Table of Content

01 July 2022, Volume 28 Issue 13

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Special Subject：Ovarian Tumors

MRI combined with tumor markers in diagnosis of ovarian tumors

Shi Wenyan, Zhu Jianye, Guan Dongdong

2022, 28(13):  1778-1783.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.001

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Objective　To explore the value of magnetic resonance imaging (MRI) and serum tumor markers in the diagnosis of ovarian tumors and to better guide the treatment choice. Methods　From January 2019 to December 2020, 60 patients with ovarian malignant tumors who were 18-80 years old, with an average of 56.13 and were treated at Department of Obstetrics and Gynecology, Binzhou Medical University Hospital were selected as a malignant group, and 330 patients with benign tumors who were 16-77 years old, with an average of 43.27 and were treated at Binzhou Medical University Hospital were selected as a benign group. The results of MRI and serum tumor marker detection in both groups were collected. The pathological results were used as the gold standard. SPSS 26.0 software was used as the statistical analysis software. t test was used for the measurement data, and chi-square test for the enumeration data. The application values of MRI, serum tumor markers, and their combined detection in the preoperative diagnosis of ovarian benign and malignant tumors were evaluated, and receiver operating characteristic curve (ROC) was used to analyze the efficacy of each serum tumor marker in predicting ovarian malignant tumors. Results　The malignant tumors in the malignant group were mostly characterized by unclear borders on MRI, and the tumor properties were mostly cystic or solid; the enhanced MRI examinations were mostly markedly enhanced, and the MRI-weighted imaging (DWI) showed obviously high signal. The benign tumors mostly showed clear borders on MRI; most tumors were cystic; most of them were non-enhanced or mildly enhanced on MRI, and most of them showed slightly hyperintensity or isointensity on DWI. The difference between these two groups was statistically significant (P<0.05). The serum levels of carbohydrate antigen-125 (CA125), carbohydrate antigen-199 (CA199), carcinoembryonic antigen (CEA), and human epididymal protein 4 (HE4) were (885.37±159.14) U/ml, (236.69±65.31) U/ml, (27.49±11.75) μg/L, and (364.21±54.08) pmol/L in the malignant group, which were higher than those in the benign group [(150.44±40.45) U/ml, (92.20±19.64) U/ml, (5.68±0.66) μg/L, and (178.73±7.39) pmol/L], with statistical differences (t=4.476, 2.119, 2.423, and 3.398; all P<0.05). The positive detection rates of CA199, CEA, HE4, and their combination were 73.33% (44/60), 33.33% (20/60), 23.33% (14/60), 53.33% (32/60), and 90.00% (54/60) in the malignant group, which were higher than those in the benign group [13.94% (46/330), 17.88% (59/330), 8.18% (27/330), 2.73% (9/330), and 33.03% (109/330)], with statistical differences (χ²=100.891, 7.507, 12.389, 132.105, and 67.734; all P<0.05). The ROC analysis showed that the areas under the curves (AUC) of CA125, CA199, HE4, and CEA in the diagnosis of ovarian malignant tumors were 0.867, 0.525, 0.893, and 0.540, respectively; the sensitivity of MRI in the diagnosis of ovarian tumors was 83.33%, the specificity was 96.97%, and the accuracy was 96.15%; the sensitivity of the four tumor markers combined to diagnose ovarian tumors was 90.00%, the specificity was 66.96%, and the accuracy was 70.51%; the combination of MRI and the four tumor markers had a sensitivity of 95.00% and a specificity of 99.39%, and the accuracy was 98.72%; the differences were statistically significant (all P<0.05). Conclusions　The application value of MRI combined with tumor markers in the diagnosis of ovarian tumors is greater than that of single MRI or serum tumor markers. MRI combined with tumor markers is of great significance in the diagnosis of ovarian tumors and is worthy of clinical application.

Isolation and purification of flavonoid glycosides from Clinacanthus nutans (Burm.f.) Lindau and its antitumor effect on epithelial ovarian cancer

Sui Hongmei, He Fengxi, Li Aihua, Li Aifeng, Wang Li, Lu Huanxi

2022, 28(13):  1784-1789.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.002

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Objective　To provide theoretical references for developing the medicinal value of Clinacanthus nutans (Burm.f.) Lindau by separating and purifying its flavonoid glycosides and studying its antitumor effects on epithelial ovarian cancer. Methods　The research time was from October 2019 to March 2022.The flavonoid glycosides were isolated and purified by macroporous adsorption resins and semi-preparative high performance liquid chromatography, and their structures were identified by nuclear magnetic resonance spectrum. The cell counting kit-8 (CCK 8) method was used to determine the effect of the extract on the activities of the SKOV3, OVCAR3, and A2780 epithelial ovarian cancer cells, and flow cytometry was used to detect the apoptosis. The effects of the extract on the expressions of Beclin-1 and Bcl-2 mRNA in the epithelial ovarian cancer cells were detected by fluorescence quantitative polymerase chain reaction (PCR). Its effect on the expressions of Beclin-1 and Bcl-2 proteins in the epithelial ovarian cancer cells was detected by Western blot. The statistical softwares SPSS 22.0 and GraphPad Prism were used to analyze the experimental results. The one-way ANOVA was used to determine the cell 50% inhibiting concentration (IC₅₀) value. t test was applied. Results　Three flavonoid glycosides were isolated and purified from Clinacanthus nutans (Burm.f.) Lindau, and they were identified as saponarin, schaftoside, and vitexin. The results of the CCK8 experiment showed that vitexin significantly inhibited the proliferation of the epithelial ovarian cancer cells (P < 0.05). The IC₅₀ values (semi-inhibitory concentrations) of the SKOV3, OVCAR3, and A2780 epithelial ovarian cancer cells were 33.777 μg/μl, 34.114 μg/μl, and 31.968 μg/μl. The results of fluorescence quantitative PCR showed that compared with those in the blank group, the relative expression of Beclin-1 mRNA increased and the expression of Bcl-2 mRNA decreased in the SKOV3, A2780, and OVCAR3 epithelial ovarian cancer cell groups after vitexin treatment, with statistical differences (all P<0.01). The results of apoptosis test showed that the inhibitory effect of vitexin on the growth of the SKOV3 epithelial ovarian cancer cells significantly increased with the vitexin concentration (P<0.01). Western bolt showed that after vitexin treatment, the expression of Beclin-1 protein increased significantly (P<0.01), and the expression of Bcl-2 protein decreased significantly (P<0.01). Conclusions　Vitexin shows significant anticancer activity by inhibiting the proliferation and inducing the apoptosis of epithelial ovarian cancer cells. The anticancer activity may be related to regulating the interaction between Bcl-2 and Beclin-1, controlling the autophagy level of tumor cells, and promoting autophagy-dependent cell death.

Apoptosis of epithelial ovarian cancer cells induced by Emperum nrgrum var. Japorcum and its possible mechanism

Zhang Lili, Sui Hongmei, He Fengxi, Liu Dandan, Li Aifeng, Li Aihua

2022, 28(13):  1789-1795.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.003

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Objective　To investigate the effect of the extract of Empetrum nigrum var. Japonicum on the apoptosis of human epithelial ovarian cancer cells and to explore the mechanism. Methods　The fresh tumor tissue of 10 patients with epithelial ovarian cancer who underwent gynecological surgery in Department of Obstetrics, Liaocheng People's Hospital from January 2019 to September 2020 was collected. The expressions of Beclin-1 and Bcl-2 genes in the epithelial ovarian cancer tissue were detected. The ovarian cancer cells, SKOV3, A2780, and OVCAR3, and the normal ovarian cells, IOSE80, were cultured. The cells were co-cultured with different concentrations of the extracts. The cell activity was determined by the cell counting kit-8 (CCK-8) method, the cell apoptosis was detected by the flow cytometry method, and the mRNA and protein expressions of Beclin-1 and Bcl-2 were detected by real-time fluorescent quantitative polymerase chain reaction (PCR) and Western blot. SPSS 22.0 and GraphPad Prism were used for the statistical analysis. The cell 50% inhibiting concentration (IC₅₀) was analyzed by one way ANOVA. GraphPad Prism was used to analyze the graphs. The measurement data were compared between the groups by independent-sample t test. Results　The expressions of Bcl-2 and Beclin-1 were (0.759±0.110) and (0.537±0.150) in the epithelial ovarian cancer tissue, and were (0.294±0.160) and (1.612±0.130) in the normal ovarian tissue, with statistical differences (both P < 0.01). The Ⅱ, Ⅲ, Ⅳ, and Ⅴ extracts of Emperum nrgrum var. Japorcum significantly inhibited the proliferation of the SKOV3, A2780 and OVCAR3 epithelial ovarian cancer cells, and the apoptosis rate was significantly increased (P < 0.01); it was dose-time dependent; the order of inhibition was as below: Ⅴ>Ⅳ>Ⅱ>Ⅲ; extract I had no obvious inhibitory effect on the proliferation of tumor cells (P>0.05); all the extracts from Emperum nrgrum var. Japorcum had no inhibitory effect on the proliferation of the normal ovarian cells IOSE80 (P>0.05). The relative expression levels of Beclin-1 mRNA and protein in the SKOV3, A2780 and OVCAR3 cells treated with extract Ⅱ, Ⅲ, Ⅳ, and Ⅴ of Emperum nrgrum var. Japorcum were increased (P < 0.01), while the relative expression levels of Bcl-2 mRNA and protein were decreased (P < 0.01). The expression of Beclin-1 protein was significantly increased and the expression of Bcl-2 protein was significantly decreased in the epithelial ovarian cancer cell line SKOV3 treated with extract Ⅱ, Ⅲ, Ⅳ, and Ⅴ of Emperum nrgrum var. Japorcum (P<0.01). Conclusion　The extract Ⅱ, Ⅲ, Ⅳ, and Ⅴ of Emperum nrgrum var. Japorcum have significant inhibitory effects on the proliferation of SKOV3, A2780, and OVCAR3 cells, and the apoptosis rates of SKOV3, A2780, and OVCAR3 are significantly increased. After treatment, the relative expression of Beclin-1 mRNA and protein is significantly increased, while the relative expression of Bcl-2 mRNA and protein is significantly decreased, suggesting that the extract of Emperum nrgrum var. Japorcum may induce apoptosis by regulating the expression of autophagy gene.

Scientific Research

Protective effect of miR-132 on PC12 cell injury induced by glutamate and its possible mechanism

Liao Wang, Yang Shaoqing, Liu Chongxu, Luo Haoyu, Hou Tao, Lu Guanchao

2022, 28(13):  1796-1800.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.004

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Objective　To investigate the protective effect of microRNA-132 (miR-132) on PC12 cells and its possible mechanism. Methods　The research time was from September 2021 to March 2022. The PC12 cells in the logarithmic growth phase were treated with glutamate to establish excitatory injury models; the experimental group was transfected with miR-132 mimics by the transient transfection method, cultured for 24 h, and treated with glutamate for 24 h. CCK8 assay was used to detect the survival rate of the PC12 cells in each group; flow cytometry was used to detect reactive oxygen species (ROS) and malondialdehyde (MDA); enzyme-linked immunosorbent assay (ELISA) was used to detect interleukin (IL)-1β and IL-6. LSD-t test and χ² test were applied. Results　The expression level of miR-132 in the PC12 cells treated with glutamate was lower than that of the control group (P<0.01). The viability of the PC12 cells transfected with miR-132 mimics was higher than that after transfection with NC mimics (P<0.05). The level of oxidative stress after transfection of miR-132 mimics was lower than that of the NC mimics group (all P<0.05). miR-132 mimics cells down-regulated inflammatory factors. Conclusion　miR-132 can promote the proliferation of PC12 cells and inhibit the apoptosis of PC12 cells. The mechanism may be to inhibit oxidative stress and down-regulate the expressions of IL-1β and IL-6 related to inflammation.

Application value of autonomous 3D printing technology in neurosurgery

You Huichao, Li Wenqi, Sun Dengjiang, Ouyang Heping

2022, 28(13):  1801-1805.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.005

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Objective　To explore the experiences and effect of self-designed and produced 3D printing equipment by physicians and to provide references for others. Methods　Six patients undergoing cerebral surgery assisted by the autonomous 3D printing technology in The Third People's Hospital of Hubei Province, Jianghan University from February to November 2021 were selected, including 4 males and 2 females, and they were 34-73 years old. In this study, the 3D-Slicer software was used for image reconstruction and template production, the Ultimaker Cura software was used to design the printing process and slice, hot melt stacking curing printer and PLA printing materials were used, and finally the printed templates and models were used to guide the operation. The effect was evaluated. Results　A total of 6 cases were assisted by this technique. The results of localization and orientation were satisfactory in 2 cases of cerebral hemorrhage and 2 cases of tumor. The clipping effect guided by the printed model for one case of internal carotid artery aneurysm was poor, because the model artery connected with the supporting structure below it, but the three-dimensional image obtained in the process of making the model could guide the aneurysm clipping. In the other case of eye artery aneurysm, the model was consistent with the 3D image, and the effect of aneurysm embolization was satisfactory. Conclusions　Autonomous 3D printing technology can meet the needs of surgery, and can be used for guiding puncture, preoperative surgical simulation, and surgical planning. For complex and closely related structures, 3D modeling images obtained by autonomous 3D printing technology can guide the operation together with the printed model.

Research progress of osteoporotic vertebral compression fracture 

Zhao Jiaqing, Zhao Zihao, Yu Xiankai, Geng Xiaopeng

2022, 28(13):  1806-1809.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.006

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Osteoporotic vertebral compression fracture (OVCF) is one of the most common and serious complication in osteoporosis (OP). At present, the clinical diagnosis and treatment of OVCF has been gradually perfected. Non-strict conservative treatment may lead to further compression of the injured vertebrae. Open surgery has great trauma and a high screw loosening or nail pulling rate. Although minimally invasive vertebral augmentation has significant therapeutic effects, complications, such as bone cement leakage, bone cement loosening, re-fracture of injured vertebrae, and fracture of adjacent vertebrae, cannot be completely avoided. Because of this, scholars at home and abroad have different opinions on the choices of treatment methods and related complications. This paper reviews the epidemiology, typing, diagnosis, treatment, and complications of OVCF by reading relevant literatures at home and abroad, so as to provide some help for clinicians in the diagnosis and treatment of OVCF and for the understanding of its complications.

Research progress of colorectal serrated adenocarcinoma of human 

Wang Na, Jia Xingfang, Chu Linlin, Hao Jiahui, Liu Chengxia

2022, 28(13):  1810-1814.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.007

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As a special clinical type of colorectal cancer, serrated adenocarcinoma (SAC) has attracted the interest of many researchers due to its special carcinogenesis pathway, poor detection, and poor treatment response and prognosis. The serrated pathway is characterized by BRAF mutation, microsatellite instability (MSI), and CpG island methylator phenotype (CIMP). Due to the special morphology, endoscopic characteristics, and occurrence site, it is easy to be missed during colonoscopy, and even easily ignored during pathological evaluation. When it is clinically diagnosed, the patients are often in the advanced stage, with poor prognosis and a low survival rate. This article reviews the epidemiology, risk factors, and clinical, pathological and molecular features of serrated colorectal adenocarcinoma.

Apatinib combined with tegafur in treatment of patients with advanced gastric cancer and its influence on prognosis

Qi Youtao, Wang Dongmei, Bai Yuhuan, Kong Lingjia, Jing Changchun, Ji Bei

2022, 28(13):  1815-1819.  DOI: 2022001750

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Objective　To analyze the clinical effect of apatinib combined with tegafur in the treatment of patients with advanced gastric cancer, and to observe the effect of the combination regimen on the levels of inflammatory factors and the cytokines of T helper 1 cells (Th1) and T helper 2 cells (Th2). Methods　Eighty-eight patients with advanced gastric cancer who were admitted to Department of Gastroenterology, Liaocheng Second People's Hospital from March 2019 to February 2020 was selected for the study. They were divided into a control group and an observation group by the random number table method, with 44 cases in each group. There were 24 males and 20 females in the control group; they were (65.25±2.42) years old; they were treated with tegafur. There were 25 males and 19 females in the observation group; they were (65.33±2.35) years old; they were treated with tegafur and apatinib. χ² test was used for the enumeration data, and t test for the measurement data. The clinical efficacies, serum tumor marker levels before and after the treatment, Th1 and Th2 cytokine levels, adverse reactions, and survival were compared between the two groups. Results　The disease control rate (DCR) was 59.09% (26/44) in the control group, and was 79.55% (35/44) the observation group, with a statistical difference (χ²=4.328, P=0.037). The levels of cancer-associated carbohydrate antigen (CA19-9), carcinoembryonic antigen (CEA), and tumor-specific growth factor (TSGF) after the treatment were (9.20±4.23) U/ml, (2.53±0.41) μg/L, and (61.75±14.25) U/ml in the control group, and were (4.98±2.87) U/ml, (1.96±0.39) μg/L, and (53.20±16.37) U/ml in the observation group, with statistical differences between these two groups (t=5.476, 6.682, and 2.613; all P<0.05). After the treatment, the levels of interferon-γ (INF-γ), tumour necrosis factor-α (TNF-α), interleukin (IL)-4, and IL-10 were (9.83±1.68) μg/L, (4.98±0.83) pg/ml, (5.62±1.58) μg/L, and (12.83±2.41) μg/L in the control group, and were (12.45±1.65) μg/L, (6.12±1.47) pg/ml, (3.18±1.17) μg/L, and (8.76±2.11)  μg/L in the observation group, with statistical differences between these two groups (t=7.380, 4.479, 8.232, and 8.428; all P<0.05). The median progression time and survival time were (7.23±1.31) months and (5.10±1.39) months in the control group, and were (5.31±0.75) months and (9.33±2.54) months in the observation group, with statistical differences (t=8.437 and 9.691; both P<0.05). Conclusion　Apatinib combined with tegafur in the treatment of patients with advanced gastric cancer can effectively improve their clinical symptoms and signs, the levels of serum tumor markers, and Th1 and Th2 cytokines, and does not increase the incidence of adverse reactions, and the patients have better survival.

Application effect of Family Assessment Device in pre-examination triage of pregnant women's psychological state during the epidemic 

Ou Youliang, Zhang Jun, Zhou Yanli, Xiao Chaoqun, Wu Yuyu, Du Pingping

2022, 28(13):  1820-1824.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.009

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Objective　To explore the application effect of Family Assessment Device-General Functioning Scale (FAD-GF) in pre-examination triage of pregnant women's psychological state during coronavirus disease 2019 (COVID-19) epidemic. Methods　Six hundred and eighty-three singleton primiparae who underwent prenatal examination in Nanfang Hospital, Southern Medical University from October 2021 to February 2022 were prospectively selected, and they were 20-38 years old and 11-27 weeks pregnant. They were divided into an observation group (343 cases) and a control group (340 cases) by the random number table method. The control group took routine pre-examination triage, and the observation group used FAD-GF for pre-examination triage of the psychological state of the pregnant women. When they were 28-35 weeks pregnant, the effects were evaluated. Frequency, standard deviation, and Spearman correlation analysis were used for the descriptive statistics. Results　There were no statistical differences in the general data between the two groups. When they were 11-27 weeks pregnant, there were no statistical differences in the case numbers who did not need and needed intervention (both P>0.05); 331 cases took routine prenatal examination and 12 required psychological counseling referral in the observation group, and 107 and 33 in the control group, with statistical differences (both P<0.05). When they were 28-35 weeks pregnant, there were no statistical differences in the numbers taking routine prenatal examination and needing psychological counseling referral between these two groups (both P>0.05); 297 cases did not need intervention and 31 needed in the observation group, and 174 and 125 in the control group, with statistical differences (χ²=90.034 and 84.746, both P<0.05). There was a moderate negative correlation between routine pre-examination triage and psychological counseling referral, and the correlation coefficient was -0.435; there was a strong and negative correlation between pre-examination triage of pregnant women's psychological state by FAD-GF and psychological counseling referral, and the correlation coefficient was -0.719. The number of cases with improved psychological state and the total satisfaction in the observation group were higher than those in the control group [173 cases vs. 47 cases and (95.4±11.0) vs. (88.4±5.3)], with statistical difference between these two groups (χ²=104.829, t=10.580, both P<0.05). Conclusion　During the epidemic period, the application of FAD-GF in pre-examination triage of pregnant women's psychological state can improve the effect of triage, so it is worth being clinically generalized.

Clinical effect of Shenghua Sanjia decoction combined with mifepristone in treatment of uterine cavity residual after medical abortion

Shi Juanjuan, Zhang Dan, Zhang Jiuyan, Cui Xiujuan

2022, 28(13):  1825-1829.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.010

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Objective　To investigate the clinical effect of Shenghua Sanjia decoction combined with mifepristone in the treatment of uterine cavity residual after medical abortion. Methods　Eighty patients with uterine residue after medical abortion treated in Tengzhou Central People's Hospital from January 2021 to June 2021 were selected as the study objects. According to whether they were treated by Chinese and western medicine, the patients were divided into a control group and an observation group, with 40 cases in each group. The observation group were (31.03±6.20) years old, and were treated with Shenghua Sanjia decoction and mifepristone. The control group were (31.95±6.79) years old, and were treated with mifepristone. The clinical effects and incidences of adverse reactions in both groups were observed. t test, χ² test, and Fisher's test were used for the comparison. Results　Two cases failed in the drug treatment and took surgery, and 38 cases (95.0%) succeeded in the observation group; 8 failed and 32 (80.0%) succeeded in the control group; there was a statistical difference in the succeeded rate between these two groups (χ²=4.114, P=0.043). One week after the treatment, the size of residual intrauterine mass [(0.89±0.23) cm vs. (1.28±0.37) cm, P<0.001], the disappearance time of vaginal bleeding [(10.16±1.85) days vs. (12.03±1.91) days, P<0.001], the disappearance time of residual intrauterine mass [(11.00±2.68) days vs. (12.63±3.09) days, P=0.021)], the time for blood human chorionic gonadotropin (HCG) being reduced to normal [(10.18±1.69) days vs. (11.19±2.05) days, P=0.028], and the time for menstrual return [(31.08±5.48) days vs. (33.31±3.11) days, P=0.045] in the observation group were better than those in the control group. There was no difference in the incidence of adverse reactions between these two groups (P>0.05). There were no differences in the levels of blood HCG and vascular endothelial growth factor (VEGF) between the two groups before the treatment (both P>0.05); after the treatment, the levels of HCG and VEGF in the observation group were obviously lower than those in the control group [(283.57±253.86) mIU/ml vs. (428.81±256.15) mIU/ml, P=0.020; (83.17±35.31) mg/L vs. (101.71±38.55) mg/L, P=0.040]. Conclusion　Shenghua Sanjia decoction combined with mifepristone in the treatment of uterine cavity residual after medical abortion can accelerate the absorption of mass, decrease blood HCG, reduce vaginal bleeding, and recover menstruation, so the combination of Chinese and western medicine has a significant therapeutic effect.

Single hole laparoscopic radical resection for patients with colorectal cancer

Li Feng, Xuan Jinfeng, Gong Chao, Li jiongxian

2022, 28(13):  1829-1833.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.011

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Objective　To investigate the curative effects of single hole laparoscopic radical resection and traditional laparoscopic radical resection for colorectal cancer. Methods　This was a random control trial. Sixty patients with colorectal cancer treated in Department of Gastrointestinal Surgery, Wuzhou Red Cross Hospital from January 2020 to December 2021 were randomly selected, and were divided into an observation group and a control group by lottery, with 30 cases in each group. There were 19 males and 11 females in the observation group, and they were (59.00±6.00) years old. There were 18 males and 12 females in the control group, and they were (59.00±7.00) years old. The observation group were treated with single hole laparoscopic radical resection of colorectal cancer, and the control group with traditional laparoscopic radical resection of colorectal cancer. The short-term curative effects, operation and postoperative conditions, pain degrees, inflammatory reaction, oxidative stress indicators, and incidences of complications were compared between these two groups. Independent-sample t test and χ² test were applied. Results　The total effective rate of the observation group was significantly higher than that of the control group [96.67% (29/30) vs. 73.33% (22/30)], with a statistical difference (χ²=4.705, P=0.030). Compared with the control group, the observation group had less bleeding, less drainage on the 4th day after the operation, more lymph node dissection, shorter times for postoperative anal exhaust, early activity, and recovery of gastrointestinal function, shorter hospital stay, and lower pain degree, with statistical differences (all P<0.05). Before the operation, there were no statistical differences in the levels of inflammatory response and oxidative stress indicators between the two groups (all P>0.05). After the operation, the levels of C reaction protein, interleukin-6 (IL-6), and superoxide dismutase (SOD) were (13.57±5.34) mg/L, (16.28±5.64) ng/L, and (85.63±11.84) kU/L in the observation group, and were (26.84±5.12) mg/L, (33.54±7.50) ng/L, and (74.25±12.35) kU/L in the control group, with statistical differences between these two groups (all P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group [6.67% (2/30) vs. 30.00% (9/30)], with a statistical difference (χ²=5.454, P=0.019). Conclusion　Compared with traditional laparoscopic radical resection of colorectal cancer, single hole laparoscopic radical resection of colorectal cancer has better curative effect and high safety, and can improve inflammatory reaction and oxidative stress reaction and reduce pain.

Exploration of PBL teaching mode under the guidance of PDCA in clinical practice teaching 

Wu Xinggui, Huang Xianzhang, Chen Cha, Wang Lina, Li Mo, Liu Dan, Xu Ning

2022, 28(13):  1834-1838.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.012

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The National Standards for Undergraduate Professional Teaching Quality in Regular Higher Education Institutions (2018 Edition) issued by the Ministry of Education clearly states that colleges and universities should actively carry out education and teaching method reforms aimed at "student-centered" and "autonomous learning". This article discusses the reform and exploration of the clinical practice teaching process by problem based learning (PBL) teaching mode under the guidance of the plan-do-check-action (PDCA) management method from three aspects: theoretical teaching, practical teaching, and curriculum ideology. It also proposes a teaching evaluation system for comprehensive evaluation of quantitative scores and qualitative assessment results, which covers teaching plans, teaching practice, and teaching feedback, and focuses on self-evaluation in the process of self-learning and growth of students. The PDCA management method requires teachers to scientifically adjust the teaching plan according to students' abilities, which will help to continue the process of teaching reform, make the teaching plan dynamic and personalized, and teach students in accordance with their aptitudes. The PBL teaching mode under the guidance of the PDCA management method provides help for clinical practice teaching with students as the subjects.

Effect of continuous airway humidification and intermittent atomization inhalation on airway humidification in patients with severe craniocerebral injury undergoing tracheotomy

Xie Xiaoyan, Zhang Guimei, Huang Huairui, Liu Zhen

2022, 28(13):  1839-1843.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.013

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Objective　To investigate the effect of continuous airway humidification and intermittent atomization inhalation on airway humidification in patients with severe craniocerebral injury undergoing tracheotomy. Methods　A prospective study was conducted. Seventy-two patients with severe craniocerebral injury who underwent tracheotomy in Nanyang Second People's Hospital from January 2020 to December 2021 were selected, and were divided into a control group and an observation group by the random number table method, with 36 cases in each group. The control group had 23 males and 13 females who were 24-67 (44.32±4.72) years old, and they were treated by the intermittent atomization inhalation method. The observation group had 24 males and 12 females who were 20-65 (43.96±5.25) years old, and they were treated by the continuous airway humidification method. The sputum humidification effects, patient comfort, sleep quality, and incidences of complications were compared between the two groups. t test, χ² test, and rank-sum test were used for the analysis. Results　There were no statistical differences in the general data between the two groups (all P > 0.05). The effect of sputum humidification in the observation group was better than that in the control group, with a statistical difference (Z=2.567, P=0.010). Before the intervention, there were no statistical differences between the two groups in the scores of Koicaba Comfort Scale (GCQ) and Pittsburgh Sleep Quality Index (PSQI) (both P>0.05). After the intervention, the scores of GCQ and PSQI were (78.19±5.48) and (7.93±1.25) in the observation group, and were (70.35±6.63) and (11.27±2.54) in the control group, with statistical differences (t=5.469 and 7.079, both P<0.05). The incidence of complications in the observation group was lower than that in the control group [11.11% (4/36) vs. 33.33% (12/36)], with a statistical difference (χ²=5.143, P<0.05). Conclusions　The application effect of continuous airway humidification in patients with severe craniocerebral injury undergoing tracheotomy is better than that of intermittent atomization inhalation; it is conducive to enhance the humidification effect, improve the patients’ comfort and sleep quality, and reduce the incidence of complications.

Standard large craniectomy combined with partial frontotemporal lobectomy in treatment of patients with bilateral mydriatic cerebral hernia

Chen Qingfeng, Tang Weitai, Mo Haowei, Chen Weixing, Liang Jiepei

2022, 28(13):  1843-1847.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.014

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Objective　To analyze the clinical effect of standard large craniectomy combined with partial frontotemporal lobectomy in the treatment of in patients with bilateral mydriatic cerebral hernia. Methods　From August 2018 to August 2021, 60 patients with bilateral mydriatic cerebral hernia (including patients with severe craniocerebral trauma, cerebral hemorrhage, etc.) admitted to our hospital were selected, and were confirmed by cranial CT and/or MRI. The patients were divided into a control group [20 males and 10 females who were (36.64±5.89) years old] and an observation group [21 males and 9 females who were (36.85±5.79) years old] by the random number table method, with 30 cases in each group. The control group were treated by standard large craniectomy, and the observation group by standard large craniectomy and partial frontotemporal lobectomy. The clinical effects were compared between these two groups. t test and χ² test were applied. Results　There was no statistical difference in the score of Glasgow Coma Scale (GCS) between these two groups before the treatment (t=0.372 5, P>0.05). Seven, fourteen, and twenty-eight days after the treatment, the scores of GCS in the observation group were higher than those in the control group (t=3.925 1, 5.823 4, and 7.601 7; all P<0.05). There was no statistical difference in the score of Barthel Index between these two groups before the treatment (t=0.571 8, P>0.05). Seven, fourteen, and twenty-eight days after the treatment, the scores of Barthel Index in the observation group were higher than those in the control group (t=5.824 6, 13.716 9, and 15.082 6; all P<0.05). There was no statistical difference in the neurological deficit score between the two groups before the treatment (t=0.528 1, P>0.05). Twenty-eight days after the treatment, the neurological deficit score in the observation group was lower than that in the control group (t=14.309 5, P<0.05). The total effective rate of the observation group was 93.33% (28/30), which was significantly higher than that of the control group [73.33% (22/30)] (χ²=4.320 0, P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group [6.67% (2/30) vs. 33.33% (10/30), χ²=6.666 7, P<0.05]. The survival rate in the observation group was significantly higher than that in the control group [23.33% (7/30) vs. 6.67% (2/30), χ²=3.268 0, P<0.05]. Conclusion　Standard large craniectomy combined with partial frontotemporal lobectomy in the treatment of patients with bilateral mydriatic cerebral hernia can significantly improve the clinical efficacy, the survival rate, and their GCS score and Barthel index score, and effectively reduce their neurological deficit score and the Incidence of adverse reactions, so it is worth being generalized in primary hospitals.

Key gene screening and regulation network construction in cisplatin-induced acute kidney injury

Yang Lingyun, Xu Jinwen, Liu Xunwei, Cheng Yun, Zhou Hongxia, Zhao Liping

2022, 28(13):  1848-1853.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.015

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Objective　To identify key signaling pathways and genes in cisplatin-induced acute kidney injury (CI-AKI) by bioinformatics, and to provide potential targets in treatment of AKI. Methods　The data were collected from the establishment to March 1,2021. The datasets of GSE106993 and GSE153625 were downloaded from Gene Expression Omnibus (GEO), and the differentially expressed genes (DEGs) were identified by R language. The gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to identify the main functions of the common differential genes. The STRING database was used to construct protein-protein interaction (PPI) networks, and the key genes were selected by Cytoscape. TransmiR v2.0 database and miRWalk2.0 database were used to construct transcription factor (TF)/microRNA (miRNA)/mRNA networks. Chinese herbal medicines targeting the key genes were screened by the ETMC database. Results　Eight hundred and seventeen up-regulated genes and 769 down-regulated genes were obtained from the CI-AKI models. Tumor necrosis factor (TNF) signaling pathway, P53 signaling pathway, and metabolic signaling pathway were important pathways in CI-AKI. Eight key genes, Trp53, EGF, Stat3, Jun, Casp3, Cdh1, Ptgs2, and CAT, were identified through PPI. We constructed TF/miRNA/mRNA regulatory networks, including 2 TFs, 4 miRNAs, and 214 mRNAs. The results of ETMC database analysis showed that Sangye and Banxia could be used in the treatment of CI-AKI. Conclusions　In this study, we identified 8 key genes and 3 important signaling pathways in the CI-AKI models by bioinformatics analysis, providing targets for the treatment of CI-AKI. And the two Chinese herbal medicines obtained from our research, Sangye and Banxia, are expected to be used in the treatment of CI-AKI.

Application of different endometrial preparation protocols in first FET in patients with high-risk of OHSS

Su Ning, Xia Wei, Wang Wei, He Yan

2022, 28(13):  1854-1858.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.016

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Objective　To investigate the effects of different endometrial preparation protocols on the outcomes of first frozen-thawed embryo transfer (FET) in patients with high risk of ovarian hyperstimulation syndrome (OHSS) after whole embryo freezing. Methods　A total of 226 patients who underwent in vitro fertilization-embryo transfer (IVF-ET) and whole embryo freezing due to high risk of OHSS in Guangzhou First People's Hospital from January 2019 to October 2020 were selected. According to different endometrial preparation protocols, the patients were divided into a natural cycle (NC) group [74 cases who were (30.65±4.80) years old], a hormone replacement cycle (HRT) group [108 cases who were (29.79±4.41) years old], and a down-regulated hormone replacement cycle (GnRHa+HRT) group [44 cases who were (30.03±4.56) years old]. The ages, years of infertility, body mass indexes (BMI), basal sex hormones, anti-Müllerian hormone (AMH), average numbers of embryos transferred, embryo implantation rates, clinical pregnancy rates, ectopic pregnancy rates, early miscarriage rates, and multiple pregnancy rates were compared between these three groups. Analysis of variance and χ² test were used for the statistical analysis. The difference was considered statistically significant when P < 0.05. Results　There were no statistical differences in age, years of infertility, BMI, basal sex hormones, AMH, average number of transferred embryos, and embryo implantation rate between the three groups (all P>0.05). The endometrial thickness on the day of transplantation in the HRT group [(9.80±1.61) mm] was significantly lower than those in the NC group [(11.07±1.71) mm] and the GnRHa+HRT group [(10.23±1.66) mm], with a statistical difference (F=7.509,P=0.001); there was no statistical difference between the NC group and the GnRHa+HRT group (P>0.05). The proportion of blastocysts in the HRT group was significantly higher than that in the NC group [47.22% (51/108) vs. 32.43% (24/74)], with a statistical difference (P<0.05); there was no statistical difference between the NC group and the GnRHa+HRT group (P>0.05). There were no significant differences in the clinical pregnancy rate, ectopic pregnancy rate, early miscarriage rate, and multiple pregnancy rate between the three groups (all P>0.05). Conclusions　There is no significant difference in the clinical pregnancy effect between the three endometrial preparation protocols for the first frozen-thawed embryo transfer in patients with high risk of OHSS after whole embryo freezing. It is recommended that doctors choose an individualized protocol according to the actual situation of infertile patients to obtain ideal pregnancy outcomes.

Temporal association between resistance of Enterobacteriaceae and antibiotic consumption at a hospital

Pang Jie, Wu Xiaowen, Jin Danting, Gao Shan

2022, 28(13):  1859-1863.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.017

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Objective　To explore the temporal association between resistance of Enterobacteriaceae and antibiotics consumption and to provide references for optimizing clinical antibiotics selection. Methods　By means of retrospective survey, we collected the antibiotic consumptions and the resistance rates of Klebsiella pnenmoniae and Escherichia coli against piperacillin/tazobactam, meropenem, and imipenem at Lianyungang First People's Hospital from January 2016 to December 2021. Linear regression analysis was used to evaluate the trends of quarterly consumptions of antibiotic prescriptions and antimicrobial resistance during the study period. Cross-correlation function analyses were used to determine the temporal correlation between the quarterly isolation proportion of antibiotic consumption and resistance rate in each quarter. Results　During the 6 years, the resistance rates of Klebsiella pnenmoniae against piperacillin-tazobactam (P<0.001) and meropenem (P=0.001) increased over the 6 years period, while the resistance rate of Escherichia coli against piperacillin/tazobactam gradually decreased (P<0.001). The consumption of carbapenems showed an increasing trend (P=0.008), while the consumption of β-lactam antibiotics was decreasing (P=0.032). The resistance rate of Klebsiella pnenmoniae against piperacillin/tazobactam increased with carbapenem consumption (r=0.812, Lag=0, P=0.022), and the resistance rates of Klebsiella pnenmoniae against meropenem (r=0.704, Lag=1, P=0.037) and imipenem (r=0.885, Lag=1, P=0.005) positively correlated with carbapenem consumption. The consumption of β-lactam antibiotics positively correlated with the resistance rates of Escherichia coli (r=0.587, Lag=3, P=0.045) and Klebsiella pnenmoniae (r=0.531, Lag=2, P=0.039) against piperacillin/tazobactam. Conclusions　There is certain temporal correlation between antibiotic usage and resistance in Enterobacteriaceae. And it is necessary for the hospital to optimize the selection of antibiotics so as to curb the progress of resistance of Enterobacteriaceae.

Treatises

Screening of lncRNA related to prognosis of colon cancer based on TCGA database and establishment of prognostic risk model 

He Tian, Cao Tiansheng

2022, 28(13):  1864-1871.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.018

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Objective　To screen long non-coded RNA (lncRNA) associated with the prognosis of colon cancer, and to build a prognostic risk model of colon cancer. Methods　The data were collected from the establishment to March 1,2022. The transcriptome data of colon cancer were downloaded and sorted from The Cancer Genome Atlas (TCGA), then we constructed an expression matrix of lncRNA about paired samples. Differentially expressed lncRNAs (DElncRNAs) were obtained by R-packet "edgeR". For DElncRNAs, univariate COX regression analysis, Lasso regression analysis, Kaplan-Meier (K-M) survival analysis, and multivariate COX regression analysis were performed to obtain the prognostic associated lncRNAs. The prognostic risk model of colon cancer was established based on the coefficient of multivariate COX regression model. Then we evaluated the accuracy through C-index value, time-dependent receiver operating characteristic curve (ROC), area under ROC (AUC) value, and K-M survival analysis. CeRNA network was constructed for the lncRNAs in our model. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed for related mRNAs to explore the mechanism of lncRNA affecting the progression of colon cancer. Results　Five thousand four hundred and sixty lncRNAs were screened by arranging the transcriptome data. Eight hundred and sixty-eight DElncRNAs were obtained by paired-sample analysis, including 548 up-regulated genes and 320 down-regulated genes. After univariate COX regression analysis, 40 lncRNAs were obtained. Through lasso regression analysis, we got 34 lncRNAs. Fourteen lncRNAs remained after K-M survival analysis. Multivariate COX regression analysis revealed 7 prognostic related lncRNAs (down-regulated genes: LINC01132; up-regulated genes: ELFN1-AS1, RP5-884M6.1, LINC00461, RP1-79C4.4, RP4-816N1.7, and RP3-380B8.4). The prognostic assessment model was constructed according to the regression coefficient. The C-index value of the model was 0.82; the AUC values at 3 and 5 years were 0.79 and 0.84; K-M survival analysis showed a statistical difference in the survival rate between the high and low risk groups (P<0.000 1). Next, we constructed the ceRNA network, and the KEGG enrichment analysis suggested that the down-regulation lncRNA inhibited the progression of colon cancer possibly through the pathways of regulation of actin cytoskeleton, proteoglycans in cancer, and PI3K-Akt signaling pathway; up-regulation lncRNAs promoted colon cancer possibly through the pathways of cellular adhesion molecules, focal adhesions, and phagosomes. Conclusions　In our study, we constructed a prognostic risk model of colon cancer with 7 lncRNAs. It has a nice accuracy in predicting the patients' survival prognosis. Each lncRNA is a potential independently prognostic biomarker. The prognostic risk model has certain value for clinical prognostic assessment of colon cancer patients.

Clinical Research

Salmonella infection and its drug resistance at a hospital in Xiamen from 2019 to 2021

Wu Wenhui, Chen Yongquan, Wu Jianning

2022, 28(13):  1872-1875.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.019

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Objective　To analyze the epidemiological characteristics and drug resistance of Salmonella infection at a hospital in Xiamen. Methods　Bacterial culture, identification, and drug susceptibility tests were performed on the stool samples of the 761 patients with suspected foodborne pathogen infection who visited Xiamen Humanity Hospital, Fujian Medical University from January 2019 to December 2021. There were 447 males and 314 females, and they were 0-95 years old.The patients were grouped according to gender, age, and sampling time. The detection results and drug resistance characteristics of Salmonella were cross-sectionally studied and analyzed. The χ² test was applied. Results　According to VITEK-MS mass spectrometry analysis and serum agglutination test, a total of 69 cases of Salmonella infection were found in the 761 patients, with a total detection rate of 9.07% (69/761). The 69 strains of Salmonella were distributed in 6 serogroups and 16 serotypes, mainly group B and group D. Salmonella typhimurium and Salmonella enteritidis accounted for 42.03% (29/69) and 23.19% (16 /69), the highest. According to chi-square test, there was no statistical difference in the infection rate of Salmonella between the patients of different genders (χ²=0.142, P=0.706), and was between the patients of different age groups (χ²=65.005, P<0.001); the infection rate of the 0-18 years old group was significantly higher than that of the adults. There were certain differences in the infection rate of Salmonella between different months, showing a certain change trend with the month, and the infection rate was higher from May to October. The drug sensitivity results showed that the Salmonella had the highest resistance rates to ampicillin and ampicillin/sulbactam, 74.55% (41/55) and 61.82% (34/55); the resistance rate to compound sulfamethoxazole was 38.18% (21/55); it was not resistant to imipenem. Conclusions　The serotypes of Salmonella infection in Xiamen City are complex, mainly Salmonella typhimurium and Salmonella enteritidis. Juvenile infection accounts for the main part, with obvious seasonal and regional characteristics, and summer and autumn are the high incidence seasons. Salmonella in this area have high resistance rates to ampicillin and ampicillin/sulbactam.

Clinical effect of modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in treatment of recurrent vulvovaginal candidiasis

Liu Zhihui, Yan Caixia, Chen Yuanhong

2022, 28(13):  1876-1879.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.020

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Objective　To investigate the clinical effect of modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in the treatment of recurrent vulvovaginal candidiasis. Methods　Forty patients with recurrent vulvovaginal candidiasis treated at Department of Gynecology, East Dongguan Central Hospital from January 2019 to March 2020 were selected as the study objects, and were randomly divided into an observation group and a control group by the random number table method, with 20 cases in each group. The observation group were (36.82±7.56) years old, and the control group (36.76±7.59). The control group were treated with fluconazole capsules and miconazole nitrate suppository. The observation group were treated with modified Guishao Simiao decoction and externally washed by traditional Chinese medicine. Both groups were treated for 4 weeks. The clinical efficacies, times for the disappearance of related symptoms, and recurrence were compared between the two groups. The independent-sample t and χ² tests were applied. Results　The total effective rate in the observation group was higher than that in the control group [95.00% (19/20) vs. 70.00% (14/20), P<0.05]. The times for the disappearance of pruritus vulvae, mucosal redness, abnormal leucorrhea, and frequent urination and odynuria in the observation group were shorter than those in the control group [(2.31±0.46) d vs. (2.87±0.54) d, (2.79±0.56) d vs. (3.25±0.62) d, (1.38±0.35) d vs. (2.10±0.43) d,  and (2.57±0.43) d vs. (3.16±0.58) d; all P<0.05]. The recurrence rates after 6 and 12 months' follow up in the observation group were lower than those in the control group [10.00% (2/20) vs. 40.00% (8/20) and 15.00% (3/20) vs. 50.00% (10/20); both P<0.05]. Conclusions　Modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in the treatment of recurrent vulvovaginal candidiasis is beneficial to improve related clinical symptoms, and has remarkable clinical effect and a lower recurrence rate, so it is worth being generalized.

Effect of Xipayi Mouth Rinse Fluid combined with minocycline on levels of inflammatory factors and periodontal clinical indicators in patients with periodontitis

Wu Fuyan, Guo Hongyan

2022, 28(13):  1880-1884.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.021

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Objective　To explore the effect of Xipayi Mouth Rinse Fluid combined with minocycline on inflammatory factors in gingival crevicular fluid and periodontal clinical indicators in patients with periodontitis. Methods　Ninety-eight patients with periodontitis treated in Liaocheng No.4 People's Hospital from February 2019 to February 2022 were selected as the research objects, and they were divided into a control group and an observation group by the random number table method, with 49 cases in each group. The control group had 25 males and 24 females who were (43.73±3.58) years old, and were treated with minocycline. The observation group had 27 males and 22 females who were (44.43±4.76) years old, and were treated with Xipayi Mouth Rinse Fluid and minocycline. The clinical curative effects after the treatment, changes of inflammatory factors in gingival crevicular fluid, periodontal indicators before and after one course of treatment, and clinical safety were compared between the two groups. The independent-sample t test, paired t test, and χ² test were applied. Results　After the treatment, the total effective rate in the observation group was 95.92% (47/49), which was higher than that in the control group [79.59% (39/49)], with a statistical difference (χ²=6.078, P=0.014). After the treatment, the levels of interleukin -6(IL-6), monocyte chemoattractant protein (MCP-1), prostaglandin (PGE2), and visfatin (VF) in gingival crevicular fluid were (3.59±0.62) ng/L, (81.39±8.19) ng/L, (48.81±6.53) ng/L, and (31.41±7.56) μg/L in the observation group, and were (4.34±0.69) ng/L, (91.05±10.12) ng/L, (56.47±9.04) ng/L, and (40.58±6.53) μg/L in the control group, with statistical differences between the two groups (all P < 0.01). The periodontal probing depth (PD), attachment loss (AL), plaque index (PLI), and gingival sulcus bleeding index (SBI) were (3.02±0.56) mm, (2.08±0.49) mm, (1.12±0.33) points, and (1.18±0.39) points in the observation group, and were (3.69±0.87) mm, (2.69±0.72) mm, (1.82±0.44) points, and (2.08±0.45) points in the control group, with statistical differences between the two groups (all P < 0.01). The incidence of clinical adverse reactions was 4.08% (2/49) in the observation group, and was 10.20% (5/49) in the control group, with no statistical difference (χ²=1.427,P=0.232). Conclusion　Xipayi Mouth Rinse Fluid combined with minocycline can effectively relieve inflammation in periodontitis patients and improve their periodontal clinical indicators, and has good clinical effect.

Case Report

A case of bronchiectasis with Nocardia asiatica infection and literature review

Duan Lingling, Zou Shihai, Wang Dexi, Zhang Min

2022, 28(13):  1885-1888.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.022

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Norcardiosis is a limited or disseminated purulent or granulomatous disease caused by Nocardia infection, which mainly involves the lungs, skin, and central nervous system (CNS), and the lungs are the most commonly involved. It is common in immunosuppressed hosts, but can also occur in immunocompetent hosts. Immunosuppressed hosts are more prone to disseminated the disease and have worse prognosis. As a rare disease with a low clinical incidence, norcardiosis is even less prevalent in immunocompetent hosts. Recently, an immunocompetent patient with bronchiectasis and pulmonary Nocardia asiatica infection was admitted to Department of Respiratory Medicine, Guangzhou Red Cross Hospital, Jinan University, and is reported below with the review of literature.

Report of 1 case of pregnancy with TTP and literature review 

Feng Shixiang, Wang Yun, Dongxiaoli

2022, 28(13):  1888-1892.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.023

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Objective　To investigate the perinatal management of thrombotic thrombocytopenic purpura (TTP) during pregnancy. Methods　One pregnant woman complicated with TTP was successfully treated in Suqian First People's Hospital, Nanjing Medical University, and 16 cases of pregnancy complicated with TTP were reported. The clinical characteristics, laboratory examination, treatment points, and maternal and infant outcomes were retrospectively analyzed. Results　The mean age of the 16 pregnant patients was 26.18 (20-36), and the gestational age was (29±2) weeks (17⁺⁵～41⁺¹ weeks). Fifteen gestation patients with TTP had typical pentad or triad of thrombocytopenia, fever, nervous system symptoms, renal impairment, and microangiopathic hemolytic anemia. The treatment was mainly plasma exchange or infusion. There were four maternal deaths, and one of them was diagnosed postmortem. Case 15 and 16 were two pregnancies of the same woman; case 15 was diagnosed as the previous pregnancy; case 16 was the second pregnancy; the conditions of perinatal preventive plasma infusion were stable; the pregnancy was terminated by cesarean section at 37⁺² weeks of gestation, with good maternal and infant outcomes. There were nine cases of late pregnancy, including eight cases taking cesarean section, one case (stillbirth) taking forceps assisted delivery, and no natural birth; seven cases had alive neonates. There were seven cases of second trimester, including four cases taking hysterectomy, one case of spontaneous abortion, two case taking rivanol induced labor; no neonates survived. Conclusions　Pregnancy complicated with TTP is rare; early diagnosis and plasma exchange or plasma infusion can effectively improve the patients' prognosis. For pregnant patients with inherited TTP, fresh plasma infusion is also an effective method to prevent the onset.

Nursing Research

Application of rapid rehabilitation nursing based on ACE-STAR evidence-based mode in patients undergoing soft ureteroscopic holmium laser lithotripsy

Li Lei, Wang Zhihua

2022, 28(13):  1893-1896.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.024

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Objective　To explore the effect applying rapid rehabilitation nursing based on ACE-STAR evidence-based mode in patients undergoing soft ureteroscopic holmium laser lithotripsy. Methods　A total of 94 patients undergoing soft ureteroscopic holmium laser lithotripsy at Guangzhou Eighth People's Hospital, Guangzhou Medical University from March 2018 to March 2022 were selected, and were divided into a study group and a control group by the random number table method, with 47 cases in each group. There were 24 males and 23 females in the study group, and they were (40.05±12.21) years old. There were 26 males and 21 females in the control group, and they were (39.67±11.78) years old. The control group took routine nursing; in addition, the study group took rapid rehabilitation nursing based on ACE-STAR evidence-based mode. The postoperative recovery, incidences of complications, postoperative pain degrees, and satisfaction with nursing of the two groups were analyzed. The independent-sample t test and χ² test were applied. Results　The times to first defecation, exhaust, and ambulation and hospital stay were (14.79±5.35) h, (7.28±2.84) h, (3.11±1.05) h, (7.53±1.71) d in the study group, and were (25.28±7.75) h, (12.68±4.04) h, and (5.15±1.29) h, and (9.28±1.59) d in the control group, with statistical differences between these two groups (all P<0.05). The incidence of complications in the study group was lower than that in the control group [4.26% (2/47) vs. 17.02% (8/47)], with a statistical difference between these two groups (χ²=4.029, P=0.045). The scores of Visual Analogue Scale 6, 12, 24, and 48 h after the operation in the study group were lower than those in the control group (all P < 0.05). The satisfaction with nursing in the study group was higher than that in the control group [93.62% (44/47) vs. 78.72% (37/47)], with a statistical difference between these two groups (χ²=4.374, P=0.036). Conclusion　Rapid rehabilitation nursing based on ACE-STAR evidence-based mode for patients undergoing soft ureteroscopic holmium laser lithotripsy can reduce their postoperative pain and the incidence of complications, and shorten the postoperative rehabilitation process, with high patient satisfaction.

Evidence-based pain management for pediatric outpatients taking intramuscular injection of benzathine penicillin

Mei Jingjing, Chen Ling, Ning Jingyan, Wang Xiaoqin

2022, 28(13):  1897-1903.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.025

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Objective　To reduce the pain of pediatric outpatients taking intramuscular injection of benzathine penicillin. Methods　An evidence-based approach was used to find the best evidences to alleviate pain caused by the intramuscular injection of benzathine penicillin. Three hundred and sixty pediatric outpatients infected by group A streptococcus and treated in Guangdong Women and Children Hospital from October 2019 to June 2020 were selected, and they were 5-15 years old. They were divided into a baseline group (120 cases), including 69 boys and 51 girls, a round 1 evidence group (120 cases), including 70 boys and 50 girls, and a round 2 evidence group (120 cases), including 66 boys and 54 girls, by the random number table method. The general data and the implementation of the best evidences by the nurses and the pain scores and incidences of sclerosis before and after the evidence application were compared. The one way ANOVA, chi square test, and nonparametric test were applied. Results　A total of 10 evidences were extracted from the 10 finally included literatures, and 9 clinical review indicators were established. The children's pain score decreased from 8.42 before the evidence application to 4.26 after, the pain score 30 minutes after injection from 4.53 to 2.18, and the incidence of sclerosis at the injection site from 75.8% (91/120) to 32.5% (39/120), with statistical differences (all P<0.001). Conclusions　A series of drug and non-drug measures can reduce the procedural pain in children; the Buzzy little bee device (cold + vibration + distraction) reduces the pain of intramuscular penicillin injection; the correct configuration, injection technique, injection site, and injection speed of benzathine penicillin can alleviate the pain caused by intramuscular injection of benzathine penicillin.

Effect of comprehensive nursing intervention on recurrent infection of patients with congenital preauricular fistula

Lu Huanxiang, Xian Zhifeng, Xiao Gaihuan

2022, 28(13):  1903-1907.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.026

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Objective　To analyze the effect of comprehensive nursing intervention on recurrent infection of patients with congenital preauricular fistula (CPF). Methods　From March 2018 to March 2020, 86 patients with recurrent CPF symptoms who were admitted to Department of Otolaryngology, Dongguan Eighth People's Hospital were selected, and 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 17 males and 26 females who were (28.08±5.81) years old, and were given routine drug treatment and nursing measures. The observation group had 16 males and 27 females who were (28.84±5.73) years old, and were given comprehensive nursing intervention on the basis of the control group. The clinical nursing effects, scores of quality of life (QOL), and satisfaction with nursing were compared between these two groups. The independent-sample rank-sum, χ² , and t tests were applied. Results　The total effective rate of the observation group was significantly higher than that of the control group [95.35% (41/43) vs. 74.42% (32/43)], with a statistical difference (χ²=7.340 4, P=0.001 2). After the intervention, the scores of QOL in both groups were higher than those before the intervention, with statistical differences (both P<0.05); the score in the observation group was higher than that in the control group [(8.71±1.39) vs. (7.53±1.34)], with a statistical difference (t=4.791 3, P=0.004 3). The wound healing time of the observation group was significantly lower than that of the control group [(6.13±1.28) d vs. (11.57±1.64) d], with a statistical difference (t= 5.857 4, P=0.001 6). The acceptance rate of surgery in the observation group was significantly higher than that in the control group [86.05% (37/43) vs. 62.79% (27/43)], with a statistical difference (χ²=6.108 0, P=0.001 0). The satisfaction with nursing of the observation group was significantly higher than that of the control group [97.67% (42/43) vs. 74.42% (32/43)], with a statistical difference (χ²=9.684 7,P=0.001 7). Conclusion　Comprehensive nursing intervention for patients with recurrent infection of CPF can significantly improve the clinical efficacy, QOL, patients' acceptance rate of surgery, and satisfaction with nursing, and significantly reduce wound healing time, so it is worth being clinically generalized.

Summary

Quality of bowel preparation before colonoscopy

Wang Mengyu, Xu Ning

2022, 28(13):  1908-1911.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.027

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Colonoscopy is an important means for screening, diagnosis, and treatment of colon diseases, and the quality of bowel preparation is directly related to the implementation effect of colonoscopy and the willingness of patients to retest. Adequate bowel preparation can not only shorten the operation time and reduce patients' discomfort, but also improve the detection rate and curative effect of colon diseases. Therefore, it is very important to improve the quality of bowel preparation before colonoscopy. This paper introduces the main factors affecting the quality of intestinal preparation and the current common methods, and conduct a review on how to improve the quality of intestinal preparation.

Dapagliflozin in treatment of early diabetic retinopathy

Wang Yue, Jin Yongjun

2022, 28(13):  1912-1915.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.028

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Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes. It is the main cause of acquired vision loss in adults all over the world. Because the initial symptoms are not obvious and patients do not have enough recognition of the disease, it leads to the deterioration of the disease and blindness. Therefore, the research and development of hypoglycemic drugs to delay diabetic retinal complications get attention from the majority of scholars. Numerous studies have found that sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) can lower blood glucose and delay the progress of diabetic retinal complications. This article reviews the early pathological changes of DR and the clinical and experimental evidences of the protective effect of SGLT-2i on DR.

Mechanism of action of microRNA-137 in gliomas

Wang Ningning, Zhu Shuxia

2022, 28(13):  1916-1919.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.029

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MicroRNA-137 (miR-137) is abnormally expressed in many tumors, especially in gliomas. By targeting the regulation of CDK6, Rac1, MRGBP, Notch1, and other genes, as well as the signaling pathways mediated by PTP4A3 and FOXK1 genes, it participates in the proliferation, metabolism, cycle regulation, and invasion of glioma cells and patient prognosis. This paper focuses on several specific mechanisms of action of miR-137 in gliomas, so as to understand the potential functions of miR-137 and provide new ideas for the diagnosis and treatment of gliomas.

Application and research progress of esketamine in cesarean section 

Yang Shijie, Liu Shujie, Cao Rui, Yan Yurong

2022, 28(13):  1919-1922.  DOI: 10.3760/cma.j.issn.1007-1245.2022.13.030

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Esketamine, an isomer of ketamine, has similar pharmacological characteristics to racemic ketamine, and is currently widely used in clinical practice. Compared with racemic ketamine, it has stronger analgesic and sedative effects at the same dose, and has the advantages of stronger controllability, fewer adverse reactions, no added preservatives, and safer intravenous and intraspinal administration.