Table of Content

01 January 2023, Volume 29 Issue 1

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New Medical Advances

Progress in the clinical application of quantitative EEG in cerebrovascular disease

Zhou Jianguo, Fu Dayong, Lu Mingcong, Meng Yun, Ma Xianjun

2023, 29(1):  1.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.001

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Quantitative electroencephalogram (QEEG) uses computers to calculate and display EEG activities in time and frequency domains. It has the advantages of non-invasive and real-time, can display subtle EEG changes, and avoids the disadvantages of traditional EEG which is susceptible to subjective factors. The changes of neuroelectrophysiological conduction caused by the damage of neural network in patients with cerebrovascular disease can be recorded by recording the cortical electroencephalogram and summarizing the regularity, and given quantitative treatment. At present, QEEG has certain clinical application advantages in the diagnosis and efficacy evaluation of ischemic cerebrovascular disease, cerebral hemorrhage, post-stroke depression, and cognitive dysfunction. This paper reviews and reports as follows.

Advances in animal models of aortic aneurysm 

Zang Hanwei, Yang Lijuan, Du Zhaoqi, Li Wei

2023, 29(1):  4.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.002

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Aortic aneurysm is a common cardiovascular disease, and its incidence is increasing each year. There are no effective preventive therapies or drugs against aortic aneurysm. Surgery is the only curative treatment for aortic aneurysm, but it is still difficult to deal with the high risk and complications of surgery. Therefore, it is of great importance to research in better understanding the mechanisms of aortic aneurysm and develop drugs for the prevention and treatment of aortic aneurysm. One of the hallmarks of a good preclinical animal model for aortic aneurysm is the ability to simulate the progression of aortic aneurysm which is a major precondition in fundamental and clinical transformation studies of aortic aneurysm. At present, there are many modeling approaches, in this review, we describe the recent progress and the development of aortic aneurysm modeling approaches and their advantages and drawbacks.

Progress in the study of new oral anticoagulants in non-valvular atrial fibrillation combined with cerebrovascular disease 

Zhang Manman, Liang Zhigang, Zhan Yan

2023, 29(1):  10.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.003

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Anticoagulation is considered the cornerstone of ischemic stroke prevention strategies in patients with non-valvular atrial fibrillation. Compared with the traditional oral anticoagulant warfarin, new oral anticoagulants have the advantages of rapid onset of action, short half-life, fewer drug interactions, and no need for frequent monitoring on coagulation parameters, and are commonly used in prophylaxis, substantially reducing the risk of ischemic stroke in patients with non-valvular atrial fibrillation. However, in patients with non-valvular atrial fibrillation who are at increased risk of stroke and bleeding due to combined intracranial atherosclerotic stenosis, acute ischemic stroke, intracranial hemorrhage, and intracranial microhemorrhage, the selection of clinical anticoagulation therapy and the timing of initiation are undoubtedly challenging. This article reviews the use of new oral anticoagulants in patients with non-valvular atrial fibrillation combined with common cerebrovascular diseases, providing clinical references for treatment and prevention.

Meta Analysis

Transcutaneous electrical acupoint stimulation promoting the recovery of gastrointestinal function after gynecological laparoscopy: a meta-analysis 

Chen Liping, Xu Ziqing, Hou Huaijing, Zhao Xiaohong, Wu Yanjiao, Wang Donghong, Xue Jianjun

2023, 29(1):  15.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.004

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 Objective　To evaluate the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in promoting gastrointestinal function recovery after gynecological laparoscopy by meta analysis. Methods　The databases, including PubMed, Cochrane Library RCT database (CCRCT), Web of Science, Embase, CBM, CNKI, VIP, and Wanfang, were searched systematically. From the establishment of the databases to July 2022, all the studies on TEAS for gynecological laparoscopic surgery were collected. Two researchers screened the literatures back to back, extracted the data and used Cochrane Risk of Bias tools to evaluate the quality of the included studies, and used RevMan 5.3 software for meta analysis. Results　A total of 12 randomized controlled trials (RCTs) including 1 157 patients were included in this analysis. The meta analysis results showed that the first anal exhaust time [MD=-10.06, 95%CI (-14.44, -5.67), P<0.000 01], the first defecation time [MD=-17.24, 95%CI (-18.98, -15.51), P<0.000 01], and the first intestinal sound time [MD=-6.69, 95%CI (-10.72, -2.65), P=0.001] in the TEAS group were significantly shorter than those in the control group, with statistically significant differences. The postoperative hospital stay in the TEAS group [MD=-0.75, 95%CI (-1.49, -0.01), P=0.05] was shorter than that in the control group, but the difference was not statistically significant. Conclusion　TEAS can effectively promote the postoperative exhaust and defecation in gynecological laparoscopic patients, shorten the hospital stay, and has good clinical value in promoting the recovery of postoperative gastrointestinal function.

Efficacy and safety of Chinese herbal plaster combined with massage in the treatment of infantile constipation: a meta-analysis

Wang Siqi, Chen Manni, Lin Xiaohong, Lin Yuying, Liu Aihua, Xiong Shuqing

2023, 29(1):  22.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.005

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 Objective　To evaluate the clinical efficacy and safety of Chinese herbal plaster combined with massage in the treatment of infantile constipation by meta-analysis. Methods　The literatures on Chinese herbal plaster combined with massage in the treatment of infantile constipation were searched from CNKI, SinoMed, Wanfang, VIP, Medline, Embase, and the Cochrane Library. The time range was from the establishment of the database to August 2022. The retrieved literatures were screened to obtain studies that could be included in the analysis. After evaluating the bias risk and capturing the required data, the RevMan 5.3 software was used for statistical analysis. Results　A total of 1 527 children were included in 17 clinical studies. The results of meta-analysis showed that the experimental group was superior to the control group in the total effective rate [RR=1.26, 95%CI (1.17, 1.36)], quantitative score of syndromes [MD=-4.19, 95%CI (-4.58, -3.81)], and efficacy maintenance rate during the follow-up period [RR=1.31, 95%CI (1.16, 1.48)]. Conclusions　Chinese herbal plaster combined with massage therapy is effective and safe in the treatment of infantile constipation. The overall quality of the included studies is only common level, and there are some problems such as small sample size and lack of sufficient data for long-term efficacy and safety evaluation. Larger sample and more comprehensive clinical studies are needed in the later stage to strengthen the evidence support.

Scientific Research

Analysis of the efficacy of simultaneous application of 3D printed temporary crown in the restoration of a single non-free posterior tooth

Zhu Fangyong, Ma Hong, Xu Yanhua, Gao Yufeng, Wu Xiangbing, Hou Deqiang

2023, 29(1):  28.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.006

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Objective　To analyze the efficacy of 3D printed temporary crown in the restoration of a single non-free posterior tooth in the second stage of implantation surgery. Methods　It was a prospective randomized controlled trial. A total of 30 patients who underwent single posterior tooth implantation in Department of Stomatology, Affiliated Hospital of Jiangnan University from June 2020 to August 2022 were selected as the research objects. Based on the random number table method, they were divided into 2 groups. The 15 patients who received the 3D printed temporary crown were assigned to the 3D printed temporary crown group, and the other 15 patients were assigned to the traditional stage Ⅱ surgery group. In the traditional stage Ⅱ surgery group, there were 8 males and 7 females, aged 25-40 (30.35±3.33) years; in the 3D printed temporary crown group, there were 10 males and 5 females, aged 24-41 (31.21±3.45) years. The stability, food impaction score, masticatory efficacy, and incidence of complications were compared between the two groups. Fisher exact probability method and independent sample t test were used for statistical analysis. Results　One, three, and six months after formal implant restoration, the food impaction scores of the 3D printed temporary crown group were (2.01±0.33), (1.01±0.12), and (1.21±0.32) points, respectively, which were significantly lower than those of the traditional stage Ⅱ surgery group (all P<0.01). After formal restoration, the bite force and mastication efficiency of the 3D printed temporary crown group were (130.11±8.54) lbs and (1.43±0.11), which were significantly higher than those of the traditional stage Ⅱ surgery group (both P<0.05). The incidence of caries, periodontitis, tooth loosening, and other complications in the 3D printed temporary crown group was significantly lower than that in the traditional stage Ⅱ surgery group (0/15 vs. 6/15) (P<0.05). Conclusion　The application of 3D printed temporary crown in the second stage of implantation surgery has a good therapeutic effect in patients with single posterior tooth implant restoration, which can improve the phenomenon of food impaction and actively and effectively reduce the complications of single posterior tooth implantation, so as to provide a basis for clinical application.

A child with undiagnosed lymphoma developed severe dyspnea after procedure sedation 

Li Hao, Ma Yushan, Zhou Jieshu

2023, 29(1):  32.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.007

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The sedation effect for children with the participation of anesthesiologists is good with high safety, but the risk is still high. This paper reported a case of severe dyspnea after inhalation anesthesia when the CT examination was performed due to the neck mass and was rescued by endotracheal intubation in West China Second University Hospital in July 2022.

Prediction of cervical cancer immunotherapy response based on lncRNA model

Su Huichao, Zhang Zhen, Tang Xiaohui, Yu Jinming

2023, 29(1):  34.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.008

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Objective　To investigate the relationship between immune-related long non-coding RNA (lncRNA) models in cervical cancer and patients' prognosis and response to immunotherapy. Methods　The transcriptome sequencing data and corresponding clinical information in 255 cervical cancer patients were obtained from the Cancer Genome Atlas (TCGA) database. The immune-related lncRNAs were extracted by bioinformatic method, and the prediction model was constructed using Kaplan-Meier analysis and multifactorial COX regression analysis. The receiver operating characteristic curve (ROC) was used to assess the efficacy of the prediction model. The patients were classified into high and low risk groups by the median value of the model score. The differences in immune infiltration between different subgroups were assessed using algorithms such as CIBERSORT and single sample gene set enrichment analysis (ssGSEA), and the association of the model with immune pathways was explored using gene ontology (GO) enrichment analysis, gene set enrichment analysis (GSEA), and gene set variation analysis (GSVA). The differences in immunotherapy response between different subgroups were also explored using the tumor immune dysfunction and rejection (TIDE) score and immune epistasis (IPS) score. Results　The immune-related lncRNA prediction models were constructed by Kaplan-Meier analysis and multifactorial COX regression analysis, and the survival curve showed a statistically significant difference in the prognosis between the two groups (P<0.05). The areas under the ROCs at 1, 2, and 3 years for the prediction models were 0.850, 0.796, and 0.702, respectively. The immune score in the low-risk group was significantly higher than that in the high-risk group (P<0.05). The results of CIBERSORT, an immune algorithm based on deconvolution, suggested that CD8⁺ T cells, helper T cells, B cells, and M0 and M1 macrophages differed between the two groups (all P<0.05). Immune pathways were significantly enriched in the low-risk group. TIDE and IPS scores were significantly different between different risk groups (both P<0.05). Conclusion　Immune-related lncRNA models for cervical cancer can be used as biomarkers to predict the response rate and prognosis in cervical cancer patients receiving immunotherapy.

Value of "cloud sign" on coronal plane of ABVS in the diagnosis of breast lesions 

Li Ruolan, Liu Tao, Han Wei, Song Siyi, Zhou Qiongjuan, Shen Hongyuan, Liang Weixiang

2023, 29(1):  44.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.009

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 Objective　To explore the value of "cloud sign" on coronal plane of automated breast volume scanner (ABVS) for the differential diagnosis and prognosis evaluation of breast lesions. Methods　It was a cross-sectional study. In total, we collected 154 cases of breast lesions with Breast Imaging Reporting and Data System (BI-RADS) grade 3 and above which were confirmed by ABVS and surgical pathology in The Third Affiliated Hospital of Guangzhou Medical University from January 2020 to January 2021. The "cloud sign" and "convergence sign" were studied retrospectively, then the correlations between "cloud sign" and patient age, tumor size, benign or malignant tumor, invasion, and lymph node metastasis were analyzed. χ² test was used. The sensitivity, specificity, and accuracy of the "cloud sign" and "convergence sign" on coronal plane in the diagnosis of breast lesions were compared. Results　A total of 154 breast lesions were included in this study, including 42 benign lesions, with an age of (40.5±10.9) years old and a diameter of (26.7±13.7) mm, and 112 malignant lesions, with an age of (55.4±11.4) years old and a diameter of (17.9±11.5) mm. There were statistically significant differences in the occurrence rate of "cloud sign" among different age groups and different tumor diameter groups (P<0.001, P=0.013). The occurrence rate of "cloud sign" was significantly different between the benign and malignant tumor groups [14.3% (6/42) vs. 75.0% (84/112)] (P<0.001). The sensitivity, specificity, and accuracy of "cloud sign" for the diagnosis of benign and malignant tumors were 85.7%, 75.0%, and 77.9%. The occurrence of "cloud sign" was correlated with the positive expressions of estrogen and progesterone receptors (ER and PR) (P=0.049 and 0.005), but had no significant correlation with Ki-67, Cerb-B2, or lymph node metastasis (P=0.649, 1.000, and 0.064). The sensitivity, specificity, and accuracy of "convergence sign" in the diagnosis of breast cancer were 43.8%, 90.5%, and 56.4%. Conclusion　The "cloud sign" on coronal plane of ABVS has definite value in the diagnosis of breast lesions and prediction of ER and PR expressions.

Effect of bronchoscopic alveolar lavage combined with methylprednisolone on children with refractory Mycoplasma pneumoniae pneumonia 

Luo Qinglin, Xiong Leilei

2023, 29(1):  49.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.010

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 Objective　To investigate the effect of bronchoscopic alveolar lavage combined with methylprednisolone on children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods　It was a randomized controlled trial. A total of 90 children with RMPP who were treated in Children's Hospital Affiliated to Zhengzhou University from June 2019 to August 2021 were enrolled as the research objects. They were divided into two groups by the random number table method, with 45 cases in each group. In the control group, 26 males and 19 females, aged (5.84±0.87) years, were treated with azithromycin for anti-infection; in the study group, 28 males and 17 females, aged (5.92±0.85) years, were treated with bronchoscopic alveolar lavage combined with methylprednisolone on the basis of the control group. Both groups were treated for 4 weeks. The clinical efficacy, duration of symptom disappearance, levels of inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interferon-γ (IFN-γ)], and adverse reactions were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The total effective rate of the study group was 95.56% (43/45), which was higher than that of the control group [71.11% (32/45)], with a statistically significant difference (χ²=9.680, P=0.002). The disappearance time of fever, the disappearance time of lung rales, the disappearance time of cough, and the time of chest radiography returning to normal in the study group were (5.42±0.86) d, (6.85±0.49) d, (10.38±1.26) d, and (14.31±3.58) d, respectively, which were shorter than those in the control group [(9.86±0.88) d, (10.80±0.52) d, (14.57±1.37) d, and (19.67±3.69) d], with statistically significant differences (all P<0.05). After treatment, the levels of CRP [(13.21±3.27) mg/L], TNF-α [(15.82±3.61) ng/L], IL-6 [(14.46±4.83) ng/L], and IFN-γ [(7.62±0.48) ng/L] in the study group were lower than those in the control group [(28.85±4.15) mg/L, (26.49±3.59) ng/L, (37.49±4.42) ng/L, and (15.46±1.39) ng/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　The application of bronchoscopic alveolar lavage combined with methylprednisolone in the treatment of children with RMPP can effectively reduce the levels of inflammatory factors, shorten the course of disease, and obtain better clinical effects, without obvious adverse reactions, with high safety, which is worth popularizing.

Effect of bronchoalveolar lavage combined with local application of sensitive antibiotics on patients with chronic obstructive pulmonary disease complicated with bronchiectasis 

Li Shuyue, Dong Liangliang, Zhang Hongyue, Ning Kang

2023, 29(1):  53.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.011

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Objective　To analyze the effects of bronchoalveolar lavage (BAL) combined with local application of sensitive antibiotics on pulmonary function, blood gas analysis, inflammatory factors, and airway resistance in patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. Methods　A retrospective analysis was made on 154 patients with COPD and bronchiectasis who were treated in The Second People's Hospital of Liaocheng from January 2018 to January 2021. They were divided into a control group (63 cases) and an observation group (91 cases) according to whether they received BAL or not. In the control group, 35 males and 28 females, aged (58.3±8.3) years, received routine treatment; in the observation group, 56 males and 35 females, aged (57.8±7.1) years, were treated with BAL on the basis of the control group. The changes of pulmonary function indexes [vital capacity (VC), forced expiratory volume in the first second (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), ratio of FEV1 to predicted value (FEV1/pre), and peak expiratory flow rate (PEF)], blood gas analysis indexes [arterial partial pressure of oxygen (PaO₂), arterial oxygen saturation (SaO₂), and arterial partial pressure of carbon dioxide (PaCO₂)], levels of inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and interleukin-6 (IL-6)], and airway resistance indexes [response frequency (Fres), total respiratory resistance (Zrs), total airway resistance/predicted value at 5 Hz (R5/pre), central airway resistance/predicted value (R20/pre), and peripheral elastic resistance (X5)] before and after 10 d of treatment and the total effective rates of the two groups were compared. t test and χ² test were used. Results　After treatment, the levels of VC [(2.8±0.4) L], FEV1 [(1.9±0.4) L], FEV1/FVC [(74.5±11.6) %], FEV1/pre [(83.2±10.2) %], and PEF [(6.3±1.2) L/s] in the observation group were higher than those in the control group [(2.3±0.3) L,(1.5±0.3) L, (68.2±12.9) %, (76.8±9.2) %, and (5.9±1.1) L/s], with statistically significant differences (all P<0.05). After treatment, the PaO₂ [(84.9±6.3) %] and SaO₂[(89.4±10.2) %] in the observation group were higher than those in the control group [(78.9±7.1) % and (84.3±7.5) %], but the PaCO₂ [(36.9±5.1) mmHg (1 mmHg=0.133 kPa)] was lower than that in the control group [(42.8±5.3) mmHg], with statistically significant differences (all P<0.05). After treatment, the levels of hs-CRP [(4.3±0.9) mg/L], TNF-α [(6.3±1.2) ng/L], PCT [(1.5±0.3) μg/L], and IL-6 [(8.4±2.1) ng/L] in the observation group were lower than those in the control group [(8.6±2.1) mg/L, (12.3±3.1) ng/L, (3.2±0.7) μg/L, and (20.3±3.5) ng/L], with statistically significant differences (all P<0.05). After treatment, the Fres [(18.7±4.6) Hz], Zrs [(0.4±0.1) kPa/(L·s)], R5/pre [(184.3±20.5) %], and R20/pre [(186.9±13.8) %] in the observation group were all lower than those in the control group [(20.6±4.3) Hz, (0.7±0.1) kPa/(L·s), (203.1±25.8) %, and (215.3±15.0) %], with statistically significant differences (all P<0.05). The total effective rate of the observation group was 85.7% (78/91), which was higher than that of the control group [65.1% (41/63)], with a statistically significant difference (χ²=9.026, P=0.003). Conclusion　BAL combined with local application of sensitive antibiotics can effectively improve the blood gas value in COPD patients with bronchiectasis, and reduce the inflammatory reaction and airway resistance, thus effectively improving the lung function and clinical treatment effect.

Efficacy of salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of COPD

Wang Lingling, Shen Xiaozhu, Jia Rong

2023, 29(1):  59.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.012

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Objective　To explore the efficacy of salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods　It was a randomized controlled trial. A total of 126 elderly patients with acute exacerbation of COPD admitted to Lianyungang Second People's Hospital from March 2020 to March 2022 were selected and were divided into two groups by the random number table, with 63 cases in each group. In the control group, there were 34 males and 29 females, aged (69.19±4.25) years; in the observation group, there were 32 males and 31 females, aged (69.04±4.36) years. The control group was treated with ipratropium bromide, and the observation group was treated with salmeterol ticasone on this basis. Both groups were treated for 14 days. The lung function, serum inflammatory factor levels, and airway remodeling indexes before and after treatment, clinical efficacy, and occurrence of adverse reactions were compared between the two groups. t test and χ² test were used. Results　The total effective rate of the observation group was 96.83% (61/63), which was higher than that of the control group [79.37% (50/63)], with a statistically significant difference (χ²=9.157, P=0.002). After 14 days of treatment, the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) in the observation group were (1.94±0.55) L, (2.59±0.54) L, and (76.04±8.01)%, respectively, which were higher than those in the control group [(1.53±0.49) L, (2.23±0.51) L, and (67.94±7.35)%], with statistically significant differences (all P<0.05). After 14 days of treatment, the levels of tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and IL-8 in the observation group were (54.02±11.05) mg/L, (8.99±1.46) mg/L, (57.15±8.02) ng/L, and (34.12±8.38) ng/L, respectively, which were lower than those in the control group [(68.04±10.84) mg/L, (12.33±2.08) mg/L, (64.70±7.83) ng/L, and (40.73±9.09) ng/L], with statistically significant differences (all P<0.05). After 14 days of treatment, the levels of matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase inhibitor-1 (TIMP-1), and transforming growth factor-β (TGF-β) in the observation group were (8.39±1.79) mg/L, (56.02±8.79) mg/L, and (81.85±11.06) ng/L, respectively, which were lower than those in the control group [(10.81±2.04) mg/L, (63.91±9.48) mg/L, and (95.70±12.25) ng/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion　Salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of COPD can improve the efficacy, improve the lung function and airway remodeling, and reduce the serum inflammatory factor levels, which does not increase the adverse reactions and is safe and reliable.

Application value of metabolic equivalent exercise nursing in elderly patients with chronic obstructive pulmonary disease

Wang Qiuping, Liu Wenwen

2023, 29(1):  64.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.013

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Objective　To study the establishment and application value of metabolic equivalent exercise nursing program in elderly patients with chronic obstructive pulmonary disease (COPD). Methods　It was a randomized controlled trial. A total of 90 cases of COPD treated in Wuxi Second People's Hospital from June 2019 to June 2021 were selected as the research objects, and were divided into a control group and a study group according to the random number table, with 45 cases in each group. In the control group, 20 males and 25 females, aged (66.32±5.24) years, received routine exercise nursing; in the study group, 22 males and 23 females, aged (66.58±5.19) years, received metabolic equivalent exercise nursing. The cardiac function, lung function, and qualities of life of COPD patients in the two groups were compared on the second day after admission and after 2 weeks of intervention. t test and χ² test were used. Results　On the second day after admission, there were no statistically significant differences in the 6 min walking distance, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) between the two groups (all P>0.05). After 2 weeks of intervention, the 6 min walking distance [(402.36±32.56) m], FVC [(2.84±0.32) L], FEV1 [(2.30±1.16) L], and FEV1/FVC [(64.73±2.39) %] in the study group were higher than those in the control group [(385.62±32.13) m, (2.68±0.38) L, (1.79±1.18) L, and (63.54±2.43) %], with statistically significant differences (all P<0.05). On the second day after admission, there were no statistically significant differences in the total score and scores of each dimension of Quality of Life Instruments for Chronic Diseases - Chronic Obstructive Pulmonary Disease (QLICD-COPD) between the two groups (all P>0.05). After 2 weeks of intervention, the scores of physical function [(38.59±4.12) points], psychological function [(40.36±4.32) points], social function [(34.56±2.69) points], and specific module [(49.02±4.06) points] and total score [(162.53±15.19) points] of QLICD-COPD of the study group were higher than those of the control group [(36.58±4.06) points, (38.49±4.19) points, (33.25±2.65) points, (46.52±5.02) points, and (154.84±15.92) points], with statistically significant differences (all P<0.05). Conclusion　Metabolic equivalent exercise nursing for elderly patients with COPD can effectively improve the cardiopulmonary function, such as 6 min walking distance, FVC, and FEV1, and improve the quality of life.

Application of self-management-oriented 5A nursing model in elderly patients with asthma

Shang Xin, Chen Yuguo, Li Rong

2023, 29(1):  69.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.014

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Objective　To study the application of self-management-oriented 5A nursing model in elderly patients with asthma. Methods　It was a randomized controlled trial. A total of 120 elderly patients with asthma who were treated in Department of Respiratory Medicine, Mengyin County People's Hospital from January 2019 to January 2022 were selected. They were assigned to a control group and an experimental group by the random number table method with 60 cases in each group. In the control group, 34 males and 26 females, aged (70.57±2.04) years, received routine nursing; in the experimental group, 36 males and 24 females, aged (71.03±2.08) years, received self-management-oriented 5A nursing model. The scores of Orem's Exercise of Self-Care Agency Scale (ESCA), Self-management Behavior Scale, Asthma Control Test (ACT), Insight and Treatment Attitude Questionnaire (ITAQ), and Adult Asthma Quality of Life Questionnaire (AQLQ) were compared between the two groups. χ² test was used for the count data and t test was used for the measurement data. Results　After intervention, the scores of different domains and total score of self-care ability in both groups were higher than those before intervention (all P<0.05); the scores of health knowledge [(45.28±4.17) points], self-care responsibility [(21.16±1.24) points], self-care skills [(30.22±4.02) points], and self-concept [(25.29±2.41) points] and total score [(121.95±11.8) points] of ESCA in the experimental group were higher than those in the control group [(36.02±3.11), (16.92±3.20), (23.51±3.71), (18.53±3.07), (94.98±13.09) points] (t=13.788, 9.570, 9.501, 13.416, and 11.835; all P<0.001). After intervention, the scores of different domains and total score of Self-management Behavior Scale in both groups were higher than those before intervention (all P<0.05); the scores of visiting the doctor on time [(29.86±4.11) points], avoiding the predisposing factors [(29.67±4.58) points], monitoring the condition [(29.89±3.20) points], medication compliance [(30.74±4.23) points], and identification and response to symptom attack [(30.82±4.16) points] and total score [(150.98±9.12) points] in the experimental group were higher than those in the control group [(25.48±3.69), (25.53±4.06), (25.72±3.61), (24.18±4.01), (26.64±3.88), and (127.55±12.25) points] (t=6.124, 5.239, 6.695, 8.717, 5.691, and 11.883; all P<0.001). After intervention, the scores of ACT and ITAQ in both groups were higher than those before intervention (all P<0.05); the scores of ACT [(20.17±2.03) points] and ITAQ [(18.22±1.27) points] in the experimental group were higher than those in the control group [(17.34±2.10) and (14.63±2.15) points] (t=7.505 and 9.092; both P<0.001). After intervention, the scores of different domains and total score of AQLQ in both groups were higher than those before intervention (all P<0.05); the scores of asthma symptoms [(26.89±4.25) points], concern for their own health [(26.78±3.94) points], psychological status [(26.48±3.88) points], response to stressors [(26.82±3.91) points], and limitation of motion [(27.68±4.11) points] and total score [(134.65±13.29) points] in the experimental group were higher than those in the control group [(23.69±3.66), (24.05±3.77), (23.38±3.55), (24.29±3.64), (24.63±4.05), and (120.05±13.05) points] (t=4.419, 3.877, 4.565, 3.668, 4.094, and 6.071; all P<0.001). Conclusion　The self-management-oriented 5A nursing model can effectively improve the self-care ability and self-efficacy in elderly patients with asthma, and control the asthma symptoms, thereby improving the quality of life.

Study on the effects of different medication methods in the promoting pregnancy treatment of polycystic ovary syndrome

Gao Jianhua, Wang Chuan, Zhan Ming, Zhou Ying, Liu Fanglan

2023, 29(1):  74.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.015

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Objective　To explore the clinical effects of different medication methods on ovulation in patients with polycystic ovary syndrome (PCOS). Methods　A retrospective analysis was made on 124 PCOS patients [333 COH (controlled ovarian hyperstimulation) cycles in total] who received COH treatment in The First Affiliated Hospital of Jiangxi Medical College from June 2019 to December 2021. The patients' age ranged from 26 to 39 years old, with an average of 30.6 years old. The duration of infertility ranged from 3 to 8 years, with an average of 4.6 years. The patients were divided into a study group and a control group according to different medication methods. The 61 cases (162 cycles) in the study group received divided medication, and the 63 cases (171 cycles) in the control group received one-time medication. Both groups were treated with metformin hydrochloride sustained-release tablets, troglitazone, letrozole, follicle-stimulating hormone (FSH), urinary gonadotropin (HMG), and human chorionic gonadotropin (HCG). The average dose per cycle, the number of mature follicles, the clinical pregnancy rate, and the incidence of ovarian hyperstimulation syndrome (OHSS) were compared between the two groups. χ² test or Fisher exact probability method were used. Results　The average dose per cycle was 17.5 pills and the clinical pregnancy rate was 42.6% (26/61) in the study group, which were higher than 14.4 pills and 25.4%(16/63) in the control group; the average number of mature follicles obtained per cycle was 2.11 and the incidence of OHSS was 3.3% (2/61), which were lower than 3.43 and 15.9% (10/63) in the control group; there were statistically significant differences (all P<0.05). Conclusion　The divided medication method can improve the clinical pregnancy rate and reduce the incidence of OHSS in the ovulation induction for PCOS patients.

Analysis of the diagnostic values of body measurement indexes and metabolic indexes for non-alcoholic fatty liver disease in type 2 diabetic patients

Song Fanfan, Yang Caicai, Zhao Xumin, Chen Ying, Li Yu, Chen Yu, Jia Aihua

2023, 29(1):  78.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.016

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Objective　To analyze the diagnostic values of body mass index (BMI), triglyceride (TG), γ-glutamyl transpeptidase (GGT), and insulin resistance (IR) for non-alcoholic fatty liver disease (NAFLD) in type 2 diabetic patients. Methods　The clinical data of 191 patients with type 2 diabetes who were admitted to Department of Endocrinology, The First Hospital of Yulin were collected from January 2017 to December 2019. Among them, there were 132 males, with an age of (49.41±12.29) years old and a course of disease of (6.63±5.77) years, and 59 females, with an age of (54.81±11.52) years old and a course of disease of (6.74±6.31) years. The ultrasound diagnosis of NAFLD was used as the diagnostic criteria. The patients were divided into a NAFLD group and a control group according to whether the patients were accompanied by NAFLD or not. The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic values of different metabolic indexes including TG, GGT, IR, and BMI for NAFLD. Independent sample t test, χ² test, and logistic regression model were used. Results　A total of 93 patients in the NAFLD group and 98 patients in the control group were included. The prevalence of NAFLD in patients with type 2 diabetes was 48.69% (93/191), which was 48.48% (64/132) in males and 49.15% (29/59) in females respectively. The levels of TG [(2.49±1.57) mmol/L], GGT [(41.34±31.93) mmol/L], IR [(4.01±2.65) mU/L], and BMI [(27.05±4.41) kg/m²] in the NAFLD group were higher than those in the control group [(1.75±1.10) mmol/L, (27.82±21.41) mmol/L, (2.74±2.82) mU/L, and (24.26±3.51) kg/m²], and the level of high density lipoprotein cholesterol (HDL-C) [(0.95±0.22) mmol/L] was lower than that in the control group [(1.07±0.30) mmol/L], with statistically significant differences (all P<0.05). The sensitivity and specificity of BMI≥24.45 kg/m² in the diagnosis of NAFLD were 81.72% and 59.38%, respectively. The sensitivity and specificity of TG≥1.47 mmol/L in the diagnosis of NAFLD were 82.80% and 51.02%, respectively. Logistic regression model analysis showed that BMI and TG were independent risk factors for NAFLD in type 2 diabetic patients (both P<0.05). Conclusion　In clinical practice, when BMI≥24.45 kg/m² and/or TG≥1.47 mmol/L are seen in patients with type 2 diabetes, physicians should pay attention to patients who maybe have IR and elevated GGT, and perform imaging to assess NAFLD timely.

Predictive value of geriatric nutritional risk index combined with prealbumin for postoperative complications in elderly patients with liver cancer 

Zhang Junping, Wang Yiyan, Zhuang Feifei, Li Jia, Cong Lan

2023, 29(1):  83.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.017

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Objective　To explore the predictive value of geriatric nutritional risk index (GNRI) combined with prealbumin (PA) for postoperative complications in elderly patients with liver cancer. Methods　A total of 82 elderly patients with liver cancer admitted to Weihai Central Hospital from January 2020 to January 2022 were selected, including 42 females and 40 males, with an age of (75.68±7.85) years old. The GNRI value and PA level were detected. The patients were divided into a complication group and a non-complication group according to whether the postoperative complications occurred. The predictive efficacies of GNRI and PA on postoperative complications in elderly patients with liver cancer were analyzed. Independent sample t test, χ² test, and logistic regression analysis were used, and the receiver operating characteristic curve (ROC) was drawn. Results　There were 16 cases (19.51%) of postoperative complications in the 82 elderly patients, including 10 cases of postoperative bleeding, 2 cases of infection, 2 cases of bile leakage, and 2 cases of chylous fistula. There were no statistically significant differences in the gender, smoking, diabetes, hyperlipidemia, age, creatinine, γ-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP) between the two groups (all P>0.05). The GNRI value [(90.25±10.52)] in the complication group was lower than that in the non-complication group [(100.52±19.65)], and the PA level [(168.52±19.62) mg/L] was higher than that in the non-complication group [(69.25±10.35) mg/L], with statistically significant differences (t=2.015, P=0.047; t=28.233, P<0.001). Logistic multivariate regression analysis showed that decreased GNRI and increased PA were risk factors for postoperative complications in elderly patients with liver cancer (both P<0.001). The ROC analysis showed that the areas under curves (AUCs) of GNRI, PA, and their combination in the prediction of postoperative complications in elderly patients with liver cancer were 0.837, 0.858, and 0.954, respectively, and the AUC of combined detection was higher than that of single index. Conclusion　GNRI and PA both have a certain predictive efficacy for postoperative complications in elderly patients with liver cancer, and the combined detection has a higher predictive efficacy.

Clinical efficacy of manual reduction combined with stable occlusal plate in the treatment of temporomandibular disorders

Su Jianan, Su Zhiyong, Chen Yan

2023, 29(1):  87.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.018

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Objective　To analyze the value of manual reduction combined with stable occlusal plate in the treatment of temporomandibular disorders (TMD). Methods　A total of 200 patients with TMD admitted in Zhengzhou People's Hospital from August 2019 to February 2022 were selected as the study objects. According to the patients' intention, they were divided into a conventional group and a combined group. In the conventional group, there were 51 males and 47 females, aged (31.74±5.13) years; in the combined group, there were 64 males and 38 females, aged (30.65±5.28) years. The combined group was treated with manual reduction combined with stable occlusal plate, and the conventional group was treated with stable occlusal plate. The clinical efficacy, appearance satisfaction, pain degree [Visual Analogue Scale (VAS) score], temporomandibular joint opening index (TOI), Temporomandibular Joint Function Scale (Helkimo) score, surface electromyography (EMG) at rest [left anterior temporalis muscle (LTA), right anterior temporalis muscle (RTA), left masseter muscle (LMM), and right masseter muscle (RMM)] were compared between the two groups. t test and χ² test were used. Results　The total clinical effective rate [96.08% (98/102)] and overall appearance satisfaction rate [93.14% (95/102)] of the combined group were higher than those of the conventional group [82.65% (81/98) and 75.51% (74/98)] (χ²=9.586, P=0.002; χ²=11.857, P=0.001). After treatment, the VAS score [(2.09±0.45) points] and Helkimo score [(1.27±0.35) points] in the combined group were lower than those in the conventional group [(3.26±0.53) points and (2.04±0.33) points], and the TOI [(3.87±0.52) cm] was higher than that in the conventional group [(3.35±0.48) cm] (t=16.852, 15.944, and 7.341; all P<0.001). After treatment, the electromyography values of LTA [(2.31±0.33) μV], RTA [(2.18±0.36) μV], LMM [(1.37±0.24) μV], and RMM [(1.25±0.25) μV] in the combined group were lower than those in the conventional group [(2.87±0.35) μV, (2.79±0.38) μV, (1.68±0.23) μV, and (1.74±0.26) μV] (t=6.639, 6.646, 5.314, and 7.746; all P<0.001). Conclusion　Manual reduction combined with stable occlusal plate has a significant effect on TMD patients, which can relieve the spasm of masticatory muscles, restore the function of temporomandibular joint, relieve the patients' pain, improve the degree of mouth opening limitation, and improve the cosmetic effect.

Correlation analysis of HbA1c and C-P levels with type 2 diabetic peripheral neuropathy 

Zhang Jianjian, Xue Wei, Zhang Yue, Huang Gaode, Kang Jie

2023, 29(1):  91.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.019

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Objective　To investigate the correlations between the levels of glycosylated hemoglobin (HbA1c) and C-peptide (C-P) and type 2 diabetic peripheral neuropathy. Methods　From February 2020 to January 2022, 96 patients with type 2 diabetes were diagnosed by coronary angiography in Jinan Second People's Hospital, including 26 cases of simple type 2 diabetes and 70 cases of type 2 diabetic peripheral neuropathy. Another 32 healthy people were selected as the healthy group. In the simple type 2 diabetes group, there were 12 males and 14 females, aged 32-68 (55.26±7.14) years; in the type 2 diabetic peripheral neuropathy group, there were 32 males and 38 females, aged 30-67 (53.24±7.14) years; in the healthy group, there were 20 males and 12 females, aged 30-76 (58.25±7.69) years. The patients' clinical data were collected and compared. The levels of HbA1c and C-P were determined. Spearman method was used to analyze the correlations between HbA1c and C-P levels and type 2 diabetic peripheral neuropathy. t test and F test were used for the measurement data and χ² test for the count data. Results　The levels of HbA1c [(7.37±0.87) % and (8.52±0.96) %] and C-P [(5.63±1.67) μg/L and (7.14±1.84) μg/L] in the type 2 diabetes group and the type 2 diabetic peripheral neuropathy group were higher than those in the healthy group [(7.02±0.68) % and (3.12±1.53) μg/L], with statistically significant differences (both P<0.05). There were no statistically significant differences in the general data such as gender, age, body weight, course of disease, hypertension, smoking, drinking, fasting blood glucose, and heart rate between the two groups of type 2 diabetic patients (all P>0.05). Spearman correlation analysis showed that C-P and HbA1c levels were positively correlated with type 2 diabetic peripheral neuropathy (r=0.895, 0.870; P=0.010, 0.016). Conclusions　The levels of HbA1c and C-P are abnormal in patients with type 2 diabetic peripheral neuropathy. The levels of HbA1c and C-P are related to type 2 diabetic peripheral neuropathy, which can provide some references for guiding clinical early diagnosis and early prevention and treatment of type 2 diabetic peripheral neuropathy.

Clinical analysis of Director Zhang Dinghua's treatment of subacute thyroiditis

Dong Na, Zhang Dinghua, Shi Xiaowei, Pei Wenli, Wen Xuecheng, Jiang Peiwen

2023, 29(1):  95.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.020

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With the change of social pressure and living habits, the incidence of subacute thyroiditis is gradually increasing. Director Zhang Dinghua believes that the main cause of subacute thyroiditis is exogenous evil poison and poor emotion, which results in endogenous evil heat, internal heat toxin, damage to body fluid, and Qi and blood blocking. Therefore, the main pathogenesis of the disease is excessive accumulation of toxic heat and phlegm-heat accumulated in the anterior portion. Director Zhang Dinghua puts forward staged treatment for the disease, and self-created Ya Jia Kang prescription to treat the disease by stages, with remarkable clinical curative effect.

Teacher Li Daozheng's experiences in treating pulmonary diseases with Hufu Tongbian scrapping

Zheng Jingxia, Zhang Lijuan, Wu Bian, Xu Yan, Cai Jing

2023, 29(1):  98.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.021

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Teacher Li Daozheng, in view of the characteristics of lung disease that is susceptible, easy to spread, and involves many organs, believes that the basic pathogenesis of this type of disease is the disorder of the five organs and the loss of lungs. Hufu Tongbian scrapping therapy focuses on scraping the veins, bladder meridian, thymus, and lung meridian, and the effect is quite good. We are here to sort out one medical case and share it with others.

Treatises

Expression of gC1qR in sepsis and its effects on macrophage pyroptosis and mitochondrial function in patients with sepsis

Wang Dan, Wang Wei

2023, 29(1):  101.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.022

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Objective　To investigate the expression of globular C1q receptor (gC1qR) in sepsis and its effects on macrophage pyroptosis and mitochondrial function in patients with sepsis. Methods　From January 2020 to May 2022, 60 patients with sepsis in The Second Affiliated Hospital of Nanjing Medical University were selected as an observation group and 60 healthy people as a control group. In the observation group, there were 30 males and 30 females, aged (49.21±18.54) years; in the control group, there were 32 males and 28 females, aged (47.23±20.51) years. The expression of gC1qR in serum was detected by real-time fluorescent quantitative PCR (RT-qPCR). The macrophages were isolated from the patients' whole blood, and were divided into an empty transfection group and a transfection group. The effects of gC1qR on macrophage pyroptosis and mitochondrial function change in patients with sepsis were analyzed. Independent sample t test, paired t test, χ² test, and Pearson correlation analysis were used for statistical analysis. Results　The expressions of serum gC1qR mRNA in the control group and the observation group were (1.00±0.00) and (2.31±0.21) (t=48.320,P<0.001). The pyroptosis rates of macrophages in the empty transfection group and the transfection group were (41.36±5.21)% and (15.44±2.11)%, respectively, with a statistically significant difference between the two groups (t=11.300, P<0.001). The adenosine triphosphate (ATP) contents of macrophages in the empty transfection group and the transfection group were (8.24±2.56) μmol/L and (38.47±4.89) μmol/L, respectively, with a statistically significant difference between the two groups (t=13.420, P<0.001). gC1qR was positively correlated with macrophage pyroptosis (r=0.879, P<0.001), and was negatively correlated with ATP (r=-0.957, P<0.001). Conclusions　gC1qR is highly expressed in patients with sepsis. gC1qR can promote the macrophage pyroptosis and lead to the mitochondrial dysfunction.

Study on the relationship between change of intestinal mucosal permeability and liver function classification in patients with liver cirrhosis 

Wang Li, Zhang Rui

2023, 29(1):  105.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.023

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Objective　To investigate the relationship between change of intestinal mucosal permeability and liver function classification in patients with liver cirrhosis. Methods　A total of 96 patients with liver cirrhosis who were treated in Clinical Laboratory, The Sixth People's Hospital of Zhengzhou from November 2020 to April 2022 were selected as an observation group, and were divided into three subgroups, group A, B, and C (35, 43, and 18 cases), according to the Child-Pugh liver function classification. During the same period, 40 healthy controls without liver cirrhosis were selected as a control group. Group A included 25 males and 10 females, aged (55.01±8.71) years; group B included 30 males and 13 females, aged (55.19±8.76) years; group C included 14 males and 4 females, aged (55.34±8.81) years; the control group included 27 males and 13 females, aged (54.52±8.56) years. The fecal sample was collected, the changes of main intestinal flora were determined by bacterial culture, and the intestinal mucosal permeability indexes [D-lactic acid (D-LAC), endotoxin (ETX), and diamine oxidase (DAO)] were determined. Pearson correlation analysis was used to analyze the correlations among intestinal mucosal permeability indexes, Spearman correlation analysis was used to analyze the correlations between intestinal mucosal permeability indexes and Child-Pugh liver function classification, and the receiver operating characteristic curve (ROC) was used to analyze the predictive values of intestinal mucosal permeability indexes. F test and independent-sample t test were used for the measurement data and χ² test was used for the count data. Results　The numbers of enterobacterium [(8.61±0.42) lgCFU/g, (8.95±0.39) lgCFU/g, and (9.22±0.56) lgCFU/g] and enterococcus [(7.75±0.46) lgCFU/g, (8.42±0.87) lgCFU/g, and (9.28±0.63) lgCFU/g] in group A, B, and C were all higher than those in the control group [(8.12±0.68) lgCFU/g and (7.18±0.71) lgCFU/g], and the numbers of Lactobacillus [(9.08±0.63) lgCFU/g, (8.60±0.48) lgCFU/g, and (8.04±0.76) lgCFU/g] and bifidobacterium [(9.15±0.58) lgCFU/g, (8.54±0.61) lgCFU/g, and (7.96±0.82) lgCFU/g] were lower than those in the control group [(9.85±1.01) lgCFU/g and (9.97±0.96) lgCFU/g], with statistically significant differences (all P<0.05). With the increase of Child-Pugh liver function classification, the numbers of enterobacterium and enterococcus showed an upward trend, while the numbers of Lactobacillus and bifidobacterium showed a downward trend, with statistically significant differences (all P<0.05). The levels of D-LAC [(5.83±2.63) mg/L, (8.75±3.27) mg/L, and (10.16±3.58) mg/L], ETX [(10.53±4.36) U/L, (12.67±5.12) U/L, and (23.08±9.37) U/L], and DAO [(34.06±10.36) U/L, (40.12±11.72) U/L, and (43.07±14.20) U/L] in group A, B, and C were higher than those in the control group [(3.92±2.27) mg/L, (3.72±2.51) U/L, and (3.65±1.63) U/L], with statistically significant differences (all P<0.05). The levels of D-LAC and DAO in group B and C were higher than those in group A (all P<0.05), but there were no statistically significant differences between group B and C (both P>0.05). The level of ETX in group C was higher than those in group A and B (both P<0.05), but there was no statistically significant difference between group A and B (P>0.05). Pearson correlation analysis showed that D-LAC was positively correlated with ETX and DAO (r=0.595 and 0.489; both P<0.05), and ETX was positively correlated with DAO (r=0.353, P<0.05). Spearman correlation analysis showed that D-LAC, ETX, and DAO were positively correlated with Child-Pugh liver function classification (r=0.468, 0.470, and 0.236; all P<0.05). ROC analysis showed that D-LAC had the highest diagnostic value in predicting Child-Pugh liver function classification, the area under the curve (AUC) was 0.772, the optimal cut-off value was 6.60 mg/L, and the sensitivity and specificity were 78.69% and 65.71%, respectively. Conclusions　The intestinal microecological imbalance caused by intestinal flora disturbance and intestinal mucosal permeability changes in patients with liver cirrhosis can aggravate the disease and is not conducive to the prognosis. Non-invasive, reliable, and practical monitoring on intestinal mucosal permeability indicators helps to provide important guidance for the diagnosis and treatment of patients with liver cirrhosis.

Scientific Research

Magnetic resonance imaging features of dermatofibrosarcoma protuberans

Chen Zipan, Chen Xiaodong, Luo Shucun, Luo Wenxuan, Luo Junjia, Deng Kang, Luo Zebin

2023, 29(1):  110.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.024

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Objective　To improve the understanding on the magnetic resonance imaging (MRI) features of dermatofibrosarcoma protuberans (DFSP) by analyzing the MRI features of 14 cases of DFSP. Methods　It was a descriptive study. The MRI data of 14 patients with DFSP diagnosed by pathology and immunohistochemistry in Affiliated Hospital of Guangdong Medical University from March 2011 to June 2022 were collected, and the MRI characteristics of DFSP were analyzed, including the imaging characteristics of T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), diffusion weighted imaging (DWI), and enhanced scanning sequences. Results　Among the 14 cases of DFSP, 9 cases were male and 5 cases were female. The age ranged from 21 to 58 years old, with an average age of (43.8±12.2) years old. All the 14 cases were single, manifested as nodules/masses protruding from the skin surface, with a maximum length of 21-160 mm and an average of (57.1±37.0) mm, with an average volume of 57.1 mm × 40.4 mm × 28.4 mm. The signal of unenhanced T1WI was similar to that of muscle, with high signal on T2WI. A few linear low-signal separations were seen in 6 cases. Three cases showed obvious high signal on DWI. Ten cases showed obvious uniform enhancement, but 4 cases showed uneven enhancement, and patchy low enhancement was seen in the lesions. In 6 cases, there was no obvious enhancement on low lipemia T2WI. In 1 case, a flow vacant vascular shadow was seen in the mass. In 1 case, hemorrhagic signal was seen in the mass, which showed high signal on T1WI plain scan. The lesions were confined to the skin and subcutaneous adipose tissue in 14 cases, with fat tail sign in 5 cases and fascia tail sign in 4 cases. The demarcation between the lesions and the deep surrounding structures was clear in 14 cases, and there was no invasion to adjacent deep structures. Conclusions　DFSP is confined to the skin and subcutaneous adipose tissue. MR plain and enhanced scans have certain imaging features. Correctly understanding these imaging features helps to improve the understanding on DFSP, which is helpful for the pathological diagnosis and clinical diagnosis and treatment.

Occupational Health

Study on the correlation between noise-induced hearing loss and white blood cell count 

Lu Yingjun, Zhang Weisen, Zhou Hao, Xiao Lyuwu, Zhou Hailin

2023, 29(1):  115.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.025

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Objective　To analyze the correlation between noise-induced hearing loss (NIHL) and white blood cell count (WBC), so as to provide new population study evidences for occupational noise health damage. Methods　In 2009, Guangzhou Occupational Disease Prevention and Control Institute was commissioned by 157 factories to carry out the occupational health inspection, including 14 396 workers who were exposed to noise. Combined with the occupational health examination, a total of 3 508 noise-exposed workers with blood routine, fasting blood glucose, blood lipids, and pure sound hearing examination were selected, including 2 969 men and 539 women. Data including general information, occupational exposure history, and history of auditory system disease were collected at the meantime. The correlation between NIHL and WBC was determined by t-test and analysis of covariance, and correlation with elevated WBC was analyzed by logistic regression analysis. Results　T-test of two independent samples and covariance analysis after adjusting for gender, age, noise-exposed years, fasting blood glucose, total cholesterol, and triacylglycerol both suggested that the WBC in the NIHL group was higher than that in the normal hearing group [(7.15±0.06) ×10⁹/L vs. (6.91±0.03) ×10⁹/L, (6.94±0.07) ×10⁹/L vs. (6.79±0.04) ×10⁹/L], with statistically significant differences (t=-3.912, P<0.001; F=5.618, P=0.018). After adjusting for gender, age, noise-exposed years, fasting blood glucose, total cholesterol, and triacylglycerol, logistic regression analysis showed that compared with the normal hearing group, the risk of elevated WBC increased by 32% in the NIHL group, and the odds ratio was 1.32 (95% confidence interval: 1.03-1.70, P<0.05). Conclusions　NIHL is independently associated with elevated WBC. It is suggested that noise exposure may induce chronic inflammatory response.

Case Report

Diagnosis and treatment of two children with Fabry disease in a family and literature review

Yu Chunmei, Ma Kai, Jin Ruifeng, Liu Yong

2023, 29(1):  119.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.026

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Objective　To investigate the clinical characteristics, gene mutation, and treatment of Fabry disease in two children from a family with neuropathic pain as the main clinical manifestation. Methods　The proband, an 11-year-old boy, was diagnosed with pain in both toes for more than 2 years in Jinan Children's Hospital in May 2021. His cousin, a 13-year-old boy, was diagnosed due to burning pain at the end of his toe for one year in Jinan Children's Hospital in July 2021. Peripheral blood samples were collected from the proband and his parents. LR-PCR and generation Ⅱ sequencing were used to determine the mutation gene locus in the pedigree. The clinical manifestation, diagnosis and treatment process of 2 cases were retrospectively analyzed after 1 year follow-up of enzyme replacement therapy. Results　The activity of α-galactosidase A (α-Gal A) was significantly decreased in both cases. The detection of GLA gene showed c.1080_1082delTGG hemizygous mutation, all of which originated from the mother. After one year of treatment, the clinical symptoms in both cases were relieved without recurrence, and the activity of α-Gal A in plasma returned to normal. Conclusion　We investigate the clinical characteristics, gene detection, and therapeutic principle of children with Fabry disease, to provide references for clinical diagnosis and treatment of Fabry disease in children.

A case of acquired reactive perforating collagenosis

Mai Jingming, Zhong Huilin, Li Shaojing, Li Zhaojun

2023, 29(1):  123.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.027

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Acquired reactive perforating collagenosis (ARPC) is a rare perforating skin disease, and its pathogenesis is still unclear. ARPC is rare clinically, and it is easy to be missed or be misdiagnosed. At present, there is no relevant reference guide for the diagnosis and treatment of ARPC, so antihistamine and antipruritic are the symptomatic treatments. Because this disease is often secondary to other systemic diseases, we should actively treat or control the primary diseases while treating this disease, so that this disease can be quickly controlled. A case of ARPC admitted to Affiliated Hospital of Guangdong Medical University in August 2021 is reported in this paper.

A case of IgG4-associated retroperitoneal fibrosis diagnosed by ultrasound 

Hua Lanlan, Li Mingzhe

2023, 29(1):  126.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.028

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Nursing Research

Analysis of influencing factors of willingness to use wearable mobile medical devices in home exercise of patients after cardiac surgery

Huang Huanhuan, Lyu Linhua, Chen Bijiao, Wu Zhongkai, Peng Fenfen, Yang He

2023, 29(1):  128.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.029

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Objective　To investigate the current status of the willingness to use wearable mobile medical devices in home exercise of patients after cardiac surgery and analyze the influencing factors. Methods　A questionnaire was designed based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model. The questionnaire was distributed to 200 patients who were hospitalized in Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University from January to December 2021, and 190 valid questionnaires were collected. Among the 190 patients, there were 102 (53.7%) males and 88 (46.3%) females, and 47.4% (90/190) were older than 60 years. The patients' basic personal information and cognition on wearable mobile medical devices were investigated, and the factors affecting patients' willingness to use wearable mobile medical devices were divided into seven dimensions: performance expectation, effort expectation, social influence, hedonic motivation, promotion condition, usage habits, and perceived risk. SPSS software was used to collect and analyze the data for multiple linear regression analysis. Results　The performance expectation, effort expectation, social influence, promotion condition, and usage habits had positive effects on the usage intention (t=3.226, 2.607, 2.332, 2.953, and 2.437; all P<0.05); the perceived risk had a negative effect on the usage intention (t=-11.173, P<0.001); the hedonic motivation had no significant effect on the usage intention (P>0.05). Conclusions　Strengthening patients' performance expectation, effort expectation, social influence, promotion condition, and usage habits and reducing patients' perceived risks can increase patients' willingness to use wearable mobile medical devices. The results can provide references for the application and promotion of wearable mobile medical devices in home exercise of patients after cardiac surgery.

Rehabilitation care for a patient with difficulty in extubation after tracheotomy for subarachnoid hemorrhage

Yang Huilin, Fan Maohua, Hu Nan, Yang Huilian, Wu Xuelian

2023, 29(1):  133.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.030

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Objective　To summarize the rehabilitation and nursing process of a patient with difficulty in extubation after tracheotomy for subarachnoid hemorrhage. Methods　A 74-year-old woman in the recovery period of cerebral hemorrhage was admitted to The Second Affiliated Hospital of Guangzhou Medical University on October 18, 2021. The main rehabilitation problems included tracheostomy with dysphagia, bilateral limb muscle strength loss, partial dependence on daily living, and cognitive and speech dysfunction. According to the patient's rehabilitation points, we set up a multidisciplinary team and developed a personalized treatment and rehabilitation plan, which mainly included six aspects: respiratory function rehabilitation nursing, swallowing function rehabilitation nursing, limb function rehabilitation nursing, cognitive impairment rehabilitation nursing, tracheotomy tube blocking, and extubation training. We provided the patient with integrated, personalized, and precise rehabilitation nursing. Results　After the planned rehabilitation treatment and nursing, the tracheal intubation was successfully blocked and removed on the 25th day, and the patient was stable and discharged from hospital on the 37th day after admission. Conclusions　Extubation difficulties can occur in subarachnoid hemorrhage patient with tracheotomy, and is rare in the clinic. It is important to summarize key points of rehabilitation care, offering evidence-based references for the clinical staff.

Effect of graded nursing in the prevention of contrast medium extravasation in dual-source enhanced CT scanning

Chen Haiyan, Yang Liping, Huang Rong, Liu Changhua, Wang Zhibin, Ouyang Ling

2023, 29(1):  138.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.031

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Objective　To explore the effect of graded nursing in the prevention of contrast medium extravasation in dual-source enhanced CT scanning. Methods　This study was a prospective controlled study. A total of 1 646 subjects who received dual-source enhanced CT scanning in the CT room of The 73rd Group Military Hospital from January to August 2021 were selected as a control group, including 894 males and 752 females, aged (48.30±8.65) years. Another 1 682 subjects who received dual-source enhanced CT scanning from September 2021 to May 2022 were selected as a research group, including 912 males and 770 females, aged (48.38±8.79) years. The control group received the routine dual-source CT nursing process; in the research group, the risk grading of contrast medium extravasation was determined according to the subjects' age, times of chemotherapy in the past 3 months, hypertension, times of venipuncture in the past 1 week, and diabetes status, and the graded nursing was performed. The incidence of contrast medium extravasation, the damage grade caused by contrast medium extravasation, and the evaluation of CT image quality were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　The incidence of contrast medium extravasation in the research group was significantly lower than that in the control group [0.59% (10/1 682) vs. 1.40% (23/1 646)], with a statistically significant difference (χ²=5.461, P=0.019). There were 9 cases of mild injury and 1 case of moderate injury in the research group; there were 12 cases of mild injury, 11 cases of moderate injury, and 1 case of severe injury in the control group; the damage grade caused by contrast medium extravasation in the research group was significantly lower than that in the control group, with a statistically significant difference (Z=2.159, P=0.031). There was no statistically significant difference in the CT image quality score between the research group and the control group [(2.77±0.45) points vs. (2.75±0.43) points] (t=1.297, P=0.295). Conclusion　The application of graded nursing in dual-source CT scan subjects can reduce the incidence of contrast medium extravasation, reduce the severity of damage caused by contrast medium extravasation, and the quality of CT images has no significant change, which has good application value.

Application of narrative nursing in one patient with acute stress disorder caused by lovelorn and epilepsy after acoustic neuroma operation 

Lin Haiyan, Tao Duo

2023, 29(1):  143.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.032

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Through narrative nursing, a patient with acute stress disorder caused by lovelorn and epilepsy after acoustic neuroma operation was intervened in Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The patient's plight was absorbed, explained, and responded to, and the patient's life story was excavated through the core technologies of narrative nursing such as externalization, deconstruction, and rewriting. The patient's life story was guided to reconstruct the meaning of life and disease stories, and the positive self-identity was reshaped. At the same time, through the case, the specific clinical application of narrative nursing in different cases is analyzed, and the clinical application and promotion of narrative nursing are promoted.