Table of Content

15 September 2022, Volume 28 Issue 18

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Special Article

Impact of the COVID-19 pandemic on the number and proportion of outpatients in the pediatric internal medicine clinic of a tertiary hospital

Xie Wanhua, Yu Ying

2022, 28(18):  2517-2521.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.001

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Objective　COVID-19 exerts a huge impact on health services. The current study aimed to provide the data of impact of COVID-19 on the number and proportion of outpatients in the pediatric internal medicine clinic of a tertiary hospital. Methods　This cross-sectional study investigated the impact of the COVID-19 pandemic on the number and proportion of total hospital outpatients, pediatric internal department outpatients, and the top three clinics of pediatric internal department outpatients (pediatric internal general clinic, respiratory clinic, and digestive clinic) in Guangzhou Women and Children's Medical Center from January to April 2020, which were compared with those from January to April 2019. Independent sample t test and χ² test were used for statistical analysis. Results　Compared to the data during the same period in 2019, the number and the proportions of total hospital outpatients, pediatric internal department outpatients, pediatric internal general clinic, pediatric respiratory clinic, pediatric digestive clinic were significantly decreased (all P<0.05). The proportion of pediatric internal medicine department outpatients decreased from 47.92%-52.27% in 2019 to 20.74%-30.56% in 2020 (P<0.01). Conclusions　The number of total hospital outpatients, pediatric internal department outpatients, pediatric internal general clinic, pediatric internal respiratory clinic, and pediatric internal digestive clinic, and the corresponding proportions were decreased after the outbreak of COVID-19. These results might be related to promoting less gathering, keeping a certain social distance, less going out, wearing masks while going out, and frequent hand-washing, which is valuable for management decision-making and clinical measures.

Scientific Research

Clinical efficacy of electroacupuncture and acupoint injection in the treatment of sudden deafness

Yu Chaosheng, Yu Feng, Deng Haiyan, Li Junzheng, Huang Changjin, Li Hui

2022, 28(18):  2522-2527.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.002

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Objective　To compare the efficacies of electroacupuncture and acupoint injection in the treatment of sudden deafness. Methods　Using a randomized controlled prospective study method, 165 patients who met the inclusion criteria of sudden deafness were treated in the Department of Otolaryngology, Head, and Neck Surgery, Guangzhou Red Cross Hospital, Jinan University from April 2018 to January 2021, including 67 males and 98 females, aged (53.1±11.3) years. They were stratified and randomly divided into an electroacupuncture group, an acupoint group, and a control group. The electroacupuncture group was given electroacupuncture + drug treatment, the acupoint group was given acupoint injection + drug treatment, and the control group was only given drug treatment. The efficacy, hemorheology, cerebrovascular Doppler, auditory brainstem response, complications, and pain score were compared, and the possible mechanism was explored. Pearson's Chi-square test, analysis of covariance, and Mann-Whitney U test were used. Results　The total effective rate of the electroacupuncture group was 87.3% (48/55), that of the acupoint group was 67.3% (37/55), and that of the control group was 63.6% (35/55); Pearson's Chi-square test showed that the total effective rate of the electroacupuncture group was better than those of the acupoint group and the control group (both P<0.05). Hemorheological examination showed that the whole blood viscosity and plasma viscosity of the three groups were improved after treatment, and the pairwise comparison showed that those in the electroacupuncture group were better than those in the acupoint group and the control group (all P<0.05). Cerebrovascular Doppler examination showed that 45 cases in the electroacupuncture group were abnormal before treatment, 47 cases in the acupoint group, and 45 cases in the control group, including the increase or decrease of blood flow velocity, abnormal pulse index (PI), etc., 40 cases, 31 cases, and 28 cases were improved after treatment, with the improvement rates of 88.9%, 66.0%, and 62.2% respectively, and the pairwise comparison showed that the improvement rate of the electroacupuncture group was significantly better than those of the acupoint group and the control group (both P<0.05). The examination of auditory brainstem response showed that 49 cases in the electroacupuncture group were abnormal before treatment, 47 cases in the acupoint group, and 47 cases in the control group, 43 cases, 31 cases, and 30 cases were improved after treatment, with the improvement rates of 87.8%, 66.0%, and 63.8% respectively, and the pairwise comparison showed that the improvement rate of the electroacupuncture group was better than those of the acupoint group and the control group (both P<0.05). In terms of safety evaluation, there were no complications such as skin injury or infection in the electroacupuncture group and the acupoint group. The pain score suggested that the median scores of the electroacupuncture group and the acupoint group were 2 points, Mann Whitney U test suggested that the difference was not statistically significant (P>0.05). Conclusions　In the treatment of sudden deafness, electroacupuncture is better than acupoint injection and drug treatment, and it is safe and reliable. Its mechanism may be related to improving the blood viscosity, cerebral blood supply, and auditory nerve function.

Predictive value of lncRNA MYCNOS for major adverse cardiovascular events in patients with sepsis and acute heart failure

Liu Xiaofeng, Shao Bibo

2022, 28(18):  2528-2533.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.003

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Objective　To investigate the predictive value of long non-coding RNA MYCNOS (lncRNA MYCNOS) for major adverse cardiovascular events (MACE) in patients with sepsis and acute heart failure. Methods　One hundred and seventy-seven patients diagnosed with sepsis combined with acute heart failure in Huangshi Central Hospital, Edong Healthcare Group from March 2019 to January 2022 were selected, including 125 males and 52 females, aged (61.77±6.14) years, and all patients were followed up until February 1, 2022. The patients were divided into a MACE group and a non-MACE group according to whether MACE occurred during the follow-up. The relative expression level of lncRNA MYCNOS in the peripheral blood and other general clinical information were compared between the two groups, the risk factors for the occurrence of MACE in the patients with sepsis and acute heart failure were analyzed by Cox regression analysis, the correlations between lncRNA MYCNOS and risk factors were analyzed by Pearson correlation analysis, and the predictive value of lncRNA MYCNOS for MACE in the patients with sepsis and acute heart failure was evaluated by the receiver operating characteristic curve (ROC). Independent sample t test or rank sum test was used for the measurement data, and chi-square test was used for the count data. Results　MACE occurred during the follow-up in 32 patients. The proportion of chronic cardiac insufficiency and left ventricular ejection fraction (LVEF) of the MACE patients were lower than those of the non-MACE patients (both P<0.05), and the peripheral blood C-reactive protein (CRP) value, N-terminal pro-B-type brain natriuretic peptide (NTproBNP), ratio of neutrophil/lymphocyte (NLR), mechanical ventilation time, length of ICU stay, length of hospital stay, and relative level of lncRNA MYCNOS in the peripheral blood were higher than those of the non-MACE patients (all P<0.05). Multivariate Cox regression analysis showed that NLR (HR=1.360, 95%CI: 1.026-1.791, P=0.032) and lncRNA MYCNOS (HR=5.32, 95%CI: 1.421-19.930, P=0.013) were the influencing factors of MACE in patients with sepsis and acute heart failure. Correlation analysis showed that lncRNA MYCNOS was positively correlated with NLR (r=0.412, P<0.001). The ROC showed that the cut-off point of lncRNA MYCNOS in the diagnosis of MACE in patients with sepsis and acute heart failure was 1.829, and the area under the curve (AUC) was 0.976 (95%CI: 0.951-1.000). Conclusion　LncRNA MYCNOS is an independent predictor of the development of MACE in sepsis combined with acute heart failure.

Correlations between serum PTX3 and MMP-10 levels and severity of acute coronary syndrome 

Hu Caihong, Liu Cheng, Zhang Dongqiao, Lin Weiyong

2022, 28(18):  2534-2537.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.004

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Objective　To study the correlations between serum pentraxin 3 (PTX3) and matrix metalloproteinase 10 (MMP-10) levels and severity of acute coronary syndrome (ACS). Methods　The clinical data of 200 patients with ACS admitted to Emergency Department, Shenzhen Pingshan District People's Hospital from January 2019 to December 2021 were retrospectively analyzed. There were 65 cases of ST segment elevation myocardial infarction (STEMI), 70 cases of unstable angina pectoris (UAP), and 65 cases of non-ST segment elevation myocardial infarction (NSTEMI), and 60 normal healthy subjects were selected as the control group. There were 33 males and 32 females in the STEMI group, aged (56.92±4.66) years; there were 39 males and 26 females in the NSTEMI group, aged (56.73±5.04) years; there were 34 males and 36 females in the UAP group, aged (57.01±4.91) years; there were 30 males and 30 females in the control group, aged (57.64±3.89) years. Five ml of peripheral venous blood was drawn from the fasting for more than 8 hours, and the levels of triglyceride (TG), cardiac troponin I (cTnI), low-density lipoprotein cholesterol (LDL-C), and serum PTX3 and MMP-10 among all the subjects were detected and compared. The Gensini scores of the three ACS groups were compared and analyzed by Pearson correlation analysis, and the diagnostic efficacies of PTX3 and MMP-10 were compared. χ² test was used for the count data, and F test or independent sample t test was used for the measurement data. Results　The expression levels of cTnI, MMP-10, and PTX3 in the ACS patients were significantly higher than those in the normal healthy people (all P<0.05), and the expression levels of cTnI, MMP-10, and PTX3 in the STEMI group were significantly higher than those in the other three groups (all P<0.05). The Gensini score of the STEMI group was significantly higher than those of the NSTEMI group and the UAP group [(76.12±10.25) vs. (69.89±11.33) vs. (63.16±9.78)], and the Gensini score of the NSTEMI group was significantly higher than that of the UAP group (all P<0.05). Pearson correlation analysis showed that the expression levels of MMP-10 and PTX3 were positively correlated with Gensini score in the 200 ACS patients (r=0.232, P=0.022; r=0.144, P=0.031). The sensitivity and specificity of combined diagnosis of MMP-10+PTX3 were higher than those of MMP-10 or PTX3 alone, the positive predictive value was higher, and the area under the curve was larger (all P<0.05). Conclusion　The higher the expression of serum PTX3 and MMP-10, the more severe the symptoms of ACS patients, which is positively correlated, and the combination of PTX3 and MMP-10 is more effective as a diagnostic indicator.

EGFR gene mutation and clinicopathological features in 174 patients with early lung adenocarcinoma

Yan Chen, Xu Xiaoyan, Xu Xianwei, Yang Yulun, Yang Jinhua

2022, 28(18):  2538-2542.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.005

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Objective　To investigate the relationships between epidermal growth factor receptor (EGFR) gene mutation and clinicopathological features in early lung adenocarcinoma. Methods　A total of 54 patients with in situ lung adenocarcinoma and 120 patients with minimally invasive adenocarcinoma treated in Zhengzhou People's Hospital from January 2019 to December 2020 were selected as the research objects, including 54 males and 120 females, aged 25-79 years. The mutations of exon 18, 19, 20, and 21 of EGFR gene in the above tissues were detected by amplification refractory mutation system PCR (AMRS-PCR), and their relationships with clinicopathological characteristics were retrospectively studied. χ² test was used. Results　The total mutation rate of EGFR gene in the 174 samples was 58.6% (102/174), and mutations of exon 18, 19, 20, and 21 accounted for 4.9% (5/102), 27.5% (28/102), 3.0% (3/102), and 64.7% (66/102), respectively. The mutation rate of EGFR gene in female patients (64.2%, 77/120) was higher than that in male patients (46.3%, 25/54) (P=0.027), it was higher in patients without smoking history (64.7%, 77/119) than that in patients with smoking history (45.5%, 25/55) (P=0.017) , it was higher in patients with minimally invasive adenocarcinoma (65.0%, 78/120) than that in patients with in situ lung adenocarcinoma (44.4%, 24/54) (P=0.011), it was higher in patients with pure ground-glass lesions (59.8%, 67/112) and mixed ground-glass lesions (63.5%, 33/52) than that in patients with solid lesions (20.0%, 2/10) (P=0.035) , it was higher in patients with tumor diameter ≥1 cm (76.9%, 60/78) than that in patients with tumor diameter <1 cm (43.8%, 42/96) (P=0.001), but there was no significant correlation with age (P=0.804). Conclusions　In early lung adenocarcinoma, EGFR gene mutation is common in female patients, patients without smoking history, and patients with minimally invasive adenocarcinoma, pure ground-glass lesions, and tumor diameter ≥1 cm, and the mutation is mainly in exon 21 L858R. EGFR mutation plays an important role in the development and progression of early lung adenocarcinoma.

Risk factors of chronic gastritis and peptic ulcer in children in the Yellow River Delta area

Liu Yongjiao, Wang Lina, Zhang Xinshun, Xing Chaopin, Jia Xiuhong, Xie Qingzhi

2022, 28(18):  2542-2548.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.006

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Objective　To explore the risk factors of chronic gastritis (CG) and peptic ulcer (PU) in children in the Yellow River Delta area. Methods　A total of 542 children with CG and 92 children with PU were selected from Binzhou Medical University Hospital from January 2019 to December 2021 as experimental groups (CG group and PU group), and 260 healthy children were enrolled as a control group. A questionnaire-based survey was conducted for all children, and all risk factors were screened. The factors with P<0.2 in the univariate analysis were introduced into the logistic regression model, a multivariate regression analysis was conducted to calculate the odds ratio (OR) of each factor, and the risk factors were ranked according to the OR value from high to low. Independent sample t test was used for the measurement data, and chi-square test was used for the count data. Results　In the CG group, there were 283 males and 259 females, with an age of (8.506±3.482) years old; in the PU group, there were 42 males and 50 females, with an age of (8.728±3.803) years old; in the control group, there were 147 males and 113 females, with an age of (8.004±3.458) years old. According to the results of univariate analysis, 26 factors were identified for CG and 25 factors for PU. Among them, 13 pathogenic factors for CG in children were shown by multivariate logistic regression analysis. According to the OR value, the 13 factors in the descending order were "mental stress", "strenuous activity after eating", "parental anxiety", "single-parent family", "eating snacks", "eating meat", "overeating", "learning difficulties", "living in the countryside", "voracious eating", "family history", "Helicobacter pylori (Hp) infection (virulent type)", and "eating take-out food / small dining table" (all OR>1, P<0.05). Five protective factors were identified for CG, which were "eating fruits", "having their own bedrooms", "having their own tableware", "eating vegetables", and "adding supplement food at 4-6 months" (all OR<1, P<0.05). Eight risk factors were screened for PU, and the factors in the descending order were "Hp infection (virulent type)", "family history", "eating midnight snacks", "eating snacks", "living in the countryside", "eating take-out food / small dining table", "eating meat", and "Hp infection (weak virulence type)" (all OR>1, P<0.05); "having their own tableware" and "eating vegetables" were the protective factors (both OR<1, P<0.05). Conclusions　CG and PU in children are the results of multiple risk factors. In the Yellow River Delta area, psychological factors and diet-related factors are the main risk factors for CG in children, while Hp infection, family history, and diet-related factors are the main risk factors for PU in children.

Changes and clinical significance of serum BNP, PCT, and IL-6 in infants with Kawasaki disease aged 0-6 months

Gu Huiru

2022, 28(18):  2549-2552.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.007

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Objective　To study the expression levels of N-terminal B-type brain natriuretic peptide (NT-proBNP), procalcitonin (PCT), and interleukin-6 (IL-6) in serum of 0-6 months old infants with Kawasaki disease (KD) and their clinical significance. Methods　A total of 72 children with KD hospitalized in Children's Hospital Affiliated to Zhengzhou University from January 1, 2018 to December 31, 2020 were selected and were divided into a typical group (32 cases) and an atypical group (40 cases) according to the clinical manifestations and signs. And 30 non-KD children hospitalized with fever during the same period were selected as a control group. The level of NT-proBNP in serum was determined by electrochemiluminescence method, the level of PCT in serum was determined by immunofluorescence quantitative method, and the level of IL-6 in serum was determined by enzyme-linked immunosorbent assay. The changes of NT-proBNP, IL-6, and PCT in KD children were observed after intravenous injection of human gamma globulin. χ² test, one-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis H test were used. Results　The level of serum NT-proBNP in the control group was 537.25 (392.39, 724.95) pg/ml, which was lower than those in the typical group and the atypical group [1 340.00 (924.50, 3 050.00) pg/ml and 927.90 (585.50, 1 499.50) pg/ml], with statistically significant differences (both P<0.05), but there was no statistically significant difference between the typical group and the atypical group (P>0.05). The level of serum IL-6 in the control group was 24.90 (14.75, 33.13) pg/ml, which was lower than those in the typical group and the atypical group [98.07 (83.56, 151.15) pg/ml and 72.28 (55.35, 114.30) pg/ml], with statistically significant differences (both P<0.05), but there was no statistically significant difference between the typical group and the atypical group (P>0.05). There were statistically significant differences in the PCT level among the control group [0.96 (0.55, 2.13) μg/L], the atypical group [(0.24 (0.14, 0.50) μg/L], and the typical group [0.40 (0.29, 0.74) μg/L], with statistically significant differences (all P<0.05). After treatment, the levels of NT-proBNP and IL-6 in children with KD decreased compared with those before treatment [365.10 (205.73, 736.35) pg/ml vs. 1 168.50 (773.95, 1 972.25) pg/ml, 15.55 (5.83, 46.32) pg/ml vs. 91.70 (69.24, 136.67) pg/ml], with statistically significant differences (both P<0.05). There was no statistically significant difference in the level of PCT between before and after treatment [0.12 (0.07, 0.25) μg/L vs. 0.33 (0.17, 0.58) μg/L] (P>0.05). Conclusion　NT-proBNP, IL-6, and PCT can be used as important reference indexes for the diagnosis of KD in infants aged 0-6 months in the early stage of the disease.

Application effect of ultrasound-guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy

Guan Wenchuan, Sang Jing, Song Qiong

2022, 28(18):  2553-2557.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.008

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Objective  To explore the effect of ultrasound-guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy (CEA) and its effect on postoperative Mini-Mental State Examination (MMSE) score and incidence of adverse reactions. Methods  A total of 109 patients, with a male to female ratio of 66/43 and an age of (61.41±6.24) years old, who received CEA in Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2020 to April 2022 were retrospectively analyzed. According to different anesthesia plans, they were divided into a control group (54 cases) and an observation group (55 cases). The control group received preoperative general anesthesia, and the observation group received ultrasound-guided superficial cervical plexus block on the basis. The recovery [15-item Quality of Recovery Scale (QoR-15)], vital signs [heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP)], cognitive function (MMSE score), and incidence of adverse reactions were compared between the two groups. All the data were imported into SPSS 21.0 software for processing, and t test, χ² test, and Fisher exact probability method were used. Results  One day after surgery, the QoR-15 score of the observation group was (103.66±10.16), which was higher than that of the control group (91.86±10.12) (t=6.074, P<0.001). Before anesthesia, there were no statistically significant differences in the vital signs between the two groups (all P>0.05); after anesthesia, the vital signs of the two groups were decreased (all P<0.05); during skin cutting, the HR, SBP, and DBP levels in the observation group were (66.86±6.63) times/min, (125.55±9.54) mmHg (1 mmHg=0.133 kPa), and (66.91±9.31) mmHg, which were lower than those in the control group (all P<0.05). The MMSE score of the observation group was (25.66±1.08) 1 week after surgery, and there was no statistically significant difference compared with that of the control group (25.76±1.18) (t=0.462, P=0.645). The incidence of adverse reactions in the observation group was 21.81% (12/55), which was slightly higher than 18.51% (10/54) in the control group, but the difference was not statistically significant (P>0.05). Conclusion  General anesthesia combined with ultrasound-guided superficial cervical plexus block for patients receiving CEA has a higher effect, which can reduce the fluctuation of intraoperative vital signs, has a greater impact on the cognitive function, and can be applied in clinical practice.

Perioperative nursing care of total thoracoscopic surgery for hypertrophic obstructive cardiomyopathy

Song Haijuan, Xie Qing, Chen Xiaoxia, Guo Huiming, Lu Changqing, Liu Xiaomin

2022, 28(18):  2558-2561.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.009

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Objective　To summarize the perioperative nursing experiences of total thoracoscopic surgery for hypertrophic obstructive cardiomyopathy. Methods　A total of 36 patients with hypertrophic obstructive cardiomyopathy admitted to Guangdong Provincial People's Hospital from December 2018 to June 2021 were selected as the study subjects, including 20 males and 16 females, with an age of (54.6±10.2) years old, who underwent modified enlarged Morrow surgery via the mitral valve under thoracoscopy. The perioperative nursing plan was made, including preoperative condition assessment and respiratory function training, paying attention to psychological care, strengthening intraoperative condition monitoring, preparation for emergency treatment, and postoperative prevention of arrhythmia, respiratory tract and postural related peripheral nerve injury complications. The main outcome indexes included postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, postoperative hospitalization time, postoperative pulmonary infection, pulmonary edema, atelectasis, and other complications, and nursing satisfaction during hospitalization. Results　The 36 patients underwent complete thoracoscopic modified mitral valve Morrow surgery, with satisfactory results and no death during the perioperative period. The postoperative mechanical ventilation time was (24.0±21.2) h, the treatment time in ICU was (76.7±57.8) h, and the postoperative hospitalization time was (14.0±8.9) d. No postoperative complications such as pulmonary infection, pulmonary edema, atelectasis, or other complications occurred. The statistical results of nursing satisfaction questionnaire during hospitalization were satisfactory. Conclusion　Perioperative nursing strategies with scientific basis can exert the prospective nursing effect and family coordinated nursing effect, effectively prevent the complications, promote the early recovery, and improve the nursing satisfaction.

Effect of nursing intervention based on the ERAS concept on postoperative rehabilitation and prognosis in patients with glioma 

Zi Dongyan, Liu Zhen

2022, 28(18):  2562-2565.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.010

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Objective　To explore the impact of nursing intervention based on the concept of enhanced recovery after surgery (ERAS) on postoperative rehabilitation and prognosis in patients with glioma. Methods　A prospective study was conducted on 82 patients with glioma who received surgical treatment in Nanyang Second People's Hospital from May 2020 to August 2021. According to the random number table method, they were divided into two groups with 41 cases in each group. In the control group, there were 18 males and 23 females, with an age of (50.93±4.89) years old; there were 19 males and 22 females in the observation group, with an age of (51.24±5.37) years old. The control group was given routine nursing care, and the observation group was given nursing care based on the concept of ERAS, intervening until the patients were discharged from the hospital. The postoperative rehabilitation, health status, daily living ability, and complications were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The postoperative first defecation time, first getting out of bed time, urinary catheter removal time, pain duration, and hospital stay in the observation group were shorter than those in the control group [(2.36±0.65) d vs. (3.44±1.03) d, (1.32±0.55) d vs. (2.09±0.73) d, (7.47±1.05) h vs. (24.88±2.19) h, (1.97±0.30) d vs (3.09±1.14) d, (5.65±0.73) d vs (7.76±1.22) d], with statistically significant differences (t=5.678, 5.394, 45.900, 6.084, and 9.503; all P<0.001). Before surgery, there were no statistically significant differences in the Karnofsky Performance Status (KPS) score and modified Barthel index (MBI) score between the two groups (both P>0.05); 1 week after surgery, the KPS and MBI scores of the two groups were higher than those before surgery, with statistically significant differences (all P<0.001); 1 week after surgery, the KPS and MBI scores of the observation group were higher than those of the control group [(62.31±7.56) vs. (53.82±6.45), (71.65±10.39) vs. (60.78±7.20)], with statistically significant differences (t=5.470 and 5.506; both P<0.001). The total incidence of complications in the observation group was lower than that in the control group [4.88% (2/41) vs. 19.51% (8/41)], with a statistically significant difference (χ²=4.100, P=0.043). Conclusion　Nursing intervention based on the ERAS concept is helpful to reduce the occurrence of postoperative complications of glioma, promote the patients' rehabilitation, and improve their prognosis.

Application effect of early systematic rehabilitation training in coma patients with severe craniocerebral injury

Hua Daorui, Xin Qingzhao, Li Yingguang, Fu Guohui

2022, 28(18):  2566-2570.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.011

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Objective　To explore the application effect of early systematic rehabilitation training in coma patients with severe craniocerebral injury. Methods　A prospective study was conducted on 92 coma patients with severe craniocerebral injury admitted to Nanyang Central Hospital from January 2020 to January 2022, and they were divided into a control group and an observation group according to the random number table method, with 46 patients in each group. The control group [21 females and 25 males, aged (45.69±3.18) years] received routine nursing, the observation group [22 females and 24 males, aged (45.67±3.21) years] received early systematic rehabilitation training on the basis of routine nursing, and the intervention lasted for 1 week. The neurological function, daily living ability, motor function, complications, quality of life, and degree of nursing satisfaction were compared between the two groups. t test and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the scores of National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living Scale (ADL), Fugl-Meyer Motor Function Assessment (FMA), and Generic Quality of Life Inventory (GQOLI) between the two groups before intervention (all P>0.05). After intervention, the NIHSS score of the observation group was lower than that of the control group [(6.67±2.11) vs. (9.79±2.18)], and the ADL score of the observation group was higher than that of the control group [(76.89±5.36) vs. (65.95±5.32)], with statistically significant differences between the two groups (both P<0.001). After intervention, the upper and lower limb motor function scores of the observation group were (54.70±4.15) and (29.88±3.74), which were higher than those of the control group [(49.84±3.92) and (25.96±3.62)], with statistically significant differences (both P<0.001). The total incidence of complications in the observation group was lower than that in the control group [4.35% (2/46) vs. 17.39% (8/46)] (χ²=4.039, P=0.045). After intervention, the scores of social function, material life, physical function, and psychological function of the GQOLI in the observation group were higher than those in the control group [(74.48±5.21) vs. (67.75±5.52), (83.56±5.34) vs. (70.86±5.27), (72.53±6.15) vs. (66.50±6.13), (72.78±7.06) vs. (65.94±6.07)], and the scores of operation technique, nursing attitude, training guidance, and safety management of the nursing satisfaction degree in the observation group were higher than those in the control group [(82.97±3.35) vs. (80.63±3.21), (82.99±3.42) vs. (80.54±3.30), (82.94±3.53) vs. (80.57±3.36), (82.98±3.62) vs. (80.61±3.57)], with statistically significant differences (all P<0.05). Conclusion　Early systematic rehabilitation training can improve the neurological function and motor function in coma patients with severe craniocerebral injury, promote the improvement of daily living ability, reduce the occurrence of complications, and promote the improvement of quality of life, so as to obtain a higher nursing satisfaction degree.

Application of PBL oriented teaching mode in standardized ECMO training

Xu Yonghao, Sun Qingwen, Zhang Huijin, Li Ronghua, Kong Shaofeng, Chen Lihua, Liu Xiaoqing, Chen Sibei

2022, 28(18):  2571-2575.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.012

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Objective　To evaluate the effect of problem-based learning (PBL) oriented teaching mode in standardized extracorporeal membrane oxygenation (ECMO) training. Methods　A total of 97 trainees who join our ECMO special training courses were selected by the convenience sampling from September 2020 to March 2022, including 56 males and 41 females, with an age of (33.10±4.67) years old. The PBL oriented teaching mode was adopted in the standardized training courses of theoretical lectures, operation techniques, clinical ward rounds, etc. The trainees' performance before and after training was analyzed. Paired t test was used for statistical analysis. Results　Among them, 82.47% (80/97) of the trainees were from the general intensive care unit (ICU), the proportion of medical and nursing staff was nearly half, 87.62% (85/97) of the trainees had junior and intermediate titles, and 63.92% (62/97) of the trainees had 4-10 years of ICU work experience. The survey showed that most of the trainees hoped to achieve the requirements of independent ECMO preflushing and catheterization [96.91% (94/97)], ECMO transfer [88.66% (86/97)], and long-term operation management of ECMO [93.81% (91/97)] through the training. After 3 months of standardized training, the score of the final examination was significantly higher than that of the pre-training examination [(90.58±8.98) vs. (61.57±15.61)], with a statistically significant difference (t=15.664, P<0.001). Conclusion　PBL oriented teaching mode can effectively improve the effect of standardized ECMO training and is valuable for standardized ECMO training.

Discussion on teaching experiences of ultrasound medicine in traditional Chinese medicine colleges and universities under modern teaching mode

Cai Lishan, Zhuo Wenxing, Zhang Jianxing

2022, 28(18):  2576-2579.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.013

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In modern medicine, ultrasound medicine is becoming more and more important, with rapid development and knowledge updating, and its discipline is more practical and operational. However, there are still some deficiencies in students' mastery of basic western medicine disciplines in colleges and universities of Chinese medicine, therefore, it is the key to carry out clinical teaching. In the actual teaching process, diversified teaching methods should be adopted to promote students' ability to analyze and solve problems, adapt to changes, and cultivate clinical thinking, effectively improve the quality of teaching, and lay a good clinical foundation for medical students.

Drug treatment regimen for one case of pulmonary abscess caused by multiple anaerobic bacteria infection

Wu Tingting, Song Xiaobo, Zhang Yu, Zhang Yanli

2022, 28(18):  2579-2582.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.014

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Clinical pharmacists participated in the diagnosis and treatment process of a patient with pulmonary abscess caused by multiple anaerobic bacteria infection admitted to Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage) in February 2022, and assisted the clinicians to formulate the anti-infection plan. The patient was finally effectively controlled. This paper intends to improve the understanding on pulmonary abscess caused by rare anaerobes and summarize the clinical experiences through summarizing the clinical manifestations, imaging, pathology, pathogenic microorganisms, and other characteristics of the patient with pulmonary abscess and reviewing the relevant literatures.

Effect of laparoscopic radical prostatectomy on androgen level and incidence of postoperative urinary incontinence in patients with early prostate cancer 

Zhang Xiao, Sun Jian, Ding Xiqi

2022, 28(18):  2583-2586.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.015

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Objective　To investigate the androgen level and incidence of postoperative urinary incontinence in patients with early prostate cancer treated by laparoscopic radical prostatectomy. Methods　A total of 102 patients with early prostate cancer admitted to Affiliated Hospital of Jiangnan University from October 2020 to October 2022 were selected, and were divided into a conventional group (51 cases) and an observation group (51 cases) by the random number table. The age of the observation group was (56.85±10.26) years old, and that of the conventional group was (57.25±11.25) years old. The conventional group was treated with open radical prostatectomy, while the observation group was treated with laparoscopic radical prostatectomy. The surgery-related indicators, androgen (free testosterone and dihydrotestosterone) levels, and incidence of postoperative urinary incontinence 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　The intraoperative blood loss of the observation group was lower than that of the conventional group, and the operation time and postoperative extubation time of the observation group were shorter than those of the conventional group (all P<0.05). There were no statistically significant differences in the preoperative free testosterone and dihydrotestosterone levels between the two groups (both P>0.05); the levels of free testosterone and dihydrotestosterone in the two groups after surgery were lower than those before surgery, but those in the observation group were higher than those in the conventional group (all P<0.05). The incidence of postoperative urinary incontinence in the observation group [5.88% (3/51)] was lower than that in the conventional group [19.61% (10/51)] (P<0.05). Conclusion　Laparoscopic radical prostatectomy for early prostate cancer is helpful to improve the surgical indicators, increase the androgen level, and reduce the incidence of postoperative urinary incontinence, which is worth popularizing.

Effect observation of staged rehabilitation combined with therapeutic communication system intervention mode in patients undergoing gallbladder cancer surgery

Yi Yi, Zhang Jie, Wang Lei

2022, 28(18):  2586-2590.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.016

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Objective　To explore the effect of staged rehabilitation combined with therapeutic communication system (TCS) intervention mode in patients undergoing gallbladder cancer surgery. Methods　A prospective study was conducted on 106 patients who underwent gallbladder cancer surgery in Wuxi Second People's Hospital from March 2018 to February 2022, including 56 males and 50 females, aged (64.28±7.03) years, disease stage: 40 cases of stage T1b, 35 cases of stage T2, and 31 cases of stage T3. They were simply randomly divided into two groups. The control group received perioperative routine intervention, and the study group received staged rehabilitation combined with TCS intervention mode. The postoperative recovery, psychological states before and after intervention, change in quality of life, and incidence of postoperative complications were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The postoperative exhaust time, first out-of-bed time, and hospital stay of the study group were (23.72±2.08) h, (3.47±1.09) h, and (7.31±1.79) d, which were shorter than those of the control group (t=31.688, 10.531, and 9.224; all P<0.001). The score of physiological role in the study group 3 months after surgery was (68.25±7.06), the score of physical function was (71.28±7.28), the score of physical pain was (71.84±6.96), the score of social function was (75.22±7.59), the score of emotional function was (74.11±7.58), the score of mental health was (69.92±7.05), the score of vitality was (72.41±7.51), and the score of overall health was (70.04±7.25), which were higher than those in the control group (t=6.150, 6.474, 7.746, 6.009, 9.696, 5.922, 5.150, and 4.912; all P<0.001). The somatization score in the study group 3 months after surgery was (1.24±0.35), the compulsion score was (1.26±0.40), the anxiety score was (1.29±0.36), the depression score was (1.35±0.42), the terror score was (1.36±0.41), the paranoia score was (1.28±0.39), the hostility score was (1.30±0.38), the score of psychosis was (1.45±0.34), and the score of interpersonal sensitivity was (1.27±0.38), which were significantly lower than those in the control group (t=10.569, 12.243, 13.832, 13.490, 14.699, 12.994, 12.484, 8.838, and 11.347; all P<0.001). The total incidence of postoperative complications in the study group was 7.55% (4/53), which was lower than 32.08% (17/53) in the control group, with a statistically significant difference (χ²=10.036, P=0.002). Conclusion　Staged rehabilitation combined with TCS intervention mode applied in patients undergoing gallbladder cancer surgery can promote the postoperative recovery, improve their psychological state and quality of life, and reduce the incidence of complications.

Effect of fine nursing intervention on weight control of maintenance hemodialysis patients during the interdialytic period

Zhong Liping, Tang Jiamin, Su Caihong, Kuang Qiutian, Li Jialin, Su Yanyan

2022, 28(18):  2591-2595.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.017

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Objective　To observe the effect of fine nursing intervention on weight control of maintenance hemodialysis patients during the interdialytic period. Methods　A total of 92 patients receiving maintenance hemodialysis in People's Hospital of Huadu District from October 2019 to April 2021 were selected as the research objects, and they were divided into two groups by the random draw method. There were 27 males and 19 females in the research group, aged (59.72±12.24) years; there were 24 males and 22 females in the control group, aged (58.02±12.48) years. The control group received routine nursing methods, and the research group received fine nursing intervention on the basis of routine nursing for 6 months. The body weight control, complication rate, and nursing satisfaction were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Results　Before nursing intervention, there was no statistically significant difference in the body weight control between the two groups (P>0.05). After nursing intervention, the body weight control of the control group was less than 3% in 5 cases and >5% in 10 cases, the body weight control of the research group was less than 3% in 19 cases and >5% in 1 case, and those in the research group were significantly better than those in the control group, with statistically significant differences (both P<0.05). The incidences of complications during dialysis treatment in the research group were significantly lower than those in the control group (all P<0.05). The nursing satisfaction in the research group was significantly higher than that in the control group [97.82% (45/46) vs. 76.09% (34/46)], with a statistically significant difference between the two groups (χ²=6.907, P=0.009). Conclusion　Fine nursing intervention can effectively control the weight gain of maintenance hemodialysis patients during the interdialytic period, improve their quality of dialysis, and reduce the incidence of hemodialysis related complications, worthy of promotion.

Study on the transfer stress status and influencing factors among family members of ICU transferred patients 

Lu Peishan, Liao Youwan, Chen Ying, Gao Jing, Xie Yinjun

2022, 28(18):  2595-2599.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.018

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Objective　To identify the current situation and influencing factors of transfer stress among family members of ICU transferred patients. Methods　A cross-sectional approach was adopted in this study. A total of 120 family members of patients who were successfully transferred out of ICU after ICU treatment in Guangdong Provincial People's Hospital from April 2020 to February 2021 were selected as the research subjects, including 53 males and 67 females, aged (45.64±9.76) years. The general situation questionnaire and the Chinese version of ICU Patients' Family Migration Stress Scale were used to investigate their migration stress status. Univariate and multivariate analysis were used to analyze the factors affecting the migration stress among their family members after they were transferred out of ICU. Independent sample t test, analysis of variance, and multiple linear regression analysis were used for statistical analysis. Results　The total stress score of transferred ICU patients' family members was (54.25±6.31) points, and all items were (3.23±0.48) points. The dimensions with the highest and lowest item average scores were transfer preparation [(3.78±0.51) points] and transfer satisfaction [(2.75±0.31) points]. Univariate analysis showed that there were statistically significant differences in the score of transfer stress among different family members' gender, education level, and religious belief and patients' age, payment method, and ICU treatment time groups (all P<0.05). Multivariate analysis showed that the main factors affecting the family members' transfer stress were family members' education level and gender and patients' age and ICU treatment time (all P<0.05). Conclusions　The transfer stress level among family members of ICU transferred patients is above medium. While paying attention to the patients' recovery, nurses should also pay more attention to the family members' psychology, especially the family members of patients with younger age and longer ICU stay and female family members with lower education level, and give positive psychological counseling.

Study on hemodynamics, circulating endothelial cells, and safety in patients with acute myocardial infarction treated by intravenous thrombolysis with half-dose reteplase

Bai Yanping, Guo Yaya

2022, 28(18):  2600-2603.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.019

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Objective　To study the effects of intravenous thrombolysis with half-dose reteplase on hemodynamics, circulating endothelial cells (CEC), and safety in patients with acute myocardial infarction (AMI). Methods　A total of 90 AMI patients admitted to Affiliated Hospital of Yan 'an University from January 2020 to January 2022 were collected and were divided into a control group (urokinase treatment) and a study group (half-dose reteplase treatment) according to different treatment drugs, with 45 patients in each group. There were 27 males and 18 females in the study group, aged (57.12±8.47) years; there were 29 males and 16 females in the control group, aged (56.24±9.31) years. The incidences of cardiovascular events and complications in the two groups were detected. The revascularization rate was observed at 0.5 h, 1.0 h, 1.5 h, and 2.0 h after intervention. The echocardiography was used to detect the hemodynamic related indicators in the two groups, the Perooll method was used to separate and count the CEC, and the radioimmunoassay was used to detect the level of endothelin-1 (ET-1). t test, χ² test, and Fisher exact test were used. Results　There were no statistically significant differences in the levels of mean left atrial pressure (mLAP), mean pulmonary arterial pressure (mPAP), and malignant mitral valve prolapse (mMVP) between the two groups before treatment (all P>0.05), but the levels of mLAP, mPAP, and mMVP decreased after treatment (all P<0.05), and the decrease was more significant in the study group (all P<0.05). There were no statistically significant differences in the levels of ET-1 and CEC between the two groups before treatment (both P>0.05), but the levels of ET-1 and CEC in the two groups decreased after treatment (all P<0.05), and the decrease was more significant in the study group (both P<0.05). The revascularization rate in the study group was higher than that in the control group at different time points [26.67% (12/45) vs. 6.67% (3/45), 35.56% (16/45) vs. 13.33% (6/45), 60.00% (27/45) vs. 33.33% (15/45), 77.78% (35/45) vs. 51.11% (23/45); all P<0.05]. There were no statistically significant differences in the incidences of cardiovascular events and complications between the two groups (all P>0.05). Conclusion　Intravenous thrombolysis with half-dose reteplase can improve the hemodynamics in patients with AMI, improve the vascular endothelial cell injury by inhibiting CEC expression, and has a low complication rate, which is safe for the treatment of AMI.

Treatises

Differences between two different postural fixation methods and correlations of setup errors in radiotherapy for lung cancer

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

2022, 28(18):  2604-2608.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.020

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Objective　To explore the differences between two different postural fixation methods and the correlations of setup errors in radiotherapy for lung cancer. Methods　A retrospective analysis was performed on 108 patients with lung cancer who received radiotherapy in Sun Yat-sen University Cancer Center (84 males and 24 females, with a median age of 58 years old). All patients were fixed with negative pressure vacuum bags. According to the different fixation methods, they were divided into group A (52 cases with hands up) and group B (56 cases with hands down). The patients were scanned with airborne cone beam CT (CBCT) before treatment, and a total of 677 volume CT images were obtained. Six-dimensional registration was performed on the reconstructed and localized CT images, and the setup error values were recorded. The Kolmogorov-Smirnov Z nonparametric rank sum test was performed after taking the absolute value of the original data, and the correlation analysis was performed on the original data. Results　After taking the absolute value of the six-dimensional registration errors in group A and B, the error values in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were successively as follows: 0.20 (0.30) cm, 0.20 (0.20) cm, 0.20 (0.20) cm, and 0.20 (0.30) cm, 0.20 (0.20) cm, 0.10 (0.20) cm; after taking the absolute value of the original data, the nonparametric rank sum test analysis was performed: Z values in the SI, LR, and AP directions were 0.875, 0.844, and 2.164, respectively, and there was a statistically significant difference in the AP direction (P=0.007). The errors in the RTN, Pitch, and Roll directions of group A and B were 0.50 (0.60)°, 0.60 (0.70)°, 0.70 (0.90)°, and 0.50 (0.60)°, 0.80 (1.20)°, 0.60 (1.00)°; after taking the absolute value of the original data, the nonparametric rank sum test analysis was performed: Z values were 0.942, 2.645, and 2.356, respectively, and there were statistically significant differences in the Pitch and Roll directions (both P<0.05). The error in the SI direction was correlated with the errors in the LR, AP, and Pitch direction, the correlation coefficient r values were 0.209, 0.338, and 0.287, respectively, and the differences were statistically significant (all P<0.01). The error in the AP direction was correlated with the errors in the Pitch and Roll direction, the correlation coefficient r values were 0.150 and -0.086, respectively, and the differences were statistically significant (both P<0.05). Conclusions　Linear direction: the setup error of group B in the AP direction was smaller than that of group A; rotation direction: the setup error of group A in the Pitch direction was smaller than that of group B, and the setup error of group B in the Roll direction was smaller than that of group A. According to the correlation analysis, the error in the SI direction was low correlated with the errors in the LR and Pitch direction, and moderately correlated with the error in the AP direction; the error in the AP direction was low correlated with the error in the Pitch and Roll direction. In clinical application, different fixation methods could be selected according to the actual situation.

Study on the correlations between levels of Hcy, NSE, and IL-2 and cognitive function in acute phase of ischemic stroke

Chen Hua, Qian Wenjun, Zhang Xiaogang

2022, 28(18):  2608-2613.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.021

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Objective　To explore the correlations between levels of homocysteine (Hcy), neuron specific enolase (NSE), and interleukin-2 (IL-2) and cognitive function in the acute phase of ischemic stroke, and to provide guidance for reducing the cognitive impairment. Methods　A total of 122 patients with acute phase of ischemic stroke (1-2 weeks after the onset) who were accepted by Department of Neurology, Yantai Yeda Hospital from April 2019 to May 2021 were selected as the research objects, including 70 males and 52 females, aged (66.67±9.16) years. The Mini-mental State Examination (MMSE) was used to evaluate the cognitive function, the fasting venous blood was collected to detect the levels of Hcy, NSE, and IL-2, and the baseline data survey was completed. The baseline data and levels of Hcy, NSE, and IL-2 of different cognitive function groups were compared, Pearson correlation analysis was used to analyze the correlations between levels of Hcy, NSE, and IL-2 and MMSE score, and the linear regression analysis was used to analyze the influencing factors of MMSE score. χ² test was used for the count data, one-way analysis of variance was used for comparison of the measurement data among multiple groups, and LSD method was used for pairwise comparison of the measurement data. Results　The 122 cases of acute phase of ischemic stroke were divided into a normal cognitive function group (65 cases), a mild cognitive impairment group (33 cases), a moderate cognitive impairment group (15 cases), and a severe cognitive impairment group (9 cases) according to the MMSE score. The levels of Hcy, NSE, and IL-2 in the mild, moderate, and severe cognitive impairment group were higher than those in the normal cognitive function group, and the levels of Hcy and NSE in the severe cognitive impairment group were higher than those in the mild cognitive impairment group [(29.49±8.64) µmol/L vs. (23.33±5.17) µmol/L, (33.25±8.32) ng/L vs. (24.28±6.12) ng/L], with statistically significant differences (all P<0.05). The levels of Hcy, NSE, and IL-2 were negatively correlated with MMSE score (r=-0.577, -0.549, and -0.498; all P<0.001). The linear regression analysis showed that age, Hcy, NSE, and IL-2 were the influencing factors of MMSE score in patients with acute ischemic stroke (all P<0.001). Conclusions　The levels of Hcy, NSE, and IL-2 are negatively correlated with the MMSE score in patients with acute phase of ischemic stroke. Age, Hcy, NSE, and IL-2 are related to the cognitive impairment of ischemic stroke. It may help to reduce the cognitive impairment to regulate the levels of Hcy, NSE, and IL-2.

One case report of congenital mesenteric hernia with intestinal necrosis in children

Huang Yiwen, Huang Baisha, Cen Long, Li Peng, Le Shenglin

2022, 28(18):  2614-2616.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.022

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Congenital mesenteric hernia is a cracked hole in the hernia of hernias into the congenital membrane defect, which causes acute abdomen. The onset of the disease is acute and the progress is rapid. Intestinal strangulation, intestinal necrosis, shock, and even life-threatening can occur in a short time. This article aims to improve clinical doctors' understanding on the clinical characteristics of congenital mesenteric hernia in children based on the clinical data of a child with congenital mesenteric hernia and intestinal necrosis admitted to Guangdong Women and Children's Hospital in January 2021.

Clinical Research

Effects of rigid bronchoscopy combined with flexible bronchoscopy on respiratory mechanics and short-term prognosis in patients with malignant central airway stenosis

Xu Hongbang, Liu Li, Xiong Jie

2022, 28(18):  2617-2621.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.023

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Objective　To explore the effects of rigid bronchoscopy combined with flexible bronchoscopy on respiratory mechanics and short-term prognosis in patients with malignant central airway stenosis. Methods　A total of 80 patients with malignant central airway stenosis who were treated in Linyi Central Hospital were selected between September 2017 and September 2021, and they were divided into a conventional group and a combined group according to the ratio of 1:1, with 40 cases in each group. There were 28 males and 12 females in the conventional group, with an age of (57.65±9.10) years old; there were 30 males and 10 females in the combined group, with an age of (58.07±9.34) years old. The conventional group was treated with laryngoscopy and flexible bronchoscopy for interventional therapy, while the combined group was treated with rigid bronchoscopy and flexible bronchoscopy. After surgery, the clinical efficacy, shortness of breath index, Karnofsky Performance Status (KPS) score, degree of airway stenosis, vital capacity (VC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), arterial oxygen saturation (SaO₂), and incidence of complications were compared between the two groups. t test, χ² test, and Fisher exact test were used for statistical analysis. Results　There was no statistically significant difference in the total clinical effective rate between the combined group and the conventional group [97.50% (39/40) vs. 92.50% (37/40), χ²=1.053, P=0.305]. After surgery, the shortness of breath index and airway stenosis degree in the combined group were lower than those in the conventional group, and the KPS score was higher than that in the conventional group, with statistically significant differences between the two groups (all P<0.05). After surgery, there was no statistically significant difference in the PEF level between the two groups (P>0.05), and the levels of VC and FEV1 in the combined group were higher than those in the conventional group (both P<0.05). There were no statistically significant differences in the PaO₂, PaCO₂, and SaO₂ levels between the two groups before and after surgery (all P>0.05). The incidence of total complications in the combined group was lower than that in the conventional group [5% (5/40) vs. 30% (12/40)], but the difference was not statistically significant (χ²=3.660, P=0.056). Conclusions　Interventional therapy with rigid bronchoscopy and flexible bronchoscopy for patients with malignant central airway stenosis can effectively improve the degree of airway stenosis, restore the patency of airway function, and relieve the shortness of breath. Compared with the laryngoscopy, it has fewer complications and ensures better short-term prognosis.

Analysis of off-label use of omeprazole in pediatric outpatient department

Du Zhanying, Bi Tingting, Huang Fangyuan, Tang Qianjie

2022, 28(18):  2621-2624.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.024

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Objective　To analyze the off-label use of omeprazole in pediatric outpatient department in Guangdong Women and Children's Hospital, and to provide references for promoting clinical rational drug use. Method　Retrospective analysis method was used to collect and analyze the relevant medication data of omeprazole in pediatric outpatient department of Guangdong Women and Children's Hospital from March to October 2020. Results　A total of 930 prescriptions were collected and reviewed. The medication in these prescriptions were mainly taken orally (921 cases, 99.03%). Omeprazole was mainly used to treat acute and chronic gastritis [51.40% (478/930)], Helicobacter pylori infection [22.26% (207/930)], and dyspepsia [11.29% (105/930)]. There were 746 prescriptions for omeprazole combination medication with antibiotics (279 cases, 37.40%), gastric mucosal protectants (151 cases, 20.24%), probiotics (143 cases, 19.17%) and so on. Conclusions　Over indication medication and over applicable groups medication were main types of off-label use of omeprazole in pediatric outpatient department of Guangdong Women and Children's Hospital. The usage was basically conformed to the requirements of evidence-based medicine. These prescriptions including dosages, diagnoses, and medication regimens were judged to be reasonable. Doctors and pharmacists should work together to promote the rational use of omeprazole to ensure safe and effective drug use for children.

Case Report

1 case of hyperglycemia caused by PD-1 inhibitors

Chen Canyou, Meng Cuiping

2022, 28(18):  2625-2627.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.025

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The monoclonal antibody of programmed cell death protein 1 (PD-1) can block the interaction between PD-1 and its ligand, meanwhile also restore the anti-tumor immunity of T cells. PD-1 inhibitors are approved widely for the treatment of various types of malignancies. A large number of literatures have explained the excellent anti-tumor effects of Sindilizumab as well as some side effects. But it is very rare to see acute autoimmune insulin-dependent diabetes mellitus caused by PD-1 inhibitors in children. We now report one child with hyperglycemia after using PD-1 inhibitors in The First Affiliated Hospital of Guangdong Pharmaceutical University in November 2021.

A case of EGFR and ALK double mutations in non-small cell lung cancer

Song Pengcheng, Zhu Xiaona, Gao Xiangjing, Ju Sha, Li Fei

2022, 28(18):  2627-2630.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.026

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 The double mutation of epithelial growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) is a rare molecular event, with an incidence of 1.3%-1.6%. Its clinicopathological features are still unclear, and no final conclusion has yet been reached on its therapeutic strategies, especially on the selection of its targeted drugs. This paper reports the clinical data of one female lung adenocarcinoma patient with the coexistence of double mutations of EGFR and ALK admitted to Weihai Central Hospital in November 2021, and reviews the pertinent literatures, hoping to provide clinical references for the treatment of this kind of disease. Moreover, follow-up observation is performed for her treatment processes and adverse reactions during the treatment, and now it is reported as follows.

One case of secretory carcinoma of the parotid gland 

Xiang Longquan, Ma Tingting, Wang Hui, Zhang Xiaochang, Lin Fanzhong, Zhang Guanghai

2022, 28(18):  2630-2634.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.027

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 Mammary analogue secretory carcinoma (MASC) is a primary low-grade salivary gland tumor that has been first reported in 2010, also called as secretory carcinoma of the parotid gland. It has the same histological, immunophenotypic, and molecular characteristics as secretory breast cancer (SBC), and is often misdiagnosed as acinar cell carcinoma (AciCC) of the salivary gland. Due to the small number of patients with secretory carcinoma of the parotid gland, the guiding principles of diagnosis, treatment, and follow-up have not been standardized. Through report of a young male patient with primary secretory carcinoma of the parotid gland admitted to Jining First People's Hospital in May 2016, we aim to improve the understanding on this diagnosis and provide evidences for making standardized treatment options.

Nursing Research

Observation on the effect of trocar in arteriovenous graft for dialysis patients

Yang Qijun, Jin Huiping, Duan Xia, Wang Jianmei

2022, 28(18):  2635-2638.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.028

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Objective　To compare the effects of trocar and ordinary steel needle (16G) in arteriovenous graft (AVG) puncture for dialysis patients. Methods　From January 2018 to January 2021, 30 patients who received maintenance hemodialysis using AVG as vascular access in Blood Purification Centre, The Fifth Affiliated Hospital of Guangzhou Medical University were selected, including 18 males and 12 females, with an age of (40.2±5.1) years old. Trocar puncture was used in the first 10 times of each patient, and steel needle puncture was used in the last 10 times to establish a self-control. The pain sensation, elbow range of motion, arterial pressure and venous pressure, incidence of subcutaneous hematoma, and hemostasis time by finger pressing in the patients punctured with two kinds of puncture needles were observed. Independent sample t test was used for the measurement data, and Fisher exact probability method was used for the count data. Results　The arterial pressures in the patients punctured with trocar and steel needle (16G) were (-50±18) mmHg (1 mmHg=0.133 kPa) vs. (-70±22) mmHg after the blood flow velocity become steady and (-55±21) mmHg vs. (-76±23) mmHg 3 hours after dialysis, the arterial pressures were (105±15) mmHg vs. (140±22) mmHg and (108±16) mmHg vs. (145±23) mmHg, and the differences were statistically significant (all P<0.05). There were statistically significant differences in the elbow range of motion [(2.33±0.61) vs. (1.25±0.53)] and hemostasis time by finger pressing [(7.08±2.11) min vs. (12.12±3.15) min] between the patients punctured with trocar and steel needle (16G) (both P<0.05); there was no statistically significant difference in the pain perception during puncture (P>0.05). Conclusion　The use of trocar for AVG puncture for hemodialysis treatment can improve the patients' comfort and safety, obtain better blood flow and vascular patency, reduce the incidence of subcutaneous hematoma and long-term complications, thus improve the quality of life.

Application of PEWS combined with graded nursing model in children with acute febrile convulsion

Yan Keke, Liu Zhao, Xu Yahao

2022, 28(18):  2638-2641.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.029

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分级护理；儿童早期预警评分；高热惊厥；护理满意度

Investigation and analysis of the current situation of standardized use of eye drops in patients with keratopathy

Zhai Xiangjuan, Li Chun, Li Xia

2022, 28(18):  2642-2647.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.030

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Objective　To investigate the current situation of standardized use of eye drops in patients with keratopathy, and to provide guidance for health education of the correct use of eye drops. Methods　From August 2021 to February 2022, 346 cases of keratopathy in the ophthalmology ward of Jinan Second People's Hospital were selected as the survey subjects. One trained ophthalmological nurse observed the use of eye drops before the patients received relevant education on the use of eye drops, and evaluated the standardization of eye drops instillation behaviors. The relevant perceptions of standardized use of eye drops in patients with keratopathy were investigated by the Eye Drops Standardized Use Cognition Questionnaire designed by the ophthalmology ward of Jinan Second People's Hospital. Results　Among the 346 patients, 156 (45.09%) were males and 190 (54.91%) were females; there were 36 cases (10.40%) ≤ 30 years old, 32 cases (9.25%) over 30-40 years old, 47 cases (13.58%) over 40-50 years old, 87 cases (25.14%) over 50-60 years old, 94 cases (27.17%) over 60-70 years old, and 50 cases (14.45%) over 70 years old. The specialist nurse observed 346 cases of keratopathy using eye drops once and found that 43.93% (152/346) of the patients did not wash their hands before instilling the eye drops, 41.53% (49/118) of the patients did not shake the suspension eye drops well, 41.62% (144/346) of the patients did not choose the correct supine head back position when instilling the eye drops, 43.93% (152/346) of the patients did not look towards the top of their heads when instilling the eye drops, 43.06% (149/346) of the patients had direct contact with the eyeballs, 53.47% (185/346) of the patients had contact between the bottle mouth and the eyelash during instillation, 63.29% (219/346) of the patients did not press the nasolacrimal tube when instilling the eye drops, only 27.27% (42/154) of the patients correctly chose to wipe with tissues after the eye drops overflowed, 36.13% (125/346) of the patients rubbed and pressed their eyes immediately after instillation, and 69.08% (239/346) of the patients did not perform the correct behaviors of pulling the eyelid and closing the eye for more than 1 min after instillation. The questionnaire survey showed that 34.97% (121/346) of the 346 patients believed that the interval between two or more eye drops was more than 10 min, 53.18% (184/346) of the patients believed that the eye drops should take into account the temperature and light, and should be properly stored according to the instructions, 56.36% (195/346) of the patients believed that the frequency of instilling the eye drops should be according to the doctor's recommendation or the instruction manual, 55.49% (192/346) of the patients believed that the shelf life of eye drops should be paid attention to after opening, 56.07% (194/346) of the patients believed that the less irritating ones should be dropped first when two or more kinds of eye drops were infused, 58.96% (204/346) of the patients believed that the dosage of eye drops was 1-2 drops each time, 73.41% (254/346) of the patients believed that immediate drug withdrawal/seeking medical advices was required when abnormal symptoms occurred after the eye drops used, 73.70% (255/346) of the patients believed that the eye drops should be discontinued immediately when the color changed or became cloudy, 47.40% (164/346) of the patients believed that there was no need to restrict diet during the use of eye drops, 52.60% (182/346) of the patients believed that the intake of certain foods should be restricted according to the instructions or doctor's orders during the use of eye drops, and only 56.36% (195/346) of the patients read the instructions before using the eye drops. Conclusion　The standardized use behaviors and cognition of eye drops in patients with keratopathy are not ideal, and ophthalmological nurses should pay attention to the relevant education on the use of eye drops to promote the standardized use of eye drops.

Efficacy of graded intraocular pressure management on intraocular pressure management after surgery for primary angle closure glaucoma

Li Qun, Shu Xiangwen, Ji Yongjing

2022, 28(18):  2647-2651.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.031

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Objective　To explore the efficacy of graded intraocular pressure management on intraocular pressure management after surgery for primary angle closure glaucoma (PACG). Methods　The type of study was a prospective controlled study. Ninety-six patients with PACG who underwent surgery in Jinan Second People's Hospital from January 2020 to October 2021 were divided into a control group and a study group by the random number table method, with 48 cases in each group. The control group included 19 males and 29 females, with an age of (58.95±7.54) years old; the study group included 22 males and 26 females, with an age of (59.40±7.82) years old. The control group was given routine intraocular pressure management after surgery; the study group was given graded intraocular pressure management on the basis of non-pharmacologic intraocular pressure control strategies. The goal of intraocular pressure management was set as follows: compared with the baseline value before discharge, the increase rate was less than 20.0% or the absolute value of intraocular pressure was less than 18 mmHg (1 mmHg=0.133 kPa), without progression of visual field defects; the changes of intraocular pressure and progression of visual field defects were determined by follow-up, and the goal of graded intraocular pressure management was achieved by drugs. The intraocular pressures, visual acuity, and visual field defect degrees at baseline and 1, 3, and 6 months after surgery were compared between the two groups, and whether the intraocular pressure, visual acuity, and visual field defect degree were affected by the intervention method were analyzed. The measurement data were analyzed by independent sample t test or repeated-measures analysis of variance, and the count data were analyzed by χ² test. Results　The intraocular pressure of the study group was lower than that of the control group months after surgery [(15.04±2.97) mmHg vs. (16.48±3.39) mmHg], with a statistically significant difference (t=2.214, P=0.029), the visual acuity was higher than that of the control group [(0.59±0.14) vs. (0.51±0.16)], with a statistically significant difference (t=2.607, P=0.011), and the visual field defect degree of the study group was lower than the control group [(-4.32±0.66) dB vs. (-4.69±0.72) dB], with a statistically significant difference (t=2.625, P=0.010). Conclusion　Graded intraocular pressure management can effectively reduce the postoperative intraocular pressure level in PACG patients, and reduce the degrees of visual acuity loss and visual field defect.

Summary

Current status of researches on assessment of energy expenditure in critical patients

Feng Jing, Zhu Youfeng

2022, 28(18):  2652-2655.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.032

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Energy expenditure consists of basal energy expenditure, diet-induced thermogenesis, and physical activity. In intensive care units, it is often necessary to determine patients' energy needs by estimating the energy expenditure. Energy expenditure is also useful in understanding the metabolic impacts of patients' disease states and interventions. Clinically, the commonly used methods are indirect calorimetry, prediction equation, carbon dioxide production, and thermodilution measurement. The purpose of this review is to examine relevant methods for estimating energy expenditure in critical patients starting from clinical studies, and to discuss the benefits and limitations of each method and practical considerations for its use.

A brief description on the origins of pulmonary embolism emboli

Zhou Qi, Zhang Xiaochen, Meng Xiaofei, Zhang Qingtan

2022, 28(18):  2655-2659.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.033

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Pulmonary embolism (PE) is a common disease found in clinical practices characterized by high mortality, rapid onset, and rapid progression, making it a major health problem worldwide. The sources of pulmonary emboli are diverse and the pathogenesis is complex. PE with different embolic types has different pathogenesis. In particular, nonthrombotic PE is less common than thrombotic PE and prone to being clinically left undiagnosed and misdiagnosed. On top of that, its pathogenesis also remains unclear. Apart from mechanical obstruction, embolic properties may also play a part, which makes timely and accurate diagnoses much harder for clinicians to pull off. On this basis, this paper briefly reviews the embolic sources and pathogenesis of PE, so as to provide clinical references for the early prevention and etiology analysis of PE.

Research progress of hemoglobin oxygen carriers in increasing the therapeutic effect of tumors

Yang Xiaoqian, Chen Shaoshui

2022, 28(18):  2659-2663.  DOI: 10.3760/cma.j.issn.1007-1245.2022.18.034

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The hypoxic microenvironment formed by the abnormal proliferation of tumor cells leads to the unsatisfactory effect of various anti-cancer treatments, which accelerates the malignant progression and increases the metastasis. In solid tumors, adequate O₂ supply is crucial to improving the sensitivity of antitumor therapy. Hemoglobin oxygen carriers (HBOCs) with oxygen-carrying function can effectively alleviate the tumor hypoxia and have achieved good results in combination with a variety of current clinical tumor treatment methods. This paper reviews the research progress of HBOCs in recent 5 years and their application in alleviating the tumor hypoxia and increasing the curative effect of tumor treatment, to provide a reference for clinical tumor treatment.