Table of Content

15 August 2022, Volume 28 Issue 16

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Scientific Research

Current status and influencing factors of dynamic intestinal obstruction after laparoscopic surgery in patients with colorectal cancer

Wang Chao, Yuan Zixu, Zhang Jiye, Cai Jian, Lei Binhua

2022, 28(16):  2221-2224.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.001

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Objective　To analyze the current status and influencing factors of dynamic intestinal obstruction after laparoscopic surgery in patients with colorectal cancer, in order to provide guidances for clinical prevention of dynamic intestinal obstruction. Methods　The clinical data of 86 patients with colorectal cancer who underwent laparoscopic surgery in Sanmenxia Central Hospital from January 2018 to January 2020 were retrospectively analyzed. There were 34 females and 52 males, aged (56.82±4.38) years. A baseline data research table was designed, and the patients' clinical data was read. The tumor location, TNM stage, abdominal infection, radiotherapy, and other information and the occurrence of dynamic intestinal obstruction in the patients were counted. Logistic regression analysis was used to analyze the influencing factors of dynamic intestinal obstruction after laparoscopic surgery in patients with colorectal cancer. The count data were tested by χ² test. Results　Of the 86 patients with colorectal cancer after laparoscopic surgery, dynamic intestinal obstruction occurred in 6 cases, with an incidence of 6.98%. Univariate and multivariate analysis showed that tumor located in the rectum [17.86% (5/28)], preoperative intestinal obstruction [21.05% (4/19)], TNM stage Ⅲ [15.63% (5/32)], postoperative abdominal infection [26.67% (4/15)], and postoperative radiotherapy [19.05% (4/21)] were all risk factors for dynamic intestinal obstruction in patients with colorectal cancer undergoing laparoscopic surgery (OR=12.391, 8.667, 9.815, 12.545, and 7.412; all P<0.05). Conclusions　Tumor located in the rectum, preoperative intestinal obstruction, TNM stage Ⅲ, postoperative abdominal infection, and postoperative radiotherapy are all risk factors for postoperative dynamic intestinal obstruction in patients with colorectal cancer undergoing laparoscopic surgery; clinical interventions can be taken accordingly to reduce the incidence of dynamic intestinal obstruction.

Radiological imaging analysis of 1 case of primary sacral aneurysmal bone cyst

Mao Xiaofen, Yang Bo, Liu Huiyi, Zhou Yuanmin

2022, 28(16):  2224-2229.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.002

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Experimental study of trans-differentiation of peripheral blood mononuclear cells into corneal epithelial cells 

Wang Ping, Liang Liying, Xia Chan, Zhang Chi

2022, 28(16):  2230-2235.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.003

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Objective　To evaluate the feasibility of using peripheral blood mononuclear cells (PBMCs) as an alternative cell source to corneal limbal stem cells envisaging corneal epithelial regeneration. Methods　The experiment was conducted from January 2020 to January 2021, and 30 healthy New Zealand white rabbits aged from 5 to 8 months were selected from the physiological laboratory of Jinan University. Culture and identification of PBMCs in vitro: the rabbit PBMCs were isolated by density gradient centrifugation, the morphology of PBMCs was observed under inverted phase contrast microscope, and the CD14, a surface marker of monocytes, was detected by flow cytometry. PBMCs were cultured in the microenvironment of fresh limbal stem cells and corneal epithelial cells for one week. The positive rate of cytokeratin, a specific marker on cell surface, was detected by flow cytometry before and after induction. Analysis of variance was used to compare the positive expression rate index of cell surface keratin before and after induction. t test was used for the measurement data. Results　The positive rate of cytokeratin of PBMCs was 1.64% before induction by flow cytometry; the positive rate of cytokeratin of PBMCs was 11.30% after induction by flow cytometry. Before induction, there was no statistically significant difference in the positive expression rate of cytokeratin between the experimental group and the control group (P>0.05); after 7 days of induction, the positive expression rate of cytokeratin in the experimental group was (10.298±0.996)%, which was significantly higher than that in the control group [(1.786±0.237)%] (P<0.05). The positive expression rate of cytokeratin in the experimental group was (1.308±0.376)% before induction and (10.298±0.996)% after 7 days of induction, with a statistically significant difference (P<0.05). There was no statistically significant difference in the positive expression rate of cytokeratin in the control group before induction and after 7 days of induction (P>0.05). Conclusion　PBMCs as an alternative autologous cell source for limbal stem cells is envisaged as an effective therapeutic strategy for corneal surface reconstruction.

Application value of composite echocardiography technique in detecting cardiotoxicity caused by lymphoma chemotherapy

Xue Jing, Zhang Zhoulong, Chen Shengjiang, Yuan Xiaozhi, Duan Like, Wang Huifen

2022, 28(16):  2236-2240.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.004

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Objective　To investigate the application value of composite echocardiography technique in dynamically monitoring cardiotoxicity caused by lymphoma chemotherapy. Methods　A total of 28 non-Hodgkin lymphoma patients underwent chemotherapy in The First Affiliated Hospital of Henan University of Science and Technology, including 12 males and 16 females, aged (51.22±10.17) years; 30 healthy volunteers were selected as controls during the same period, including 12 males and 18 females, aged (50.19±12.06) years. Real-time two-dimensional echocardiography (RT-2DE), tissue Doppler imaging (TDI), and two-dimensional speck-tracking imaging (2D-STI) were used to detect the cardiac function indexes in all patients after 2, 4, and 6 cycles of chemotherapy. The left ventricular ejection fraction (LVEF), left ventricular anterior diameter (LV), left atrial anterior diameter (LA), peak E, peak A, E/A, mitral peak E deceleration time (DT), the ratio of early diastolic velocity of blood flow spectrum (E) to early diastolic peak velocity of mitral annulus (e'), left ventricular global circumferential strain (LVGCS), left ventricular global radial strain (LVGRS), left ventricular global longitudinal strain (LVGLS), and peak left ventricular twist angle (LVPtw) were observed and compared in both groups. Independent sample t test or one-way ANOVA was used for the measurement data, and Chi-square test was used for the count data. Results　There were no statistically significant differences in the LVEF, LV, LA, peak E, peak A, and E/A between the chemotherapy group and the control group after 2 and 4 cycles of chemotherapy (all P>0.05). There was no statistically significant difference in the DT between the chemotherapy group and the control group after 2 cycles of chemotherapy (P>0.05), but there was a statistically significant difference after 4 cycles of chemotherapy [(213.16±21.23) ms vs. (181.26±20.23) ms] (P<0.05). After 6 cycles of chemotherapy, the LVEF, LV, LA, peak E, peak A, E/A, and DT in the chemotherapy group were (49.01±4.12)%, (56.68±4.32) mm, (43.64±4.02) mm, (78.36±12.20) cm/s, (90.96±12.61) cm/s, (0.76±0.21), and (256.23±32.14) ms, with statistically significant differences compared with those in the control group (all P<0.05). There were no statistically significant differences in the e' and E/e' between the chemotherapy group and the control group after 2 cycles of chemotherapy (both P>0.05). In the chemotherapy group, the e' was (8.22±1.27) cm/s and the E/e' was (18.17±3.12) after 4 cycles of chemotherapy, the e' was (4.29±2.17) cm/s and the E/e' was (20.17±4.06) after 6 cycles of chemotherapy, with statistically significant differences compared with those in the control group (all P<0.05). There were statistically significant differences in the LVGRS, LVGCS, LVGLS, and LVPtw between the chemotherapy group and the control group after 2, 4, and 6 cycles of chemotherapy (all P<0.05). Conclusion　Chemotherapy with anthracycline for tumor patients can lead to cardiotoxicity, and RT-2DE combined with TDI and 2D-STI can detect the cardiotoxicity caused by chemotherapy earlier and more sensitively, which is of great significance for guiding clinical practice.

Influencing factors of persistent cough in patients with non-small cell lung cancer after thoracoscopic surgery 

He Jinghan, Cui Can, Jia Yu, Zhang Qian

2022, 28(16):  2241-2245.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.005

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Objective　To explore the influencing factors of persistent cough in patients with non-small cell lung cancer after video-assisted thoracoscopic surgery (VATS). Methods　A total of 80 patients with non-small cell lung cancer treated in The First Affiliated Hospital of Henan University from June 2018 to December 2020 were selected as the research subjects, including 44 males and 36 females, aged (61.98±3.48) years. All patients were treated with VATS. The patients' persistent cough within 30 days after operation was observed and recorded, the patients were grouped, the patients' relevant data were recorded, the possible influencing factors were included, the baseline data questionnaire was designed, and the relevant factors that might lead to persistent cough after VATS in the patients with non-small cell lung cancer were analyzed. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　Among the 80 patients with non-small cell lung cancer, 20 patients developed as persistent cough after VATS, with an incidence of 25.00%. The anesthesia time, endotracheal intubation time, and chest tube retention time in the occurrence group were (205.49±11.32) min, (5.49±0.89) d, and (8.62±2.45) d, which were longer than those in the non-occurrence group [(182.95±8.59) min, (3.53±0.59) d, and (5.37±1.67) d], and the proportions of lobectomy and peritracheal lymph node resection in the occurrence group were 65.00% (13/20) and 55.00% (11/20), which were higher than those in the non-occurrence group [30.00% (18/60) and 25.00% (15/60)], with statistically significant differences (all P<0.05). There were no statistically significant differences in the baseline data such as history of diabetes, pathological type, and pathological stage between the two groups (all P>0.05). Logistic regression analysis showed that long anesthesia time, lobectomy, peritracheal lymph node resection, long endotracheal intubation time, and long chest tube retention time were the influencing factors for the occurrence of persistent cough in the patients with non-small cell lung cancer after VATS (all OR>1, P<0.05). Conclusion　The occurrence of persistent cough in patients with non-small cell lung cancer after VATS is related to the factors such as long anesthesia time, lobectomy, peritracheal lymph node resection, long endotracheal intubation time, and long chest tube retention time.

Summary of evidences for prevention and intervention of anxiety, depression, and sadness in patients undergoing induction of labor in second trimester 

Zou Ting, Chen Yun, Huang Meiling, Li Na, Liu Bing, Yang Shuai

2022, 28(16):  2245-2250.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.006

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Objective　To search, evaluate, and integrate the best evidences for prevention and intervention of anxiety, depression, and sadness in patients undergoing induction of labor in second trimester, and to provide a basis for the clinical development of effective nursing intervention measures. Methods　Evidence-based nursing method was applied and relevant literatures were retrieved according to the 6S model. The literature retrieval time was from database construction to February 2022. The quality evaluation and evidence recommendation rating system (2014 edition) of the Joanna Briggs Institute (JBI) Evidence-based Healthcare Centre was used to evaluate the quality and evidence recommendation rating of various studies. Results　A total of 7 articles were included, including 2 randomized controlled trials, 2 qualitative studies, 1 cohort study, 1 case study, and 1 review. Finally, 13 best evidences were summarized, including four aspects: before, during, and after induction of labor and follow-up. Conclusions　The nursing for alleviating anxiety, depression, and sadness in patients undergoing induction of labor in second trimester should follow evidence-based nursing prevention and intervention measures, and the transformation of evidences should be effectively combined with cultural differences, clinical conditions, and maternal wills, so as to promote the development and application of high-quality nursing.

Value of early enteral nutritional support in patients undergoing TIPS for portal hypertension

Zhang Panpan, Wang Chaoyang, Lu Lu, Yan Yan

2022, 28(16):  2250-2254.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.007

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Objective　To investigate the effects of early enteral nutrition support program on stress response level, liver function, and nutritional status in patients undergoing transjugular intrahepatic portal-body shunt (TIPS) for portal hypertension. Methods　A prospective study was conducted on 95 cirrhotic portal hypertension patients after TIPS surgery in The First Affiliated Hospital of Henan University of Science and Technology from July 2018 to October 2020. The patients were divided into two groups by the random number table method. The control group consisted of 47 patients, 32 males and 15 females, aged (48.32±4.25) years; the observation group consisted of 48 patients, 32 males and 16 females, aged (49.61±4.41) years. The control group received routine nutritional support, and the observation group received early enteral nutrition support program. The liver function, stress response level, and nutritional status were compared between the two groups. χ² test was used for the count data and t test was used for the measurement data. Results　After intervention, the serum albumin (Alb) level in the observation group was (39.68±4.23) U/L, which was higher than that in the control group [(35.89±4.50) U/L], and the total bilirubin (TBil) level was (14.22±2.63) μmol/L, which was lower than that in the control group [(18.54±2.15) μmol/L], with statistically significant differences (both P<0.05). After intervention, the levels of transferrin (TRF) and prealbumin (PA) and prognostic nutrition index (PNI) in the observation group were (2.78±0.30) g/L, (3.33±0.42) g/dl, and (58.24±3.34), which were higher than those in the control group [(2.53±0.38) g/L, (2.98±0.40) g/dl, and (55.62±3.85)], with statistically significant differences (all P<0.05). After intervention, the levels of C-reactive protein (CRP) and prothrombin time (PT) in the observation group were (14.08±3.62) mg/L and (13.42±0.62) s, which were lower than those in the control group [(20.35±4.25) mg/L and (15.75±0.80) s], with statistically significant differences (both P<0.05). Conclusions　Early enteral nutrition support program has a definite effect on patients with cirrhotic portal hypertension after TIPS, which can effectively improve their nutritional status and liver function and reduce their stress response level, with clinical promotion value.

Aggressive fibromatosis of ureter: a case report 

Chen Shuangxing, Chen Min, Zhuang Haoquan, Xu Yuyu, Yang Weiqing

2022, 28(16):  2255-2257.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.008

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Aggressive fibromatosis is a rare and benign stromal tumor. Aggressive fibromatosis is characterized by mesenteric fibrous hyperplasia. Although aggressive fibromatosis occasionally invades intestine or adjacent tissues with invasive myofibroblast proliferation, it lacks the ability of malignant tumorigenesis and distant metastasis. Aggressive fibromatosis associated ureteral stricture is a rare urinary disease. This paper reported a case of aggressive fibromatosis of ureter admitted to The Fifth Affiliated Hospital of Guangzhou Medical University in May 2021.

Clinical study of uniportal thoracoscopic surgery without chest tube in rapid rehabilitation surgery - single center retrospective analysis 

Chen Huiyon, Li Weiling, Wan Renping, Huang Miaolong, Wang Linhui, Liu Jingting, Liao Hongliang, Gan Wen

2022, 28(16):  2257-2262.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.009

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Objective　To compare the incidences of pneumothorax, pleural effusion, atelectasis, subcutaneous emphysema, and incision effusion, score of Numerical Rating Scale (NRS), and average postoperative hospital stay between the patients who underwent uniportal thoracoscopic surgery without chest tube indwelling and with conventional chest tube indwelling, so as to evaluate the safety and effectiveness of the two groups, and to provide evidence support for some patients who receive uniportal thoracoscopic surgery without chest tube. Methods　From January 1, 2019 to November 1, 2020, a total of 1 480 cases of thoracic surgery under general anesthesia and double-lumen endotracheal intubation in Yuebei People's Hospital were retrospectively analyzed, and 112 cases of uniportal thoracoscopic pulmonary wedge resection, pulmonary bulla resection, and mediastinal tumor resection were selected. After screening again, 73 cases were divided into a tube-free group and a conventional chest tube group. In the 34 patients of the tube-free group, the incision was directly sutured without drainage tube indwelling after the chest tube exhaust water detection showed no air leakage during the operation; in the 39 patients of the conventional chest tube group, No. 22 thoracic drainage tube was indwelled in the intercostal incision during the operation. The incidence of transferring to porous thoracoscopic surgery or thoracotomy, complications, pain score, and average postoperative hospital stay were analyzed. Wilcoxon rank sum 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 age, gender, and disease distribution between the two groups (all P>0.05). None of the patients in the two groups were transferred to porous thoracoscopic surgery or thoracotomy. There were no statistically significant differences in the operation time, intraoperative blood loss, and NRS score on the second day after the operation between the two groups (all P>0.05). There were statistically significant differences in the NRS score [2 points: 38.2% (13/34) vs. 7.7% (3/39), 3 points: 52.9% (18/34) vs. 56.4% (22/39), 4 points: 8.8% (3/34) vs. 35.9% (14/39)] on the first day after the operation and postoperative hospital stay [0 d: 0.0% (0/34) vs. 7.7 (3/39), 1 d: 38.2% (13/34) vs. 15.4% (6/39), 2 d: 58.8% (20/34) vs. 48.7% (19/39), 3 d: 2.9% (1/34) vs. 17.9% (7/39), 4 d: 0.0% (0/34) vs. 10.3% (4/39)] between the tube-free group and the conventional chest tube group (both P<0.05). The incidence of complications in the tube-free group was 50.0% (17/34), without statistically significant difference compared with 51.3% (20/39) in the conventional chest tube group (χ²=0.012, P=0.913). Conclusion　Uniportal thoracoscopy without chest tube is safe and feasible for selective pulmonary wedge resection, pulmonary bullae resection, and mediastinal tumor resection, which is helpful for quick postoperative recovery, pain relief, and shortening hospital stay.

Application of enhanced recovery after surgery in the perioperative period of tuberculosis surgery in Zunyi area, Guizhou

Tang Yang, Li Qiao, Qu Wendong, Liang Lubiao, Gong Ming, Han Hao, Song Yongxiang, Chen Cheng

2022, 28(16):  2262-2266.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.010

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Objective　To analyze and validate the efficacy and safety of enhanced recovery after surgery (ERAS) in the perioperative period of pulmonary tuberculosis patients in Zunyi area, Guizhou. Methods　A total of 110 patients with pulmonary tuberculosis underwent surgery in Department of Thoracic Surgery, The Affiliated Hospital of Zunyi Medical University from May 2021 to February 2022, and they were divided into an observation group and a control group by the random number table method, 55 cases in each group. The control group included 42 males and 13 females, aged (54.65±14.94) years; the observation group included 34 males and 21 females, aged (52.15±14.12) years. In the control group, the traditional rehabilitation measures were used to promote the patients' rehabilitation during the perioperative period; the observation group was given ERAS during the perioperative period. The related indexes in the patients were observed and analyzed. χ² test was used for the count data, and independent sample t test or Mann-Whitney U test was used for the measurement data. Results　The amount of blood loss was 100 (50, 110) ml in the observation group and 100 (90, 160) ml in the control group, without statistically significant difference (P=0.471). There were no statistically significant differences in the operation time and cost between the two groups (both P>0.05). The postoperative Visual Analog Scale (VAS) score, postoperative white blood cell count, length of hospital stay, extubation time, postoperative length of stay, and total cost of hospitalization were (3.82±1.36) points, (8.98±2.37) ×10⁹/L, (10.69±2.27) d, (5.13±1.73) d, (7.89±2.45) d, and (59 932.16±12 914.00) yuan, which were lower than those in the control group [(4.62±1.89) points, (10.83±3.93) ×10⁹/L, (12.13±2.63) d, (6.09±2.56) d, (8.95±2.54) d, and (65 421.43±14 684.88) yuan], with statistically significant differences (all P<0.05). The incidence of complications in the observation group was 3.6% (2/55), which was significantly lower than that in the control group [14.5% (8/55)] (χ²=3.960, P=0.047). Conclusion　The perioperative application of ERAS in patients with pulmonary tuberculosis can effectively promote their rapid recovery, which is safe and effective and has the feasibility of implementation.

Analysis of clinicopathological characteristics and prognostic factors of 16 cases of cervical neuroendocrine carcinoma 

Zhou Dongmei, Zhong Min, Sheng Xiujie

2022, 28(16):  2267-2272.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.011

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Objective　To investigate the prognostic factors of cervical neuroendocrine carcinoma (NECC). Methods　Clinical data of 16 NECC patients admitted to The Third Affiliated Hospital of Guangzhou Medical University from July 2012 to August 2021 were retrospectively collected. Survival analysis was performed by Kaplan-Meier and Cox regression method. Results　The age of the patients ranged from 23 to 63 (42.94±1.2) years old, the median age was 44.5 years old, and the tumor length ranged from 1.0 to 10.0 (5.03±1.9) cm. There were 10 cases of pure NECC, 4 cases of squamous cell carcinoma with NECC, and 2 cases of adenocarcinoma with NECC. Among them, 13 patients underwent extensive total hysterectomy + bilateral adnexectomy + pelvic lymph node dissection (5 cases of them received neoadjuvant chemotherapy), 1 patient without surgery gave up therapy after receiving postoperative radiotherapy once, and 2 cases of pregnancy complicated with NECC underwent cesarean section and total hysterectomy (1 case received chemotherapy and 1 case gave up postoperative chemoradiotherapy). Sixteen patients were finally followed up for 2-97 months. Among the 15 patients receiving operation, 6 patients had no recurrence or metastasis, 1 patient survived with distant metastasis (pelvic metastasis), and 8 patients died of multiple organ failure caused by multiple metastases (4 patients with lung, liver, lumbosacral, and pelvic metastases and 4 patients with abdominal cavity, diaphragmatic angle, mediastinal, and subclavicle multiple lymph node metastases). One unoperated patient (stage ⅣB) died of multiple organ failure after 3 months of follow-up. Univariate analysis showed that age (≥40 years old), postoperative chemotherapy, pelvic lymph node metastasis, and International Federation of Genecology and Obstetrics (FIGO) stage (>stage ⅡA) were the influencing factors of progression-free survival (PFS) and overall survival (OS) (all P<0.05). Multivariate analysis of Cox regression model showed that FIGO stage > ⅡA (HR=0.168, 95%CI: 0.038-0.743, P=0.019) was the only independent factor affecting PFS, and postoperative chemotherapy (HR=5.034, 95%CI: 1.137-22.282, P=0.033) was the only independent factor affecting OS. Conclusions　The prognosis of NECC is related to tumor stage and post-operative chemotherapy. Improving the rate of early diagnosis and early treatment of tumor can benefit the survival in patients. Postoperative adjuvant chemotherapy is recommended even for early patients, which is of great significance to improve the prognosis.

Observation of the curative effect of noninvasive positive pressure ventilation combined with lobeline in the treatment of COPD complicated with respiratory failure

Wu Yingying, Jiang Chengyang, Guo Weidong, Guo Yanfen

2022, 28(16):  2272-2275.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.012

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Objective　To observe the effect of non-invasive positive pressure ventilation (NPPV) combined with lobeline on patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods　A total of 82 patients with COPD and respiratory failure who were admitted to The Seventh Affiliated Hospital of Southern Medical University from January 2020 to October 2021 were selected and were simply randomly divided into two groups with 41 cases in each group. In the control group, there were 25 males and 16 females, with an age of (69.12±7.53) years old; there were 24 males and 17 females in the observation group, with an age of (68.96±7.31) years old. The control group was treated with lobeline, and the observation group was treated with NPPV on the basis of the control group. The blood gas indexes, pulmonary function indexes, and clinical efficacy were compared between the two groups. t test was used for the measurement data, and chi-square test was used for the count data. Results　After 1 week of treatment, the total effective rate of the observation group was 97.56% (40/41), which was significantly higher than that of the control group [80.49% (33/41)], with a statistically significant difference between the two groups (χ²=6.116, P=0.002). After 1 week of treatment, the arterial partial pressure of oxygen (PaO₂) and oxygenation index (PaO₂/FiO₂) in the observation group were (70.35±10.79) mmHg (1 mmHg=0.133 kPa) and (371.14±49.86) mmHg, which were significantly higher than those in the control group [(61.87±10.77) mmHg and (336.07±47.82) mmHg], and the arterial partial pressure of carbon dioxide (PaCO₂) was (49.15±8.27) mmHg, which was significantly lower than that in the control group [(56.03±8.69) mmHg], with statistically significant differences (all P<0.05). After 1 week of treatment, the forced expiratory volume in 1 second (FEV₁), vital capacity (FVC), and peak expiratory flow (PEF) in the observation group were (1.66±0.40) L, (2.63±0.46) L, and (2.87±0.59) L/s, which were significantly higher than those in the control group [(1.37±0.29) L, (2.31±0.40) L, and (2.39±0.54) L/s], with statistically significant differences (all P<0.05). No obvious adverse reactions occurred in the two groups during treatment. Conclusion　NPPV combined with lobeline in the treatment of COPD patients with respiratory failure can significantly improve the clinical efficacy, is safe and reliable, can effectively improve the patients' blood gas and lung function indexes, and greatly promotes their early recovery.

Effect of papain on angiogenesis of rat vascular endothelial cells 

Yang Shuying, Wu Guofeng

2022, 28(16):  2276-2278.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.013

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Objective　To detect the promoting effect of papain on the angiogenesis of rat endothelial progenitor cells (EPCs) in vitro. Methods　The EPCs in 3rd passage were cultured with complete medium containing papain with the concentrations of 10, 50, and 100 μg/ml. After cultured for 0, 7, and 14 days, the expression levels of angiogenesis genes VEGF (vascular endothelial growth factor) and CD31 (platelet endothelial cell adhesion molecule) were detected by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The proliferation of EPCs was detected by CCK-8 assay. The statistical method was analysis of variance. Results　After cultured for 14 days, the expression levels of VEGF and CD31 and proliferation ability of EPCs in the papain groups were significantly higher than those of the blank control group. The expression level of VEGF reached the highest when EPCs cultured with medium with 50 μg/ml of papain (3.28 times of the blank control group). The expression level of CD31 increased with the increase of papain concentration, reaching 3.66 times of the blank control group. Conclusion　Proper concentration of papain can promote the angiogenesis and proliferation of EPCs in vitro, which shows that the papain can promote the formation of vascular tissue.

Effects of pulmonary rehabilitation therapy on lung function and quality of life in patients with stable COPD

Xu Xiujuan, Cheng Jiaoyang, Peng Chunlin

2022, 28(16):  2279-2282.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.014

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Objective　To analyze the positive effects of pulmonary rehabilitation training combined with drug therapy on lung function and quality of life in patients with chronic obstructive pulmonary disease (COPD) in stable stage. Methods　From January 2018 to December 2021, 100 patients who were clearly diagnosed with COPD in Panyu Hospital of Chinese Medicine were evaluated as stable after discharge, and they were divided into an intervention group and a control group with the random number table method. In the intervention group, the male to female ratio was 30∶20, the age was (64.38±5.86) years old, and the course of disease was (7.61±2.12) years; in the control group, the male to female ratio was 31∶19, the age was (65.12±5.75) years old, and the course of disease was (7.74±2.06) years. The control group received conventional drug therapy, and the intervention group received conventional therapy and pulmonary rehabilitation therapy. The lung function and quality of life were compared between the two groups. SPSS 25.0 software was used to compare the differences in the observation indicators, t test was used for the measurement data, and χ² test was used for the count data. Results　After 6 months of treatment, the forced expiratory volume in one second (FEV₁), ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC), and 6-minute walking distance (6MWD) in both groups were higher than those before treatment, and those in the intervention group were higher than those in the control group [(62.79±9.10)% vs. (57.90±9.74)%, (67.07±8.29)% vs. (61.70±8.97)%, (456.24±37.91) m vs. (415.17±29.27) m], with statistically significant differences (all P<0.05). After 6 months of treatment, the modified Medical Research Council Dyspnea Scale (mMRC) scores of the two groups were lower than those before treatment, and that in the intervention group was lower than that in the control group [(0.92±0.60) points vs. (1.51±0.45) points], with statistically significant differences (all P<0.05). After 6 months of treatment, the scores of respiratory symptoms, activity, and disease effect dimensions of St George's Respiratory Questionnaire (SGRQ) in the two groups were lower than those before treatment, and those in the intervention group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusion　Pulmonary rehabilitation therapy can significantly improve the levels of lung function and quality of life in patients with stable COPD, and it is worth promoting on the basis of conventional treatment.

Special Column of Pediatrics

Shprintzen-Goldberg syndrome: a case report and literature review 

Zhong Yuming, Fang Xiaoli, Zhang Xiangjun, Song Ping

2022, 28(16):  2284-2287.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.015

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Objective　To summarize the clinical features of Shprintzen-Goldberg syndrome and improve the understanding on the disease. Methods　The clinical data of a case of Shprintzen-Goldberg syndrome diagnosed in Shenzhen Children's Hospital were summarized and the related literatures were reviewed. Results　The child, male, G2P2, had a full-term delivery, without a family history of neurological diseases. Normal pregnancy and childbirth, low muscle tension after birth, currently lagging behind in motor development, 1 year old, he could not raise head, sit, or crawl, without twitch. Physical examination showed special facial features such as long head deformity, protruding forehead, widened eye distance, shallow orbit, stenosis of upper palate, high jaw arch, and small mandible, no abnormality on cardiopulmonary auscultation, no abnormality on physical examination of abdomen, slender fingers and toes. Auxiliary examination: head MRI showed bilateral lateral ventricles widened and slightly deformed, the anterior horn of the left lateral ventricle more prominent, bilateral ventricular subependymal cysts, foramen magnum and lower spinal stenosis in the craniocervical junction area, the anteroposterior diameter of the spinal canal about 5 mm, and the cervical spinal cord compressed. Head CT suggested craniosynostosis. Heart color Doppler ultrasound showed left-to-right shunt of atrial septum, with the size of about 0.37 cm. The karyotype was normal: 46XY. Whole-exome sequencing indicated that the SKI gene c.100G>C mutation was a missense mutation. The parents' genes were normal, and it was a new mutation. According to the American College of Medical Genetics and Genomics (ACMG) guidelines, this variant was pathogenic. The related literatures were reviewed, the child was in line with the clinical manifestations of Shprintzen-Goldberg syndrome, the gene was consistent, the mutation site had not been reported before, the mutation site was in the functional area of the gene, it was considered as a pathogenic variant combined with the protein function prediction software, and the diagnosis was considered combined with clinical manifestations. This disease had not been reported in detail in the Chinese literatures and was an autosomal dominant genetic disease. The disease mainly manifested as abnormal appearance, which can be combined with multi-system damages, mainly manifested as mental retardation, craniosynostosis, and slender limbs, similar to Marfan syndrome. The treatment was mainly symptomatic support. Conclusions　Shprintzen-Goldberg syndrome should be considered with developmental retardation + craniosynostosis + similar manifestations of Marfan syndrome, the diagnosis can be confirmed by timely three-dimensional CT examination of the skull and gene detection, and early intervention is implemented to improve the prognosis.

Two cases of severe anemia caused by gastrointestinal stromal tumor in children

Zhang Sheng, Cai Huiqiang, Hou Chongzhi

2022, 28(16):  2288-2291.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.016

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Gastrointestinal stromal tumor in children is a rare solid tumor of gastrointestinal tract. As the clinical manifestations are not specific, it often shows anemia in the early stage and is easy to be misdiagnosed. The primary focus is located in the wall of the stomach or small intestine, and if the tumor size is small, it is easy to be miss diagnosed. Abdominal color ultrasound, CT, and gastroenteroscopy are the main methods to diagnose the disease. In addition to surgical treatment, necessary targeted drugs should be given according to the results of gene detection and pathological immunohistochemistry. This paper reported two cases of gastrointestinal stromal tumor admitted to Xi 'an Children's Hospital since 2021 with the chief complaint of anemia. The processes of diagnosis and treatment were analyzed based on relevant literatures.

Analysis of risk factors of perioperative severe respiratory complications in children undergoing bronchoscopic removal of airway foreign body

Zhao Shuling, Sun Xiaoyan, Zhu Junling

2022, 28(16):  2291-2294.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.017

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Objective　To explore the risk factors of perioperative severe respiratory complications in children undergoing bronchoscopic removal of airway foreign body. Methods　A total of 291 children who underwent bronchoscopic removal of airway foreign body in Xuzhou Children's Hospital from June 2019 to June 2021 were selected. The children's clinical data were retrospectively analyzed. The children who did not have serious respiratory complications during operation and within 24 hours after operation were regarded as a complication free group, and the children who had serious respiratory complications during operation and within 24 hours after operation were regarded as a complication group. The general data, operation time, foreign body retention time, foreign body location, foreign body type, and other data were compared between the two groups, and logistic regression analysis was performed for the factors with statistically significant differences in the univariate analysis to determine the risk factors for perioperative severe respiratory complications. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The complications occurred in 37 cases of 291 children, with an incidence of 12.71% (37/291). The complication group included 19 males and 18 females, aged (3.12±0.51) years; the complication free group included 163 males and 91 females, aged (3.19±0.59) years. In the complication group, the operation time, foreign body retention time, and rates of preoperative respiratory tract infection and poor anesthetic effect were (20.12±4.05) min, (7.09±0.48) d, 51.35% (19/37), and 70.27% (26/37), respectively, which were significantly higher than those in the complication free group [(12.18±1.11) min, (3.61±0.55) d, 12.99% (33/254), and 7.48% (19/254)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that operation time, foreign body retention time, preoperative respiratory tract infection, and poor anesthetic effect were the risk factors of perioperative serious respiratory complications (all P<0.05). Conclusions　The risk factors of perioperative serious respiratory complications in children undergoing bronchoscopic removal of airway foreign body mainly include operation time, foreign body retention time, preoperative respiratory tract infection, and poor anesthetic effect. Clinical vigilance and preventive measures should be taken in time.

Correlation analysis between pathological Lee's grade and clinical characteristics in 66 children with IgA nephropathy in a single center

Lin Xiaoqing, Gong Wangqiu, Zhang Jing, Gao Xia, Deng Huiying, Yang Huabin

2022, 28(16):  2295-2298.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.018

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Objective　To investigate the possible relationships between pathological Lee's grade and clinical features of IgA nephropathy (IgAN) in children. Methods　The clinical and pathological Lee's grade data of 66 children with IgAN who were enrolled in the Department of Nephrology, Guangzhou Women and Children's Medical Center from July 2017 to December 2020 were retrospectively analyzed. One-way analysis of variance, Kruskal-Wallis H test, and Spearman rank correlation analysis were used for statistical analysis. Results　Among the 66 IgAN children in this study, there were 44 males (66.7%) and 22 females (33.3%), the ratio of male to female was 2:1, and the age was (7.7±2.6) years old. The clinical manifestations of the 66 IgAN children were dominated by hematuria combined with proteinuria (49 cases), followed by isolated hematuria (16 cases), and isolated proteinuria (1 case); 10 cases of IgAN children (15.2%) had a family history of kidney disease. Lee's grade III was the most common pathological type, counting for 59.1% (39 cases), followed by 25.7% (17 cases) of grade II, 7.6% (5 cases) of grade IV, 4.5% (3 cases) of grade I, and 3.0% (2 cases) of grade V. There were statistically significant differences in the 24 h urinary protein quantification (24 h-UP), ratio of urinary protein to urinary creatinine, serum cystatin C, and glomerular filtration rate (GFR) among children with different Lee's grades (all P<0.05). Spearman correlation analysis showed that Lee's grade was positively correlated with 24 h-UP, ratio of urinary protein to urinary creatinine, serum creatinine, urea nitrogen (BUN), and serum cystatin C (all P<0.05), and negatively correlated with GFR (P<0.05). Conclusions　Hematuria combined with proteinuria is the most common clinical manifestation of IgAN children in our study. The histological type is dominated by Lee's grade III. There are statistically significant correlations between proteinuria level, renal function indexes, and Lee's grade.

Study on biological behaviors in children with Klebsiella pneumoniae infection

Shi Guixiu, Chen Haiying, Fei Xiukun, Zeng Qinghe, Yu Zhenzhen

2022, 28(16):  2299-2302.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.019

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Objective　To analyze the clinical characteristics and bacterial drug resistance in children with Klebsiella pneumoniae (KP) infection, so as to provide clinical evidences for prevention and control of KP infection. Methods　The clinical data of 68 children with sepsis of KP infection were collected from Zaozhuang Maternal and Child Health Hospital from January to December 2019 (28 males and 40 females). Antimicrobial susceptibility was tested with broth microdilution method. They were divided into an extended spectrum β-lactamases (ESBLs) positive KP infection group and an ESBLs negative KP infection group. The prognosis, length of hospital stay, grade of antibiotics used in treatment, type of antibiotics, mechanical ventilation, and so on were compared between the two groups. χ² test or Fisher exact probability method was used for the count data, and Mann-Whitney U test was used for the measurement data. Results　The mortality of the ESBLs-positive KP infection group was higher than that of the ESBLs-negative KP infection group (3/23 vs. 0/45), the length of hospital stay was longer than that of the ESBLs-negative KP infection group, the number of antibiotics used was more than that of the ESBLs-negative KP infection group, the usage rate of Carbapenms was higher than that of the ESBLs-negative KP infection group, and the mechanical ventilation rate was higher than that of the ESBLs-negative KP infection group (all P<0.05). There were no statistically significant differences in the hospitalization history and antibiotic exposure between the two groups (both P>0.05). Conclusion　The infection of KP with ESBLs positive is negatively correlated with the prognosis.

A randomized controlled and longitudinal follow-up study on medium-long term efficacy of multi-modal pulmonary rehabilitation program on children with asthma 

Liu Yuemei, Tang Yu, Zhang Lei

2022, 28(16):  2303-2306.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.020

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Objective　To analyze the effect of multi-modal pulmonary rehabilitation program on medium-long term efficacy in children with asthma. Methods　A total of 178 children with asthma who were treated in Children's Hospital Affiliated to Zhengzhou University between March 2018 and May 2019 were collected as the research subjects, and they were divided into an intervention group (89 cases) and a control group (89 cases) according to the order of admission. In the intervention group, there were 42 males and 47 females, aged (7.57±1.73) years; in the control group, there were 45 males and 44 females, aged (7.68±1.82) years. The control group was given routine nursing intervention, and the intervention group was given multi-modal pulmonary rehabilitation program, including breathing exercises, sports training, nutrition guidance, and health education. After 6 months, the exercise tolerance, pulmonary function, asthma control, and quality of life were compared between the two groups before and after intervention. After the end of intervention, the children of the two groups were followed up for 1 year, and the numbers of hospitalizations and the numbers of acute asthma attacks in the two groups within 1 year were compared. t test was used for the measurement data, and chi-square test was used for the count data. Results　After 6 months of intervention, the 6 min walking distance (6MWD), forced expiratory capacity (FVC), forced expiratory capacity in 1 second (FEV₁), and rate of forced expiratory capacity in 1 second to forced vital capacity (FEV₁/FVC) in the intervention group were (376.14±14.68) m, (2.69±0.46) L, (1.74±0.23) L, and (79.02±8.54)%, which were significantly higher than those in the control group [(298.42±12.51) m, (2.43±0.49) L, (1.59±0.19) L, and (72.63±8.29)%] (all P<0.05); the Asthma Control Test (ACT) score [(21.69±4.06) points] was significantly higher than that in the control group [(17.33±3.87) points] (P<0.05); the score of St. George's Respiratory Questionnaire (SGRQ) [(44.65±10.83) points] was significantly lower than that in the control group [(59.67±11.18) points] (P<0.05). During the follow-up period, the number of hospitalizations and the number of acute asthma attacks in the intervention group were (1.84±0.91) times and (2.64±1.26) times, which were significantly less than (3.56±1.04) times and (4.28±1.37) times in the control group (both P<0.05). Conclusion　Multi-modal pulmonary rehabilitation program can effectively improve the exercise tolerance and pulmonary function-related indicators in children with asthma, enhance their asthma control ability and quality of life, and reduce the number of later acute attacks and the number of hospitalizations, with high popularization and application values.

Application observation of quality control circle airway management combined with clinical nursing pathway intervention in children with severe pneumonia 

Su Gaoyan, Guo Jie

2022, 28(16):  2307-2310.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.021

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Objective　To explore the application effect of quality control circle (QCC) airway management combined with clinical nursing pathway (CNP) intervention in children with severe pneumonia. Methods　The clinical data of 88 children with severe pneumonia treated in Children's Hospital Affiliated to Zhengzhou University from June 2019 to June 2021 were analyzed retrospectively. According to different nursing methods, they were divided into a control group and an observation group, with 44 cases in each group. In the control group, there were 21 females and 23 males, the course of disease was (3.59±0.21) d, and the age was (5.31±1.05) years old; in the observation group, there were 20 females and 24 males, the course of disease was (3.56±0.24) d, and the age was (5.34±1.03) years old. The control group took routine intervention, and the observation group took QCC airway management combined with CNP intervention on this basis until the children were discharged from hospital. The clinical symptom relief time, serum inflammatory factors levels, and family satisfaction degree were compared between the two groups. The measurement data were tested by independent sample t test and the count data were tested by χ² test. Results　The cough relief time [(5.68±1.02) d], asthma relief time [(3.38±0.52) d], lung rales relief time [(4.39±0.49) d] in the observation group were shorter than those in the control group [(7.16±1.23) d, (4.67±0.79) d, and (6.45±1.12) d], the serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF)-α after intervention were (3.62±0.51) mg/L, (6.05±1.04) μg/ml, and (9.35±2.10) μg/L, which were lower than those in the control group [(5.49±1.02) mg/L, (11.05±2.29) μg/ml, and (12.97±2.17) μg/L], and the nursing satisfaction was 95.45% (42/44), which was higher than that in the control group [81.82% (36/44)], with statistically significant differences (all P<0.05). Conclusion　QCC airway management combined with CNP intervention can shorten the improvement time of clinical symptoms in children with severe pneumonia, and reduce the inflammatory reaction, so as to improve the nursing satisfaction.

Basic Research

Effect and mechanism of bisdesmethoxycurcumin on breast cancer in mice

Li Xueying, Xu Yang, Wang Mi

2022, 28(16):  2311-2315.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.022

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Objective　To investigate the effect and mechanism of bisdesmethoxycurcumin (BDMC) on breast cancer in mice. Methods　Mouse breast cancer 4T1 cells were used and were divided into a control group and 3, 9, and 27 μM BDMC groups. The effect of BDMC on the proliferation of mouse breast cancer 4T1 cells was detected by CCK8 assay, the effect of BDMC on the apoptosis of 4T1 cells was detected by TUNEL staining, and the effects of BDMC on the expressions of Bax, Bcl-2, and cleaved caspase-3 in 4T1 cells were detected by Western blot. The 4T1 breast cancer tumor-bearing mouse models were used and were divided into a control group and 10 and 30 mg/kg BDMC groups. The effects of BDMC on tumor volume and body weight of mouse models were detected, and the effects of BDMC on the expressions of Bax, Bcl-2, and cleaved caspase-3 in tumors were detected by Western blot. One-way ANOVA was used. Results　Compared with the control group, BDMC at 9 and 27 μM could significantly inhibit the proliferation of 4T1 cells (both P<0.01), promote the apoptosis (both P<0.01), and significantly up-regulate the ratio of Bax/Bcl-2 and expression of cleaved caspase-3 (all P<0.01). Compared with the control group, BDMC at 10 and 30 mg/kg could significantly inhibit the growth of tumor volume in mouse models of breast cancer (both P<0.05), significantly up-regulate the ratio of Bax/Bcl-2 and expression of cleaved caspase-3 in tumor (all P<0.05), and had no significant effect on the body weight. Conclusion　BDMC can exert significant antitumor effect on mouse models of breast cancer, and its mechanism is related to the activation of mitochondrial apoptosis pathway.

Treatises

Prevalence of refractive error and its associated factors among patients with diabetes in Huanghua community, Guangzhou, China

Ouyang Meiling, Cai Yue, Liu Yuanzhen, Liu Bin, Yu Xiao, Li Yuting

2022, 28(16):  2316-2320.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.023

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Objective　To investigate the prevalence of refractive error and its influencing factors among patients with type 2 diabetes over 50 years old in Guangzhou. Methods　A cross-sectional study was conducted among diabetic patients who participated in chronic disease management in the community in Huanghua Community Health Service Center, Yuexiu District, Guangzhou from January 2019 to May 2021. A total of 454 diabetic patients were selected to explore their general conditions, biochemical tests, and hemoglobin A1c (HbA1c) level. All subjects underwent general ophthalmic examination, including optometry. Independent sample t test, χ² test, and multivariate logistic regression analysis were used to analyze the data. Results　A total of 454 patients with type 2 diabetes participated in the study, including 186 males (41.0%), aged (65.70±8.27) years, with a course of diabetes of (9.46±7.28) years. The prevalences of myopia, hyperopia, and astigmatism were 22.7% (95%CI: 18.8%-26.6%), 47.6% (95%CI: 43.0%-52.2%), and 50.7% (95%CI: 46.0%-55.3%), and the prevalence of hyperopia increased with the increase of age (P<0.05). Multivariate regression analysis showed that myopia was only related to the education level (P<0.05), hyperopia was only related to age and course of diabetes (both P<0.05), and astigmatism and anisometropia were only related to age (both P<0.05). Conclusion　The prevalence of refractive error in type 2 diabetic patients in Huanghua community is high, among which the level of education is the influencing factor of myopia, the age and course of diabetes are the influencing factors of hyperopia, and the age is the influencing factor of astigmatism and anisometropia.

Correlations between serum angiotensin Ⅱ and tumor necrosis factor-α levels and myocardial reperfusion injury after heart valve replacement

Zhuang Yan

2022, 28(16):  2320-2325.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.024

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Objective　To analyze the relationships between serum angiotensin Ⅱ (AngⅡ) and tumor necrosis factor-α (TNF-α) levels and myocardial reperfusion injury in patients after heart valve replacement. Methods　A total of 119 patients with rheumatic heart disease who underwent heart valve replacement in Jiamusi Central Hospital from June 2015 to June 2021 were selected, including 78 males and 41 females, aged (72.57±3.42) years. The levels of serum AngⅡ and TNF-α in all patients were measured before heart valve replacement, and the levels of serum cardiac troponin T (cTnT) and creatine kinase (CK) were measured 24 hours after operation. Pearson correlation analysis was used to analyze the correlations between serum AngⅡ and TNF-α levels and myocardial reperfusion injury indexes (serum cTnT and CK) in patients after heart valve replacement. Results　The levels of serum AngⅡ, TNF-α, cTnT, and CK in the 119 patients with rheumatic heart disease were (128.64±14.38) ng/dl, (38.67±4.52) fmol/ml, (1.26±0.28) μg/L, and (267.52±10.54) U/L. Pearson correlation analysis showed that serum AngⅡ and TNF-α were positively correlated with serum cTnT and CK levels in the patients after heart valve replacement (all r>0, P<0.05). Conclusion　The levels of serum AngⅡ and TNF-α are closely related to myocardial reperfusion injury in patients after heart valve replacement.

Cox risk analysis of secondary pulmonary embolism in patients with chronic obstructive pulmonary disease

Duan Xintong

2022, 28(16):  2325-2329.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.025

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 Objective　To explore the risk factors of secondary pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) by Cox risk ratio model, and to provide references for early clinical identification of high-risk patients and early intervention. Methods　A total of 245 COPD patients were chosen from Chenzhou First People's Hospital from January 2019 to January 2021, including 143 males and 102 females, with an age of (58.6±10.3) years old. The follow-up time was 11.0-22.5 months. A total of 29 cases (11.84%) of secondary PE were diagnosed by CT pulmonary angiography, and the diagnosis time was recorded. The general clinical data, coagulation indicators, inflammatory markers, and CT pulmonary artery quantitative parameters of the PE group and the non-PE group were compared. The risk factors of secondary PE were analyzed by Cox risk analysis. χ² test was used for the count data and independent sample t test was used for the measurement data. Results　Comparison of the general clinical data showed that the PE group had higher proportions of severe pneumonia and heart failure, a lower proportion of prophylactic anticoagulant therapy, and a higher COPD severity grade, with statistically significant differences (all P<0.05). Comparison of the coagulation indicators found that the activated partial thromboplastin time (APTT) in the PE group decreased [(34.3±4.5) s vs. (41.6±4.8) s], the levels of D-dimer [(0.5±0.1) mg/L vs. (0.2±0.1) mg/L] and fibrinogen (FIB) [(4.2±0.4) g/L vs. (3.3±0.2) g/L] increased (all P<0.05). Comparison of the inflammatory markers found that the serum levels of high-sensitivity C-reactive protein (hs-CRP) [(9.8±1.3) mg/L vs. (6.5±1.1) mg/L], interleukin-6 (IL-6) [(56.5±12.3) mg/L vs.(42.2±9.6) mg/L], and tumor necrosis factor -α (TNF-α) [(35.6±8.7) mg/L vs. (22.4±6.5) mg/L] in the PE group increased (all P<0.05). Comparison of the CT pulmonary artery quantitative parameters found that the pulmonary artery pressure increased in the PE group [(45.6±6.3) mmHg vs. (38.9±5.4) mmHg (1 mmHg=0.133 kPa)], the blood perfusion velocity decreased [(21.8±4.7) cm/s vs. (32.4±5.2) cm/s], and the emphysema score increased [(8.6±2.4) points vs. (4.5±1.3) points] (all P<0.05). Cox analysis showed that no prophylactic anticoagulant therapy, higher COPD severity grade, high D-dimer level, high hs-CRP level, and low blood perfusion velocity were the main risk factors for secondary PE (all P<0.05). Conclusion　Patients with COPD who have not been treated with prophylactic anticoagulant therapy and have high COPD severity, high D-dimer level, high hs-CRP level, and low blood perfusion velocity should be paid more attention of secondary PE risk.

Clinical Research

Renal artery pseudoaneurysm after blunt renal trauma: a case report and literature review

Fang Xudong, Lian Bijun, Li Feng, Jin Hangyang, Cao Zhilie, Fu Er, Wu Yifeng, Xiao Na, Wang Quanjun

2022, 28(16):  2330-2334.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.026

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Objective　To investigate the clinical features and treatment of renal artery pseudoaneurysm (RAP) after blunt renal trauma. Methods　The clinical data of 1 case treated in The 903rd PLA Hospital in December 2021 and 35 cases of RAP after blunt renal trauma reported in literatures from 1996 to 2021 were retrospectively analyzed. There were 28 males and 7 females in the whole cases, and the gender of 1 case was not reported; the age was (27.0±14.4) years old. The RAP onset time was reported in 32 cases, and the diagnosis time was (14.0±12.5) d. Independent sample t test was used. Results　RAP mostly formed about 14 days after blunt renal injury, and the most common clinical manifestations were gross hematuria and abdominal/flank pain. Of the 36 patients, 31 cases underwent superselective arterial embolization, and the other 5 cases chose conservative treatment. Except for 1 case with RAP residue after conservative treatment, the other 35 cases were recovered. There was a statistically significant difference in the maximum diameter of tumor between the 4 patients who were cured by conservative treatment and the 31 patients who were treated by arterial embolization [(7.5±3.1) mm vs. (15.7±6.2) mm] (P=0.022). Conclusions　RAP should be considered for delayed gross hematuria or sudden lumbar and abdominal pain after blunt renal injury. Enhanced CT and Doppler ultrasonography are recommended as the initial screening. The gold standard for diagnosis is digital subtraction angiography (DSA). Superselective arterial embolization is a first-line treatment option. So far, conservative treatment lacks high-level evidence support, but it can be considered in asymptomatic patients with a maximum diameter of RAP ≤10 mm.

Effect analysis of Bushen Quyu Huoxue decoction in the treatment of patients with chronic glomerulonephritis

Xu Lina, Wang Wenyin

2022, 28(16):  2335-2338.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.027

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Objective　To investigate the effects of Bushen Quyu Huoxue decoction on the renal function and blood lipid in patients with chronic glomerulonephritis. Methods　It was a prospective study. A total of 96 cases of chronic glomerulonephritis were selected from The People's Hospital of Linqing from July 2019 to July 2021, and they were divided into a control group (48 cases) and an experimental group (48 cases) with the random number table method. There were 25 males and 23 females in the control group, aged (49.67±8.52) years; there were 26 males and 22 females in the experimental group, aged (49.53±8.67) years. Both groups were given routine treatment, the control group was given losartan treatment, and the experimental group was given Bushen Quyu Huoxue decoction on the basis of the control group. The two groups received continuous treatment for 6 months. The clinical effect, renal function, blood lipid level, and adverse reactions during the treatment were compared between the two groups. Independent sample t test was used for inter-group comparison of the measurement data, paired t test was used for intra-group comparison of the measurement data, and χ² test was used for the count data. Results　After treatment, the total clinical effective rate of the experimental group was higher than that of the control group [93.75% (45/48) vs. 79.17% (38/48)], with a statistically significant difference (χ²=4.360, P=0.037). After treatment, the levels of serum creatinine (Scr), urea nitrogen (BUN), 24 h urine protein quantification (24 h UP), triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in the experimental group were lower than those in the control group [(89.46±10.34) μmol/L vs. (125.35±14.18) μmol/L, (3.27±0.52) mmol/L vs. (6.58±0.75) mmol/L, (0.76±0.12) g/24 h vs. (1.45±0.27) g/24 h, (1.51±0.35) mmol/L vs. (2.13±0.37) mmol/L, (4.83±0.57) mmol/L vs. (6.76±0.75) mmol/L, (1.72±0.24) mmol/L vs. (3.15±0.45) mmol/L], with statistically significant differences (all P<0.001). After treatment, the glomerular filtration rates (GFR) and serum high density lipoprotein cholesterol (HDL-C) levels in the two groups were increased compared with those before treatment, and the GFR and HDL-C in the experimental group were higher than those in the control group [(91.18±6.16) ml/(min•1.73 m²) vs. (75.35±9.74) ml/(min•1.73 m²), (1.48±0.25) mmol/L vs. (1.16±0.23) mmol/L], with statistically significant differences (all P<0.001). No serious adverse reactions were observed in the two groups during the treatment. Conclusion　Bushen Quyu Huoxue decoction can effectively relieve the clinical symptoms in patients with chronic glomerulonephritis, improve their renal function, and regulate the blood lipid level, with a significant effect.

Effect of propofol combined with phenylephrine induction on hemodynamics during ophthalmic general anesthesia surgery 

Zhang Guangqi, Ge Junfeng

2022, 28(16):  2339-2342.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.028

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Objective　To explore the effect of propofol combined with phenylephrine induction on hemodynamics during ophthalmic general anesthesia surgery. Methods　It was a retrospective analysis. From March 2019 to October 2020, 220 patients undergoing ophthalmic general anesthesia surgery in Jinan Second People's Hospital were selected as the study subjects, and were divided into two groups according to the anesthesia drugs. In the control group, there were 70 males and 40 females, with an age of (40.35±6.54) years old; in the observation group, there were 65 males and 45 females, with an age of (40.79±6.13) years old. The control group was given propofol + cis-atracurium anesthesia induction, and the observation group was given propofol + phenylephrine anesthesia induction. The anesthesia efficiency, postoperative recovery, and hemodynamics and heart rate (HR) at different time points were compared between the two groups. Independent sample t test and χ² test were used. Results　The effective rate of anesthesia in the observation group was 98.18% (108/110), which was higher than that in the control group [91.82% (101/110)], with a statistically significant difference (χ²=4.689, P=0.030). The systolic blood pressures (SBP) of the observation group after induction of anesthesia (T1), 5 min after laryngeal mask placement (T2), and 10 min after surgery (T3) were (108.45±9.45) mmHg (1 mmHg=0.133 kPa), (108.65±8.12) mmHg, and (109.65±7.45) mmHg, which were significantly lower than those of the control group [(116.56±9.26) mmHg, (126.59±8.45) mmHg, and (112.36±7.65) mmHg], the diastolic blood pressures (DBP) were (73.89±4.82) mmHg, (75.89±4.35) mmHg, and (76.59±7.56) mmHg, which were significantly higher than those of the control group [(72.01±4.67) mmHg, (73.12±4.95) mmHg, and (74.65±7.95) mmHg], the mean arterial pressures (MAP) were (75.64±5.15) mmHg, (82.63±7.23) mmHg, and (83.45±6.95) mmHg, which were significantly higher than those of the control group [(71.55±4.96) mmHg, (76.32±6.54) mmHg, and (80.12±5.84) mmHg], and the heart rates (HR) were (72.14±5.26) beats/min, (68.02±5.26) beats/min, and (70.26±5.49) beats/min, which were significantly lower than those of the control group [(79.45±5.64) beats/min, (85.31±5.64) beats/min, (75.84±5.95) beats/min], with statistically significant differences (all P<0.05). After surgery, the eye opening time and waking time of the observation group were (7.12±1.67) min and (5.15±1.21) min, and those of the control group were (9.46±2.35) min and (11.46±3.15) min, with statistically significant differences between the two groups (both P<0.05). No serious adverse reactions occurred in the two groups, and symptoms such as mild headache, decreased blood pressure, gastrointestinal discomfort, and respiratory depression gradually relieved after the disappearance of the pesticide effect. Conclusion　The use of propofol combined with phenylephrine for anesthesia induction is beneficial to improve the hemodynamics in patients undergoing ophthalmic general anesthesia surgery, to restore their postoperative consciousness, and to ensure the efficacy of intraoperative anesthesia, with acceptable safety of drug use.

Observation on the intervention effect of herb-partitioned moxibustion at the Shenque acupoint on people with yang deficiency

Shan Xingyu, Lai Shuting

2022, 28(16):  2343-2346.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.029

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Objective　To observe, evaluate, and analyze the clinical effect of herb-partitioned moxibustion at the Shenque acupoint on people with yang deficiency. Methods　From July 2019 to December 2021, 60 volunteers with yang-deficiency who finally completed the clinical study in the outpatient department of pre-treatment of Zengcheng Hospital of Traditional Chinese Medicine were selected as the research objects. The volunteers were divided into two groups according to the sequence of outpatient clinics with the random number table method. The control group consisted of 30 cases, 12 males and 18 females, aged (42.36±10.94) years; the observation group consisted of 30 cases, 11 males and 19 females, aged (41.86±10.54) years. The control group was treated with salt-partitioned moxibustion at the Shenque acupoint, and the observation group was treated with herb-partitioned moxibustion at the Shenque acupoint. The conversion scores before and after treatment and treatment effect were compared between the two groups. t test and χ² test were used for statistical analysis. Results　All 60 subjects completed the course of treatment successfully and completely. After treatment, the proportion of patients with non-yang-deficiency constitution and conversion score <30 points in the observation group was significantly higher than that in the control group [36.67% (11/30) vs. 6.67% (2/30)], with a statistically significant difference (χ²=7.954 2, P=0.001 3); the proportion of patients with yang-deficiency constitution and conversion score ≥40 points in the observation group was lower than that in the control group [30.00% (9/30) vs. 73.33% (22/30)], with a statistically significant difference (χ²=11.279 2, P=0.001 0). The conversion scores of the observation group and the control group after treatment were significantly lower than those before treatment, with statistically significant differences (t=13.291 4 and 7.081 5; both P<0.000 1); after treatment, the conversion score of the observation group was lower than that of the control group [(36.82±10.76) points vs. (47.75±11.76) points], with a statistically significant difference (t=3.755 8, P=0.000 4). After 3 courses of treatment, the total effective rate of the observation group was significantly higher than that of the control group [93.33% (28/30) vs. 40.00% (12/30)], with a statistically significant difference (χ²=19.200 0, P=0.001 5). Conclusion　Herb-partitioned moxibustion at the Shenque acupoint can significantly improve people with yang deficiency and the clinical efficacy, which provides a new treatment idea and an effective treatment method for the clinical treatment of people with yang deficiency.

Clinical analysis of amlodipine besylate combined with traditional Chinese medicine in the treatment of hypertension with hyperlipidemia

Huang Qingju, Guan Jibing, Wang Feng

2022, 28(16):  2347-2350.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.030

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Objective　To observe, evaluate, and analyze the clinical effect of amlodipine besylate combined with Jiangya Tiaozhi decoction in the treatment of hypertension complicated with hyperlipidemia. Methods　A total of 98 patients with hypertension and hyperlipidemia admitted to Community Health Service Center of Lishui Town, Nanhai District, Foshan City from January 2019 to January 2020 were simply randomly divided into two groups. In the control group, there were 29 males and 20 females, aged (59.15±8.97) years; there were 28 males and 21 females in the observation group, aged (58.69±8.73) years. The control group was treated with amlodipine besylate, and the observation group was treated with Jiangya Tiaozhi decoction on the basis of the control group. The clinical effects, heart rates and levels of systolic blood pressure, diastolic blood pressure, and blood lipids before treatment and after 12 weeks of treatment were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The total effective rate of the observation group was significantly higher than that of the control group [97.96% (48/49) vs. 77.55% (38/49)], with a statistically significant difference between the two groups (χ²=9.496 1, P=0.002 1). After 12 weeks of treatment, the heart rate, systolic blood pressure, and diastolic blood pressure in the two groups were significantly lower than those before treatment (all P<0.05), and the heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were significantly lower than those in the control group (t=4.742 6, 7.727 3, and 4.953 2; all P<0.000 1). After 12 weeks of treatment, the levels of triglyceride (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) in both groups were lower than those before treatment (all P<0.05), and those in the observation group were significantly lower than those in the control group (t=3.293 5, 4.725 3, and 5.673 4; all P<0.000 1). The levels of high density lipoprotein cholesterol (HDL-C) in the two groups after 12 weeks of treatment were higher than those before treatment (both P<0.05), and that in the observation group was significantly higher than that in the control group (t=4.250 3, P<0.000 1). Conclusion　Amlodipine besylate combined with traditional Chinese medicine in the treatment of hypertension with hyperlipidemia can significantly improve the clinical efficacy, effectively improve the patients' blood pressure and blood lipids, worthy of promotion and application in grassroots community health service centers.

Nursing Research

Summary of best evidences of dietary quality management in stage 5 CKD patients undergoing hemodialysis

Wang Jiao, Zhang Haiyan, Zhang Qi, Liu Hongchao, Hu Xueping

2022, 28(16):  2351-2355.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.031

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Objective　To search, evaluate, and summarize the best evidences for dietary quality management in stage 5 chronic kidney disease (CKD) patients undergoing hemodialysis. Methods　Cochrane Library, JBI Library, BMJ best practice, UpToDate, National Kidney Foundation, International Society of Renal Nutrition and Metabolism, The Renal Association, Italian Society of Nephrology, Chinese Society of Nephrology, PubMed, Web of Science, Springer, Medline, Elsevier, CNKI, Wanfang, and VIP were searched to collect the literatures. The search period was from the time of construction to Feb, 2021. Results　A total of 14 articles were enrolled, including 6 guidelines, 2 systematic reviews, 2 randomized controlled trials, and 4 expert consensus. Conclusions　The best evidences of dietary quality management for stage 5 CKD patients undergoing hemodialysis were summarized and specific recommendations were formed, which provided evidence-based nursing for clinical medical staff.

Nursing effect of acupoint application with raw rhubarb powder for patients with constipation after mixed hemorrhoid surgery

Huang Xiufeng, Liao Ping, Zhang Li

2022, 28(16):  2355-2358.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.032

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Objective　To observe, evaluate, and analyze the clinical effect of acupoint application with raw rhubarb powder in the treatment of patients with constipation after mixed hemorrhoid surgery. Methods　From December 2020 to May 2021, 66 patients with constipation after mixed hemorrhoid surgery in Department of Colorectal Surgery, Dongguan First Hospital Affiliated to Guangdong Medical University were selected and were divided into two groups according to the treatment methods. In the control group, there were 15 males and 18 females, aged (45.27±3.26) years, and they were given conventional intervention; in the observation group, there were 14 males and 19 females, aged (45.89±3.42) years, and they were given acupoint application with raw rhubarb powder on the basis of the control group. The clinical effects of the two groups after the intervention were compared. Independent sample t test and χ² test were used. Results　After 7 days of intervention, the total effective rate of the observation group was 93.93% (31/33), which was significantly higher than 75.76% (25/33) of the control group, with a statistically significant difference (χ²=4.243, P=0.039). The time of first defecation, duration of defecation, and interval of defecation in the observation group were significantly shorter than those in the control group (t=6.204, 5.418, and 5.109; all P<0.001). The proportion of severe defecation pain in the observation group was significantly lower than that in the control group [6.06% (2/33) vs. 24.24% (8/33)], with a statistically significant difference (χ²=4.243, P=0.039). Conclusions　Acupoint application with raw rhubarb powder has positive effect in the treatment of patients with constipation after mixed hemorrhoid surgery, which can effectively achieve the function of spontaneous defecation as soon as possible after surgery, significantly shorten the time of first defecation, duration of defecation, and interval of defecation, and prevent the occurrence of constipation, has high safety, and is worthy of vigorous clinical promotion and application.

Analysis on the effect of information handover in operating room

Huang Shijie, Chen Xiaoxia, Liu Xiaomin, Zhang Xinfang, Song Haijuan

2022, 28(16):  2359-2361.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.033

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Objective　To explore the advantages and disadvantages of the information handover process and written handover process. Methods　on 414 patients who underwent aortic dissection surgery in Heart Surgery Operating Room, Guangdong Provincial People's Hospital from January 2019 to December 2020. There were 357 males (86.2%) and 57 females (13.8%), aged (51.3±10.7) years. According to the ways of handover, they were divided into an experimental group (information handover) and a control group (written handover). There were 193 cases in the experimental group and 221 cases in the control group. The main observation indexes were the incidence of handover related problems, handover time, and telephone follow-up rate after handover. Independent sample t test, Mann-Whitney U test, and χ² test were used. Results　After the use of information handover mode, the incidence of handover related problems in the experimental group was lower than that in the control group [15.5% (30/193) vs. 26.7% (59/221)], and the handover time was shorter than that in the control group [2.5 (2.0, 3.2) min vs. 5.0 (4.2, 6.0) min], the telephone follow-up rate after handover was lower than that in the control group [13.0% (25/193) vs. 22.6% (50/221)], and there were statistically significant differences in the above indicators between the two groups (all P<0.05). Conclusion　The optimized information handover mode can reduce the handover related problems and telephone follow-up rate in operating room, shorten the handover time, and improve the handover efficiency.

Summary

Advances in treatment of Stanford type A aortic dissection

Li Guanqing, Chen Haisheng, Cheng Keluo, Guan Xiaoran, Zhu Ximeng, Yang Xia

2022, 28(16):  2362-2366.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.034

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Aortic dissection is a common cardiovascular surgical emergency with acute onset, rapid progress, easy postoperative complications, serious complications, and high operative mortality. Stanford classification is commonly used, and Stanford type A aortic dissection (TAAD) accounts for 70%-75% of all aortic dissections. The aortic dissection break can be located in the ascending aorta, aortic arch or descending aorta. At the same time, the dissection can also involve the aortic arch and descending aorta. In 1838, Penneck reported the first case of aortic dissection, which has been more than 100 years. Thanks to the rapid development of medical technology, the levels of diagnosis and treatment of aortic dissection have gradually improved, and the mortality of aortic dissection has decreased significantly after treatment compared with that before treatment. Over the years, various treatments for TAAD have emerged in endlessly. This paper reviews the progress of the treatment of Stanford TAAD.

Research progress of polymer used in siRNA delivery system

Wang Fuxi, Deng Hongtu, Wang Bin

2022, 28(16):  2366-2369.  DOI: 10.3760/cma.j.issn.1007-1245.2022.16.035

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Small interfering RNA (siRNA) has the effect of silencing target messenger RNA (mRNA) to inhibit the expressions of disease-related genes. Because of its high efficiency and specificity, siRNA has great potential as a gene drug, but it is easily inactivated by factors such as vascular barrier, endosomal escape, and RNase in vivo. Therefore, it is important to design efficient siRNA-loaded nanocarriers to deliver them to the target for the research of siRNA drug, while polymer nanocarriers are one of the current research hotspots. In this study, the research progress of polymer nanocarriers for siRNA drug delivery is reviewed.