Table of Content

01 February 2023, Volume 29 Issue 3

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New Medical Advances

Advances in the relationships between small heat shock proteins and tumor apoptosis

Wang Yimin, Li Qinghua

2023, 29(3):  297-301.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.001

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Small heat shock proteins (sHSPs) are a large group of many heat shock proteins (HSPs), including HSPB1, HSPB5, HSPB6, and HSPB8. Recent studies have shown that they play key roles in many signaling pathways that have many connections with tumorigenesis, anti-radiation, and apoptosis inhibition, especially in tumor apoptosis. In this paper, the effects of sHSPs on tumor apoptosis pathways are reviewed.

Research progress of miRNA in neurofibromatosis

Chen Yiheng, Gao Qinbin, Liu Guanjun, Guo Weitao

2023, 29(3):  301-305.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.002

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Neurofibromatosis (NF) is an inherited disease of the nervous system, which mainly affects the development and growth of nerve cells. According to clinical manifestations and gene mapping, NF can be classified into type Ⅰ neurofibromatosis (NF1), type Ⅱ neurofibromatosis (NF2), and schwannomatosis (NF3). NF1 accounts for 96% of all cases, 3% for NF2, and less than 1% for NF3. The pathogenic gene of NF1 is located on chromosome 17q11.2, which encodes a tumor suppressor protein and plays a negative regulatory role in Ras/MAPK and PI3K/mTOR signaling pathways. NF2 is due to the loss of function of the NF2 gene on chromosome 22, resulting in the dysfunction of its encoded Merlin protein. In contrast, the molecular mechanism of NF3 pathogenesis is still unclear, which is mainly believed to be related to the mutations of SMARCB1 and LZTR1 genes. However, the mechanism of NF has made breakthroughs in the field of molecular genetics, many studies have found that non-coding RNA also plays a crucial role in the pathogenesis of NF. Studies have shown that non-coding RNA can cause changes in gene mutation level, expression level, and RNA level during RNA processing, thus affecting the occurrence, growth, and progression of tumors. Among them, microRNA (miRNA) is abnormally expressed in a variety of solid tumors, which has more important significance for the formation of solid tumors. This article summarizes the research progress of miRNA in NF in recent years, so as to understand the role of miRNA in the occurrence and development of NF.

Application and progress of exosomes derived from mesenchymal stem cells in bone defect regeneration

Zhang Zhiwei, Zhou Nan, Li Mengqi, Zhang Kai, Li Peng

2023, 29(3):  306-310.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.003

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Exosomes are extracellular vesicles derived from paracrine cells. Because exosomes contain a variety of bioactive factors, they play an important role in cell-cell communication and inducing cell differentiation. Exosomes derived from mesenchymal stem cells can promote the bone defect regeneration by affecting the proliferation of bone tissue cells, inducing the osteogenesis through signaling pathway regulation, and reducing the immune inflammatory response. In recent years, researchers have paid more attention to the relationship between exosomes and bone defect regeneration. This paper reviews the research progress in this field.

Research progress on tumor immune microenvironment and immune checkpoint inhibitors in esophageal squamous cell carcinoma

Yuan Xiaoli, Wang Zhenbo

2023, 29(3):  310-314.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.004

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Esophageal squamous cell carcinoma (ESCC) is the major histological type of esophageal cancer, accounting for 90% worldwide. Despite extensive research and treatment, the prognosis is still poor. In recent years, monoclonal antibodies that inhibit programmed death-1 (PD-1) or programmed death ligand-1 (PD-L1) have achieved good efficacies in a variety of malignant tumors including esophageal cancer. However, only a small number of patients experience clinical benefits because of drug resistance. Therefore, in clinical practice, the biomarkers that can accurately predict the clinical efficacy should be identified for individualized immunotherapy. Tumor immunity, such as PD-L1 expression of tumor cells, tumor infiltrating lymphocytes, tumor associated macrophages, and myeloid derived tumor suppressor cells, warrants further investigation in ESCC because the tumor immune microenvironment may influence the patients' response to immune checkpoint inhibitors. This article reviews the recent research progress on tumor immune microenvironment and immune checkpoint inhibitors in ESCC.

Application progress of ultrasound in the assessment of cervix uteri for predicting preterm birth

Sui Zhenhui, Tang Liwei, Zhang Mingzhu, Dong Jingyun, Gao Yanbing

2023, 29(3):  315-318.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.005

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Approximately 15 million babies are born prematurely each year worldwide and preterm birth is the leading cause of neonatal death. Early and accurate prediction of preterm birth and timely intervention are of great significance for improving the pregnancy outcomes and reducing the premature infant mortality. Ultrasound technology predicts preterm birth by observing the changes in cervical shape and length in real time, evaluating the cervical hardness, etc. It has the advantages of simplicity, convenience, no radiation, and good repeatability, and has very important values in the prediction of premature birth. This article reviews the current research status of ultrasound technology to assess the cervix uteri for predicting preterm birth.

Progress of bispecific antibodies in relapsed/refractory multiple myeloma

Ling Juan, Zeng Huilan

2023, 29(3):  319-323.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.006

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In recent years, monoclonal antibodies against specific surface antigens on multiple myeloma (MM) cells have been increasingly used to treat relapsed and refractory multiple myeloma (R/RMM). Bispecific antibodies (BsAb) combine with tumor cell antigens and CD3 on T cells to activate T cells and target tumor cells. There are a variety of BsAb targeted at B cell mature antigen (BCMA) targets and non BCMA targets, such as GPRC5D and FcRH5, showing their respective pharmacokinetic characteristics and related efficacy and adverse reactions. A number of clinical trials have confirmed that they have promising clinical efficacy and safety in R/RMM patients.

Meta Analysis

Meta analysis of risk factors of type 2 diabetic patients with diabetic retinopathy

Chen Lijuan, Su Zhiqiang, Lin Zeya, Cai Yuan

2023, 29(3):  324-332.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.007

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Objective　To systematically evaluate the risk factors of type 2 diabetic patients with diabetic retinopathy (DR). Methods　The CNKI and Wanfang databases were searched to collect the literatures about type 2 diabetic patients with DR from the establishment of databases to May 1, 2022. Two researchers independently screened case-control studies, assessed the quality, and extracted the data according to the pre-defined criteria, and assessed the risk of bias in included studies. The data were analyzed by the Stata 16.0 software. Results　Totally 59 articles including 27 926 subjects were included. Among the exposure factors, triglyceride (WMD=0.33, 95%CI 0.24-0.45), low density lipoprotein cholesterin (WMD=0.30, 95%CI 0.12-0.40), and homocysteine (WMD=3.89, 95%CI 0.92-6.85) were risk factors related to lipid metabolism; glycosylated hemoglobin (WMD=1.32, 95%CI 1.03-1.61) and fasting plasma glucose (WMD=1.82, 95%CI 1.17-2.47) were risk factors related to glucose metabolism; systolic blood pressure (WMD=6.45, 95%CI 4.91-8.00) and diastolic blood pressure (WMD=4.70, 95%CI 3.57-5.84) were risk factors related to blood pressure; C-reactive protein (CRP) (WMD=1.34, 95%CI 0.55-3.14) was a risk factor related to inflammatory response; blood uric acid (WMD=60.45, 95%CI 20.63-100.27), urea nitrogen (WMD=0.90, 95%CI 0.46-1.34), and microalbumin (WMD=180.98, 95%CI 72.23-289.74) were risk factors related to renal function; other risk factors included diabetic duration (WMD=3.91, 95%CI 3.36-4.47), age (WMD=3.74, 95%CI 1.91-5.58), and retinol-binding protein 4 (RBP4) (WMD=12.28, 95%CI 7.20-17.37). Conclusion　Diabetes, hypertension, hyperlipidemia, high uric acid, high urea nitrogen, high CRP, and high RBP4 are risk factors for type 2 diabetic patients with DR.

Scientific Research

Curative effect of eicosapentaenoic acid soft capsules on hyperlipidemia and its effects on serum TNF-α, ADPN, and Hcy levels

Lyu Wenying, Feng Hong, Chen Xingxing, Cheng Long

2023, 29(3):  333-337.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.008

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Objective　To observe the clinical efficacy of eicosapentaenoic acid (EPA) soft capsules in the treatment of hyperlipidemia, and to explore its effects on serum tumor necrosis factor-α (TNF-α), adiponectin (ADPN), and homocysteine (Hcy) levels. Methods　It was a randomized controlled trial. A total of 108 patients with hyperlipidemia in Community Health Service Center of Beijing Chaoyangmen from June 2018 to December 2019 were enrolled and were divided into a study group and a control group by the random number table method. Excluding the excluded and dropped 2 cases, 106 cases finally completed the study. There were 52 cases in the study group, including 17 males and 35 females, aged (57.85±5.10) years; there were 54 cases in the control group, including 19 males and 35 females, aged (56.69±6.27) years. The study group was given EPA soft capsules orally, 2 times per day, 1 capsule each time (1.0 g per capsule); the control group was given placebos, 2 times per day, 1 capsule each time. The treatment period was 60 days. The changes of lipid metabolism indexes [triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C)] and serum levels of TNF-α, ADPN, and Hcy before and after treatment were compared between the two groups, and the safety was evaluated. t test and χ² test were used. Results　After treatment, the levels of serum TC, TG, and LDL-C in the study group were (5.03±0.59), (1.59±0.19), and (2.95±0.53) mmol/L, respectively, which were significantly lower than those in the control group [(5.76±0.41), (1.93±0.23), and (3.68±0.39) mmol/L] (all P<0.05). After treatment, the serum levels of TNF-α and Hcy in the study group were significantly lower than those in the baseline period, and were also lower than those in the control group; the serum ADPN level was significantly higher than that in the baseline period, and was also higher than that in the control group (all P<0.05). After treatment, there was no abnormal change in the safety indexes of the two groups. Conclusion　EPA soft capsules can significantly improve the lipid metabolism in patients with primary hyperlipidemia, regulate the serum TNF-α, ADPN, and Hcy levels, and have significant clinical lipid lowering effect.

Application of digital classification based on AO classification in floating knee injury

Zhao Dongyang, Zhou Nan, Ma Mingliang, Liu Hongzhi, Zhang Xingkai, Wang Zhigang

2023, 29(3):  337-341.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.009

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Objective　To establish a digital classification system based on AO classification for floating knee injury. Methods　The data of 100 adult patients with floating knee injury admitted to Binzhou Medical University Hospital from March 2005 to December 2020 were retrospectively analyzed, including 74 males and 26 females, with an average age of 43.74 years old. The distribution of the affected limbs in them was 54 cases (54.0%) on the left side, 43 cases (43.0%) on the right side, and 3 cases (3.0%) on both sides. The femur and tibia were divided into three parts separately in this system based on AO classification, which had six types after partial combination. The patients' images in this study were analyzed by using the classification to summarize the distribution rule of the classification in floating knee injury. The count data were measured by χ² test. Results　The proportions of type Ⅰ-Ⅵ injury were 42.7% (44/103) for type Ⅰ, 18.4% (19/103) for type Ⅱ, 9.7% (10/103) for type Ⅲ, 10.7% (11/103) for type Ⅳ, 11.7% (12/103) for type Ⅴ, and 6.8% (7/103) for type Ⅵ, respectively. There were no statistically significant differences in the gender (χ²=6.068, P>0.05) and injury side (χ²=0.658, P>0.05) among different injury types. Conclusion　The digital classification system of floating knee injury based on AO classification can classify most cases of floating knee injury and cases with open injury, which refers a reference effectively for the selection of surgical treatment plans and is more conducive to prognosis evaluation and academic exchange.

Experimental study on the therapeutic effect of acupuncture on AD rats and its mechanism

Tao Jing, Yang Xiaofan, Zhao Zhixuan, Li Hong

2023, 29(3):  342-347.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.010

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Objective　To explore whether acupuncture therapy can alleviate the learning and memory deficits in Alzheimer's disease (AD) rats induced by D-galactose (D-gal) combined with aluminum trichloride (AlCl₃) and its mechanism. Methods　It was an animal experiment. The male rats with body mass of 240-270 g were grouped into a control (A) group, a model (B) group, an acupuncture (C) group, and a drug treatment control (D) group according to the random number table method, with 5 rats in each group. After modeling and treatment, the cognitive function of rats in each group were evaluated by Y-maze, platform jumping, and Morris water maze experiments; Nissl body methylene blue special staining was applied to assess the neuronal damage; TUNEL staining was applied to detect the neuronal apoptosis in rat hippocampus; the levels of β-amyloid (β-AP) and phosphorylated tau in hippocampus were detected by immunohistochemistry. One-way analysis of variance was used for multivariate comparisons, and Tukey test for multiple comparisons. Results　Compared with group A, the rats in group B had cognitive dysfunction, neuronal damage, and a high neuronal apoptosis rate, and the levels of β-AP and phosphorylated tau were significantly higher (all P<0.05); compared with group B, the cognitive impairment of the rats in group C and group D was alleviated, the neuronal damage was improved, and the neuronal apoptosis rate was lower, and the levels of β-AP and phosphorylated tau were down-regulated (all P<0.05). Conclusion　Acupuncture therapy may reduce the concentrations of β-AP and phosphorylated tau in hippocampus to improve the cognitive impairment in AD rats.

Comparison of clinical efficacies of unilateral corner puncture vertebroplasty and traditional straight needle puncture vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Comparison of clinical efficacies of unilateral corner puncture vertebroplasty and traditional straight needle puncture vertebroplasty in the treatment of osteoporotic vertebral compression fractures

2023, 29(3):  348-352.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.011

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Objective　To compare the clinical outcomes of traditional unilateral or bilateral straight needle puncture vertebroplasty and unilateral corner puncture vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods　It was a randomized controlled trial. A total of 150 patients with OVCFs were diagnosed in Yiyang Central Hospital from November 2017 to December 2020. There were 66 males and 84 females; aged 65-92 years, with an age of (70.3±6.2) years old. They were divided into a unilateral straight needle puncture group, a bilateral straight needle puncture group, and a unilateral corner puncture group by the random number table method with 50 patients in each group. The operation time, radiation exposure time, intraoperative blood loss, postoperative first ambulation time, bone cement injection amount, bone cement distribution in the vertebral body, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) 1 month and 3 months after surgery were compared among the three groups. χ² test, rank sum test, and t test were used. Results　The operation time, radiation exposure time, intraoperative blood loss, and postoperative first ambulation time of the unilateral corner puncture group were all lower than those of the traditional unilateral or bilateral straight needle puncture group [(34.30±5.60) min vs. (58.26±4.34) min and (64.30±5.60) min, (5.28±2.21) min vs. (10.70±3.63) min and (15.98±4.20) min, (20.30±2.53) ml vs. (32.06±4.30) ml and (36.72±3.40) ml, (2.03±1.30) d vs. (3.54±4.17) d and (3.71±2.14) d], the bone cement distribution in the vertebral body was better than those of the traditional unilateral or bilateral straight needle puncture group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the bone cement injection volume among the three groups (P>0.05). The VAS scores and ODI of the three groups 1 month and 3 months after surgery were significantly lower than those before surgery (all P<0.05), but there were no statistically significant differences among the three groups (all P>0.05). Conclusions　Unilateral corner puncture vertebroplasty may be beneficial to the patients' early postoperative rehabilitation compared with traditional straight needle puncture vertebroplasty. Long-term follow-up studies involving large sample are needed to further confirm our findings in order to support the clinical promotion of this technology.

Effect of Fuzheng Huatan decoction combined with EGFR-TKI on patients with advanced lung adenocarcinoma

Miao Jianlong, Liu Ruijuan

2023, 29(3):  352-355.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.012

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Objective　To analyze the efficacy of Fuzheng Huatan decoction combined with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in patients with advanced EGFR-sensitive mutant lung adenocarcinoma, to explore the synergistic and toxic attenuation effects of Fuzheng Huatan decoction, and to evaluate the influence of Fuzheng Huatan decoction on the patients' prognosis. Methods　This study selected 78 patients with stage IIIB or IV EGFR gene mutation lung adenocarcinoma in Jining No.1 People's Hospital from July 2017 to December 2019, who were divided into a control group (38 cases) and an observation group (40 cases). Among them, there were 36 males and 42 females, aged (60.65±12.12) years, and the Karnofsky Performance Status (KPS) score before treatment was (63.84±15.30). The observation group was given EGFR-TKI combined with Fuzheng Huatan decoction, and the control group was given EGFR-TKI only. The objective response rate (ORR), progression-free survival (PFS), KPS score, and adverse reactions were compared between the two groups. Independent sample t test, χ² test, Fisher exact probability method, and Kaplan-Meier method were used. Results　(1)There were no statistically significant differences in the ORR and PFS between the two groups [82.50% (33/40) vs. 81.57% (31/38), (10.86±2.60) months vs. (10.08±1.56) months] (both P>0.05). (2)Compared with those in the control group, the incidences of liver damage, rash, diarrhea, interstitial pneumonia, and oral catarrh in the observation group were lower, but the differences were not statistically significant (all P>0.05). (3)The improvement rate of KPS score in the observation group was significantly higher than that in the control group [77.50% (31/40) vs. 55.26% (21/38), P<0.05]. Conclusion　Fuzheng Huatan decoction combined with EGFR-TKI in the treatment of advanced EGFR mutant lung adenocarcinoma patients can improve their quality of life and may reduce the occurrence of adverse reactions, but can not significantly prolong their PFS.

Effect of ERAS + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery

Hao Zhi, Rao Kong, Li Shuai

2023, 29(3):  356-360.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.013

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Objective　To explore the effect of enhanced recovery after surgery (ERAS) + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery. Methods　It was a randomized controlled trial. A total of 86 elderly patients who underwent laparoscopic general anesthesia surgery in Bayannur City Hospital from January 2020 to January 2022 were selected as the study subjects for a prospective study. They were simply randomly divided into an observation group and a control group, with 43 patients in each group. The observation group consisted of 29 males and 14 females; the age was (76.92±6.27) years old; ERAS nursing + non endotracheal intubation reserved spontaneous respiration was used for general anesthesia. The control group consisted of 26 males and 17 females; the age was (75.86±6.93) years old; regular nursing + one lung ventilation with double lumen bronchial intubation was used for general anesthesia. The changes of hemodynamic indexes [heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP)], stress response indexes [C-reactive protein (CRP), cortisol (Cor), and adrenaline (Adr)], arterial oxygen saturation (SaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and anxiety [scores of Hamilton Anxiety Scale (HAMA) and Self-rating Anxiety Scale (SAS)] before and after surgery and postoperative complications were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　After surgery, the HR [(77.67±7.91) beats/min], SBP [(135.05±9.21) mmHg (1 mmHg=0.133 kPa)], and DBP [(82.01±7.13) mmHg] in the observation group were lower than those in the control group [HR (87.25±8.53) beats/min, SBP (138.94±8.0) mmHg, and DBP (85.48±7.26) mmHg] (all P<0.05). After surgery, the levels of CRP [(73.95±15.29) mg/L], Cor [(113.77±4.25) nmol/L], and Adr [(197.25±6.71) pmol/L] in the observation group were lower than those in the control group [CRP (85.67±16.51) mg/L, Cor (120.51±3.17) nmol/L, and Adr (213.37±7.22) pmol/L] (all P<0.05). After surgery, the SaO₂ of the observation group was lower than that of the control group [(94.25±1.58) % vs. (95.23±2.17) %], and the PaCO₂ of the observation group was higher than that of the control group [(56.96±4.87) p/kPa vs. (46.57±4.21) p/kPa] (both P<0.05). The HAMA score and SAS score of the observation group were lower than those of the control group [(12.67±4.13) vs. (15.93±2.36), (55.38±2.61) vs. (62.07±2.84)] (both P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group [11.63% (5/43) vs. 39.53% (17/43)] (χ²=8.796, P=0.003). Conclusion　ERAS + non endotracheal intubation reserved spontaneous respiration can reduce the stress response in elderly patients after laparoscopic general anesthesia surgery, alleviate the anxiety, and promote the patients' recovery, with a low complication rate, which is recommended for clinical application.

Analgesic effects and safety of ropivacaine and sufentanil during the rebirth of scarred uterus in the free body position

Wu Linlin

2023, 29(3):  361-364.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.014

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Objective　To observe the analgesic effects and safety of ropivacaine and sufentanil during the rebirth of scarred uterus in the free body position. Methods　It was a randomized controlled trial. A total of 110 re-pregnancy patients with scarred uterus admitted to Maternal and Child Health Hospital of Jiaozuo City from March 2021 to March 2022 were selected as the research objects, and they were divided into group A [55 cases, with an age of (30.23±0.16) years old] and group B [55 cases, with an age of (30.11±0.35) years old] according to the proportion of 1∶1 by drawing lots. Both groups were given birth analgesia in the free body position. Group A was given ropivacaine for analgesia, and group B was given sufentanil. The analgesic effects, pregnancy outcomes, and prognosis of the two groups were compared. χ² test and independent sample t test were used. Results　Under different analgesia modes, the Visual Analog Scale (VAS) scores in group A 10 min, 30 min, 60 min, and 90 min after analgesia [(5.72±0.31) points, (5.04±0.33) points, (4.45±0.31) points, and (3.66±0.41) points] were slightly lower than those in group B [(5.75±0.28) points, (5.05±0.26) points, (4.52±0.28) points, and (3.72±0.36) points], but there were no statistically significant differences (all P>0.05). The level of malondialdehyde (MDA) in group A was lower than that in group B [(411.36±10.15) nmol/ml vs. (435.47±10.38) nmol/ml] (t=12.316, P<0.001), but the level of superoxide dismutase (SOD) was higher than that in group B [(385.32±10.16) U/L vs. (341.36±10.31) U/L] (t=22.523, P<0.001). The neonatal Apgar scores in group A 1 min, 5 min, and 10 min after birth [(8.33±0.16) points, (8.85±0.47) points, and (9.11±0.46) points] were higher than those in group B [(7.64±0.28) points, (8.23±0.16) points, and (8.82±0.41) points], with statistically significant differences (all P<0.05). The incidence of adverse prognosis in group A was 9.09% (5/55), which was lower than that in group B [21.82% (12/55)] (χ²=6.201, P=0.013). Conclusion　The analgesic effects of ropivacaine and sufentanil on re-pregnant women with scarred uterus in the free body position are similar, but in contrast, the stress response of ropivacaine used in intravenous patient-controlled analgesia pump is lighter, the safety is higher, and it is more positive in improving the maternal and infant outcomes.

Application effects of sevoflurane and propofol combined with remifentanil intravenous inhalation in laparoscopic myomectomy

Zhang Dongyu, Xu Guoting

2023, 29(3):  365-368.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.015

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Objective　To explore and compare the clinical effects of different strategies of intravenous inhalation anesthesia in laparoscopic myomectomy (LM). Methods　A total of 127 patients undergoing LM admitted to The First Affiliated Hospital of Nanyang Medical College from June 2020 to March 2022 was selected as the research objects, and were divided into an observation group [64 cases, aged (43.47±5.28) years] and a control group [63 cases, aged (43.59±5.14) years] according to different surgical anesthesia plans. The two groups were given different intravenous inhalation anesthesia strategies: the control group was given propofol + remifentanil, and the observation group was given sevoflurane + remifentanil. The anesthesia safety indexes, hemodynamic indexes [heart rate (HR) and mean arterial pressure (MAP)] and stress response related indexes [norepinephrine (NA) and serum cortisol (COR)] before anesthesia and 10 min after surgery, and risk of adverse reactions in the peri-anesthetic period were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　The MMSE scores of the two groups before anesthesia were (28.73±0.25) points in the observation group and (28.69±0.28) points in the control group, respectively, and there was no statistically significant difference (t=0.850, P=0.397); the MMSE scores of the two groups 1 d after surgery were (28.02±0.24) points in the observation group and (27.11±0.22) points in the control group, respectively, and the difference was statistically significant (t=22.264, P<0.001). The dose of remifentanil administered in the observation group was (132.47±12.15) μg, which was lower than that in the control group [(189.43±23.67) μg], with a statistically significant difference (t=17.099, P<0.001). The recovery time of spontaneous respiration in the observation group was (5.47±1.25) min, which was shorter than that in the control group [(7.76±1.39) min], with a statistically significant difference (t=9.766, P<0.001). The incidence of peri-anaesthesia adverse reactions in the observation group [3.13% (2/64)] was significantly lower than that in the control group [14.29% (9/63)] (χ²=4.999, P=0.025). Conclusion　The effect of sevoflurane + remifentanil compound medication strategy in LM is significantly better than that of propofol + remifentanil, which can reduce the dose of remifentanil administered, reduce the impact on cognitive function, stress response, and risk of adverse reactions, shorten the recovery time of spontaneous respiration, maintain relatively stable hemodynamics, and is worthy of clinical promotion.

Simultaneous multiple primary malignant neoplasms of female reproductive system: report of 2 cases and literature review

Zhang Xiaoxue, Guo Qingzhi, Sun Congcong, Zhou Chao, Gao Xuefeng, Zhang Yingzi

2023, 29(3):  369-371.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.016

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Clinical effect of rosuvastatin combined with dapagliflozin in the treatment of type 2 diabetes mellitus with coronary heart disease

Zhang Jianjian, Kang Jie, Zhang Ningxin, Yang Ming, Zhang Wei

2023, 29(3):  372-376.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.017

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Objective　To investigate the clinical effect of rosuvastatin combined with dapagliflozin in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Methods　It was a randomized controlled trial. Ninety-two patients with T2DM and CHD who were treated in Jinan Second People's Hospital from March 2020 to February 2022 were prospectively randomly selected as the research objects, and they were divided into two groups by the random number table method, with forty-six patients in each group. In the control group, 21 males and 25 females, aged (61.24±8.75) years, were treated with dapagliflozin; in the combination group, 24 males and 22 females, aged (59.73±8.53) years, were treated with dapagliflozin combined with rosuvastatin. The efficacy, blood glucose, blood lipid, and inflammation levels, and occurrence of adverse drug reactions were compared between the two groups. χ² test and t test were used. Results　The overall response rate of the combination group was significantly higher than that of the control group [97.83% (45/46) vs. 82.61% (38/46)], with a statistically significant difference (χ²=4.434, P=0.035). After treatment, the levels of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) in the combination group were significantly lower than those in the control group [(5.47±1.09) mmol/L vs. (6.58±1.32) mmol/L, (7.34±1.47) % vs. (8.14±1.63) %], with statistically significant differences (t=4.398 and 2.472; both P<0.05). After treatment, the levels of triglyceride (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) in the combination group were significantly lower than those in the control group [(1.46±0.29) mmol/L vs. (1.87±0.37) mmol/L, (3.21±0.64) mmol/L vs. (3.54±0.71) mmol/L, (2.11±0.42) mmol/L vs. (2.36±0.47) mmol/L], but the level of high density lipoprotein cholesterol (HDL-C) in the combination group was significantly higher than that in the control group [(1.57±0.31) mmol/L vs. (1.42±0.28) mmol/L], with statistically significant differences (t=5.915, 2.341, 2.690, and 2.435; all P<0.05). After treatment, the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in the combination group were significantly lower than those in the control group [(5.32±1.06) mg/L vs. (7.58±1.52) mg/L, (58.47±6.51) ng/L vs. (65.48±7.28) ng/L], with statistically significant differences (t=8.272 and 4.868; both P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the combination group and the control group [10.85% (5/46) vs. 4.34% (2/46)] (χ²=0.618, P=0.432). Conclusions　The clinical application of rosuvastatin combined with dapagliflozin in T2DM patients with CHD can significantly improve the clinical efficacy, effectively control the blood glucose and lipid levels, and effectively lower the levels of inflammatory factors. At the same time, it is safer to use the drug without increasing adverse reactions, and the clinical comprehensive efficacy is good.

Effect of labetalol combined with phentolamine on patients with gestational hypertension

Shao Shuai, Men Guixiang, Sun Juxiang, Hong Shanling, Ren Guohua

2023, 29(3):  377-380.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.018

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Objective　To investigate the effects of labetalol combined with phentolamine on the pregnancy outcomes and levels of Apelin and thrombomodulin (PTM) in patients with gestational hypertension. Methods　It was a randomized controlled trial. A total of 86 patients with gestational hypertension admitted to Linyi People's Hospital from February 2019 to February 2022 were selected as the research objects. They were divided into an observation group (43 cases) and a control group (43 cases) by the random number table method. The age of the control group was (29.12±3.93) years old and the gestational age was (29.63±4.12) weeks; the age of the observation group was (28.23±3.19) years old and the gestational age was (31.01±4.13) weeks. The control group was treated with phentolamine, and the observation group was treated with labetalol on the basis of the control group. The effects of both groups were observed after 7 days of continuous treatment. The clinical effects and adverse pregnancy outcomes of the two groups were compared, and the levels of Apelin and PTM before and after treatment were compared. χ² test, independent sample t test, and paired t test were used. Results　The clinical effective rate of the observation group was higher than that of the control group [93.02% (40/43) vs. 76.74% (33/43)], with a statistically significant difference between the two groups (χ²=4.440, P=0.035). Before treatment, there were no statistically significant differences in the levels of Apelin and PTM between the two groups (both P>0.05). After treatment, the levels of Apelin and PTM decreased in both groups, and the levels of Apelin and PTM in the observation group were lower than those in the control group [(38.52±5.12) ng/L vs. (43.25±6.25) ng/L, (201.32±18.25) ng/L vs. (281.51±19.25) ng/L], with statistically significant differences (t=3.839 and 19.824; both P<0.001). The incidence of adverse pregnancy outcomes in the observation group was lower than that in the control group [4.65% (2/43) vs. 20.93% (9/45)] (χ²=5.108, P=0.024). Conclusion　Labetalol combined with phentolamine can improve the therapeutic effect in patients with gestational hypertension, reduce the levels of Apelin and PTM, and reduce the incidence of adverse pregnancy outcomes.

Effect of overall nursing intervention on patients with medullary sponge kidney stone complicated with infection undergoing percutaneous nephrolithotomy

Zeng Lijuan, Xu Guibin, Wang Huidan, Xie Qingling, Huang Yiqiao, Su Zhengming

2023, 29(3):  381-384.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.019

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Objective　To investigate the overall nursing for patients with medullary sponge kidney stone complicated with infection undergoing percutaneous nephrolithotomy (PCNL). Methods　A total of 20 patients with medullary sponge kidney stone complicated with infection admitted to Urinary Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University from December 2018 to December 2020 were included in the study, including 12 males and 8 females, aged 12-68 years. Preoperative evaluation and health education, nursing psychological intervention, dietary guidance, postoperative observation on patients' conditions and drainage fluid, and adjusting the diet plan were performed on these patients. Results　All the 20 patients got infection control, with normal white blood cell count, no bacteria found in urine culture, and the creatinine level recovered to 58-312 µmol/L, uric acid 320-498 µmol/L. The vital signs returned to normal 2 days later in 3 patients with septic shock, and the urine color turned clear 5 days later in 1 patient with hematuria. The stone clearance rate reached to 90%, and the patients were improved and discharged. Conclusions　Sponge kidney patients concurrent with kidney stone or infection are common. Rational use of antibiotics, prevention of complications, patient psychological intervention, and overall specialized nursing intervention are conducive to the patients' early recovery.

Observation on the application of MDT nursing mode in neonates with persistent pulmonary hypertension undergoing tracheal intubation

Shi Lanlan, Duanmu Yanyan, Liu Yanyan

2023, 29(3):  385-389.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.020

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Objective　To explore the application effect of multidisciplinary teamwork (MDT) nursing mode in tracheal intubation for persistent pulmonary hypertension of the newborn (PPHN). Methods　It was a prospective randomized controlled trial. A total of 92 cases of PPHN who came to Children's Hospital Affiliated to Zhengzhou University from March 2020 to May 2022 were selected as the research objects, and were simply randomly divided into a conventional group (46 cases) and an observation group (46 cases). In the conventional group, there were 22 males and 24 females, with a gestational age of (39.35±0.74) weeks; in the observation group, there were 20 males and 26 females, with a gestational age of (39.08±0.82) weeks. The conventional group was given traditional nursing intervention, and the observation group was given MDT nursing mode on the basis of the conventional group. The incidence of complications, rehabilitation, systemic blood pressure, systolic pulmonary artery pressure (SPAP), neurobehavior [Neonatal Behaviral Neurological Assessment (NBNA) score], and family members' nursing satisfaction were compared between the two groups. Statistical methods were χ² test and independent sample t test. Results　The incidence of complications in the observation group was lower than that in the conventional group [6.52% (3/46) vs. 21.74% (10/46)], with a statistically significant difference (χ²=4.390, P=0.036). The neonatal intensive care unit (NICU) stay, tracheal intubation time, and oxygen therapy time in the observation group were shorter than those in the conventional group [(8.26±1.38) d vs. (10.14±1.27) d, (5.32±1.05) d vs. (6.74±1.13) d, (7.25±0.97) d vs. (9.47±1.16) d], with statistically significant differences between the two groups (t=6.800, 6.244, and 9.957; all P<0.001). After nursing, the systemic blood pressure of the observation group was (63.89±6.25) mmHg (1 mmHg=0.133 kPa) and (63.64±6.58) mmHg of the conventional group, and there was no statistically significant difference between the two groups (t=0.187, P=0.852); the SPAP in the observation group was significantly lower than that in the conventional group [(37.46±3.85) mmHg vs. (45.84±4.03) mmHg], with a statistically significant difference (t=10.198, P<0.001). The scores of primitive reflex, active muscle tone, passive muscle tone, behavioral ability, and general response of the NBNA in the observation group were (5.32±0.28) points, (5.73±0.34) points, (7.49±0.36) points, (9.35±1.03) points, and (4.38±0.56) points, respectively, which were higher than those in the conventional group [(3.77±0.16) points, (4.32±0.25) points, (5.48±0.27) points, (7.41±0.12) points, and (3.62±0.48) points], with statistically significant differences (t=32.598, 22.660, 30.294, 12.689, and 6.989; all P<0.001). The family members' nursing satisfaction in the observation group was higher than that in the conventional group [91.30% (42/46) vs. 76.09% (35/46)], with a statistically significant difference (χ²=3.903, P=0.048). Conclusion　MDT nursing mode can reduce the risk of complications in children with PPHN, improve their pulmonary artery pressure, promote their neurobehavioral development, accelerate their rehabilitation, and improve their family members' nursing satisfaction.

Influence of nursing under the mode of graded airway management on neonates with hyaline membrane disease treated by NCPAP

Jiao Yafang, Chen Tingxuan, Du Wenyan

2023, 29(3):  390-394.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.021

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Objective　To explore the application value of nursing intervention under the mode of graded airway management in neonates with hyaline membrane disease (HMD) treated by nasal continuous positive airway pressure (NCPAP) ventilator. Methods　It was a prospective randomized controlled trial. A total of 94 neonates with HMD in Shangqiu First People's Hospital from March 2018 to June 2022 were selected and were divided into a study group (47 cases) and a routine group (47 cases) according to different nursing methods. In the routine group, there were 26 males and 21 females, with a gestational age of (33.11±1.20) weeks; in the study group, there were 23 males and 24 females, with a gestational age of (32.95±1.06) weeks. The routine group received routine nursing intervention, while the study group received nursing intervention under the mode of graded airway management on the basis of the routine group. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, blood gas indexes [arterial partial pressure of carbon dioxide (PaCO₂), tidal volume (VT), oxygenation index (PaO₂/FiO₂), and arterial partial pressure of oxygen (PaO₂)], mechanical ventilation time, hospital stay, and complication rate were compared between the two groups. t test, χ² test, and Fisher exact probability method were used for statistical analysis. Results　After intervention, the APACHEⅡ score of the study group was lower than that of the routine group [(11.42±2.05) points vs. (14.73±3.18) points], with a statistically significant difference (t=5.998, P<0.001). After intervention, the PaCO₂, VT, PaO₂/FiO₂, and PaO₂ in the study group were (39.87±3.25) mmHg (1 mmHg = 0.133 kPa), (508.36±15.73) ml, (195.36±13.65), and (86.36±4.20) mmHg, respectively, which were higher than those in the routine group [(35.43±2.08) mmHg, (457.92±13.42) ml, (178.61±10.03), and (77.14±3.62) mmHg], with statistically significant differences (all P<0.001). The duration of mechanical ventilation and hospital stay in the study group were (6.25±1.17) d and (8.62±1.53) d, respectively, which were both shorter than those in the routine group [(8.73±1.38) d and (11.36±1.76) d], with statistically significant differences (t=9.397 and 8.055; both P<0.001). The total incidence of complications in the study group was lower than that in the routine group [0 vs. 12.77% (6/47)], with a statistically significant difference (P=0.026). Conclusion　Nursing intervention under the mode of graded airway management can promote the recovery of HMD neonates treated by NCPAP, correct their blood gas values, reduce the risk of complications, and further improve the prognosis.

Effect of evidence-based predictive nursing intervention on patients with intracranial aneurysms after interventional therapy

Zhang Yandi, Guo Yingying

2023, 29(3):  395-399.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.022

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Objective　To observe the effect of evidence-based predictive nursing intervention on patients with intracranial aneurysms after interventional therapy. Methods　It was a randomized controlled trial. A total of 100 patients with intracranial aneurysms after interventional therapy in The First Affiliated Hospital of Henan University of Science and Technology from April 2020 to May 2022 were selected for the research. The patients were numbered and grouped in the order of admission, with 50 cases in each group. In the control group, there were 24 males and 26 females, aged (51.36±11.24) years; in the observation group, there were 25 males and 25 females, aged (52.30±11.46) years. The control group received routine nursing, while the observation group received evidence-based predictive nursing. The mood states before and after intervention, the risk of postoperative complications, the recovery effect, and the nursing job satisfaction were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical ananlysis. Results　The total incidence of postoperative complications in the observation group was lower than that in the control group [6.0% (3/50) vs. 22.0% (11/50)] (χ²=5.316, P=0.021). The recovery rate of the observation group was higher than that of the control group [74.0% (37/50) vs. 54.0% (27/50)] (χ²=4.340, P=0.037). After intervention, the scores of nervousness, anger, fatigue, depression, and panic in the observation group were lower than those in the control group [(12.43±2.17) points vs. (14.27±2.61) points, (14.18±3.05) points vs. (17.28±3.50) points, (10.32±2.16) points vs. (12.73±2.76) points, (14.52±2.67) points vs. (16.43±3.27) points, (10.33±2.00) points vs. (12.74±2.81) points], and the scores of energy and self-esteem were higher than those in the control group [(19.55±3.85) points vs. (16.73±3.23) points, (16.19±3.35) points vs. (14.56±2.98) points], with statistically significant differences (all P<0.05). The nursing job satisfaction of the observation group was higher than that of the control group [88.0% (44/50) vs. 70.0% (35/50)] (χ²=4.883, P=0.027). Conclusion　The application of evidence-based predictive nursing in patients with intracranial aneurysms after interventional therapy can reduce the incidence of postoperative complications, improve their recovery effects, improve their mood states, and enhance their nursing satisfaction.

Effect of Siebens domain management in patients with ulcerative colitis

Zu Mengmeng, Xu Ying, Zhao Ning

2023, 29(3):  399-403.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.023

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Objective　To explore the effect of Siebens domain management model on improving the self-management ability and intestinal function in patients with ulcerative colitis based on clinical practice experiences. Methods　It was a prospective randomized controlled trial. A total of 98 patients with ulcerative colitis admitted to The Fifth Clinical Medical College of Henan University of Chinese Medicine from August 2021 to August 2022 were selected and were divided into two groups according to the random number table method. There were 27 males and 22 females in the traditional group, aged (42.18±3.12) years; there were 26 males and 23 females in the Siebens group, aged (42.19±3.05) years. The patients in the traditional group received routine treatment and nursing of ulcerative colitis according to the doctors' advices, and the patients in the Siebens group received continuous nursing measures based on the Siebens domain management model on this basis. The intestinal function and scores of Inflammatory Bowel Disease Questionnaire (IBDQ), self-management ability, anxiety, and depression were compared between the two groups before and after intervention. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After intervention, the serum β-defensin level in the Siebens group was lower than that in the traditional group [(61.07±6.58) mg/L vs. (75.31±8.63) mg/L], the secretory immunoglobulin A (sIgA) level was higher than that in the traditional group [(2.98±0.24) mg/L vs. (1.84±0.15) mg/L], with statistically significant differences (both P<0.05). After intervention, the scores of intestinal symptoms, systemic symptoms, emotional ability, and social ability of the IBDQ in the Siebens group were higher than those in the traditional group, with statistically significant differences (all P<0.05). After intervention, the scores of symptom management, emotion management, information management, daily life, and self-efficacy in the Siebens group were higher than those in the traditional group, with statistically significant differences (all P<0.05). After intervention, the scores of anxiety and depression in the Siebens group were lower than those in the traditional group [(3.26±0.37) points vs. (4.51±0.59) points, (3.15±0.29) points vs. (4.48±0.32) points], with statistically significant differences (both P<0.05). Conclusion　Siebens domain management model can improve the self-management ability in patients with ulcerative colitis, improve their intestinal function, improve their quality of life, and reduce their negative emotions, which is worthy of further promotion and application.

Effect of scraping intervention based on the midnight-noon ebb-flow theory combined with emotional nursing on patients with primary hypertension with phlegm-dampness stagnation

Li Run, Li Liuna, Wang Mengqi, Niu Jingjing, Li Ruili, Chen Yuanyuan, Jiang Jiamei

2023, 29(3):  404-408.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.024

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Objective　To explore the effect of scraping intervention under the theory of midnight-noon ebb-flow combined with emotional nursing on patients with primary hypertension with phlegm-dampness stagnation. Methods　It was a prospective randomized controlled trial. From February 2021 to February 2022, 110 patients with primary hypertension with phlegm-dampness stagnation in Luoyang Hospital of Traditional Chinese Medicine were selected and were divided into two groups according to the order of admission, with 55 cases in the control group and 55 cases in the observation group. In the control group, there were 29 males and 26 females, aged (55.16±3.26) years; in the observation group, there were 30 males and 25 females, aged (55.01±3.68) years. The control group was given routine intervention, and the observation group was given scrapping intervention guided by the theory of midnight-noon ebb-flow and emotional nursing on this basis. The blood pressure control, scores of Therapeutic Adherence Scale for Hypertensive Patients (TASHP), Spitzer Quality of Life Index (SQOL), and Profile of Mood States (POMS), and nursing satisfaction were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After nursing, the systolic blood pressure and diastolic blood pressure in the observation group were (134.25±5.05) mmHg (1 mmHg=0.133 kPa) and (84.56±4.82) mmHg, which were lower than those in the control group [(139.64±5.62) mmHg and (91.06±5.18) mmHg], with statistically significant differences (both P<0.001). After nursing, the scores of TASHP and SQOL in the observation group were higher than those in the control group [(102.86±5.28) points vs. (83.16±5.73) points, (8.69±0.59) points vs. (7.94±0.67) points], with statistically significant differences (both P<0.001). After nursing, the positive mood state score in the observation group was higher than that in the control group [(34.67±2.33) points vs. (30.24±3.28) points], and the negative mood state score was lower than that in the control group [(63.76±6.82) points vs. (75.08±6.49) points], with statistically significant differences (both P<0.001). The nursing satisfaction of the observation group was higher than that of the control group [96.36% (53/55) vs. 83.64% (46/55)], with a statistically significant difference between the two groups (χ²=4.950, P=0.026). Conclusion　Scraping intervention under the theory of midnight-noon ebb-flow combined with emotional nursing can improve the mood states in patients with primary hypertension, enhance their compliance behaviors, help them to maintain blood pressure stable, and thus improve their quality of life and satisfaction.

Treatises

Cause analysis and management of ureteroscopic lithotripsy related ureteral stenosis

Sheng Ming, Chen Jiahui, Liu Xing, Bian Jun, Lai Dehui

2023, 29(3):  409-413.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.025

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Objective　To analyze and discuss the causes and management of ureter stenosis after ureteroscopic lithotripsy. Methods　The clinical data of 60 patients with ureteral stenosis diagnosed by ureteroscopy after ureteroscopic lithotripsy admitted to The Fifth Affiliated Hospital of Guangzhou Medical University from December 2016 to December 2018 were retrospectively analyzed, including 28 males and 32 females, aged (48.1±10.5) years. All the patients were treated with ureteroscopic holmium YAG laser lithotripsy. All the patients did not have serious underlying diseases except for ureterolithiasis. The patients' age, gender, body mass index, and preoperative complications, and length, treatment methods, and treatment times of ureteral stenosis were recorded and analyzed. Results　The follow-up period was (2.6±1.1) years. The length of ureteral stenosis was (1.7±1.2) cm. The times of surgical treatment of stenosis were (4.1±1.5) times. All the patients suffered from ureteral stenosis after ureteroscopic holmium YAG laser lithotripsy. Only 24 cases (40.0%) were successfully treated by endourological treatment (endoscopic balloon dilation combined with internal incision), 6 cases (10.0%) needed long-term indwelling of ureteral stent, 3 cases (5.0%) needed long-term indwelling of nephrostomy tube, 21 cases (35.0%) underwent urinary tract reconstruction, and 6 cases (10.0%) underwent nephrectomy for severe renal impairment. Conclusions　The successful rate of endoscopic surgery for ureteral stenosis after ureteroscopic holmium YAG laser lithotripsy is low. Therefore, we recommend against use of ureteroscopic holmium YAG laser lithotripsy. Gentle operation and appropriate lithotripsy are beneficial to reduce the incidence of postoperative ureteral stenosis.

Effect of exogenous basic fibroblast growth factor on the proliferation of rat corpus cavernosal muscle-derived stem cells

Feng Juanjuan, Wang Zhengwei, Zhang Chen, Liu Yuanyuan, Cheng Guangzhou, Wang Lei

2023, 29(3):  413-418.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.026

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Objective　To investigate the effect of basic fibroblast growth factor on the proliferation of rat corpus cavernosal muscle-derived stem cells. Methods　This experiment was completed in the Precision Laboratory of Tengzhou Central People's Hospital from December 2020 to June 2021. The penis was taken from five healthy male Wister rats [(200±50) g] under aseptic conditions, and the muscle-derived stem cells were isolated by enzymatic digestion and purified by density gradient centrifugation and differential adhesion. The second generation of muscle-derived stem cells were selected and were divided into two groups. The experimental group: 200 µl of growth medium + the second generation of muscle-derived stem cells were treated with 10 µg/L, 30 µg/L, 50 µg/L,70 µg/L, and 90 µg/L of exogenous basic fibroblast growth factor; the control group added 200 µl of growth medium + muscle-derived stem cells. The methyl thiazolyl tetrazolium (MTT) solution was added after 24 h, 48 h, 72 h, 96 h, 120 h, and 144 h of culture. The rat corpus cavernosal muscle-derived stem cells were identified by immunocytochemistry, and the cell proliferation was detected by MTT assay. Independent sample t test and Tukey test were used. Results　(1)Most of the muscle-derived stem cells showed Sca-1 positive reaction, with the expression level of (79.90±1.82) %, while a few showed Desmin positive reaction, with the expression level of (68.60±0.72) %. (2)The muscle-derived stem cells in both groups proliferated significantly with the prolongation of culture time (all P<0.01), and the culture time for significant proliferative effect was 96 h. (3)Compared with the control group, various concentrations of basic fibroblast growth factor in the experimental group had obvious proliferative effect on muscle-derived stem cells. When the concentration increased from 10 to 70 µg/L, the proliferative effects were also significantly enhanced (all P<0.01), and the proliferative effect reached the peak when the concentration was at 70 µg/L. Conclusion　Exogenous basic fibroblast growth factor can promote the proliferation of rat corpus cavernosal muscle-derived stem cells in vitro in a concentration-time dependent manner, with 96 h and 70 µg/L as the optimal in vitro culture time and concentration.

Predictive value of SAA combined with Cys C and Lp(a) for coronary restenosis after PCI in patients with coronary heart disease

Ren Hao, Wang Huilin, Wang Lei

2023, 29(3):  419-423.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.027

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Objective　To investigate the predictive value of serum amyloid A (SAA) combined with cystatin C (Cys C) and serum lipoprotein (a) [Lp(a)] for coronary restenosis after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods　A total of 184 CHD patients were divided into a non-stenosis group (145 cases) and a restenosis group (39 cases) according to whether coronary restenosis occurred within six months after PCI, including 96 males and 88 females, aged (65.1±7.7) years. The gender, age, body mass index (BMI), smoking history, drinking history, underlying diseases (hypertension, diabetes, hyperlipidemia, and stroke), preoperative degree of coronary artery stenosis, stent length, and stent diameter were compared between the two groups. At admission, the levels of SAA, Cys C, and Lp(a) in serum were detected by immunoturbidimetry; the blood lipid indexes [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C)] were detected by automatic blood biochemical analyzer; the left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were measured by echocardiography; the specific locations of coronary artery lesions were determined by coronary angiography (CAG). Multiple logistic regression equation was used to analyze the risk factors of coronary restenosis in patients with CHD after PCI. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of SAA combined with Cys C and Lp(a) for coronary restenosis in patients with CHD after PCI. χ² test and independent sample t test were used. Results　There were statistically significant differences in the SAA [(18.15±4.28) mg/L vs. (13.86±2.25) mg/L], Cys C [(1.82±0.34) mg/L vs. (1.43±0.26) mg/L], Lp(a) [(2.11±0.31) g/L vs. (1.80±0.28) g/L], LDL-C [(2.73±0.65) mmol/L vs. (2.25±0.51) mmol/L], LAD [(55.73±7.47) mm vs. (48.51±5.62) mm], LVEF [(39.77±4.51) % vs. (45.02±5.92) %], and preoperative degree of coronary artery stenosis [(93.17±3.78) % vs. (90.06±3.54) %] between the restenosis group and the non-stenosis group (all P<0.001). High expressions of SAA, Cys C, and Lp(a), low LVEF, and severe preoperative coronary artery stenosis were all risk factors for coronary restenosis after PCI in CHD patients (all P<0.05). The area under the curve (AUC), sensitivity, and specificity of SAA combined with Cys C and Lp(a) in predicting coronary restenosis after PCI in CHD patients were better than those of single index (all P<0.05). Conclusion　SAA combined with Cys C and Lp(a) has a good clinical value in predicting coronary restenosis in CHD patients after PCI.

Clinical Research

Efficacy of total glucosides of paeony capsule combined with tacrolimus capsule in the treatment of systemic lupus erythematosus

Zong Shihua, Sun Yonghua, Wei Shitong

2023, 29(3):  424-427.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.028

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Case Report

One case of primary adrenal non-Hodgkin's lymphoma

Cao Han, Zhang Wen, Zhou Shuiyang, Xia Jindong, Zhang Lijuan

2023, 29(3):  428-430.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.029

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One case of idiopathic hypertrophic cranial and spinal pachymeningitis

Zhan Xia, Li Zhixia

2023, 29(3):  430-433.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.030

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Hypertrophic pachymeningitis (HP) is a chronic fibrous inflammatory disease of the spinal dura, and is rare in clinic. It can be divided into hypertrophic cranial pachymeningitis (HCP) and hypertrophic spinal pachymeningitis (HSP), which can exist at the same time. It can be divided into secondary and idiopathic, which may be related to immune factors. The treatment methods include glucocorticoids and other immunosuppression and surgery. Pathology is the gold standard for diagnosis, and magnetic resonance imaging (MRI) enhancement may assist in diagnosis. A case of idiopathic hypertrophic cranial and spinal pachymeningitis in Weihai Central Hospital is reported now.

Nursing Research

Clinical effect of bedside blind nasointestinal tube insertion technique in long-term bedridden patients

Li Jing, Lyu Yang, Song Xuelian

2023, 29(3):  434-439.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.031

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Objective　To apply the technique of blind insertion of nasointestinal tube at bedside to long-term bedridden patients and to explore the clinical effect. Methods　The study subjects were 60 long-term bedridden patients who needed enteral nutrition in Benxi Central Hospital from December 2020 to June 2022, and they were divided into a control group and an observation group according to their choices of nutrition supply modes, with 30 cases in each group. In the control group, there were 17 males and 13 females, aged (65.83±11.65) years, and the gastric tube was placed routinely for nutrition support. In the observation group, there were 18 males and 12 females, aged (65.51±11.89) years, and the nasointestinal nutrition tube was directly blindly inserted at the bedside. The comfort, immune function, and quality of life of the two groups were compared, and the complications related to nasogastric intubation were recorded. t test and χ² test were used. Results　Before catheterization, there were no statistically significant differences in the score of General Comfort Questionnaire (GCQ) and the levels of immunoglobulin (Ig) A, IgM, IgG, albumin (Alb), hemoglobin (Hb), and serum transferrin (TF) between the two groups (all P>0.05). After 7 days of catheterization, the GCQ score [(80.36±8.78) points] and the levels of IgA [(3.75±0.36) g/L], IgM [(3.95±0.25) g/L], IgG [(11.96±2.36) g/L], Alb [(36.28±4.76) g/L], Hb [(113.38±15.51) g/L], and TF [(275.79±29.15) mg/dl] in the observation group were significantly higher than those in the control group [(73.52±11.82) points, (3.19±0.43) g/L, (3.34±0.17) g/L, (10.63±2.19) g/L, (31.35±4.63) g/L, (108.63±16.64) g/L, and (239.35±23.53) mg/dl], with statistically significant differences (all P<0.05). After 1 month of catheterization, the scores of physiological function [(78.23±6.18) points], mental health [(76.16±6.35) points], social function [(77.75±6.34) points], emotional function [(79.12±6.72) points], vitality [(66.90±5.45) points], physical pain [(72.14±5.67) points], physiological role [(71.40±6.71) points], and overall health [(74.64±8.58) points] in the observation group were higher than those in the control group [(71.49±6.67) points, (70.25±6.39) points, (70.27±6.58) points, (70.98±7.06) points, (58.58±5.71) points, (67.28±5.36) points, (64.24±6.46) points, and (66.57±8.75) points], with statistically significant differences (all P<0.05). During catheterization, the incidence of complications in the observation group [10.00% (3/30)] was lower than that in the control group [26.67% (8/30)], with a statistically significant difference (P<0.05). Conclusion　Blind insertion of nasointestinal tube by bedside has achieved good clinical results for enteral nutrition for long-term bedridden patients, which helps to increase the patients' comfort, enhance the immune function, reduce the incidence of complications related to nasogastric intubation, improve the nutritional status, and improve the quality of life.

Evaluation of the application of personalized nursing follow-up in auricle reconstruction for children with congenital microtia

Wu Yanqun, Lan Jianzhen, Wang Sunjuan, Li Youjin, Pan Xiaohuan

2023, 29(3):  439-444.  DOI: 10.3760/cma.j.issn.1007-1245.2023.03.032

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Objective　To analyze the efficacy of personalized nursing follow-up in congenital microtia children treated with auricle reconstruction. Methods　It was a randomized controlled trial. One hundred and twenty children with congenital microtia who underwent auricle reconstruction in Guangdong Provincial Second General Hospital from January 2018 to January 2020 were enrolled. The children were divided into an observation group (60 cases) and a control group (60 cases) by the random number table method. In the control group, there were 51 males and 9 females, aged (8.2±1.9) years; in the observation group, there were 43 males and 17 females, aged (8.4±2.1) years. The control group received regular nursing procedure, while the observation group received personalized follow-up nursing procedure. The incidences of postoperative complications, including bloated shape of reconstructed ear, exposed ear support, and incision infection, were compared between the two groups. The satisfaction surveys were conducted on the children's family members at different follow-up time points. χ² test and independent sample t test were used. Results　After nursing, the incidence of adverse reactions in the observation group was 1.7% (1/60), which was lower than that in the control group [13.3% (8/60)], with a statistically significant difference (χ²=5.886, P=0.015). The total satisfaction of children's family members in the observation group was 100.0% (60/60), which was higher than that in the control group [90.0% (54/60)], with a statistically significant difference (χ²=6.316, P=0.012). Conclusion　Personalized follow-up nursing can significantly reduce the incidence of complications and improve the children's family members' satisfaction on auricle reconstruction.