Table of Content

15 December 2022, Volume 28 Issue 24

Previous Issue   

Scientific Research

Role of Card9 in intestinal diseases

Ji Changxue, Yang Zhiwen

2022, 28(24):  3415.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.001

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Caspase recruitment domain containing protein 9 (Card9) is an important immunoinflammatory protein distributed in the macrophages, which plays a critical role in nuclear factor (NF)-κB and MAPK activation. It leads to the initiation of inflammatory cytokine cascade, and elicits the host immune response against fungal and bacterial invasion. Current research indicates that Card9 plays an important role in regulating intestinal microecology, leading to the occurrence of various intestinal diseases. Here, we mainly focus on the function of Card9 in inflammatory bowel disease, colitis-associated colorectal cancer, and colon cancer.

Progress in the relationship between intestinal flora and intestinal immune microenvironment in colorectal cancer patients

Zhu Kun, Lu Qingjun, Ren Xiang, Jiang Hong

2022, 28(24):  3419.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.002

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Colorectal cancer (CRC) is one of the most commonly malignant tumors of digestive tract. Its occurrence and development are affected by many factors such as diet, genetics, and immunity. At present, more studies have turned to the role of intestinal flora in immune regulation of CRC. In this review, the composition of intestinal flora and the relationship between intestinal flora and intestinal immune microenvironment in CRC patients are studied, and we emphatically discuss the regulation of intestinal flora in intestinal immune microenvironment in CRC patients in order to provide a new way for the prevention and treatment of CRC.

Expression of lncRNA CCAT1 in the endometrial carcinoma tissue and its relationship with pathological parameters

Jiang Qiuhui, Song Xiaoxia

2022, 28(24):  3423.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.003

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Effect of modified SWAN-RLMC score on assessment and prognosis of asymmetrically veins sign in chronic middle cerebral artery occlusion

Xu Kaixi, Chen Xinjian, Gu Baodong, Xu Xingru, Ma Xianjun, Zuo Taosheng, Meng Yun, Bian Guangrong

2022, 28(24):  3426.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.004

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Objective　To evaluate chronic middle cerebral artery occlusion (CMCAO) by asymmetrically veins sign (AVS) on susceptibility weighted angiography (SWAN), to investigate the manifestation of AVS in patients with different collateral circulation status, and to evaluate the predictive ability of AVS for prognosis of CMCAO. Methods　A total of 39 patients with CMCAO, 25 males and 14 females, aged 46-90 (67.18±10.167) years, were enrolled in Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2017 to February 2022. All patients underwent conventional magnetic resonance imaging (MRI), three dimensional time of flight magnetic resonance angiography (3D TOF-MRA), and SWAN examination. According to the improved regional leptomeningeal collateral (rLMC) score, namely SWAN-rLMC score, the patients were divided into a poor group (SWAN-rLMC score >12 points) and a good group (SWAN-rLMC score ≤12 points). The area under receiver operating characteristic curve (ROC) was used to evaluate the predictive ability of different sequences of rLMC scores for poor prognosis. Independent sample t test and χ² test were used. Results　Among the 39 CMCAO patients, 23 cases (58.97%) were on the left side and 16 cases (41.03%) on the right side. SWAN-rLMC score showed that there were 20 cases (51.28%) with poor collateral circulation and 19 cases (48.72%) with good collateral circulation. The rate of good prognosis was 89.5% (17/19) in the good collateral circulation group and 10.0% (2/20) in the poor collateral circulation group, and the difference was statistically significant (χ²=24.633, P<0.001). The area under the curve (AUC) value of SWAN-rLMC score for poor prognosis was 0.886 (95%CI: 0.761-1.000), showing a statistically significant difference (P<0.001), indicating good predictive value for poor prognosis. Conclusions　AVS is more common in patients with poor collateral circulation of CMCAO. Improved SWAN-rLMC score helps to predict and evaluate the prognosis in patients with CMCAO and provides valuable information for clinical treatment.

Analysis of influencing factors of CD-RISC score after interventional therapy for intracranial aneurysms

Zhao Nan, Li Hui, Kong Xiangzhi, Chang Liguo

2022, 28(24):  3431.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.005

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Objective　To analyze the influencing factors of Connor-Davidson Resilience Scale (CD-RISC) score after interventional therapy for intracranial aneurysms and its relationship with simple coping style. Methods　A total of 80 patients with intracranial aneurysms after interventional therapy in Liaocheng Third People's Hospital from October 2018 to November 2021 were selected, including 34 males and 46 females, aged (58.63±7.62) years. General data questionnaire, Perceptive Social Support Scale (PSSS), Simplified Coping Style Questionnaire (SCSQ), and CD-RISC were used to conduct a questionnaire survey. The factors affecting the patients' CD-RISC score were analyzed by single factor analysis, and the factors with statistically significant differences were assigned and were further analyzed by multiple linear regression analysis. Independent sample t test and one-way analysis of variance were used for the measurement data. Results　The CD-RISC score in patients with intracranial aneurysms after interventional therapy was (63.52±5.95), which was at a medium level. There were statistically significant differences in the CD-RISC score among patients with different postoperative complications, psychological nursing, social support, positive coping SCSQ score, and negative coping SCSQ score (all P<0.05). Multiple linear regression analysis showed that postoperative complications (β=-2.983, P<0.05), psychological nursing (β=3.427, P<0.05), social support (β=4.251, P<0.05), positive coping SCSQ score (β=2.154, P<0.05), and negative coping SCSQ score (β=-2.476, P<0.05) were the influencing factors of CD-RISC score. Conclusions　The psychological resilience in patients with intracranial aneurysms after interventional therapy is at a medium level. Postoperative complications, psychological nursing, social support, positive coping SCSQ score, and negative coping SCSQ score are the influencing factors of CD-RISC score after interventional therapy for intracranial aneurysms. Medical staff should pay attention to the relevant influencing factors and formulate the targeted nursing measures to improve the prognosis.

Ischemic preconditioning in intracranial artery stenosis of acute ischemic stroke 

Lou Bo, Feng Bo

2022, 28(24):  3436.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.006

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Objective　To analyze the efficacy of ischemic preconditioning (IP) in treating patients with acute ischemic stroke (AIS) and intracranial artery stenosis and to provide guiding basis for clinical treatment. Methods　A total of 105 patients with AIS and intracranial artery stenosis admitted to Liaocheng Third People's Hospital from February 2020 to August 2021 were selected for the study, and were divided into 52 cases in the control group [33 males and 19 females, aged 50-70 (63.28±2.06) years] and 53 cases in the observation group [30 males and 23 females, aged 50-71 (63.30±2.09) years] by the random number table method. The control group received oral atorvastatin calcium tablets and aspirin enteric tablets, and the observation group was given IP treatment on the basis of the control group. The efficacy of the two groups and the scores of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), vascular elasticity indexes [vascular pressure-strain elasticity coefficient (Ep), compliance (AC), augmentation index (AI), and pulse wave velocity (PWVβ)], endothelial function indexes [von Willebrand factor (vWF), endothelin 1 (ET-1), and nitric oxide (NO)], low-density lipoprotein receptor-related protein 6 (LRP6), high-sensitivity C-reactive protein (hs-CRP), and carotid intima-media thickness (IMT) before and after treatment were recorded. After 6 months of follow-up, the prognosis was assessed by the Glasgow Outcome Scale (GOS). Statistical software SPSS 22.0 was used to analyze the data, t test was used for the measurement data, and χ² test was used for the count data. Results　The total effective rate in the observation group [94.34% (50/53)] was higher than that in the control group [80.77% (42/52)] (P<0.05). After treatment, the NIHSS score, mRS score, Ep, AI, and PWVβ in the observation group were lower than those in the control group, and the AC was higher than that in the control group (all P<0.05). After treatment, the levels of vWF, ET-1, and hs-CRP and IMT in the observation group were lower than those in the control group, while the levels of NO and LRP6 were higher than those in the control group (all P<0.05). After 6 months of follow-up, 3 cases in the control group and 4 cases in the observation group were lost to follow-up; the good prognosis rate of the observation group was 95.92% (47/49), which was higher than that of the control group [77.55% (38/49)] (P<0.05). Conclusion　IP treatment has definite efficacy for patients with intracranial artery stenosis of AIS and can reduce the neurological and endothelial function damage, improve the vascular elasticity, inhibit the inflammatory response, enhance the living ability, and improve the patients' prognosis.

Application effects of different doses of low-radiation manual trigger technology in multi-slice spiral CT pulmonary artery angiography

Wang Haibin, Li Liqiang, Zhang Zhenming, Yin Xiaoxia, Zeng Fanxue, Du Xiaorui, Dong Xianfeng

2022, 28(24):  3441.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.007

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Objective　To compare the application effects of different doses of low-radiation manual trigger technology in multi-slice spiral CT pulmonary artery angiography. Methods　A total of 90 cases of pulmonary embolism treated in Luanzhou People's Hospital from April 2020 to April 2021 were selected and were divided into 2 groups according to the time of admission with 45 cases in each group. Both groups received multi-slice spiral CT scanning. In the control group, there were 20 males and 25 females, aged (49.98±10.03) years, and the conventional dose (60 ml) low-radiation manual trigger technique was used; in the observation group, there were 24 males and 21 females, aged (50.49±10.06) years, and the low-dose (30 ml) low-radiation manual trigger technique was used. The radiation dose, image quality, CT value, and contrast-to-noise ratio (CNR) were compared between the two groups. χ² test was used for the count data, and independent sample t test was used for the measurement data. Results　The CT volume dose, dose-length product, and effective dose in the observation group [(5.42±1.03) mGy, (112.98±20.45) mGy·cm, and (2.30±0.32) mSv] were significantly lower than those in the control group [(11.14±2.16) mGy, (313.76±25.43) mGy·cm, and (5.27±0.88) mSv], with statistically significant differences (all P<0.05). There were no statistically significant differences in the calculated signal-to-noise ratio, and signal intensity between the two groups (all P>0.05). The background noise and image quality score in the observation group [(15.67±0.48) Hu and (4.78±1.02) points] were higher than those in the control group [(8.31±0.35) Hu and (3.55±0.78) points], with statistically significant differences (both P<0.05). The CT value of the observation group was higher than that of the control group [(452.96±24.38) Hu vs. (387.12±43.09) Hu], and the CNR value of the observation group was lower than that of the control group [(33.17±3.54) vs. (36.21±4.36)], with statistically significant differences (both P<0.05). Conclusions　Different doses of low-radiation manual trigger technique can obtain the images of the same quality in multi-slice spiral CT scanning of pulmonary artery vessels. However, low-dose manual trigger technique can significantly reduce the dose of contrast agent and radiation, and improve the reasonable utilization of medical resources.

Analysis on the application effect of responsible holistic nursing model in imported falciparum malaria

Qiu Dongxia, Wang Ruirui, Cui Erping, Ma Shuhuan

2022, 28(24):  3445.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.008

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Objective　To explore the application effect of responsible holistic nursing model in imported falciparum malaria. Methods　Forty cases of imported falciparum malaria diagnosed in Department of Infection, The Sixth People's Hospital of Zhengzhou from September 2018 to September 2019 were collected, and were divided into a control group and a study group according to the random number table method with 20 cases in each group. In the control group, there were 14 males and 6 females, aged (44.9±1.0) years, and they received conventional nursing intervention; in the study group, there were 15 males and 5 females, aged (45.3±1.2) years, and they received responsible holistic nursing model intervention on the basis of the control group. The length of hospital stay, disease cognition, and compliance were compared between the two groups after intervention. Independent sample t test and χ² test were used. Results　The length of hospital stay in the study group was shorter than that in the control group [(8.30±1.85) d vs. (9.35±1.25) d], and the degree of disease cognition and satisfaction in the study group were higher than those in the control group [75.0% (17/20) vs. 50.0% (10/20), 95.0% (19/20) vs. 60.0% (12/20)], with statistically significant differences (all P<0.05). There was no statistically significant difference in the compliance between the two groups (P>0.05). Conclusion　The application of responsible holistic nursing model in imported falciparum malaria has a significant clinical effect, which can improve the treatment compliance and satisfaction in patients and reduce the length of hospital stay, and is worth popularizing.

Predictive values and prognostic correlations of serum PCT, IL-6, and CRP levels for intracranial infection after hypertensive intracerebral hemorrhage surgery

Lan Xichang, Gao Han, Chen Zhisheng, Tan Shaotao, Chen Zhihe

2022, 28(24):  3449.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.009

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Effect of hyperbaric oxygenation combined with core stability training on lower limb dysfunction after craniocerebral injury

Meng Wenwen, Xu Yahui, Cong Haiming, Yu Fengyuan, Li Xiling

2022, 28(24):  3453.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.010

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Objective　To explore the effect of hyperbaric oxygenation combined with core stability training on lower limb dysfunction after craniocerebral injury. Methods　A total of 94 patients with craniocerebral injury admitted to Weihai Central Hospital from January 2020 to January 2022 were prospectively selected as the study subjects. According to the random number table method, they were divided into a study group and a control group. In the control group, there were 22 females and 25 males, aged (60.02±8.52) years; in the study group, there were 26 males and 21 females, aged (61.02±8.68) years. The 47 patients in the control group were given routine core stability training, and the 47 patients in the study group were given hyperbaric oxygenation on the basis of the control group. The patients' limb function in the two groups were assessed by the Fugl-Meyer Motor Function Assessment Scale (FMAS), and the score of Mini-Mental State Examination (MMSE) and the incidence of adverse events after one month of intervention were compared between the two groups. t test and χ² test were used. Results　There was no statistically significant difference in the FMAS score between the two groups before training (t=1.530, P=0.128); the FMAS scores of the two groups after training were higher than those before training (both P<0.05), and the FMAS score of the study group was higher than that of the control group [(28.36±4.82) points vs. (24.96±3.52) points] (t=4.522, P=0.001). There was no statistically significant difference in the MMSE score between the two groups before training (t=1.204, P=0.232); the MMSE score of the two groups after training were higher than those before training (both P<0.05), and the MMSE score of the study group was higher than that of the control group [(24.25±2.85) points vs. (19.56±2.56) points] (t=8.393, P<0.001). The incidence of adverse events in the study group was lower than that in the control group [6.38% (3/47) vs. 23.40% (11/47)] (χ²=5.371, P=0.020). Conclusions　Hyperbaric oxygenation combined with core stability training is beneficial to the recovery of lower limb function in patients with lower limb dysfunction after craniocerebral injury, can improve the mental state and reduce the incidence of adverse events, and is worth popularizing and applying.

Study on enteral nutrition strategies of traumatic brain injury patients undergoing invasive mechanical assisted ventilation guided by B-ultrasound 

Deng Hong, Tao Jianfeng, Zhang Hongju, Tan Zhejun, Huang Yingyan, Yi Yinhua, Zhang Zhijuan

2022, 28(24):  3457.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.011

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Objective　To explore the application of B-ultrasound guidance in enteral nutrition (EN) strategies for patients with traumatic brain injury undergoing invasive mechanical assisted ventilation. Methods　A total of 72 patients with traumatic brain injury undergoing invasive mechanical assisted ventilation admitted to the Intensive Care Unit (ICU) of Lianzhou People's Hospital from November 2019 to May 2021 were divided into a reference group (36 cases) and an experimental group (36 cases) by the random number table. In the reference group, there were 24 males and 12 females, aged (46.28±7.64) years; in the experimental group, there were 26 males and 10 females, aged (47.07±7.22) years. All patients in the two groups received EN treatment by indwelling nasogastric tube within 24-72 hours after admission. The reference group adopted the traditional EN scheme formulated according to the clinical experiences, and the experimental group adopted the EN scheme of invasive ventilator formulated under the guidance of improved B ultrasound single section method of antrum. The nutritional indexes [serum total protein (TP), albumin (Alb), prealbumin (PA) and hemoglobin (Hb)] of the two groups were compared before treatment and after 14 d of treatment. After treatment, the time to reach the target feeding amount, the length of ICU stay, and the length of ventilator use were compared. The incidences of EN related complications (reflux, abdominal distension, diarrhea, ventilator-associated pneumonia, and EN interruption) were calculated. t test was used for the measurement data and Chi-square test or Fisher exact probability method was used for the count data. Results　After treatment, the serum levels of TP, Alb, PA, and Hb in the experimental group were better than those in the control group [(59.14±7.22) g/L vs. (55.65±7.19) g/L, (38.09±7.18) g/L vs. (34.16±7.53) g/L, (192.56±22.18) mg/L vs. (182.73±22.45) mg/L, (107.11±3.22) g/L vs. (105.28±3.47) g/L] (all P<0.05). The time to reach the target feeding amount, the length of ICU stay, and the length of ventilator use of the experimental group were significantly shorter than those in the control group [(2.29±0.42) d vs. (3.68±0.47) d, (9.18±1.20) d vs. (11.25±1.23) d, (8.01±0.52) d vs. (10.17±0.55) d] (all P<0.001). The incidences of abdominal distension, diarrhea, ventilator-associated pneumonia, and EN interruption in the experimental group were 5.56% (2/36), 5.56% (2/36), 2.78% (1/36), and 8.33% (3/36), which were lower than 22.22% (8/36), 27.78% (10/36), 25.00% (9/36), and 27.78% (10/36) in the control group, with statistically significant differences (all P<0.05). Conclusion　Gastrointestinal nutrition guided by ultrasound monitoring can effectively reduce the incidence of EN complications in patients with traumatic brain injury undergoing invasive mechanical assisted ventilation, and improve their nutritional status and prognosis, which is worthy of popularization and application.

Effect analysis of outpatient collaborative nursing combined with cognitive reconstruction intervention on elderly patients with coronary heart disease

Chen Xiang, Wu Xuejuan

2022, 28(24):  3461.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.012

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Objective　To explore the application of outpatient collaborative nursing combined cognitive reconstruction intervention in reducing coronary heart disease readmission in the elderly. Methods　A total of 82 elderly patients with coronary heart disease were selected and regularly reviewed after outpatient treatment in Wuxi Second People's Hospital from July 2019 to July 2021. They were divided into an experimental group and a reference group by the parity grouping method, with 41 cases in each group. In the reference group, there were 18 males and 23 females, aged (69.07±5.62) years; there were 22 males and 19 females in the experimental group, aged (69.31±5.47) years. The reference group received cognitive reconstruction intervention, and the experimental group received outpatient collaborative nursing on the basis. The disease knowledge mastery, self-efficacy measurement scale [Exercise of Self-care Agency Scale (ESCA)], and Seattle Angina Questionnaire (SAQ) quality of life data were evaluated in the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The disease knowledge mastery rate of the experimental group was higher than that of the reference group [95.12% (39/41) vs. 80.49% (33/41)], with a statistically significant difference (χ²=4.100, P=0.043). After intervention, the scores of self-care skills [(36.21±2.82) points vs. (34.51±2.74) points], self-responsibility [(11.26±2.74) points vs. (9.52±2.65) points], self-concept [(25.36±2.63) points vs. (23.52±2.84) points], and health knowledge level [(48.29±2.67) points vs. (46.56±2.58) points] of self-efficacy in the experimental group were higher than those in the reference group, with statistically significant differences (all P<0.05). After intervention, the scores of physical activity [(24.89±2.59) points vs. (26.53±2.63) points], physical symptoms [(23.71±2.64) points vs. (25.46±2.84) points], emotional distress [(15.76±2.63) points vs. (17.45±2.88) points], and life satisfaction [(14.66±2.56) points vs. (16.35±2.64) points] of quality of life in the experimental group were lower than those in the reference group, with statistically significant differences (all P<0.05). The readmission rate of the experimental group was lower than that of the reference group [2.44% (1/41) vs. 14.63% (6/41)], with a statistically significant difference (χ²=3.905, P=0.048). Conclusion　Outpatient collaborative nursing combined with cognitive reconstruction intervention can effectively improve the degree of disease knowledge mastery in elderly patients with coronary heart disease, improve their self-efficacy and quality of life level, and reduce the readmission rate.

Application effect of continuous nursing under quantitative evaluation strategy in patients with chronic obstructive pulmonary disease

Shi Pengpeng, Wang Zhen, Zhang Weihua, Jiao Pengfei

2022, 28(24):  3467.  DOI: 2022-03410

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Objective　To explore the effect of continuous nursing intervention under quantitative evaluation strategy in patients with chronic obstructive pulmonary disease (COPD). Methods　A prospective study was conducted. A total of 78 patients with COPD treated in Shangqiu First People's Hospital from January 2020 to December 2021 were divided into a control group and an observation group according to the random number table method, with 39 cases in both groups. The control group [18 women and 21 men, with an age of (58.96±3.19) years old and a course of disease of (6.86±1.23) years] received routine nursing, while the observation group [19 women and 20 men, with an age of (58.94±3.21) years old and a course of disease of (6.83±1.25) years] received continuous nursing under quantitative evaluation strategy. Both groups received continuous nursing for 2 months. The self-perceived burden, pulmonary function, quality of life, and nursing satisfaction were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After nursing, the economic score [(3.29±0.37) point vs. (5.42±0.81) points], emotional score [(13.07±2.11) point vs. (15.67±2.14) points], and physical score [(4.09±0.42) point vs. (6.12±1.01) points] in the Self-Perceived Burden Scale (SPBS) of the observation group were all lower than those of the control group (t=14.937, 5.403, and 11.590; all P<0.001). After nursing, the forced expiratory volume in 1 s (FEV1) [(1.69±0.18) L vs. (1.31±0.16) L], forced vital capacity (FVC) [(2.28±0.29) L vs. (1.73±0.26) L], and peak expiratory flow (PEF) [(368.87±22.65) L/min vs. (326.93±22.54) L/min] in the observation group were higher than those in the control group (t=9.854, 8.819, and 8.197; all P<0.001). After nursing, the COPD Assessment Test (CAT) score of the observation group was lower than that of the control group [(20.78±3.10) points vs. (26.54±3.14) points], with a statistically significant difference (t=8.152, P<0.001). The total nursing satisfaction of the observation group was higher than that of the control group [94.87% (37/39) vs. 79.49% (31/39)], with a statistically significant difference (χ²=4.129, P=0.042). Conclusion　The continuous nursing under quantitative evaluation strategy for COPD patients can minimize their self-perceived burden, and promote the improvement of lung function and quality of life, so as to improve the patient satisfaction.

Observation on the intervention effect of risk management based on test critical values on nursing safety in nephrology

Lu Qian, Qian Lizhi

2022, 28(24):  3471.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.014

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Objective　To observe the intervention effect of risk management based on test critical values on nursing safety in nephrology. Methods　The convenience sampling method was adopted to randomly select 200 nephrology patients from Wuxi Second People's Hospital from January 2017 to December 2020, who were given routine nephrology nursing. In order to further improve the nursing safety degree, the hospital began to carry out the risk management based on the test critical values since July 2019. The general data questionnaire was used to collect the gender, age, and disease type in nephrology patients. The general data of patients admitted to the hospital were compared between from January 2017 to June 2019 (before implementation) and from July 2019 to December 2020 (after implementation), the incidences of no treatment within 10 min, unqualified specimen collection, delayed disease tracking, and effective complaints on nursing staff before and after implementation were compared, and the processing success rate, the successful treatment time, the time of issuing diagnosis and treatment tasks, the time of reporting the critical values were compared. Independent sample t test and χ² test were used to determine the differences between groups. Results　In the pre-implementation group, there were 57 males and 45 females, aged (52.53±5.61) years; in the post-implementation group, there were 53 males and 45 females, aged (52.39±5.79) years. The incidences of no treatment within 10 min, unqualified specimen collection, delayed disease tracking, and effective complaints in the post-implementation group were significantly lower than those in the pre-implementation group [3.06% (3/98) vs. 17.65% (18/98), 2.04% (2/98) vs. 14.71% (15/98), 1.02% (1/98) vs. 9.80% (10/98), 2.04% (2/98) vs. 12.75% (13/98)] (all P<0.05). The processing success rate of the post-implementation group was higher than that of the pre-implementation group [92.97% (172/185) vs. 82.01% (155/189)] (χ²=10.225, P=0.001); the successful treatment time [(1.75±0.43) d vs. (2.35±0.56) d] and the completion time of reporting the critical value events [(25.15±3.12) min vs. (40.31±10.25) min] in the post-implementation group were significantly lower than those in the pre-implementation group (both P<0.001). Conclusions　Risk management based on test critical values is the management way to train the critical values in nursing staff in nephrology. It can improve the timeliness of nursing staff's critical value processing, improve the qualified rate of specimen collection, track the condition more timely, reduce the nursing complaints, and shorten the treatment time.

Effects of micro-implant anchorage therapy on gingival crevicular fluid chemokines and subgingival flora in orthodontic treatment

Chen Juanjuan, Huang Zhumei, Chen Xin

2022, 28(24):  3475.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.015

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Objective　To investigate the effect of micro-implant anchorage on gingival crevicular fluid chemokines and subgingival flora in orthodontic treatment. Methods　A retrospective study was conducted on 128 patients who received orthodontic treatment in The 73rd Group Army Hospital of the Chinese People's Liberation Army from January 2021 to May 2022. They were divided into a control group (64 cases) and an observation group (64 cases) according to the different anchorage. There were 28 males and 36 females in the control group, aged (23.14±4.98) years; there were 32 males and 32 females in the observation group, aged (22.97±5.12) years. The control group was treated with orthodontic method with external arch reinforcement anchorage, and the observation group was treated with micro implant anchorage technology. The therapeutic effects and masticatory efficiencies of the two groups were compared. The mRNA levels of CX3CL1, CXCL2, CCL4, and CCL7 in the gingival crevicular fluid were compared between the two groups before treatment and after 1 and 4 weeks of treatment. The common pathogens in the subgingival plaque were analyzed by polymerase chain reaction (PCR). t test and χ² test were used for statistical analysis. Results　The success rate of treatment in the observation group was 89.06% (57/64), which was higher than that in the control group [65.63% (42/64)], with a statistically significant difference between the two groups (χ²=10.031, P=0.002). The mRNA levels of CX3CL1, CXCL2, CCL4, and CCL7 in the observation group after 1 and 4 weeks of treatment were higher than those in the control group [(35.13±9.75) pg/nl vs. (27.26±6.71) pg/nl, (37.63±10.14) pg/nl vs. (33.56±9.87) pg/nl, (1.87±0.13) pg/nl vs. (1.26±0.12) pg/nl, (2.23±0.22) pg/nl vs. (1.45±0.16) pg/nl, (1.87±0.23) pg/nl vs. (1.36±0.17) pg/nl, (2.36±0.32) pg/nl vs. (1.74±0.18) pg/nl, (1.69±0.32) pg/nl vs. (1.46±0.11) pg/nl, (2.35±0.42) pg/nl vs. (1.61±0.21) pg/nl], with statistically significant differences (t=5.319, 2.301, 27.583, 22.939, 14.235, 13.509, 5.438, and 12.607; all P<0.05). After treatment, the detection rate of subgingival pathogen Tannerella forsythensis (Tf) in the observation group was significantly lower than that in the control group [12.50% (8/64) vs. 29.69% (19/64)], with a statistically significant difference (χ²=5.680, P=0.017). Conclusion　Micro-implant anchorage has good curative effect in the treatment of oral deformity, can effectively reduce the content of chemokines in the gingival crevicular fluid, and reduce the subgingival flora, which is suitable for clinical application.

Evaluation on the effect of PDCA cycle method in the quality management of hospital tumor registration and reporting

Wang Fenfen, Cui Hongwei, Liu Ying, Liang Junqing

2022, 28(24):  3480.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.016

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Objective　To explore the application effect of PDCA cycle method in the quality management of hospital tumor registration and reporting. Methods　A retrospective survey method was used to select 1 340 tumor cases in a tertiary oncology medical consortium hospital in Inner Mongolia from January to December 2021, including 672 males and 668 females, aged (50.5±1.2) years. The PDCA cycle method was carried out on the basis of routine quality management (formulating questionnaires, daily random and regular inspection of tumor reports, full-time staff review, publicity and training of tumor registration and reporting, etc.). The cyclical quality control was carried out by 4 steps: plan, namely analyzing the reasons by the brainstorming method; do, namely setting up a quality control team, strengthening the three-level quality control supervision, and improving the information system; check and action, namely combined random and regular inspections. The completeness rate and accuracy rate of tumor registration and reporting and underreporting rate were compared before and after PDCA cycle management. Chi-square test was used for statistical analysis. Results　The accuracy rate and completeness rate of tumor registration and reporting and underreporting rate were 68.89% (62/90), 65.56% (59/90), and 73.33% (66/90) within 3 months before the implementation of PDCA cycle method; those were 87.78% (79/90), 94.44% (170/180), 96.67% (261/270), 84.44% (76/90), 91.11% (164/180), 93.33% (252/270), 43.30% (39/90), 25.56% (46/180), and 8.89% (24/270) within 3, 6, and 9 months after the implementation of PDCA cycle method; the reporting quality was significantly improved, and the underreporting rate was significantly decreased, with statistically significant differences (all P<0.05). Conclusions　PDCA cycle method used in the quality management of hospital tumor registration and reporting, effectively improves the accuracy rate and completeness rate of tumor reports and reduces the underreporting rate. PDCA cycle method has strong operability and high application value, and is worth popularizing.

New Perspective

Application research of Chinese medicine characteristic therapy in acute pain

Zhang Xiaochun, Chen Feng, Chen Li

2022, 28(24):  3485.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.017

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In this paper, we review the literatures related to the pain relief in acute pain patients by Chinese medicine characteristic therapy, and combined with the clinical practice, taking acute pain as the research object, analyze its etiology and pathogenesis. We elaborate the clinical application effect of commonly used characteristic therapy for acute pain, fully demonstrate that Chinese medicine external treatment methods, including acupuncture, acupressure, moxibustion, auricular acupuncture, etc., whether applied alone or combined various means, have certain positive therapeutic effect on patients with acute pain, can significantly reduce the patients' pain, and are simple to use, economical, and worth promoting.

Treatment status of atrial fibrillation patients by different ablation methods

Xu Qian, Diao Shuling

2022, 28(24):  3490.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.018

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In recent years, with the continuous development of interventional technology, the treatment of atrial fibrillation has gradually shifted from drug therapy to interventional therapy, especially for patients with poor drug treatment effect and persistent symptoms of atrial fibrillation, interventional therapy can be the first choice. At present, there are radiofrequency ablation, cryoablation, and pulse field ablation for the treatment of atrial fibrillation. The purpose of this review is to review the clinical application of different ablation methods in patients with atrial fibrillation.

Radiation induced lung injury: mechanism of occurrence and progress in prevention and treatment

Zhang Kun, Han Xia, Chen Shaoshui

2022, 28(24):  3494.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.019

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The incidence and mortality of chest malignant tumors remain high for a long time. The latest published cancer data in China indicate that among all cancer patients, the incidence and mortality of lung cancer account for more than 50%, and still occupy a dominant position. As a significant treatment for chest malignant tumors, such as non-small cell lung cancer, esophageal cancer, breast cancer and so on, radiation therapy has brought serious side effects, one of which is called as radiation induced lung injury (RILI), characterized by progressive and irreversible development into pulmonary fibrosis. And this has attracted more and more clinical and scientific researchers to explore its pathogenesis and corresponding therapeutic schedule. This paper reviews the pathophysiology, important cells and molecules involved in the occurrence, and progress in prevention and treatment of RILI.

Research progress on tunneled peripherally inserted central catheter

Hua Xiaoling, Liang Xide, Gao Mengxin, Chen Yuan, Sun Hongling

2022, 28(24):  3500.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.020

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Peripherally inserted central catheter (PICC) has the characteristic of less trauma, less complications, more secure, and higher puncture success rate than others, and is widely used in clinic treatment. As the name suggests the catheter is inserted in a peripheral vein and advanced so that its tip lies in central venous system. In recent years, tunneled PICC has attracted more and more attention whose exit of catheter is far away from the puncture site by establishing subcutaneous tunnel. This article aims at reviewing the progress of puncture vein, exit site, complications, and effect of tunneled PICC.

Special Column of Pediatrics

Characteristics and influencing factors of executive function in children with autism spectrum disorder

Yang Zhenjiao, Liu Chunhua, Yi Mingji

2022, 28(24):  3505.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.021

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Autism spectrum disorder (ASD) is a common neurodevelopmental disorder. The executive function deficits in children with ASD include working memory, inhibitory control, cognitive flexibility, language and social function impairments, and so on. The deficits are often more severe when the child has co-morbidities such as attention deficit hyperactivity disorder (ADHD), sleep disorders, and intellectual disability. This article summarizes the progress of researches in characteristics and influencing factors of executive function in children with ASD.

Advances in diagnosis and treatment of hydrocephalus after neonatal intracranial hemorrhage

Chi Xiufang, Zhang Yong, Xiang Jianwen

2022, 28(24):  3509.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.022

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Hydrocephalus after intracranial hemorrhage is one of the common serious complications in preterm infants and can cause sequela or death. Its pathogenesis is complex, the treatment methods are diverse, and the treatment effects are also different. Currently, there is no standard treatment guide. In this paper, the related researches on hydrocephalus after intracranial hemorrhage are reviewed, and the incidence, risk factors, pathogenesis, diagnosis, and treatment of hydrocephalus after intracranial hemorrhage are summaried, in order to provide references for prevention, diagnosis, and treatment of hydrocephalus after intracranial hemorrhage.

Analysis of related influencing factors and comprehensive intervention effect of intracranial hemorrhage in premature infants

He Li, Wang Kai, Jia Xiaoqin, Long Wei, Yang Zhen, Huang Chi, Huang Chaomei

2022, 28(24):  3514.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.023

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Objective　To investigate the related influencing factors and comprehensive intervention effect of intracranial hemorrhage in premature infants. Methods　The clinical data of 158 premature infants delivered in Foshan Maternal and Child Health Hospital from January 2019 to May 2022 were retrospectively analyzed, including 78 males and 80 females, with a gestational age of 28-36 (32.11±0.85) weeks. All premature infants underwent cranial ultrasound within 3 days after birth. The premature infants were divided into an intracranial hemorrhage group and a non-intracranial hemorrhage group according to whether intracranial hemorrhage occurred. The basic data of gestational age, gender, birth weight, delivery mode, intrauterine asphyxia, maternal premature rupture of membranes, maternal pregnancy induced hypertension, maternal prenatal use of dexamethasone, mechanical ventilation therapy, acidosis within 12 hours after birth, history of high concentration oxygen inhalation, and electrolyte disorder of the two groups were collected, single factor analysis was performed first, multi-factor logistic regression analysis was further carried out for the obtained items with statistically significant differences, and independent risk factors affecting intracranial hemorrhage in premature infants were finally obtained. Chi-square test was used. Results　Among the 158 premature infants, 15 cases of intracranial hemorrhage were detected by cranial ultrasound, with an incidence of 9.49% (15/158). Univariate analysis showed that gestational age, birth weight, intrauterine asphyxia, maternal prenatal use of dexamethasone, mechanical ventilation therapy, acidosis within 12 h after birth, and history of high concentration oxygen inhalation were correlated with the occurrence of intracranial hemorrhage in preterm infants, with statistically significant differences (all P<0.05). Multivariate analysis showed that gestational age <32 weeks, birth weight <1 500 g, intrauterine asphyxia, no maternal prenatal use of dexamethasone, mechanical ventilation therapy, acidosis within 12 h after birth, and history of high concentration oxygen inhalation were all independent risk factors for intracranial hemorrhage in preterm infants (all OR>1, P<0.05). Conclusions　Gestational age <32 weeks, birth weight <1 500 g, intrauterine asphyxia, no maternal prenatal use of dexamethasone, mechanical ventilation therapy, acidosis within 12 h after birth, and history of high concentration oxygen inhalation are all independent risk factors for intracranial hemorrhage in preterm infants. It is necessary to identify these risk factors as early as possible and formulate targeted intervention measures to reduce the occurrence of intracranial hemorrhage.

Application value of procalcitonin in the identification of bacteria for bloodstream infection in newborns

Chu Fudi, Guo Zhongyan, Ma Yajun

2022, 28(24):  3518.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.024

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Objective　To explore the application value of procalcitonin (PCT) in the identification of bacteria for bloodstream infection in newborns. Methods　A total of 198 cases of neonatal bloodstream infection were selected from Tengzhou Central People's Hospital Affiliated to Jining Medical University from January 2019 to December 2021 for a retrospective analysis. According to the blood culture results, they were divided into a Gram-negative group (86 cases) and a Gram-positive group (112 cases). Meanwhile, 90 children with negative blood culture results were selected as the control group. There were 45 males and 41 females in the Gram-negative group with an age of (15.15±2.63) days old; there were 58 males and 54 females in the Gram-positive group with an age of (15.35±2.41) days old; there were 47 males and 43 females in the control group with an age of (15.65±2.78) days old. The levels of PCT, C-reactive protein (CRP), and white blood cell count (WBC) in the three groups were measured and compared, the composition ratio of bacteria and the level of serum PCT were observed, and the serum PCT levels in the Gram-negative group and the Gram-positive group were compared. F test and chi-square test were used. Results　The levels of PCT [(7.53±1.93) μg/L and (2.91±0.83) μg/L], CRP [(37.32±16.61) mg/L and (30.73±15.94) mg/L], WBC [(17.23±3.43) ×10⁹/L and (15.53±3.12) ×10⁹/L] in the Gram-negative and Gram-positive groups were higher than those in the control group [(0.07±0.02) μg/L, (9.32±3.35) mg/L, and (8.54±2.37) ×10⁹/L], with statistically significant differences (all P<0.05). The PCT level of the Gram-negative group was higher than that of the Gram-positive group [(7.53±1.93) μg/L vs. (2.91±0.83) μg/L], with a statistically significant difference (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of PCT in predicting neonatal bloodstream infection were 94.44%, 92.22%, 96.39%, 88.30%, and 86.67%, respectively, which were higher than those of CRP and WBC, with statistically significant differences (all P<0.05). The main bacteria detected in the blood culture were Escherichia coli, Staphylococcus epidermidis, and Klebsiella pneumoniae, accounting for 41.86% (36/86), 38.39% (43/112), and 27.91% (24/86), respectively. The level of PCT was the highest in newborns with Klebsiella pneumoniae infection [(11.21±3.32) μg/L], followed by Escherichia coli [(9.32±3.43) μg/L]. There was a statistically significant difference in the PCT distribution between the Gram-negative and Gram-positive groups (P<0.05). Conclusion　The application value of PCT in the identification of bacteria for bloodstream infection in newborns is higher, it can be used to identify the type of bacterial infection and to provide basis for early diagnosis and treatment.

Analysis of infection types in children with febrile seizures

Xu Shuzheng

2022, 28(24):  3522.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.025

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Objective　To analyze the infection types in children with febrile seizures, so as to provide references for the rational use of antibiotics and provide more valuable basis for clinical diagnosis and treatment. Methods　The clinical data of 176 hospitalized children with febrile seizures in The First Affiliated Hospital of Fujian Medical University from January 2019 to December 2021 were collected as research objects. The relationships between different infection types and clinical characteristics such as the types of febrile seizures were analyzed through blood routine text, C-reactive protein (CRP), procalcitonin (PCT), respiratory pathogen antigen of pharynx swab and/or immunoglobulin M (IgM) antibody of serum respiratory pathogen. Chi-square test was used. Results　Among the 176 children with febrile seizures, there were 112 boys (63.6%) and 64 girls (36.4%), with a median age of 2 years and 7 months old (4 months to 6 years old). Among the 176 children with febrile seizures, 34 cases (19.3%) had white blood cell count (WBC) >15.0 ×10⁹/L, 22 cases (12.5%) had CRP >40 mg/L, 65 cases (36.9%) had PCT >0.5 μg/L, only 15 cases (8.5%) met any two of the above conditions, and only 3 cases (1.7%) met all the above three conditions. The overall positive detection rate of respiratory pathogens was 58.5% (103/176), and there were no statistically significant differences in the detection rates of respiratory pathogens between simple febrile seizures and complex febrile seizures (all P>0.05). Conclusion　The combined application of WBC, CRP, PCT, and respiratory pathogens in children with febrile seizures can distinguish the type of infection in the early stage, and can reflect the changes of the children's conditions more accurately and sensitively, so as to provide a certain reference value for guiding the diagnosis and treatment of children with febrile seizures.

Analysis of influence factors of nervous system complications in neonatal purulent meningitis

Deng Xueling, Nie Xianjuan, Mo Xingzhi, Luo Xiaowei, Chen Lizhen

2022, 28(24):  3526.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.026

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Objective　To analyze the influence factors of nervous system complications in neonatal purulent meningitis. Methods　A total of 92 cases of neonatal purulent meningitis admitted to Huaiji People's Hospital from January 2012 to June 2022 were selected, including 51 males and 41 females, 25 cases with gestational age <37 weeks and 67 cases with gestational age ≥37 weeks. According to the presence of nervous system complications (subdural effusion, hydrocephalus, brain abscess, ependymitis, etc.) examined by head CT/MRI, the children were divided into a nervous system complication group (22 cases) and a non-nervous system complication group (70 cases). The gender, birth weight, age of onset, time from onset to medical visit, and fever, heat peak ≥39 ℃, refusal to milk, lethargy, jaundice, shortness of breath, poor response, anterior fontanelle bulge, convulsions, irritability, and other signs were collected, and the serum white blood cell count, neutrophil percentage, C-reactive protein (CRP), hemoglobin, and procalcitonin levels and cerebrospinal fluid (CSF) white blood cell count, protein concentration, and glucose concentration were also measured. Univariate analysis (χ² test and independent sample t test) and multivariate logistic regression analysis were performed. Results　The results of univariate analysis showed that the gestational age in the nervous system complication group was lower than that in the non-nervous system complication group, the proportions of anterior fontanelle bulge, convulsions, irritability, positive blood culture, and positive CSF culture were higher than those in the non-nervous system complication group, and the CSF white blood cell count, protein concentration, and glucose concentration were higher than those in the non-nervous system complication group (all P<0.05). Multivariate logistic regression analysis showed that gestational age (OR=4.166, 95%CI: 1.769-9.811), convulsions (OR=2.815, 95%CI: 1.443-5.492), irritability (OR=2.186, 95%CI: 1.350-3.540), high CSF white blood cell count (OR=3.348, 95%CI: 1.755-6.375), and high CSF protein concentration (OR=3.487, 95%CI: 1.833-6.632) were independent risk factors for nervous system complications in neonatal purulent meningitis (all P<0.05). Conclusion　Low gestational age, high white blood cell count and protein concentration in the CSF, and combined convulsions and irritability signs are important factors affecting nervous system complications in neonatal purulent meningitis.

Effect of family manual training on functional independence in children with spastic hemiplegia cerebral palsy under the ICF concept

Deng Haorong, Shan Minyu, Cui Wenrui, Yang Jiewen

2022, 28(24):  3531.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.027

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 Objective　To explore the effect of family manual training on functional independence in children with spastic hemiplegia cerebral palsy under the ICF (International Classification of Functioning, Disability and Health) concept. Methods　Fifty children with spastic hemiplegia cerebral palsy and hand motor dysfunction aged 6-12 years admitted to Department of Rehabilitation, Guangzhou Social Welfare Institute Rehabilitation Hospital from March 2021 to September 2021 were enrolled in the study. They were divided into an experimental group and a control group according to the random number table method, with 25 cases in each group. In the experimental group, there were 15 males and 10 females, aged (8.2±1.0) years; in the control group, there were 14 males and 11 females, aged (8.6±0.6) years. The concise general version of the International Classification of Functioning, Disability and Health (Children and Youth version) (ICF-CY) core classification combination was used for the initial assessment of the two groups, targeted comprehensive rehabilitation programs were formulated together with the caregivers (guardian role), and the caregivers were correspondingly trained according to the rehabilitation programs. The children in the experimental group were given 40 minutes of manual training and routine rehabilitation treatment every day, and the children in the control group were given routine rehabilitation treatment for 3 months. The functional independence of the two groups were compared before and after treatment. Chi-square test and t test were used. Results　There was no statistically significant difference in the Functional Independence Measure for Children (WeeFIM) score between the two groups before treatment (P>0.05). After 3 months of treatment, the WeeFIM score of the experimental group was significantly higher than that of the control group [(75.76±5.07) points vs. (61.24±3.06) points], and the WeeFIM scores in the two groups were significantly higher than those before treatment [(75.76±5.07) points vs. (49.84±3.95) points, (61.24±3.06) points vs. (49.84±3.46) points], with statistically significant differences (all P<0.05). There was statistically significant difference in the difference of WeeFIM score before and after treatment between the experimental group [(25.92±3.39) points] and the control group [(11.40±2.78) points] (P<0.05). Conclusion　Manual training can improve the functional independence in children with spastic hemiplegic cerebral palsy, and manual training can be appropriately introduced into home and community rehabilitation treatment.

Effect of terminal position of PICC catheter on secondary chylothorax in neonates of different body weight

Chen Xiaoling, Chen Ni, Xie Weichun

2022, 28(24):  3535.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.028

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Objective　To explore the risk of secondary chylothorax associated with catheter tip position after peripherally inserted central catheter (PICC) in neonates of different body weight. Methods　A total of 687 neonates with PICC were collected from Department of Neonatology, Shantou Central Hospital from November 2013 to December 2020. Among them, 6 neonates developed chylothorax after catheterization. Related risks were analyzed through PICC catheter tip position and body weight factor. Fisher exact probability method was used. Results　Six neonates with secondary chylothorax (including 5 males and 1 female, 5 neonates with body weight of 1.0-1.5 kg and 1 neonate with body weight of 1.9 kg) underwent PICC catheterization via the right basilic vein, and chest radiography indicated that the catheter tip was located on the right side of T2 in 5 cases and T1 in 1 case. All the 6 neonates were cured and discharged from the hospital after symptomatic treatment including thoracentesis, fasting, fluid replacement, and respiratory support. There were statistically significant differences in the incidence of chylothorax between the catheter tip at T2 and non-T2 groups (1.0-1.5 kg, 1.5-2.0 kg, and overall) (all P<0.05). There was no statistically significant difference in the incidence of chylothorax among all the body weight groups (P>0.05). Conclusions　PICC catheter tip at T2 position may be a high-risk factor for neonatal secondary chylothorax, which should be avoided as far as possible. X-ray should be performed regularly to locate terminal position of the catheter in neonates with catheter tip at T2 position away from the center to reduce the influence of secondary chylothorax and other complications.

Effects of early nutritional strategy changes on the incidence of extrauterine growth retardation in extremely premature infants and risk factors 

Zou Jingjing, Huang Yongxin, Long Fang, Wang Junping

2022, 28(24):  3539.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.029

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Objective　To investigate the effect of early nutritional strategy adjustment on the incidence of extrauterine growth retardation (EUGR) in extremely premature infants and analyze its risk factors. Methods　It was a prospective observational cohort study. Extremely premature infants under 32 weeks of gestational age who were delivered in the obstetric department of Guangdong Women and Children Hospital between January 1, 2018 and December 31, 2019 were selected. They were divided into a control group and an intervention group before and after adjustment of nutrition strategies. The clinical data of the two groups were collected, including general information, enteral nutrition, and complications. The difference in the incidence of EUGR was compared between the two groups. Multivariate logistic regression analysis was used to analyze the high-risk factors of EUGR in extremely premature infants. Independent sample t test, χ² test, and rank sum test were used for comparison. Results　A total of 356 premature infants eligible for the study were included in the two groups, including 177 cases in the control group and 179 cases in the intervention group. In the control group, there were 114 males and 63 females, with a gestational age of (30.15±1.39) weeks; in the intervention group, there were 110 males and 69 females, with a gestational age of (29.83±1.33) weeks. There were no statistically significant differences in the gender, birth weight, cesarean section rate, small for gestational age rate, asphyxia rate, prenatal glucocorticoid use rate, multiple pregnancy rate, and maternal hypertension rate during pregnancy between the two groups (all P>0.05). The gestational age of the intervention group [(29.83±1.33) weeks] and the control group [(30.15±1.39) weeks] were significantly different (P<0.05). The time of starting enteral feeding [0.5 (0.5, 28.0) h], total enteral feeding time [(28.12±11.76) d], intravenous nutrition time [22 (14, 30) d], time of birth weight recovery [(7.58±5.76) d], and time of achieving sufficient intestinal heat accumulation [(22.59±9.23) d] in the intervention group were shorter than those in the control group [18.0 (0.5, 68.0) h, (32.29±14.02) d, 26 (18, 35) d, (10.73±7.35) d, and (28.64±12.17) d], with statistically significant differences (all P<0.05). The fasting time in the intervention group [(6.16±6.02) d] was less than that in the control group [(8.19±6.98) d], and the amino acid content 1 week after birth, total amino acid content during hospitalization, calories per week, and growth rate of body mass in the intervention group [(11.74±3.67) g/kg, (45.40±34.99) g/kg, (360.03±124.31) kcal/kg, and (21.04±5.71) g/d] were higher than those in the control group [(10.72±2.81) g/kg, (39.22±18.00) g/kg, (312.51±79.82) kcal/kg, and (19.12±5.52) g/d], with statistically significant differences (all P<0.05). The incidence of EUGR in the intervention group was 69.3% (124/179), which was lower than that in the control group [81.4% (144/177)], with a statistically significant difference (P<0.05). Multivariate regression analysis model showed that birth weight (OR=1.980, 95%CI 1.113-3.580, P=0.012), fasting time (OR=1.096, 95%CI 1.006-1.194, P=0.036), total amino acid content during hospitalization (OR=1.087, 95%CI 1.014-1.165, P=0.018) were the high-risk factors for EUGR. Conclusions　The incidence of EUGR in extremely premature infants can be reduced by adopting early intensified nutrition strategies. The incidence of EUGR can be reduced by increasing the total amino acids in parenteral nutrition and adjusting nutrition strategies according to daily weight gain.

Literature Analysis

Evaluation of ursodeoxycholic acid for primary sclerosing cholangitis: a meta-analysis

Wang Yanping, Wang Huan, Liang Haijun, Gao Haili, Wang Xinwei, Yang Daokun

2022, 28(24):  3544.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.030

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Objective　To evaluate the efficacy of ursodeoxycholic acid (UDCA) for primary sclerosing cholangitis (PSC) by the evidence-based pharmaceutical method. Methods　The trials of UDCA in the treatment of PSC published at home and abroad were collected, and high-quality literatures meeting the standards were screened and used for meta-analysis. The quality of the included studies was evaluated by Q test and I² test and analyzed by Stata 13.0. The deadline for literature publishing was May 30, 2019. Results　Five studies with a total of 364 patients were included. Liver function indexes [alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin (TBIL)] were significantly improved in the UDCA group compared with those in the placebo group (SMD=-0.43, 95%CI [-0.65, -0.22], P<0.001; SMD=-0.90, 95%CI [-1.24, -0.56], P<0.001; SMD=-0.01, 95%CI [-0.28, 0.27], P<0.001; SMD=0.00, 95%CI [-0.20, 0.21], P<0.001; SMD=-0.31, 95%CI [-0.52, -0.10], P=0.001). In terms of immunoglobulin (Ig), UDCA significantly improved IgA (SMD=-0.02, 95%CI [-0.28, 0.25], P=0.013), but had no significant effects on IgG (SMD=-0.17, 95%CI [-0.44, 0.09], P=0.399) and IgM (SMD=0.16, 95%CI [-0.11, 0.42], P=0.715). Conclusion　UDCA can significantly improve the liver function indexes in PSC patients, but has no significant effects on the immunological indexes.

Treatises

Lipid-soluble and water-soluble iodine contrast agents for hysterosalpingography: a comparative study of clinical application 

Niu Qian, Duan Lili

2022, 28(24):  3548.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.031

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Objective　To compare the effects of lipid-soluble and water-soluble iodine contrast agents (iodine oil and iodine water) on the image quality of hysterosalpingography (HSG) digital radiology (DR) and postoperative pregnancy rate in infertile women. Methods　The subjects were all infertility patients who visited the infertility clinic in the Reproductive Medicine Center of The Sixth Affiliated Hospital of Sun Yat-Sen University from June 2014 to June 2018. A total of 625 patients underwent HSG examination with complete imaging and clinical data, including 124 patients in the iodine oil group and 501 patients in the iodine water group, and the patients were followed up for 6-12 months after HSG. The median age of the iodine oil group was 29.0 years old and the median infertility time was 22.5 months; the median age of the iodine water group was 30.0 years old and the median infertility time was 21.5 months. The excellent and good rate of HSG image quality and follow-up pregnancy rate were compared between the two groups. Chi-square test was used. Results　Two kinds of agents for HSG had obtained the good images. The excellent and good rate of HSG image quality in the iodine oil group was 95.97% (119/124), and there was no statistically significant difference compared with that in the iodine water group [95.41% (478/501)] (χ²=0.072, P=0.788). The postoperative pregnancy rate of the iodine oil group was 38.71% (48/124), and there was no statistically significant difference compared with that in the iodine water group [37.92% (190/501)] (χ²=0.026, P=0.872). The iodine oil contrast agent made the uterine cavity more defined, and the iodine water contrast agent showed more details of the fallopian tube. No serious complications occurred in either case. Conclusion　Lipid-soluble and water-soluble iodine contrast agents for HSG have no significant effects on diagnostic images and postoperative pregnancy rate.

Clinical analysis of coumarins associated acquired vitamin K-dependent coagulation factor deficiency

Wu Shixin, Huang Yueqin

2022, 28(24):  3551.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.032

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Objective　To investigate the clinical characteristics and therapeutic effect of acquired vitamin K dependent coagulation factor deficiency caused by coumarins including overdosage of warfarin and rodenticide poisoning. Methods　The clinical data of 61 patients diagnosed in Department of Hematology, Donghai Branch, The Second Affiliated Hospital of Fujian Medical University from July 2013 to July 2022 were retrospectively analyzed. According to the type of coumarins, they were divided into group A (overdosage of warfarin, 34 cases) and group B (rodenticide poisoning, 27 cases). There were 19 males and 15 females in group A, aged 32-82 years, with a median age of 71 years old; in group B, there were 15 males and 12 females, aged 19-88 years, with a median age of 53 years old. The patients with severe bleeding symptom were given intravenous infusion of vitamin K₁ 10-60 mg/d supplemented with infusion of fresh frozen plasma. The changes of prothrombin time (PT) and activated partial thromboplastin time (APTT) before and after treatment and the detoxification time of vitamin K₁ were detected. t test was used. Results　The patients with overdosage of warfarin and bleeding in group A showed PT (111.58±46.50) s and APTT (100.02±20.58) s before vitamin K₁ treatment, and PT (17.13±4.30) s and APTT (37.77±58.91) s after vitamin K₁ treatment, with statistically significant differences (both P<0.01); warfarin should be suspended only in patients without bleeding. The patients with rodenticide poisoning in group B showed PT (102.13±75.34) s and APTT (84.02±48.24) s before vitamin K₁ treatment, and PT (17.39±4.43) s and APTT (33.03±7.78) s after vitamin K₁ treatment, with statistically significant differences (both P<0.01). The detoxification time of vitamin K₁ in patients with overdosage of warfarin and bleeding was 1 day, and 1 month to 1 year in patients with rodenticide poisoning, and the detoxification time of vitamin K₁ was different between the two (P<0.01). Conclusions　Warfarin and rodenticide are coumarin anticoagulants. Vitamin K₁ is effective in the treatment of overdose of warfarin or rodenticide poisoning. Because the purpose and half-life of the two drugs are different, the detoxification methods after overdose are not the same.

Clinical Research

Predictive value of modified frailty index for postoperative complications in elderly patients with colorectal cancer

Zhu Fangqin, Dai Pan, Hu Xiaoyan, Lin Xi

2022, 28(24):  3555.  DOI: 2022-04405

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Evaluation of the efficacy and safety of laparoscopic-assisted total mesorectal excision for low rectal cancer

Wang Jingtao

2022, 28(24):  3559.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.034

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Case Report

A case of ruptured abdominal aortic aneurysm into duodenum

Yong Qiang, Zhou Hongke

2022, 28(24):  3563.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.035

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主动脉肠瘘（aortoenteric fistula，AEF）是指主动脉与胃肠道形成的窦道，是导致消化道大出血的少见病因，可分为原发性AEF、继发性AEF，典型临床表现为腹痛、消化道出血和腹部搏动性肿块，由于临床少见且病情往往进展较快，患者常因不能及时被诊断，从而发展至失血性休克，甚至延误手术时机。现就暨南大学附属第一医院1例腹主动脉十二指肠瘘患者进行报道，总结对该病的诊治体会。

A case of blastic plasmacytoid dendritic cell neoplasm complicated with chronic myelomonocytic leukemia

Wang Yaping, Zhang Xueya

2022, 28(24):  3565.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.036

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 Blastic plasmacytoid dendritic cell neoplasm is a rare and invasive hematological malignant tumor derived from precursors of plasmacytoid dendritic cells. We reported a case of cutaneous blastic plasmacytoid dendritic cell neoplasm complicated with bone marrow chronic myelomonocytic leukemia which was presented with multiple skin nodules admitted to The Second Affiliated Hospital of Fujian Medical University in May 2020, and the definite diagnosis was obtained combined with the skin pathology, immunohistochemistry, bone marrow cytology, flow cytometry, and gene detection.

Nursing Research

Nursing experiences of home continuous nursing mode in outpatients using indwelling needle 

Wei Xiaoyan

2022, 28(24):  3568.  DOI: 10.3760/cma.j.issn.1007-1245.2022.24.037

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Objective　To explore the nursing experiences of home continuous nursing mode in outpatients using indwelling needle. Methods　A total of 728 outpatients with indwelling needle in Beijing Boai Hospital, China Rehabilitation Research Center from May to July 2021 were selected as the research objects, and were divided into two groups according to different nursing methods, with 364 cases in each group. In the control group, there were 184 males and 180 females, aged (54.65±3.83) years; in the study group, there were 176 males and 188 females, aged (55.77±3.93) years. The control group received regular care, and the study group received home continuous nursing mode. The nursing quality score, time of intravenous indwelling needle, nursing satisfaction, and incidence of complications were compared between the two groups. Independent sample t test and chi-square test were used. Results　The scores of nursing attitude, professional knowledge, operation standards, and operation feeling of the study group were (91.42±8.31) points, (93.52±8.11) points, (90.95±7.81) points, and (92.36±7.39) points, respectively, which were higher than those of the control group [(76.63±7.61) points, (80.31±7.42) points, (77.63±6.39) points, and (80.93±8.55) points], with statistically significant differences (all P<0.05). The time of intravenous indwelling needle in the study group was (53.24±4.55) h, which was longer than that in the control group [(43.68±3.37) h], with a statistically significant difference (P<0.05). The nursing satisfaction of the study group was significantly higher than that of the control group [90.11% (328/364) vs. 74.73% (272/364)], with a statistically significant difference (P<0.05). The incidences of tube blockage [3.57% (13/364)], phlebitis [2.47% (9/364)], and puncture site infection [2.20% (8/364)] in the study group were all lower than those in the control group [7.97% (29/364), 6.32% (23/364), and 5.49% (20/364)], with statistically significant differences (all P<0.05). Conclusion　Home continuous nursing mode can improve the nursing satisfaction and reduce the incidence of complications in outpatients using indwelling needle.