Table of Content

01 December 2022, Volume 28 Issue 23

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Scientific Research

Herpes zoster-induced Ogilvie's syndrome: a case report and literature review

Wang Kai, Cheng Xianyong, Liu Haiyan, Jia Xingfang, Li Kun, Chen Yan, Liu Chengxia

2022, 28(23):  3257.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.001

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Objective　To analyze the clinical manifestations, diagnosis, and treatment of Ogilvie's syndrome caused by herpes zoster, and to improve the understanding of physicians about Ogilvie's syndrome. Methods　The clinical data of a patient with Ogilvie's syndrome caused by herpes zoster treated at Binzhou Medical University Hospital on December 24, 2020 were collected, and the relevant literatures were reviewed, and its pathogenic mechanism was analyzed. Results　The male patient was 72 years old, and was hospitalized because of no anus defecation for 7 days and being worsened with abdominal pain for 3 days. Combined with the patient's symptoms and imaging examinations, the diagnosis of intestinal obstruction was considered, and he was found with herpes zoster, so Ogilvie's syndrome was diagnosed. After the active treatment, the patient's symptoms improved significantly and he was discharged lastly. Conclusions　There are few clinical reports on Ogilvie's syndrome caused by herpes zoster, and physicians do not know enough about it. Through this case report, we can deepen our understanding of Ogilvie's syndrome, especially for Ogilvie's syndrome caused by herpes zoster, and early antiviral treatment is very important. Besides imaging examinations, detailed physical examinations are still necessary in the process of disease diagnosis and treatment.

Efficacy of paclitaxel liposome combined with cisplatin for patients with advanced ovarian cancer and analysis of serum tumor markers

Liu Jin, Zhang Min, Wang Hui, Guo Xiao, Yin Chunxia

2022, 28(23):  3260.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.002

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目的　探讨紫杉醇脂质体联合顺铂治疗晚期卵巢癌患者的疗效及血清肿瘤标志物水平。方法　选取2018年12月至2021年12月聊城市第三人民医院收治的82例晚期卵巢癌患者，依照随机数表法分为研究组和对照组，每组41例。研究组年龄（51.85±5.19）岁，对照组年龄（50.89±5.58）岁。对照组采用TP方案（紫杉醇+顺铂），研究组采用紫杉醇脂质体联合顺铂治疗。比较两组患者临床疗效、T细胞亚群水平、血清肿瘤标志物癌胚抗原（CEA）及人附睾分泌蛋白4（HE4）水平和不良反应。采用t检验和χ²检验。结果　研究组客观缓解率高于对照组［73.17%（30/41）比51.22%（21/41），P<0.05］。与治疗前相比，两组治疗后CD3⁺、CD4⁺均呈现升高趋势，且研究组均高于对照组（均P<0.05）。与治疗前相比，两组治疗后CEA、HE4水平均降低，且研究组均低于对照组（均P<0.05）。研究组不良反应发生率低于对照组［7.32%（3/41）比29.27%（12/41），P<0.05］。结论　晚期卵巢癌患者应用紫杉醇脂质体联合顺铂治疗可提高疗效，改善免疫功能，减低患者肿瘤标志物水平以及不良反应。

Expressions and clinical significance of PD-L1 and CD8⁺TILs in lymphocyte-predominant breast cancer

Yang Yue, Zhang Huifang, Chen Miaoling, Han Yuzhen

2022, 28(23):  3264.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.003

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Objective　To investigate the relationship between the expressions of programmed death ligand-1 (PD-L1) and CD8⁺ tumor infiltrating lymphocytes (TILs) in different locations and clinicopathological features and their effects on the prognosis of patients with lymphocyte-predominant breast cancer (LPBC). Methods　Sixty female patients with LPBC at Department of Pathology, Binzhou Medical University Hospital were selected from January 2011 to December 2018, with a median age of 51; the median diameter of the mass was 2.5 cm; the rate of lymph node metastasis was 40.0%; the histological type was invasive ductal carcinoma. The immunohistochemistry of EnVision method was used to detect the expressions of PD-L1 in tumor cells and immune cells and the expressions of CD8 in stromal (s) and intratumoral (i) TILs. Chi-square test or Fisher exact test and Spearman rank correlation test were used for the correlation analysis, and the Kaplan-Meier method was used for survival analysis and Log-Rank test. Results　The positive expression rate of PD-L1 in LPBC was 81.7% (49/60). The expression of PD-L1 in tumor cells was related to histological grade (P=0.041, P<0.05), and the expression of PD-L1 in immune cells to tumor size and Ki-67 (P=0.004 and 0.001). The high density of CD8⁺sTILs was significantly correlated with better disease-free survival (DFS) (P=0.037), and the high density of CD8⁺iTILs with worse DFS (P=0.042, P<0.05); the expressions of CD8⁺sTILs and CD8⁺iTILs were not correlated with overall survival (OS) (P=0.084 and 0.076). There was a positive correlation between the expression of CD8⁺iTILs and the expression of PD-L1 in tumor cells (r_s=0.301, P=0.019). Conclusions　The high expression of CD8⁺iTILs suggests poor prognosis, while the high expression of CD8⁺sTILs predicts better prognosis. The expression of CD8⁺iTILs is positively correlated with the expression of PD-L1 in tumor cells. Therefore, the poor prognosis of patients with a high expression of CD8⁺iTILs may be due to the inhibition of tumor immunity of CD8⁺iTILs by PD-L1 in tumor cells.

Immunosuppressive agents for rheumatoid arthritis

Wang Jingbo, Cui Hongwei, Yu Lei, Li Guohua, Lyu Xinliang

2022, 28(23):  3269.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.004

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Rheumatoid arthritis is a common systemic autoimmune disease in the family of rheumatic immunology. According to the different degrees of the disease progress, the treatment plan is different, including improving the conditions of anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, biological agents, botanical preparations, and other drugs and adjuvant therapies, such as targeted exercise, improved diet, hot compress, and cold compress. The current treatment method has significantly improved the conditions of RA, among which immunosuppressants play a role that cannot be ignored. Therefore, from the perspective of immunosuppression, it can effectively control the progress of the disease and achieve the goal of alleviating the disease and improving the patients' quality of life, which has been widely used and developed. This paper briefly describes the action mechanism and clinical application of selective immunosuppressive agents and nonselective immunosuppressors in the treatment of rheumatoid arthritis, which provides a theoretical basis for immunosuppressants in treating RA.

Value of RIFLE grades in evaluation of acute kidney injury for prognostic prediction in elderly patients with community-acquired pneumonia 

Zhang Hongying, Han Ximei, Weng Ling

2022, 28(23):  3274.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.005

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Objective　To explore whether RIFLE grades in evaluation of cute kidney injury (AKI) can predict the prognosis in elderly patients with community-acquired pneumonia (CAP). Methods　Four hundred and eight no less than 65-year-old patients with definite diagnosis as CAP treated at Fuzhou Pulmonary Hospital from January 2017 to December 2021 were selected, including 313 males and 95 females. According to the RIFLE grades, there were 281 cases in the no-AKI group and 127 cases in the AKI group. The AKI group was further stratified into a risk group (61 cases), an injury group (47 cases), and a failure group (19 cases). The influences of demographic characteristics and severities on prognosis in the four groups were compared. The measurement data of normal distribution were compare between the groups by ANOV, and the measurement data not of normal distribution by rank sum test. The enumeration data were compared by chi square test. The two-way ordinal categorical data were done by Spearman correlation test. Results　In this study, 127 patients developed AKI. The incidence of AKI was 31.1%. The majority of the patients in every group was male. There were no statistical differences in gender and smoke history between the 4 groups. The AKI group was (74.8±4.8) years old, the risk group (73.9±4.1), the injury group (74.1±4.1), and the failure group (79.8±5.4), indicating that AKI grades had a positive correlation with age (r=0.359). There were no statistical differences in the ratios of coronary heart disease, chronic obstructive pulmonary disease, and cerebrovascular disease between the 4 groups, but were in the ratios of hypertension [the no-AKI group 9.25% (26/281), the risk group 19.7% (12/61), the injury group 25.5% (12/47), and the failure 31.6% group (6/19)] and diabetes [the no-AKI group 15% (42/281), the risk group 22.9% (14/61), the injury group 27.6% (13/47), and the failure group 42.1% (8/19)] (χ²=17.216, P=0.001; χ²=12.560, P=0.006). The ratios of developing AKI between the low-risk and high-risk groups calculated by PSI and CURB-65 scores were 48.0% (61/127) vs. 52.0% (66/127) and 29.9% (38/127) vs 70.1% (89/127), respectively. With the rising grade of RIFLE, the portions of the patients administrated with machinal ventilation, vasoactive agents, and continuous renal replacement therapy also went up. The hospital stays in the no-AKI group, the risk group, the injury group, and the failure group were (12.2±2.4) days, (17.1±2.4) days, (19.8±3.0) days, and (29.8±4.7) days, and the mortalities 0.4% (1/281), 1.6% (1/61), 6.4% (3/47), and 47.4% (9/19), respectively, with statistical differences between the 4 groups. Correlation analysis showed that AKI grade was positively correlated with hospital stay (r=0.747) and mortality (r=0.992). Conclusions　The incidence of AKI is high in elderly patients with CAP, and has a positive correlation with age. Severe pneumonia complications with hypertension and diabetes cline to develop AKI, resulting in prolonged hospitalization and increased mortality.

Aerosol inhalation and pulmonary infection in patients taking tracheal intubation and non-mechanical ventilation

Li Yinyou, Zhou Xiuhong, Zhang Qing, Zhong Yeling

2022, 28(23):  3278.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.006

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Objectives　To explore the correlation between atomization inhalation and pulmonary infection in patients taking tracheal intubation and non-mechanical ventilation. Methods　Sixty patients with intracerebral hemorrhage who took tracheal intubation at Department of Neurosurgery, Longgang District Central Hospital within 24 h after admission from January 2020 to June 2021 were selected, and were divided into group A and group B by the random number table method, with 30 cases in each group. There were 27 males and 3 females in group A who were averagely 50.23 years old. There were 26 males and 4 females in group B who were averagely 51.20 years old. Group A took airway humidification on the basis of artificial nose and full fluid replacement, and intravenously injected 30 mg mucosolvan and 20 ml normal saline for sputum excretion, Bid. Group B added 1 mg budesonide and 10 ml normal saline Tid on the basis of group A. The respiratory rates, oxygen saturations of blood (SPO₂), sputum volumes, and clinical pulmonary infection scores (CPIS) of the two groups were compared. t test was applied. Results　There were no statistical differences in respiratory rate, SPO₂, sputum volume, and CPIS between the two groups at admission (all P>0.05). Seventy-two hours after admission, the sputum volume was (22.40±1.15) ml in group A, and was (25.93±1.24) ml in group B, with a statistical difference (P<0.05). One hundred and forty-four hours after admission, the sputum volume and CPIS were (21.00±0.89) ml and (2.63±0.32) in group A, and was (25.00±0.98) ml and (4.33±0.38) in group B, with statistical differences (both P<0.05). Conclusions　Atomization inhalation increases or aggravates the patients' pulmonary infection. It is not recommended to prevent or treat pulmonary infection in patients taking endotracheal intubation and non-mechanical ventilation.

NICU emergency prevention and control nursing plan during epidemic period in COVID-19

Tan Baoqin, Chi Chunxin, Hou Haiping, Wei Ting

2022, 28(23):  3282.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.007

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Objective　To explore the application value of the neonatal intensive care unit (NICU) emergency prevention and control nursing plan during the epidemic period of COVID-19. Methods　A total of 320 isolated neonates admitted to NICU, Xiaolan Hospital, Southern Medical University from March 2021 to April 2022 were included as the observation objects, and were divided into an observation group and a control group by the random number table method, with 160 cases in each group. The observation group were 0-19 (14.62±5.21) days old. The control group were 0-20 (13.88±5.22) days old. The control group implemented standard prevention during the treatment after being received, while the observation group formulated personalized protective measures after conducting risk assessment using the self-made risk assessment table based on the control group. The clinical data of the two groups were calculated, and the NICU nursing team with the same personnel configuration performed the nursing work. The infection rates, psychological status scores, and protective equipment use of the medical staff in the two groups were compared, and the application value of emergency prevention and control nurses in NICU was comprehensively analyzed. The comparison between the two groups were performed by independent-sample t and χ² tests. Results　The infection rates of the medical staff in both groups were 0. The self-confidence, recognition of protective measures, optimism, and sleep quality of the medical staff in the observation group were higher than those in the control group [(4.26±0.32) vs. (3.01±1.31), (4.55±0.31) vs. (3.61±0.43), (4.26±0.53) vs. (3.42±0.87), and (4.72±0.14) vs. (3.04±1.43)], but the score of anxiety was lower than that in the control group [(2.08±0.33) vs. (3.14±1.21)], with statistical differences (t=3.933, 7.523, ,3.498 4.961, and 3.586; all P<0.05). The observation group used 138 boxes of masks, 27 N95 masks, 56 pairs of protective glasses, and 327 isolation gowns; the control group used 211 boxes of masks, 56 N95 masks, 87 pairs of protective glasses, and 413 isolation gowns; the amount of protective equipment used in the observation group was less than that in the control group. Conclusions　It is of positive significance to formulate the NICU emergency prevention and control nursing plan during the epidemic period of COVID-19; the plan can effectively reduce the infection rate of medical staff, improve their psychological status, and effectively reduce the use of protective equipment.

Concept of "preventive treatment of diseases" in traditional Chinese medicine in controlling transmission risk of asymptomatic infection of COVID-19

Liu Panpan, Fan Jie, Chai Ying, Shao Chunmei

2022, 28(23):  3287.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.008

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Objective　To observe the application of the concept of "preventive treatment of diseases" in traditional Chinese medicine in the control of asymptomatic infection of COVID-19 and its application value in blocking the risk of transmission. Methods　This is a prospective study. Ninety-three asymptomatic patients with COVID-19 who were admitted to the first isolation area of the shelter isolation site in Zhangge Town, Shangqiu Demonstration Area from August 2, 2022 to August 23, 2022 were selected as the study objects. According to the analysis of their physical and cardiac status when they entered the shelter, the patients were divided into an observation group (47 cases) and a control group (46 cases). There were 25 men and 22 women in the observation group, with an age of (39.26±0.12). There were 26 men and 20 women in the control group, with an age of (39.41±0.32). The control group took routine clinical isolation and control measures. The observation group were isolated and controlled based on the concept of "preventive treatment of diseases" in traditional Chinese medicine. The negative status, control effects, psychological state, and symptom improvement were compared between these two groups. χ² and t tests were applied for the comparison between these two groups. Results　Under different control modes, all the patients in the two groups were released from isolation, and the nucleic acid negative rates both were 100.00%, but the nucleic acid negative time in the observation group was shorter than that in the control group [(18.17±0.16) d vs. (19.82±0.71) d; t=15.536, P<0.001]. During the control period, the transmission rate in the observation group was lower than that in the control group [4.26 (2/47) vs. 17.39% (8/46); χ²=4.180, P=0.041], the remission rate of mild symptoms was higher than that in the control group [95.74% (45/47) vs. 80.43% (37/46); χ²=5.225, P=0.022], and the deterioration rate was lower than that in the control group [2.13% (1/47) vs. 15.22% (7/46); χ²=5.066, P=0.024]. On the first day of intervention, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the observation group were lower than those in the control group [(32.55±0.36) vs. (34.27±0.41) and (33.14±0.35) vs. (35.11±0.25)], with statistical differences (t=21.510 and 31.175, both P<0.001). On the seventh day of intervention, the scores of SAS and SDS in the observation group were lower than those in the control group [(28.45±0.33) vs. (30.16±0.41) and (30.16±0.25) vs. (32.25±0.33)], with statistical differences (t=22.180 and 34.474, both P<0.001). On the 14th day of intervention, the scores of SAS and SDS in the observation group were lower than those in the control group [(25.17±0.42) vs. (27.62±0.41) and (26.44±0.35) vs. (27.95±0.33)], with statistical differences (t=28.459 and 21.397, both P<0.001). On day 1, 7, and 14 of isolation, the symptom scores in the observation group were lower than those in the control group [(6.12±0.35) vs. (7.88±0.24), (4.17±0.25) vs. (5.33±0.65), and (3.23±0.11) vs. (4.42±0.16); t=28.223, 11.404, and 41.873; all P<0.001]. Conclusions　Centralized isolation and control of asymptomatic infection of COVID-19 based on the concept of " preventive treatment of diseases" in traditional Chinese medicine can effectively speed up the patients’ recovery and inhibit the disease spread, and has positive significance in avoiding the patients with mild symptoms getting worse and improving their psychological states and isolation satisfaction. It can ensure the patients have medical isolation, recover, and discharge, and has high application value.

Research progress of multidrug-resistant organism and nursing prevention and control in ICU

Wang Limin, Du Shuping, Wang Zhijuan

2022, 28(23):  3292.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.009

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ICU is a department with high-incidence infections of multidrug-resistant organism (MDRO) in hospitals, and effective prevention and control strategies for such infections have become hospitals' focus. Nursing staff play a key role in the prevention and control of MDRO infections. This article reviews the current situation of studies about MDRO infections and summarizes the multi-target clinical nursing measures, so as to reduces the incidence of MDRO infections in ICU by strengthening nursing prevention and control.

Correlations of blood glucose fluctuation with renal function and oxidative stress in patients with type 2 diabetes nephropathy

Zhang Na, Liu Mei, Ji Gaode, Yang Ming, Ju Han

2022, 28(23):  3296.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.010

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Objective　To explore the correlations of blood glucose fluctuation with renal function and oxidative stress in patients with type 2 diabetes nephropathy. Methods　Eighty-two patients with type 2 diabetes treated at Jinan Second People's Hospital from January 2019 to January 2022 were divided into a simple type 2 diabetes group (28 cases) and a type 2 diabetes nephropathy group (54 cases); 17 healthy people were selected as a healthy group. The clinical data were collected and compared. In the simple type 2 diabetes group, there were 14 males and 14 females who were 31-68 (49.52±8.52) years old, with 5 smokers. In type 2 diabetes nephropathy group, there were 33 males and 21 females who were 30-70 (50.52±8.61) years old, with 3 smokers. In the healthy group, there were 10 males and 7 females who were 30-80 (52.52±8.77) years old, with 3 smokers. The 24 h mean blood glucose standard deviations and mean blood glucose fluctuation ranges of the three groups were compared. The blood urea nitrogen (BUN) and creatinine (SCr) were measured by the automatic biochemical analyzer. The levels of reactive oxygen species (ROS) and superoxide dismutase (SOD) of the three groups were compared. t and χ² tests and one-way ANOVA were applied. The Pearson method was used to analyze the correlations of blood glucose fluctuation with renal function and oxidative stress in the patients with type 2 diabetes nephropathy. Results　The 24 h mean blood glucose standard deviations and the mean blood glucose fluctuation ranges in the simple type 2 diabetes group and the type 2 diabetes nephropathy group were higher those in the healthy group (F=26.446 and, 49.198, both P<0.001), and those in the type 2 diabetes nephropathy group were higher than those in the simple type 2 diabetes group, with statistical significance (both P<0.05). The BUN and SCR in the simple type 2 diabetes group and the type 2 diabetes nephropathy group were lower than those in the healthy group (F=17.541 and 16.524, both P<0.001), and those in the type 2 diabetes nephropathy group were lower than those in the simple type 2 diabetes group (both P<0.05). The ROS and SOD in the simple type 2 diabetes group and the type 2 diabetes nephropathy group were lower than those in the healthy group (F=21.250 and 18.522, both P<0.001), and the levels in the type 2 diabetes nephropathy group were lower than those in the simple type 2 diabetes group (both P<0.05). Pearson's results showed that BUN, SCR, ROS, and SOD were negatively correlated with the mean blood glucose fluctuation of the patients with type 2 diabetes nephropathy (r=-0.365, -0.687, -0.854, and -0.257; P= 0.012, 0.021, 0.015, and 0.010). Conclusion　There are negative correlations of blood glucose fluctuation with renal function and oxidative stress in patients with type 2 diabetes nephropathy.

Sublingual dust mite drops combined with cetirizine hydrochloride drops and azelastine nasal spray in treatment of children with allergic rhinitis

Qin Qianqian, Lian Yongcheng

2022, 28(23):  3300.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.011

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Objective　To investigate the clinical value of dust mite drops combined with cetirizine and azelastine in the treatment of children with allergic rhinitis (AR). Methods　One hundred and sixty children with AR treated at Jiaozuo Maternal and Child Health Hospital from June 2020 to March 2022 were selected. According to the treatment schemes, they were divided into a control group, treated by cetirizine, and a study group, treated by cetirizine and sublingual dust mite drops, with 80 cases in each group. Both groups were treated for 2 months. The symptom improvement times, the levels of C-reactive protein (CRP), immunoglobulin A, E, and M (IgA, IgE, and IgM), and interleukin-6 (IL-6) before and after the treatment, and adverse reactions were compared between the two groups.t and χ² tests were applied. Results　The improvement times of nasal congestion , runny nose , nasal itching , and sneezing  in the study group were shorter than those in the control group (t=9.792, 5.810, 5.737, and 4.969;all P<0.05). Before the treatment, there were no statistical differences in IgM , IgA , and IgE  between the two groups (t=0.714, 0.529, and 0.474; all P>0.05). After the treatment, the levels of IgM , IgA , and IgE  in the study group were lower than those in the control group, with statistical differences (t=2.879, 5.464, and 0.584;all P<0.05). Before the treatment, there no statistical differences in CRP [(8.13±0.95)mg/L vs. (8.03±0.89)mg/L] and IL-6 [(36.47±10.97) pg/ml vs. (30.52±6.23)pg/ml] between the study group and the control group, with no statistical differences (t=0.518 and 0.026; both P<0.05). After the treatment, the levels of CRP and IL-6  in the study group were lower than those in the control group, with significant differences (t=13.871 and 4.912; both P<0.05). The total incidence of adverse reactions was 11.25%(9/80) in the control group, and was 10.00%(8/80) in the study group, with no statistical difference （χ²=0.066， P=0.798). Conclusion　Dust mite drops combined with cetirizine hydrochloride and azelastine can effectively shorten the time of symptom improvement in children with AR, and improve the levels of serum inflammatory factors and immune factors.

Thyroid function and pregnancy outcomes of women in second trimester of pregnancy

Lai Xiaoduan, Chen Zhixiong, Chen Shaohong

2022, 28(23):  3304.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.012

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Objective　To analyze the effect of thyroid function during pregnancy on pregnancy outcomes. Methods　The data of the pregnant women in Puning Overseas Chinese Hospital from January 2018 to January 2020 were collected, and 3 752 pregnant women were selected for the experimental analysis according to the completion of the data. The incidences of thyroid dysfunction [clinical hypothyroidism, hyperthyroidism, and abnormal thyroid peroxidase antibody (TPOAb)], hypothyroidism (T4), thyroid nodules, thyrotoxicosis, and subclinical hypothyroidism (SCH) in the 3 752 women during pregnancy were analyzed. The 3 752 pregnant women were divided into a control group (2 980 cases with normal thyroid function), an SCH+TPOAb positive group (158 cases), an SCH+TPOAb negative group (265 cases), and a TPOAb positive group (349 cases). The pregnancy outcomes of the four groups were compared. χ² test was applied. Results　The incidences of complications in the SCH+TPOAb positive group, the SCH+TPOAb negative group,and the TPOAb positive group were 79.75% (126/158), 62.26% (165/265), 61.60% (215/349), respectively, compared with that in the control group [48.22% (1 437/2 980)],with  statistical differences (all P<0.05). There were statistical differences in spontaneous abortion, preterm birth, and full-term low birth weight infants between these four groups (χ²=24.456, 54.088, and 14.324; all P<0.05). Conclusion　Both positive or negative TPOAb in SCH and positive TPOAb alone can lead to pregnancy outcomes and multiple complications, such as pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, term low birth weight infants, and preterm birth.

Effect of modified bird's nest nursing intervention for infants with neonatal jaundice

Zhao Xiaogai, Fu Mengmeng, Li Danfeng

2022, 28(23):  3307.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.013

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Objective　To explore the effect of modified bird's nest nursing for infants with neonatal jaundice. Methods　In the prospective study, 80 infants with neonatal jaundice who received blue light treatment in the Children's Hospital of Zhengzhou University from January 2020 to December 2021 were selected, and were divided into an observation group and a control group by the random number table method, with 40 cases in each group. The observation group, 21 males and 19 females with a gestational age of 30-41 weeks, received the modified bird's nest nursing intervention, while the control group, 23 males and 17 females with a gestational age of 31-41 weeks, received the conventional bird's nest nursing intervention. The baseline data of the two groups were counted; the relevant indicators (daily sleep time, daily crying time, hospitalization time, and body temperature fluctuation) of the two groups were recorded; the levels of bilirubin [indirect bilirubin (IBIL) and total bilirubin (TBIL)] before nursing and after 1 day's, 3 days', and 5 days' nursing of the two groups were compared; the adverse reactions of the two groups were counted; the satisfactions of the family members of the two groups with nursing were evaluated. t and χ² tests were applied. Results　The fluctuation of body temperature in the observation group was smaller than that in the control group [(0.35±0.10) ℃ vs. (0.83±0.12) ℃], the daily crying time and hospitalization time in the observation group [(45.37±4.09) min and (4.83±0.82) d] were shorter than those in the control group [(56.73±5.82) min and (6.08±0.78) d], and the daily sleep time in the observation group [(21.12±0.79) h] was longer than that in the control group [(17.26±2.93) h], with statistical differences (t=19.435, 10.100, 6.986, and 8.045; all P<0.001). On day 1, 3, and 5 of nursing, the serum levels of IBIL and TBIL in the two groups were successively lower than those before nursing, and were lower in the observation group than in the control group (all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [5.00% (2/40) vs. 20.00% (8/40)], with a statistical difference (χ²=4.114, P=0.043). The nursing satisfaction of the family members in the observation group was higher than that in the control group [95.00% (38/40) vs. 77.50% (31/40)], with a statistical difference (χ²=5.165, P=0.023). Conclusion　The modified bird's nest nursing intervention for infants with neonatal jaundice can improve their sleep quality, reduce the crying time and complications, adjust their bilirubin level, and improve the nursing satisfaction of the children's family members.

Research Progress on the mechanism of trained immunity and its role in diseases

Hao Shanshan, Hou Yanqiang, Peng Liang

2022, 28(23):  3312.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.014

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In recent years, it has been found that natural killer cells (NK), monocytes/macrophages (Mo/Mø) and other innate immune cells will make enhanced or weakened immune response when they are exposed to the same or unrelated pathogens or stimuli as the first invasion, showing memory characteristics similar to adaptive immunity. This phenomenon is called trained immunity (TI). TI is not only a subversion of the traditional immune system, but also an important supplement to the immune system of the body. Different from the classical adaptive immune memory, the occurrence of TI is mediated by pathogen associated molecular patterns (PAMPs) or damage related molecular patterns through pattern recognition receptors (PRRS) acting on the cell surface, which is not specific and has a short duration; it involves metabolic and epigenetic reprogramming mechanisms. Elucidating the regulatory mechanism of TI not only provides a new perspective for the pathogenesis of infectious diseases, immune diseases, and other diseases, but also provides new ideas for disease prevention, drug development, and new vaccine design. This article reviews the discovery, mechanism, and role of TI in diseases.

Wrist-ankle acupuncture combined with Evodia rutaecarpa hot ironing in treating pain after PCNL

Chen Min, Chen Jinlan, Zhu Rui, Liang Siyang, Su Zhengming, Bian Jun, Zhou Chushan, Feng Zihua

2022, 28(23):  3316.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.015

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Objective　To investigate the clinical effect of wrist-ankle acupuncture combined with Evodia rutaecarpa hot ironing in reducing pain score in patients after percutaneous nephrolithotomy (PCNL). Methods　One hundred and twenty patients who underwent PCNL in Department of Urological Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University from January 2021 to May 2022 were included in this randomized controlled trial. They were randomly divided into four groups, with 30 cases in each group. There were 17 males and 13 females in the diclofenac sodium group who were (51.68±5.88) years old, 20 males and 10 females in the wrist-ankle acupuncture group who were (49.91±6.71) years old, 18 males and 12 females in Evodia group who were (50.28±8.33) years old, and 17 males and 13 females in the wrist-ankle acupuncture combined with Evodia japonica group who were (49.07±8.91) years old. The pain scores calculated by Numerical Rating Scale (NRS), analgesic onset times, analgesic retention times, and adverse reactions were compared between the four groups before and after the treatment. The measurement data were analyzed by ANOV, and the enumeration data chi-square test. Results　There was no statistical difference in pain score between the four groups (P=0.305). The wrist-ankle acupuncture combined with Evodia rubra group showed significant effect 5 minutes after the intervention, and the average pain score was 1.12 after 15 minutes. The pain score was 0.68 after 120 minutes, and was more superior than the other groups. The wrist-ankle acupuncture group showed a slow decline during the observative point. After 60 minutes' intervention, the pain score in the Evodia rubra group increased. The diclofenac sodium group did not see significant pain relief in the initial 15 minutes. One case of nausea and vomiting occurred in the diclofenac sodium group. Complications did not occurred in the other three groups. Conclusion　Wrist-ankle acupuncture combined with Evodia rutaecarpa hot ironing is a safe option in improving pain after PCNL with rapid and long-lasting effect.

Influence of intermittent clean catheterization combined with comprehensive rehabilitation training on bladder function recovery and prognosis of paraplegic patients with spinal cord injury

Liu Yi, Chen Hong, Bai Yunjie

2022, 28(23):  3320.  DOI: 2022-03478

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Objective　To investigate the effect of intermittent clean catheterization combined with comprehensive rehabilitation training for paraplegic patients with spinal cord injury (SCI). Methods　Using random number table method, 80 paraplegic patients with SCI admitted to Zhumadian Hospital of Traditional Chinese Medicine from January 2019 to January 2022 were randomly divided into a control group and an observation group, with 40 cases in each group. The control group took routine catheterization and intervention, and the observation group took intermittent clean catheterization and comprehensive rehabilitation training. Before and after the intervention, the bladder function, urodynamic indicators, and quality of life of the two groups were evaluated, and the prognosis of the two groups was evaluated. t and χ² tests were applied. Results　After the intervention, the residual urine volume decreased in the two groups, and was lower in the observation group than in the control group (t=7.324, P<0.001); the bladder volume and maximum voiding volume increased in both groups, and were higher in the observation group than in the control group, with statistical differences (t=5.789 and 13.905; both P<0.001). After the intervention, the levels of detrusor pressure (Pdet) and bladder pressure (Pves) decreased in both groups, and were lower in the observation group than in the control group, with statistical differences (t=4.138 and 5.611; both P<0.001); the bladder compliance (BC) increased in both groups, and was higher in the observation group than in the control group, with statistical a difference (t=3.330, P=0.001). After the intervention, the scores of the International Advisory Council on Urinary Incontinence Questionnaire - Overactive Bladder Sub-Questionnaire (ICIQ-OAB) decreased in both groups, and were lower in the observation group than in the control group, with statistical differences (all P<0.001). The incidence of urinary tract infection in the observation group was lower than that in the control group [5.00% (2/40) vs. 20.00% (8/40)], with a statistical difference (χ²=4.114, P=0.043). Conclusion　Intermittent clean catheterization combined with comprehensive rehabilitation training for paraplegic patients with SCI can effectively improve their bladder function, urodynamic indicators, quality of life, and prognosis.

Public health emergencies at Haizhu District, Guangzhou from 2013 to 2021

Wang Guoling

2022, 28(23):  3324.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.017

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Objective　To analyze the public health emergencies at Haizhu District, Guangzhou from 2013 to 2021 and to provide scientific evidences for effectively responding to public health emergencies in the future. Methods　Descriptive epidemiological methods were used to analyze the data of public health emergencies reported by the national online system at Haizhu District, Guangzhou from 2013 to 2021. Results　A total of 191 public health emergencies were reported from 2013 to 2021, and during which 7 038 patients and 8 death cases were involved. Most of the emergencies were unclassified events (97.91%, 187/191). 98.43% (188/191) of the events were infectious diseases, and 33.33 percent (16/48) occurred in schools and child care institutes except COVID-19, and nursery schools had the highest number of events. The peaks of infectious disease events occurred in January, February, April, and August, while the majority of food poisoning events occurred in June and July. The timely report rate of the emergencies was 98.43% (188/191), and the timely checking rate was 100.00% (191/191). Conclusions　The majority of public health emergencies at Haizhu District are caused by infectious diseases, especially COVID-19, Dengue fever, other infectious diarrhea, and chicken pox. The prevention and control measures should be strengthened in schools. The timelyness of finding out and reporting public health emergencies should be improved to enhance emergency controlling.

Determination of three rodenticides in biological specimens by gas chromatography-tandem mass spectrometry

Liu Yunfu, You Huiyuan, Wu Yanmei

2022, 28(23):  3328.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.018

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Objective　To establish a gas chromatography tandem mass spectrometry (GC-MS/MS) method for the simultaneous determination of rodenticides tetramine, fluoroacetamide, and bromadiolone in whole blood and urine. Methods　Form May to June 2022, the experiment was done in the laboratory of Huizhou Agricultural Product Quality and Safety Supervision and Testing Center. An appropriate amount of sodium chloride was added to the whole blood or urine samples for dehydration, extracted with ethyl acetate, determined by GC-MS/MS, qualitatively determined by characteristic ions, and quantitatively determined by the characteristic ion peak area external standard method. Results　The detection limits of this method were as below: tetramine' limits were 0.07 µg/ml (blood) and 0.10 µg/ml (urine); fluoroacetamide' limits were 0.01 µg/ml (blood) and 0.02 µg/ml (urine); bromadiolone' limits were 0.06 µg/ml (blood) and 0.04 µg/ml (urine). The method had good reproducibility, and the relative standard deviations were as below: tetramine' deviation was 2.3%-8.1%; tluoroacetamide' deviation was 2.2%-9.9%; bromadiolone's deviation was 2.0%-6.4%. The average recovery rates of tetramine, fluoroacetamide, and bromadiolone were 81.5%-101.8%, 79.5%-103.2%, and 87.6%-98.7%. Conclusion　The method has low detection limits and good precision and recovery, and is suitable for the determination of three rodenticides in whole blood and urine samples of patients with suspected rodenticide poisoning.

New Perspective

Application and prospect of robot technology in hip arthroplasty 

Ding Hao, Wang Guangda, Jiao Delin, Ma Shengnan, Chen Geng, Liu Wei, Li Xinpeng

2022, 28(23):  3333.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.019

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With the increasing incidence of hip diseases and the continuous improvement of people's requirements for their own quality of life, the number of artificial hip replacement surgery is also increasing. How to place the prosthesis accurately during the operation to ensure the accurate angle relationship, so as to prolong the life of the prosthesis and avoid the unequal lengths of lower limbs caused by human factors? The complications such as early loosening, dislocation, and fracture of the prosthesis have always been the most concerned problems for joint surgeons. At present, with the development of robot-assisted surgery technology, orthopedic surgery robot technology has also been mature, because it can provide good accuracy and optimize the operation process, robot-assisted hip arthroplasty has gradually become the focus of the development of hip arthroplasty technology. The application progress of robotics in artificial hip arthroplasty is reviewed below.

Nanoliposomes in treatment of rheumatoid arthritis

Wang Jing, Zhu Meiyu, Kang Li, Han Juanjuan, Zhu Xuekai

2022, 28(23):  3337.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.020

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Rheumatoid arthritis is an autoimmune disease of unknown etiology. The typical pathological change is chronic synovitis, which significantly affects the patients' quality of life. Current drugs can relieve symptoms and delay the disease cours, but there are obvious adverse reactions. Nano-drug delivery systems represented by liposomes have shown obvious clinical advantages, and can improve the therapeutic effect of drugs through passive or active targeting. In this study, we review the role of liposomal drug delivery systems in the treatment of rheumatoid arthritis, describe their progress in preclinical studies and clinical trials, and discuss factors which may hinder their clinical translation.

Research progress of miR-181 in ophthalmic diseases

Fu Qianfang, Li Shiyi, Zhang Peipei, Xie Yingbin

2022, 28(23):  3342.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.021

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MicroRNA-181 (miR-181) family members are a group of highly conserved non-coding small molecule RNAs. With the deepening of research, it has been confirmed that they can participate in various signaling pathways that regulate various pathophysiological processes, and affect the proliferation, differentiation, and apoptosis of cells and tissues. In this paper, the action mechanism of miR-181 and the research status of ophthalmic diseases are mainly described, so as to provide references for further research on ophthalmic diseases and treatment.

Anesthesia

Effects of different general anesthesia methods on anesthetic recovery period in patients undergoing gynecological endoscopic surgery

Wu Yasong

2022, 28(23):  3346.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.022

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Objective　To compare the effects of different general anesthesia methods on the anesthetic recovery period in patients undergoing gynecological endoscopic surgery. Methods　A prospective study was conducted on 70 patients who underwent gynecological endoscopic surgery in Maternal and Child Health Care Hospital at Huli District from January 2020 to May 2021. They were 20 to 55 years old; the surgery was finished within 2 hours; the patients were classified as American Society of Anesthesiologists (ASA) Grade Ⅰ to Ⅱ. The patients were divided into an observation group and a control group by the random number table method, with 35 cases in each group. The observation group took intravenous anesthesia during the whole course, and the control group took intravenous and inhalation anesthesia during the maintenance stage. The recovery time of spontaneous respiration, the time to open eyes, the time to pull out tracheal tube, and Ramsay sedation score were recorded respectively during the recovery period of general anesthesia. The blood pressures and heart rates in different time periods were recorded. The patients' cognition was scored. The adverse reactions, such as cough, restlessness, and nausea and vomiting, were recorded. χ² and independent-sample t tests were applied. Results　The Ramsay sedation score in the observation group was significantly higher than that in the control group [(2.78±0.68) vs. (1.69±0.51); t=7.587, P<0.05]. There were no statistical differences in hemodynamic indicators between the two groups at different time points (all P>0.05). The scores of Mini-Mental State Examination (MMS) 12 and 24 h after anesthesia were (27.89±0.41) and (29.01±0.51) in the observation group, respectively, which were significantly higher than those in the control group [(25.10±0.38) and (27.15±0.43)] (t=29.527 and 16.496; both P<0.05). The incidences of cough and restlessness in the observation group were 11.43% (4/35) and 8.57% (3/35), respectively, which were significantly lower than those in the control group [40.00% (14/35) and 31.43% (11/35)] (χ²=7.479 and 5.714, both P<0.05). Conclusion　The application of total intravenous anesthesia in the whole process of gynecological endoscopic surgery within 2 hours does not affect the times of awakening and decannulation and the stability of hemodynamics, and has little impact on the patients' cognitive function, reduces the incidence of adverse reactions during decannulation, and improves the quality of general anesthesia awakening.

Application of dexmedetomidine in cervical cancer surgery and its effect on VAS score 

Zhang Ran, Xu Guoting

2022, 28(23):  3350.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.023

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Objective　To observe and analyze the effect of dexmedetomidine in cervical cancer surgery and its influence on patients' score of Visual Analogue Scale (VAS). Methods　One hundred and thirty patients with cervical cancer surgically treated at First Hospital, Nanyang Medical College from May 2021 to May 2022 were selected as the research objects, and were divided into an experimental group and a control group by lottery, with 65 cases in each group. The experimental group were (45.36±1.17) years old, with a disease course of (6.65±0.33) months. The control group were (45.11±1.46) years old, with a disease course of (6.58±0.24) months. Both groups were given routine anesthesia induction and maintenance anesthesia during operation. Dexmedetomidine was used as auxiliary anesthesia during operation in the experimental group. The VAS scores, intraoperative hemodynamics, postoperative stress reaction, and adverse events after awakening were compared between the two groups at different times. t and χ² test were applied. Results　The VAS score of the experimental group before administration (T0) was not statistically different from that of the control group [(2.52±0.11) vs. (2.55±0.42), t=0.557, P=0.578). The VAS scores immediately (T1), 10 min (T2), and 30 min (T3) after administration, and after the operation (T4) in the experimental group were lower than those in the control group [(2.05±0.17) vs. (2.31±0.22), t=7.540, P<0.001; (1.82±0.33) vs. (2.17±0.45), t=5.057, P<0.001; (1.55±0.35) vs. (1.92±0.46), t=5.161, P <0.001; (1.62±0.47) vs. (1.98±0.72), t=3.376, P<0.001]. The oxygen saturation of blood (SpO₂), arterial oxygen partial pressure (PaO₂), arterial blood carbon dioxide partial pressure (PaCO₂), and mean arterial pressure (MAP) were (98.44±0.27)%, (95.15±0.41) mmHg, (35.22±1.45) mmHg, and (84.41±2.23) mmHg in the experimental group, and were (98.62±0.74)%, (95.34±0.72) mmHg, (35.04±1.62) mmHg, and (84.15±2.12) mmHg in the control group (t=1.842, P=0.068, t=1.849, P=0.065; t=0.668, P=0.506; and t=0.681, P=0.497). After the operation, the levels of hydrogen peroxide (CAT), glutathione peroxidase (GSH-Px), malonaldehyde (MDA), and cortisol (Cor) and the incidence of postoperative adverse events were (7.32±0.26) U/ml, (135.37±10.88) U/ml, (5.25±0.24) nmol/ml, (40.35±2.17) ng/ml, and 10.77% (7/65) in the experimental group, and were (6.55±0.17) U/ml, (132.62±10.41) U/ml, (6.44±0.62) nmol/ml, (43.37±2.26) ng/ml, and 7.69% (5/65) in the control group (t=19.984, P<0.001; t=1.472, P<0.001; t=14.431, P<0.001; t=7.771, P<0.001; χ²=0.566, P=0.452). Conclusions　Dexmedetomidine assisted anesthesia can enhance the analgesic effect of cervical cancer patients during operation. This drug can ensure the stability of hemodynamics during operation and reduce the risk of postoperative stress and adverse events after awakening.

Recent progress of adjuvants to local anesthetics in peripheral nerve block

Pan Zhihao, Yu Kaihua, Wang Bo, Ju Yanxin

2022, 28(23):  3355.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.024

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Peripheral nerve block (PNB) is commonly used in surgical anesthesia and pain treatment. The length of analgesia when a single local anesthetic is used may not last long enough to satisfy clinical need. Adding adjuvants, such as opioids, α-2 agonist, steroids, and so on, may prolong analgesic effect. It is important to acquaintance the action mechanism, advantages, and limitations of these adjuvants to make better clinical choices in PNB.

Clinical effects of esketamine in induction of general anesthesia for lumbar surgery

Ju Yanxin, Yu Kaihua, Tian Demin, Liu Zhiwu

2022, 28(23):  3359.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.025

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Objective　To observe the effect of esketamine in induction of general anesthesia for lumbar surgery on hemodynamics and the extubation period. Methods　A total of 60 patients [American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ] who were scheduled to undergo lumbar surgery under general anesthesia at 970th Hospital of the PLA were enrolled in this study. They were divided into an esketamine group (group E) and a fentanyl group (group F) by the random number table method, with 30 cases in each group. There were 16 males and 14 females in group E, and they were (58.0±7.5) years old. There were 18 males and 12 females in group F, and they were (57.4±7.2) years old. During induction of anesthesia, etomidate 0.3 mg/kg and atracurium 0.3 mg/kg were intravenously injected in all the patients, and group E took esketamine 0.5 mg/kg and group F took fentanyl 5 μg/kg. The hemodynamic changes, such as heart rate (HR) and mean arterial pressure (MAP), were observed and recorded before anesthesia induction (T0), immediately before endotracheal intubation (T1), and 1 min (T2) and 5 min (T3) after intubation. The extubation times and accurate activity times of both lower limbs, and postoperative adverse reactions in both groups were recorded. One-way ANOVA, t test, and χ² test were applied. Results　There were no statistical differences in HR and MAP between two groups at T0 (both P>0.05). The MAP's in group E [(90.5±7.9) mmHg vs. (99.6±8.2) mmHg] and group F [(89.0±9.8) mmHg vs. (97.5±5.7) mmHg] at T1 were significantly lower than those at T0 (both P<0.05). The MAP recovered rapidly in group E after endotracheal intubation, and the MAP's at T2 [(101.4±10.9) mmHg] and T3 [(99.5±7.3) mmHg] were not statistically different from that at T0 (both P>0.05). The MAP's at T2 [(91.5±6.9) mmHg] and T3 [(92.1±7.9) mmHg] of group F were significantly lower than that at T0 (both P<0.05). After induction of anesthesia, the HR at T1 [(61.4±7.5) beats/min] was significantly lower and the HR at T3 [(73.1 ±10.1) beats/min] was significantly higher than that at T0 [(67.7±10.7) beats/min] in group F (both P<0.05). There were no significant changes in HR of group E (all P>0.05). The postoperative extubation time and accurate activity time of both lower limbs in group E were significantly shorter than those in group F [(10.3±0.8) min vs. (13.5±1.5) min and (7.9±2.3) min vs. (9.1±2.8) min], with statistical differences (both P<0.05). The incidence of agitation during waking period of postoperative in group E was significantly lower than that in group F [3.33% (1/30) vs. 20.00% (6/30)]. Conclusion　Esketamine for induction of anesthesia is benificial to stable hemodynamic change and recovery of postoperative cognitive function and could reduce the incidence of adverse reactions such as agitation during the waking period.

Anesthetic effects and recovery qualities of sevoflurane and propofol combined with remifentanil in laparoscopic cholecystectomy

Zhang Xiaoyong, Liu Hui, Jin Gang, Han Jingtian

2022, 28(23):  3363.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.026

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Objective　To analyze and compare the anesthetic effects and recovery qualities of sevoflurane and propofol combined with remifentanil for patients undergoing laparoscopic cholecystectomy. Methods　A total of 104 patients who underwent laparoscopic cholecystectomy in Fumine General Hospital from January 2021 to February 2022 were selected, and divided into a reference group and a study group by the random number table method, with 52 cases in each group. There were 31 males and 21 females in the reference group, and they were (67.28±4.48) years old. There were 30 males and 22 females in the study group, and they were (66.89±4.31) years old. The reference group was anesthetized with propofol and remifentanil, and the study group with sevoflurane and remifentanil. The heart rates (HR), mean arterial pressures (MAP), recovery qualities, and total incidences of adverse reactions were compared between these two groups. t and χ² tests were applied. Results　There were no statistical differences in HR's and MAP's at T₀ and T₄ between the two groups (all P>0.05). The HR's and MAP's at T₁ and T₂ in the two groups were lower than those at T₀, and the HR's and MAP's in the study group were lower than those in the reference group (all P<0.05). The recovery time of spontaneous breathing, eye opening time, speech response time, and extubation time in the study group were significantly shorter than those in the reference group [(6.18±1.10) min vs. (8.37±1.92) min, (6.69±1.85) min vs. (10.23±2.17) min, (9.31±2.38) min vs. (11.45±2.78) min, and (9.75±1.85) min vs. (11.94±3.04) min; t=7.137, 8.952, 4.217, and 4.438; all P<0.05]. The total incidence of adverse reactions, such as nausea and vomiting, dizziness, muscle stiffness, body movement response, and respiratory depression, in the study group was lower than that in the reference group [3.85% (2/52) vs. 17.31% (9/52); χ²=4.981, P<0.05]. Conclusion　Sevoflurane combined remifentanil has good anesthesia effect on patients undergoing laparoscopic cholecystectomy, and can maintain the stability of hemodynamics, shorten the time of recovery, and reduce the incidence of adverse reactions, so it is worth being generalized.

Clinical Teaching

Application of CBL combined with ETM teaching method in ward round of neurology teaching

Liao Wang, Liu Chongxu, Luo Haoyu, Yang Shaoqing

2022, 28(23):  3367.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.027

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Clinical practice is the next step for medical students to carry out their work in the future, and the application of traditional teaching in the complex knowledge of neurology is low. How to effectively use this time to lay a solid foundation for clinical work is the problem teachers must solve. The authors combine the characteristics of neurology, adopt the teaching mode of excavation teaching method (ETM) combined with case-based learning (CBL), which is problem-oriented and guides students to fall into the "trap". It has achieved good response and is worth being generalized.

Clinical teaching method of femoral venipuncture catheterization in oncology department

Lin Jieheng, Lin Jietao, Cao Yang

2022, 28(23):  3369.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.028

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Objective　To explore the application of the clinical teaching method of femoral venipuncture catheterization in oncology department and improve the mastery of femoral venipuncture catheterization for clinical rotation training beginners. Methods　Twenty-eight interns for training in rotation in Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2020 to February 2022 were selected. The clinical teaching of femoral venipuncture catheterization was carried out. The success rate of femoral venipuncture catheterization in the teaching process was counted, and the experience and lessons of femoral venipuncture catheterization were shared and summarized. χ² tests and ANOVA were applied. Results　The first, second, and third year graduates did the puncture during the teaching process (3.62±0.92) times, (3.83±1.19) time, and (4.25±1.49) times, respectively, with no statistical difference (F=0.55, P=0.582). The first, second, and third year graduates spent (5.75±2.77) min, (6.17±3.21) min, and (3.88±1.64) min on successful catheterization, respectively, with no statistical difference (F=1.79, P=0.188). The success rates of catheterization of the first, second, and third year graduates when they left the center were 50%(4/8),75.0%(9/12),and 62.5%(5/8), respectively, with no statistical difference (χ²=1.32, P=0.516). The proportions of mastering puncture site localization of the first, second, and third year graduates were 87.5%(7/8),91.7%(11/12),and 100.0%(8/8), respectively, with no statistical difference (χ²=0.99, P=0.61). Conclusions　Femoral venipuncture catheterization is widely used in patients with tumors. Because of its difficulty and risk, it requires higher proficiency of the operators. According to the results of teaching and training for medical students of different grades, the overall effect of the clinical teaching method of puncture technique is basically the same, which is helpful to guide beginners to master femoral venipuncture catheterization, and is welcomed by medical students.

Treatises

Effect of dyslipidemia on pregnancy outcomes in non-PCOS patients undergoing in vitro fertilization-embryo transfer

Cheng Ling, Yan Xiaohong, Li Youzhu

2022, 28(23):  3376.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.029

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Objective　To investigate the effect of dyslipidemia on pregnancy outcomes in patients with non-polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization-embryo transfer. Methods　The clinical data of 677 non-PCOS infertile couples who attended Department of Reproductive Medicine, The First Hospital of Xiamen University from December 2016 to December 2020 and underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were collected. They were divided into a normal lipid group (556 cases) who were (29.32±3.03) years old and an abnormal lipid group (121cases) who were (29.68±2.83) years old according to the female lipid level. The general data and pregnancy outcomes in both groups were analyzed. The data were compared between these two groups by independent-sample t test, χ² test, and Fisher's precision probability test. Results　The body mass index (BMI), years of infertility, gonadotropin (Gn) days, and total Gn in the abnormal lipid group were higher than those in the normal lipid group, with statistical significant differences (all P<0.05). There were no statistical differences in female age, male age, basal follicle stimulating hormone (FSH), basal luteinizing hormone (LH), basal estradiol (E₂), human chorionic gonadotropin (HCG) daily E₂ level, HCG daily progesterone (P) level, HCG daily endometrial thickness, mode of fertilization, and infertility between the two groups (all P>0.05). The live birth rate in the abnormal lipid group was lower than that in the normal lipid group [41.89% (31/74) vs. 55.32% (156/282)], and the miscarriage rate in the abnormal lipid group was higher than in the normal lipid group [22.50% (9/40) vs. 10.86% (19/175)], with statistical differences (χ²=4.238 and 4.896, both P<0.05). There were no statistical difference in the number of eggs obtained, number of MII eggs, fertilization rate, number of embryos transferred, infant weight, pregnancy rate, implantation rate, preterm birth rate, type of embryos transferred, newborn gender, and newborn weight ratio between the two groups (all P>0.05). Conclusion　Dyslipidaemia can lead to a lower live birth rate and a higher miscarriage rate in non-PCOS infertile patients, and controlling lipid levels to normal prior to assisted reproductive treatment may have better pregnancy outcomes.

Effect and prognosis of tirofiban combined with thrombus aspiration in emergency PCI for patients with STIMI

Li Wenqiang, Ma Zhen

2022, 28(23):  3380.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.030

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Objective　To compare the clinical efficacies and prognosis of tirofiban combined with thrombus aspiration and tirofiban alone for patients with ST segment elevation myocardial infarction (STIMI) undergoing emergency percutaneous coronary intervention (PCI). Methods　One hundred and seventy-one patients with STIMI who went to Department of Cardiovascular Medicine, Fuyang People's Hospital from the Emergency Department for emergency PCI from January 2018 to April 2021 were collected. The patients were divided into a study group (74 cases) and a control group (97 cases) according to the intraoperative treatment methods. The study group used thrombus aspiration catheter and intracoronary injection of tirofiban in PCI. The control group were treated by intracoronary injection of tirofiban and PCI. The thrombolysis in myocardial infarction (TIMI) blood flow grades of infarcted artery after operation, ejection fractions within one week after operation, incidences of cardiovascular adverse events, incidences of stroke, incidences of bleeding, lengths of hospital stay, cost, and re-hospitalization rates within one year after operation were compared between these two groups. The data were compared between these two groups by t test, χ² test, or Fisher's precision probability test. Results　There were no statistical differences in TIMI blood flow grade, ejection fraction, incidence adverse cardiovascular events (MACE), incidence of stroke, incidence of bleeding, and readmission rate due to cardiovascular disease within one year after operation between the two groups during hospitalization (all P>0.05). The first hospitalization days and cost were 10.5 (9.0, 13.0) d and 31 951.3 (26 137.7, 38 866.0) in the study group, and were 9.0 (8.0, 11.5) d and 28 668.6 (25 773.6, 32 972.3) in the control group, with statistical differences (Z=-2.459 and -2.207, P=0.014 and 0.027). Conclusions　The combination of tirofiban and thrombus aspiration therapy on the basis of intracoronary injection does not improve the clinical efficacy and reduce the incidence of adverse events related to prognosis in patients with STIMI after emergency PCI as compared with tirofiban alone. On the contrary, it is possible to prolong the length of hospitalization and increase the cost of hospitalization, so conventional use should not be recommended.

Case Report

A case of breast tuberculosis misdiagnosed as lactating mastitis due to breast abscess

Zhou Bingyu, Hu Pingping

2022, 28(23):  3385.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.031

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Breast tuberculosis is a chronic special infection of the breast, caused by Mycobacterium tuberculosis. This disease is rare, but is not very rare. It is reported that the incidence in South Africa, India, and other countries is high, accounting for about 4.5% of breast diseases. The incidence in developed countries, such as European, American, tec., is low, accounting for 0.5%-1.0% of breast diseases. In China, it accounts for 1.5%-2.8% of breast diseases. It is common in 20-40 years old women. Due to its diverse clinical symptoms and lack of specificity, various examination methods have their limitations, and the literature reports that the misdiagnosis rate can reach 57.0%-80.0%. Detailed physical examination and perfect auxiliary examination can help clinicians diagnose this disease and avoid misdiagnosis and missed diagnosis. In order to improve the understanding of breast tuberculosis, this paper intends to review the clinical data of a case of breast tuberculosis in Department of Breast Surgery ,Weihai Central Hospital, Qingdao University.

Clinical Research

Dipeptidyl peptidase-4 inhibitor and acarbose for elderly patients firstly diagnosed with type 2 diabetes mellitus

Zhang Jian, Fan Wenwen

2022, 28(23):  3388.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.032

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Clinical analysis on axillary chylous fistula after breast-conserving operation and axillary lymph node dissection for breast cancer

Zhang Changhe, Gao Xuezhong

2022, 28(23):  3391.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.033

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Effects of two methods of gray area sample processing in elimination of interference of hepatitis C antibody detection

Ye Hongling, Li Na, Zeng Jian, Hou Sinan

2022, 28(23):  3394.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.034

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Modified Chaihu Guizhi Ganjiang decoction for insomnia (stagnation of liver-qi and phlegm)

Chen Bangshi, Wu Ailing, Shi Xietong

2022, 28(23):  3399.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.035

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Objective　To evaluate the effectiveness and safety of modified Chaihu Guizhi Ganjiang decoction for insomnia (stagnation of liver-qi and phlegm). Methods　Sixty cases of insomnia patients diagnosed as stagnation of liver-qi and phlegm treated at Department of Traditional Chinese Medicine, Jieyang People's Hospital from August 2021 to June 2022 were selected, and were divided into an observation group and a control group by the random number table method, with 30 cases in each group. There were 10 males and 20 females in the observation group, and they were (50.40±16.30) year old. There were 8 males and 22 females in the control group, and they were (50.17±14.80) year old. The observation group were treated with modified Chaihu Guizhi Ganjiang decoction, and the control group with hypnotics (zolpidem tartrate), for 2 weeks. The scores of Athens Insomnia Scale (AIS) and traditional Chinese medicine (TCM) syndromes, effectiveness, and safety in the two groups were observed and compared. t and χ² tests were applied. Results　The AIS scores before and after the treatment were (11.77±1.83) and (6.63±1.30) in the control group, and were (10.90±1.88) and (4.80±1.50) in the observation group; the AIS scores of the two groups after the treatment were significantly lower than those before the treatment, with statistical differences (both P<0.05); the AIS score of the observation group after the treatment was much better than that of the control group, with a statistical difference (P<0.05). The TCM syndrome scores before and after the treatment were (9.50±1.61) and (9.27±2.32) in the control group, and were (9.60±1.81) and (4.17±1.86) in observation group; the TCM syndrome score of the observation group after the treatment was significantly lower than that before the treatment, with a statistical difference (P<0.05). The effective rate was 73.33% (22/30) in the control group, and was 93.33% (28/30) in the observation group, with a statistical difference (P<0.05). The incidence of adverse reactions was 33.33% (10/30) in the control group, and was 10.00% (3/30) in the observation group, with a statistical difference (P<0.05). Conclusion　The modified Chaihu Guizhi Ganjiang decoction has definite curative effect on insomnia (stagnation of liver-qi and phlegm) and fewer adverse reactions, and can improve the patients' sleep quality and symptoms.

Correlations of halo needle with blood glucose, blood pressure, and BMI in outpatient physical examination adults

Deng Jingyi, Wang Zhuhong Lin Chan

2022, 28(23):  3403.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.036

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Objective　To explore the correlations of halo needle with blood sugar, blood pressure, and body mass index (BMI) in outpatient physical examination adults. Methods　This was a cross-sectional survey method. A total of 6 438 adults taking outpatient physical examination at The Third Affiliated Hospital of Sun Yat-Sen University from July 2021 to June 2022 were continuously included as the research objects. Among them, there were 3 421 males and 3 017 females, with an age of (43.61±11.52). They were divided into a halo needle group and a no halo needle group. The age, gender, and BMI were investigated. According to their BMI, they were divided into the low body weight, normal weight, pre-obesity, and obesity categories. The systolic blood pressure and diastolic blood pressure were measured by electronic sphygmomanometer before blood drawing, and they were divided into the hypotension, normotensive, and hypertensive categories. According to blood glucose test results, they were divided into the hypoglycemia, normoglycemia, impaired blood sugar, and hyperglycemia categories. Univariate analysis and binary logistic regression analysis were used to analyze the related factors of halo needle, and Spearman correlation was used to analyze the correlation between blood glucose, blood pressure, and BMI in the outpatient physical examination adults and halo needle. Results　Univariate analysis showed that there were statistical differences in the incidences of halo needle in different gender, BMI, fasting blood glucose (FBG), and blood pressure factors (all P<0.05). Spearman correlation analysis showed that halo needle had weak negative correlations with blood glucose (r=-0.246) and blood pressure (r=-0.260), and a weak positive correlation with BMI (r=0.184), all P<0.001. Binary logistic regression analysis showed that pre-obesity (OR=1.343, 95%CI 1.089-1.656), obesity (OR=1.730, 95%CI 1.107-2.703), hypoglycemia (OR=2.232, 95%CI 1.268-3.960), and hypotension (OR=1.520, 95%CI 1.084-2.131) were the risk factors for halo needle, all P<0.05. Conclusions Hypoglycemia, hypotension, pre-obesity, and obesity are closely related to halo needle in outpatient physical examination. It is necessary to strengthen the prevention of halo needle in adults with such characteristics.

Nursing Research

Needs of continuous care for threatened abortion patients after assisted reproductive pregnancy

Tan Hongxia, Wenjuan , Song Yueling

2022, 28(23):  3407.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.037

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Objective　To understand the continuous nursing needs of patients with threatened abortion after assisted reproductive pregnancy. Methods　One hundred and twenty-one patients with threatened abortion after assisted reproductive pregnancy at Guangdong Second People's Hospital were investigated by questionnaire from April to July 2021. They were (33.7 ±4.50) years old. The influencing factors of continuous nursing needs were analyzed by multiple linear regression. Results　The top three content requirements were safe medication guidance, disease observation, and medical guidance. The top three formal requirements were online consultation "Ding Bai doctor", opening consultation telephone number, and Wechat official account information pushing. Multiple linear regression analysis showed that education level and hospital-clinic-visiting frequency were related to the degree of continuous nursing needs (t=4.11 and 2.68, both P<0.05). Conclusions　Patients with threatened abortion after assisted reproductive assistance have an urgent need for continuous nursing after discharge, and there are various forms. Their health guidance of patients after discharge should be strengthened and individualized and modern continuous nursing measures adopted to improve their quality of life after discharge.

Application of vein detained needles in patients taking transfusion in outpatient and emergency departments of a large general hospital

Deng Handi, Li Liuying, Zuo Man

2022, 28(23):  3411.  DOI: 10.3760/cma.j.issn.1007-1245.2022.23.038

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Objective　To investigate the effect applying vein detained needles in patients taking transfusion in the outpatient and emergency departments of a large general hospital. Methods　The patients who used disposable scalp needles for transfusion in the central injection room of the outpatient and emergency departments of Guangdong Provincial People's Hospital from May 2019 to April 2020 were selected as a control group. From May 2020 to April 2021, the patients who used vein detained needles for transfusion in the outpatient and emergency departments of Guangdong Provincial People's Hospital were taken as an observation group. There were 561 males and 488 females in the control group; they were (41.14±20.61) years old; they had transfusion (330.41±137.27) ml per day for (5.69±2.20) days. There were 612 males and 600 females in the observation group; they were (39.61±19.48) years old; they had transfusion (341.17±137.60) ml per day for (5.70±2.21) days. There were no statistical differences in the general data between these two groups (all P>0.05). Except the patients in the control group who controlled blood pressure or glucose by pumping, all the patients in the outpatient and emergency departments used scalp needles for infusion according to the intravenous infusion procedure. The patients in the experimental group who infused o two bottles of liquid in the outpatient and emergency departments used the vein detained needles for transfusion according to the intravenous infusion procedure. The incidences of infusion exosmosis/exudation of intravenous infusion and the patients' complaint rates and satisfaction rates were compared between the experimental group and the control group. t and χ² tests were applied. Results　The incidence of extravasation/exudation of intravenous infusion and the patients' complaint rate and satisfaction rate were 2.23% (27/1 212), 0.17% (2/1 212), and 98.43% (1 193/1 212) in the observation group, and were 6.96% (73/1 049), 0.95% (10/1 049), and 90.09% (945/1 049) in the control group, with statistical differences (χ²=29.833, 6.619, and 76.152; all P<0.05). Conclusion　The application of vein detained needles in outpatient and emergency transfusion patients in large general hospitals can improve patient satisfaction and reduce the rate of infusion exudation/extravasation, so it is worth being generalized.