Table of Content

15 June 2022, Volume 28 Issue 12

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Scientific Research

Treatment strategy for common poor healing of median thoracic incision after cardiac surgery

Sun Yonghui, Li Guanghui, Qian Xiaoliang, Zhao Ziniu, Zhang Jie

2022, 28(12):  1629-1632.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.001

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Objective　To explore the treatment strategies for different types of poor healing of median thoracic incision after cardiac surgery. Methods　A retrospective analysis was performed on 1 067 adult patients in Fuwai Huazhong Cardiovascular Hospital from February 2017 to January 2020. The operations included coronary artery bypass grafting, heart valve repair or replacement, coronary artery bypass grafting + valve repair or replacement, correction of congenital heart disease, modified extended Morrow procedure, etc. All of them adopted the median thoracic surgical incision. After operation, 44 patients had different types of poor incision healing, including 19 males and 25 females, aged (65.2±6.73) years. After active treatment, all of them healed well. Results　The fat liquefaction of median thoracic incision occurred in 14 cases, and all of them were cured by dressing change and pressure bandage. The poor healing of local median thoracic incision occurred in 11 cases, and all of them were cured by secondary suturing after debridement. The whole median thoracic incision was poorly healed in 10 cases, the secondary suturing was performed after debridement; the middle incision in 1 case was given debridement and suturing again, and the other cases all healed well. The sternal wire loosening occurred in 5 cases, the debridement and suturing were performed after tightening the wire, and the healing was good. The sternum dehiscence occurred in 4 cases, all of them were treated with transposition of pectoralis major myocutaneous flap and were cured at one time. Conclusion　For different types of poor incision healing of median thoracic operation after cardiac surgery, taking individualized treatment methods can achieve satisfactory clinical results.

Treatment progress of exposed keratitis

Xu Xingyan, Zhou Youdi

2022, 28(12):  1633-1635.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.002

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Exposure keratitis is to show that the cornea is exposed to the peripheral environment, loses the protection from eyelid, and causes corneal epithelial detachment and loss of moisture, resulting in corneal infection. It is a kind of disease that can cause blindness and disability, so the treatment and prevention of this disease has important practical significance. This article reviews the clinical treatment status, methods, and progress of this disease.

Clinical effect of Xiaozheng Futong decoction combined with methotrexate in the treatment of ectopic pregnancy

Shi Juanjuan, Zhang Jiuyan, Yang Hui, Cui Xiujuan, Zhang Dan

2022, 28(12):  1636-1640.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.003

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Objective　To investigate the clinical effect of Xiaozheng Futong decoction combined with methotrexate in the treatment of ectopic pregnancy, and to provide a basis for clinical use of integrated traditional Chinese and chemical medicine in the treatment of this disease. Methods　Eighty patients were treated conservatively for ectopic pregnancy in Tengzhou Central People's Hospital from January to June 2020, and according to the treatment methods, the patients were randomly divided into two groups with 40 cases in each group. The control group was (30.45±6.00) years old, and the observation group was (31.32±3.93) years old. The control group was treated with methotrexate alone and the observation group was treated with Xiaozheng Futong decoction combined with methotrexate. The age, days of menopause, days of abdominal pain, days of vaginal bleeding, human chorionic gonadotropin (HCG), progesterone, ectopic pregnancy mass, and endometrial thickness were compared between the two groups. The clinical effects of the two groups were compared during the whole treatment cycle, and the adverse drug reactions were observed. Independent sample t test, χ² test, and Fisher exact probability test were used for the statistical comparison. Results　In the observation group, there were 2 cases of failure of drug therapy and transferred to operation, and 38 successful cases (95.00%); in the control group, there were 10 cases of failure and 30 successful cases (75.00%); there was a statistically significant difference in the success rate between the two groups (χ²=6.275, P=0.012). There were no statistically significant differences in the blood HCG on the 7th day after treatment and hospitalization cost between the two groups (both P>0.05). In the observation group, the ectopic pregnancy mass on the 7th day after treatment, time of blood HCG returning to normal, time of ectopic pregnancy mass disappearance, and hospital stay were (2.14±0.92) cm, (14.61±4.76) d, (26.24±9.75) d, and (7.16±3.11) d, respectively, which were all lower than those in the control group [(2.61±0.80) cm, (17.47±6.01) d, (32.50±12.98) d, and (8.87±3.61) d], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the levels of vascular endothelial growth factor (VEGF), creatine kinase (CK), and inhibin A (INH-A) between the two groups (all P>0.05). After treatment, the levels of VEGF, CK, and INH-A in the observation group were (83.17±35.31) μg/L, (33.07±10.04) U/L, and (6.86±2.36) μg/L, respectively, which were all lower than those in the control group [(103.50±39.16) μg/L, (38.71±7.31) U/L, and (8.05±2.03) μg/L], with statistically significant differences (all P<0.05). Conclusions　Xiaozheng Futong decoction combined with methotrexate in the treatment of ectopic pregnancy can accelerate the absorption of mass, promote the blood HCG returning to normal, and reduce the length of stay. The combination of Chinese and chemical drugs has a significant therapeutic effect without adverse reactions, which can be promoted in clinical practice.

Effect of individualized biofeedback training under the ERAS concept on the rehabilitation in elderly patients with low rectal cancer after anus-preserving surgery

Dang Yuanna, Jie Jingya, Zhang Yang, Lu Di

2022, 28(12):  1641-1645.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.004

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Objective　To investigate the effect of individualized biofeedback training under the concept of enhanced recovery after surgery (ERAS) on the anal sphincter function and defecation function in elderly patients with low rectal cancer after anus-preserving surgery. Methods　According to the matching principle of baseline data between groups, 149 elderly patients with low rectal cancer who underwent anus-preserving surgery in Department of Gastroenterology, Henan Provincial People's Hospital from August 2017 to August 2020 were divided into two groups. There were 44 males and 30 females in the control group, aged (65.28±2.63) years; there were 46 males and 29 females in the observation group, aged (65.31±3.01) years. The control group was given routine perioperative nursing intervention, and the observation group was given individualized biofeedback training under the ERAS concept. The postoperative recovery, anal sphincter function, anal defecation function, and complications were observed in the two groups. χ² test was used for the count data, rank sum test was used for the grade data, and t test was used for the measurement data. Results　The time of first anal exhaust, feeding time, time of out-of-bed ambulation, and hospital stay in the observation group were (2.23±0.65) d, (4.03±1.01) d, (2.62±0.24) d, and (8.26±2.01) d, respectively, which were all shorter than those in the control group [(3.32±1.02) d, (6.01±1.26) d, (3.69±0.35) d, and (12.25±3.24) d], with statistically significant differences (t=7.757, 10.575, 21.736, and 9.019; all P<0.05). After the intervention, the maximum anal systolic pressure, resting pressure, anal contraction vector volume, and anal resting vector volume of the observation group were (145.96±29.35) mmHg (1 mmHg=0.133 kPa), (60.69±8.68) mmHg, (62 531.26±1 112.24) cm×mmHg², and (563.69±35.68) cm×mmHg², which were all higher than those of the control group [(131.01±28.01) mmHg, (55.23±9.86) mmHg, (58 632.14±655.32) cm×mmHg², and (459.69±32.62) cm×mmHg²], with statistically significant differences (t=3.181, 3.586, 26.112, and 18.573; all P<0.05). The anal defecation function of the observation group was better than that of the control group (Z=2.365, P<0.05). The incidence of complications in the observation group was 2.67% (2/75), which was lower than that in the control group [12.16% (9/74)], with a statistically significant difference (χ²=4.912, P=0.027). Conclusion　Individualized biofeedback training under the ERAS concept can adjust the anal sphincter function in elderly patients with low rectal cancer after anus-preserving surgery, improve the defecation function, reduce the postoperative complications, and promote the rapid postoperative recovery.

Characteristics of patients undergoing bronchoscopic removal of pulmonary aspergilloma and nursing countermeasures 

Lu Yanyun, Peng Dehu, Xiao Haihao, Xie Yikai, Lu Xiaowei

2022, 28(12):  1646-1649.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.005

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Objective　To explore the characteristics and countermeasures of patients treated by bronchoscopic removal of pulmonary aspergilloma. Methods　This study was a retrospective study. The clinical data of 52 patients undergoing bronchoscopic removal of pulmonary aspergilloma (the treatment group) and 52 patients undergoing ordinary bronchoscopy (the control group) were reviewed in Guangzhou Chest Hospital from November 2018 to December 2020. There were 46 males and 6 females in the treatment group, with an age of (47.00±13.48) years old; there were 44 males and 8 females in the control group, with an age of (48.00±16.28) years old. The differences of heart rate, oxygen saturation, blood pressure, operation time, and bleeding were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The heart rate and operation time of the treatment group were (112.0±6.46) beats/min and (39.95±8.32) min, respectively, which were higher than those of the control group [(100.0±9.11) beats/min and (8.83±2.46) min], and the blood oxygen saturation was (96.0±0.69)%, which was lower than that of the control group [(98.0±1.11)%], with statistically significant differences (all P<0.05). There were no statistically significant differences in the systolic blood pressure and diastolic blood pressure between the two groups (both P>0.05). The incidence of microscopic bleeding in the treatment group was 48.08% (25/52), which was higher than that in the control group [0.00% (0/52)], with a statistically significant difference between the two groups (χ²=32.911, P<0.001). Conclusions　Patients treated with bronchoscopic removal of pulmonary aspergilloma are more tense and have a high risk of hypoxemia and hemorrhage. Adopting preoperative, intraoperative, and postoperative nursing strategies, control of high-risk factors, and grasping the timing of treatment play key roles in preventing serious complications.

Research progress in diagnosis and treatment and clinical significance of orthostatic hypertension

Dong Yumei, Sun Tao, Ma Aiqing, Liang Lei, Zhu Linghua, Zhang Bin

2022, 28(12):  1650-1655.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.006

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Orthostatic hypertension is a neglected but common clinical phenomenon of abnormal blood pressure regulation. Its pathophysiological mechanism is unclear and may be related to autonomic nervous system dysfunction and sympathetic overactivity. A growing number of studies have shown that orthostatic hypertension is associated with hypertension and diabetes mellitus. Treatment of orthostatic hypertension has not been shown to improve outcomes. However, orthostatic hypertension is not a low percentage of the hypertensive population and may be associated with increased cardiovascular risk, so hypertensive patients with or without orthostatic hypertension should be paid attention to. This paper provides the latest researches on the definition, diagnosis, pathophysiological mechanism, clinical significance, and treatment of orthostatic hypertension in recent years to provide new ideas for future research on orthostatic hypertension.

Observation on the effect of H-uvulopalatopharyngoplasty for OSAHS patients

Xu Zhenbin, Yang Xiaoxiong, Zhuang Yanyun, Xi Yanjun, Chen Peng, Wu Qi, Yuan Meirong, Ji Chulian

2022, 28(12):  1656-1660.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.007

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Objective　To investigate the efficacy of H-uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods　The clinical data of 108 patients with OSAHS admitted to Department of Otolaryngology, Dongguan Chang'an Hospital from January 2015 to January 2020 were retrospectively analyzed. All patients were divided into an experimental group and a control group according to the random number table, with 54 cases in each group. In the control group, there were 26 males and 28 females, aged (39.34±3.26) years; in the experimental group, there were 28 males and 26 females, aged (38.84±3.54) years. The control group underwent simple palatopharyngoplasty, and the experimental group underwent H-uvulopalatopharyngoplasty. Apnea hypopnea index (AHI), Epworth Sleepiness Scale (ESS), lowest blood oxygen saturation (LSaO₂), momentary expiratory flow at 75% (MEF75), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEF) were compared between the two groups before surgery and 1, 3, and 6 months after surgery, and the clinical efficacies of the two groups were evaluated. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The AHI value of the experimental group were (18.36±1.89) times/h 1 month after surgery, (15.24±1.35) times/h 3 months after surgery, and (14.09±1.25) times/h 6 months after surgery, respectively, which were lower than those of the control group [(20.95±1.74) times/h, (18.63±1.42) times/h, and (16.34±1.08) times/h], the ESS scores were (7.24±1.56) points, (6.95±0.69) points, and (5.67±0.35) points, respectively, which were lower than those of the control group [(9.29±1.47) points, (8.33±0.72) points, and (8.01±0.54) points], with statistically significant differences (all P<0.05). The MEF75 index of the experimental group was (89.85±7.69)% 3 months after surgery and (96.34±8.44)% 6 months after surgery, which were higher than those of the control group [(84.29±7.30)% and (89.36±7.95)%], the FEV1 indexes were (95.30±7.41)% and (99.20±7.25)%, which were higher than those of the control group [(92.34±6.71)% and (94.24±6.03)%], the PEF indexes were (91.29±4.36)% and (95.37±5.88) %, which were higher than those of the control group [(87.63±5.01)% and (91.24±5.24)%], and the LSaO₂ indexes were (85.01±6.34)% and (89.01±7.42)%, which were higher than those of the control group [(80.63±5.96)% and (84.39±6.33)%], with statistically significant differences (all P<0.05). The total effective rate of the experimental group was 96.30% (52/54), which was significantly higher than 85.19% (46/54) of the control group, with a statistically significant difference (χ²=3.967, P=0.046). Conclusion　H-uvulopalatopharyngoplasty has better short-term and long-term efficacies in the treatment of OSAHS patients, which is of great significance for improving the quality of life in patients with OSAHS.

Application of ERAS combined with pathway mode management in PCNL patients

Pan Xiaolong, Feng Zaosheng, Wu Qiuhua, Li Xiao, Heng Baoli, Wu Fanyu

2022, 28(12):  1660-1665.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.008

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Objective　To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) combined with pathway mode management in patients undergoing percutaneous nephrolithotomy (PCNL). Methods　A total of 60 patients with comparable upper ureteral stones and/or kidney stones admitted to Yingde People's Hospital from January 2020 to November 2021 were collected and were divided into 2 groups by the random number table method. The observation group included 16 males and 14 females, aged (47.63±2.42) years; the control group included 17 males and 13 females, aged (51.07±2.16) years. The patients in the observation group were managed by ERAS combined pathway mode, and the patients in the control group were given conventional mode management. The clinical indicators of stone clearance, operation time, postoperative complications, postoperative pain, postoperative out-of-bed activity time, catheter removal time, hospitalization cost, and hospital stay of the two groups were analyzed. Independent sample t test was used for the measurement data, and chi-square test or Fisher's exact test was used for the count data. Results　In the observation group, the preoperative fasting time, postoperative first feeding time, out-of-bed activity time, catheter removal time, postoperative pain score, length of hospital stay, and hospitalization cost were (6.00±0.00) h, (5.00±0.19) h, (12.8±1.95) h, (2.67±0.12) d, (1.73±0.19), (6.27±0.23) d, (12 744±296.70) yuan, which were all lower than those in the control group [(9.60±0.22) h, (6.00±0.00) h, (68.0±2.33) h, (6.03±0.06) d, (3.93±0.33), (9.47±0.22) d, and (14 136±217.90) yuan], with statistically significant differences (all P<0.05). There were no statistically significant differences in the age, gender, stone size, stone distribution, hemoglobin decrease value, postoperative complications (hemorrhage, perirenal hematoma, and infection), fever rate, and stone clearance rate between the two groups (all P>0.05). Conclusions　The application of ERAS combined with pathway mode management in patients undergoing PCNL is safe and effective, compared with conventional medical and nursing modes, the patients' comfort is improved, the postoperative recovery is accelerated, the length of hospital stay is shortened, and the hospitalization cost is reduced, which is worthy of clinical promotion and application. At the same time, the ERAS concept can optimize and revise the implementation content of pathway, and the pathway management can effectively improve the execution rate of medical activities under the ERAS concept.

Clinical factors analysis for lower urinary tract symptoms in older secondiparas

Yang Haichao, Xu Hanbiao, Chen Xuanlin

2022, 28(12):  1666-1669.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.009

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Objective　To explore the clinical factors of lower urinary tract symptoms in older secondiparas within 1 year after delivery. Methods　A questionnaire survey was conducted among 643 older secondiparas aged (36.64±1.71) years from Huizhou No.2 Women's and Children's Healthcare Hospital from April 2018 to April 2019. Logistic regression analysis was used to analyze the correlations between the occurrence of lower urinary tract symptoms and clinical factors within 1 year after delivery. Results　Within 3 months after delivery, the history of lower urinary tract during pregnancy, frequent coughing and constipation, and age were risk factors for lower urinary tract symptoms during the urinary storage period (OR=9.968, 13.276, 1.844); within 6 months after delivery, the history of lower urinary tract during pregnancy and female age were risk factors for lower urinary tract symptoms during the urinary storage period (OR=2.228, 2.254); within 9 months after delivery, the fetal body weight, female age, and lateral episiotomy for natural labor were the risk factors for lower urinary tract symptoms during the urinary storage period (OR=3.006, 1.723, 3.098); within 12 months after delivery, the nationality, fetal body weight, female age, and lateral episiotomy for natural labor were the risk factors for the occurrence of lower urinary tract symptoms during the urinary storage period (OR=8.402, 2.603, 1.829, 2.444). Cesarean section was a significant protective factor to avoid post micturition symptoms in older secondiparas within 1 year after delivery. Conclusions　Compared with lateral episiotomy delivery and normal delivery, cesarean section is a significant protective factor to avoid the occurrence of lower urinary tract symptoms in older secondiparas within 1 year after delivery. The increase of female age and lateral episiotomy significantly increase the risk of lower urinary tract symptoms during the urinary storage period.

Correlation between PTH and hs-cTnI levels in patients undergoing single-center maintenance hemodialysis

Lei Zihan, Wang Yuquan, Su Yanyan, Chen Siqi, Wang Qi, Yang Shen

2022, 28(12):  1670-1673.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.010

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Objective　To investigate the correlation between parathyroid hormone (PTH) and high-sensitivity troponin I (hs-cTnI) in patients undergoing maintenance hemodialysis. Methods　A retrospective study was conducted on 290 patients with chronic kidney disease (CKD) at stage 5 undergoing maintenance hemodialysis in Huadu Hospital of Southern Medical University from January to June 2020. The patients were divided into 3 groups according to the PTH level, and the correlation between PTH level and hs-cTnI positive rate was analyzed. The data were statistically analyzed by independent sample t test, univariate analysis of variance, rank-sum test, χ² test, and logistic regression equation. Results　A total of 290 eligible maintenance hemodialysis patients were included, aged (58.94±14.16) years, with male patients of 57.59% (167/290), a median dialysis age of 31 months, PTH of (52.23±46.97) pmol/L, and a positive rate of hs-cTnI of 5.86% (17/290). Univariate analysis showed that the proportion of males and the levels of B-type natriuretic peptide, urea nitrogen, myoglobin, serum calcium, and PTH before dialysis in the hs-cTnI positive (>0.1 μg/L) patients were significantly higher than those in the hs-cTnI negative patients, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that every 10.00 pmol/L increase of PTH increased the hs-cTnI positive effect value in hemodialysis patients by 14% (OR=1.14, 95%CI: 1.01-1.27, P=0.029). Conclusion　The PTH level is associated with myocardial injury in maintenance hemodialysis patients.

Analysis of poor-scoring items in the nursing work environment survey in a specialized hospital

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

2022, 28(12):  1674-1678.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.011

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Objective　To improve the hospital nursing management by analyzing the poor-scoring survey items. Methods　In the cross-sectional study, a questionnaire survey was conducted among nurses in Guangzhou Chest Hospital from July 9 to 22, 2020; 441 nurses should participate in the survey, and 249 nurses actually gave feedback on the questionnaire results. The nurses were classified according to 7 age groups of ≤25 years old, >25-30 years old, >30-35 years old, >35-40 years old, >40-45 years old, >45-50 years old, and ≥50 years old, or 4 professional title levels of nurse, registered nurse, supervisor nurse, and senior nurse (including deputy chief nurse and chief nurse). Poor-scoring items with a Likert 4-point average score ≤2.50 in the Practice Environment Scale of the Nursing Work Index (PES-NWI) survey were selected. The distribution frequencies, percentages, and their mean±standard deviation (x±s) of "strongly disagreed", "disagreed", "agreed", and "strongly agreed" on Likert 4 levels were calculated. Results　(1) There were 341 (11 × 31) population item sets (hereinafter referred to as "groups") formed by 11 types of nurse populations and 31 items in 4 dimensions of PES-NWI. There were 24 poor-scoring groups with an average score of ≤2.50, accounting for 7.04% of the total number of groups. The poor-scoring groups involved 6 items in the dimension of "nurses' participation in hospital affairs" and 2 items in the dimension of "adequate human and material resources" of PES-NWT. (2) There were 18 poor-scoring groups in the nurses of 7 age groups, accounting for 8.29% of the total number of groups (7 × 31). The poor-scoring groups involved 6 items in the dimension of "nurses' participation in hospital affairs" and 2 items in the dimension of "adequate human and material resources" of PES-NWT. (3) There were 6 poor-scoring groups in the nurses of 4 professional title levels, accounting for 4.84% of the total number of groups (4 × 31). The poor-scoring groups involved 3 items in the dimension of "nurses' participation in hospital affairs" and 3 items in the dimension of "adequate human and material resources" of PES-NWT. (4) The poor-scoring groups of the 7 age groups involved 0, 1, 5, 4, 3, 2, and 3 items from the youngest to the oldest. The poor-scoring groups of the 4 professional title level groups involved 0, 2, 3, and 1 items respectively from lowest to highest. Conclusion　The nurses' age is more sensitive to the perception of nursing work environment than the level of professional titles, and the nurses' status in hospital and the adequacy of the number of nursing staff are the most concerned.

Results of a survey on the nursing work environment in a specialized hospital 

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

2022, 28(12):  1679-1683.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.012

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Objective　To acquire a comprehensive and in-depth understanding on the attitude towards the work environment in nurses working in a specialized hospital and further provide rationales for decision making of continuous improvement of nursing management and quality. Methods　It was a cross-sectional study. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to administer the questionnaire from July 9 to 22, 2020 in Guangzhou Chest Hospital as a cross-sectional study. A total of 249 nurses, aged 18 to 50 years, were selected. The Likert 4-level scoring method was used to calculate its score and score category by dimensions and items. Results　The scores of healthcare cooperation, foundation of high-quality nursing service, nurse managers' competence and leadership, nurses' participation in hospital affairs, and adequate manpower and material resources dimensions were (3.04±0.55), (2.98±0.59), (2.90±0.70), (2.74±0.73), and (2.65±0.69), respectively. The top 5 ranking items in order of score from highest to lowest were "the rapport between nurses and doctors", "a good teamwork spirit between nurses and doctors", "the supports to the nursing work from the managers of the department", "the guiding and training programs for new onboarding nurses", and "the opportunity to work with competent nurses in clinical work", respectively. Conversely, the last 5 items in order of score from lowest to highest were "the opportunity to participate in the management decisions of the hospital for nurses", "the opportunity to further study and collaborate for me", "giving me more time to care for patients by adequate support equipment","adequate staff (doctors, nurses, carers, etc.) for completing the work tasks", and "managers listening to and responding to nursing staff's opinions and suggestions", respectively. Conclusions　The cooperation and high-quality service for nursing have many good qualities in the specialized hospital. But, the status, human development, as well as staffing for nurses must be paid great attention to.

Comparative study on percutaneous nephrolithotomy for staghorn renal calculi in the oblique supine lithotomy position and prone position

Jiang Ganggang, Zeng Peng, Lan Ziquan, Yang Jianggen, Huang Guixiao, Jiang Xianhan

2022, 28(12):  1684-1688.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.013

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Objective　To explore the safety and efficacy of percutaneous nephrolithotomy (PCNL) for staghorn renal calculi in the oblique supine lithotomy position and prone position. Methods　A retrospective analysis was performed on 180 patients with staghorn renal calculi from January 2012 to April 2020, all of whom were treated with PCNL, including 100 cases from The Fifth Affiliated Hospital of Guangzhou Medical University (group A) and 80 cases from The Sixth Affiliated Hospital of Guangzhou Medical University (group B). In group A, there were 43 males and 57 females, aged (53.42±10.71) years, undergoing surgery in the prone position; in group B, there were 34 males and 46 females, aged (52.83±11.25) years, undergoing surgery in the oblique supine lithotomy position. The puncture site, operative time, intraoperative bleeding volume, stage Ⅰ stone-free rate, hospital stay, hemodynamic changes (systolic blood pressure, diastolic blood pressure, and heart rate) were observed and compared in the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　There were no statistically significant differences in the puncture site and stage Ⅰ stone-free rate between the two groups (both P>0.05). The operative time and hospital stay of group B were (90.13±17.70) min and (10.15±1.54) d, respectively, which were lower than those of group A [(107.25±45.55) min and (14.92±5.23) d], with statistically significant differences (both P<0.05). The incidence of postoperative serious complications in group B was 0.00% (0/80), which was lower than that in group A [6.00% (6/100)], with a statistically significant difference (P<0.05). There were no statistically significant differences in the systolic blood pressure, diastolic blood pressure, and heart rate between the two groups 30 min before anesthesia (T₀) and after anesthesia (T₁) (all P>0.05). The systolic blood pressure of group B was (132.00±13.50) mmHg (1 mmHg=0.133 kPa) at intraoperative 25th min (T₂) and (128.97±11.84) mmHg at extubation (T₃), respectively, the diastolic blood pressures were (80.24±9.88) mmHg and (80.56±7.93) mmHg, respectively, which were higher than those of group A [(125.24±15.63) mmHg, (123.84±15.65) mmHg, (75.94±13.92) mmHg, and (73.93±10.25) mmHg], with statistically significant differences (all P<0.05). The systolic blood pressure of group A at T₀ and T₁ were (138.30±16.83) mmHg and (134.72±17.56) mmHg, the diastolic blood pressures were (84.00±13.00) mmHg and (81.23±12.84) mmHg, respectively, which were higher than those at T₂ [(125.24±15.63) mmHg and (75.94±13.92) mmHg], with statistically significant differences (all P<0.05). There was no statistically significant difference in the heart rate between groups or within groups (all P>0.05). Conclusion　The clinical effects of PCNL for patients with staghorn renal calculi in the oblique supine lithotomy position and prone position are similar, and the operative time and hospital stay in the oblique supine lithotomy position were significantly shorter than those in the prone position with higher safety.

Effect of acupoint selection and application along the meridians in preventing nausea and vomiting after lumbar internal fixation and fusion

Zhang Yin, Chen Shaohua, Wu Yurui, Lai Peiqian, Lan Meiyan, Hu Tianhong

2022, 28(12):  1689-1692.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.014

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Objective　To observe the effect of acupoint selection and application along the meridians combined with traditional Chinese medicine nursing in preventing nausea and vomiting after lumbar surgery. Methods　A total of 94 consecutive inpatients in the No.1 Department of Orthopedics, Dade Road General Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from June to December 2020 were selected, and they were divided into an observation group and a control group by the randomized controlled research method. The observation group consisted of 48 cases, including 22 males and 26 females, with an age of (59.67±10.74) years old; the control group consisted of 46 cases, including 14 males and 32 females, with an age of (58.35±10.29) years old. The control group was given routine traditional Chinese medicine nursing, and the observation group was given acupoint selection and application therapy along the meridians on the basis of the control group. The incidences of postoperative nausea and vomiting were observed and the degree of nausea was evaluated in both groups. Nonparametric rank sum test was used for the grade data, χ² test was used for the count data, and independent sample t test was used for the measurement data. Results　The incidences of nausea and vomiting in the observation group were 18.8% (9/48) and 8.3% (4/48), respectively, which were lower than those in the control group [41.3% (19/46) and 23.9% (11/46)], with statistically significant differences (χ²=5.713, 4.251; P=0.017, 0.039). The incidences of mild, moderate, and severe nausea in the observation group were 14.6% (7/48), 4.2% (2/48), and 0.0% (0/48), respectively, which were lower than 19.6% (9/46), 15.2% (7/46), and 6.5% (3/46) in the control group, with a statistically significant difference (Z=2.837, P=0.005). Conclusion　Acupoint selection and application along the meridians has an obvious effect in the prevention and treatment of postoperative nausea and vomiting, which is conducive to the recovery of postoperative gastrointestinal function.

Special Column of Pediatrics

Progress in the diagnosis and treatment of childhood malaria

Luo Qingming, Lin Chaofeng

2022, 28(12):  1693-1699.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.015

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Malaria is an infectious disease caused by plasmodium parasites, which is prevalent all over the world. According to the latest report, there were an estimated 241 million cases and 627 000 deaths globally in 2020, the African region accounted for 95% of cases and 96% of deaths; children under the age of 5 years old accounted for about 80% of all malaria deaths in the region. Microscopic examination is the gold standard for the diagnosis of malaria, and rapid antigen diagnosis can also be used as a diagnostic method. Artemisinin-based combination therapies (ACTs) are recommended by the World Health Organization as the preferred treatment for malaria. In severe malaria, efficient and rapid injection of artesunate or artemether is preferred for rescue. After the disease is improved and the patients can take food, the 3-day oral regimen of ACTs is continued. Although the malaria parasite becomes less sensitive to artemisinin in some areas, most patients can be cured by prolonged drug treatment. The global fight against malaria still has a long way to go.

A control study of serum hormone levels in children with autism spectrum disorder

He Weijun, Xiong Xiyue, Lou Mingxing, Peng Ying, Wang Yichao

2022, 28(12):  1699-1703.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.016

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Objective　To investigate the differences of several serum hormone levels between ASD and normal children. Methods　A case-control study was conducted. A total of 120 ASD children (68 males / 52 females, aged 24-108 months) and 120 normal control children (68 males / 52 females, aged 24-109 months) were collected according to the diagnostic criteria of the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in Hunan Provincial Maternal and Child Health Care Hospital from June 2018 to December 2020. Serum levels of progesterone (P), testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH), cortisol hormone (CORT), and adrenocorticotropic hormone (ACTH) were determined by electrochemiluminescence. Wilcoxon rank sum test was used for the measurement data, and χ² test was used for the count data. Results　Serum levels of P, LH, CORT, and ACTH in the ASD children were 0.61 (0.36, 0.95) nmol/L, 0.38 (0.26, 0.45) IU/L, 345.28 (223.98, 465.50) nmol/L, and 10.41 (6.43, 16.65) pg/ml, respectively, which were significantly higher than those in the control group [0.16 (0.16, 0.16) nmol/L, 0.25 (0.21, 0.32) IU/L, 167.80 (125.15, 203.45) nmol/L, and 8.49 (5.50, 14.74) pg/ml] (all P<0.05); there were no statistically significant differences in serum levels of T, FSH, and GH between the two groups (all P>0.05). In the ASD children, the levels of FSH and GH in the females were 2.66 (1.32, 3.80) IU/L and 3.68 (0.90, 6.37) μg/L, respectively, which were higher than those in the males [0.93 (0.65, 1.31) IU/L and 1.56 (0.53, 3.95) μg/L] (both P<0.05); there were no statistically significant differences in serum P, T, LH, CORT, and ACTH levels between the males and the females (all P>0.05). Conclusion　The levels of serum P, LH, CORT, and ACTH in children with ASD increase, without significant gender difference, suggesting that their changes are closely related with ASD.

Clinical analysis of 38 children with urinary tract infection

Zhang Jian, Jia Xiuhong, Zhu Cong

2022, 28(12):  1704-1706.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.017

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Objective　To investigate the prevalence, clinical characteristics, auxiliary examination, treatment, and efficacy of urinary tract infection in children. Method　The prevalence, clinical characteristics, auxiliary examination, treatment, and efficacy of pediatric urinary tract infection in Binzhou Medical University Hospital from January to December 2021 were retrospectively analyzed. Results　A total of 38 children were included, including 18 males and 20 females; the average age was 3.7 years old; the disease could occur all year round. Clinical characteristics: most of the children had urinary tract irritation, fever, and hematuria, and a few had nausea and vomiting, abdominal pain, and diarrhea. There were 4 cases (10.5%) complicated with respiratory tract infection. Auxiliary examination: 27 cases (71.1%) had elevated white blood cell count in blood routine, and 18 cases (47.4%) had elevated inflammatory indicators of procalcitonin and C-reactive protein. Routine urine examination showed that 34 cases (89.5%) had white blood cell count >5/HPF at high magnification, 24 cases (63.2%) had red blood cell count >3/HPF, and 25 cases (65.8%) had protein +. The positive rate of urine culture was 68.4% (26/38). The positive rate of double kidney, ureter, and bladder color Doppler ultrasound was 42.1% (16/38). Treatment and efficacy: most of the children had a good prognosis after symptomatic supportive treatment such as anti-infection and alkaline urine. Conclusions　Most pediatric urinary tract infections have age characteristics, and most of the symptoms are atypical. Escherichia coli infection accounts for the vast majority, which needs to be combined with urine sediment analysis, urine bacteriological examination, and imaging diagnosis. After formal anti-infection treatment, the vast majority of children can be cured.

Application effect of multi-frequency vibration sputum elimination machine for expectoration in children with severe pneumonia 

Gao Xianghua, Dong Bailing, Zhou Xihua

2022, 28(12):  1706-1710.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.018

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Objective　To explore the application effect of multi-frequency vibration sputum elimination machine for expectoration in children with severe pneumonia. Methods　A retrospective study method was used to study 50 children with severe pneumonia who were admitted to Children's Hospital Affiliated to Zhengzhou University from January to December 2021. The observation group had 14 males and 11 females, with an age of (5.23±1.01) years old; the control group had 13 males and 12 females, with an age of (5.26±1.04) years old. The control group was treated with artificial back knocking to expel sputum, and the observation group was treated with multi-frequency vibration sputum elimination machine to expel sputum. The treatment effect, respiratory function, serum inflammatory factors levels, and improvements of symptoms and signs were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test or Fisher's exact probability method was used for the count data. Results　The total effective rate of the observation group was 100.00% (25/25), which was higher than 76.00% (19/25) of the control group, with a statistically significant difference (P=0.022). After treatment, the arterial partial pressure of carbon dioxide (PaCO₂) [(36.96±2.41) mmHg (1 mmHg=0.133 kPa)] and work of breathing (WOB) [(0.67±0.07) J/L] in the observation group were lower than those in the control group, and the arterial partial pressure of oxygen (PaO₂) [(95.41±5.73) mmHg], oxygen saturation (SaO₂) [(95.19±4.94)%], dynamic compliance (Cydn) [(38.49±3.52) mL /cmH₂O (1 cmH₂O=0.098 kPa)], and oxygenation index (PaO₂/FiO₂) [(384.49±50.65)] were higher than those in the control group, with statistically significant differences (all P<0.05). After treatment, the serum C-reactive protein (CRP) [(13.85±2.51) ng/L], white blood cell count (WBC) [(6.95±1.10) ×10⁹/L], interleukin-6 (IL-6) [(6.09±1.06) μg/ml], and procalcitonin (PCT) [(1.32±0.45) μg/L] in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). The cough relief time [(6.23±1.15) d], fever resolution time [(2.78±0.36) d], lung rales disappearance time [(6.04±1.09) d], and hospital stay [(12.37±3.26) d] in the observation group were shorter than those in the control group, with statistically significant differences (all P<0.05). Conclusion　The multi-frequency vibration sputum elimination machine to expel sputum can improve the respiratory function in children with severe pneumonia, reduce the inflammatory reaction, improve the clinical efficacy, and promote their rehabilitation.

Diagnosis and treatment of pediatric lower urinary tract stones 

Abulaizi Alimujiang, Wang Hailiang, Maimaiti Aikebaierjiang, Qin Shibiao, Li Sisi, Guo Kaikai, Batur Jesur

2022, 28(12):  1711-1714.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.019

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Objective　To evaluate the values of different imaging examinations for pediatric lower urinary stones and their effects on treatment outcomes. Methods　The clinical data of 105 children with lower urinary tract stones in The People's Hospital of Jiashi County and The First People's Hospital of Kashgar Prefecture from January 2014 to August 2017 were analyzed retrospectively. The 105 children were divided into two groups according to whether they underwent non-contrast computed tomography (NCCT) or not. Group A underwent ultrasound (US) + plain film of kidney-ureter-bladder (KUB), group B underwent US + KUB + NCCT, and transurethral lithotripsy of bladder stones was performed in both groups. Group A included 50 cases, all males, aged (2.09±1.37) years; there were 55 children in group B, including 54 males and 1 female, aged (2.61±1.56) years. The detection rates of stones and perioperative indexes of the two groups were compared. Independent sample t test and χ² test were used. Results　All the 105 children were diagnosed with lower urinary stones; 100 children underwent US, with a detection rate of 98.00% (98/100); 99 children underwent KUB examination, with a detection rate of 74.75% (74/99); 55 children underwent NCCT, with a detection rate of 98.18% (54/55). The combined detection rate of US + KUB in group A was 100.00% (50/50), and the combined detection rate of US + KUB + NCCT in group B was 100.00% (55/55). NCCT detected 1 case of urethral calculi not detected by US + KUB, and 1 case of left renal calculi (the surgical scheme was not changed). All operations were successful and there were no serious complications in both groups. There were no statistically significant differences in the postoperative indwelling catheter time (P=0.363), length of hospital stay (P=0.077), and incidence of complications (P=0.627) between the two groups. The operation time of group B was shorter than that of group A [(19.63±11.82) min vs. (28.20±13.49) min], with a statistically significant difference between the two groups (t=3.469, P<0.001). Conclusions　When suspected to be pediatric lower urinary tract stones, US and/or KUB should be used as the initial examination method, which is sufficient for diagnosis and treatment and can also avoid the radiation and economic stress of CT examination. This program is worthy of further promotion and application in the poor areas such as Kashgar in southern Xinjiang of China.

Treatises

Changes of serum BNP and hs-CRP levels and their predictive values for long-term prognosis in AMI patients after PCI

Li Li

2022, 28(12):  1715-1719.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.020

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Objective　To explore the changes in serum levels of brain natriuretic peptide (BNP) and hypersensitive C-reactive protein (hs-CRP) and their predictive values for long-term prognosis in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A total of 160 AMI patients undergoing PCI in Department of Cardiovascular Medicine, The Third Affiliated Hospital of Inner Mongolia Medical University from January 2019 to October 2020 were enrolled, including 117 males and 43 females, aged (57.54±11.90) years. Another 80 healthy controls during the same period were enrolled as a normal group, including 59 males and 21 females, aged (56.96±10.84) years. The AMI patients were followed up for 1 year. According to the presence or absence of major adverse cardiac events (MACE), they were divided into a non-MACE group and a MACE group. The changes of serum BNP and hs-CRP before and after surgery were compared between the two groups, and their predictive values for prognosis in patients with AMI were analyzed. t test was used for the measurement data, χ² test was used for the count data, and Z test was used for the area under curve (AUC). Results　The AMI patients were followed up for 1 year. There were 5 cases (3.13%) lost to follow-up. The incidence of MACE within 1 year in the AMI patients was 27.74% (43/155). According to the presence or absence of MACE, there were 43 cases in the poor prognosis group and 112 cases in the good prognosis group. Before and after surgery, there were statistically significant differences in the serum hs-CRP and BNP levels in the AMI patients (both P<0.05), and the serum hs-CRP and BNP levels in the AMI group were higher than those in the normal group (all P<0.05). Before surgery, the serum hs-CRP and BNP levels in the poor prognosis group were higher than those in the good prognosis group (both P<0.05); the difference of serum hs-CRP before and after surgery in the poor prognosis group was larger than that in the good prognosis group, and the difference of serum BNP before and after surgery was smaller than that in the good prognosis group (both P<0.05). According to the AUC, the optimal diagnostic cut-off points for the differences of serum hs-CRP and BNP before and after surgery were selected. The receiver operating characteristic curve (ROC) analysis showed that the AUC of the combination of differences of serum hs-CRP and BNP before and after surgery to predict the prognosis in AMI patients was 0.930, which was higher than that of the combination of serum hs-CRP and BNP before surgery (0.777) (P<0.05). Conclusion　The combination of differences of serum BNP and hs-CRP in AMI patients before and after PCI has high efficacy in predicting the risk of MACE after PCI, which is worthy of clinical application.

Clinical effect of staged deep acupuncture combined with oral training in the treatment of dysphagia after stroke

Bi Keping, You Jian, Wang Zhuangzhi, Sui Peng

2022, 28(12):  1719-1723.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.021

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Objective　To explore the effect of staged deep acupuncture combined with oral training in the treatment of dysphagia after stroke. Methods　Ninety-six patients with post-stroke dysphagia admitted to Weihai Central Hospital from August 2019 to August 2021 were divided into a control group and a treatment group by the random number table method (48 cases in each group). The control group [28 males and 20 females, aged (57.84±10.08) years] was given oral sensorimotor training, and the treatment group [26 males and 22 females, aged (57.90±10.11) years] was given staged acupoint deep acupuncture on the basis of the control group. Before and after treatment, the swallowing function was detected by Water Swallow Test, the nutritional status was assessed by Nutritional Risk Screening 2002 (NRS2002), the cerebral hemodynamics was examined by transcranial color Doppler ultrasonography, the activities of daily living were examined by modified Barthel index (MBI), and the quality of life was assessed by Swallowing Quality of Life Questionnaire (SWAL-QOL), and the clinical effect was recorded in the two groups. t test was used for the measurement data, and chi-square test was used for the count data. Results　The treatment group had a higher effective rate compared with the control group [95.83% (46/48) vs. 79.17% (38/48)] (χ²=6.095, P=0.014). After treatment, the scores of Water Swallow Test, Functional Oral Intake Scale (FOIS), and Video Fluoroscopic Swallowing Study (VFSS) increased in both groups, the NRS2002 score decreased (all P<0.05); compared with those in the control group, the scores in the treatment group were better after treatment, with statistically significant differences (all P<0.05). After treatment, the mean flow velocity (Vm) and systolic velocity (Vs) significantly increased in both groups, and the resistance index (RI) decreased (all P<0.05); compared with those in the control group, the Vm and Vs were higher and the RI was lower in the treatment group after treatment, with statistically significant differences (all P<0.05). After treatment, the MBI and SWAL-QOL scores in the two groups increased, and the MBI and SWAL-QOL scores in the treatment group were higher than those in the control group, with statistically significant differences (all P<0.05). Conclusion　For patients with dysphagia after stroke, deep acupuncture on acupoints combined with oral training has an ideal clinical effect, which can improve patients' feeding and swallowing function, improve their cerebral hemodynamics and activities of daily living, reduce the risk of malnutrition, and improve their quality of life, which is worth promoting.

Clinical Research

Curative effect of inhaled salmeterol/fluticasone propionate combined with budesonide in the treatment of asthma

Zhao Xusheng, Jiang Tao, Li Lei

2022, 28(12):  1724-1727.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.022

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Objective　To explore the clinical effect of inhaled salmeterol/fluticasone propionate combined with budesonide in the treatment of asthma, and analyze its influence on serum interleukin-21 (IL-21) and IL-18 levels. Methods　A total of 86 patients with bronchial asthma who were admitted to Haiyang People's Hospital from January 2020 to December 2021 were selected. They were randomly divided into an observation group (47 cases) and a control group (39 cases) by the coin flipping method. There were 22 males and 25 females in the observation group, aged (43.48±5.57) years; there were 25 males and 14 females in the control group, aged (44.39±6.01) years. All patients underwent conventional symptomatic treatment. On this basis, the patients in the control group were treated with inhaled salmeterol/fluticasone propionate, and the patients in the observation group were treated with inhaled salmeterol/fluticasone propionate combined with budesonide. The two groups were compared in terms of clinical effect, clinical symptom improvement time, and changes in pulmonary function and serum IL-21 and IL-18 levels. The recurrence of asthma within 3 months after treatment and adverse reactions during treatment were recorded. t test was used for the measurement data and χ² test was used for the count data. Results　The total effective rate of the observation group was 91.49% (43/47), which was higher than that of the control group [71.79% (28/39)] (P<0.05). After treatment, the clinical symptom improvement time in the observation group was shorter than that in the control group (P<0.05), the forced expiratory volume in 1 second (FEV₁), FEV₁/ forced vital capacity (FVC), and peak expiratory flow (PEF) levels were higher than those in the control group (all P<0.05), the serum IL-21 and IL-18 levels were lower than those in the control group (both P<0.05). The recurrence rate of asthma in the observation group was 6.38% (3/47), significantly lower than that in the control group [23.08% (9/39)] (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions　Inhaled salmeterol/fluticasone propionate combined with budesonide can significantly improve the clinical symptoms and lung function in asthmatic patients, with a low recurrence rate and good safety. The mechanism may be related to regulation of serum IL-21 and IL-18 levels.

Effects of different anesthesia maintenance regimens on anesthetic effects and hemodynamics in patients undergoing laparoscopic total hysterectomy

Wu Yasong, Fu Zhihai

2022, 28(12):  1728-1731.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.023

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Objective　To explore the effects of different anesthesia maintenance regimens on anesthetic effects and hemodynamics in patients undergoing laparoscopic total hysterectomy. Methods　Sixty-eight patients who were scheduled to undergo laparoscopic total hysterectomy in Xiamen Huli District Maternity and Child Care Hospital from December 2016 to December 2019 were selected and were randomly divided into a control group (34 cases) and an observation group (34 cases) by the sealed envelope method. The control group was (48.73±6.52) years old with (2.86±0.58) births, and the observation group was (49.24±6.87) years old with (2.92±0.63) births. The control group adopted intravenous-inhalation combined anesthesia maintenance regimen of remifentanil target-controlled infusion and intermittent inhalation of sevoflurane, and the observation group adopted simple intravenous maintenance anesthesia regimen of target-controlled infusion of propofol and remifentanil. The anesthetic effects, hemodynamic indexes before anesthesia induction (T₀), after anesthesia induction (T₁), at tracheal intubation (T₂), 5 min after establishment of pneumoperitoneum (T₃), at the end of surgery (T₄), at extubation (T₅), and 30 min after extubation (T₆), and adverse reactions of the two groups were compared. Repeated-measure ANOVA or independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The anesthesia induction time, postoperative wake-up time, extubation time, and recovery time of orientation were shorter and the incidence of postoperative agitation [5.88% (2/34) vs. 29.41% (10/34)] was lower in the observation group compared to those in the control group (all P<0.05). At T₀-T₆, the systolic blood pressure, diastolic blood pressure, and heart rate in the two groups were fluctuated significantly (all P<0.05), and the systolic blood pressure, diastolic blood pressure, and heart rate in the observation group at T₂ and T₃ were significantly lower than those in the control group (all P<0.05). In terms of postoperative adverse reactions such as nausea and vomiting, dizziness, drowsiness, and bradycardia, there were 3 cases in the observation group and 5 cases in the control group, and there was no statistically significant difference between the two groups (P>0.05). Conclusion　The anesthetic effect of simple intravenous anesthesia maintenance in laparoscopic total hysterectomy is better than that of intravenous-inhalation combined anesthesia maintenance, and the former regimen is beneficial to hemodynamic stability and reduce the risk of stress response, with fewer adverse reactions.

Case Report

Misdiagnosis of testicular tumor in two cases

Chen Xiuxiao, Sui Wenqian, Wu Yuanyuan

2022, 28(12):  1732-1733.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.024

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Nursing Research

Effects of ball grip exercise intensities of different metabolic equivalents on catheter complications and exercise fatigue after PICC catheterization

Dou Shoukun, Xia Guili, Liu Zeqin, Wan Xin, Zhang Jing, Cheng Qing

2022, 28(12):  1734-1739.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.025

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Objective　To explore the effects of ball grip exercise intensities of different metabolic equivalents (METs) on catheter complications and exercise fatigue after peripherally inserted central catheter (PICC). Methods　From April 2020 to August 2021, 90 patients who underwent PICC in Shenzhen Hospital of Southern Medical University were randomly divided into 3 groups by the random number table method, with 30 cases in each group. The intensity of ball grip exercise was measured by MET the patientsin, the three groups were corresponded to exercise intensities of 1-2 METs, 2-3 METs, and 3-4 METs, the patients in the three groups wore sports watches showing exercise oxygen consumption when gripping the ball, and they all gripped the ball 300 groups every day, which were divided into 3 times within 2 h after three meals, 100 groups each time. The maximum blood flow velocity (Vmax) and minimum blood flow velocity (Vmin) of the axillary vein at rest state and 10 minutes after reaching the target exercise intensity were measured by color Doppler ultrasound on the 3rd day after the catheterization. The graded diagnosis of upper extremity venous thrombosis was completed by color Doppler ultrasound on the 7th and 14th day after catheterization. The incidence of other catheter complications (clogging, phlebitis, bleeding at the puncture point, and catheter displacement) within 14 days after PICC catheterization and patients' subjective fatigue after exercise 3-14 d after PICC catheterization were recorded. χ² test or rank sum test were used for the count data, one-way ANOVA was used for comparison among three groups, LSD method was used for pial comparison, and independent sample t test was used for comparison between two groups. Results　There were 17 males and 13 females in the 1-2 METs group, aged (54.60±10.45) years; there were 15 males and 15 females in the 2-3 METs group, aged (55.70±11.07) years; there were 18 males and 12 females in the 3-4 METs group, aged (55.25±10.93) years. The axillary vein Vmin and Vmax 10 minutes after reaching the target exercise intensity were significantly higher than those at rest state in the 1-2 METs, 2-3 METs, and 3-4 METs groups, with statistically significant differences (all P<0.05); there were no statistically significant differences in the axillary vein Vmin and Vmax among the three groups at rest state or 10 minutes after reaching the target exercise intensity (all P>0.05). There were no statistically significant differences in the incidence of upper limb venous thrombosis within 7 d and 14 d after catheterization among the three groups [10.00% (3/30) vs. 6.67% (2/30) vs. 6.67% (2/30), 20.00% (6/30) vs. 13.33% (4/30) vs. 10.00% (3/30)] (both P>0.05). There were no statistically significant differences in the incidences of clogging, phlebitis, bleeding at the puncture point, catheter displacement, and total complications among the three groups within 14 d after catheterization (all P>0.05). The proportion of exercise fatigue in the 1-2 METs group was lower than those in the 2-3 METs group and 3-4 METs group [26.67% (8/30) vs. 53.33% (16/30) vs. 76.67% (23/30)], with statistically significant differences (both P<0.05). Conclusions　In patients with PICC catheterization, exercise intensities of 1-2 METs, 2-3 METs, and 3-4 METs have similar axillary vein blood flow velocity, incidence of upper limb venous thrombosis, and incidence of other catheter complications. Considering the exercise fatigue factor, the exercise intensity of 1-2 METs is suitable for ball grip exercise within 14 days after PICC catheterization.

Effect of iced saline spraying oral mucosa in relieving thirst in patients with dysphagia

Bao Liyan, Hai Zhixi, Fu Yongwang, Chang Wenzhong

2022, 28(12):  1740-1745.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.026

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Objective　To explore the application effect of iced saline spraying oral mucosa in relieving thirst in patients with dysphagia. Methods　This study was a pilot study. From November 2020 to August 2021, 70 patients with dysphagia in the neurology intensive care unit of Inner Mongolia People's Hospital were admitted. According to the random number table, they were randomly divided into 35 cases in the treatment group and 35 cases in the control group. There were 23 males and 12 females in the control group, with an age of (68.11±10.16) years old; there were 19 males and 16 females in the treatment group, with an age of (67.69±13.54) years old. For the control group, we used sterile cotton swabs dipped in normal saline to moisten the lip and tongue every 4 hours for 5 consecutive days; for the treatment group, we put 2-6 ℃ iced saline into an elephant nose watering pot and sprayed directly onto the oral mucosa. The thirsty subjective evaluation and objective evaluation indexes were used to evaluate patients' thirsty degree and oral saliva pH value. The two methods were compared in relieving patients' thirst. Spearman correlation analysis was used to analyze the correlation between the thirsty degree and oral saliva pH value. Independent sample t test was used for the measurement data, χ² test was used for the count data, and rank sum test was used for the grade data. Results　After intervention, the score of Numeric Rating Scale (NRS) was (8.51±0.85) in the control group and (1.26±1.12) in the treatment group, with a statistically significant difference (t=30.487, P<0.001); the pH value of oral saliva in the control group was (6.01±0.19), and that in the treatment group was (6.94±0.24), with a statistically significant difference (t=-17.890, P<0.001). Spearman correlation analysis showed that there was a negative correlation between the score of NRS and oral saliva pH value (r_s<0, P<0.05). Conclusions　Spraying the oral mucosa with iced saline can relieve the patients' thirst. There is a moderate negative correlation between the degree of thirst and the pH value of oral saliva. The more severe the thirst, the lower the oral saliva pH value. The severity of thirst can be judged by the pH value of oral saliva.

Clinical practice of active intervention in puerpera with fever during painless labor during the second stage of labor

Li Xiaofeng, Liang Yanhong, Wang Yuan

2022, 28(12):  1746-1748.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.027

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Objective　Free position as the way of active intervention in the second stage of puerpera with fever during painless labor, to shorten the second stage of labor and reduce fetal distress in uterus caused by fever during painless labor. Methods　A total of 80 cases of puerpera with fever during painless labor in Department of Obstetrics, Panyu Central Hospital from April 2020 to November 2021 were selected. They were numbered according to the sequence of maternal enrollment and were divided into a control group and an observation group with 40 cases in each group, with No. 1-40 as the control group and No. 41-80 as the observation group. The observation group was (28.450±4.095) years old with a body weight of (67.530±10.595) kg, and the control group was (27.800±3.969) years old with a body weight of (65.769±8.217) kg. The observation group exerted their strength at free position immediately at the beginning of the second stage of labor, and the control group exerted their strength at traditional lithotomy position with time delay. The second stage of labor, the rate of conversion from spontaneous labor to cesarean section, assisted delivery rate, and newborn birth status were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The second stage of labor of the observation group [(30.43±19.61) min] was lower than that of the control group [(73.10±32.33) min], with a statistically significant difference (P<0.05). The rate of conversion from spontaneous labor to cesarean section and assisted delivery in the observation group was significantly lower than that in the control group, with a statistically significant difference (P<0.05). The normal rate of neonates in the observation group was 75.0% (30/40), which was higher than that in the control group [47.5% (19/40)], with a statistically significant difference (P<0.05). Conclusion　Using free position during the second stage of labor as the way of active intervention for puerpera with fever during painless labor can shorten the second stage of labor, and reduce the rates of caesarean section, assisted delivery, and adverse neonatal condition.

Investigation on the operative cognition and improvement of visual function in middle-aged and elderly cataract patients

Wu Peng, Xin Tian, Wu Tingting, Huang Xin

2022, 28(12):  1749-1754.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.028

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Objective　To investigate the evaluation or expectation of the operative cognition status and visual function improvement in middle-aged and elderly cataract patients in order to provide guidances for cataract surgery education, expectation guidance, and improvement of the willingness of surgery. Methods　This was a cross-sectional investigation study. The Cataract Surgery Cognition Questionnaire designed by Department of Ophthalmology, The Second People's Hospital of Jinan City was used to investigate the patients' operative cognition, the Evaluation or Expectation Questionnaire of Cataract Patients on the Improvement of Visual Function was used to investigate the cataract patients' evaluation or expectation on the improvement of visual function. The investigation time was from April to August 2021, and the investigation site was The Second People's Hospital of Jinan City. χ² test was used for the count data and independent sample t test was used for the measurement data. Results　A total of 531 cataract patients were included in the analysis. According to whether they had undergone surgery, they were divided into a surgery group (169 cases) and a non-surgery group (362 cases). In the surgery group, there were 14 patients aged 50 to 60 years, 52 patients aged ≥60 to 70 years, 67 patients aged ≥70 to 80 years, and 36 patients aged ≥80 years, including 67 males and 102 females; the maximum binocular visual acuity was less than or equal to 0.3 in 22 cases and greater than 0.3 in 147 cases. In the non-surgery, there were 42 patients aged 50 to 60 years old, 91 patients aged ≥60 to 70 years old, 132 patients aged ≥70 to 80 years old, and 97 patients aged ≥80 years old, including 138 males and 224 females; the maximum binocular visual acuity was less than or equal to 0.3 in 94 cases and greater than 0.3 in 268 cases. The correct recognition rates of "surgery is the main way to treat senile cataract" [93.49% (158/169) vs. 44.48% (161/362)], "cataract surgery is usually finished within 0.5 h" [94.67% (160/169) vs. 39.23% (142/362)], and "cataract surgery has been covered by China's medical insurance" [91.12% (154/169) vs. 66.57% (241/362)] in the cataract patients who had undergone surgery were significantly higher than those in the cataract patients who did not undergo surgery, and the false recognition rate of "poor eyesight can be corrected by wearing glasses" [4.73% (8/169) vs. 26.24% (95/362)], "surgery should be considered only when the eyes are completely blurred" [8.88% (15/169) vs. 58.31% (193/362)], and "cataract surgery should be carried out only when the cataract is mature"[2.96% (5/169) vs. 29.56% (107/362)] in the cataract patients who had undergone surgery were significantly lower than those in the cataract patients who did not undergo surgery, with statistically significant differences (all P<0.05). The cataract patients who had undergone surgery were able to see clearly their faces after surgery [87.57% (148/169) vs. 77.96% (282/362)], use electronic products [89.94% (152/169) vs. 75.97% (275/362)], and enhance indoor leisure activities [78.11% (132/169) vs. 61.05% (221/362)], the postoperative visual improvement experience was significantly higher than the expectation of the cataract patients who did not undergo surgery, with statistically significant differences (all P<0.05). Conclusions　Cataract patients who have undergone surgery have a better cognition on surgery than those who do not undergo surgery. Cataract patients who have undergone surgery have a higher experience of visual improvement than those who do not undergo surgery expect.

Application of professional health education nurse in the management of tuberculosis patients

Song Tao, Liang Zhiqiang, Liu Yumei, Wu Xiaoying, He Liqian, He Liyan, Deng Hong, Ouyang Caihong

2022, 28(12):  1755-1757.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.029

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Investigation Report

Investigation on new coronavirus vaccine vaccination situation and hesitation and analysis of influencing factors in rural areas of Liuzhou, Guangxi

Li Yinxi, Chen Lu, Lukatie , Li Zhi, Lyu Jiachun

2022, 28(12):  1758-1763.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.030

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Objective　To understand the vaccination rate, hesitation rate, and influencing factors of new coronavirus vaccine among residents in rural areas of Liuzhou, Guangxi, and to provide references for improving the vaccine coverage rate. Methods　From October 10, 2021 to November 10, 2021, a questionnaire survey was conducted on residents in rural areas of Liuzhou, Guangxi by means of Questionnaire Star, analyzing the situation of new coronavirus vaccine vaccination and hesitation among residents in rural areas of Liuzhou, Guangxi. Univariate analysis was conducted on the demographic data and multivariate logistic regression analysis was conducted on related factors affecting vaccine hesitation, factors with odds ratio (OR) >1 and 95% confidence interval (95%CI) >1 were the risk factors for vaccine hesitation. χ² test was used for the count data. Results　A total of 1 033 questionnaires were received. Among the 1 033 respondents, 532 cases (51.5%) were males and 501 cases (48.5%) were females, aged (55.2±18.7) years. Among the 1 033 residents surveyed on vaccination and hesitance in Liuzhou, Guangxi, 1,023 residents (99.0%) had already received new coronavirus vaccine, but 10 residents (1.0%) were still hesitant to get vaccinated. According to the logistic regression analysis, believing that the vaccine is effective against COVID-19 (OR=0.507, 95%CI 0.278-0.924), believing that the personal protection can prevent COVID-19 (OR=1.610, 95%CI 1.012-2.563), believing no need for vaccination because the domestic risk is not high (OR=1.846, 95%CI 1.052-3.241), believing no need for vaccination because the treatment is perfect (OR=2.734, 95%CI 1.594-4.690), believing that vaccines are risky (OR=3.831, 95%CI 2.230-6.581), considering the underlying diseases (OR=4.148, 95%CI 2.554-6.735), worrying about the side effects of vaccine (OR=4.694, 95%CI 2.742-8.034), worrying about fake or expired vaccines (OR=2.191, 95%CI 1.206-3.981), fear of improper operation of vaccination personnel (OR=2.290, 95%CI 1.295-4.051), believing that the vaccine is safe but ineffective (OR=2.742, 95%CI 1.371-5.483), and not knowing where to get vaccinated (OR=1.772, 95%CI 1.118-2.807) were all risk factors for residents' hesitation in new coronavirus vaccine vaccination (all P<0.05). Conclusions　Solving the influencing factors of vaccine hesitation, enhancing people's awareness on vaccines, and increasing the vaccination coverage are the key to achieving herd immunity and the ultimate way to eliminate the epidemic. The epidemic prevention and control is good, and the investigation on the factors affecting vaccine hesitation has a certain reference value for the prevention work in rural areas.

Summary

Progress in improving the success rate of ureteroscopic lithotripsy 

Zhao Wei, Xiao Yunxin, Chen Guangyao

2022, 28(12):  1764-1767.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.031

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Ureteroscopic lithotripsy is an important treatment for upper urinary calculi with the advantages of high safety, high stone clearance rate, and little trauma. Photogenic difficulty and calculus upward movement are two key factors leading to surgical failure. In recent years, with the popularization and development of ureteroscopy, how to improve the success rate of ureteroscopic lithotripsy has been paid attention to and studied by clinical workers. This article reviews the methods to improve the success rate of ureteroscopic lithotomy by referring to relevant literatures.

Research progress of colchicine in cardiovascular diseases 

Dong Wenjing, Sun Jingwu, Zhang Ning, Liu Zhen, Shi Xinye, Liu Jingyang

2022, 28(12):  1767-1771.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.032

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Colchicine is a unique and complex anti-inflammatory agent, which has been used to prevent the acute inflammatory attack of gout for decades. Its potential in a series of cardiovascular diseases has been proved by clinical trials in recent years. Coronary heart disease is a chronic vascular inflammatory disease, the main pathological feature of which is that the accumulation of subintimal lipoprotein leads to abnormal immune response, further results in the formation of lipid rich inflammatory plaque. Inflammatory response is closely related to the occurrence and development of coronary heart disease, of which the infiltration and activity of neutrophils are considered to be an important mechanism of the progression. Colchicine can affect the mitotic process of cells by binding with tubulin dimer, inhibit the leukocyte motility, exocytosis, and phagocytosis triggered by tubulin, interrupt the activation and phagocytosis of NLRP3 inflammasome, prevent the production of leukotrienes and cytokines, and reduce the chemotaxis of inflammatory cells caused by microtubule, especially the chemotaxis, adhesion, and recruitment of neutrophils. The effect of colchicine on platelets is mainly manifested in the inhibition of platelet activation and the interaction between platelets and leukocytes. Anti-inflammatory and anti-platelet aggregation are important mechanisms of colchicine in the treatment of cardiovascular diseases, and anti-inflammatory may be the core mechanism of colchicine. Low-dose, long-duration colchicine intervention regimen may have substantial benefits for patients with cardiovascular diseases. This paper reviews the application of colchicine as an additional therapy in cardiovascular diseases such as pericarditis, coronary heart disease, acute coronary syndrome, in-stent restenosis, atrial fibrillation, and heart failure.

Application progress of optical coherence tomography angiography in maculopathy

Zhang Yishan, Li Ruizhuang, Zhou Zhou

2022, 28(12):  1772-1776.  DOI: 10.3760/cma.j.issn.1007-1245.2022.12.033

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Optical coherence tomography angiography (OCTA) is a new imaging method using motion contrast to detect blood flow signals, and can provide non-invasive and high-resolution images of the retinal vascular structure in different layers. A series of quantitative metrics obtained through image measurement and calculation are of great guiding significances for the pathogenesis, early diagnosis, and treatment evaluation of diseases. At present, OCTA metrics have been applied in the study of age-related macular degeneration, diabetic retinopathy, myopic retinopathy, and other retinal diseases as well as cardiovascular and cerebrovascular diseases. In this review, we discuss the practical application of OCTA-based retinal vascular stratification in the macular area in research and clinic.