Table of Content

15 November 2022, Volume 28 Issue 22

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Scientific Research

3D导板引导下微种植支抗精准植入的应用研究

Zhu Fangyong, Xue Dai, Xu Yanhua, Gao Yufeng, Wu Xiangbing

2022, 28(22):  3109-3112.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.001

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Objective　To design a computer navigation and establish a 3D printing system for precise implantation of micro-implant anchorage, and to study the accuracy of the technology. Methods　A total of 15 patients (30 microimplants) who required microimplant implantation and were admitted to Department of Stomatology, Affiliated Hospital of Jiangnan University from November 2020 to November 2021 were selected, including 6 males and 9 females, aged (17.11±6.28) years. Before surgery, the medical digital imaging and communication (DICOM) file of cone beam CT (CBCT) and the STL file scanned by the model were imported into the 3 Shape Dental System software. Relevant data fitting and matching operations needed to be processed to design the 3D guide plate. Assist implantation method was used intraoperatively, and postoperative CT was used to evaluate the position and implantation angle of micro-implant anchorage. Compared with the original design, paired t test was used. Results　The feasibility of precise implantation method of micro-implant anchorage guided by 3D guide plate was determined, and the production process was designed. CBCT data before and after microimplant implantation were compared; the meandeviations of neck and root from the original design were (0.13±0.40) mm and (0.21±0.60) mm, respectively, and the mean deviation of angle was (1.15±3.21)° in the mesial-distal direction and (1.25±3.71)°in the buccal-lingual direction respectively, showing no statistically significant differences (all P>0.05). There were 26 grade Ⅰ microimplants and 4 grade Ⅱ microimplants, without grade Ⅲ microimplant. No loosening of microimplants was recorded 1 and 3 months after surgery. Conclusions　Microimplant implantation is more accurate under the guidance of 3D guide plate. This technology can achieve accurate positioning, thus ensuring the safety, stability, and success rate after implantation.

Correlations between fibrinogen and thromboelastogram (K value, α angle) and complex lesions of coronary artery in the elderly with ACS

Yang Xiaoyun, Shen Xiaozhu, Zhao Xiaofei, Xie Chunhui, Zhao Jinyan, Hu Guangyun

2022, 28(22):  3113-3117.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.002

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Objective　To investigate the correlations between fibrinogen (Fib) and thromboelastogram (TEG) (K value, α angle) and complex coronary artery lesions in elderly patients with acute coronary syndrome (ACS). Methods　A total of 183 elderly patients with ACS confirmed by coronary angiography admitted to The Second People's Hospital of Lianyungang City from June 2018 to June 2021 were enrolled in this study. According to the degree of involved coronary artery lesions, they were divided into a complex lesion group (111 cases) and a uncomplex lesion group (72 cases), and sixty elderly patients without coronary heart disease excluded by coronary angiography during the same period were selected as the control group. The Fib and TEG (K value, α angle) were compared among the three groups. One-way analysis of variance, Kruskall-Wallis test, χ² test, binary logistic regression analysis, and receiver operating characteristic curve (ROC) were used for statistical analysis. Results　The Fib level of the complex lesion group [(4.23±1.05) g/L] was significantly higher than that in the uncomplex lesion group [(3.84±0.71) g/L] and the control group [(3.76±0.81) g/L] (F=2.530, P=0.012). The TEG (K value) of the complex lesion group [(2.18±0.42) min] was significantly lower than that in the uncomplex lesion group [(2.32±0.59) min] and the control group [(2.41±0.74) min] (F=2.130, P=0.036). Binary logistic regression analysis showed that Fib level was a risk factor for complex coronary artery lesions in elderly ACS patients (OR=2.023, P=0.015), and TEG (K value) was a protective factor for complex coronary artery lesions (OR=0.591, P=0.018). ROC analysis indicated that the area under the curve predicted by Fib combined with TEG (K value) for complex coronary artery lesions in elderly ACS patients was 0.756, the sensitivity and specificity were 76.68% and 63.52%, the optimal cut-off values were 4.67 g/L and 2.07 min, respectively. Conclusions　Fib and TEG (K value) at admission are not only associated with, but also show predictive values for complex coronary artery lesions in elderly ACS patients. Fib is a risk factor for complex coronary artery lesions in elderly ACS patients, while TEG (K value) is a protective factor.

Effects of etomidate on cognitive function and oxidative stress in Alzheimer's disease mice by regulating MAPK/ERK signaling pathway

Wang Binyan, Liu Aifen, Sun Fengxian

2022, 28(22):  3118-3123.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.003

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Objective　To investigate the effects of etomidate on cognitive function and oxidative stress in Alzheimer's disease mice by regulating mitogen-activated protein kinase (MAPK) / extracellular signal-regulated kinase (ERK) signaling pathway. Methods　The study was conduct from May 2020 to September 2021.In this study, fifty APP/PS1 transgenic mice were divided into a model group, low, medium, and high dose of etomidate groups, and a positive control group, ten SPF grade C57BL/6 mice were used as control. Among them, the low, medium, and high dose of etomidate groups were given gavage with 1.0, 2.5, and 5.0 mg/kg of etomidate, the positive control group was given gavage with 10 mg/kg of donepezil hydrochloride, and the model group and control group were given gavage with an equal volume of normal saline, 1 time/d, for 30 d. The Morris water maze test was used to observe the learning and memory abilities of the mice, and the nerve injury score and brain tissue water content of the mice were measured; Western blot was used to detect the expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-10, IL-1β, and MAPK/ERK signaling pathway-related proteins in mouse brain tissue; enzyme-linked immunosorbent assay (ELISA) was used to detect the activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) and the content of malondialdehyde (MDA) in mouse brain tissue. One-way analysis of variance was used to compare the measurement data among multiple groups, and LSD-t test was used for further pairwise comparison. Results　Compared with those of the control group, the escape latency of the model group was significantly prolonged, the number of cross-platforms, the platform area stay distance, and the activities of SOD, CAT, and GSH-Px were decreased, the nerve injury score, brain tissue water content, and MDA content were increased, the protein expressions of TNF-α, IL-10, and IL-1β were up-regulated, and the protein expressions of phosphorylated extracellular signal-regulated kinase (p-ERK) 1/2 and p-p38 were down-regulated (all P<0.05). Compared with those of the model group, the escape latency of the low, medium, and high dose of etomidate groups were significantly shortened, the numbers of cross-platform, platform area stay distances, and activities of SOD, CAT, and GSH-Px were increased, the nerve injury scores, brain tissue water contents, and MDA contents were decreased, the protein expressions of TNF-α, IL-10, and IL-1β were down-regulated, and the protein expressions of p-ERK1/2 and p-p38 were up-regulated (all P<0.05). Conclusion　Etomidate may improve the cognitive function in Alzheimer's disease mice by increasing MAPK/ERK signaling pathway, and reduce the oxidative stress and inflammatory response in mouse brain tissue.

A survey on the needs on premature infants nursing and health knowledge in advanced maternal age woman

Lyu Panpan, Liu Fang, Wang Xin, Geng Limeng, Liu Congcong

2022, 28(22):  3124-3128.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.004

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Objective　To study the main concerns and urgent needs of advanced maternal age woman in the process of raising preterm infants. Methods　A total of 356 premature infants born by advanced maternal age woman who visited the Department of Children Health Care, Binzhou Medical University Hospital from June 2018 to October 2019 and established archives were selected as the research subjects. The age of premature infants who first visited the hospital was from birth to three months old. The survey was conducted on the parents of premature infants who were admitted to the hospital by means of on-the-spot questioning and recording, and the survey results were analyzed. Results　In the process of caring for premature infants, the main contents and urgent needs of knowledge in advanced maternal age woman were most daily nursing measures, common exception handling methods, and vitamin supplement and nutrient deficiency, accounting for 89.89% (320/356), 86.24% (307/356), and 81.18% (289/356), respectively. The parents of early preterm infants mainly paid attention to medication guidance, vaccination knowledge, and defecation, accounting for 98.31% (58/59), 96.61% (57/59), and 96.61% (57/59), respectively; the parents of late preterm infants mainly paid attention to daily nursing measures and common exception handling methods, accounting for 88.89% (264/297) and 84.85% (252/297), respectively. The first-child parents mainly paid attention to daily nursing measures, maternal dietary attention, and defecation problems, accounting for 95.45% (21/22), 86.36% (19/22), and 86.36% (19/22), respectively; the second-child and above parents mainly paid attention to daily nursing measures, common exception handling methods, and vitamin supplement and nutrient deficiency, accounting for 89.52% (299/334), 86.83% (290/334), and 81.74% (273/334), respectively. Conclusions　The main contents and knowledge needs in advanced maternal age woman in the process of raising preterm infants are urgent. The needs of knowledge are different with different gestational weeks and parity of preterm infants, and a set of routine and targeted guidance program is needed.

Value of neutrophil CD64 index combined with MNA-SF nutrition score in predicting the prognosis of elderly patients with community-acquired pneumonia

Liao Jingxian, Shen Xiaozhu, Miao Lei

2022, 28(22):  3129-3134.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.005

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Objective　To investigate the prognostic value of neutrophil CD64 index combined with Mini Nutrition Assessment Short Form (MNA-SF) score in elderly patients with community-acquired pneumonia. Methods　A total of 116 patients over 60 years old who were hospitalized and diagnosed with community-acquired pneumonia in Department of Geriatric Medicine, The Second People's Hospital of Lianyungang from January 2020 to December 2021 were selected as the research objects. The MNA-SF nutritional score on admission and C-reactive protein (CRP) and neutrophil CD64 index on the first and third day after admission were recorded. According to the severity of pneumonia, the patients were divided into a severe pneumonia group and a common pneumonia group. In the severe pneumonia group, there were 26 males and 17 females, with an age of (84.02±6.86) years old; there were 41 males and 32 females in the common pneumonia group, with an age of (81.89±8.92) years old. At the same time, they were divided into a death group and a survival group according to the 28-day clinical outcome. There were 11 males and 11 females in the death group, with an age of (85.64±6.18) years old; there were 56 males and 38 females in the survival group, with an age of (81.99±8.54) years old. t test, rank sum test, and chi-square test were used. Results　There were statistically significant differences in the Charlson comorbidibility index [(3.47±1.14) vs. (2.19±1.15)], MNA-SF score [(6.33±2.00) vs. (8.74±2.87)], and white blood cell count (WBC) [(13.64±5.89) ×10⁹/L vs. (9.67±4.08) ×10⁹/L, (11.91±5.76) ×10⁹/L vs. (7.98±2.38) ×10⁹/L], CRP [107.14 (72.06, 165.27) mg/L vs. 50.87 (22.98, 91.13) mg/L, 67.93 (36.99, 111.20) mg/L vs. 16.80 (11.40, 26.06) mg/L], and CD64 index [3.11 (1.78, 5.40) vs. 1.27 (1.14, 2.33), 1.80 (1.14, 3.15) vs. 1.03 (0.69, 1.30)] on the first and third day after admission between the severe pneumonia group and the common pneumonia group (all P<0.05). Among the 116 cases, 22 cases died, with a mortality rate of 18.97%. Compared with those in the survival group, the death group had a higher Charlson comorbidity index and a lower MNA-SF score, with statistically significant differences between the two groups (both P<0.05); there were statistically significant differences in the WBC, CRP, and CD64 index on the first and third day after admission between the two groups (all P<0.05). The areas under the curve (AUC) of CRP, CD64 index, and WBC in predicting prognosis were higher on the third day than those on the first day. The AUC of CRP d1+CD64 index d1+WBC d1+MNA-SF score in predicting prognosis was 0.909, the sensitivity was 95.5%, and the specificity was 72.9%; the AUC of CRP d3+CD64 index d3+WBC d3+MNA-SF score was 0.963, the sensitivity was 95.5%, and the specificity was 85.9%. Logistic regression analysis showed that malnutrition, CRP d3, and CD64 index d1 were risk factors for death in elderly patients with community-acquired pneumonia (all P<0.05). The survival curve (K-M curve) analysis showed that the 28-day survival rate in patients with CD64 index d1 <1.55 was significantly higher than that in patients with CD64 index d1 ≥1.55, and the 28-day survival rate of the two groups was statistically significant (96.55% vs. 65.52%, χ²=18.027, P<0.001). Conclusion　Neutrophil CD64 index combined with MNA-SF nutritional score can guide the clinical treatment and predict the prognosis of elderly patients with community-acquired pneumonia.

Study of immune mechanism of regulatory T cells in abnormal clones of paroxysmal nocturnal hemoglobinuria

Lin Ying, Zhang Rongdong, Chen Qi, Chen Renli

2022, 28(22):  3135-3139.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.006

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Objective　To determine the change of regulatory T cells in paroxysmal nocturnal hemoglobinuria (PNH) patients and analyze its probable immune mechanism in abnormal clones of PNH. Methods　Thirty-one PNH patients admitted to Department of Hematology, Ningde Municipal Hospital of Ningde Normal University from January 2018 to January 2022 were selected as a case group, including fifteen cases of episodic PNH (10 males and 5 females, aged 23-69 years) and sixteen cases of aplastic anemia-paroxysmal nocturnal hemoglobinuria (AA-PNH) (11 males and 5 females, aged 20-68 years). Twenty-five healthy subjects were selected as a control group (14 males and 11 females, aged 19-56 years). Whole blood samples in subgroups were assayed by flow cytometer to detect T cells, Th lymphocyte subsets, and the numbers of CD4⁺CD25⁺ regulatory T cells and Th3 cells. The expression levels of transforming growth factor-β (TGF-β) and forkhead box P3 (FOXP3) were analyzed by real-time quantitative polymerase chain reaction (RT-PCR). Enzyme-linked immunosorbent assay (ELISA) kits were used to detect the plasma concentrations of TGF-β and interleukin-10 (IL-10). F test, Bonferroni method, H test, and chi-square test were used. Results　The number of CD4⁺/CD3⁺ cells and the CD4⁺/CD8⁺ ratio in the AA-PNH group were lower than those in the control group [(44.55±11.91)% vs. (57.61±6.90)%, 0.66 (0.38, 1.26) vs. 1.32 (0.86, 1.64)], but the CD8⁺/CD3⁺ cells were higher than those in the control group [(62.31±10.76)% vs. (45.51±5.54)%], with statistically significant differences (all P<0.05). The number of Th1/CD3⁺CD4⁺ cells in the AA-PNH group was significantly higher than those in the episodic PNH group and the control group [(24.27±4.30)% vs. (12.61±3.02)%, (4.07±1.93)%], with a statistically significant difference (P<0.05). The numbers of CD4⁺CD25⁺ T cells and Th3 cells in the AA-PNH group and the episodic PNH group were higher than those in the control group [(67.82±15.67) ×10⁶/L, (97.11±17.10) ×10⁶/L vs. (43.86±9.52) ×10⁶/L; (57.15±10.58) ×10⁶/L, (82.27±15.15) ×10⁶/L vs. (42.35±9.33) ×10⁶/L], with statistically significant differences (all P<0.05). The positive expression rates of FOXP3 and TGF-β mRNA and the concentrations of TGF-β and IL-10 in the episodic PNH group and the AA-PNH group were higher than those in the control group [86.67% (13/15), 75.00% (12/16) vs. 40.00% (10/25); 73.33% (11/15), 62.50% (10/16) vs. 36.00% (9/25); (49.76±2.03) μg/L, (37.29±1.78) μg/L vs. (17.01±3.27) μg/L; (7.86±1.17) pg/ml, (5.57±1.13) pg/ml vs. (1.33±0.49) pg/ml], with statistically significant differences (all P<0.05). Conclusion　The number and function of regulatory T cells in PNH patients are increased and its inhibitive function might contribute to abnormal clones of PNH to evade the immune surveillance.

Clinical effect of ilaprazole injection on peptic ulcer with hemorrhage

Wang Yanchao

2022, 28(22):  3140-3143.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.007

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Objective　To observe the clinical effect of ilaprazole injection on peptic ulcer patients with hemorrhage. Methods　It was a retrospective study. The study randomly selected 135 patients with peptic ulcer and hemorrhage from Pingdingshan Second People's Hospital from July 2020 to January 2022. After analyzing the patients' medical records, the patients were divided into a study group [68 cases, 36 males and 32 females, aged (50.45±2.31) years, ilaprazole adjuvant treatment] and a control group [67 cases, 37 males and 30 females, aged (50.16±2.72) years, endoscopic hemostasis + basic drugs]. The treatment efficiencies, ulcer healing time, abdominal pain and fever symptom relief time, hemostasis success rates, re-bleeding rates, and adverse reaction rates of the two groups were compared. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　After treatment, the effective rate of the study group was 95.59% (65/68), which was higher than that of the control group [85.07% (57/67)], with a statistically significant difference (χ²=4.287, P=0.038). After treatment, there was no statistically significant difference in the hemostatic time between the two groups (P>0.05); the ulcer healing time, antipyretic time, and abdominal pain relief time in the study group [(2.21±0.35) d, (1.45±0.16) d, and (1.17±0.26) d] were lower than those in the control group [(3.44±0.72) d, (2.05±0.33) d, and (1.92±0.33) d], with statistically significant differences (all P<0.05). The success rate of hemostasis in the study group was 91.18% (62/68), which was higher than that in the control group [77.61% (52/67)] (χ²=6.991, P=0.008), and the re-bleeding rate was 3.23% (2/62), which was lower than that in the control group [19.23% (10/52)] (χ²=12.840, P<0.001). After treatment, there was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions　Ilaprazole sodium for injection can play a good auxiliary effect in patients with peptic ulcer and hemorrhage after receiving routine hemostasis and basic medication, and it can achieve the rapid hemostasis, promote the ulcer healing, achieve the complete hemostasis, and reduce the risk of re-bleeding. This drug has no serious adverse reactions in patients, with high safety, which is worthy of promotion.

Application of 4R crisis management theory in the prevention management of gastrointestinal dysfunction in patients with sepsis

Huang Suchang, Wen Guixiang, Yu Jing, Zhou Min, Han Zhijun

2022, 28(22):  3144-3148.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.008

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Objective　To explore the application effect of 4R crisis management theory in the prevention management of gastrointestinal dysfunction in patients with sepsis. Methods　A total of 82 patients with sepsis treated in Guangdong Second Traditional Chinese Medicine Hospital from December 2020 to December 2021 were selected as the research objects for a prospective study, and they were divided into a control group [23 males and 18 females, aged (76.17±9.27) years]and an observation group [22 males and 19 females, aged (77.22±9.03) years] with 41 cases in each group by the random number table method. The control group received routine nursing intervention for sepsis, and the observation group received preventive management of gastrointestinal dysfunction based on 4R crisis management theory. The score of Acute Physiology and Chronic Health Evaluation Scoring System (APACHEⅡ), gastrointestinal function injury score, incidence of gastrointestinal dysfunction, and nursing satisfaction were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test for the count data. Results　After intervention, the APACHEⅡ score and gastrointestinal function injury score of the observation group [(19.41±3.15) and (24.85±4.49)] were lower than those of the control group [(23.27±3.41) and (29.07±5.12)], with statistically significant differences (t=5.315 and 3.969; both P<0.001). After intervention, the incidence of gastrointestinal dysfunction in the observation group was 7.32% (3/41), which was significantly lower than 24.39% (10/41) in the control group, with a statistically significant difference (χ²=4.479, P=0.034). After intervention, the total nursing satisfaction rate in the observation group was 97.6% (40/41), which was higher than 85.4% (35/41) in the control group, with a statistically significant difference (χ²=3.905, P=0.048). Conclusion　Applying 4R crisis management theory can improve the condition and gastrointestinal function in patients with sepsis, reduce the incidence of gastrointestinal dysfunction, and improve the nursing satisfaction.

Effect of 4R crisis management in emergency nursing of fever clinic

Ou Xiaoping, Li Yuqun

2022, 28(22):  3149-3152.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.009

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Objective　To explore the effect of 4R crisis management in nursing emergency of fever clinic. Methods　Sixty-five patients who were hospitalized in the fever clinic in Wuxi Second People's Hospital from January 2020 to January 2021 were selected as a control group, and routine crisis management was applied. Sixty-five patients who were hospitalized in the fever clinic from February 2021 to January 2022 were selected as an observation group, and 4R crisis management intervention was applied. There were 34 males and 31 females in the control group, with an age of (45.15±5.16) years old; there were 33 males and 32 females in the observation group, with an age of (45.09±5.05) years old. The satisfaction score, incidence of adverse events, and nursing quality were compared between the two groups. Independent sample t test and χ² test were used. Results　The scores of service attitude, clinic environment, warmth prompt, and nurse-patient communication in the observation group were (3.35±1.10), (3.64±1.48), (3.27±1.14), and (3.21±1.05), which were higher than those in the control group [(2.79±1.24), (2.95±1.00), (2.68±1.05), and (2.82±1.07)], with statistically significant differences (all P<0.05). The incidence of adverse events in the observation group was 6.15% (4/65), which was lower than that in the control group [20.0% (13/65)], with a statistically significant difference (χ²=5.482, P=0.019). The scores of nursing safety, disinfection and isolation, drug management, and characteristic nursing in the observation group were (80.21±6.80), (77.62±2.53), (92.62±2.83), and (88.62±5.93), which were higher than those in the control group [(77.80±3.51), (76.21±3.12), (91.03±3.42), and (86.33±4.24)], with statistically significant differences (all P<0.05). Conclusion　4R crisis management nursing for patients in fever clinic can effectively improve patients' satisfaction, reduce the incidence of adverse events, and improve the quality of nursing, which is worthy of reference and promotion by all departments.

Application effect of nursing intervention based on FMEA in preventing deep venous thrombosis caused by PICC catheter chemotherapy for malignant tumors

Guo Huina, Cao Yang, Lian Shufan, Zhang Wenbo

2022, 28(22):  3153-3157.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.010

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Objective　To explore the effect of nursing care based on failure mode and effect analysis (FMEA) in patients with malignant tumors undergoing peripherally inserted central catheter (PICC). Methods　A prospective study was conducted. A total of 102 patients with malignant tumors who received PICC catheter chemotherapy in Zhengzhou Third People's Hospital from February 2019 to February 2022 were divided into two groups according to the random number table method, with 51 cases in each group. The control group [26 males and 25 females, aged (55.72±2.10) years] received routine intervention, while the observation group [28 males and 23 females, aged (55.67±2.13) years] received nursing intervention based on FMEA, continued nursing for 2 months. The complications during catheterization, comfort degrees, qualities of life, and nursing satisfaction in the two groups were compared. t test and χ² test were used. Results　There were no statistically significant differences in the scores of General Comfort Questionnaire (GCQ) and Health Survey Short Form (SF-36) between the two groups before nursing (all P>0.05). The incidence of complications during catheterization in the observation group was 3.92% (2/51), which was lower than 15.69% (8/51) in the control group (χ²=3.991, P=0.046). After nursing, the physiological [(22.59±3.61) points], psychological [(23.69±4.59) points], mental [(19.67±4.27) points], and social and cultural scores [(13.79±3.25) points] of the observation group were higher than those of the control group, with statistically significant differences (t=6.648, 5.254, 3.462, and 4.790; all P<0.001). After nursing, the scores of physical function [(86.39±3.72) points], physiological function [(83.37±3.59) points], physical pain [(85.45±3.70) points], emotional function [(85.70±4.12) points], life vitality [(85.57±3.80) points], social function [(82.22±3.66) points], mental health [(83.40±3.68) points], and overall health [(83.41±3.69) points] of SF-36 in the observation group were higher than those of the control group (t=15.252, 9.320, 9.026, 9.346, 13.559, 7.717, 8.968, and 6.082; all P<0.001). The scores of health education [(82.86±3.28) points], complication prevention [(83.95±3.42) points], operation skills [(82.87±3.38) points], communication style [(82.96±3.73) points], and catheter maintenance effect [(82.89±3.84) points] of nursing satisfaction in the observation group were higher than those in the control group (t=2.928, 3.297, 2.905, 3.303, and 3.157; all P<0.01). Conclusion　Nursing intervention based on FMEA for patients with malignant tumors undergoing PICC chemotherapy can reduce complications such as deep vein thrombosis, improve their comfort degree with catheter, contribute to the improvement of quality of life, and promote the improvement of patients' satisfaction on nursing services.

Effects of different care models on psychological status and quality of life in stroke patients in recovery period

Wang Hui, Shen Xiaozhu, Fu Bing

2022, 28(22):  3158-3162.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.011

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Objective　To observe the psychological status and quality of life in elderly stroke patients in recovery period under family and institutional care models, and to compare the advantages and disadvantages of different care models. Methods　A total of 314 elderly people who had been diagnosed with stroke for 1-3 months in Lianyungang City from January 2019 to March 2021 were selected. They were divided into a family care group and an institutional care group according to different elderly care models. The patients in the institutional care group were from many elderly care institutions and social welfare institutions in Lianyungang City. There were 169 cases in the family care group, 88 males and 81 females, aged (75.64±6.15) years; there were 145 cases in the institutional care group, 70 males and 75 females, aged (73.71±6.70) years. After 12 months, the anxiety, depression, and quality of life were assessed in the two groups, and the psychological state and quality of life were compared. χ² test was used for the count data, and t test was used for the measurement data. Results　The proportion of urban residents choosing institutional care services was 53.7% (109/203), which was significantly higher than that of rural residents [32.4% (36/111)], with a statistically significant difference (P<0.05). The scores of Hamilton Anxiety Scale and Hamilton Depression Scale in the family care group were (10.35±2.62) and (12.15±4.85), respectively, which were lower than those in the institutional care group [(15.81±5.22) and (17.65±5.88)], with statistically significant differences (both P<0.05). The scores of daily living ability and memory and thinking ability in the institutional care group were (58.98±7.09) and (78.19±7.85), respectively, which were higher than those in the family care group [(44.43±10.21) and (67.62±9.58)], and the scores of sensory and affective control, participation ability, and hand function were (32.98±4.23), (12.67±5.74), and (49.62±3.68), respectively, which were lower than those in the family care group [(40.91±6.65), (20.96±3.56), and (51.85±6.02)], with statistically significant differences (all P<0.05). The comparison of adverse risk events between the two groups showed that the incidences of accumulation pneumonia, pressure ulcers, and pipe shedding in the institutional care group were significantly lower than those in the family care group, with statistically significant differences (all P<0.05). Conclusions　The proportion of urban residents choosing institutional care service is higher. Institutional care is inferior to family care in emotional states such as anxiety and depression, sensory and affective control, and participation ability. In terms of daily living ability, memory and thinking ability, and avoiding the incidence of accumulation pneumonia, pressure ulcers, and pipe shedding, institutional care is superior to family care.

Model exploration of clinical pharmacists participating in clinical pathway of femoral neck fracture under the background of ERAS

Liu Chun, Xu Zhengquan, Zhang Xiangxin, Liu Xin, Zhou Qin, Sun Jiantong

2022, 28(22):  3163-3167.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.012

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Objective　To explore the rational medication management mode of clinical pharmacists participating in the clinical pathway of femoral neck fracture under the background of enhanced recovery after surgery (ERAS). Methods　Patients with femoral neck fracture admitted to Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to December 2021 were prospectively collected. With the patients with femoral neck fracture as a pilot, a total of 110 cases for whom clinical pharmacists did not participate in the clinical pathway were set as a control group, and 122 cases for whom clinical pharmacists participated in the clinical pathway were set as an observation group. Clinical pharmacists implemented comprehensive intervention through the establishment of clinical pathway medication list, medication list review, perioperative medication optimization, and other whole-process pharmaceutical management. t test and χ² test were used. Results　There were 49 males and 73 females in the observation group, with an age of (71.02±11.13) years old; there were 40 males and 70 females in the control group, with an age of (69.41±18.01) years old. The drug cost [open reduction and internal fixation (2 903.49±381.36) yuan, closed reduction and internal fixation (2 980.70±298.76) yuan, hip replacement (6 568.81±923.11) yuan, and femoral head replacement (5 319.50±744.38) yuan] and the proportion of drug consumption of the observation group [open reduction and internal fixation (6.61%), closed reduction and internal fixation (16.90%), hip replacement (10.20%), and femoral head replacement (12.48%)] were significantly lower than those of the control group, with statistically significant differences (all P<0.05). The number of antibiotic use, the intensity of antibiotic use, the incidence of incision infection, the incidence of venous thromboembolism (VTE), the number of opioids used, and the rate of opioids in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusions　Through clinical pharmacists' participation in the implementation of clinical pathway, patients can receive targeted drug treatment, and the improvement of service efficiency indexes can be realized through the whole-process closed-loop pharmaceutical guidance, which provides references for rational drug use and intervention entry point in clinical practice.

Clinical study on the treatment of chronic pelvic inflammatory disease of damp-heat stasis type with Jinling Shaoyao powder

Mo Xiaoyu, Xie Yiyan, Cui Xuefang

2022, 28(22):  3168-3171.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.013

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Objective　To observe, evaluate, and analyze the clinical effect of Jinling Shaoyao powder intermittently used in the treatment of chronic pelvic inflammatory disease (CPID) of damp-heat and blood stasis type. Methods　A total of 129 patients with CPID admitted to Zhongshan Chenxinghai Hospital from March 2020 to December 2021 were selected, and were randomly divided into three groups with 43 patients in each group. The control group A was (34.73±8.79) years old and was treated with Jinling Shaoyao powder, the control group B was (33.98±8.91) years old and was treated with Chinese patent medicine "Gongyanping tablets", and the observation group was (34.89±8.64) years old and was treated with Jinling Shaoyao powder, a self-made Chinese medicine, intermittently. The clinical effects and safety of each group were compared. Independent sample t test and χ² test were used. Results　After 30 days of treatment, there were no statistically significant differences in the total effective rate of comprehensive curative effect between the observation group and the control group A and B [95.35% (41/43) vs. 93.02% (40/43), 90.70% (39/43)] (χ²=0.212, 0.717; P=0.474, 0.801). After 30 days of treatment, there were no statistically significant differences in the total effective rate of physical signs between the observation group and the control group A and B [97.67% (42/43) vs. 95.35% (41/43), 93.02% (40/43)] (χ²=0.345, 1.048; P=0.590, 0.127). There were statistically significant differences in the incidence of adverse reactions between the observation group and the control group A and B [4.65% (2/43) vs. 25.58% (11/43), 23.26% (10/43)] (χ²=7.704, 6.519; both P<0.001). Conclusion　Jinling Shaoyao powder used intermittently to treat CPID of damp-heat and blood stasis type has the same clinical treatment effect as the treatment methods of the control group A and B, and compared with the treatment methods of the control group A and B, it can significantly reduce the patients' economic burden, improve their quality of life, save the drug resources, effectively reduce the adverse gastrointestinal effects of clinical use, and has good safety, which is worthy of clinical promotion and application.

Special Column of Pediatrics

Relationships between serum ApoAI, HDL-C, and SAA and the severity of meningococcal sepsis in children

Wei Hongxia, Xu Zhe, Li Xiaolei

2022, 28(22):  3172-3176.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.014

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Objective　To analyze the relationships between serum apolipoprotein AI (ApoAI), high-density lipoprotein cholesterol (HDL-C), and serum amyloid A (SAA) and the severity of meningococcal sepsis in children. Methods　The general data of 90 children with meningococcal sepsis admitted to Children's Hospital Affiliated to Zhengzhou University from September 2019 to October 2021 were analyzed. The 90 children with meningococcal sepsis were divided into a meningococcal sepsis group (52 cases), a severe meningococcal sepsis group (30 cases), and a meningococcal septic shock group (8 cases) according to the guidelines issued by the American College of Chest Physicians and the Society of Critical Care Medicine. The children's general information [gender, age, course of disease, and body mass index (BMI)] were collected, and the children's serum ApoAI, HDL-C, and SAA levels were detected. Logistic regression analysis method was used to analyze the factors affecting the severity of meningococcal sepsis in children, and a risk assessment model was established. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of the model. χ² test and F test were used. Results　There were 31 males and 21 females in the meningococcal sepsis group, with an age of (6.11±0.91) years old; there were 18 males and 12 females in the severe meningococcal sepsis group, with an age of (5.97±0.89) years old; there were 5 males and 3 females in the meningococcal septic shock group, with an age of (6.27±0.94) years old. There were no statistically significant differences in the gender, age, course of disease, and BMI among the three groups (all P>0.05). There were statistically significant differences in the serum ApoAI, HDL-C, and SAA levels among the three groups (all P<0.05), and compared with those in the meningococcal sepsis group and the severe meningococcal sepsis group, the meningococcal septic shock group had the lowest serum ApoAI and HDL-C levels, and the highest SAA level (all P<0.05). Multivariate logistic regression analysis showed that serum ApoAI (OR=0.156, P<0.001), HDL-C (OR=0.231, P=0.007), and SAA (OR=1.047, P=0.002) were the independent factors affecting the severity of meningococcal sepsis in children. ROC analysis results showed that the AUC value of the combined detection of the above three indicators was the highest, which was 0.957, and the sensitivity and specificity were 94.73% and 71.05%. Conclusion　Serum ApoAI, HDL-C, and SAA levels are closely related to the severity of meningococcal sepsis in children. The more severe the meningococcal sepsis in children, the lower the serum ApoAI and HDL-C levels, and the higher the SAA level. At the same time, the combined detection of serum ApoAI, HDL-C, and SAA has high clinical value in evaluating the severity of meningococcal sepsis in children.

Exploration of the developmental characteristics in children with global developmental delay

Yu Hongye, Jiang Huiyun, Qin Hongxia, Meng Xiaomei, He Qiaozhi

2022, 28(22):  3176-3180.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.015

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Objective　To explore the developmental characteristics in children with global developmental delay (GDD), in order to provide a feasibility basis for early diagnosis and intervention. Methods　A total of 138 GDD children aged 0-5 years were recruited in Maternity and Child Healthcare Hospital, Guangxi Zhuang Autonomous Region from 2019 to 2020, including 103 males and 35 females, with an age of (2.68±1.13) years old, and 89 normal children aged 0-5 years [58 males and 31 females, with an age of (2.56±1.19) years old] were selected as control. Gesell Infant Development Scale was used for assessment. χ² test, independent sample t test, and Spearman correlation analysis were used. Results　(1) The developmental quotients of all functional areas in the GDD children were lower than those in the normal children, and the language area was the most backward [(48.77±13.88) vs. (92.97±6.19)], with statistically significant differences (all P<0.05). (2) With the increasing degree of developmental retardation, other functional areas besides the gross motor area also showed abnormal development. (3) Among the GDD children, the largest proportion was the developmental delay of language area [98.6% (136/138)]. The proportion of children with developmental delay in the adaptive behavior and language areas increased with age. (4) There were positive correlations between the developmental retardation in the language area and other functional areas (r=0.636, 0.206, 0.378, and 0.676; all P<0.05). Conclusion　GDD children are combined with different degrees of developmental retardation in functional areas, especially in the language and adaptive behavior areas, but there is no necessarily delay in the gross motor area.

Values of magnetic resonance imaging and spectrum in neonatal bilirubin encephalopathy

Yan Zongwei, Zeng Yanni

2022, 28(22):  3180-3185.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.016

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Objective　To investigate the characteristics and clinical diagnostic values of magnetic resonance imaging (MRI) and proton magnetic resonance spectrum (¹H-MRS) in neonatal bilirubin encephalopathy. Methods　Twenty-two neonates with bilirubin encephalopathy in Huadu District People's Hospital of Guangzhou from January 2016 to April 2020 were selected, and twenty normal full-term newborns were selected as control. Conventional MRI scan and ¹H-MRS of the bilateral globus pallidus were performed separately. Two associate chief doctors of the radiology evaluated the conventional MRI features. The ¹H-MRS data of the bilateral globus pallidus were obtained by PRESS sequence, and the values of N-aceytl aspartate (NAA), creatine (Cr), choline (Cho), NAA/Cr, NAA/Cho, and Cho/Cr were statistically analyzed between the two groups. Bivariate correlation analysis was conducted for the values of NAA, Cr, Cho, NAA/Cr, Cho/Cr, and NAA/Cho and total serum bilirubin (TSB) peak value among the 42 neonates. F-test, independent sample t-test, and Pearson correlation analysis were used. Results　The age of the bilirubin encephalopathy group was (7.4±2.6) days, and the gestational age was (37.89±2.1) weeks; the age of the control group was (9.2±4.8) days, and the gestational age was (38.6±1.9) weeks. In the bilirubin encephalopathy group, 18 cases (81.8%) had an abnormally high signal of T1 weighted imaging (T1WI) images in the bilateral globus pallidus and 12 cases (54.5%) had slightly increased signal in corresponding position in T2WI fluid attenuated inversion recovery (FLAIR) sequence. The values of NAA, NAA/Cho, and NAA/Cr of the bilateral globus pallidus MRS in the bilirubin encephalopathy group were significantly reduced compared with those in the control group, with statistically significant differences between two groups (all P<0.05). Conclusion　MRI combined with ¹H-MRS is an important auxiliary diagnostic method for neonatal bilirubin encephalopathy.

Effect of operation timing on children with congenital thumb polydactyly

Wei Xiangao, Wang Zhaoqing, Wei Wanmian, Rao Yuanyong, Yang Jialin, Cheng Yong, Lan Gengliang, Qin Guangyang, He Yongheng

2022, 28(22):  3186-3188.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.017

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Objective　To analyze the effect of different operation timings on children with congenital thumb polydactyly. Methods　A total of 50 children with congenital thumb polydactyly were selected in The First People's Hospital of Hechi City from May 2017 to May 2021, including 26 males and 24 females, aged (1.6±0.4) years. All the children received imaging examinations and routine examinations before operation. They were divided into Wassel Ⅰ type, Wassel Ⅱ type, Wassel Ⅲ type, Wassel Ⅳ type, Wassel Ⅴ type, Wassel Ⅵ type, and Wassel Ⅶ type, and received simple polydactyly resection, joint capsule repair, flap plasty, osteotomy, tendon displacement, transplantation, and ligament reconstruction at about 1.5 years old, 1.0 year old, and 2.5 years old. All the children were followed up 1 year and 2 years after operation, and the treatment effect was evaluated by the modified Tada score. Results　Among the 50 cases, the therapeutic effect was excellent in 31 cases, 12 good cases, 5 moderate cases, 2 poor cases, and the excellent and good rate was 86.00%. The children were followed up 1 year later, and 1 child had angular deformity of the affected finger, and 1 child had the palmar dysfunction of the affected finger. The children were followed up 2 years later, 1 child had the metacarpophalangeal joint residual epiphysis of the affected finger. After re-operation on the above children, the appearance and extension and flexion function of the thumb in the children recovered well, and the position satisfaction was high, no impact on daily life at all. Conclusions　The operation timing of congenital thumb polydactyly should be based on the appearance time of the thumb ossification center, the deformity structure, and the severity. The operation timing should be reasonably judged, the individualized treatment plan should be formulated according to the different children's conditions, the precision of the operation should be improved, and the postoperative follow-up should be strengthened, so as to better ensure the surgical results.

Effect of continuous infusion of lidocaine on agitation during anesthesia recovery in children undergoing adenoidectomy

Wu Jiayao, Zhou Lin, Deng Lian, Wang Kan

2022, 28(22):  3189-3192.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.018

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Objective　To observe the effect of intraoperative continuous infusion of lidocaine on agitation during anesthesia recovery in children undergoing adenoidectomy. Methods　A total of 40 children aged 3-10 years with American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ undergoing pediatric adenoidectomy under general anesthesia with sevoflurane in Guangdong Women and Children Hospital from February to June 2022 were enrolled in this study, and were divided into a normal saline control group (N group) and a continuous infusion of lidocaine group (L group) according to the random number table method, with 20 cases in each group. There were 7 males and 13 females in group N, aged 6 (5,8) years; there were 10 males and 10 females in group L, aged 7 (5,8) years. After induction, group L was given intravenous injection of 1 mg/kg of lidocaine followed by continuous infusion of 2 mg/(kg·h) of lidocaine, whereas group N was given the same volume of normal saline. The primary outcome variables included the agitation score, number of agitation, and additional anesthetics during recovery; the secondary outcome variables included the pain score 30 minutes after extubation, extubation time, and length of postanesthesia care unit (PACU) stay. Independent sample t test, Mann-Whitney U test, and Pearson Chi-Square test were used. Results　The WATCHA agitation score in group L during anesthesia recovery was lower than that in group N [1 (0,2) vs. 3 (0,4), P<0.05], the incidence of agitation in group L was lower than that in group N [20% (4/20) vs. 50% (10/20), P<0.05], and the rate of additional anesthetics during anesthesia recovery in group L was lower than that in group N [15% (3/20) vs. 60% (12/20), P<0.01]. The extubation time of group L was shorter than that of group N [(13.00±7.33) min vs. (19.40±7.39) min, P<0.01], the length of PACU stay of group L was shorter than that of group N [(42.00±7.85) min vs. (50.15±7.14) min, P<0.01], and the pain score 30 min after extubation in group L was lower than that in group N [0 (0, 2) vs. 2 (0, 2), P<0.05]. Conclusion　Continuous infusion of lidocaine can reduce the incidence of agitation during anesthesia recovery in children undergoing adenoidectomy, shorten the time of extubation and length of PACU stay, and relieve the postoperative pain, which is of great significance for accelerating the children's recovery.

Effects of vitamin D supplementation in the third trimester of pregnancy on maternal and neonatal 25 hydroxyvitamin D levels and neonatal diseases

Zhang Ming, Zhuang Lijuan, Feng Xiao, Qiu Huiying, Chen Caiyan, Wei Xiaofan, Xiao Naian

2022, 28(22):  3193-3197.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.019

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Objective　To investigate the effects of vitamin D supplementation in the third trimester of pregnancy on maternal and neonatal 25 hydroxyvitamin D [25(OH)D] levels, neonatal physical development, and neonatal diseases. Methods　The pregnant women who delivered in Zhongshan Hospital Xiamen University and The First Affiliated Hospital of Xiamen University from January 2019 to December 2021 and their neonates were collected as research objects and were randomly divided into an intervention group (316 cases) and a control group (337 cases). In the intervention group, 269 cases were <35 years old and 47 cases were ≥35 years old; in the control group, 283 cases were <35 years old and 54 cases were ≥35 years old. The intervention group received daily vitamin D supplementation ≥600 IU from 28 weeks of gestation to delivery, and the control group received daily vitamin D supplementation <600 IU. The maternal antepartum and neonatal 25(OH)D levels were detected, the neonatal body weight, length, and head circumference were measured, and the delivery mode, premature delivery rate, and incidence of neonatal diseases were counted. Independent sample t test and χ² test were used. Results　The maternal antepartum and neonatal 25(OH)D levels in the intervention group were significantly higher than those in the control group [(27.91±7.56) μg/L vs. (24.65±6.83) μg/L, (16.24±4.31) μg/L vs. (12.60±3.97) μg/L], with statistically significant differences (both P<0.001). The maternal antepartum and neonatal vitamin D deficiency rates in the intervention group were significantly lower than those in the control group [19.62% (62/316) vs. 47.18% (159/337), 17.09% (54/316) vs. 49.26% (166/337)], with statistically significant differences (both P<0.001). The neonatal body weight, length, and head circumference in the intervention group were significantly higher than those in the control group (all P<0.05). The incidences of neonatal early-onset sepsis and neonatal necrotizing enterocolitis in the intervention group were significantly lower than those in the control group [1.27% (4/316) vs. 4.15% (14/337), 2.53% (8/316) vs. 6.23% (21/337)], with statistically significant differences (both P<0.05). There were no statistically significant differences in the cesarean section rate and premature delivery rate between the two groups (both P>0.05). Conclusion　Daily vitamin D supplementation ≥600 IU in the third trimester of pregnancy can increase the maternal and neonatal serum 25(OH)D levels, promote the neonatal physical development, and reduce the incidence of severe neonatal diseases, but has no significant effects on the cesarean section rate and premature delivery rate.

Effect of interactive scalp acupuncture combined with vibration therapy on gross motor function, balance ability, and cerebral hemodynamics in children with cerebral palsy

Liu Yangbing

2022, 28(22):  3197-3201.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.020

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Objective　To observe the effect of interactive scalp acupuncture combined with vibration therapy on gross motor function, balance ability, and cerebral hemodynamics in children with cerebral palsy. Methods　A total of 70 children with spastic diplegia treated in Jining Maternal and Child Health and Family Planning Service Center from January 2020 to February 2022 were divided into two groups with the random number table method. There were 35 children in the study group, including 18 males and 17 females, with an age of (3.43±1.02) years old; there were 35 children in the control group, including 19 males and 16 females, with an age of (3.51±1.06) years old. The 35 children in the control group were given vibration therapy, and the 35 children in the study group were given interactive scalp acupuncture on the basis of the control group. Neuron-specific enolase (NSE), ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), brain-derived neurotrophic factor (BDNF), cerebral artery systolic peak flow velocity (Vs), mean blood flow velocity (Vm), and vascular resistance index (RI) were detected before and after treatment in the two groups. The Gross Motor Function Measure Scale (GMFM) and Berg Balance Scale (BBS) were evaluated for the two groups. t test and χ² test were used. Results　After treatment, the levels of NSE and UCH-L1 in the study group were lower than those in the control group [(13.15±4.12) μg/L vs. (19.41±5.87) μg/L, (12.36±3.11) μg/L vs. (19.51±4.15) μg/L], and the level of BDNF was higher than that in the control group [(5.92±1.56) μg/L vs. (4.57±1.29) μg/L] (all P<0.05). After treatment, the Vm and Vs in the study group were higher than those in the control group [(140.18±4.24) cm/s vs. (133.14±3.17) cm/s, (126.97±7.29) cm/s vs. (114.71±6.21) cm/s], and the RI was lower than that in the control group [(0.61±0.11) vs. (0.74±0.15)] (all P<0.05). After treatment, the scores of A, B, C, D, and E areas of GMFM in the study group were higher than those in the control group (all P<0.05). The BBS score of the study group was higher than that of the control group after treatment (P<0.05). Conclusion　Interactive scalp acupuncture combined with vibration therapy in the treatment of children with cerebral palsy can reduce the nerve damage, improve their cerebral blood circulation, and improve their gross motor function and balance ability.

Application of evidence-based medicine based lifestyle empowerment integrated management in long-term insulin pump treatment for preschool children with type 1 diabetes mellitus

Liu Yujiao, Wang Qiuli, Zhu Dongmei

2022, 28(22):  3202-3207.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.021

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Objective　To explore the value of evidence-based medicine based lifestyle empowerment integrated management in long-term insulin pump treatment for preschool children with type 1 diabetes mellitus (T1DM). Methods　A prospective study was conducted on 86 preschool children with T1DM who were admitted to the Department of Endocrinology, Genetics and Metabolism, Children 's Hospital Affiliated to Zhengzhou University from March 2020 to March 2022, including 38 males and 48 females, with an age of (4.71±0.73) years old. They are divided into an evidence-based group and a routine group according to the random number table method, with 43 cases in each group. The evidence-based group used evidence-based medicine based lifestyle empowerment integrated management, and the routine group used conventional management methods. The levels of glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2 hours' postprandial plasma glucose (2hPG) were compared between the two groups before and after management, and the incidence of adverse events was recorded. The Connor-Davidson Resilience Scale (CD-RISC) scale was used to evaluate the changes of the psychological state among the caregivers, the caregivers' understanding on T1DM was analyzed, and the satisfaction questionnaire was used to evaluate the caregivers' satisfaction. χ² test, rank sum test, and t test were used. Results　The FPG, 2hPG, and HbA1c in the evidence-based group were (6.34±0.41) mmol/L, (10.97±1.65) mmol/L, and (6.42±0.51) mmol/L after 3 months of management, which were lower than those in the routine group [(8.19±0.86) mmol/L, (13.64±1.70) mmol/L, and (7.91±0.43) mmol/L] (t=12.733, 7.390, and 14.647; all P<0.001). The incidence of adverse events in the evidence-based group [4.65% (2/43)] was lower than that in the routine group [18.60% (8/43)] (χ²=4.074, P=0.044). After 3 months of management, the CD-RISC score of the evidence-based group was (88.11±8.55), which was higher than that of the routine group (70.93±6.95) (t=10.224, P<0.001). The T1DM cognitive questionnaire score of the evidence-based group was (30.82±2.50) after 3 months of management, which was higher than that of the routine group (23.81±1.98) (P<0.05). The caregivers’ satisfaction rate in the evidence-based group was 95.35% (41/43), which was higher than that in the routine group [79.07% (34/43)] (χ²=5.108, P=0.024). Conclusion　Evidence-based medicine based lifestyle empowerment integrated management can further control the blood glucose in pre-school T1DM children, reduce the adverse events, and improve caregivers' understanding on the disease and satisfaction.

Treatises

Effect of acupuncture on sphenopalatine ganglia combined with loratadine in the treatment of allergic rhinitis

Yu Yunqing

2022, 28(22):  3208-3211.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.022

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Objective　To explore the effect of loratadine combined with sphenopalatine ganglion acupuncture on allergic rhinitis (AR). Methods　Seventy-one AR patients admitted to Second Hospital of Tianjin Medical University from May 2020 to January 2022 were selected for the prospective study, including 37 males and 34 females, with an age of (37.99±19.51) years old. The patients were divided into group A (39 cases) and group B (32 cases) according to the therapeutic methods. Group A was treated with loratadine, and group B was treated with sphenopalatine ganglion acupuncture on the basis of group A. The clinical efficacy and changes of related cytokines in the two groups were observed, the data were analyzed with SPSS 20.0 statistical software, and χ² test and independent sample t test were used. Results　After treatment, the total syndrome score of TCM in group B was (4.86±0.89), which was lower than that in group A (7.32±1.06) (t=10.447, P<0.001). The total effective rate in group B was 84.38% (27/32), which was higher than 58.97% (23/39) in group A (χ²=4.991, P=0.027). The overall score of quality of life in group B was (9.15±2.12), which was lower than that in group A (14.75±1.93) (t=11.637, P<0.001). The levels of interleukin (IL)-4, IL-10, interferon (INF)-γ, and Th1/Th2 in group B after treatment were (10.27±0.51) ng/L, (7.55±0.67) ng/L, (18.22±0.23) ng/L, and (13.14±0.46)%, those in group A were (12.11±0.31) ng/L, (9.85±0.53) ng/L, (20.92±0.14) ng/L, and (15.78±0.22)%, and the levels of all cytokines in group B were lower than those in group A (all P<0.05). Conclusion　In the treatment of AR patients, compared with conventional single western medicine, sphenopalatine ganglia acupuncture combined with loratadine has a good clinical effect, which is beneficial to regulate the levels of related cytokines and improve the quality of daily life.

Efficacy evaluation of Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of AECOPD patients with phlegm heat stasis lung syndrome

Wang Hailing, Huang Wentong, Yang Jie, Xu Zhijun, Wang Zongyao

2022, 28(22):  3212-3216.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.023

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Objective　To study the efficacy of Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with phlegm heat stasis lung syndrome. Methods　A total of 136 AECOPD patients with phlegm heat stasis lung syndrome in Zhengzhou Hospital of Traditional Chinese Medicine from June 2018 to June 2021 were selected and were simply randomly divided into a control group (68 cases) and a combined group (68 cases). There were 30 females and 38 males in the control group, aged (55.07±6.03) years; there were 31 females and 37 males in the combined group, aged (56.25±5.62) years. The control group was treated with bilateral Zusanli acupoint injection (Huangqi injection) and acupoint application, and the combined group was treated with Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application. The clinical efficacy and TCM syndrome scores, pulmonary function [forced vital capacity (FVC), forced expiratory vital capacity in the first second (FEV₁), and inspiratory capacity (IC)], red blood cell immune function [red blood cell immunomodulator C3b receptor rosette inhibition rate (RFIR), red blood cell immune complex rosette (RBC-ICR), red blood cell C3b receptor rosette (RBC-C3bR), and red blood cell immune regulator C3b receptor rosette promotion rate (RFER)], and serum lipocalin-1 (LCN-1) and LCN-2 levels before treatment and after 14 days of treatment were compared between the two groups.χ² test and independent sample t test were used. Results　The total effective rate of the combined group was 94.12% (64/68), which was higher than that of the control group [82.35% (56/68)] (P<0.05). After 14 days of treatment, the TCM syndrome score of the combined group was lower than that of the control group [(6.24±1.87) vs. (8.03±2.16)] (P<0.05). After 14 days of treatment, the FVC, FEV₁, and IC of the combined group were higher than those of the control group (all P<0.05); the RFER and RBC-C3BR in the combined group were higher than those in the control group, and the RFIR and RBC-ICR were lower than those in the control group (all P<0.05); the serum levels of LCN-1 and LCN-2 in the combined group were lower than those in the control group (both P<0.05). No serious adverse reactions occurred in both groups during treatment. Conclusion　Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of AECOPD patients with phlegm heat stasis lung syndrome can effectively improve the clinical symptoms, improve the lung function and red blood cell immune function, and reduce the inflammatory state, with significant curative effect and good safety.

Clinical study on minimally invasive extraction of maxillary anterior teeth and immediate dentum implant implantation

Liang Fangjie, Ha Yue

2022, 28(22):  3216-3219.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.024

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Clinical Research

Application effect and adverse reaction analysis of dexmedetomidine in daytime hysteroscopic anesthesia

Wang Yanbin, Huang Rui

2022, 28(22):  3220-3224.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.025

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Objective　To study the application effect and adverse reactions of dexmedetomidine in daytime hysteroscopic anesthesia. Methods　A total of 360 hysteroscopic anesthesia patients in Xiamen First Hospital Affiliated to Xiamen University from October 2019 to October 2020 were divided into two groups with the random number table method with 180 cases in each group. In the control group, the age was (34.74±5.12) years old, and the body weight was (57.52±6.58) kg; in the study group, the age was (35.32±4.51) years old, and the body weight was (56.02±7.01) kg. The control group was given propofol combined with sevoflurane, and the study group was given dexmedetomidine combined with sevoflurane. The vital signs before induction of anesthesia (T0), during induction (T1), during operation (T2), and while awake (T3), awakening, recovery score after anesthesia, adverse reactions, Ramsay sedation score, Observer's Assessment of Alertness/Sedation Scale (OAA/S) score, and Numerical Rating Scale (NRS) score were observed. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the operation time, incidences of hypertension, tachycardia, and bradycardia, and heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO₂) at T0 between the two groups (all P>0.05). There were statistically significant differences in the HR, MAP, and SpO₂ between T1, T2, and T3 and T0 in the two groups (all P<0.05), and the HR and MAP decreased to a certain extent in the two groups. The awakening time and leaving time of the study group were shorter than those of the control group, and the incidence of respiratory depression was lower than that of the control group [0 vs. 3.89% (7/180)], with statistically significant differences (all P<0.05). The Alderete scores of the study group 10, 20, and 30 min after operation were higher than those of the control group, with statistically significant differences (all P<0.05). The incidences of postoperative pain [6.67 (3/180) vs. 38.33% (18/180)] and nightmare recall [0 vs. 16.67% (8/180)] in the study group were lower than those in the control group, with statistically significant differences (both P<0.05). After operation, the Ramsay score and OAA/S wakefulness score of the study group were higher than those of the control group, with statistically significant differences (both P<0.05). After operation, the NRS score of the study group was lower than that of the control group [(1.03±0.27) vs. (2.46±0.34)], with a statistically significant difference (t=44.189, P<0.001). Conclusion　Dexmedetomidine can be used for daytime hysteroscopy, which has good anesthetic effect, high safety, and less impact on patients' vital signs, so it is worthy of application.

Effects of propofol and sevoflurane combined with dexmedetomidine anesthesia on patients undergoing hepatectomy

Yang Yuzhu, Yin Xiaowei, Yu Xin, Yang Yushan

2022, 28(22):  3225-3225.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.026

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Objective　To analyze the effects of propofol and sevoflurane combined with dexmedetomidine on patients undergoing hepatectomy. Methods　A prospective analysis was conducted on 120 patients who were scheduled to undergo laparoscopic hepatectomy in Shanxian Central Hospital from January 2020 to March 2022, and they were divided into group A and group B according to the random number table method, 60 cases in each group. There were 37 males and 23 females in group A, with an age of (52.45±8.76) years old. There were 35 males and 25 females in group B, with an age of (52.64±8.23) years old. Group A was given propofol combined with dexmedetomidine anesthesia, and group B was given sevoflurane combined with dexmedetomidine anesthesia. The heart rate (HR), mean arterial pressure (MAP), operation time, spontaneous breathing recovery time, eye opening time, and extubation time were compared between the two groups, the recovery quality was evaluated, the liver function indexes were detected, and the complications of the two groups were analyzed. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The HR in group A and group B were (89.78±5.25) beats/min and (85.96±4.52) beats/min at intubation, (93.75±4.53) beats/min and (87.88±4.42) beats/min at skin cutting, and (86.58±5.01) beats/min and (84.68±3.85) beats/min at the end of surgery, which were significantly higher than those before anesthesia [(82.70±3.62) beats/min and (87.98±6.59) beats/min] (all P<0.05); the MAP in group A and group B were (93.55±5.36) mmHg (1 mmHg=0.133 kPa) and (89.13±4.70) mmHg at intubation, (103.42±5.26) mmHg and (91.67±5.93) mmHg at skin cutting, (95.96±5.59) mmHg and (92.93±4.89) mmHg at the end of surgery, which were significantly higher than those before anesthesia [(87.98±6.59) mmHg and (87.67±5.82) mmHg] (all P<0.05); those in group B were significantly lower than those in group A (all P<0.05). The spontaneous breathing recovery time, eye opening time, and extubation time of group B were significantly shorter than those of group A [(10.03±1.73) min vs. (13.36±2.06) min, (11.05±1.70) min vs. (14.42±2.08) min, (12.10±1.70) min vs. (15.39±2.06) min], with statistically significant differences (t=9.59, 9.72, and 9.54; all P<0.01); there was no statistically significant difference in the operation time between the two groups (t=1.56, P=0.12). The cough score and Biker sedation-agitation score of group B were significantly lower than those of group A [(1.99±0.36) vs. (2.56±0.26), (2.10±0.41) vs. (3.17±0.35)], and the Ramsay sedation score in group B was significantly higher than that in group A [(3.38±0.48) vs. (2.45±0.32)], with statistically significant differences (t=9.94, 15.37, and 12.49; all P<0.05). On the third day after surgery, the serum levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin in group B were significantly lower than those in group A [(69.70±22.00) U/L vs. (95.35±25.51) U/L, (52.26±18.22) U/L vs. (70.18±15.30) U/L, (22.19±2.14) μmol/L vs. (25.86±2.50) μmol/L], and the serum albumin level was higher than that in group A [(35.44±4.46) g/L vs. (29.98±5.63) g/L], with statistically significant differences (t=5.90, 5.83, 8.64, and 5.89; all P<0.01). The total incidence of complications in group B was slightly lower than that in group A [10.00% (6/60) vs. 13.33% (8/60)], but the difference was not statistically significant (χ²=0.32, P=0.57). Conclusion　Sevoflurane combined with dexmedetomidine anesthesia can effectively improve the liver function and quality of anesthesia recovery in patients undergoing laparoscopic hepatectomy, and maintain stable hemodynamics with fewer complications, which has a certain clinical application value.

ideline-based hospital-family lung rehabilitation training program in patients with stable COPD

Yang Wenjing, Zhao Xu, Gao Ting

2022, 28(22):  3230-3234.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.027

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Objective　To explore the application of guideline-based hospital-family lung rehabilitation training program in patients with stable chronic obstructive pulmonary disease (COPD). Methods　A total of 99 patients with COPD admitted to Zaozhuang Chest Hospital from June 2019 to June 2021 were selected and were divided into an observation group (50 cases) and a control group (49 cases) with the random number table method. The control group included 30 males and 19 females, with an age of (65.01±3.49) years old and a duration of (4.96±2.29) years. There were 32 males and 18 females in the observation group, with an age of (64.89±3.56) years old and a duration of (4.78±2.36) years. The control group received routine pulmonary rehabilitation training, and the observation group received hospital-family lung rehabilitation training program based on guidelines. The exercise tolerance (6 minutes walking distance and deep inspiratory volume), pulmonary function indexes [forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC], and quality of life [St. George's Respiratory Questionnaire (SGRQ)] were compared between the two groups before and after intervention. χ² test, rank sum test, independent sample t test, and paired t test were used for statistical analysis. Results　After intervention, the 6-minute walking distance, inspiratory capacity, FVC, FEV1, and FEV1/FVC in the observation group were (400.16±52.76) m, (2.58±0.42) L, (2.44±0.42) L, (1.39±0.02) L, and (63.82±5.78)%, which were higher than (352.18±48.19) m, (1.79±0.38) L, (2.11±0.34) L, (1.28±0.01) L, and (55.77±5.62)% in the control group, with statistically significant differences (all P<0.05). After intervention, the scores of respiratory symptoms, activity restriction, and disease impact in SGRQ of the observation group were (43.49±7.35) points, (32.29±9.20) points, and (47.63±13.22) points, which were significantly lower than those of the control group [(52.43±7.18) points, (37.61±10.35) points, and (55.88±10.72) points], with statistically significant differences (all P<0.05). Conclusion　Guideline-based hospital-family lung rehabilitation training program can significantly enhance the exercise tolerance in patients with COPD, improve their lung function and quality of life, and has important clinical significance.

Case Report

A case of generalized eczema with Fasciola hepatica infection

Li Jiayan, Luo Yuwu

2022, 28(22):  3235-3237.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.028

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A case of generalized eczema with Fasciola hepatica infection was reported, and the related literatures were reviewed. The 51-year-old male patient was admitted to Guangzhou Institute of Dermatology due to "generalized eczema". In the routine examination on admission, it was found that there were eggs of Fasciola hepatica in the stool routine, and the disease was diagnosed. After antiallergy and antiparasite treatment, the patient recovered and was discharged from the hospital.

Nursing Research

Influence of time-point management guided by mind map on the quality of hospital outpatient service

Wu Liping, Xie Xiaohong, Zhang Lihua

2022, 28(22):  3238-3242.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.029

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Objective　To study the effect of time-point management guided by mind map on the quality of hospital outpatient service. Methods　The clinical data of 380 outpatients in Guangzhou Twelfth People's Hospital from June 2020 to June 2022 were analyzed retrospectively. According to the patients were treated with time-point management guided by mind map or not, they were divided into a pre-implementation group [104 males and 86 females, with an age of (57.85±6.02) years old] and a post-implementation group [101 males and 89 females, with an age of (58.13±5.63) years old]. The outpatient service quality, outpatient nosocomial infection control indicators, and outpatient satisfaction were evaluated and compared before and after implementation of time-point management guided by mind map. Two independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　After the implementation, the outpatient visit environment score [(96.51±7.33) points], outpatient response score [(96.35±2.14) points], patient order score [(97.28±4.22) points], and satisfaction rate [97.89% (186/190)] were higher than those before the implementation, with statistically significant differences (all P<0.05). After the implementation, the in-hospital hand hygiene compliance rate [97.92% (47/48)], equipment disinfection compliance rate [97.92% (47/48)], and environmental hygiene compliance rate [95.83% (46/48)] in the spot check for medical staff were higher than those before the implementation, with statistically significant differences (all P<0.05). Conclusion　After targeted and comprehensive time-point management guided by mind map, the service quality for outpatients has been significantly improved, and the in-hospital hygiene has been significantly improved, which is worthy of popularization and application.

Coordination of nerve function localization during surgical resection of glioma in brain functional area under whole-course wake-up anesthesia

Zhu Xiaoyan, Li Shengjie, Ji Yugui, Bai Hongmin

2022, 28(22):  3243-3245.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.030

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Literature Analysis

Expression of NRP-1 in gastric cancer tissues and its correlations with clinicopathological characteristics and prognosis: a meta-analysis

Yang Han, Gu Yulan

2022, 28(22):  3246-3251.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.031

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Objective　To evaluate the correlations between neuropilin (NRP)-1 expression and clinicopathological characteristics and prognosis of gastric cancer by meta-analysis. Methods　The researches on the expression of NRP-1 in gastric cancer published in PubMed, Web of Science, Embase, The Cochrance Library, CNKI, Wanfang, VIP, and other databases from the establishment of the database to April 2022 were retrieved. According to the included literatures, the relevant data were extracted. RevMan 5.3 and Stata12 software were used for the meta-analysis. Results　A total of 13 studies including 1 635 patients with gastric cancer were included. Meta-analysis showed that NRP-1 overexpression was associated with poor prognosis in patients with gastric cancer (HR=1.66, 95%CI 1.25-2.22, P=0.000 5), and was associated with TNM stage (OR=0.37, 95%CI 0.18-0.77, P=0.008), degree of differentiation (OR=0.43, 95%CI 0.31-0.58, P<0.001), lymph node metastasis (OR=0.32, 95%CI 0.16-0.63, P=0.000 9), and distant metastasis (OR=0.15, 95%CI 0.06-0.39, P=0.000 1), but there was no significant correlation with tumor size (OR=0.40, 95%CI 0.15-1.10, P=0.08), depth of invasion (OR=0.44, 95%CI 0.15-1.35, P=0.15), or Lauren's classification (OR=0.73, 95%CI 0.45-1.19, P=0.21). Conclusions　The expression of NRP-1 in gastric cancer is related to TNM stage, degree of differentiation, lymph node metastasis, and distant metastasis. Detecting the expression of NRP-1 may be helpful to judge the prognosis of patients with gastric cancer.

Summary

Research progress of inflammatory indicators in the prognosis of aneurysmal subarachnoid hemorrhage

Peng Hui, Chen Weiqiang

2022, 28(22):  3252-3256.  DOI: 10.3760/cma.j.issn.1007-1245.2022.22.032

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Aneurysmal subarachnoid hemorrhage (aSAH) is a common clinical cerebrovascular disease and a critical emergency in the field of neurosurgery with a high mortality and a disability rate. Considerable progress has been made in the management of its cause, namely intracranial aneurysms, and the incidence of re-bleeding has been greatly reduced, but a large proportion of patients with aSAH still have poor prognosis. Among these, the neuroinflammatory response that causes early brain injury may be a key factor for poor prognosis. Inflammatory indicators related to the prognosis of aSAH have been reported and used in clinical practice, and this article reviews the progress of domestic and international studies on these indicators.