.69)%, (1.33±0.46) μg/L vs. (0.75±0.32) μg/L], with statistically significant differences (t=7.417 and 6.656, both P<0.001). Multivariate logistic regression analysis confirmed that Treg, Th17, Treg/Th17, and PCT were the influencing factors of AECOPD (all P<0.05). ROC analysis showed that the levels of Treg, Th17, Treg/Th17, and PCT in the peripheral blood could be used to evaluate AECOPD, and the areas under the curves were 0.895, 0.910, 0.932, and 0.803, respectively (all P<0.001). Correlation analysis showed that peripheral blood Treg and Treg/Th17 were negatively correlated with AECOPD, and Th17 and PCT levels were positively correlated with AECOPD (all P<0.05). Conclusions　Treg, Th17, Treg/Th17, and PCT were all influencing factors of AECOPD and were closely related to AECOPD. These indicators could be used as markers to evaluate AECOPD and provide references for clinical prevention and treatment of AECOPD.

Analysis of the correlations between serum MyD88, IL-33, and LCR levels and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease combined with respiratory failure

Zhang Juan, Liu Xiaodong

2024, 30(22):  3811-3815.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.024

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Objective　To investigate the expression levels of serum myeloid differentiation factor 88 (MyD88), interleukin 33 (IL-33), and lactate clearance rate (LCR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure and their correlations with prognosis. Methods　This study was a retrospective cohort study. A total of 120 patients with AECOPD combined with respiratory failure admitted to the Department of Respiratory and Critical Care Medicine, Affiliated Shenmu Hospital of Northwest University from January 2022 to December 2023 were included. According to the 28-day prognosis, they were divided into a good prognosis group (survival) (84 cases) and a poor prognosis group (death) (36 cases). The basic data of the patients were collected at admission, including age, gender, smoking history, and duration of COPD. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score was measured before treatment to determine whether it was an acute exacerbation period. The levels of platelet count (PLT), neutrophil count, serum creatinine (Scr), glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GCT), MyD88, and IL-33 were measured before treatment, and the lactate level was measured before treatment and after treatment with an interval of 24 h. Logistic regression analysis was used to explore the independent factors affecting prognosis, and Spearman correlation analysis was used to evaluate the correlations between serum biomarkers and patients' prognosis.χ² test and t test were used. Results　In the good prognosis group, there were 50 males and 34 females, aged (70.68±3.36) years, and the duration of COPD was (18.74±3.65) years. In the poor prognosis group, there were 21 males and 15 females, aged (70.41±3.27) years, and the duration of COPD was (18.59±3.78) years. Multivariate logistic regression analysis showed that APACHEⅡ score, neutrophil count, MyD88, IL-33, and LCR were the influencing factors of poor prognosis in patients with AECOPD combined with respiratory failure (all P<0.05). Spearman correlation analysis showed that serum MyD88 and IL-33 were positively correlated with poor prognosis (r=0.641 and 0.640, both P<0.05), and LCR was negatively correlated with poor prognosis (r=-0.695, P<0.05). The receiver operating characteristic curve (ROC) showed that the area under the curve of combined serum MyD88, IL-33, and LCR in predicting poor prognosis in patients with AECOPD combined with respiratory failure was 0.987 (95%CI 0.972-1.000), the sensitivity was 94.4%, the specificity was 97.6%, and the Youden index was 0.920, with the highest diagnostic efficiency. Conclusions　Serum MyD88 and IL-33 levels are upregulated, and LCR level is decreased in poor prognosis patients with AECOPD combined with respiratory failure. The combined application of the three indicators has good diagnostic efficacy.

Efficacy of holmium laser lithotripsy under rigid ureteroscopy in the treatment of complex upper urinary calculi

Feng Chang, Tang Yahua, Ye Guilin

2024, 30(22):  3816-3820.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.025

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Objective　To investigate the effect of rigid ureteroscopy combined with holmium laser lithotripsy in the intervention of complex upper urinary calculi and its effects on inflammation, complications, and recurrence. Methods　This study was a randomized controlled trial. A total of 138 patients with complex upper urinary calculi admitted to Dongguan Wanjiang Hospital from February 2022 to October 2023 were selected as the study objects and were divided into a control group (68 cases) and an observation group (70 cases) according to the random number table method. In the control group, 40 males and 28 females were (38.22±4.11) years old, and the stone diameter was (3.79±0.45) cm. In the observation group, 42 males and 28 females were (38.15±4.05) years old, and the stone diameter was (3.75±0.46) cm. The control group underwent traditional percutaneous nephrolithotomy, and the observation group underwent holmium laser lithotripsy under rigid ureteroscopy. Perioperative indicators, stone clearance rate, inflammatory response factors [C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT)] before and after operation were compared between the two groups, and postoperative complications and recurrence were recorded after 6 months of follow-up. χ² test and t test were used. Results　In the observation group, the operation time was (95.15±8.56) min, the postoperative getting out of bed time was (1.45±0.42) d, the postoperative hospitalization time was (8.12±1.25) min, the intraoperative blood loss was (18.52±2.46) ml, and those in the control group were (116.52±10.15) min, (2.66±0.58) d, (13.45±1.76) d, and (41.18±4.05) ml, with statistically significant difference (t=17.617, 17.456, 25.340, and 46.816, all P<0.001). There was no statistically significant difference in the stone clearance rate between the observation group [97.14% (68/70)] and the control group [95.59% (65/68)] (χ²=0.238, P=0.625). Three days after surgery, the levels of CRP, IL-6, and PCT in both groups were lower than those before surgery, and those in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ²=0.238, P=0.625). After 6 months of follow-up, the recurrence rate of the observation group was lower than that of the control group [1.43% (1/70) vs. 10.29% (7/68)], with a statistically significant difference (χ²=4.964, P=0.026). Conclusions　Holmium laser lithotripsy under rigid ureteroscopy has a good effect on stone removal in patients with complex upper urinary calculi, and the postoperative complications are not significantly different from those of conventional percutaneous nephrolithotomy. However, holmium laser lithotripsy under rigid ureteroscopy has the advantages of short operation time, less surgical trauma, and fast postoperative recovery, which can reduce the inflammatory reaction and recurrence rate of stones, and is worth promoting.

Application value of vaginal two-dimensional and three-dimensional color Doppler ultrasound in the diagnosis of endometrial polyps

Lu Liyu, Liu Xiaoyan, Xu Jing, Wang Zhijuan

2024, 30(22):  3820-3823.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.026

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Objective　To explore the application value of transvaginal two-dimensional (2D) and three-dimensional (3D) color Doppler ultrasound in the diagnosis of endometrial polyps. Methods　A total of 86 patients with suspected endometrial polyps who visited Guangzhou United Family Hospital from May 2021 to December 2023, aged 25-50 years, were retrospectively selected as the study subjects. All the 86 patients with suspected endometrial polyps underwent transvaginal 2D and 3D color Doppler ultrasound examinations and hysteroscopic pathological biopsy. The efficacies of transvaginal 2D and 3D color Doppler ultrasound examinations in the diagnosis of endometrial polyps were compared by χ² test according to the pathological diagnosis results. Results　Among the 86 patients with suspected endometrial polyps, 81 cases were pathologically diagnosed as endometrial polyps. Among them, 72 cases of endometrial polyps were confirmed by transvaginal 2D ultrasound, with 9 missed diagnoses, resulting in a diagnostic accuracy rate of 88.9%; 79 cases of endometrial polyps were confirmed by transvaginal 3D ultrasound, with 2 missed diagnoses, resulting in a diagnostic accuracy rate of 97.5%; the diagnostic accuracy rate of transvaginal 3D ultrasound was higher than that of transvaginal 2D ultrasound (P<0.05). Conclusion　Transvaginal ultrasound technology has high accuracy and reliability in the diagnosis and evaluation of endometrial polyps, especially transvaginal 3D ultrasound, which can provide important references for clinical treatment.

Medication Research

Determination of alkaloid content in different batches of strychnos seed kernel and vinegar products

Lin Wenman, Jiang Liyun

2024, 30(22):  3824-3827.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.027

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Objective　To compare the alkaloid content in different batches of strychnos seed kernel and vinegar products, and to provide a certain reference for scientific process of vinegar strychni Semen. Methods　Twelve batches of strychnos seed kernel were collected and the contents of strychnine and bruceine were determined by high performance liquid chromatography (HPLC). The contents of two alkaloids were compared before and after processing. Results　The contents of strychnine and bruceine in 12 batches of strychnos seed kernel were 1.68%-2.11% and 0.99%-1.43%, and the contents of strychnine and bruceine in 12 batches of vinegar products were 1.21%-1.48% and 0.65%-0.94%, which were reduced by 21.47%-38.89% and 27.35%-50.35% after vinegar preparation. Conclusion　The contents of strychnine and bruceine in strychnos seed kernel were decreased significantly after preparation of vinegar, which might be the principle of attenuated toxin of strychni semen.

Basic Research

Study on the effect of anthocyanin on improving airway inflammation in asthma model mice by regulating the CD147/MMP-9 pathway

Han Bo, Zuo Junli, Qiao Lianjie

2024, 30(22):  3828-3833.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.028

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Objective　To investigate the effect of anthocyanin (ACN) on improving airway inflammation in asthma model mice by regulating the extracellular matrix metalloproteinase inducer (CD147)/matrix metalloproteinase-9 (MMP-9) pathway. Methods　Male Balb/c mice aged 7-8 weeks, with a weight of (20±5) g, were used to construct the asthma model. The mice were divided into an ovalbumin (OVA) group (model group), L-ACN, M-ACN, and H-ACN groups [75, 150, and 300 mg/(kg·d) of ACN orally administered 1 hour before immune challenge], and an ACN+sCD147 group [300 mg/(kg·d) of ACN orally administered 1 hour before immune challenge + intraperitoneal injection with 22 mg/kg of soluble CD147 (sCD147)], with 10 mice in each group. Another 10 mice were randomly selected from the raised mice as a control group. The airway hyperresponsiveness (AHR) and inflammatory cells in bronchoalveolar lavage fluid (BALF) of the mice in each group were measured. HE staining and PAS staining were applied to observe the pathological changes in lung tissue of asthmatic mice. Enzyme-linked immuno sorbent assay (ELISA) was applied to detect the levels of interleukin (IL)-4, IL-5, IL-13, and interferon (IFN)-γ in the serum of asthmatic mice. Western blot was applied to detect the protein expressions of CD147 and MMP-9 in the lung tissue of asthmatic mice. One-way analysis of variance and SNK-q test were used. Results　In the OVA group, severe cell infiltration was observed in the walls and interstitium of the alveoli, with a significant increase in PAS positive epithelial cells, extensive proliferation of goblet cells, and increased mucus secretion. The AHR, eosinophils (EOS), macrophages (TAM), lymphocytes (Lym), neutrophils (Neu), IL-4, IL-5, IL-13, and protein expressions of CD147 and MMP-9 in the OVA group were higher than those in the control group, and the expression of IFN-γ was lower than that in the control group, with statistically significant differences (all P<0.05). In the L-ACN group, M-ACN group, and H-ACN group, the inflammation of lung tissue was alleviated, the number of PAS positive epithelial cells decreased in sequence, and the mucus secretion decreased. The AHR, EOS, TAM, Lym, Neu, IL-4, IL-5, IL-13, and protein expressions of CD147 and MMP-9 in the L-ACN group, M-ACN group, and H-ACN group were lower than those in the OVA group, and the expression of IFN-γ was higher than that in the OVA group (all P<0.05). In the ACN+sCD147 group, the inflammation of lung tissue was further worsened, the PAS positive epithelial cells increased, and the mucus secretion increased. The AHR, EOS, TAM, Lym, Neu, IL-4, IL-5, IL-13, and protein expressions of CD147 and MMP-9 in the ACN+sCD147 group were higher than those in the H-ACN group, and the expression of IFN-γ was lower than that in the H-ACN group (all P<0.05). Conclusion　ACN can inhibit the CD147/MMP-9 pathway and improve airway inflammation in asthma model mice.

Case Report

Case report of 2 patients with Marfan syndrome and reflections

Li Yang, Wang Jian, Yang Shoujuan, Cheng Jinfeng, Li Jinlong, Cheng Yanli

2024, 30(22):  3834-3837.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.029

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Marfan syndrome (MFS) is an autosomal dominant connective tissue disease with a low prevalence rate that is easily overlooked in clinical practice. Involvement of the cardiovascular system, skeleton, and eyes is considered the "classic triad" of MFS. Cardiovascular lesions such as aortic root dilatation with aortic valve insufficiency, aortic aneurysm, and aortic coarctation are more common. Cardiovascular events such as cardiac enlargement, malignant arrhythmia, and rupture of the aortic coarctation are the main causes of death in MFS patients. In this article, we report two patients with MFS and review them in the context of the literatures, aiming to help clinicians improve their understanding on MFS.

Nursing Research

Nursing care for 2 children with severe anaphylactic shock caused by rabbit anti-human thymocyte immunoglobulin

Feng Minxian, Cen Xiuxian

2024, 30(22):  3838-3840.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.030

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This study retrospectively analyzed and explored the severe allergic shock phenomenon that occurred in two children during the pre-treatment stage of hematopoietic stem cell transplantation when using rabbit anti-human thymocyte immunoglobulin (rATG). Summary of experiences included: comprehensive evaluation of medical history, precise identification of allergic risk; standardizing the medication process and strictly implementing preventive measures; normalized emergency drills to ensure rapid and efficient rescue; implementing humanistic care to alleviate the anxiety. After timely and effective rescue treatment, both children successfully passed the pre-treatment phase of medication and completed hematopoietic stem cell transplantation surgery. They were improved and discharged at 28 and 23 days after surgery, respectively.

Impact of safflower wine wet compressing on the function and complications of early arteriovenous fistula in hemodialysis patients

Liu Xue, Li Yingna, Quan Linfei, Liu Wanshan

2024, 30(22):  3841-3846.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.031

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Objective　To investigate the effect of safflower wine wet compressing on the function and complications of early arteriovenous fistula in hemodialysis patients. Methods　This study was a randomized controlled trial. A total of 60 patients who underwent regular maintenance hemodialysis with new internal fistula in the Blood Purification Center of Guangzhou First People's Hospital from January to December 2022 were selected as the study objects. The patients were divided into a control group (30 cases) and an observation group (30 cases) by the random number table method. There were 12 males and 18 females in the control group, aged (54.31±7.51) years, with a body mass index (BMI) of (22.34±3.24) kg/m². There were 19 males and 11 females in the observation group, aged (55.42±8.23) years, with a BMI of (22.56±2.91) kg/m². The control group received routine nursing care, while the observation group received safflower wine wet compressing nursing care. Both groups underwent a 6-month nursing intervention period. The cephalic vein diameter and blood flow at the anastomosis were compared between the two groups before intervention and after 1, 3, and 6 months of intervention, as well as the internal fistula function grade after 6 months of intervention, the occurrence of complications, and the degree of puncture pain during intervention. Independent sample t test, χ² test, rank sum test, and mixed linear effect model were used. Results　The diameter of cephalic vein in the observation group was (3.84±0.46) cm, (4.44±0.35) cm, (4.93±0.26) cm, and (5.39±0.21) cm before intervention and after 1, 3, and 6 months of intervention, respectively, and the cephalic vein blood flow was (419.14±35.44) ml/min, (514.16±51.63) ml/min, (701.39±88.59) ml/min, and (897.53±121.76) ml/min, respectively. In the control group, the diameter of cephalic vein was (4.00±0.43) cm, (4.49±0.30) cm, (4.77±0.35) cm, and (5.15±0.21) cm before intervention and after 1, 3, and 6 months of intervention, respectively, and the cephalic vein blood flow was (404.26±31.07) ml/min, (544.80±50.12) ml/min, (689.44±88.52) ml/min, and (723.09±156.55) ml/min, respectively. The cephalic vein diameter and blood flow before intervention, after 1 month, and after 3 months were all lower than those after 6 months (all P<0.05). The cephalic vein diameter and blood flow in the control group were lower than those in the observation group (all P<0.05). After 6 months of intervention, the excellent and good rate of internal fistula function in the observation group was higher than that in the control group [76.67% (23/30) vs. 50.00% (15/30)] (P<0.05). During the intervention period, the total incidence of complications in the observation group was lower than that in the control group [16.67% (5/30) vs. 43.33% (13/30)] (P<0.05). The degree of puncture pain in the observation group was lower than that in the control group (P<0.05). Conclusion　Safflower wine wet compressing can significantly increase the cephalic vein diameter and venous blood flow of new arteriovenous fistula in hemodialysis patients, promote the maturation of internal fistula, improve the function of internal fistula, reduce the related complications, and alleviate the pain during puncture, which is suitable for application and promotion in hemodialysis patients.

Application of mobile health intervention based on integrated theory of health behavior change in patients after PCI

Lin Haiying, Chen Haihong, Jian Xiangyu, Zhang Zhenhong

2024, 30(22):  3847-3851.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.032

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Objective　To explore the application effect of mobile health intervention based on the integrated theory of health behavior change (ITHBC) in patients after percutaneous coronary intervention (PCI). Methods　A total of 112 patients with coronary heart disease who underwent PCI in the Second People's Hospital of Foshan City from October 2022 to August 2023 were prospectively selected as the study objects. The patients were divided into a control group (56 cases) and an observation group (56 cases) by the random number table method. In the control group, there were 36 males and 20 females, aged (65.84±9.71) years, and the number of stents implanted was 1 in 28 cases, 2 in 25 cases, and 3 in 3 cases. There were 38 males and 18 females in the observation group, aged (64.45±9.55) years, and the number of stents implanted was 1 in 26 cases, 2 in 25 cases, and 3 in 5 cases. The control group received routine postoperative care, and the observation group received mobile health interventions based on ITHBC on the basis of the control group. Both groups were intervened until 3 months after discharge. The self-management efficacy [General Self-Efficacy Scale (GSES)], self-management ability [Coronary Heart Disease Self-Management Scale (CSMS)], and quality of life [Seattle Angina Questionnaire (SAQ)] before and after intervention and incidence of cardiovascular adverse events were compared between the two groups. Independent sample t test, rank sum test, and χ² test were used. Results　After intervention, the GSES and CSMS scores of the observation group were higher than those of the control group [(31.27±3.52) points vs. (27.45±3.69) points, (100.68±8.43) points vs. (91.71±7.55) points] (both P<0.05). The scores of all dimensions of the SAQ in the observation group were higher than those in the control group [(81.64±5.89) points vs. (76.25±6.76) points, (78.43±5.23) points vs. (73.82±6.69) points, (82.05±4.63) points vs. (77.21±5.69) points, (82.29±4.87) points vs. (76.80±7.71) points, (91.05±6.22) points vs. (86.27±6.95) points] (all P<0.05). During intervention, the total incidence of cardiovascular adverse events in the observation group was lower than that in the control group [3.6% (2/56) vs. 16.1% (9/56)] (P<0.05). Conclusion　Implementing mobile health interventions based on ITHBC for patients after PCI can improve their self-efficacy and self-management ability, improve their quality of life, and reduce the incidence of cardiovascular adverse events.

Study on the effectiveness of nursing intervention based on behavioural change wheel theory on volume management in patients with chronic heart failure

Chen Shanxia, Zhang Junmei, Xie He'nan

2024, 30(22):  3852-3856.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.033

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Objective　To study the effect of nursing intervention based on the behaviour change wheel (BCW) theory on volume management in patients with chronic heart failure (CHF). Methods　This was a prospective, randomized, controlled, and single-center study. A total of 86 CHF patients admitted to the Department of Geriatric Medicine, Henan Provincial People's Hospital from April 2023 to November 2023 were selected as the study objects. The patients were divided into a control group and an experimental group by the random number table method. The experimental group screened 43 cases, excluded 3 cases, and finally included 40 cases in the analysis; the control group screened 43 cases, excluded 2 cases, and finally included 41 cases in the analysis. There were 14 males and 27 females in the control group, aged (60.17±5.22) years, with a height of (165.10±7.45) cm and body weight of (69.41±13.28) kg. There were 18 males and 22 females in the experimental group, aged (58.33±4.50) years, with a height of (166.65±10.72) cm and body weight of (68.12±13.31) kg. The control group received routine nursing intervention, and the experimental group received nursing intervention based on the BCW theory on the basis of the control group. Both groups received four interventions during hospitalization (on the first day after admission, on the second day after admission, on the third day after admission, and before discharge), and once a week in the first month after discharge, a total of four times. The two groups were followed up by telephone one month after the end of intervention. The qualitied rates of dry weight of the two groups were compared 1 month and 2 months after discharge, and the weight management ability, self-management ability, and quality of life of the two groups were compared before intervention and 1 month and 2 months after discharge. Independent sample t test, paired t test, and χ² test were used. Results　At 1 month and 2 months after discharge, the qualitied rate of dry weight of the experimental group [85.00% (34/40) and 72.50% (29/40)] was higher than that of the control group [63.41% (26/41) and 48.78% (20/41)] (both P<0.05). At 1 month and 2 months after discharge, the scores of weight management ability [(36.93±1.50) points and (35.17±2.07) points], self-management ability [(75.34±1.53) points and (73.95±1.16) points] of the experimental group were higher than those of the control group [(30.03±0.84) points, (27.13±0.83) points, (67.40±1.43) points, and (64.03±1.14) points] (all P<0.05); the quality of life score of the experimental group [(63.85±6.35) points and (62.68±4.57) points] was lower than that of the control group [(83.45±5.44) points and (89.80±5.10) points] (both P<0.05). Conclusion　In CHF patients, the application of nursing intervention based on the BCW theory can improve the qualitied rate of dry weight, weight management ability, self-management ability, and quality of life.

Impact of nursing intervention based on story theory on self-care ability in patients with ankylosing spondylitis

Zhang Min, Guo Jia, Wang Yanfei

2024, 30(22):  3857-3861.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.034

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Objective　To observe the role of nursing intervention based on story theory applied in the nursing care of ankylosing spondylitis (AS). Methods　This study was a randomized controlled trial. A total of 90 AS patients admitted to the Department of Orthopedics of Baoji Central Hospital from January 2020 to January 2023 were selected as the study objects. The patients were divided into a control group (45 cases) and an observation group (45 cases) by the random number table method. There were 25 males and 20 females in the control group, aged 21-65 (34.26±3.79) years, and the course of disease was 1-6 (3.28±0.54) months. There were 24 males and 21 females in the observation group, aged 20-65 (34.65±3.51) years, and the course of disease was 1-6 (3.27±0.50) months. The control group received conventional nursing, and the observation group received nursing intervention based on story theory for 20 days. The clinical treatment indexes 1 day before discharge, self-care ability [Exercise of Self-care Agency Scale (ESCA)] and lumbar function [Japanese Orthopaedic Association Score (JOA)] on the day of admission and 1 day before discharge were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　One day before discharge, the duration of morning stiffness in the observation group was shorter than that in the control group [(21.65±2.54) min vs. (23.33±3.15) min], and the thoracic mobility and lumbar anterior flexion were higher than those in the control group [(5.04±0.36)° vs. (4.86±0.22)°, (73.65±3.65)° vs. (71.54±3.02)°] (all P<0.05). The scores of self-concept, self-responsibility, self-management skills, and health literacy level of the ESCA in the observation group were higher than those in the control group [(33.78±3.54) points vs. (32.11±3.48) points, (34.61±3.51) points vs. (32.97±3.44) points, (37.37±3.86) points vs. (35.46±3.75) points, (38.43±3.94) points vs. (36.56±3.87) points] (all P<0.05). The scores of four dimensions (subjective symptoms, clinical signs, limitations in daily activities, and bladder function) of the JOA in the observation group were higher than those in the control group [(38.55±4.98) points vs. (36.24±4.57) points, (39.72±4.41) points vs. (37.69±4.28) points, (39.47±4.11) points vs. (37.65±4.05) points, (39.43±4.94) points vs. (36.96±4.87) points] (all P<0.05). Conclusion　The implementation of nursing intervention based on story theory can significantly reduce the duration of morning stiffness in patients with AS, enhance their self-care ability, and thus improve their lumbar spine function, which is worthy of clinical promotion.

Effect of phased comprehensive management intervention on blood glucose control in diabetic patients

Chen Jing, Shen Yan

2024, 30(22):  3861-3865.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.035

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Objective　To investigate the impact of phased comprehensive management intervention on blood glucose control in patients with diabetes. Methods　This study was a randomized controlled trial. A total of 120 diabetic patients who visited the Department of Nephrology and Endocrinology, The Second Affiliated Hospital of Xi'an Medical University from January 2022 to November 2023 were selected as the research objects. The patients were divided into a control group (60 cases) and an observation group (60 cases) by the random number table method. There were 43 males and 17 females in the control group, aged (47.62±6.35) years, and the course of disease was (6.31±3.57) years. There were 39 males and 21 females in the observation group, aged (47.39±6.14) years, and the course of disease was (6.65±3.74) years. The control group received standard care, and the observation group received phased comprehensive management nursing intervention based on the control group for 3 months. Blood glucose levels [glycated hemoglobin (HbA1c) and fasting blood glucose (FBG)], self-management ability [Diabetes Self-Management Questionnaire (DSMQ)], medication compliance [Eight-item Morisky Medication Adherence Scale (MMAS-8)], and quality of life [Diabetes Quality of Life Questionnaire (DQOL)] were compared between the two groups before and after intervention. Independent sample t test, paired t test, and χ² test were used. Results　After intervention, the levels of HbA1c [(50.72±0.92) mmol/mol] and FBG [(7.15±0.46) mmol/L] in the observation group were lower than those in the control group [(53.47±1.06) mmol/mol and (7.68±0.57) mmol/L] (both P<0.05). The scores of diet control [(5.85±1.93) points], physical activity [(5.12±1.66) points], blood glucose monitoring [(4.05±1.08) points], and medication adherence [(4.47±1.28) points] of the DSMQ in the observation group were all higher than those in the control group [(4.85±1.38) points, (4.25±1.19) points, (2.94±0.72) points, and (3.52±1.09) points] (all P<0.05). The MMAS-8 score of the observation group [(8.54±0.52) points] was higher than that of the control group [(7.31±0.58) points] (P<0.05). The scores of satisfaction [(32.25±4.75) points], impact [(43.82±7.04) points], disease-related anxiety [(9.14±1.41) points], and social concern [(9.25±1.53) points] of the DQOL in the observation group were lower than those in the control group [(36.19±5.28) points, (51.46±7.63) points, (12.59±1.85) points, and (12.93±1.97) points] (all P<0.05). Conclusion　The phased comprehensive management nursing intervention significantly improves the blood glucose level, self-management ability, medication adherence, and quality of life in diabetic patients.

Influence of TCM nursing mode on sub-healthy patients

Chen Rongling, Xu Haiying, Sun Wei

2024, 30(22):  3866-3869.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.036

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Objective　To analyze the impact of the traditional Chinese medicine (TCM) nursing mode based on the "Theory of TCM Constitution Identification" on the prognosis and quality of life of sub-healthy patients. Methods　This study was a randomized controlled trial. A total of 100 sub-healthy patients admitted to the Preventive Treating Disease Center, Lianyungang Hospital of Traditional Chinese Medicine from April 2021 to April 2023 were prospectively selected as the study objects. The patients were divided into a control group (50 cases) and an observation group (50 cases) by the random number table method. There were 29 males and 21 females in the control group, aged (40.20±2.01) years, and the duration of fatigue symptoms was (6.45±1.43) months. There were 31 males and 19 females in the observation group, aged (39.98±2.40) years, and the duration of fatigue symptoms was (6.37±1.40) months. The control group received routine nursing, and the observation group received TCM nursing mode based on the "Theory of TCM Constitution Identification" for 30 days. The TCM syndrome score and quality of life [EuroQol Five-Dimensional Questionnaire (EQ-5D)] before and after intervention were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After intervention, the scores of physical fatigue, mental fatigue, pale mouth not thirsty, and poor appetite in the observation group were lower than those in the control group [(1.01±0.30) points vs. (1.25±0.69) points, (1.43±0.22) points vs. (1.66±0.59) points, (1.00±0.35) points vs. (1.29±0.46) points, (0.73±0.22) points vs. (1.04±0.41) points] (all P<0.05). The scores of action ability, self-management ability, activity, pain or discomfort, and anxiety or depression in the observation group were higher than those in the control group [(2.01±0.64) points vs. (1.78±0.14) points, (1.95±0.43) points vs. (1.72±0.34) points, (1.82±0.26) points vs. (1.67±0.27) points, (2.01±0.27) points vs. (1.90±0.12) points, (1.92±0.14) points vs. (1.78±0.30) points] (all P<0.05). Conclusion　The TCM nursing mode based on the "Theory of TCM Constitution Identification" can effectively improve the TCM syndrome score of sub-healthy patients and comprehensively improve their quality of life.

Intervention value of fine nursing combined with traditional Chinese medicine rehabilitation nursing for children with asthmatic bronchopneumonia undergoing aerosol inhalation

Tao Juan, Li Ning

2024, 30(22):  3870-3874.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.037

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Objective　To analyze the intervention value of fine nursing combined with traditional Chinese medicine (TCM) rehabilitation nursing for children with asthmatic bronchopneumonia undergoing aerosol inhalation. Methods　Eighty children with asthmatic bronchopneumonia undergoing aerosol inhalation in Pingdingshan Hospital of Traditional Chinese Medicine from April to October 2023 were selected as the study objects, and were divided into a control group (40 cases) and an observation group (40 cases) by the random number table method. There were 22 boys and 18 girls in the control group, aged 3-10 (5.93±1.34) years, the course of disease was 1-6 (3.68±1.15) d, and there were 13 cases of bacterial infection and 27 cases of viral infection. There were 24 boys and 16 girls in the observation group, aged 3-10 (6.14±1.29) years, the course of disease was 1-6 (3.72±1.13) d, and there were 11 cases of bacterial infection and 29 cases of viral infection. The control group received fine nursing, and the observation group received TCM rehabilitation nursing on the basis of the control group for a week. The symptom improvement time (cough disappearance time, asthma disappearance time, and temperature recovery time), lung function [forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume in the first second (FEV1)], treatment compliance (self-made pediatric treatment compliance scale), and quality of life [Universal Core Scale for Children's Quality of Life (PedsQLTM4.0)] before and after intervention, and adverse reactions during intervention were compared between the two groups. Independent sample t test and χ² test were used. Results　The time of cough disappearance [(3.35±1.06) d], the time of asthma disappearance [(3.39±0.94) d], and the time of body temperature recovery [(2.57±0.31) d] in the observation group were shorter than those in the control group [(5.92±1.27) d, (6.85±1.23) d, and (3.69±0.58) d] (all P<0.05). After intervention, the levels of FVC [(3.08±0.16) L], PEF [(3.57±0.24) L/s], and FEV1 [(2.53±0.21) L] in the observation group were higher than those in the control group [(2.71±0.14) L, (3.25±0.21) L/s, and (2.32±0.18) L] (all P<0.05). The scores of medication [(9.13±0.89) points], exercise [(8.84±0.81) points], and diet [(8.97±0.84) points] of the self-made pediatric treatment compliance scale in the observation group were higher than those in the control group [(7.51±0.75) points, (7.49±0.72) points, and (7.13±0.67) points] (all P<0.05); the scores of physiological function [(78.92±5.03) points], emotional function [(74.67±4.78) points], social function [(76.85±4.92) points], and school performance [(70.19±4.08) points] of the PedsQLTM4.0 in the observation group were higher than those in the control group [(69.35±4.42) points, (66.29±4.29) points, (67.09±4.51) points, and (64.93±3.79) points] (all P<0.05). During the intervention period, the total incidence of adverse reactions in the observation group [10.00% (4/40)] was lower than that in the control group [37.50% (15/40)] (P<0.05). Conclusion　Fine nursing combined with TCM rehabilitation nursing can improve the symptoms in children with asthmatic bronchopneumonia undergoing aerosol inhalation, improve the lung function, enhance the treatment compliance, reduce the incidence of adverse reactions, and improve the quality of life.

Impact of nursing interventions based on causal analysis on compliance behaviors, recovery, and quality of life in patients with chronic obstructive pulmonary disease

Zhao Min, Xia Xinjuan

2024, 30(22):  3875-3879.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.038

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Objective　To explore the impact of nursing interventions based on causal analysis on compliance behaviors, recovery, and quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods　This study was a randomized controlled trial. A total of 82 COPD patients admitted to No.215 Hospital of Shaanxi Nuclear Industry from January 2022 to December 2022 were prospectively selected as the study objects. The patients were divided into a control group (41 cases) and a study group (41 cases) by the random number table method. There were 23 males and 18 females in the control group, aged (51.38±6.15) years, and the course of disease was (5.25±1.07) years. There were 26 males and 15 females in the study group, aged (50.74±6.61) years, and the course of disease was (5.51±1.24) years. The control group received routine nursing care, and the study group received nursing interventions based on causal analysis for 1 month. The compliance behaviors and lung function [peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1), ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC)], self-care ability (ESCA), and quality of life [WHO Quality of Life Brief Scale (WHOQOL-BREF)] before and after intervention were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　The total compliance rate of the study group was higher than that of the control group [95.12% (39/41) vs. 80.49% (33/41)] (P<0.05). After intervention, the PEF, FEV₁, and FEV₁/FVC in the study group were higher than those in the control group [(5.34±1.03) L/s vs. (4.71±0.89) L/s, (1.95±0.44) L vs. (1.62±0.41) L, (75.42±7.86)% vs. (62.93±7.11)%] (all P<0.05). The scores of self-concept, self-care responsibility, self-care skills, and health knowledge level of the ESCA in the study group were higher than those in the control group [(30.03±1.15) points vs. (26.94±2.28) points, (22.09±1.12) points vs. (18.43±2.03) points, (40.20±2.58) points vs. (35.37±3.15) points, (46.98±2.12) points vs. (41.16±3.14) points] (all P<0.05). The scores of social, environmental, psychological, and physiological dimensions of the WHOQOL-BREF of the study group were higher than those of the control group [(71.74±15.15) points vs. (64.59±13.79) points, (70.88±14.37) points vs. (64.12±13.85) points, (71.18±16.51) points vs. (63.71±14.96) points, (68.58±14.03) points vs. (62.03±12.72) points] (all P<0.05). Conclusion　Nursing interventions based on causal analysis can improve the compliance behaviors in COPD patients, promote the disease recovery, and improve their quality of life.

Effect of quality control management based on cycle management method in improving hand hygiene and preventing hospital infection

Hu Die, Zhang Jiuxia, Zhao Yi, Wu Lanyan

2024, 30(22):  3880-3884.  DOI: 10.3760/cma.j.issn.1007-1245.2024.22.039

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Objective　To observe the effect of quality control management based on cycle management method in improving hand hygiene of medical staff and preventing hospital infection. Methods　This was a retrospective study. According to the implementation time of quality control management based on cycle management method in the Third People's Hospital of Hubei Province Affiliated to Jianghan University, the period from January to June 2023 was before the implementation, and the period from July to December 2023 was after the implementation. The medical staff before and after the implementation were the same batch, including 23 females and 7 males, aged 21-47 (33.27±3.15) years; for education level, there were 2 college students, 25 undergraduates and 3 postgraduates. Before and after the implementation, the qualified rate of hospital environmental sample test, qualified rate of medical staff's hand hygiene, mastered rate of knowledge of infection control, mastered rate of hygiene and disinfection skills, management quality, and hand hygiene compliance were compared. Paired t test and χ² test were used. Results　After the implementation, the qualified rates of environmental samples collected from disinfectants in use and surface of a random object were higher than those before the implementation, but the differences were not statistically significant (both P>0.05). After the implementation, the qualified rates of medical staff's hand hygiene before and after contacting with patients, before cleaning or sterile operation, and after contacting with patients' surroundings and body fluids were higher than those before the implementation [96.67% (29/30) vs. 70.00% (21/30), 90.00% (27/30) vs. 60.00% (18/30), 56.67% (17/30) vs. 26.67% (8/30), 93.33% (28/30) vs. 70.00% (21/30), 96.67% (29/30) vs. 76.67% (23/30)] (all P<0.05). After the implementation, the scores of infection control knowledge and disinfection skills of medical staff were higher than those before the implementation [(87.56±5.24) points vs. (76.29±7.83) points, (91.27±3.11) points vs. (84.59±5.14) points] (both P<0.05). After the implementation, the scores of quality of environmental management, awareness of risk prevention, and safety identification ability of medical staff were higher than those before the implementation [(88.35±4.05) points vs. (79.52±6.18) points, (87.43±3.72) points vs. (76.82±5.59) points, (91.35±2.47) points vs. (83.98±4.16) points] (all P<0.05). After the implementation, the hand hygiene compliance rate of medical staff was higher than that before the implementation [70.38% (221/314) vs. 39.02% (119/305)] (P<0.05). Conclusion　Quality control management based on cycle management method can enhance the medical staff's compliance with hand hygiene and awareness of hospital infection prevention and control, thereby improving the quality of hospital infection prevention and control.