Table of Content

01 June 2022, Volume 28 Issue 11

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Special Subject :Breast Cancer

Application of simulated reduction verification in intensity modulated radiotherapy for breast cancer patients

Fang Yongwen, Fang Jianlan, Liu Biaoshui, Yao Wenyan, Lin Xiaosheng, Lin Chengguang, Xiao Liangjie

2022, 28(11):  1482-1485.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.001

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Objective　To analyze the error of simulated reduction verification in breast cancer patients before radiotherapy and to explore the necessity of simulated reduction verification before radiotherapy. Methods　One hundred and seventy-four breast cancer patients who received radiotherapy in Sun Yat-sen University Cancer Center from November 2020 to November 2021 were randomly selected for the retrospective study, with a total of 870 cone beam CT (CBCT) placement errors. The breast cancer patients who underwent X-ray simulation reduction verification before radiotherapy were set as group A; the breast cancer patients without simulated reduction verification were set as group B, and CBCT was used for postural verification during the treatment. The postural error data after CBCT calibration for the first treatment and the time required for the first treatment (the time in group A was the simulation reset verification time plus the first treatment time, and the time in group B was the first treatment time) were recorded and observed. The independent-sample t test analysis was conducted respectively. Results　The errors in the SI direction of the head and foot between group A and group B were (0.07±0.33) cm and (0.15±0.43) cm, with a statistical difference (t=3.575, P<0.001); there were no statistical differences in the left and right LR and anterior and posterior AP directions (both P>0.05). In the analysis of the first treatment time, the time of group A was much shorter than that of group B [(17.73±2.87) min vs. (34.51±3.28) min], with a statistical difference (t=48.480, P<0.001). According to the formula M_PTV=2.5∑+0.7σ, the external boundaries of group A and group B in all directions were calculated as below: LR 7.6 mm and 7.9 mm, SI 7.6 mm and 10.6 mm, and AP 10.2 mm and 10.7 mm. Conclusions　The repeatability of the patients in group A in the SI direction of the head and foot was better than that in group B after being verified by simulated reduction before radiotherapy; in the analysis of the first treatment time, the time of the patients in group A was much shorter than that in group B, and the time of the patients maintaining the treatment position was shortened. Reposition verification before upper breast cancer radiotherapy can improve the precision of radiotherapy and reduce the patients' positional uncertainty caused by a long single treatment time.

Expressions of Ki-67, EGFR, and E-cad in breast cancer and their effects on prognosis

Cheng Chen, Li Xueping, Xu Yi, Zhao Hongyan, Zhao Haitao

2022, 28(11):  1486-1491.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.002

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Objective　To investigate the expressions of Ki-67, EGFR, and E-cad in breast cancer and their effects on prognosis. Methods　One hundred and sixty-seven breast cancer specimens from Lianyungang First People's Hospital and Lianyungang Hospital of Traditional Chinese Medicine between May 2015 and December 2021 were retrospectively studied. The patients were followed up, and their data were sorted out. The SPSS 24.0 software was used for statistical analysis. The chi-square test was used to compare the enumeration data between the groups. Spearman analysis was used to evaluate the correlation of biological prognostic factors with clinicopathological characteristics and the Neo-bioscore prognostic evaluation system. The overall survival and survival analysis were observed by the Kaplan-Meier method. Single factor analysis was performed, and the survival curves were drawn. Cox regression model was used to carry out multivariate analysis to further exclude the influence of confounding factors. Results　The patients was averagely 46.4 years old. The pathological molecular typing of breast cancer was significantly different from the expressions of Ki-67 and EGFR (χ²=30.463, P<0.001; χ²=25.652, P<0.001); there were statistical differences between the expressions of Ki-67 and EGFR and between the expressions of EGFR and E-cad (χ²=7.167, P=0.007; χ²=18.576, P<0.001). There was a close positive correlation between the expression levels of EGFR and Ki-67 (r=0.207, P=0.007), and a negative correlation between the expression levels of EGFR and E-cad (r=-0.325, P<0.001); the Neo-bioscore score of breast cancer was positively correlated with the expression levels of Ki-67 and EGFR (r=0.324, P<0.001; r=0.176, P=0.023), and negatively with the expression level of E-cad (r=-0.162, P=0.037). The Kaplan-Meier univariate and COX model multivariate survival analysis showed that the Ki-67 expression level and Neo-bioscore score of breast cancer were the prognostic factors of breast cancer (χ²=3.950, P=0.047; χ²=13.372, P=0.004), and were the independent risk factors affecting the survival of breast cancer patients. Conclusions　The expressions of Ki-67, EGFR, and E-cad have an auxiliary judgment effect on the expressions of proliferative active molecules, making personalized and targeted therapy possible, and have a direct or indirect correlation with the prognosis of breast cancer patients. Dynamically monitoring the effect of tumor-targeted therapy has better clinical service.

Clinical effect of immunohistochemical detection in pathological diagnosis of breast cancer 

Yang Yang, Li Jianhua, Cheng Yao, Zhu Ruiping

2022, 28(11):  1492-1494.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.003

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Objective　To analyze the clinical effect of immunohistochemical detection in the pathological diagnosis of breast cancer. Methods　The subjects of the study were 241 female breast cancer patients who were admitted to Zhongshan Hospital, Dalian University from January 1, 2019 to August 1, 2021. All the patients underwent surgical treatment after enrollment. According to the surgical resection of breast tumor specimens, the ER+ (estrogen receptor positive) PR+ (progesterone receptor positive) patients were included in the positive group (121 cases), and the ER- (estrogen receptor negative) and PR- (progesterone receptor negative) patients were included in the negative group (120 cases). The positive group were (56.87±4.35) years old, and the negative group (57.13±4.46). Both groups underwent immunohistochemical detection, and the results were compared. The independent-sample t test was applied. Results　The proportions of HER-2 (human epidermal growth factor receptor) (+) and HER-2 (-) of breast tumor specimens and the axillary lymph node metastasis rate were 23.96% (29/121), 76.03% (92/121), and 31.40% (38/121) in the positive group, and were 85.00% (102/120), 15.00% (18/120), and 65.83% (79/120) in the negative group, with statistical differences (all P<0.05). Conclusion　Immunohistochemical detection can provide effective references for the pathological diagnosis of breast cancer, clarify the positive rate of HER-2 and axillary lymph node metastasis, and point out an accurate direction for further clinical intervention, and is conducive to the improvement of the prognosis.

Investigation on constitution types of traditional Chinese medicine, Kupperman score, and treatment methods of perimenopausal patients with breast cancer 

Kang Mengling, Li Liangfang, Liu Dongdong, Huang Lezhen

2022, 28(11):  1495-1499.  DOI: 10.3760/cma.j.issn.1007-1245.2022.09.004

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Objective　To observe the improved Kupperman score, constitution types of traditional Chinese medicine (TCM), and treatment methods of perimenopausal patients with breast cancer and the influence of TCM constitution types on Kupperman score. Methods　We conducted a cross-sectional survey on the perimenopausal patients with breast cancer treated at Breast Department, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine in 2015 by questionnaire. The questionnaire content included general information, the patients' diagnosis and treatment, TCM constitution types, and improved Kupperman score. We used descriptive statistical analysis, independent-sample t test, rank-sum test to observe the patients' common TCM constitution types and kupperman score, and to explore the effects of different treatment methods and TCM constitution types on kupperman score. Results　A total of 228 people were included in the survey, they were (52.50±4.75) years old. We found that the patients' TCM constitution types were often mixed; and the common constitution types were as below: blood stasis type (116 cases, 50.9%), qi stagnation type (110 cases, 48.2%), yang deficiency type (109 cases, 47.8%), and qi deficiency type (101 cases, 44.3%); 96.1% (219/228) of the patients had a Kupperman score over 6, 89.0% (203/228) had fatigue, 85.1% (194/228) had insomnia, and 85.1% (194/228) had emotional agitation. The Kupperman score was higher in the chemotherapy group than in the non-chemotherapy group (P=0.013). There were no statistical differences in the Kupperman score between the radiotherapy, endocrinological treatment, and targeted treatment. The total Kupperman score of the patients of normal constitution was lower than that of the patients without this constitution, while the total Kupperman scores of the patients with the other 7 types of constitutions except intrinsic constitution were higher than those in the patients without these constitutions, with statistical differences (all P<0.05). Conclusions　Blood stasis, qi stagnation, yang deficiency, and qi deficiency are the common constitution types of respondents. Perimenopausal syndrome occurs in most respondents. Chemotherapy can exacerbate perimenopausal symptoms. Normal constitution is a protective factor for the occurrence of perimenopausal syndrome, while the other seven constitutions except intrinsic constitution are the risk factors.

Scientific Research

Tet in regulation of Th17/Treg cell differentiation and in participatesion of pathogenesis of autoimmune diseases

Jiang Guantong, Zhou Jin, Xue Haibo

2022, 28(11):  1500-1504.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.005

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CD4⁺ T cells are an important part of human immunity. T helper cell 17 (Th17) and regulatory T cells (Treg), two newly discovered subsets of CD4⁺ T cells, play a key role in the occurrence and development of autoimmune diseases. Th17 cause autoimmunity and inflammation, while Treg inhibit the emergence of diseases and maintain immune homeostasis. Ten-eleven translocation (Tet), as a key factor in DNA demethylation, affects the Th17/Treg balance and involves in the progression of autoimmune diseases when it is absent. This review focuses on the research of the regulatory role of Tet on Th17/Treg cell immunization balance and the possible pathogenesis of autoimmune diseases.

Efficacy of prednisone combined with vincristine in treatment of chronic immune thrombocytopenia and its influence on cellular immune function

Lin Chunyan, Zhang Yunfan, Li Liyu, Chen Qiong, Li Qiaoru

2022, 28(11):  1504-1507.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.006

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Objective　To study the efficacy of prednisone combined with vincristine in the treatment of chronic immune thrombocytopenia and its effect on cellular immune function. Methods　One hundred and thirty-six children with chronic immune thrombocytopenia who were admitted to Zhongshan People's Hospital from January 2019 to August 2021 were selected for the prospective study, and were divided into a control group and a study group by the random number table method, with 68 cases in each group. The control group had 33 boys and 35 girls who were (11.13±2.83) years old, and they were treated with prednisone. The study group had 34 boys and 34 girls who were (11.12±2.28) years old, and they were treated with prednisone and vincristine. After continuous treatment for 2 months, the cellular immune function before and after the treatment, the treatment effects, and the incidences of adverse reactions in these two groups were observed and compared. The SPSS 22.0 statistical software was used to analyze the data. The t and χ² test were applied. Results　After the treatment, the CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the study group were (54.87±4.59)%, (33.97±3.85)%, and (1.85±0.36), which were higher than those in the control group [(52.35±5.24), (31.03±3.70)%, and (1.72±0.21)]; the CD8⁺ in the study group was (23.78±2.38)%, which was lower than that in the control group [(25.32±2.43)%]; there were statistical differences (t=2.983, 4.720, 2.572, and 3.733; all P<0.05). The effective rate in the study group was higher than that in the control group [94.12% (64/68) vs. 79.41% (54/68); χ²=6.403, P=0.011]. There was no statistical difference in the incidence of adverse reactions between the two groups (χ²=0.119, P=0.730). Conclusion　Prednisone combined with vincristine has a good effect in the treatment of children with chronic immune thrombocytopenia, and has a positive impact on their cellular immune function, so it is worth for widespread promotion.

High resolution magnetic resonance angiography in diagnosis of intracranial arteriosclerosis in patients with ischemic stroke

Xiao Taixing, Zhang Min, Tang Xueke, Feng Bo

2022, 28(11):  1508-1512.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.007

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Objective　To explore the application of magnetic resonance high-resolution vascular wall imaging (HR-VWI) in the diagnosis of intracranial arteriosclerosis in patients with ischemic stroke. Methods　Eighty patients with intracranial arteriosclerosis ischemic stroke treated in Liaocheng Third People's Hospital from January 2019 to February 2021 were divided into an artery-artery embolization group (single cortical infarction or multiple infarction in the same vascular innervation area) and a perforator artery involvement group (lesions in the blood supply area of lenticular artery and parapontine artery). There were 43 cases in the artery-artery embolization group, including 24 males and 19 females, and they were 57-75 years old. There were 37 cases in the perforator artery involvement group, including 22 males and 15 females, and they were 56-76 years old. All the patients were examined by digital subtraction angiography (DSA) and HR-VWI. The detection of intracranial arteriosclerosis by HR-VWI was counted. The changes of intracranial arteries and the related indicators of intracranial arteriosclerosis plaque morphology were compared between the two groups. SPSS 23.0 was used to analyze the data. The measurement data were compared between these two groups by t test, and the enumeration data by χ² test. The coincidence was tested by the Kappa index. If P<0.05, there was a statistical difference. Results　There was no statistical difference in the accuracy of intracranial arteriosclerosis stenosis between HR-VWI and DSA [93.75% (75/80) vs. 100.00% (80/80), P>0.05]. The Kappa index (0.911) of intracranial arteriosclerosis diagnosed by HR-VWI was higher (P<0.05). The vessel wall thickness, lumen diameter, and lumen area by HR-VWI were (0.42±0.08) mm, (2.28±0.64) mm, and (4.51±1.28) mm² in the artery-artery embolization group, and were (0.40±0.16) mm, (2.25±0.61) mm, and (4.45±1.12) mm² in the perforator artery involvement group, with no statistical differences between the two groups (all P>0.05). There were statistical differences in the plaque location, remodeling form, remodeling index, and enhancement rate between the two groups (t=51.098, 23.978, 2.295, and 17.890; all P<0.05). Conclusions　HR-VWI has high value in the diagnosis of intracranial arteriosclerosis in patients with ischemic stroke. It can effectively diagnose intracranial artery wall structure and get the relevant information of plaque morphology, and has positive significance for clinical diagnosis, treatment, and condition evaluation.

Correlation between D-dimer and peripheral neuropathy in type 2 diabetes mellitus

Huang Ke, Shi Shousen, Zhang Yanfang

2022, 28(11):  1512-1516.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.008

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Objective　To explore the correlation between D-dimer (D-D) and type 2 diabetic peripheral neuropathy (DPN). Methods　Nine hundred and thirty-seven eligible patients with type 2 diabetes mellitus (T2DM) hospitalized in Department of Endocrinology, Luoyang Central Hospital, Zhengzhou University from November 2018 to November 2020 were collected for the retrospective cross-sectional study. According to whether they had DPN, the patients were divided into a DPN group and a non-DPN group. Their general data and clinical indicators were collected. The t test was used for the comparison between groups, and the chi-square test was used for the comparison of count data between groups. The correlation between D-D and DPN was statistically analyzed. Results　There were 367 males and 253 females in the non-DPN group, and they were (53.49±12.40) years old. There were 194 males and 123 females in the DPN group, and they were (58.02±10.88) years old. Compared with the non-DPN group, the DPN group were older (P=0.001), had a longer disease course (P<0.001), higher levels of glycosylated hemoglobin (HbA1c) (P=0.012), creatinine (Cr) (P<0.001), low density lipoprotein-cholesterol (LDL-C) (P=0.024), and D-dimer (D-D) (P<0.001), and a higher proportion of hypertension (P=0.013). The indicators with statistical differences were included into the multivariate logistic regression analysis model, and the results showed that DPN correlated with age (OR=1.021; 95%CI 1.006-1.035; P=0.004), T2DM duration (OR=1.029; 95%CI 1.006-1.053; P=0.013), HbA1c (OR=1.155;95%CI 1.063-1.256; P=0.001), Cr (OR=1.009; 95%CI 1.001-1.016; P=0.025), LDL-C (OR=1.221; 95%CI 1.049-1.422; P=0.010), and D-D (OR=1.001; 95%CI 1.000-1.002; P=0.004). Conclusion　D-D may be a risk factor for the development of DPN in patients with T2DM.

Effect of Jianpiyiqi prescription combined with acupoint application in prevention and treatment of chemotherapeutic gastrointestinal reactions after colorectal cancer surgery

Peng Shuling, Zhang Weihua, Zhong Yubo, Liu Lili, Huang Hongzhen

2022, 28(11):  1516-1520.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.009

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Objective　To investigate the clinical effect of Jianpiyiqi prescription combined with acupoint application in the prevention and treatment of chemotherapeutic gastrointestinal reactions after colorectal cancer surgery. Methods　A total of 90 patients taking chemotherapy after colorectal cancer surgery at Department of Gastrointestinal Surgery, Foshan Second People 's Hospital between January 2019 and November 2021 were selected for the case control study, including 49 males and 41 females, and they were (58±13) years old. They were divided into a control group (group A), a traditional Chinese medicine group (group B), and an integrated traditional Chinese and western medicine group (group C), with 30 cases in each group. Group A was given dexamethasone 10 mg, tropisetron 5 mg, and metoclopramide 10 mg by intramuscular injection before the chemotherapy. Group B began to take Jianpiyiqi prescription 3 days before chemotherapy, 1 dose a day, until 3 days after chemotherapy; at the same time, apply acupoints once a day for 12 hours until 3 days after chemotherapy. On the basis of group A, group C began to take Jianpiyiqi prescription 3 days before chemotherapy, and acupoint application was performed until 3 days after chemotherapy. The scores of nausea, vomiting, abdominal pain, diarrhea, and functional status were compared between the three groups. Analysis of variance and chi-square test were used. Results　The nausea scores of group A, group B, and group C were 1.00 (2.00), 1.00 (2.00) and 1.00 (1.00), the vomiting scores 1.00 (2.00), 1.00 (2.00) and 1.00 (1.00), and the diarrhea abdominal pain scores 1.00 (2.00), 0.00 (1.00) and 0.00 (1.00) (all P<0.05). The functional status scores before chemotherapy of group A, group B, and group C were (96.3±4.9), (97.7±5.0), and (96.3±5.6); the scores of functional status after chemotherapy of group A, group B, and group C were (91.0±8.4), (96.0±6.2), and (95.7±5.7), with a statistical difference between the 3 groups (F=4.943, P=0.009). The effective rates of nausea, vomiting prevention and treatment were 80.00% (24/30), 73.33% (22/30), and 96.67% (29/30) in group A, group B, and group C, respectively, with a statistical difference between the 3 groups (χ²=6.240, P=0.044). The effective rates of prevention and treatment of diarrhea and abdominal pain were 80.00% (24/30), 96.67% (29/30), and 96.67% (29/30) in group A, group B, and group C, respectively, with a statistical difference between the 3 groups (χ²=6.860, P=0.032). Compared with those in group A, the scores of nausea and vomiting in group B and group C were significantly decreased (all P<0.05), the diarrhea abdominal pain score in group B was significantly lower (P<0.05), and the functional status scores after chemotherapy in group B and group C were significantly increased (both P<0.05). Conclusion　On the basis of routine use of western medicine antiemetic drugs, Jianpiyiqi prescription combined with acupoint application has good effect in preventing and treating chemotherapeutic gastrointestinal reactions after colorectal cancer surgery.

Two cases of liver injury caused by Gukang capsules combined with non-steroidal anti-inflammatory drugs

Qi Liuying, Gao Yue, Yang Lin

2022, 28(11):  1521-1523.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.010

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Objective　To remind clinicians to pay attention to the superposition of adverse drug reactions when using combination drugs. Methods　This paper reports the data of 2 cases of liver injury caused by Gukang capsules combined with non-steroidal anti-inflammatory drugs. Literature review was conducted to analyze the correlation and pathogenesis of liver function injury caused by the drugs. Results　The liver function of the two patients returned to normal after withdrawal of Gukang capsules and non-steroidal drugs and treatment with hepatoprotective drugs. Both of them scored 7 points on the causality assessment form, and the correlation was judged as very likely. Conclusion　It is necessary to strengthen liver function monitoring and pay attention to the adverse reactions of liver injury when patients take Gukang capsules and non-steroidal anti-inflammatory drugs.

Application of information-based medical collaborative management and family cooperative management in stroke patients taking rehabilitation at home

Yu Xiangying, Sang Shenghua, Chi Jing, Du Xia, Ren Qiuhua, Zhang Lin

2022, 28(11):  1524-1529.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.011

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Objective　To explore the methods and effect of applying information-based medical collaborative management and family cooperative management in stroke patients taking rehabilitation at home, and to provide references in building a complete stroke rehabilitation management model. Methods　From June 2020 to June 2021, 60 first-time stroke patients hospitalized at the ward of Department of Neurology, Weihai Central Hospital were selected as the research objects. The 30 qualified stroke patients from three communities under collaborative stroke rehabilitation management were enrolled into an experimental group, while the 30 qualified stroke patients from other communities were recruited as a control group. The control group had 19 males and 11 females who were 50-70 (63.72±3.97) years old, and received regular discharge guidance and health education. The experimental group had 18 males and 12 females who were 51-70 (64.21±3.54) years old, and were under information-based medical collaborative management and family cooperative management. The activity abilities of daily living (Barthel index) when they were discharged and 6 months after discharge were compared between the two groups. The patients' rehabilitation cognition and compliance to rehabilitation treatment were compared between the two groups. The patients and caregivers' satisfaction with clinical care and family contracted doctors and nurses was inquired. The data were analyzed by t, t^,, and χ² tests. Results　There were no statistical differences in the Barthel Index scores between these two groups when they were discharged (all P>0.05). Six months after discharge, the total score of Barthel Index in the experimental group was higher than that in the control group [(80.77±6.76) vs. (70.53±6.35)], with a statistical difference (P<0.001). Six months after discharge, the scores of knowledge about early signs and emergency treatment, on-time medication, and scheduled rehabilitation exercise were (27.48±1.28), (26.52±1.36), and (29.07±0.34) in the experimental group, and were (19.50±0.79), (20.16±0.88), and (20.52±0.50) in the control group, with statistical differences (t=28.994, 21.497, and 77.420; all P<0.001). When the patients were discharged, the patients and caregivers in both groups were satisfactory with doctors and nurses, with no statistical difference between these two groups (P>0.05). Six months after discharge, the patients and caregivers in the experiment group had higher overall satisfaction than those in the control group [96.67% (29/30) vs. 83.33% (25/30)], with a statistical difference (χ²=8.819, P=0.012). Conclusions　Information-based medical collaborative management and family cooperative management are helpful in integrating medical resources, and can provide continuous, systematic, comprehensive, and full rehabilitation interventions for patients and caregivers, and has a positive effect on improving patients' activities of daily living.

Perioperative nursing effect evaluation of percutaneous transluminal angioplasty for hemodialysis patients with arteriovenous fistula stenosis

Zhong Liping, Luo Jie, Su Yanyan, Su Caihong, Tang Jiamin, Yang Shen

2022, 28(11):  1529-1533.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.012

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Objective　To investigate the perioperative nursing effect of percutaneous transluminal angioplasty (PTA) for hemodialysis patients with arteriovenous fistula (AVF) stenosis. Methods　Sixty-four maintenance hemodialysis patients taking PTA for AVF stenosis in Huadu District People's Hospital from March 2019 to October 2021 were selected. The 32 patients treated from March 2019 to March 2020 were set as a control group, and the 32 ones from April 2020 to April 2021 as an experimental group. There were 21 males and 11 females in the control group, and they were (59.72±13.22) years old. There were 23 males and 9 females in the experimental group, and they were (58.41±14.16) years old. The control group were routinely cared; in addition, the experimental group took comprehensive perioperative nursing. Both groups were followed up for 6 months. The internal fistula vessel diameters, internal fistula natural blood flow volumes, puncture needle blood flow volumes, and clinical detection results before and after PTA were observed in both groups. The incidences of complications and the recurrence rates of AVF stenosis in both groups were calculated. The independent-sample t test, paired t test, and χ² test were applied. Results　After PTA, the vascular diameter, intravascular natural blood flow volume, puncture needle blood flow volume, hemoglobin (Hb), blood albumin (ALB), urea clearance rate (URR), and blood phosphorus (P) were better than those before PTA, and were significantly better in the experimental group than in the control group, with statistical differences (all P<0.05). The incidence of complications and recurrence rate of AVF stenosis in the experimental group were significantly lower than those in the control group [12.5% (4/32) vs. 37.5% (12/32) and 0 vs. 18.75% (6/32) ], with statistical differences (χ²=5.333, P=0.021 and 0.024). Conclusion　Perioperative nursing intervention for hemodialysis patients with AVF stenosis treated by PTA has significant clinical effect and is worth being generalized.

Construction and implementation of "hospital-community-family" linkage model of medical care and health for cancer pain 

Cai Jiaozhi, Xiao Shujing, Yang Minfei, Li Juan

2022, 28(11):  1533-1538.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.013

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Objective　To construct the "hospital-community-family" linkage model of medical care and health for cancer pain, and to explore its application effect for cancer pain patients. Methods　This study was a randomized control trial. A total of 126 cancer pain patients who were admitted to Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine from October 2020 to August 2021 were selected. They were randomly divided into a control group and an observation group, with 63 cases in each group. There were 38 males and 22 females in the control group, and they were (58.50±9.73) years old. There were 39 males and 21 females in the observation group, and they were (55.52±11.22) years old. The control group received routine care, and the observation group received continuous nursing based on "hospital-community-family" linkage model of medical care and health for cancer pain. The pain levels [Numerical Rating Scale (NRS)], awareness of pain knowledge (Pain Questionnaire for Cancer Patients), and negative emotions [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)] were compared between the two groups. The independent-sample t test and χ² test were applied. Results　After the intervention, the awareness rate of pain knowledge, the medical compliance behavior taking medication according to the amount, the observation and handling of adverse reactions, pain self-assessment, and planned follow-up visits in the observation group were higher than those in the control group [(76.00±11.23)% vs. (58.00±12.32)%, 98.3% (59/60) vs. 86.7% (52/60), 90.0% (54/60) vs. 11.7% (7/60), 70.0% (42/60) vs. 26.7% (16/60), and 91.7% (55/60) vs. 73.3% (44/60)], with statistical differences (all P<0.05). The incidence of burst pain, pain score, anxiety score, and depression score in the observation group were lower than those in the control group [5.0% (3/60) vs. 18.2% (11/60), 0.87 (1.00) vs. 1.45 (1.00), (41.98±8.59) vs. (45.02±6.92), and (52.83±11.00) vs. (57.46±9.14); all P<0.05]. Conclusion　The "hospital-community-family" linkage model of medical care and health for cancer pain can effectively improve the patients' knowledge of cancer pain, compliance behaviors, and cancer pain outcomes, and relieve their adverse emotions.

Application effect of strengthening pre-hospital emergency nursing management in pre-hospital care

Yan Minyi, Wang Yan

2022, 28(11):  1539-1542.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.014

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Objective　To explore the application effect of strengthening pre-hospital emergency nursing management in pre-hospital care. Methods　The data of 304 pre-hospital emergency patients in Shenzhen Emergency Center from October 2020 to May 2021 were retrospectively studied. They were divided into an observation group and a control group by the random number table method, with 152 cases in each group. There were 80 males and 72 females in the observation group, and they were (38.49±2.47) years old. There were 78 males and 74 females in the control group, and they were (39.28±2.64) years old. The control group took routine Pre-hospital first aid nursing management, and the obserration group strengthened Pre-hospital first aid nursing management. The times required for first aid, mortalities, and nursing satisfaction were compared between these two groups. The independent-sample t and χ² tests were applied. Results　The time transferred to hospital, the time getting to the patients, and departure reaction time in the observation group were shorter than those in the control group [(6.28±2.12) min vs. (12.26±2.84) min, (7.64±2.18) min vs. (13.51±3.51) min, and (2.12±0.57) min vs. (3.20±0.68) min], with statistical differences (t=5.201,4.632, and 5.102; P=0.016, 0.013, and 0.024). The mortality of the observation group was significantly lower than that of the control group [5.92% (9/152) vs. 27.63% (42/152); χ²=25.657, P<0.001]. The nursing satisfaction of the observation group was higher than that of the control group [98.68% (150/152) vs. 75.66% (115/152); χ²=16.201, P<0.001]. Conclusion　Strengthening the management of pre-hospital emergency care can effectively shorten the time required for first aid, reduce the mortality, and improve the satisfaction of family members with nursing care.

Efficacy analysis of clinical blood transfusion of red blood cells and platelets

Ye Xiaofang, Wu Hui'e, Chen Weiyuan, Lyu Xiaoying

2022, 28(11):  1543-1546.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.015

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Objective　To investigate the efficacies of red blood cell and platelet transfusion for adult patients and its influencing factors, and to improve the efficiency of blood transfusion therapy. Methods　The data of the patients who received red blood cell and platelet transfusion in The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force from July 2019 to June 2021 were retrospectively analyzed, and the efficacies of red blood cell and platelet transfusion were evaluated. The patients were divided into groups according to their gender, age, frequency of blood transfusion, and underlying diseases, and the influencing factors of red blood cell and platelet transfusion efficacies were investigated. The χ² test was applied. Results　A total of 282 patients taking red blood cell transfusion therapy, including 136 males and 146 females who were 18-82 years old, and 98 patients taking platelet transfusion therapy, including 46 males and 52 females who were 18-88 years old, were included in this study. According to data analysis, the total effective rate of red blood cell transfusion for the 282 patients was 81.91% (231/282), and the total effective rate of platelet transfusion for the 98 patients was 85.71% (84/98). According to the chi-square test, the effective rates of red blood cell and platelet transfusions in the 18-60 years old patients were higher than those in the ≥60 years old patients (χ²_{red blood cells}=7.415, P_{red blood cells}=0.006; χ²_platelet=4.961, P_platelet=0.026). The effective rates of red blood cell and platelet transfusion in the patients with the frequency of blood transfusions <3 were higher than those in the patients with the frequency of blood transfusions ≥3 (χ²_{red blood cells}=7.760, P_{red blood cells}=0.005; χ²_platelet=6.853, P_platelet=0.009). The effective rates of red blood cell and platelet transfusion in the patients with acute blood loss disease and hematopoietic dysfunction disease were higher than those in the patients with chronic blood loss disease (χ²_{red blood cells}=18.653, P_{red blood cells}<0.001; χ²_platelet=10.597, P_platelet=0.005). The effective rate of platelet transfusion in the patients with fever was lower than that in the patients with normal body temperature (χ²_platelet=8.459, P_platelet=0.004). The effective rates of red blood cell and platelet transfusion in the patients taking surgery were lower than those in the patients taking no surgery (χ²_{red blood cells} = 9.928, P_{red blood cells} = 0.002; χ²_platelet = 5.878, P_platelet = 0.015). Conclusions　The effective rates of redblood cell and platelet transfusion for adult patients in The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force are relatively high. The efficacies of redblood cell and platelet transfusion are related to the patients' age, frequency of blood transfusion, and underlying diseases. Clinical attention should be paid to the patients' blood transfusion treatment.

Analysis of false positive and negative results of acid fast bacteria in clinical samples detected by microscopic scanners

Huang Yelun, Liu Xin, Huang Yanjun, Chen Jianfeng, Xie Weisheng, Luo Shaozhen, Liu Zhihui

2022, 28(11):  1547-1550.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.016

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Objective　To understand the application of microscopic scanners in detecting the false positive and negative results of acid-fast bacilli in clinical smear samples, to optimize the instrument detection parameters, and to continuously improve the detection accuracy. Methods　The data from Guangzhou Chest Hospital were studied from December 2019 to June 2020. For the clinical samples from sputum, bronchoscopy flushing fluid, pleural effusion, cerebrospinal fluid, and joint effusion, direct smears were performed on their glass slides provided with the instrument as required. The dried smears were stained for auramine O fluorescence. Manual retest was performed on all the instrument-reported positive smears, and about 15% of the instrument-reported negative smears were randomly selected. The false positive and negative rates were described as categorical data. For those with false negative results, the position of the manually retested acid-fast bacilli in the smear was marked with a microscope slide clip coordinate ruler, and the locations inside and outside the scanning area of the instrument were estimated. Results　Among the 5 284 smears, 1 290 cases were reported positive by the instrument, and 850 cases were reported positive by manual retest, with a false positive rate of 34.11% (440/1 290). Six hundred and sixty-five negative smear samples reported by the instrument were randomly checked, and 100 cases were reported positive by manual retest, with a false negative rate of 15.04%. The false negative results included 38 cases ±, 50 cases 1+, 6 cases 2+, 4 cases 3+, and 2 cases 4+. Among the false-negative smears, 42 cases of acid-fast bacteria were found in the scanning area of the instrument, and 58 cases outside the area. The false negative rates of the two were 6.32% (42/665) and 8.72% (58/665), respectively. Conclusion　The detection of acid-fast bacilli in clinical samples by microscopic scanners has certain false positive and negative rates. The instrument scanning parameters should be continuously improved, and the laboratory manual retest procedures should be strengthened.

Cognition of nurses of different ages about their nursing work environment in a specialized hospital

Liu Yumei, Zhou Minjuan, Wu Jinyao, Yang Qiong, Liang Minqing, Zeng Huazhi

2022, 28(11):  1550-1555.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.017

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Objective　To deeply understand the cognition of nurses of different ages about their nursing work environment and to provide scientific guidance for improving hospital nursing management and the quality of nursing work. Methods　The results of Likert 4 grades of 31 items in 5 dimensions of Practice Environment Scale of the Nursing Work Index (PES-NWI) in the ≤25, 25-30, >30-35, >35-40, >40-45, >45-50, and > 50 years old groups (249 cases) from July 9 to 22, 2020 at Guangzhou Chest Hospital were statistically analyzed and compared by Chi-square test and F-test. This was a cross-sectional study. Results　"Strongly disagree", "Disagree", "Agree", and "Strongly agree" were scored from 1 to 4 points on the Likert 4 grades. There were statistical differences in the percentages of the 4-level classification of nurses' participation in hospital affairs, basis of high-quality nursing service, sufficient human and material resources, ability and leadership of nurse managers, and doctor-nurse cooperation between the different age groups (all P<0.05). There were statistical differences in the Likert 4 scores of 31 items between the different age groups (all P<0.05). According to the 31 items of 6 groups of people, it was divided into 217 sections, and the nursing work environment was divided into 3 grades, "poor", "good", and "excellent", according to the score ≤2.5, 2.5-3.0, >3.0. The numbers of the 3 grades were 18, 127, and 72, accounting for 8.29%, 58.53%, and 33.18%, respectively. Among the 18 "poor" sub-sections, 13 sections came from 6 items in the dimension of "nurse's participation in hospital affairs", and 5 sections from 2 items in the dimension of "sufficient human and material resources". In addition, there were 5 sections associated with the items "nursing staff have the opportunity to participate in hospital management decisions" and 4 sections associated with the items "the department has adequate support equipment so that I have more time to care for patients". Conclusions　There are different expectations for their working environment by nurses of different age groups, and they should be classified and implemented in hospital nursing management. Meanwhile, how to improve the status of nurses in the hospital and to strengthen nursing support technology should be given enough attention.

Laboratory Medicine Column

Comparative study on detection methods of Mycobacterium tuberculosis in Regional Tuberculosis Laboratory 

Hao Shanshan, Hou Yanqiang

2022, 28(11):  1557-1560.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.018

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Objective　To compare detection rates, coincidence rates, detection cycles, and costs of three detection methods [acid fast staining, liquid culture, and real-time fluorescence polymerase chain reaction (PCR)] in the detection of Mycobacterium tuberculosis in the Regional Tuberculosis Laboratory, and to provide scientific basis for clinicians to select suitable detection methods. Methods　The morning sputum samples of 1 169 patients in the Regional Tuberculosis Laboratory from May 2018 to August 2021 were selected as the research objects. Among the patients, there were 830 males and 339 females, and they were 10 to 89 years old. Each sample was tested by the above three methods, and the detection rates of Mycobacterium tuberculosis were analyzed by χ² test. The coincidence rates, detection cycles, and costs were compared. Results　The positive rates of acid fast staining, liquid culture, and real-time fluorescent PCR were 16.6% (194/1 169), 28.1% (329/1 169), and 26.1% (305/1 169), respectively, with statistical differences between acid fast staining and liquid culture (χ²=44.888, P<0.001), between acid fast staining and real-time fluorescent PCR (χ²=31.391, P<0.001), and no statistical difference between liquid culture and real-time fluorescence PCR (χ²=1.247, P>0.05), but the results of the three detection methods were consistent. The detection cycles of acid fast staining, liquid culture, and real-time fluorescence PCR were 30 minutes, 6 weeks, and 2 hours, and the costs were 15 yuan, 100 yuan, and 800 yuan, respectively. Conclusions　The detection rates of Mycobacterium tuberculosis by liquid culture and real-time fluorescence PCR are higher than that by acid fast staining, but the cost of acid fast staining is lower and the detection cycle is shorter than those by liquid culture and real-time fluorescence PCR. Real time fluorescent PCR is more sensitive and specific than the other two methods, but it is expensive. Although the three detection methods have their own advantages and disadvantages, their results are consistent.

Analysis and summary of inter-laboratory quality assessment results for morphology department in the clinical laboratories of National Health Commission from 2009 to 2019

Meng Shaowei, Zhang Hongyuan, Liu Jianping, Long Yifei

2022, 28(11):  1561-1565.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.019

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Objective　To analyze and summarize the inter-laboratory quality assessment results of morphology organized by the National Center for Clinical Laboratories in the past 11 years at Department of Laboratory Medicine, University Town Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine, find the reasons for errors, and propose corresponding rectification measures to improve the staff's morphological inspection ability. Methods　A retrospective analysis was made on the morphological data of the inter-laboratory quality assessment activities in hematology, humoral, and parasitology organized by the National Center for Clinical Laboratories from January 2009 to December 2019 and reported by Department of Laboratory Medicine, University Town Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine. The total number of assessments, the number of errors, the error rates, and the coincidence rates of the inter-laboratory quality assessment activities in hematology, humoral and parasitology were calculated. The possible causes of errors were analyzed, and the corresponding rectification and corrective measures were proposed. Results　Among the 326 results of blood cell morphology, the error rate was 5.8% (19/326), and the coincidence rate was 94.2% (307/326). The errors were mainly distributed in the identification of granulocytes and blasts. Among the 158 results of urinary sediment morphology, the error rate was 5.1% (8/158), and the coincidence rate was 94.9% (150/158). The errors were mainly distributed in the identification of urine casts and crystals. Among the 160 results of parasite morphology, the error rate was 3.8% (6/160), and the coincidence rate was 96.3% (154/160). The errors were mainly distributed in the confusion between Fasciola brucei and Fasciola hepatica eggs. Conclusions　In the past 11 years, the results of the inter-laboratory quality assessment activities of morphology in Department of Laboratory Medicine, University Town Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine were satisfactory, and the conformity rate was basically >90%, which met the quality target requirements of the department. Although the morphological inter-laboratory quality assessment method organized by the National Center for Clinical Laboratories is slightly insufficient, but periodically conducting a retrospective analysis of the results, summarizing the causes of errors, and proposing corrective measures will help improve the staff's morphological inspection level.

Expression of human high mobility group protein B1 in cerebrospinal fluid of patients with neurosyphilis

Liang Yanhua, Liang Jingyao, Wang Jianqin, Cao Wenling, Li Huaping, Yang Ridong, Bi Chao

2022, 28(11):  1565-1568.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.020

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Objective　To investigate the expression of human high mobility group protein B1 (HMGB-1) in cerebrospinal fluid of patients with neurosyphilis. Methods　Forty-seven patients with syphilis treated at Guangzhou Institute of Dermatology from September 2017 to September 2021 were selected as the study objects, including 21 cases in the neurosyphilis group and 26 cases in the non-neurosyphilis group. The cerebrospinal fluid of the patients in both group was collected to detect the expression of HMGB-1, total protein, and leukocyte count and for tolulized red unheated serum test (TRUST), treponema pallidum particle agglutination (TPPA), fluoresent treponemal antibody-absorption test (FTA-ABS). The χ² test and independent-sample t test were applied. Results　There were 18 males and 3 females in the neurosyphilis group, and they were (51.3±15.1) years old. There were 20 males and 6 females in the non-neurosyphilis group, and they were (48.6±8.3) years old. The cerebrospinal fluid TRUST dilution [(5.29±3.89) vs. (0.96±1.48); median 4 (2,8) vs. 0 (0,0)], amount of leukocytes [(82.91±66.42)×10⁶/L vs. (14.00±17.23)×10⁶/L; median 50.0 (26.5,69.0)×10⁶/L vs. 3.0 (2.0,4.0)×10⁶/L], total protein [(714.57±134.69) mg/L vs. (288.22±115.20) mg/L], and HMGB-1 [(1 265.16±345.10) ng/L vs. (693.92±166.26) ng/L] in the neurosyphilis group were significantly higher than those in the non-neurosyphilis group, with  statistical differences (all P<0.05). There was a positive correlation between the expression level of HMGB-1 and the number of leukocytes in the neurosyphilis group (r=0.62, P<0.01). Conclusion　The expression level of HMGB-1 increases significantly in cerebrospinal fluid of patients with neurosyphilis, so it may be helpful to the diagnosis of neurosyphilis.

Performance evaluation of ABL825 blood gas analyzer purchased from Radiometer

Yan Xingxing, Zhang Hongyuan, Luo Yanfen

2022, 28(11):  1569-1573.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.021

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Objective　To evaluated the performance of ABL825 blood gas analyzer purchased from Radiometer, Denmark in the detection of potential of hydrogen (pH), partial pressure of carbon dioxide (PCO₂), partial pressure of oxygen (PO₂), calcium ion (Ca²⁺), lactate (Lac), and other indicators in human blood. Methods　From January to March 2021, a non-randomized controlled experimental study was conducted on various quality control substances and clinical samples tested by the ABL825 blood gas analyzer according to the EP15-A2 file of the American Clinical Laboratory Standardization Institute (CLSI). The precision and accuracies in detecting pH, PCO₂, PO₂, Ca²⁺, and Lac were evaluated. The consistency of the test results was verified with another approved ABL825. The stability evaluation and carry-over pollution in detecting Ca²⁺ were evaluated according to People's Republic of China Pharmaceutical Industry Standard/Electrolyte Analyzer YY/T 0589/2016. Results　The total CV's of different concentrations of each item detected by the two systems of ABL825 were as bellow: pH 0.001 and 0.001, PCO₂ 0.78% and 1.31%, PO₂ 1.31% and 2.03%, Ca²⁺ 1.07% and 1.27%, and Lac 4.60 % and 3.67%; and the within-run CV's were as bellow: pH 0 and 0, PCO₂ 0.50% and 0.77%, PO₂ 1.26% and 1.30%, Ca²⁺ 0 and 0, and Lac 2.75% and 1.02%; which were smaller than the manufacturer's declaration and met the laboratory requirements. The correlation coefficients (R²) of pH, PCO₂, PO₂, Ca²⁺, and Lac of the two detection systems were 0.989 8, 0.993 9, 0.997 5, 0.995 5, and 0.979 5, and all R²>0.95; it had a good correlation with another ABL825; the relative bias was smaller than the manufacturer's declaration; the detection results had high accuracy. Stability: the fluctuation percentage of Ca²⁺ (R) was 0. Carrying pollution rate: the carrying pollution rate from low to high concentration (C_LH) was 0.50%, and the carrying pollution rate from high to low concentration (C_HL) was 1.49%, which corresponded to the requirements of the document. Conclusion　The performance of ABL825 blood gas analyzer has confirmed the laboratory requirements, and the test results are reliable, which meet the needs of clinical testing.

Treatises

Randomized controlled study of Shaofu Zhuyu granule combined with ceftazidime in treatment of chronic pelvic inflammatory disease 

Lin Shipeng, Chen Furong, Zheng Saimei

2022, 28(11):  1574-1578.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.022

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Objective　To observe the effect of Shaofu Zhuyu granule combined with ceftazidime in the treatment of chronic pelvic inflammatory disease (CPID) and to provide references for the selection of a disease treatment scheme. Methods　One hundred and twelve patients with CPID admitted to Maternal and Child Health Center of Haifeng County from June 2019 to June 2021 were selected for the prospective study. They were divided into a combined group and a reference group by the random number table method, with 56 cases in each group. The combined group was (38.58 ± 8.03) years old, with a disease course of (5.05±1.66) years. The reference group was (36.89 ± 7.34) years old, with a disease course of (4.67±1.72) years. The reference group was treated with ceftazidime, and the combined group with Shaofu Zhuyu granule and ceftazidime, for 2 weeks. The curative effects, adverse reactions, and recurrence rates 3 and 6 months after the treatment were compared between the two groups by the χ² test, and the pelvic mass diameters, pelvic effusion depths, and hemorheological indexes (high shear whole blood specific viscosity, plasma specific viscosity, low shear whole blood specific viscosity, and hematocrit) before and after the treatment by the paired t test and independent-sample t test. Results　The total effective rate of the combined group was higher than that of the reference group [89.29% (50/56) vs. 71.43% (40/56); χ²=5.657, P=0.017). There was no statistical difference in the total incidence of adverse reactions between the combined group and the reference group [12.50% (7/56) vs. 16.07% (9/56); χ²=0.292, P=0.589]. After 2 weeks' treatment, the diameter of pelvic mass, depth of pelvic effusion, high shear whole blood specific viscosity, plasma specific viscosity, low shear whole blood specific viscosity, and hematocrit in the combined group were (1.06±0.38) cm, (1.42±0.48) cm, (2.86±0.49) mPa·s, (1.28±0.35) mPa·s, (6.41 ± 1.56) mPa·s, and (42.38 ± 3.45)%, which were lower than those in the reference group [(2.88±0.57) cm, (1.96±0.55) cm, (3.95±0.53) mPa·s, (1.77±0.38) mPa·s, (9.79±1.97) mPa·s, and (45.07±4.02)%] (t=19.881, 5.536, 11.301, 7.098, 10.066, and 3.800; all P<0.001). Three and six months after the treatment, the recurrence rates in the combined group were lower than those in the reference group [1.82% (1/55) vs. 14.55% (8/55) and 7.41% (4/54) vs. 25.93% (14/54); χ²=4.356 and 6.667, P=0.037 and 0.010]. Conclusion　Shaofu Zhuyu granule combined with ceftazidime in the treatment of patients with CPID can improve hemorheology, promote the regression of pelvic mass and pelvic effusion, enhance curative effect, reduce recurrence, and obtain good safety.

Clinical Research

Effect of dapagliflozin on renal function and glucose and lipid metabolism in patients with type 2 diabetes mellitus

Ji Gaode, Jiang Lihua, Li Qun

2022, 28(11):  1579-1583.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.023

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Objective　To observe the effect of dapagliflozin on renal function and glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM). Methods　This was a prospective study. Eighty-six patients with T2DM admitted to Jinan Second People's Hospital from July 2019 to July 2021 were selected as the research objects. They were divided into a control group and an observation group by the random number table method, with 43 cases in each group. The control group had 25 males and 18 females, and they were (52.80±5.77)years old. The obser vation group had 28 males and 15 females, and they were (53.19±5.82)years old, All the patients were given conventional treatment, and the observation group were treated with dapagliflozin on this basis. The clinical effects, the levels of blood glucose [fasting blood glucose (FBG), 2h postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA_1c)], blood lipids [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)], oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px)], and renal function indicators [blood urea nitrogen (BUN), serum creatinine (Scr), and urine microalbumin (UMA)], and the incidences of adverse reactions were compared between these two groups. The independent-sample t test, paired t test, and χ² test were applied. Results　The treatment response rate in the observation group was higher than that in the control group [93.02% (40/43) vs. 74.42% (32/43)], with a statistical difference (χ²=5.161,P=0.023). After the treatment, the levels of FBG, 2hPG, HbA_1c, TC, TG, LDL-C, MDA, BUN, Scr, and UMA were (6.50±1.33) mmol/L, (8.35±1.44) mmol/L, (6.01±0.54)%, (4.58±0.23) mmol/L, (1.41±0.22) mmol/L, (2.23±0.34) mmol/L, (3.20±0.33) μmol/L, (6.33±1.07) mmol/L, (110.53±18.77) μmol/L, and (10.34±3.21) mg/L in the observation group, which were significantly lower than those in the control group [(7.39±1.50) mmol/L, (11.29±2.53) mmol/L, (7.02±1.19)%, (5.23±0.70) mmol/L, (1.95±0.44) mmol/L, (3.31±0.52) mmol/ L, (4.50±0.52) μmol/L, (9.86±2.55) mmol/L, (178.41±25.36) μmol/L, and (18.55±5.27) mg/L], with statistical differences (t=2.911, 6.623, 5.068, 5.785, 7.198, 11.399, 13.842, 8.371, 14.108, and 8.725; all P<0.05). The levels of HDL-C and SOD were (1.74±0.65) mmol/L and (43.96±8.22) U/ml in the observation group, which were significantly higher than those in control group [(1.46±0.53) mmol/L and (36.77±7.03) U/ml], with statistical differences (t=2.189 and 4.359; both P<0.05). There was no statistical difference in GSH-Px between the two groups (t=0.206, P=0.837). There was no statistical difference in the incidence of adverse reactions between the two groups [4.65% (2/43) vs. 9.30% (4/43);χ²=0.677, P=0.410]. Conclusion　Dapagliflozin is effective in the treatment of T2DM, and can effectively control blood glucose level and improve lipid metabolism, oxidative stress, and renal function.

Screening results of close contacts of patients with pulmonary tuberculosis at schools

Liang Zhiqiang, Lin Xiaoshan, Liu Zhihui, Song Tao, Liu Guobiao, Chen Qichen, Gong Fang

2022, 28(11):  1584-1586.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.024

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目的　调查2018—2021年广州市越秀区学校肺结核患者密切接触者的筛查情况，为开展学校结核病防控工作提供依据。方法　按照《关于印发学校结核病防控工作规范（2017版）的通知》的要求，对学校密切接触者进行结核可疑症状、结核菌素试验和/或胸部X线等检查。结果　2018—2021年广州市越秀区学校共发现学生肺结核患者161例（2018年42例，2019年50例，2020年38例，2021年31例）。大学生73例（45.34%），中专及高中学生74例（45.96%），初中生8例（4.97%），托幼机构6例（3.73%）。其中男性患者83例（51.55%），女性患者78例（48.45%）。发现的161例学生肺结核患者中，病原学阳性患者48例（29.81%），病原学阴性患者113例（70.17%）。通过对161例确诊患者进行流行病学调查，共筛查密切接触者7 698例，其中7 667例密切接触者结核菌素皮肤试验（PPD试验）结果中，强阳性326例；有6 193例进行胸片筛查，胸片表现为异常者38例，在7 698例密接者中共发现活动性肺结核患者8例。结论　通过对学校肺结核患者密切接触者的筛查，可及早发现结核患者并杜绝传染源，从而防止学校结核疫情的发生。

Transanal endoscopic microsurgery for benign rectal tumors

Yu Xiyang, Zhao Shengying, Yu Wenjing, Ren Jianhua, Ma Kefeng, Dai Xuefeng

2022, 28(11):  1586-1591.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.025

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Objective　To investigate the effect of transanal endoscopic microsurgery on postoperative gastrointestinal function recovery and serum advanced oxidized protein product (AOPP) and glutathione peroxidase (GSH-Px) levels in patients with benign rectal tumors. Methods　Seventy-three patients with benign rectal tumors treated at Lanshan District People's Hospital from August 2017 to August 2019 were selected for the prospective study and divided into a microsurgery group (37 cases) and a traditional surgery group (36 cases) according to a random number table. There were 22 males and 15 females in the microsurgery group, and they were (51.42±5.58) years old. There were 23 males and 13 females in the traditional surgery group, and they were (52.26±6.04) years old. The microsurgery group underwent transanal endoscopic microsurgery, and the traditional surgery group conventional surgery. The surgical conditions, surgical efficacies, incidences of complications, and serum levels of oxidative stress indicators (AOPP and GSH-Px), and gastrointestinal hormone indicators [serum motilin (MTL) and gastrin (GAs)] before and 1 and 3 days after the operation were compared between the two groups. The independent-sample t test, paired t test, and χ² test were applied. Results　The postoperative bowel sound recovery time, first anal flatus time, time to eat, and hospital stay were (5.17±0.94) h, (6.93±1.72) h, (29.31±5.28) h, and (3.42±0.81) d in the microsurgery group, which were shorter than those in the traditional group [(11.62±1.85) h, (15.70±2.14) h, (68.74±11.02) h, and (7.60±1.29) d], with statistical differences (t=18.855, 19.326, 19.579, and 16.629; all P<0.001). The intraoperative blood loss was (30.53±5.69) ml in the microsurgery group, and was (49.17±8.50) ml in the traditional surgery group, with a statistical difference (t=11.038, P<0.05). The total effective rate and the incidence of postoperative complications were 97.30% (36/37) and 8.11% (3/37) in the microsurgery group, and were 77.78% (28/36) and 27.78% (10/36) in the traditional surgery group, with statistical differences (χ²=4.753 and 4.823; both P<0.05). The serum AOPP levels 1 and 3 days after the operation were higher than those before the operation in the two groups, and were lower in the microsurgery group than in the traditional surgery group [(65.11±8.24) μmol/L vs. (102.58±16.70) μmol/L and (52.48±6.61) μmol/L vs. (78.12±10.23) μmol/L; t=12.208 and 12.754, both P<0.001]. The serum GSH-Px levels 1 and 3 days after the operation were lower than those before the operation in the two groups, and were higher in the microsurgery group than in the traditional surgery group [126.27±18.59) U/ml vs. (84.91±12.52) U/ml and (141.10±22.73) U/ml vs. (104.58±19.65) U/ml; t=11.118 and 7.335 both P<0.001]. The serum levels of MTL and GAs 3 days and 1 week after the operation were lower than those before the operation in both groups, and were higher in the microsurgery group than in the traditional surgery group [(228.17±19.53) pg/ml, (254.50±22.47) pg/ml, (66.35±5.48) μmol/L, and (71.41±6.34) μmol/L vs. (181.25±15.58) pg/ml, (203.56±20.52) pg/ml, (61.43±4.91) μmol/L, and (66.45±5.39) μmol/L], with statistical differences (t=11.328, 10.106, 4.036, and 3.597; all P<0.001). Conclusion　Compared with traditional surgery, transanal endoscopic microsurgery for benign rectal tumors can improve the treatment effect, reduce surgical trauma, promote postoperative gastrointestinal function recovery, and reduce the occurrence of complications, and has little effect on serum AOPP and GSH-Px levels, and the body's oxidative stress response is mild.

Case Report

Primary immune thrombocytopenia complicated with perioperative deep venous thrombosis: a case report and literature review

Chang Jing, Sun Aichun

2022, 28(11):  1592-1594.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.026

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Objective　To explore the clinical scheme in prevention of bleeding and thrombosis in perioperative patients with primary immune thrombocytopenia (ITP). Methods　The clinical data of a patient with ITP and deep venous thrombosis during perioperative period were analyzed retrospectively, and the relevant literatures were summarized and reviewed. Results　ITP patients should pay attention not only to the risk of thrombocytopenia related bleeding, but also to the risk of thrombotic events. Surgery and platelet raising therapy may be the risk factors of thrombosis in patients with ITP. During the perioperative period, it is recommended to routinely monitor blood routine, coagulation function, and vascular ultrasound, stop platelet raising drugs in time, and take anticoagulant treatment if it is necessary, so as to prevent and early detect deep venous thrombosis. Conclusion　Patients with ITP should be alert to the risk of thrombosis during perioperative period.

One case of multiple injuries with fever and acute liver injury caused by piperacillin sodium and tazobactam sodium

Li Rui, Wang Ruijie, Sun Bin, Zhang Hongguang, Yuan Ying, Qiu Jianqing

2022, 28(11):  1595-1597.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.027

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Piperacillin is a broad-spectrum penicillin antibiotic. It is used in combination with β-lactamase inhibitor tazobactam for moderate to severe infectious diseases caused by sensitive bacteria. Its common adverse reactions include allergy, rash, gastrointestinal reactions, etc., and can also lead to fever and drug-induced liver injury, but cases resulted in fever and acute liver injury are rare. This paper reports the fever and acute liver injury in a patient who was treated with piperacillin sodium and tazobactam sodium. The purpose is to arouse the attention of clinicians, and to provide references for early detection, diagnosis, and intervention.

Nursing Research

Application of platinum ten-minute ambulance mode in pre-hospital emergency care for patients with AMI and its impact on clinical outcomes 

Yang Xiwen

2022, 28(11):  1598-1602.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.028

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Objective　To investigate the application of platinum ten-minute ambulance mode in pre-hospital emergency care for patients with acute myocardial infarction (AMI) and its impact on clinical outcomes. Methods　One hundred patients with AMI admitted to Pre-hospital Emergency Department, Liaocheng People's Hospital between July 2020 and August 2021 were selected. They were divided into a control group (45 cases) and a study group (55 cases) by the random number table method. There were 23 males and 22 females in the control group, and they were (55.59±5.78) years old. There were 26 males and 29 females in the study group, and they were (55.77±5.62) years old. The control group received routine pre-hospital emergency care, and the study group were intervened by the platinum ten-minute ambulance mode. The rescue statuses (response time of pre-hospital first aid, triage assessment time, first electrocardiogram collection time, and hospital stay), complications, cardiac function indicators, and qualities of life were compared between the two groups. t test and χ² test were used. Results　The response time of pre-hospital first aid, first electrocardiogram collection time, triage assessment time, and hospital stay in the study group were shorter than those in the control group [(2.35±0.42)min vs. (5.63±1.05) min, (7.97±1.39) min vs. (12.78±2.45) min, (1.88±0.24) min vs. (3.42±0.60) min, and (12.58±2.51) d vs. (17.52±3.22) d], with statistical differences (t=21.204, 12.341, 17.423, and 8.621; all P<0.001). The total incidence of complications in the study group was significantly lower than that in the control group [3.64% (2/55) vs. 17.78% (8/45); χ²=5.499, P=0.019]. Before the nursing, there were no statistical differences in the left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), and left ventricular end systolic diameter (LVESD) between these two groups (all P>0.05). After the nursing, the LVEDD and LVESD were lower and the LVEF was higher in the study group [(52.16±6.08) mm vs. (58.79±6.34) mm, (41.39±4.68) mm vs. (46.98±5.12) mm, and (58.76±7.42)% vs. (53.64±6.12)%], with statistical differences (t=5.322, 5.696, and 3.709; all P<0.001). Before the nursing, there were no statistical differences in the scores of physical pain, social role, emotional role, and physiological function between these two groups (all P>0.05). After the nursing, the scores of physical pain, social role, emotional role, and physiological function in study group were higher than those in the control group [(63.07±7.89) vs. (56.31±7.22), (65.37±7.06) vs. (60.14±6.42), (72.31±7.86) vs. (66.13±6.19), and (70.34±7.15) vs. (65.68±6.72)], with statistical differences (t=4.427, 3.838, 4.295, and 3.331; all P<0.001). Conclusion　Applying platinum ten-minute ambulance mode in pre-hospital emergency care for patients with AMI can achieve obvious intervention effect, significantly improve the efficiency of first aid and the patients' cardiac function, quality of life, and clinical outcomes, and reduce the incidence of complications.

Honglu Bajin meridian therapy in promotion of anal exhaust after cesarean section

Wang Hui, Wu Liying, Liu Yuanling, Yang Aiwen

2022, 28(11):  1602-1605.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.029

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Objective　To explore the effect of Honglu Bajin meridian therapy in the promotion of anal exhaust after cesarean section. Methods　This was a clinical intervention study. The research subjects were 100 puerperae who underwent cesarean section in Department of Obstetrics, Guangdong Second Hospital of Traditional Chinese Medicine. They were divided into a control group and an observation group by the random number table method, with 50 cases in each group. The control group were (26.56±4.25) years old, and the observation group were (27.21±3.26) years old. The control group were routinely given dietary guidance, exercise guidance, psychological care, and abdominal and acupoint massage after cesarean section. On the basis of control group except for acupoint massage, the observation group took Honglu Bajin meridian therapy on Zuyang Mingwei meridian and lower limb section of Zutai Yinpi meridian. The convalescing times of bowel sounds, the first anal exhaust times, the first defecation times and the abdominal distension before anal exhaust were compared between the two groups after the intervention. t test and rank sum test were used. Results　After the intervention, the convalescing time of bowel sounds, the first anal exhaust time, the first defecation time, and the incidence of abdominal distension were (21.10±2.35) h, (28.36±3.25) h, (59.48±7.65) h, and 78% (39/50) in the control group, and were (15.25±1.52) h, (17.26±2.65) h, (46.69±6.52) h, and 62% (31/50) in the observation group, with statistical differences (t=14.782, P<0.001; t=18.717, P<0.001; t=8.998, P<0.001; Z=-2.608, P=0.009). Conclusion　Honglu Bajin meridian therapy can effectively shorten the convalescing time of gastrointestinal function after cesarean section, and the operation is simple, so it is worth being clinically generalized.

Application of CICARE communication mode in elderly patients taking strengthened abdominal MRI

Cao Lifei, Wu Hongzhen, Zi Qinglan, Zhang Shubin, Xu Xiangdong, Chang Hanzheng, Zhong Weihong, Lan Xiaofeng

2022, 28(11):  1606-1610.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.030

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Safe eating time of patients undergoing general anesthesia video-assisted thoracoscopic pulmonary resection under concept of enhanced recovery after surgery

Dong Min, Guo Wenwei, Liu Hui, Zeng Qiuxuan

2022, 28(11):  1610-1614.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.031

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Objective　To explore the safe eating time of patients undergoing general anesthesia video-assisted thoracoscopic (VATS) pulmonary resection under the concept of enhanced recovery after surgery (ERAS). Methods　From August 2020 to August 2021, a total of 240 patients who underwent VATS pulmonary resection at Department of Thoracic Surgery, First Affiliated Hospital, Guangzhou Medical University were divided into a study group and a control group by the random number table method, with 120 cases in each group. The study group ate the first time 2 hours after the surgery, and the control group 6 hours after. The prealbumin and albumin levels before and after the surgery, anal exhaust times, and incidences of cough, nausea, vomiting, diarrhea, and pulmonary infection were compared between the two groups. The t and χ² test were used for the analysis. Results　Thirty-four patients withdrew from the trial because they could not operate on time or were converted to thoracotomy, and 206 completed the trial. There were 116 cases in the study group, including 66 males and 50 females, and they were (62.33±12.77) years old. There were 90 cases in the control group, including 54 males and 36 females, and they were (60.19±13.28) years old. The levels of prealbumin and albumin on day 2 after the surgery in the study group were significantly higher than those in the control group [(279.2±75.3) mg/L vs. (248.8±67.8) mg/L and (38.6±8.3) g/L vs. (35.9±6.2) g/L], with statistical differences (t=3.001 and 2.578; P=0.003 and 0.011). The postoperative exhaust time in the study group was shorter than that in the control group[(24.8±11.0) h vs. (31.2±12.3) h], with a statistical difference (t=3.933, P<0.001). There was no statistical difference in the incidence of complications, such as choking, nausea, vomiting, diarrhea, and pulmonary infection, between the two groups (P>0.05). Conclusions　It is safe and feasible for patients undergoing VATS pulmonary resection under the concept of ERAS to eat within 2 hours after operation, without increasing the incidences of coughing, nausea, vomiting, diarrhea, and pulmonary infection. It is worthy of clinical promotion for the improvement of the patients' nutritional status and the promotion of their gastrointestinal function recovery.

Experience Exchange

PDCA cycle method in improvement of traditional Chinese medicine prescriptions

Huang Lanzhen, Wang Jingtao, Wu Xiujun, Gu Xuemin, He Shuiping

2022, 28(11):  1615-1618.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.032

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Objective　To explore the application of PDCA (plan, do, check, and act) cycle method in the improvement of traditional Chinese medicine prescriptions. Methods　The process management of the four stages of PDCA cycle was used to continuously improve the quality of traditional Chinese medicine prescriptions. The 32 292 prescriptions from January to March 2021 were set as a control group, and the 50 557 ones from April to August 2021 a management group. The numbers of two types of unreasonable prescriptions with high incidences before and after the application of PDCA cycle method, as well as the qualified rates of outpatient and inpatient prescriptions, were compared. Results　The qualified rate of outpatient prescriptions increased from 97.6% (965/988) before the cycle to 97.8% (1 506/1 540) after the cycle, and the qualified rate of inpatient prescriptions from 89.1% (106/119) to 95.6% (259/271). The number of 2 types of unreasonable prescriptions with high incidences decreased significantly. Conclusion　The application of PDCA circulation method in the evaluation of traditional Chinese medicine prescriptions can improve their quality, standardize rational drug use, ensure patients' medical safety, and increase the management level and service quality of departments.

Summary

Research progress on hematological markers of cognitive impairment in patients with cerebral small vessel disease

Xie Rongji, Liu Zhou, Zhao Bin

2022, 28(11):  1619-1624.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.033

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Nowadays, vessel cognitive impairment (VCI) has become the second leading cause of dementia, and cerebral small vessel disease (CSVD) is recognized as the most common cause of VCI. In clinical practice, the diagnosis of cognitive impairment of cerebrovascular disease (CSVCI) is mainly based on the evaluation of neurological scale and neuroimaging, and the diagnosis is obtained after excluding cognitive impairment caused by other diseases. In recent years, due to the increasingly mature detection technology of hematological markers, many scholars believe that hematological marker detection is a simple and practical detection method, and provides important references for the clinical diagnosis of CSVCI, so as to intervene CSVCI in the early stage. This paper reviews the research progress of CSVCI hematological markers in recent 10 years.

Physiological function of long chain non-encoding RNA in peripheral blood and its correlation with islet β cell function in patients with type 2 diabetes mellitus

Liang Jian, Chen Yan, Liu Qiang, Hu Yuhua, Hong Yunyun, Zhang Yan

2022, 28(11):  1625-1628.  DOI: 10.3760/cma.j.issn.1007-1245.2022.11.034

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