Table of Content

15 January 2023, Volume 29 Issue 2

Previous Issue   

New Medical Advances

Roles of TCF7L2 and canonical Wnt signaling pathway in liver cancer

Yao Baole, Zhu Xiaojuan, Wen Wangwen, Dai Wei, Liu Shenglan, Huang Hao

2023, 29(2):  149.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.001

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Liver cancer (LC), the most common malignant tumor with a high mortality rate, has been a globally tricky health problem characterized by difficult detection and diagnosis. Transcription factor 7 like 2 (TCF7L2) is the transcription factor in the canonical Wnt/β-catenin singnaling pathway, and β-catenin directly activates TCF7L2. During liver development and regeneration, the activation of canonical Wnt/β-catenin induces the formation of liver tissue. However, in normal mature healthy hepatocytes, β-catenin is inhibited. Liver damage and LC initiate the event that TCF7L2 transcriptionally activites downstream damaged targets in the β-catenin-dependent manner. The expression of TCF7L2 is positively correlated with the occurrence and progression of hepatocellular carcinoma. TCF7L2 is a potential target for the diagnosis and treatment of liver cancer.

Research progress on clinical application of Lao Moxibustion

Yang Lina, Wang Yu, Xia Bo

2023, 29(2):  154.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.002

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Lao Moxibustion is an important diagnosis and treatment technology in Ningxia minority medicine. It has significant curative effect on the obstruction of meridians and tendons and bone and joint injury diseases. The therapy is simple, safe, and effective. In recent years, remarkable progress has been made in the clinical application of Lao Moxibustion. In this paper, the clinical research progress of Lao Moxibustion was reviewed by retrospective clinical literature study, so as to provide basis for Lao Moxibustion diagnosis and treatment strategies and further promotion.

Research progress of tumor associated macrophages in tumor pathogenesis and treatment

Hao Shanshan, Hou Yanqiang, Dai Wanqin

2023, 29(2):  157.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.003

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Macrophages is one of the important immune cells involved in the body immune response. With the deepening of research on macrophages, the concept of tumor-associated macrophages (TAMs) has been proposed. TAMs are complex and heterogeneous cell groups in the tumor microenvironment (TME); they are closely related to the occurrence of tumor-related inflammation; they can affect tumor growth, invasion, metastasis, and angiogenesis. TAMs can also secrete a variety of cytokines and chemokines to inhibit the occurrence of anti-tumor immune response. TAMs are closely related to the occurrence and development of tumors. Therefore, They become interesting targets for tumor therapy. This review focuses on the origin and polarization of TAMs, their involvement in tumor progression, metabolism, epigenetic regulation, and their clinical use as targets for tumor therapy.

Research Progress of application of soft tissue balance measurement in total knee arthroplasty

Mo Huagui, Huang Yuanqiao, Wu Liping, Luo Huan, Luo Zhen, Chen Jiahui, Luo Yuqiang, Yuan Xiangwei

2023, 29(2):  161.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.004

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Osteoarthritis is the most common joint disease in the world, and its prevalence rate rises rapidly with age. The emergence of artificial knee arthroplasty provides an effective means for serious knee joint lesions. There are still many problems in the application of this technical means, mainly involving soft tissue balance regulation and biological force line measurement. The authors fully combine recent research at home and abroad, summarize the recent development of soft tissue balance measurement involved in knee arthroplasty. With the continuous improvement of sensing technology in related fields, combined with the continuous optimization and improvement of computer-aided surgical navigation, there will be more new breakthroughs in soft tissue balance measurement in knee arthroplasty in the medical field, and the service life of artificial joints is expected to be extended.

Research progress of neurobrucellosis

Lin Yiru, Wang Bo, Ding Guofeng

2023, 29(2):  166.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.005

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Brucellosis is a common zoonotic disease caused by Brucella infection; the main source of infection is sheep and cattle. Brucella can be transmitted to humans through a variety of ways. Brucella infection in humans often leads to complications in several organs and systems. Neurobrucellosis has a low incidence but is serious, with a risk of misdiagnosis and mismanagement, which can lead to disability and death. In this paper, a retrospective analysis of relevant literature reports was conducted to improve clinicians' understanding of neurobrucellosis and to achieve early diagnosis and treatment.

Prevention and Treatment of COVID-19

Analysis of drugs for COVID-19 Omicron variant strain infection in Shanghai Songjiang Shelter Hospital

Jiang Junfei, Gao Yue, Yang Lin

2023, 29(2):  170.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.006

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Objective　To retrospectively analyze the clinical data of COVID-19 variant Omicron infection in Shanghai Songjiang Shelter Hospital, and to understand the rationality of drug use for Omicron infection. Methods　The clinical information of 1 059 patients with Omicron infection in Shanghai Songjiang Shelter Hospital from April 1 to May 15, 2022 was collected. The basic information (gender and age), clinical diagnosis and medication, hospitalization duration, outcomes, and discharge of the infected patients were analyzed using descriptive analysis. Results　Among the 1 059 cases of Omicron infection, there were 538 males (50.80%) and 521 females (49.20%). Twenty-one cases (1.98%) had basic diseases. The clinical diagnosis was mild in 87 cases (8.22%); 972 cases (91.78%) had no symptoms. According to the characteristics of Omicron variant, Chinese patent medicine and traditional Chinese medicine are mainly used in Shanghai Songjiang Shelter Hospital for drug treatment, including Lianhua Qingwen Granules, Shenling Baisu Granules, Shenling Jianpi Granules, etc., and the prescription of decoction and medicine is used for synergistic treatment, which has achieved very good therapeutic effect. Conclusions　The medication of patients infected with Omicron in Shanghai Songjiang Shelter Hospital was basically reasonable and in line with the relevant requirements in the COVID-19 Diagnosis and Treatment Program (Trial Version 9). Chinese medicine has a definite curative effect and small adverse reactions in the treatment of patients infected with Omicron and the prevention of infection, but there are still some problems in the combination of drugs under different situations, and we need to strengthen supervision to avoid increasing the adverse reactions.

Scientific Research

A case of systemic lupus erythematosus with a large abdominal mass as a special presentation and review of relevant literatures 

Cui Kaiyue, Peng Yang, Zhao Peiqing, Lan Yongting

2023, 29(2):  174.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.007

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Objective　To explore the atypical clinical manifestations of systemic lupus erythematosus (SLE), to identify early diagnosis, and to reduce missed diagnosis. Methods　The clinical data of the patient with SLE and a large abdominal mass as a special manifestation treated at Zibo Central Hospital was analyzed; the relevant literatures were reviewed. Results　The patient, a 29-year-old female, with fever and massive abdominal mass, showed no improvement after anti-tuberculosis treatment. After being diagnosed with SLE in Zibo Central Hospital, her conditions improved after hormonal shock and immunosuppressive agents. However, the nature of the abdominal mass could not be determined. After taking SLE drugs for some time, the abdominal mass disappeared and was determined as highly enlarged abdominal lymph nodes. Conclusion　When SLE combined with atypical clinical manifestations, early diagnosis and rational treatment can effectively improve the prognosis.

3.0T magnetic resonance vessel wall imaging in relationship between vertebrobasilar atherosclerotic vessel wall and posterior circulation cerebral infarction 

Li Yong, Xiao Rong, Zhao Yanling, Feng Bo

2023, 29(2):  178.  DOI: 10.3760/cma.j.issn.1007-1245.2023.01.008

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Objective　To evaluate the relationship between vertebrobasilar atherosclerotic vessel wall and posterior circulation cerebral infarction (PCCI) using 3.0T magnetic resonance vessel wall imaging (3.0T MRI). Methods　One hundred and seventeen patients with PCCI admitted to Liaocheng Third People's Hospital from March 2020 to January 2022 were selected. All of them were examined by 3.0T MRI for atherosclerotic vessel wall changes in vertebrobasilar arteries and the presence of atherosclerotic plaques. The distribution, thickness, and intensification of the responsible plaques were recorded and observed; the remodeling index (RI) of the responsible vessel was calculated. According to the RI, the patients were divided into a positive remodeling group (RI ≥ 1.05; 82 cases), a negative remodeling group (RI≤0.95; 27 cases), and a no remodeling (0.95<RI<1.05; 8 cases). There were 50 males and 32 females in the positive remodeling group who were 51-72 (61.08±4.84) years old. There were 16 males and 11 females in the positive remodeling group who were 52-74 (62.46±5.02) years old. The vessel wall of the responsible vessel of PCCI was measured; the vessel wall characteristics, RI's, and plaque loads of the two groups were compared. t and χ² tests were applied. Results　The distribution of vertebrobasilar atherosclerotic plaques was the most in the dorsal wall (38.46%, 45/117), followed by the left wall (23.08%, 27/117), and the least in the circumferential shape (5.13%, 6/117); plaque thickness was predominantly >0.5-1.5 mm (70.09%, 82/117) and the least between 0 and 0.5 mm (13.68%, 16/117). The differences in plaque morphology and plaque signal between the two groups were not statistically significant (χ²=0.112 and 1.201; both P>0.05). The percentage of significant plaque enhancement was higher in the positive remodeling group (70.73%, 58/82) than in the negative remodeling group (37.04%, 10/27), with a statistical difference (χ²=11.723, P=0.008). The analysis of the narrowest level of the responsible vessel lumen showed that the vessel, plaque, vessel wall, and lumen area in the positive remodeling group were larger than those in the negative remodeling group (all P<0.05). The vessel RI and plaque load in the positive remodeling group were higher than those in the negative remodeling group (t=12.521 and 6.541; both P<0.05). Conclusion　3.0T MRI applied to PCCI can show the alteration of vertebrobasilar artery atherosclerotic vessel wall, make etiological diagnosis, and guide the development of clinical treatment plan.

Expressions and clinical significance of XBP1, Twist1, and VEGF protein in human glioma 

Zhou Baodan, Gao Fei, Wang Qimin, Wang Mingguo

2023, 29(2):  183.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.009

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Objective　To investigate the expression and clinical significance of X-box binding protein 1 (XBP1), Twist related protein 1 (Twist1), and vascular endothelial growth factor (VEGF) in human glioma. Methods　Fifty cases of glioma tissue preserved in The Second People's Hospital of Nanyang City from September 2018 to June 2020 were selected; of which, 28 cases were male and 22 cases were female, with an age of (37.66±5.66) years; they were divided into a survived group and a death group according to their prognosis. Forty cases of normal brain tissue were selected as a control group, including 24 males and 16 females who were (37.75±7.68) years old. The positive expressions of XBP1, Twist1, and VEGF in the tissues of both groups were detected. Their correlations with clinicopathological features were analyzed. The logistic regression analysis was used to analyze the risk factors affecting patient prognosis. Kaplan-Meier was used for survival analysis. Results　The positive expressions of XBP1, Twist1, and VEGF in the survived group and the death group were higher than those in the control group (χ²=57.270, 55.350, and 55.589; all P<0.05). XBP1, Twist1, and VEGF were associated with the patients' tissue differentiation (χ²=6.349, 10.938, and 8.140; P=0.012, 0.001, and 0.004), clinical stage (χ²=4.504, 8.295, and 6.062; P=0.034, 0.004, and 0.014), and Karnofsky Performance Status score (χ²=8.333, 4.688, and 6.527; P=0.004, 0.067, and 0.011); XBP1, Twist1, and VEGF were risk factors affecting the patients' prognosis (all P<0.05); the patients with positive expressions of XBP1, Twist1, and VEGF had shorter survival time than those with negative expressions (all P<0.05). Conclusion　XBP1, Twist1, and VEGF have certain correlations with clinicopathological features, prognosis, and survival of glioma patients.

Efficacy and safety of Yiqi Yangyin Huoxue recipe in treatment of non-valvular atrial fibrillation

Wang Hongchun, Ouyang Dequn

2023, 29(2):  187.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.010

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Objective　To explore the efficacy and safety of Yiqi Yangyin Huoxue recipe in the treatment of non-valvular atrial fibrillation. Methods　One hundred and twenty patients with non-valvular atrial fibrillation admitted to Ningyuan County People's Hospital from March 2015 to November 2016 were selected for the study. They were divided into a treatment group and a control group by the random number table method, with 60 cases in each group. There were 33 males and 27 females in the treatment group who were 48-74 (65.00±3.71) years old. There were 36 males and 24 females in the control group who were 43-75 (65.33±2.79) years old. The control group were treated with conventional western medicine, and the treatment group with conventional western medicine and Yiqi Yangyin Huoxue recipe, for 1 month. The curative effects, scores of traditional Chinese medicine syndrome (TCM), coagulation function, and incidences of adverse reactions were compared between the two groups. χ² and t tests were applied. Results　The total effective rate was 98.33% (59/60) in the treatment group, and was 93.33% (56/60) in the control group, with no statistical difference (P>0.05). Before the treatment, there were no statistical differences in TCM syndrome score and coagulation function [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer (D-D)] between the two groups (all P>0.05). After one month's treatment, the TCM syndrome score of the treatment group was significantly lower than that of the control group [(3.87±1.43) vs. (5.48±1.74)], with a statistical difference (P<0.05). After one month's treatment, the TT, PT, APTT, D-D level were (14.38±1.37) s, (12.45±0.91) s, (32.50±3.44) s, and (1.82±0.68) mg/L in the treatment group, and were (13.70±1.23) s, (11.27±1.06) s, (30.25±3.51) s, and (2.11±0.77) mg/L in the control group, with statistical differences between the two groups (all P<0.05). The incidence of adverse drug reactions was 6.67% in the treatment group, and was 10.00% in the control group, with no statistical difference (P>0.05). Conclusion　Yiqi Yangyin Huoxue recipe combined with western medicine in the treatment of patients with non-valvular atrial fibrillation is effective and can effectively improve their symptoms and coagulation function and inhibit thrombosis, and does not increase the incidence of adverse reactions, so it is worthy of popularization and application.

Predictive value of neutrophil lymphocyte ratio combined with N-terminal brain natriuretic peptide for early recurrence of persistent atrial fibrillation after radiofrequency ablation

Jiang Qianqian, Cui Jinzhen, Miao Chunbo, Lu Lingyan, Li Lijuan, Fan Yuguang, Chang Yifang, Wang Tao, Dong Aizhi

2023, 29(2):  191.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.011

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Objective　To investigate the predictive value of neutrophil lymphocyte ratio (NLR) combined with N-terminal brain natriuretic peptide (NT-proBNP) for early recurrence of persistent atrial fibrillation after radiofrequency ablation. Methods　From October 2019 to May 2022, 102 patients with persistent atrial fibrillation after radiofrequency ablation treated in Liaocheng Second People's Hospital were selected as the study objects. The patients' early recurrences during the 1 month in hospital were counted. According to whether they relapsed, they were divided into a recurrent group and a non-recurrent group. The clinical data were compared between these two groups. Logistic multivariate regression analysis was used to analyze the factors influencing the early recurrence. The values of NLR and NT-proBNP in the prediction of early recurrence were analyzed. The data were analyzed by t test, χ² test, and Fisher's exact test. Results　Sixteen patients recurred early after radiofrequency ablation, with a recurrence rate of 15.69%. There were no statistical differences in age, diabetes, hypertension, stroke, drinking, smoking, hyperlipidemia, serum albumin, and tumor necrosis factor- α (TNF-α) between these two groups (all P>0.05). The NLR and NT-proBNP levels in the recurrent group were higher than those in the non-recurrent group [(9.25±1.52) vs. (5.36±1.21) and (902.52±109.25) ng/L vs. (278.52±20.58) ng/L], with statistical differences (both P<0.05). With NLR and NT-proBNP as the independent variables (all were continuous variables), whether the patient recur red during hospitalization as the dependent variable (recurrence=1, no recurrence=0), logistic regression analysis was conducted; the results showed that NLR and NT-proBNP were risk factors for the early recurrence after radiofrequency ablation of persistent atrial fibrillation (both P<0.05). The receiver operating characteristic curve (ROC) analysis showed that the sensitivity, specificity, and area under curve (AUC) of NLR combined with NT-proBNP in predicting the recurrence of the patients with persistent atrial fibrillation after radiofrequency ablation were 72.73%, 97.70%, and 0.884, respectively. The specificity and AUC of NLR combined with NT-proBNP in predicting recurrence of persistent atrial fibrillation after radiofrequency ablation were higher than those of single prediction (all P<0.05). Conclusion　NLR and NT-proBNP are effective in predicting recurrence of persistent atrial fibrillation after radiofrequency ablation, but their combined predictive value is higher.

Clinical value of cyclic adenosine monophosphate combined with coenzyme Q10 in the treatment of viral myocarditis

Dong Aizhi, Chang Yifang, Jiang Qianqian, Lu Lingyan, Cui Jinzhen, Li Lijuan, Fan Yuguang, Feng Zerui, Sun Guifeng

2023, 29(2):  195.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.012

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Objective　To explore the effect of cyclic adenosine monophosphate and coenzyme Q10 in the clinical treatment of patients with viral myocarditis. Methods　Ninety-five patients with viral myocarditis who were treated in Liaocheng Second People's Hospital from April 2020 to April 2022 were selected as the study objects. They were divided into a control group (48 cases) and a combination group (47 cases) by the computer random number table method. There were 27 males and 21 females in the control group who were 20-50 (35.21±7.04) years old. There were 22 males and 25 females in the combination group who were 20-45 (33.74±6.75) years old. The control group were treated with cyclic adenosine monophosphate and conventional therapy; and the combination group were treated with cyclic adenosine monophosphate, coenzyme Q10, and conventional therapy. The clinical efficacies, levels of oxidative stress indicators and myocardial injury markers, and adverse drug reactions of the two groups were compared and analyzed. t and χ² tests were applied. Results　The efficacy in the combination group was better than that in the control group [97.87% (46/47) vs. 83.33% (40/48)], with a statistical difference (P<0.05). After the treatment, the levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were higher and the level of malondialdehyde (MDA) was lower than those before the treatment in both groups (all P<0.05). The levels of SOD, GSH-Px, CAT, and MDA in the combination group were better than those in the control group [(84.31±12.04) IU/L vs. (78.65±11.24) IU/L, (95.47±11.93) U/L vs. (87.62±10.95) IU/L, (75.43±8.38) U/L vs. (67.21±7.47) U/L, and (3.45±0.69) μmol/L vs. (4.37±0.87) μmol/L], with statistical differences (all P<0.05). After the treatment, the levels of C-reactive protein (CRP), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), and lactate dehydrogenase (LDH) were lower than those before the treatment in both groups (all P<0.05). After the treatment, the levels of CRP, cTnI, CK-MB, and LDH in the combination group were significantly lower than those in the control group [(1.65±0.33) mg/L vs. (2.14±0.43) mg/L, (0.31±0.07) μg/L vs. (0.37±0.09) μg/L, (12.37±2.47) U/L vs. (15.41±3.08) U/L, and (112.73±12.53) IU/L vs. (142.84±15.87) IU/L], with statistical differences (all P<0.05). There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions　The combination of cyclic adenosine monophosphate and coenzyme Q10 in the clinical treatment of patients with viral myocarditis can significantly improve the clinical efficacy, the oxidative stress reaction, and myocardial injury, and reduce the adverse reactions. It is safe and reliable.

Effect of pharyngeal ice stimulation combined with feeding training on movement of hyoid laryngeal complex in patients with dysphagia after stroke

Liu Mei, Zhang Na, Jia Ru, Gao Linlin, Ge Fangfang

2023, 29(2):  200.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.013

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Objective　To explore the effect of pharyngeal ice stimulation combined with feeding training on the movement of hyoid laryngeal complex in patients with dysphagia after stroke. Methods　A total of 102 patients with dysphagia after stroke admitted to Jinan Second People's Hospital from January 2018 to December 2021 were selected and divided into a treatment group and a control group by the computer random number method, with 51 cases in each group. In the control group, there were 30 females and 21 males who were (63.52±9.63) years old. There were 31 females and 20 males in the treatment group who were (62.36±9.12) years old. The control group took feeding training; the treatment group took pharyngeal ice stimulation and feeding training. The scores of Video Fluoroscopic Swallowing Study (VFSS) and hyoid laryngeal complex movement before and 4 weeks after the treatment and adverse events were compared between the two groups. t test, χ² test, and Fisher's exact test were applied. Results　There was no statistical difference in the VFSS score between the treatment group and the control group before the training [(2.69±0.34) vs. (2.85±0.41); P>0.05]. After the training, there was a statistical difference in the VFSS score between the treatment group and the control group [(7.96±1.25) vs. (5.62±1.02); t=10.358, P<0.001]. Before the training, there were no statistical differences in hyoid bone movement and hyoid bone movement between the two groups (both P>0.05). After the training, the anterior and upper hyoid displacement distances of the two groups were higher than those before the training. After the training, the anterior and upper hyoid displacement distances of the treatment group were longer than those of the control group (t=5.296 and 9.107; both P<0.001). The incidence of adverse events in the treatment group was lower than that in the control group [1.96% (1/51) vs. 13.73% (7/51); P=0.027]. Conclusion　Pharyngeal ice stimulation combined with feeding training for patients with dysphagia after stroke is helpful to improve their swallowing function and movement of hyoid laryngeal complex and to reduce the incidence of adverse events.

Effect of rehabilitation training combined with repetitive transcranial magnetic stimulation for stroke patients

Fu Lingping, Li Shuna, Liu Erping, Guo Jiayu, Wang Yunpeng

2023, 29(2):  204.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.014

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Objective　To evaluate the effect of rehabilitation training combined with repeated transcranial magnetic stimulation on mental disorders and neurological dysfunction in stroke patients. Methods　A total of 88 stroke patients admitted to The First Affiliated Hospital of Henan University of Science and Technology from April 2019 to March 2021 were selected for the random control trial. According to the random number table method, the patients were divided into a reference group and a combined group, with 44 cases in each group. There were 24 males and 20 females in the reference group who were 49-83 (64.3±5.2) years old. There were 25 males and 19 females in the combined group who were 50-83 (64.7±5.0) years old. The reference group took rehabilitation training. The combined group took rehabilitation training and repeated transcranial magnetic stimulation. The psychological disorders, neurological function, and daily life ability before and after the treatment were compared between the two groups. The data were processed by SPSS 19.0. The data were compared between these two groups by t and χ² tests. Results　There were no statistical differences in the scores of depression and anxiety between the two groups before the treatment (both P>0.05). After the treatment, the scores of depression and anxiety in the combined group were lower than those in the reference group [(53.78±3.33) vs. (57.46±4.29) and (47.67±4.94) vs. (53.05±4.83); t=4.495 and 5.165; both P<0.001]. Before the treatment, there were no statistical differences in the scores of neurological function and activity of daily living between the two groups (both P>0.05).After the treatment, the scores of neurological function and activity of daily living in the combined group were better than those in the reference group [(7.78±1.33) vs. (9.46±1.69) and (67.67±6.94) vs. (58.05±7.83); t=5.182 and 6.099; both P<0.001]. Conclusion　Rehabilitation training combined with repeated transcranial magnetic stimulation is effective in the treatment of stroke patients and is helpful to improve their psychological disorders, nerve function, and daily life ability, so it is worth being clinical generalized.

Effects of tacrolimus combined with piperazine ferulate on renal function and blood coagulation in children with nephrotic syndrome

Luan Haiyan, Tian Qiaohuan, Wang Cong

2023, 29(2):  207.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.015

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Objective　To investigate the effects of tacrolimus combined with piperazine ferulate on renal function and coagulation in children with nephrotic syndrome (NS). Methods　Sixty-one children with NS admitted to Department of Nephrology, Liaocheng Third People's Hospital from January 2019 to December 2020 were selected for the study and divided into in a control group (30 cases) and a study group (31 cases) by the random number table method. There were 12 boys and 18 girls in the control group who were 1-10 (5.61±1.35) years old. There were 15 boys and 16 girls in the study group who were 1-11 (5.52±1.28) years old. The control group were treated with piperazine ferulate, and the study group with tacrolimus and piperazine ferulate. The clinical efficacies and renal function [blood creatinine (Scr), urea nitrogen (BUN), 24 h urine protein quantification], coagulation function [prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], immune function [immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM)], and renal tubular injury indicators [urinary neutrophil gelatinase-associated lipid transport protein (NGAL), kidney injury factor (KIM-1)] before and after the treatment and incidences of adverse reactions were compared between the two groups by independent-sample t test and χ² test. Results　The total effective rate in the study group was higher than that in the control group [90.32% (28/31) vs. 70.00% (21/30)], with a statistical difference (P<0.05). After the treatment, the levels of 24 h urine protein quantification, Scr, BUN, FIB, D-D, NGAL, and KIM-1 were lower and the PT and levels of IgA, IgG, and IgM were higher in the study group than in the control group (all P<0.05). There was no statistical difference in the incidence of adverse reactions between the study group and the control group [19.35% (6/31) vs. 16.67% (5/30); P>0.05]. Conclusion Tacrolimus combined with piperazine ferulate is effective and safe in treating children with NS and can improve their renal function and coagulation, regulate their immune function, and reduce the expression levels of renal tubular injury indicators.

Family function of preschool children with type 1 diabetes mellitus and influencing factors

Wang Qiuli, Luo Lulu, Cao Yuqin, Li Jing

2023, 29(2):  212.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.016

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 Objective　To investigate the status and influencing factors of family function in preschool children with type 1 diabetes mellitus. Methods　One hundred and twenty-four preschool children with type 1 diabetes mellitus who were 3-6 years old and were treated at Department of Endocrinology, Genetics, and Metabolism, Children's Hospital, Zhengzhou University from February 2017 to February 2020, including 66 boys and 58 girls, and their main caregivers were selected. According to the family function, they were divided into a good family function group and a poor family function group. The demographic data, clinical indicators, and related scale scores of the family members of the two groups were collected. The children's status quo of family function was analyzed. Univariate and multivariate logistic regression analyses were conducted to analyze the factors affecting family function. t and χ² tests were applied. Results　The overall score of Family Assessment Device (FAD) in the 124 preschool children was (108.24±10.23); 84 children's FAD score ≤ 120; the other 40 children's >120; 67.74% (84/124) had good family function. There were no statistical differences in gender, age, residential address, and family genetic history but were in education level, marital status, family monthly income, medical insurance, fasting blood glucose (FBG), two hours postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbA1c), Family Adaptability and Cohesion Evaluation Scale (FACS Ⅱ-CV), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) between the two groups (χ²=5.560, 9.804, 2.698, and 6.483; t=5.048, 7.469, 3.495, 5.386, 7.482, and 7.220; all P<0.05). Logistic regression model showed that marital status, family monthly income, HbA1c, FACS Ⅱ-CV, SAS, and SDS were independent influencing factors of family function in the preschool children. Conclusions　The status quo of family function of preschool children with type 1 diabetes mellitus is relatively weak and needs to be improved. The influencing factors are mainly attributed to marital relationship, family monthly income, blood glucose control, parent-child intimacy and adaptability, and the degrees of anxiety and depression of the family members. Efforts can be made to solve the psychological problems of the children's family members, strengthen blood glucose control and other aspects to improve family function, so that the children can be better cared for.

Application effect of standardized communication mode combined with WeChat platform in pediatric emergency outpatient nursing management 

Zhao Ying, Cao Zhe

2023, 29(2):  217.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.017

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Objective　To explore the application value of standardized communication mode combined with WeChat platform in pediatric outpatient emergency nursing management. Methods　A retrospective analysis was performed on the clinical data of 80 cases of children who were treated in the pediatric emergency outpatient department of Children's Hospital Affiliated to Zhengzhou University from January 2020 to June 2021. Among them, 40 children (20 nurses) who received routine nursing were set as a control group, including 21 boys and 19 girls who were 4-13 (8.48±1.17) years old. At the same period, 40 children (20 nurses) who received standardized communication mode combined with Welhat platform management were set as an observation group, including 23 boys and 17 girls who were 4-13 (8.52±1.20) years old. The nurses' goal achievement conditions [Chinese version of Nurse Behavior Goal Achievement Evaluation Scale (NPGA) scores] of the two groups were compared. The nursing qualities of the two groups were evaluated. The nursing satisfactions of the children's family members of the two groups were investigated. χ² and t tests were applied. Results　The nurses' NPGA scores of personalized nursing measures, independent decision-making, team role, team cooperation, empathy, and common participation and total score of the observation group were higher than those of the control group [(25.73±5.61) vs. (18.37±4.20), (45.70±6.22) vs. (31.52±5.03), (11.03±1.62) vs. (9.25±1.70), (25.74±4.47) vs. (20.62±3.03), (10.62±1.94) vs. (8.75±2.20), and (140.08±15.77) vs. (113.18±13.48)], with statistically differences (t=4.697, 7.760, 3.390, 4.240, 2.851, and 5.799; all P<0.05). The children's family members' SERVQUAL scores of responsiveness and reliability dimensions and total score of the observation group were higher than those in the control group [(12.37±1.07) vs. (10.03±1.62), (17.08±1.85) vs. (13.62±2.17), and (76.88±8.49) vs. (70.38±9.68)], with statistical differences (t=7.623, 7.674, and 3.193; all P<0.05). The children's family members' nursing satisfaction in the observation group was higher than that in the control group [95.00% (38/40) vs. 80.00% (32/40)], with a statistical difference (χ²=4.114, P=0.043). Conclusion　Standardized communication mode combined with WeChat platform can effectively improve the goal achievement of pediatric outpatient emergency nurses, the quality of nursing service, and the nursing satisfaction of children's family members.

One case of "frozen pelvis" with constipation as clinical manifestation 

Wang Xian, Wang Li, Yao Shujuan

2023, 29(2):  221.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.018

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The patient, a 51 year old female, was admitted to the hospital because of uterine leiomyoma. Her clinical symptoms were not obvious. She only had a long-term history of constipation and took laxatives intermittently, with poor effect. The gynecological examination after admission suggested that it was possible to freeze the pelvis. Combined with the findings during the operation, multiple adhesions and abscesses formed in the pelvis, and intestinal adhesions were serious. Finally, partial sigmoid colon resection and sigmoid colostomy were performed at the same time. According to this case, it also confirmed gynecological examination is important in clinical diagnosis and treatment.

Application of ultrasound-guided quadratus lumborum block in abdominal and colorectal surgery and its influence on VAS scores 4, 6, 12, and 24 h after surgery

Zhang Dongyu, Xu Guoting

2023, 29(2):  224.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.019

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Objective　To explore the effect of ultrasound-guided quadratus lumborum block (QLB) in laparoscopic and colorectal surgery and its influence on the scores of Visual Analogue Scale (VAS) 4, 6, 12, and 24 h after surgery. Methods　One hundred and twenty-one patients undergoing laparoscopic and colorectal surgery at First Hospital, Nanyang Medical College from October 2020 to July 2022 were selected as the research objects for prospective study. After analyzing the patients' medical records, the patients were divided into an observation group (61 cases) and a control group (60 cases) according to the different anesthesia schemes. There were 34 males and 27 females in the observation group who were (51.27±3.49) years old. There were 32 males and 28 females in the control group who were (51.52±3.13) years old. The observation group received QLB, and the control group received transverse abdominal muscle block (TAP). The VAS scores of incision pain and visceral pain 4, 6, 12, and 24 h after the operation, block-related indicators, and adverse reactions were compared between the two groups. t and χ² tests were applied. Results　There were no statistical differences in the amounts of fluid and blood loss between the two groups (both P>0.05). While the intraoperative dosages of sufentanil and remifentanil were the same, the total consumptions of sufentanil and remifentanil in the observation group were significantly lower than those in the control group [(185.74±13.32) μg vs. (204.37±13.67) μg and (947.42±82.25) μg vs. (1 525.28±125.34) μg], with statistical differences (t=7.593 and 30.030; both P<0.05). The incidence of adverse reactions during analgesia in the observation group was lower than that in the control group [3.28% (2/61) vs. 15.00% (9/60)], with a statistical difference (χ²=5.028, P=0.025). There were no statistical differences in the VAS scores of incision pain after the operation between the two groups (all P>0.05). The VAS scores of visceral pain 4, 6, 12, and 24 h after the operation in the observation group were lower than those in the control group [(1.79±0.11) vs. (5.83±0.51), (1.58±0.11) vs. (5.64±0.53), (1.54±0.13) vs. (4.55±0.40), and (1.31±0.10) vs. (3.91±0.38)], with statistical differences (t=60.460, 58.565, 55.853, and 37.350; all P<0.05). Conclusion　QLB has a significant clinical effect in laparoscopic colorectal surgery, and can effectively improve postoperative visceral pain scores and reduce the dosage of analgesics and adverse reactions, so it is worthy of clinical promotion.

One case of eosinophilic gastroenteritis

Ouyang Xiaojia, He Qiong

2023, 29(2):  228.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.020

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Eosinophilic gastroenteritis (EGE) is a rare disease characterized by the dense eosinophil (Eos) infiltration of gastrointestinal tract. It is easily misdiagnosed and missed diagnosed. In this paper, the diagnosis and treatment of one case of EGE with atypical endoscopic features is reported. The patient was admitted to hospital due to the recurrent abdominal pain for 2 years and vomiting accompanied with diarrhea for 1 day. After ruling out the possibility of parasitic infection and allergic diseases, the patient was diagnosed with EGE based on the clinical manifestations,increased peripheral blood Eos, and gastrointestinal pathological result. After prednisone therapy for a month, the patient's symptoms basically disappeared and the laboratory blood tests returned to normal. As so far, the patient remained physically stable. This case provides the clinicians with the references to diagnose and treat EGE, so as to strengthen their understanding of this disease and improve their ability to identify EGE, especially those with atypical endoscopic features and to reduce the rate of misdiagnosis and missed diagnosis.

Moxibustion and acupoint application nursing for patients with gastrointestinal dysfunction after craniocerebral trauma 

Li Baomei, Wang Jing, Lyu Shiyin, Wang Yinqiu

2023, 29(2):  231.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.021

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Objective　To explore the recovery effect of moxibustion and acupoint application nursing for patients with gastrointestinal dysfunction after craniocerebral trauma. Methods　Eighty patients with gastrointestinal dysfunction after craniocerebral trauma admitted to Department of Brain Surgery, Liangyungang Hospital Affiliated to Nanjing University of Chinese Medicine from January 2020 to April 2022 were selected for the random control trial. They were divided into an observation group and a control group by the random number table method, with 40 cases in each group. There were 20 males and 20 females in the control group who were (43.69±7.64) years old. There were 24 males and 16 females in the observation group who were (45.41±9.45) years old. The control group took routine gastrointestinal nursing. The observation group took moxibustion and acupoint application nursing. The gastrointestinal function recovery, disorder and quality of life of the two groups were compared the next day of admission and 2 weeks after admission. t and χ² tests were applied. Results　The bowel sound recovery time, first exhaust time, and first defecation time in the observation group were shorter than those in the control group, with statistical differences (t=3.091, 3.197, and 3.130; all P<0.05). The total scores of gastrointestinal dysfunction 2 weeks after admission in both groups were lower than those the next day of admission. The total score of gastrointestinal dysfunction 2 weeks after admission in the observation group was lower than that in the control group [(1.91±0.43) vs. (2.25±0.47); t=3.376, P=0.001]. The scores of symptoms, emotion, body function, social function, and medication 2 weeks after admission in both group were higher than those the next day of admission. The scores of symptoms, emotion, body function, social function, and medication 2 weeks after admission in the observation group were higher than those in the control group, with statistical differences (t=3.146, 2.674, 2.725, 2.671, and 3.313; all P<0.05). Conclusion　Moxibustion and application acupoint nursing are conducive to the recovery of patients with gastrointestinal dysfunction after craniocerebral trauma, shorten the time of gastrointestinal ventilation, and improve their quality of life.

Clinical characteristics and genotypes of human papilloma virus of non-genital cutaneous warts

Dai Hairong, Ling Hongzhong, Cao Guangling, Ou Shuyu, Xie Jihuang, Zhou Hui

2023, 29(2):  236.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.022

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Objective　To investigate the clinical characteristics and genotypes of human papilloma virus (HPV) of non-genital cutaneous warts. Methods　One hundred and sixteen patients with non-genital cutaneous warts treated at The First Affiliated Hospital of Sun Yat-sen University from July 2019 to November 2020 were enrolled for the cohort study, including 63 males and 53 females who were (38.00±12.41) years old. The clinical data were collected; the DNA was harvested from the warts samples; the common primers were used to amplify the DNA. According to the 11 common HPV genotypes by gene sequencing of specific primers, the characteristics of the HPV genotypes and the clinical features of the cutaneous warts were analyzed. The chi-square test, independent samples t test, and one-way ANOVA were used. Results　HPV DNA was detected in 90.50% patients (105/116). The proportions of plantar warts, common warts, and flat warts were 51.43% (54/105), 32.40% (34/105) and 16.20% (17/105), respectively. The most predominantly prevalent genotypes were HPV 1 (53.33%), HPV 27 (37.14%), HPV 2 (29.52%), and HPV 4 (23.81%). The proportion of double or multiple genotype infection was 54.29%; the proportion was higher in hand and foot warts. The common multiple HPV genotypes were HPV 1+4, HPV 1+2, HPV 1+27, HPV 2+27, and HPV 1+4+27. High risk HPV was detected in 3 cases of common warts (HPV 18) and 1 case of flat wart (HPV 58). Conclusions　The prevalence characteristics of HPV genotypes in non-genital cutaneous warts in Guangdong may be distinctive from other areas. Multiple genotype HPV infection is common, especially in hand and foot warts.

Clinical efficacy of Jianpi-Yishen decoction and chemotherapy for patients with advanced non-small cell lung cancer and its effect on CTCs

Long Huidong, Lin Yun'en, Liang Shixiang

2023, 29(2):  242.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.023

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Objective　To investigate the clinical efficacy of Jianpi Yishen decoction combined with chemotherapy for patients with advanced non-small cell lung cancer (NSCLC) on and its effect on the level of circulating tumor cells (CTCs). Methods　Sixty patients with advanced NSCLC and Spleen and Kidney difficiency treated in Tumor Hospital, Guangzhou Medical University from January 2019 to January 2021 were selected as the study objects, including 33 males and 27 females; they were 18-75 years old. The patients were divided into a control group and an observation group according to whether they were treated by Jianpi Yishen decoction or not, with 30 cases in each group. The control group was given conventional TP (docetaxel + nedaplatin) chemotherapy; the observation group was given Jianpi Yishen decoction and TP chemotherapy. The levels of CTCs, clinical symptoms, and Karnofsky Performance Status (KPS) of the two groups were observed before and after the treatment. t and χ² tests were applied. Results　After the treatment, the number of CTCs in the observation group was significantly lower than that in the control group [(3.47±1.871) vs. (6.90±2.264)], with a statistical difference (t=-6.403, P<0.001). The symptoms, such as fatigue, anorexia, lumbar debility, nocturia, and dizziness, in the observation group were better than those in the control groups (χ²=4.344, 9.643, 11.915, 4.444, and 5.934; all P<0.05). The KPS score in the observation group was significantly better than that in the control group [(85.83±7.21) vs. (80.36±4.86)], with a statistical difference (t=4.626, P=0.036). Conclusion　Jianpi Yishen decoction combined with chemotherapy for patients with advanced NSCLC can reduce the level of CTCs and improve their clinical symptoms and quality of life.

Treatises

Prevalence of enuresis in 5 to 12 years old children at Xinhui District, Jiangmen City

Chen Haishan, Zhang Yuzhen, Fang Wen, Guo Xiaofang

2023, 29(2):  246.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.024

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Objective To estimate the prevalence of enuresis (NE) in 5 to 12 years old children at Xinhui District, Jiangmen City. Methods　From November 2021 to July 2022, the 5-12 years old children at Xinhui District, Jiangmen City were investigated by the anonymous WeChat questionnaire on enuresis. χ² test was applied. Results　A total of 49 kindergartens and 22 primary schools participated. There were 2 717 valid questionnaires, 1 478 for boys (54.4%) and 1 239 for girls (45.6%); the male to female ratio was 1.19:1; they were (7.0±1.9) years old. The total prevalence rate of NE was 5.7% (154/2 717). The prevalence rates of the 5, 6, 7, 8, 9, 10, 11, and 12 years old were 10.7% (54/507), 6.4% (40/621), 4.5% (34/755), 4.1% (11/268), 5.8% (10/171), 2.0% (3/151), 1.2% (2/167), and 0 (0/77), respectively (trend χ²=31.968, P<0.01). The prevalence rate of the boys was higher than that of the girls [6.9% (102/1 478) vs. 4.2% (52/1 239); χ²=9.218, P=0.002]. The mild,moderate, and severe enuresis accounted for 63.0% (97/154), 27.9% (43/154), and 9.1% (14/154), respectively. The prevalence of primary nocturnal enuresis (PNE) was 4.3% (117/2 717), accounting for 75.9% (117/154) of NE; the prevalence of secondary nocturnal enuresis (SNE) was 1.4% (37/2 717), accounting for 24.1% (37/154) of NE. The prevalence of monosymptomatic enuresis (MNE) was 4.7% (127/2 717), accounting for 82.5% (127/154) of NE. The proportion of the children with NE who visited doctors was only 20.1% (31/154). Fifty-two point six percent (81/154) of the NE children suffered from life troubles, 63.0% (97/154) from sleep problems, and 61.0% (94/154) from school performance or grades.  Sixty point four percent (93/154)  of the NE children's parents had life trouble, and 72.8% (111/154) had sleep problems. Conclusions　The total prevalence of NE in 5 to 12 years old children at Xinhui District, Jiangmen City is higher than that in the 5-18 years old in China in 2017. The prevalence decreases as they grow bigger. The prevalence in boys is higher than that in girls. The proportion of mild NE is the highest. NE has negative impact on the quality of life of the children and their parents. The rate of seeking medical treatment is low. It needs to be paid more attention to, strengthen education, and advocate early diagnosis and treatment.

Clinical Research

Clinical analysis of 18 cases of parapharyngeal space tumors 

Huang Yulin, Feng Jinbiao, Hu Tingbao, Lu Jianpeng

2023, 29(2):  250.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.025

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 Objective　To investigate how to choose a reasonable surgical approach according to the clinical characteristics and imaging manifestations of paropharyngeal space tumors. Methods　Eighteen patients with parapharyngeal space tumors treated at Guangzhou Panyu Central Hospital from January 2012 to June 2022 were retroretrospectively analyzed. There were 10 males and 8 females. They were 20-64 years old, with an average of 44. They were surgically treated through different approaches according to the results of preoperative CT and (or) MRI and clinical characteristics. Results　Fourteen cases were operated through the lateral transcervical approach, ２cases through the transparotid approach, 1 case through the transoral approach, and 1 case through the transoral and lateral transcervical approaches. Postoperative pathological diagnosis confirmed that there were 8 cases of pleomorphic adenoma, 8 cases of neurilemmoma, 1 case of adenolymphoma, and 1 case of parotid ductal carcinoma. After surgery, 3 cases got voice hoarseness. Seventeen cases of benign tumors were followed up and had no recurrence for 4 months to 10 years. One case of parotid ductal carcinoma was treated with radiotherapy after surgery and followed up for 26 months, with no tumor recurrence or metastasis. Conclusions　The lateral transcervical approach is the most commonly surgical method for parapharyngeal space tumors. Benign tumors have the main bodies protruding toward the oropharynx and locate in the medial of internal carotid; the transoral approach is a choice for them. The choice of a large pleomorphic adenoma derived from the deep lobe of the parotid gland through the transoral approach and transparotid approach is obviously better than through the lateral transcervical approach alone. Extracapsula resection of neurilemmoma is easy to damage the vagus nerve and get hoarseness.

Clinical application of ultrasound-guided IINB combined with TAPB in inguinal hernia repair for elderly patients

Tan Junyuan, Zhang Rong, Li Yinmei

2023, 29(2):  255.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.026

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Objective　To investigate the clinical value of ultrasonic-guided ilio-subventral and ilio-inguinal nerve block (IINB) and transverse abdominal muscle block (TAPB) in inguinal hernia repair for elderly patients. Methods　A total of 70 elderly patients who underwent selective tension-free unilateral inguinal hernia repair in Yingde People's Hospital from June 2019 to March 2022 were selected for the random control trial, including 63 males and 7 females who were (77.61±9.85) years old. They were divided into an observation group and a control group by the random number table method, with 35 cases in each group. The observation group took ultrasonic-guided IINB and TAPB. The control group took traditional lumboepidural block anesthesia. There was no difference in general data between the two groups. The scores of Visual Analogue Scale (VAS) immediately and 6, 12, and 24 h after operation were compared between the two groups. The heart rates (HR) and mean arterial pressures (MAP) at entry (T0), 5 min after anesthesia (T1), after incision (T2), and 6 (T3) and 12 h (T4) after surgery were compared between the two groups. The anesthesia effects, anesthesia satisfactions, and incidences of adverse events were compared between the two groups. The independent-sample t test, χ² test, and Fisher's exact test were used for the comparison between the 2 groups. Results　The VAS scores 6, 12, and 24 h after surgery in the observation group were significantly lower than those in the control group [(1.15±0.12) vs. (2.26±0.21), (1.56±0.14) vs. (4.26±0.42), and (2.01±0.19) vs. (4.47±0.41); all P<0.05]. There were statistical differences in MAP's [(83.26±8.11) mmHg (1 mmHg=0.133 kPa) vs. (62.06±6.39) mmHg and (84.22±8.31) mmHg vs. (60.29±6.03) mmHg] and HR's [(68.92±6.32) min^-1 vs. (81.26±8.33) min^-1 and (65.29±6.26) min^-1 vs. (78.64±7.62) min^-1] at T1 and T2 between the observation group and the control group, with statistical differences (all P<0.05); there were no statistical differences in MAP's and HR's at other time points between these two groups (all P>0.05). The total effective rate of anesthesia in the observation group was 88.57% (31/35), and was 85.71% (30/35) in the control group, with no statistical difference (P>0.05). The anesthesia satisfaction score of the observation group was significantly higher than that of the control group [(2.96±0.26) vs. (2.18±0.22); P<0.05]. There were no postoperative adverse events, such as urinary retention, nausea and vomiting, and bradycardia, in the observation group, while there were 4 cases of urinary retention in the control group, with an incidence of 11.43%; the incidence of adverse reactions in the control group was significantly higher than that in the observation group (P<0.05). Conclusion　IINB and TAPB in inguinal hernia repair for elderly patients can make the perioperative hemodynamics more stable, with postoperative analgesia effect and high safety, so it is worthy of clinical application.

Effect of transcutaneous electrical acupoint stimulation on patient comfort and lactation after cesarean section

Zhao Xiwu, Zhang Fangxiang

2023, 29(2):  260.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.027

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Objective　To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on patient comfort and lactation after cesarean section. Methods　One hundred and twenty-five women taking selective cesarean section at Guizhou People's Hospital from November 2020 to July 2021 were selected; 90 ones met the inclusion criteria; they were 18-35 years old and were 37-41 weeks singleton pregnant; the American Society of Anesthesiologists (ASA) classification was Ⅰ or Ⅱ; their body weight was 50-90 kg. Using the random number table method, the patients were divided into a transcutaneous electrical acupoint stimulation group (TEAS group), a patient-controlled epidural analgesia group (PCEA group), and a control group, with 30 cases in each group. The postoperative Visual Analogue Scale (VAS) was used to record the pain situation. The postoperative analgesic recovery rates 1 to 3 days after cesarean section were recorded. The beginning time of lactation after cesarean section was recorded. The lactation sufficiency rates 1 to 3 days after cesarean section were evaluated. The serum prolactin and dopamine contents before and 1 to 3 days after cesarean section were detected. The incidences of nausea and vomiting 1 to 3 days after cesarean section and the first anal exhaust time were recorded. The QoR-40 Scale was used to evaluate the recovery quality 1 to 3 days after cesarean section. One-way ANOVA, Kruskal-Wallis test, and χ² test were used for the comparison between the groups. Results　The VAS scores and the incidences of nausea and vomiting after cesarean section in the TEAS group and the PCEA group were much lower in those in the control group (all P<0.05). The QoR-40 scores after cesarean section in the TEAS group and the PCEA group were higher than that in the control group (both P<0.05). There was no statistical difference in the QoR-40 score between the TEAS group and the PCEA group. The beginning time of lactation after cesarean section and lactation sufficiency rate were (23.63±1.94) h and 93.3% (28/30) in the TEAS group, were (35.77±3.09) h and 83.3% (25/30) in the PCEA group, and were (41.70±2.52) h and 66.7% (20/30) in the control group. The beginning time of lactation after cesarean section and lactation sufficiency rate in the TEAS group were better than those in the PCEA group and the control group (all P<0.05). The serum prolactin content in the TEAS group was better than those in the PCEA group and the control group (both P<0.05). The first anal exhaust time and serum dopamine content in the TEAS group were lower than those in the PCEA group and the control group (all P<0.05). Conclusions　TEAS is a good choice for cesarean section patients, and can improve the patient comfort and their lactation function. There is a bright prospect for TEAS clinical application.

Effects of esketamine on remifentanil dosage and postoperative pain in obese patients undergoing general anesthesia 

Liu Xiangjie, Lin Huafu, Cheng Fang, Li Richang, Zhang Xiaodan, Li Weijian

2023, 29(2):  265.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.028

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Objective　To evaluate the effects of esketamine on remifentanil dosage and postoperative pain in obese patients undergoing general anesthesia. Methods　Sixty obese patients taking selective non-chest surgery at Jiangmen Central Hospital from June 2020 to May 2021 were selected for the clinical control trial; they were 18-65 years old; their body mass index (BMI) was over 28 kg/m²; the anesthesia grade was Ⅱ-Ⅲ. The patients were divided into an experimental group and a control group, with 30 cases in each group. The experimental group used esticketamine, propofol, sufentanil, and cisatracurium for anesthesia induction. The control group used sufentanil and cisatracurium at the same doses and a different dose of propofol for anesthesia induction. The experimental group took esticketamine, sevoflurane, and remifentanil for anesthesia maintenance. The control group took propofol, sevoflurane, and remifentanil for anesthesia maintenance. In both groups, the doses of sevoflurane, propofol, and esticketamine were constant, and the doses of remifentanil were adjusted according to intraoperative hemodynamic changes. Other drugs and fluids were consistent. Postoperative analgesia were induced by intravenous pump with flurbiprofen axetil in both groups. The amounts of remifentanil and postoperative Visual Analogue Scale (VAS) pain scores of both groups were recorded. The data were compared between these two groups by independent-sample t test and χ² test. Results　The VAS scores 2, 6, 12, and 24 h after operation in the experimental group were lower than those in the control group [(2.37±0.50) vs. (2.85±1.13), (3.05±0.46) vs. (3.45±0.42), (3.30±0.47) vs. (3.70±1.19), and (3.40±0.64) vs. (3.90±0.90)], with statistical differences (P<0.05). The amount of remifentanil in the experimental group was less than that in the control group [(1 130.00±109.92) μg vs. (1 210.00±108.12) μg], with a statistical difference (t=2.842, P=0.006). Conclusion Esketamine can reduce remifentanil dosage and postoperative pain score in obese patients undergoing general anesthesia.

Case Report

One case of perianal and back necrotizing fasciitis after perianal trauma 

Gu Jiabo, Wang Jun, Zhang Chunxia, Jin Heiying

2023, 29(2):  269.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.029

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 The low morbidity and high mortality of perianal fatal fasciitis make it a difficult clinical problem. Tissue infection is the main cause. Early diagnosis and active treatment are the key to the treatment of this disease. For patients with large tissue defects, secondary healing is recommended, and postoperative anti-infective treatment should be used as ascending steps. Surgery is still the main way to treat this disease.

One case of endoscopic resection of ectopic splenic implantation in gastric fundus combined with high grade intraepithelial neoplasia in gastric horn and literature review

Hou Guoqi, Li Yingming, Tang Yan

2023, 29(2):  272.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.030

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Nursing Research

Application of WeChat group continuous nursing + peer education in outpatient treatment for children with congenital talipes equinovarus

Wang Xiaoyun, Li Xinyi, Zhao Hongyang

2023, 29(2):  275.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.031

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Objective　To analyze the application effect of WeChat group continuous nursing + peer education in the outpatient treatment for children with congenital talipes equinovarus (CTEV). Methods　A total of 42 children with CTEV treated in Outpatient Department, Nanyang Orthopedic Hospital from January 2018 to December 2020 were selected for the random control trial. They were divided into a control group and an observation group by the random number table method, with 21 cases in each group. The control group had 14 males and 7 females who were (6.95±1.20) months old. The observation group had 16 males and 5 females who were (6.98±1.23) months old. The control group received routine nursing, and the observation group WeChat group continuous nursing + peer education. Both groups received continuous nursing for 6 weeks. The family members' mastery conditions of disease-related knowledge, the incidences of complications, and the family members' satisfaction degrees were compared between the two groups. t and χ² tests were applied. Results　The scores of pathogenesis, plaster nursing, life nursing, and complication observation in family members' disease-related knowledge were (82.29±2.65), (83.94±3.25), (83.46±3.62), and (80.16±3.11) in the observation group, which were all higher than those in the control group, with statistical differences (t=6.778, 5.029, 3.195, and 4.884; all P<0.05). There were no complications in the observation group, which was lower than that in the control group [28.57% (6/21)], with a statistical difference (χ²=4.861, P=0.028). The scores of service attitude, disease knowledge notification, operation technology, and health guidance were (83.36±3.32), (84.02±3.62), (83.15±3.40), and (83.19±3.45) in the family members' satisfaction degree in the observation group, which were higher than those in the control group, with statistical statistical differences (t=3.052, 3.466, 2.715, and 2.670; P=0.004, 0.001, 0.010, and 0.011). Conclusions　The WeChat group continuous nursing + peer education can improve the family members' mastery of health knowledge of children with CTEV, effectively reduce the occurrence risk of complications of plaster fixation, and promote the improvement of family satisfaction degree.

Effect of programmed nursing in health management center and its influence on examinees' satisfaction

Xu Yubing, Xie Weimei

2023, 29(2):  279.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.032

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Objective　To explore the application effect of programmed nursing in health management center and its influence on examinees' satisfaction. Methods　A total of 100 physical examinees in Health Management Center, Jieyang People's Hospital from January 2021 to December 2021 were selected for the random control trial. They were divided into a routine group and a programmed group by the random number table method, with 50 cases in each group. There were 27 males and 23 females in the routine group who were (41.45±1.46) years old. There were 24 males and 26 females in the programmed group who were (41.31±1.38) years old. During the physical examination, the routine group took routine nursing, and the programmed group took programmed nursing. The physical examination waiting times, physical examination times, and satisfaction were compared between the two groups. χ² and t tests were applied. Results　The physical examination waiting time and physical examination time in the programmed group were shorter than those in the routine group [(6.11±1.78) min vs. (12.15±1.64) min and (40.12±4.47) min vs. (58.24±6.12) min], with statistical differences (t=17.646 and 16.907; both P<0.001). The total satisfaction degree in the programmed group was higher than that in the routine group [98.00% (49/50) vs. 82.00% (41/50)], with a statistical difference (χ²=7.111, P=0.008). Conclusion　The application of the programmed nursing service mode in the health management center can effectively shorten the examinees' physical examination waiting time and physical examination time and optimize the medical examination efficiency and quality, so it is worthy of promotion and application in the nursing management of health management center.

Efficacy of community nurses involving in management of antihypertensive drug medication list in elderly patients with essential hypertension in community

Jia Zhongyuan, Zhang Zongli, Gao Lijuan

2023, 29(2):  282.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.033

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Objective　To explore efficacy of community nurses involving in the management of antihypertensive drug medication list in elderly patients with essential hypertension in community. Methods　From September 2021 to March 2022, 480 elderly patients with essential hypertension in the community treated at Shunyu Road Community Clinic, Jinan Maternal and Child Health Hospital were selected for the random control trial. The random number table method was used to divide the patients into a control group and a study group, with 240 cases in each group. The control group received routine antihypertensive drug guidance for 3 months. In the study group, the community nurses involved in the management of antihypertensive drug medication list for 3 months. The Morisky Medication Adherence 8-item Scale (MMAS-8) was used to evaluated the compliance of antihypertensive medication at the time of enrollment and after 1 and 3 months' intervention. The systolic blood pressures (DBP) and diastolic blood pressures (SBP) at the time of enrollment and after 1 and 3 months' intervention were recorded; the qualified rate of blood pressure control was calculated. The independent-sample t test, χ² test, and analysis of variance were applied. Results　A total of 219 cases in the control group and 221 cases in the research group were included in the final analysis. There were 126 males and 93 females in the control group; they were 62-87 (76.40±8.26) years old; the course of hypertension was (6.82±2.64) years. There were 132 males and 89 females in the study group; they were 61-90 (76.28±8.41) years old; the course of hypertension was (6.76±2.72) years. After 1 and 3 months' intervention, the MMAS-8 scores in the study group were higher than those in the control group [(6.25±0.91) vs. (5.36±0.84) and (6.78±0.83) vs. (5.64±0.86); t=10.646 and 14.148; both P<0.001]; the SBP's [(138.42±12.98) mmHg (1 mmHg=0.133 kPa) vs. (142.28±13.75) mmHg and (130.18±11.24) mmHg vs. (137.75±12.68) mmHg; t=3.028 and 6.847; P=0.003 and <0.001] and DBP's [(87.24±9.30) mmHg vs. (90.15±9.86)mmHg and (84.10±8.64) mmHg vs. (87.60±9.25) mmHg; t=3.185 and 4.102; P=0.002 and <0.001] in the study group were lower than those in the control group. The qualified rate of blood pressure control after 3 months' intervention in the study group was higher than that in the control group [77.83 (172/221) vs. 58.45 (128/219); χ²=19.045, P<0.001]. Conclusions　Community nurses involving in the management of antihypertensive drug medication list in elderly patients with essential hypertension in community can improve their compliance taking antihypertensive drugs, pressure control effect, and the qualified rate of blood pressure control.

Effect of cluster intervention mode based on magnetic nursing concept on artificial airway management in patients with cerebral hemorrhage 

Li Hui, Zhao Zhenhua, Li Lingling

2023, 29(2):  288.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.034

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Objective　To study the effect of cluster magnetic nursing intervention mode on artificial airway management in patients with cerebral hemorrhage. Methods　A total of 120 patients with cerebral hemorrhage admitted to Department of Neurosurgery, Liaocheng Third People's Hospital between October 2019 and November 2021 were selected for the random control trial. They were divided into a control group and an observation group by the random number table method, with 60 cases in each group. There were 33 males and 27 females in the control group; they were (59.03±8.66) years old. There were 36 males and 24 females in the observation group; they were (57.78±9.52) years old. The control group took routine nursing. The observation group took cluster magnetic nursing. The times staying in intensive care unit (ICU), mechanical ventilation times, scores of Hamilton Anxiety Scale (HAMA) and General Self-Efficacy Scale (GSES), incidences of complications, and nursing satisfaction were compared between the two groups. The measurement data were compared between the two groups by independent-sample t test and within the groups by paired t test. The enumeration data were analyzed by χ² test. Results　The time staying in ICU and mechanical ventilation time were (6.57±0.71) d and (5.75±1.20) d in the observation group, and were (8.23±0.92) d and (6.83±1.14) d in the control group, with statistical differences between these two groups (both P<0.05). After the intervention, the HAMA score in observation group was lower than that in the control group [(9.30±2.65) vs. (11.01±3.32); P<0.05]; the GSES score in the observation group was higher than that in the control group [(25.73±4.28) vs. (21.40±3.54); P<0.05]. The incidence of complications in the observation group was lower than that in the control group [8.33% (5/60) vs. 23.33% (14/60); χ²=5.065, P=0.024]. The satisfaction rates of airway management, psychological nursing, and nurse-patient relationship in the observation group were higher than those in the control group [95.00% (57/60) vs. 81.67% (49/60), 96.67% (58/60) vs. 85.00% (51/60), and 98.33% (59/60) vs. 86.67% (52/60); all P<0.05]. Conclusion　The application of cluster magnetic nursing in artificial airway intervention for patients with cerebral hemorrhage is beneficial to relieve their negative emotions, reduce complications, and promote early recovery, with high satisfaction.

Application of prehospital first aid chain process + family opportunity theory management in patients with acute myocardial infarction 

Gu Yan, Zhang Jingjing, Hu Danli

2023, 29(2):  292.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.035

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Objective　To explore effect of prehospital first aid chain process + family opportunity theory management for patients with acute myocardial infarction. Methods　Eighty-two patients with acute myocardial infarction treated in Wuxi Second People's Hospital from January to December 2021 were selected for the random control trial. They were divided into a control group and an observation group by the random number table method, with 41 cases in each group. There were 28 males and 13 females in the control group who were (57.18±4.19) years old. There were 29 males and 12 females in the observation group who were (57.23±4.41) years old. The control group took prehospital first aid chain process intervention; in addition, the observation group took family opportunity theory management. The first aid situations, lengths of hospital stay, incidences of complications, and caregiver stress were compared between the two groups. t and χ² test were applied. Results　After the intervention, the visiting reaction time, time arriving at the scene, on-site first aid time, and prehospital first aid time in the control group were longer than those in the observation group [(1.88±0.33) min vs. (1.11±0.22)min, (15.22±2.64) minvs. (12.44±2.37) min, (5.64±1.40) min vs. (4.97±1.31) min, and (26.20±3.64) min vs. (24.43±3.21) min], with statistical differences (all P<0.05). The incidence of complications in the observation group was lower than that in the control group [9.76% (4/41) vs. 29.28% (12/42)], with a statistical difference (χ²=4.970, P=0.026). The scores of the caregivers' care ability, stress, and disease knowledge of the caregivers in the control group were higher than those in the observation group, with statistical differences (all P<0.05). Conclusion　Prehospital first aid chain process + family opportunity theory management for patients with acute myocardial infarction can effectively improve their first aid situation, reduce hospital stay and the incidence of complications, improve the caregivers' stress and disease knowledge and the patients' prognosis.