Table of Content

15 March 2023, Volume 29 Issue 4

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New Medical Advances

Current status and future prospects of artificial intelligence in diagnosis and treatment of early gastric cancer

Li Jinglu, Liu Junna, Shi Zexuan, Niu Qiong

2023, 29(4):  445-448.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.001

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Gastroscopy is the primary method for screening and diagnosing many stomach diseases. In recent years, with the development of deep learning, more and more studies have used this technology to provide real-time assistance during gastroscopy. Stomach cancer is a major health problem worldwide; early detection plays a very important role in improving its prognosis. Therefore, the identification of precancerous lesions and early gastric cancer is particularly important in gastroscopy. This article reviews the application of artificial intelligence deep learning in gastroscopy related to gastric cancer and looks forward to its development prospects.

Research progress of lower limb motor function rehabilitation by lower limb robots in stroke patients

Hou Shiwei, Chen Huihua, Su Zhengming

2023, 29(4):  448-452.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.002

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Stroke refers to a sudden clinical syndrome caused by cerebrovascular diseases, with localized or whole brain dysfunction lasting more than 24 hours or causing death. Exercise training is an important part of rehabilitation treatment for patients with stroke; it is helpful to improve the patients' physical function. Stroke patients need lower limb function training in rehabilitation stage so as to improve their quality of life and to ensure that they can walk independently. As the number of therapists is difficult to meet the patients' needs, robots were used in the rehabilitation in the 1990s to reduce the therapists' physical labor and ensure the treatment effect. As a new medical device, lower limb robots have achieved certain results in a variety of combined treatment schemes. This paper studies the therapeutic effect of lower limb robots in the rehabilitation of stroke patients so as to provide references for rehabilitation treatment.

Psoriasis and its cardiovascular system comorbidities

Wu Xuemei, Zhang Yujie, Xie Shenghua

2023, 29(4):  453-456.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.003

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Psoriasis is a chronic, recurrent, inflammatory disease mediated by immunity that involves not only the skin, nails, and arthritis, but also multiple systems, such as cardiovascular, digestive, and endocrine systems. Common pathogenic inflammatory pathways and the same genetic background may be responsible for the occurrence of comorbidities. This paper reviews the research progress on psoriasis and its cardiovascular system comorbidities.

Associated microRNAs in patients with acute lung injury caused by sepsis

Wang Ningning, Lin Jiakai, Luo Xiaoyan, Sun Bin

2023, 29(4):  456-460.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.004

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Sepsis is the most common cause of death in acute critical patients worldwide. The essence of sepsis is the imbalance of proinflammatory and anti-inflammatory processes in the body, which leads to systemic inflammatory cascade reaction and specific immune dysfunction, and eventually evolves into multi-organ dysfunction syndrome. In the development of sepsis, acute lung injury is particularly common. Acute lung injury or acute respiratory distress syndrome secondary to sepsis are the main causes of death in sepsis patients. Therefore, early identification and diagnosis of sepsis-associated lung injury is of great significance for sepsis patients. As single-chain non-coding RNAs, microRNAs have high biological specificity, selectivity, and conserved properties. Currently, microRNAs have been used as ideal biomarkers for clinical diagnosis of a variety of diseases. Multiple studies have confirmed that microRNAs are differentially expressed in the pathogenesis of sepsis associated with lung injury; monitoring and analyzing their variation levels is effective in the diagnosis and prognosis evaluaiton of sepsis associated with lung injury. In this paper, we review the abnormal expression of microRNAs and their mechanism of action in sepsis associated with lung injury by summarizing a series of studies on microRNAs in sepsis associated with lung injury.

Research progress of IL-37 and allergic diseases

Gao Wenwen, Zhi Lili, Wu Fuling, Ma Liji

2023, 29(4):  461-464.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.005

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Allergic diseases are diseases with hypersensitive reactions of the body's immune system to foreign allergens. Glucocorticoids are currently used as the first-line drugs in the treatment of allergic diseases, but their clinical application and therapeutic effect have certain limitations and by-effects. As a natural innate and adaptive immunosuppressive agent, interleukin-37 (IL-37) has dual anti-inflammatory functions. It can inhibit the expression of inflammatory factors and activate anti-inflammatory factors at the same time. Studies have shown that IL-37 can maintain the homeostasis of the immune system in patients with allergic diseases through a variety of mechanisms and pathways. This article reviews the mechanism of IL-37 in children's common allergic diseases based on the analysis of its own characteristics, so as to provide a basis for further research and clinical diagnosis and treatment.

Meta Analysis

Meta-analysis of Baduanjin for non-small cell lung cancer

Hu Anhua, Gu Fei

2023, 29(4):  465-470.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.006

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Objective　To systematically evaluate the clinical effectiveness of Baduanjin for patients with non-small cell lung cancer. Methods　The databases, PubMed, EMBASE (Ovid), The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Weipu, Wanfang, and CBM were searched for the randomized controlled trials (RCTs) on Baduanjin (or combined with other treatments) in the treatment of patients with non-small cell lung cancer from their establishment to July 26, 2022. Meta analysis was performed using the Stata 17 software. The risk of bias was assessed according to the Cochrane's Handbook for systematic reviewers' risk of bias criteria for literature quality assessment. The outcome measures were pulmonary function tests (FEV1 and FVC), Borg dyspnea score, 6-min walk test, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Functional Assessment of Lung Cancer Therapy (FACT-L) (version 4.0). Results　Six RCTs with a total of 322 patients were included. Meta analysis showed that the test group had better FEV1 [SMD= 0.53, 95%CI (0.13, 0.94), P=0.01], FVC [SMD=0.58, 95%CI (0.17, 0.98), P=0.005], 6-min walk test [SMD=0.56, 95%CI (0.34, 0.79), P<0.01], and SAS score [SMD=-1.18, 95%CI (-1.51,-0.85), P<0.01] than the control group. The test group had significantly greater improvement in the Borg dyspnea score [SMD=-0.32, 95%CI (-0.72, 0.07), P=0.11], SDS [SMD=-0.62, 95%CI (-1.68, 0.44), P=0.253], and scores of physical status [SMD=0.35,95%CI(-0.44,1.13),P=0.385], social and family status [SMD=0.44, 95%CI (-0.29, 1.17), P=0.242], affective status [SMD=0.36, 95%CI (-0.31, 1.04), P=0.293], and additional concern [SMD=0.43, 95%CI (-0.41, 1.27), P=0.313] and total score [SMD=1.22, 95%CI (-0.18, 2.63), P=0.088] of FACT-L (version 4.0) than the control group, with statistical differences. Conclusions　Baduanjin is able to improve the patients' lung function, exercise tolerance, and anxiety status; its effects on dyspnea, depression status as well as improvement on the functional assessment scale for lung cancer treatment are not significant, so it needs further study.

Scientific Research

Current situation of poor eyesight in primary school students at Baoshan District, Shanghai from 2013 to 2019

Bai Wangyang, Wang Weixue, Ji Wei, Luo Ying, Liu Guoping, Li Guangping, Rong Fen

2023, 29(4):  471-475.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.007

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Objective　To understand the changes of poor eyesight in primary school students at Baoshan District, Shanghai, and to provide theoretical basis for relevant departments to carry out comprehensive prevention and control of children's myopia. Methods　This was a cross-sectional study. Based on the physical examination data of the students at Baoshan District, Shanghai from 2013 to 2019, descriptive analysis, χ² test, and H test were used to analyze the visual acuity of the primary school students at Baoshan District, Shanghai. Results　A total of 338 105 primary school students at Baoshan District were included in this study, including 180 691 boys and 157 414 girls. The rates of poor vision from 2013 to 2019 were 44.5% (15 961/35 905), 50.3% (17 978/35 751), 49.8% (20 800) /41 774), 51.0% (21 555/42 241), 52.5% (28 270/53 859), 53.0% (32 808/61 940), and 53.2% (35 472/66 635), respectively. The rate of poor eyesight in each year increased with the grades (P<0.001); the highest rate of poor eyesight in the fifth-grade students was 68.5% (40 573/59 272). There were gender differences in the rate of poor vision in each year; the rate of the girls was higher than that of the boys (P<0.001). Among the components of poor eyesight, moderate poor eyesight accounted for the highest proportion [19.2% (34 662/180 691) in the boys and 20.3% (31 938/157 414) in the girls]; severe visual impairment showed an increasing trend year by year (P<0.001). Conclusions　From 2013 to 2019, the rate of poor eyesight in primary school students at Baoshan District, Shanghai showed an increasing trend year by year; the current situation of poor eyesight is not optimistic. Severe poor vision needs to be paid attention to. It is of great significance to carry out health education and comprehensive prevention and treatment in primary school students for the prevention and control of myopia and related diseases.

Effect of dexmedetomidine combined with subarachnoid block anesthesia on closed reduction and internal fixation for elderly patients with femoral fracture 

Li Shuai, Rao Kong, Duan Zhiqiang, Hao Zhi

2023, 29(4):  475-479.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.008

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Objective　To investigate the effect of dexmedetomidine combined with subarachnoid block anesthesia on closed reduction and internal fixation for elderly patients with femoral fracture. Methods　From January 2019 to January 2022, 78 patients with femoral fracture treated by closed reduction and internal fixation in Bayannaoer City Hospital were selected as the research objects. They were divided into a control group and a treatment group by the random number table method, with 39 cases in each group. In the control group, there were 19 women and 20 men; they were 60-76 (67.45±5.63) old; the course of disease was 2-9 (4.15±0.36) days. In the treatment group, there were 18 women and 21 men; they were 61-75 (66.98±5.52) years old; the course of disease was 2-9 (4.24±0.39) days. The control group were given dexmedetomidine + spinal and epidural anesthesia, and the treatment group dexmedetomidine+subarachnoid block anesthesia. The changes of hemodynamic indicators during operation were recorded; the stress reaction and pain during perioperative period were compared between the two groups. χ² test was used for the enumeration data, t test and F test for measurement data. Results　Compared with those in the control group, the changes of heart rate and mean artery pressure(MAP) in the treatment group were gentle and the relative hemodynamics were relatively stable (F_time=9.632 and 9.741, both P<0.001). There were statistical differences in heart rate and MAP between the treatment group and the control group (F_group=9.365 and 8.644, both P<0.001). There were statistical differences in heart rate and MAP treands between the treatment group and the control group (F_interactive=8.635 and 8.744, both P<0.001). There were differences in adrenaline (Adr) and cortisol (Cor) between different time points (F_time=9.652 and 7.625, both P<0.001). The level of Adr and Cor in the treatment group were lower than those in the control group, with statistical differences (F_group=8.551 and 7.968, both P<0.001). There were statistical differences in the Adr and Cor trends between the treatment group and the control group (F_interactive=9.582 and 7.582, both P<0.001). The stress response during the perioperative period in the treatment was milder than that in the control group. The Visual Analogue Scale (VAS) scores between different time points were statistically significant (F_time=8.025, P<0.001). There was a statistical difference in the VAS score between the treatment group and the control group (F_group=9.658, P<0.001). The VAS score in the treatment group was lower than that in the control group, and the analgesic effect was better (F_interactive=8.569, P<0.001). Conclusion　Dexmedetomidine combined with subarachnoid block anesthesia for elderly patients with femoral fracture treated by closed reduction and internal fixation can stabilize their hemodynamic indicators and inhibit their stress reaction during the operation, and reduce the postoperative pain.

Application of ultrasound guided localization in knee arthroscopic surgery

Liu Jingyun, Zhang Li, Ren Qiang

2023, 29(4):  480-483.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.009

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Objective　To study the effect of ultrasound guided localization in knee arthroscopic surgery. Methods　Two hundred patients with knee joint diseases who underwent knee arthroscopic surgery in Binzhou Medical University Hospital from January 2020 to February 2021 were divided into a traditional group and an ultrasonic group by the random number table method, with 100 patients in each group. The traditional group had 55 males and 45 females who were (46.82 ± 6.25) years old; the anterolateral channels of knee arthroscopy were established by the traditional anatomical positioning method in the traditional group. The ultrasonic group had 53 males and 47 females who were (46.48 ± 5.64) years old; the anterolateral channels of knee arthroscopy were established by the ultrasound guided positioning method in the ultrasonic group. The operation times, incidences of intra-articular tissue injury, and pain scores of Visual Analogue Scale (VAS) 7 and 14 days after the operation were compared between the two groups by t and χ² tests. Results　The operation time in the ultrasonic group was shorter than that in the traditional group [(68.96±21.09) min vs.(76.17±23.45) min], with a statistical difference (t=-2.286, P<0.05). The incidence of intra-articular tissue injury caused by operation in the ultrasonic group was lower than that in traditional group [3% (3/100) vs. 10% (10/100); (χ²=4.031, P<0.05). The VAS scores 7 and 14 days after the operation in the ultrasound group were lower than those in the traditional group [(3.78±1.00) vs. (4.67±0.94) and (1.68±0.71) vs. (2.54±0.69)], with statistical differences between the two groups (t=-6.485 and -6.686, both P<0.05). Conclusion　For patients undergoing knee arthroscopic surgery, the establishment of anterolateral channels with ultrasound guided localization during the operation can reduce the operation time, the incidence of intra-articular tissue injury, and the patients' early postoperative pain, so it is worthy of promotion.

Percutaneous kyphoplasty in treatment of osteoporotic vertebral fractures 

Chen Zheng, Sang Fei, Jiang Lei, Liu Qingbai

2023, 29(4):  484-487.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.010

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Objective　To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral fractures. Methods　Ninety-two patients with osteoporotic vertebral fractures admitted to Huan'an First Hospital, Nanjing Medical University from February 2017 to January 2019 were divided into an experimental group and a conventional group by the random number table method, with 46 cases in each group. In the experimental group, there were 26 males and 20 females; they were 52-80 (67.25 ± 8.25) years old. In the conventional group, there were 25 males and 21 females; they were 53-83 (68.14 ± 8.36) years old. The conventional group were treated with percutaneous vertebroplasty, and the experimental group with PKP. The excellent and good rates of rehabilitation, scores of Japanese Orthopedic Association (JOA), and complications within 3 months after operation were compared between these two groups. t test was used for the measurement data, χ² for the enumeration data, and rank-sum tests for ranked data. Results　There was a statistical difference in the grade distribution of the excellent and good rate of surgery between the two groups after the treatment (Z=5.241, P=0.021); the excellent and good rate of the experimental group was higher than that of the conventional group [86.96% (40/46) vs. 67.39% (31/46); χ²=4.998, P=0.025]. The JOA score in the experimental group was higher than that in the conventional group after the operation [(25.25 ± 3.14) vs. (20.25 ± 2.58); t=8.334, P<0.001]. The incidence of complications within 3 months after the operation in the experimental group was lower than that in the conventional group [6.52% (3/46) vs. 21.74% (10/46); χ²=4.389, P=0.036]. Conclusion　PKP in the treatment of patients with osteoporotic vertebral fractures can improve the excellent rate and reduce their low back pain and the incidence of complications, so it is worth being clinically generalized.

Chinese medicine ironing and intradermal acupuncture for lumbar disc herniation

Liu Qiyu, Chen Meng, Zhang Manzhu, Li Sha

2023, 29(4):  488-491.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.011

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Objective　To observe the efficacy of Chinese medicine ironing combined with intradermal acupuncture in the treatment of lumbar disc herniation. Methods　A total of 90 patients with lumbar disc herniation hospitalized in Department of Orthopedics, Guangdong Second Hospital of Traditional Chinese Medicine from January 2021 to June 2022 were selected for the random xontrol trial, including 54 males and 36 females who were 18-80 years old. They were divided into a control group, an observation group 1, and an observation group 2, with 30 cases in each group. The control group orally took celecoxib. On the basis of the control group, the observation group 1 were ironed with Chinese medicine. On the basis of the observation group 1, the observation group 2 took intradermal acupuncture at Shenshu, Danshu, Weizhong, Yaoyangguan, Zusanli, etc. The degrees of lumbar pain, lumbar function and range of motion, and clinical efficacies of the three groups were observed and compared. The measurement data of normal distribution were compared between these 3 groups by independent sample t test and within the group by paired t test. The enumeration data were compared by χ² test. Results　The Visual Analogue Scale (VAS) scores in the observation group 1 and the observation group 2 were (2.5±0.3) and (2.1±0.5), which were significantly lower than that in the control group [(3.9±0.8)], with statistical differences (P=0.041 and 0.032); the VAS score of the observation group 2 was lower than that of the observation group 1. The scores of the Modified Oswestry Disability Index (ODI) of the Japanese Orthopaedic Association in the observation group 1 and the observation group 2 were (14.6±1.6) and (13.19±2.8), which were significantly lower than that in the control group [(19.7±1.2)], with statistical differences were (P=0.031 and 0.025); the ODI score of the observation group 2 was lower than that of the observation group 1 (P<0.05). The clinical efficacies of the observation group 1, the observation group 2, and the control group were 80.00% (24/30), 93.33% (28/30), and 66.67% (20/30), with statistical differences between the observation group 1 and the observation group 2 on one hand and the control group on the other hand (P=0.045 and 0.037) and no statistical difference between the observation group 1 and the observation group 2 (P>0.05). Conclusion　Chinese medicine ironing combined with intradermal acupuncture in the treatment of patients with lumbar disc herniation can significantly relieve their pain, and effectively improve the treatment effect and their quality of life and lumbar function.

Effect of parenteral nutrition assisted by traditional Chinese medicine on postoperative nutritional status in patients with gastric cancer

Chen Jingjing, Wang Shuanduo

2023, 29(4):  492-496.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.012

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Objective　To observe the effect of astragalus injection combined with parenteral nutrition (PN) on nutritional status in patients with gastric cancer after radical operation. Methods　Eighty-four patients with gastric cancer admitted to The First Affiliated Hospital of Nanyang Medical College from August 2020 to January 2022 were selected for the random control trial. The patients were divided into an observation group and a control group by the random number table method, with 42 cases in each group. There were 22 males and 20 females in the observation group; they were (55.16±0.25) years old. There 23 males and 19 females in the control group; they were (55.13±0.31) years old. Both groups took PN after the surgery; in addition, the observation group took astragalus injection. The body mass indexes (BMI), prognosis nutritional indexes (PNI) 7, 15, and 30 d after the treatment, the levels of albumin (ALB), transferrin (TFN), fibronectin (FN), and other nutritional indicators before and after the treatment, and the quality of life and adverse reactions after treatment were compared between the two groups. t and χ² tests were applied. Results　Seven, 15, and 30 d after the treatment, the BMI's in the observation group were higher than those in the control group [(21.47±0.25) kg/m² vs. (20.54±0.35) kg/m², (23.24±0.31) kg/m² vs. (21.06±0.45) kg/m², and (23.79±0.39) kg/m² vs. (22.13±0.36) kg/m²; t=14.013, 25.855, and 20.269; all P<0.001]. Seven, 15, and 30 d after the treatment, the PNI's in the observation group were lower than those in the control group [(42.14±0.36)% vs. (45.33±0.27)%, (38.45±0.37)% vs. (41.44±0.25)%,and (32.11±0.46)% vs. (36.42±0.37)%; t=45.941, 43.394, and 47.315; all P<0.001]. After the treatment, the levels of ALB, TFN, and FN in the observation group were higher than those in the control group [(45.11±0.87) g/L vs. (42.72±0.33) g/L, (3.75±0.77) g/L vs. (2.64±0.17) g/L, and (3.36±0.32) g/L vs. (2.14±0.41) g/L; t=16.646, 9.123, and 15.202; all P<0.001]. The scores of physical function, psychological function, social function, material life status, and overall quality of life factor of Generic Quality of Life Inventory-74 (GQOLI-74) in the observation group were higher than those in the control group [(86.24±0.31) vs. (84.14±0.25), (86.65±0.44) vs. (84.33±0.27), (87.68±0.48) vs. (85.16±0.36), (85.36±0.41) vs. (83.14±0.28), and (15.33±0.24) vs. (13.24±0.16); t=34.174, 29.125, 27.219, 28.978, and 46.958; all P<0.001]. The incidence of adverse reactions in the observation group was slightly higher than that in the control group [9.52% (4/42) vs. 7.14% (3/42); χ²=0.371, P=0.543]. Conclusion　PN combined with astragalus injection for gastric cancer patients after surgery can significantly improve their nutritional status and quality of life and does not increase the risk of adverse reactions with high safety.

Mental health status of medical graduate students at a university in closure because of COVID-19 epidemic

Zhu Yanyan, Zhuang Ruixia, Sun Qi, Feng Yuanyuan, Liang Shuang, Zhou Bo

2023, 29(4):  497-501.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.013

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Objective　To investigate the mental health status of postgraduates in medical colleges under closed management during the epidemic period and to propose corresponding mitigation measures. Methods　In September 2022, an online and offline questionnaire survey was carried out on 323 graduate students (94 men and 229 women) of Ningxia Medical University in closure because of the epidemic by the Self-Rated Depression Scale (SDS), Self-Rated Anxiety Scale (SAS), Simple Response Mode, Event Impact Scale-Revised Version (IES-R), and self-compiled scale related to the epidemic. t ang chi-square tests were applied. Results　The SDS score was (47.59±11.16); the detection rate of depressive state was 33.44% (108/323). The SAS score was (40.12±8.93); the detection rate of anxiety was 12.69% (41/323). The comorbidity rate of anxiety and depression was 16.25% (39/323); negative coping was positively correlated with depressive state, anxiety state, and stress response level during the closure because of the epidemic (all P<0.05). Conclusions　Negative coping is significantly and positively correlated with depression, anxiety, and stress levels during the school closure management of the COVID-19 epidemic. In the face of public health emergencies, medical postgraduates, as a special group, will have certain anxiety, suggesting that medical postgraduates are prone to symptoms of depression and anxiety under public health emergencies, which need to be paid attention to.

Effect of continuous injection of high-dose vitamin D and insulin pump on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus

Cong Xiaoqing, Liu Xiao, Zhao Juan, Tang Xiaohua, Wang Jingli

2023, 29(4):  501-505.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.014

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Objective　To explore the effect of continuous injection of high-dose vitamin D combined with insulin pump on blood glucose level and pregnancy outcomes in patients with gestational diabetes. Methods　From January 2020 to January 2022, 102 patients with gestational diabetes treated at Rongcheng Maternal and Child Health Hospital were selected for the random control trial. They were divided into a routine group and a study group by the random number table method, with 51 cases in each group. The routine group were (35.25±5.26) years old. The study group were (36.25±6.54) years old. The routine group took low-dose vitamin D combined with continuous insulin pump injection therapy, and the study group high-dose vitamin D combined with continuous insulin pump injection therapy. After 2 months' treatment, the efficacies, blood glucose levels [fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c)], adverse reactions, and pregnancy outcomes were compared between these two groups. χ² and t tests were applied. Results　The total effective rate of the study group was higher than that of the routine group [92.16% (47/51) vs. 74.51% (38/51); χ²=5.718, P=0.017]. Before the treatment, there were no statistical differences in HbA1c and FBG levels between the two groups (t=0.305 and 0.854, P=0.761 and 0.471). After the treatment, the levels of FBG and HbA1c in the two groups were lower than those before treatment; the levels of FBG and HbA1c in the study group were lower than those in the routine group (t=3.854 and 5.387, both P<0.001). There was no statistical difference in the total incidence of adverse reactions between the two groups (χ²=1.097, P=0.295). Follow up to delivery, there were 2 cases of neonatal asphyxia, 5 premature infants, and 2 giant infants in the routine group; there were 1 premature infant and 1 giant infant in the study group; the incidence of adverse pregnancy outcomes in the study group was lower than that in the routine group [3.92% (2/51) vs. 17.65% (9/51); χ²=4.993,P=0.025]. Conclusion　Continuous injection of high-dose vitamin D combined with insulin pump has a significant effect on patients with gestational diabetes, can reduce blood glucose level and improve pregnancy outcomes, and is safe.

Rivaroxaban and intraluminal therapy for one case of Budd-Chiari syndrome complicated with venous thrombosis

Xue Ming, Guo Xitian, Cao Shuwei, Zhang Lijun

2023, 29(4):  506-507.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.015

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Influence of traditional Chinese medicine nursing program based on OPT model on postpartum lactation deficiency of primiparas after cesarean section

Pang Atao, Du Qiaoting, Liu Lingling

2023, 29(4):  508-512.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.016

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Objective　To evaluate the influence of traditional Chinese medicine nursing program based on optimum perfor mance training model on postpartum lactation deficiency of primiparas after cesarean section. Methods　Sixty-six caesarean primiparas with postpartum lactation deficiency admitted to The First Affiliated Hospital of Henan University of Traditional Chinese Medicine from August to December 2021 were selected and divided into an intervention group (34 cases) and a control group (32 cases) according to the random number table method. They were 20-45 years old.The intervention group used the traditional Chinese medicine nursing program based on OPT model; the control group received conventional nursing. The prolactin values, beginning times of lactation, milk yield scores in each period,and success rates of breast-feeding were compared between the two groups. t and χ² tests were applied. Results　There was no statistical difference in prolactin between these two groups before the intervention (P>0.05). The prolactin value of the intervention group was significantly higher than that of the control group [(316.74±13.99) μg/L vs. (209.81±9.69) μg/L], with a statistical difference (t=35.878, P<0. 05). The beginning time of lactation in the intervention group was shorter than that of the control group [(11.91±1.83) h vs. (19.97±1.79) h], with a statistical difference (t=18.077, P<0. 05). After the intervention, the 24-<48, 48-<72, and 72-96 h milk yield scores in the intervention group were higher than those in the control group [(1.18±0.67) vs. (0.69±0.78), (1.85±0.89) vs. (1.09±0.82), and (2.88±0.48) vs. (2.16±0.95)], with statistical differences (t=2.737, 3.601, and 3.911; all P<0.05). The rates of breast feeding, breast and artificial feeding, and artificial feeding were 94.12% (32/34), 5.88% (2/34), and 0 in the intervention group, and were [62.50% (20/32), 25.00% (8/32), and 12.50% (4/32) in the control group, with statistical differences (χ²=7.131, 4.687, and 4.524; all P<0.05). Conclusion　Nursing intervention based on OPT model can improve the prolactin value, shorten the beginning time of lactation, and increase the amount of lactation and the success rate of breastfeeding.

Application of health education and wisdom platform based on Roy's adaptation theory in children with T1DM treated with pumps

Wei Shupei, Gu Jianping, Guo Jingjing, Huang Zhiqi

2023, 29(4):  513-518.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.017

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Objective　To explore the application effect of health education and wisdom platform based on Roy's adaptation theory in children with type 1 diabetes mellitus (T1DM) treated with pumps. Methods　From May 2020 to May 2022, 84 children with T1DM treated with pumps in Zhengzhou Children's Hospital and their main guardians were included for a prospective study. They were divided into a control group and an observation group, with 42 children and 42 guardians in each group. The control group took routine health education. On the basis of the control group, the observation group were given the health education based on Roy's adaptation theory and the intervention of the smart platform. The main guardians' mastery of health education knowledge, nursing levels, blood sugar control effects, and children' treatment compliances were compared between the two groups. χ² and t tests were applied Results　There were no statistical differences in the mastery of health education knowledge, caregivers' burden (ZBI), and family care (APGAR) between the two groups before the intervention. After the intervention, the mastery of health education knowledge [(68.15±7.36) vs. (54.62±10.18)] and APGAR [(8.03±1.35) vs. (6.72±1.13)] increased and the ZBI [(26.87±5.21) vs. (30.24±5.48)] decreased in both groups; the mastery of health education knowledge and APGAR were higher and the ZBI was lower in the observation group than in the control group [t=6.98, 4.822, and 2.888; all P<0.05]. There were no statistical differences in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) between the two groups before the intervention. After the intervention, the HbA1c and FBG in both groups decreased; the HbA1c and FBG in the observation group were lower than those in the control group [(6.51±0.58)% vs. (7.44±0.86)% and (6.76±0.65) mmol/L vs. (7.83±0.91) mmol/L], with statistical differences (t=5.810 and 6.201; both P<0.05). The qualified rates of HbA1c and FBG in the observation group after the intervention were higher than those in the control group (χ²=7.244 and 5.833; both P<0.05). After Redit analysis, there was a statistical difference in the treatment compliance between the two groups (χ²=2.090, P<0.05).The MMAS-8 score of the observation group was higher than that of the control group [(7.01±0.47) vs. (5.64±0.59)], with a statistical difference (t=11.770, P<0.05). Conclusion　The application of health education based on Roy's adaptation theory and smart platform in T1DM children treated by pump therapy can improve the mastery of health education knowledge of the main guardians, the care level, and treatment compliance, with good blood sugar control effect.

Effect of comprehensive nursing mode for patients with imported malaria

Wang Ruirui, Qiu Dongxia, Cui Erping, Ma Shuhuan

2023, 29(4):  518-522.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.018

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Objective　To explore the influence of comprehensive nursing mode on nursing quality, clinical effect, and satisfaction in patients with imported malaria. Methods　Forty patients with imported falciparum malaria treated in Department of Infectious Diseases, Zhengzhou Sixth People's Hospital from September 2018 to September 2019 were selected for the random control trial. They divided into a control group and a research group, with 20 cases in each group. There 14 males and 6 females in the control group; they were (44.98±1.0) years old. There 15 males and 5 females in the research group; they were (45.25±1.2) years old. The control group were routinely cared. The research group were comprehensively cared. The nursing qualities, clinical effects, and satisfaction were compared between these two groups. t and χ² tests were applied. Results　The scores of ward management, basic nursing, nursing scheme, copywriting, and health knowledge awareness in the research group were higher than those in the control group [(93.25±2.15) vs. (83.70±2.05), (94.35±3.35) vs. (82.10±5.15), (95.45±3.15) vs. (83.35±4.08), (95.28±5.15) vs. (82.70±3.25), and (86.35±4.15) vs. (71.25±3.05)], with statistical differences (t=14.377, 8.917, 10.498, 9.238, and 13.122; all P<0.05). The hospitalization time of the control group, the time for malaria parasite to turn negative, and the time for fever to subside in the research group were shorter than those in the control group, with statistical differences (t=2.533, 4.152, and 5.493; P<0.05). The total satisfaction of the observation group was higher than that of the control group [95% (19/20) vs. 60% (12/20)], with a statistical difference (χ²=7.025,P=0.008). Conclusion　Comprehensive nursing mode for patients with imported falciparum malaria can improve the nursing quality, clinical efficacy, and their satisfaction, and reduce hospital stay and complications, so it is worth being generalized.

Application of unity3D-based virtual simulation surgical training system in teaching of clinical medical students

Chen Guodong, Deng Xin, Liao WenYan , He Jun, Qi Shuo, Lei Xiaohua, Hou Jiafeng, Xie Yi, Tao Guangwei, Feng Chan, Tu Shun, Xie Xiangmin, Ding Chengming

2023, 29(4):  522-527.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.019

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With the rise of science and new technologies and the gradual improvement of public health awareness, it is very urgent to cultivate high-quality medical talents who can adapt to the development requirements of healthy China.The ways and approaches to clinical medical teaching in the new era are diverse. Nowadays, there are medical simulation teaching, problem-based learning (PBL), case-based learning (CBL), and team-based learning TBL teaching organized by clinicians, visual virtual anatomy teaching, and so on. The emergence of these teaching methods has greatly increased medical students, learning interest, given more flexibility to students' learning, and can help students fully understand medical knowledge. The discipline of modern clinical medicine is an extremely demanding science for students, and students must not only understand the books' knowledge, but also have a certain hands-on ability. Practice is the bridge between theory and the clinic; in recent years, the rapid development of virtual reality (VR) technology has also opened a gorgeous chapter in medicine. With the emergence and rapid development of new teaching methods such as multimedia technology, medical simulation technology, and visual virtual teaching, the application of virtual simulation teaching mode in clinical medical teaching has also been prominent. Virtual simulation surgical training system is a very important part of virtual simulation teaching, because it has the advantages of non-damage, plannable, repeatable operation, low cost, high cost performance, resource saving, etc., and has become an important method for clinicians' preoperative planning and surgical training. In this paper, the application of unity3D-based virtual simulation surgical training system in clinical medical teaching is investigated and analyzed.

Problems and analysis of oral combination of Chinese patent medicines in a hospital

Qi Liuying

2023, 29(4):  528-531.  DOI: 10.3760/cma.j.issn.1007-1245.2023.02.020

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Objective　To investigate the current situation of clinical use of combined Chinese patent medicines in Songjiang District Central Hospital (our hospital), and to improve the rational utilization rate of combined Chinese patent medicines in our hospital. Methods　We randomly selected 6 787 prescriptions of outpatient proprietary Chinese medicines in Songjiang District Central Hospital in February 2022 by the HIS system. We screened out 851 prescriptions containing two or more Chinese patent medicines and analyzes their rationality. Results　Among the 851 prescriptions for combined use of Chinese patent medicines, 24 departments were involved; the top three departments were orthopedics, neurology, and respiratory medicine, accounting for 18.45% (157/851), 17.39% (148/851), and 12.69% (108/851), respectively. The unreasonable manifestations mainly included repeated drug use, contradictory drug properties, and combined use of toxic ingredients, accounting for 63.78% (118/185), 17.84% (33/185), and 17.30% (32/185), respectively. Conclusions　The combined use of Chinese patent medicines in hospitals is common, and there are some irrational combinations. It is necessary to further strengthen the supervision of the use of Chinese patent medicines in order to minimize irrational combinations.

Treatises

Characteristics of coronary artery lesions and risk factors in patients with premature acute ST segment elevation myocardial infarction

Yan Bo, Zheng Wei, Guan Xiangping, Xu Qiang, Qian Yujun, Han Mei

2023, 29(4):  532-536.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.021

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Objective　To analyze the characteristics coronary artery lesions and risk factors in patients with premature acute ST segment elevation myocardial infarction (STEMI)and to provide theoretical basis for the prevention of early onset STEMI. Methods　The clinical data and coronary angiography data of the 402 patients treated at Chest Pain Center, Tengzhou Central People's Hospital from November 2018 to June 2021 were retrospectively studied. The traditional and non-traditional risk factors and the characteristics of coronary lesions in the 124 patients with early onset STEMI, including 94 men who were <55 years old and 30 women who were <65 years old and the 278 patients with late onset STEMI, including 214 men and 64 women, were statistically analyzed. t test, χ² test, and non-parametric test were applied. Results　The body mass index and proportions of the patients with obesity and family history of coronary heart disease in the early onset STEMI group were significantly higher than those in the late onset STEMI group (t=2.417; χ²=3.987 and 11.355; all P<0.05); the proportion of the patients with hypertension family history in the early onset STEMI group was significantly lower than that in the late onset STEMI group (χ²=7.277, P<0.05). The levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), apolipoprotein B (apoB), and uric acid (UA level) in the early onset STEMI group were significantly higher than those in the late onset STEMI group (t=4.796, 4.170, 5.210, 4.900,and 3.239; all P<0.05); the levels of high-density lipoprotein cholesterol (HDL-C) and homocysteine (Hcy) in the early onset STEMI group were significantly lower than those in the late onset STEMI group (t=3.369; Z=3.271; both P<0.05). The proportion of long lesion and the number and the diameter of stents implanted at the lesion sites of the patients in the early onset STEMI group were significantly lower than those in the late onset STEMI group, with statistical differences (χ²=4.389; t=2.534; Z=2.008; all P<0.05). Logistic regression analysis showed that the LDL-C (OR=2.174, 95%CI 1.123-4.209), TG (OR=1.476, 95%CI 1.161-1.877), UA (OR=1.005, 95%CI 1.002-1.007), and family history of coronary heart disease (OR=6.102, 95%CI 2.859-13.030) were the independent risk factors of early onset STEMI (all P<0.05), while the HDL (OR=0.27, 95%CI 0.099-0.734, P<0.001) was the protective factor. Conclusions　LDL-C, TG, UA, and family history of coronary heart disease are independent risk factors of early onset STEMI. The incidence of early onset STEMI is currently starting earlier and the severity of coronary artery disease is aggravating. More attention must be paid to enhance the dissemination of healthy lifestyle and actively correct the reversible risk factors to facilitate the primary prevention of coronary heart disease.

Effect of new-type cardiac rehabilitation training on cardiac function and vascular endothelial function of patients with ST-segment elevation myocardial infarction after PCI

Wei Ying, Mo Changgan, Wei Liyuan, Bei Xiaona, Lai Dongyan, Tang Xiuge

2023, 29(4):  537-541.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.022

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Objective　To evaluate the effect of new-type cardiac rehabilitation training on cardiac function and vascular endothelial function of patients with acute ST-segment elevation myocardial infarction (STEMI) after PCI. Methods　Sixty patients with acute STEMI treated by PCI at People's Hospital of Hechi City were divided into an observation group and a control group by the random number table method, with 30 cases in each group. There were 19 males and 11 females in the control group; they were (58.69±6.78) year old. There were 21 males and 9 females in the observation group; they were (59.33±7.08) year old. The control group did traditional cardiac rehabilitation training; in addition, the observation group took the new-type cardiac rehabilitation training. The left ventricular end-systolic dimensions (LVESD), left ventricular end diastolic dimensions (LVEDD), left ventricular ejection fractions (LVEF), 6 min walking test (6MWT), endothelin (ET-1), NO, and incidences of adverse events were compared between the two groups. χ² and t tests were applied. Results　After PCI, the LVESD and LVEDD were lower and the LVEF and 6MWT were higher in the observation group than in the control group [(34.17±2.86) mm vs. (38.24±2.73) mm, (47.18±3.32) mm vs. (50.36±2.13) mm, (59.06±3.37)% vs. (54.36±3.74)%, and (457.16±88.49) m vs. (409.32±79.78) m], with statistical differences (t=4.028, 2.817, 4.883, and 3.384; all P<0.05). After PCI, the ET-1 level was higher and the NO level was lower in the observation group than in the control group (t=5.728 and 4.132; both P<0.05). The incidence of adverse events in the observation group was lower than that in the control group [10.00% (3/30) vs 30.00% (9/30)], with a statistical difference (χ² =4.812, P=0.028). Conclusion　New-type Cardiac rehabilitation training for patients with acute STEMI after PCI can improve their cardiac function and vascular endothelial function and reduce adverse events.

Feasibility of personalized polyurethane foam with head, neck, and shoulder masks in craniospinal irradiation

Liu Hui, Zhang Zixian, Chen Xuanguang, He Huilang

2023, 29(4):  541-544.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.023

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Objective　To analyze the feasibility of personalized polyurethane foam with head, neck, and shoulder masks in craniospinal irradiation. Methods　Eighteen patients taking craniospinal irradiation (CSI) with helical tomotherapy (HT) at Sun Yat-sen University Cancer Center from October 2020 to May 2021 were retrospectively reviewed, including 13 males and 5 females; they were 5-22 years old. Megavoltage CT (MVCT) scanning was performed on all the patients' brains (original lesions), chests (from the first thoracic vertebra to juga), and abdomens (from the third lumbar vertebra to coccyx) before radiotherapy; the MVCT images were matched with the planned ones; the setup errors in the three-dimensional direction were recorded and statistically analyzed by the IBM SPSS 20.0 statistical software. Results　The setup errors in the three-dimensional direction of brain were (-0.18±1.47) mm, (-0.56±1.49) mm, and (1.70±1.76) mm; those of chest were (0.01±2.24) mm, (-0.13±2.01) mm, and (2.49±1.99) mm; and those of abdomen were (-0.05±2.41) mm, (-0.64±2.21) mm, and (1.42±2.16) mm, respectively. The fixed precisions on the X axis direction of brain, chest, and abdomen were similar. On the Y axis direction, the fixed precision of chest was the highest, and those of brain and abdomen were close to each other. On the Z axis direction, the fixed precisions of brain and abdomen were similar and were better than that of chest. There were no statistical differences in the setup errors before the first, sixth, and eleventh radiotherapy between the three parts (all P>0.05). Then the fixture was done by personalized polyurethane foam with head,neck and shoulder masks, the CTV-PTV margins of brain were 3.67 mm, 4.04 mm, and 4.59 mm; those of chest were 5.64 mm, 5.24 mm, and 5.76 mm; those of abdomen were 5.68 mm, 5.74 mm, and 5.88 mm, respectively. Conclusions　The combination of  personalized polyurethane foam with head, neck and shoulder masks has a high degree of integration. When applied in CSI, it can effectively improve the fixation accuracy for all time. It is worthy for clinical treatment. When it is in use, individualized margins should be set.

Clinical Research

Value of neutrophil to platelet count ratio in prediction of prognosis of patients with severe pneumonia

Ning Xin

2023, 29(4):  545-549.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.024

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Objective　To investigate the value of the ratio of neutrophil to platelet count in the prediction of prognosis of patients with severe pneumonia. Methods　One hundred and forty-seven elderly patients with complete data diagnosed as severe pneumonia at Jinqiu Hospital from December 2018 to December 2020 were collected for the retrospective study, including 87 males and 60 females who were 65-85 years old. Taking 28 days of treatment as the observation period, the patients were divided into a survival group (118 cases) and a death group (29 cases) according to the situation after the treatment. The general data of the enrolled patients, such as gender, age, disease history, etc., were collected and recorded. The white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), absolute number of neutrophils (NEUT), platelet count (PLT), and other indicators were detected in all the patients; the NPR(NEUT/PLT) was calculated. The basic data, medical history, acute physiology, and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, WBC, CRP, PCT, PLT, Lac, NPR×100, and other indicators of the two groups before and after the treatment were compared and analyzed. The meaningful indicators screened by single factor analysis were analyzed by multifactor logistic regression analysis. NPR×100 was analyzed by receiver operating characteristic curve (ROC). χ² and t tests were applied. Results　The PLT was much higher and the levels of NPR×100, PCT, and Lac and APACHE Ⅱ score were significantly lower in the survival group than in the death group [(157.73±16.99)×10⁹/L vs. (120.48±14.06)×10⁹/L, (9.00±4.08) vs. (15.78±6.26), (12.20±3.09) ng/L vs. (14.06±3.04) ng/L, (1.04±0.27) mmol/L vs. (1.73±0.27 )mmol/L, and (22.25±5.17) vs. (29.79±4.90)], with statistical differences (t=10.916, 7.139, 2.913, 12.330, and 7.107; all P<0.05). Multivariate logistic regression analysis showed that PLT, NPR×100, and Lac were important factors for monitoring the patients' prognosis (P=0.003, 0.007, and 0.008). The area under the ROC of NPR×100 for predicting the patients' prognosis within 24 hours after admission was 0.858; the optimal cut-off value of NPR was 12.960; the sensitivity was 0.729; the specificity was 0.887; the Jordan index was 0.616. Conclusions　High APACHE Ⅱ score, high NPR, high PCT, high Lac, and low PLT can all indicate poor prognosis of patients with severe pneumonia, with good predictive value for the disease prognosis. PLT, NPR, and Lac can be used as independent risk factors for predicting 28 d mortality. NPR has a good sensitivity and a good specificity in predicting the death risk of patients with severe pneumonia, so it is worthy of further study.

Efficacy and safety evaluation of low-dose nitroglycerin combined with clopidogrel for patients with coronary heart disease and angina pectoris

Liu Xiaohui

2023, 29(4):  549-553.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.025

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Objective　To study the efficacy and safety of low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris. Methods　Ninety-six patients with coronary heart disease and angina pectoris treated in Shandan County People's Hospital from April 2019 to November 2021 were selected as the research objects. The patients were divided into a routine group and an experimental group by the random number table method, with 48 cases in each group. There were 30 males and 18 females in the routine group; they were 47-76 (61.55±7.31) years old. There were 29 males and 19 females in the experimental group; they were 47-77 (62.35±6.89) years old. The routine group were treated with clopidogrel, and the experimental group with low-dose nitroglycerin (0.2 mg/time) and clopidogrel. The clinical efficacies, angina attack, cardiac function indicators [ratio of early diastolic mitral valve blood flow velocity to late diastolic mitral valve blood flow velocity (E/A), ejection fraction (EF), cardiac output (CO), and cardiac index (CI)], and levels of platelet granule membrane protein (GMP140), high mobility group box protein B1 (HMGB1), interleukin-18 (IL-18), and C-reactive protein (CRP) before and 3 months after the treatment, and adverse reactions were compared between these two groups. t and χ² tests were applied. Results　The total effective rate of the experimental group was higher than that of the routine group [95.83% (46/48) vs. 81.25% (39/48)], with a statistical difference (χ²=5.031, P=0.025). Three months after the treatment, the frequency and duration of angina pectoris in the experimental group were lower than those in the conventional group [(0.47±0.12)time/d vs. (0.68±0.19) time/d and (3.25±1.03) min vs. (6.17±1.22) min], with statistical differences (t=6.474 and 12.670; both P<0.05). Three months after the treatment, the E/A, EF, CO, and CI in the experimental group were higher than those in the routine group (t=3.458, 7.261, 3.997, and 3.472; all P<0.05). Three months after the treatment, the serum levels of GMP140, HMGB1, IL-18, and CRP in the experimental group were lower than those in the routine group (t=7.099, 8.729, 9.721, and 5.171; all P<0.05). The total incidences of adverse reactions in the experimental group and the routine group were 10.42% (5/48) and 6.25% (3/48), respectively, with no statistical difference (χ²=0.136, P=0.712). Conclusion　Low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris can further improve the efficacy and their cardiac function and recovery, and effectively shorten the attack time of angina pectoris, with high safety.

Magnetic resonance imaging DWI combined with DCE-MRI in diagnosis and staging of rectal cancer

Lin Guodong

2023, 29(4):  554-558.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.026

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Objective　To observe the value of diffusion-weighted magnetic resonance imaging (DWI) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis and staging of rectal cancer. Methods　The data of 150 patients with rectal cancer admitted to Department of Imaging, Yantaishan Hospital between August 2020 and August 2021 were retrospectively analyzed; among them, there were 83 males and 67 females; they were (49.35±9.64) years old. All the patients underwent DWI and DCE-MRI. The preoperative pathological examination results were used as the gold standard. t test was used to compare the relationship between the degree of differentiation of rectal cancer and the values of ADC and K^trans; χ² test was used to analyze the values of DWI, DCE-MRI, and combined detection in the diagnosis of tumor T stage. Results　Among the 150 patients, there were 16 cases of mucinous adenocarcinoma and 134 cases of mucosal adenocarcinoma. The ADC value of the mucinous adenocarcinoma group was significantly higher than that of the mucosal adenocarcinoma group [(1.179±0.173) mm²/s vs. (0.896±0.141) mm²/s; t=4.328, P<0.05]. The ADC value in the mucosal adenocarcinoma group increased with the differentiation degree; the K^trans value decreased as the differentiation degree increased (P<0.05). The accuracy rates of preoperative DWI in T₁-T₄ stages were 83.33% (10/12), 86.36% (38/44), 94.67% (71/75), and 89.47% (17/19), with a total accuracy rate of 90.67% (136/150). The accuracy rates of DCE in the diagnosis of T₁-T₄ stages were 78.57% (11/14), 88.64% (39/44), 95.95% (71/74), and 94.44% (17/18), with a total accuracy rate of 92.00% (138/150). The accuracy rates of DWI combined with DCE in diagnosing T₁-T₄ stages were 92.31% (12/13), 93.02% (40/43), 97.30% (72/74), and 90.00% (18/20), with a total accuracy rate of 94.67% (142/150). Conclusion　DWI combined with DCE-MRI can improve the accuracy of the staging and diagnosis of rectal cancer, so it is worthy of promotion.

Characteristics and value of high-resolution magnetic resonance imaging in patients with ischemic stroke

Qu Qizhi, Zhang Min, Zhao Yanling

2023, 29(4):  559-564.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.027

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Objective　To analyze the characteristics and value of high-resolution magnetic resonance imaging (HR-VWI) in patients with ischemic stroke. Methods　A prospective study was conducted on 60 ischemic stroke patients admitted to Liaocheng Third People's Hospital from October 2020 to December 2021, including 34 males and 26 females who were 25-75 (53.27±6.22) years old. The Chinese ischemic stroke subclassification (CISS) was used to classify the patients according to their symptoms, medical history, laboratory tests, and routine imaging examinations. CISS classification was performed again after HR-VWI examination. The CISS classification before and after HR-VWI examination was compared; the imaging characteristics were analyzed. According to the relationship between plaque and responsible artery in their ischemic areas, the patients were divided into a responsible plaque group (20 cases) and a non-responsible plaque group (16 cases). The measurement data and the count data were processed by t and χ² tests, respectively. The HR-VWI characteristics of the two groups were analyzed. Results　The CISS classification results showed that there were 20 cases (33.33%) of large arterial atherosclerosis (LAA), 6 cases (10.00%) of cardioembolic stroke (CS), 17 cases (28.33%) of perforating artery lesions, 1 case (1.67%) of other etiological type (OE), and 16 cases (26.67%) of undetermined etiology (UE). Thirty-six (60.00%) of the 60 patients had the same type, and 24 (40.00%) had different types before and after HR-VWI examination. After HR-VWI examination, the proportion of LAA type increased by 35.00%, the proportion of perforating artery lesion type decreased by 23.33%, and the proportion of UE type decreased by 13.33%. There was a statistical difference in CISS classification rate between before and after HR-VWI examination (χ²=17.833, P<0.05). HR-VWI of intracranial blood vessels showed that of the 60 patients, 30.00% (18 cases with 25 vessels) had no obvious abnormality on intracranial blood vessel walls; 10.00% (6 cases with 11 vessels) had wall thickening; 60.00% (36 cases with 96 vessels) had atherosclerotic plaques on intracranial blood vessel walls. The proportions of the patients with lumen stenosis ≥ 50%, plaque located in middle cerebral artery, and significantly enhanced plaque in the responsible plaque group [40.00%(8/20), 55.00%(11/20), and 50.00%(10/20)] were higher than those in the non-responsible plaque group [6.25%(1/16), 25.00%(4/16), and 6.25%(1/16)], with statistical differences (χ²=5.400, 8.730, and 8.048; all P<0.05). The wall area of the responsible plaque group was larger than that of the non-responsible plaque group [(14.33±2.87) mm² vs. (11.76±1.14) mm²]; the lumen area of the responsible plaque group was smaller than that of the non-responsible plaque group [(2.96±0.40) mm² vs. (5.44±1.29) mm²]; the stenosis rate of the responsible plaque group was higher than that of the non-responsible plaque group [(70.44±3.96)% vs. (39.15±2.04)%]; there were statistical differences (t=3.368, 8.147, and 28.654; all P<0.05). The percentage of lumen stenosis was lower than 50%; most of the plaques located in middle cerebral artery and basilar artery; the plaques were significantly enhanced; the wall area was large; the lumen area was small; the stenosis rate was higher in the responsible plaque group. Conclusion　HR-VWI can help to identify intracranial arterial lesions in patients with ischemic stroke, and evaluate the state of arteriosclerosis, thereby providing a basis for clinical treatment and prognosis evaluation.

Effects of medication management with clinical pharmacists' participation on medication standardization, compliance, and safety in patients with acute cerebral infarction after intervention

Liu Hui, Wang Zhenzhen, Zhao Yafei

2023, 29(4):  564-568.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.028

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Objective　To investigate the effects of medication management with clinical pharmacists' participation on medication standardization, compliance, and safety in patients with acute cerebral infarction after intervention. Methods　A total of 50 patients with acute cerebral infarction who underwent intervention in Liaocheng Third People's Hospital from February 2020 to February 2022 were selected for the random control trial, including 33 males and 17 females who were (66.16±7.85) years old. They were divided into a control group and an observation group by the random number table method, with 25 cases in each group. The control group received routine medication management and health education after operation; in addition, the observation group received medication management with clinical pharmacists' participation. The rational drug use indicators (hospital stay, hospitalization expense, and medication expense) were recorded. The medication standardization and medication compliances of the two groups were compared before and 3 months after the intervention. The safety and satisfaction were evaluated. t test, analysis of variance, and χ² test were applied. Results　The hospital stay, hospitalization expense, and medication expense of the observation group were lower than those of the control group [(13.45±3.68) d vs. (15.96±4.01) d, (5 125.44±335.71) yuan vs. (5 543.75±340.94) yuan, and (1 483.55±368.94) yuan vs. (1 876.43±377.56) yuan], with statistical differences (t=2.306, 4.371, and 3.721; all P<0.05). After the intervention, the incidence of irrational drug use and medication compliance rate in the observation group were better than those in the control group [16.00% (4/25) vs. 44.00% (11/25) and 96.00% (24/25) vs. 72.00% (18/25)], with statistical differences (both P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [12.00 % (3/25) vs. 36.00 % (9/25)] and the nursing satisfaction in the observation group was higher than that in the control group [96.00 % (24/25) vs. 76.00 % (19/25)], with statistical differences (χ²=3.947 and 4.153; both P<0.05). Conclusion　Medication management with clinical pharmacists' participation for patients with acute cerebral infarction after intervention can not only improve the clinical drug management system, enhance medication effect, and reduce irrational drug use, but also improve the patients' medication compliance and nursing satisfaction and reduce adverse reactions.

Case Report

A case of mast cell leukemia with lumbago as the first symptom

Li Fang, Man Wenyu, Yu Yaning, Ge Fenghua, Sun Xiangjun

2023, 29(4):  569-571.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.029

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To improve the diagnostic level of rare leukemia, the clinical data of a patient with mast cell leukemia (MCL) and lumbago as the first symptom were reported and the literatures were reviewed to improve the diagnostic level of MCL.

A case of congenital absence of right coronary artery concomitant with left heart failure

Wang Quanzheng, Liu Guowen, Yang Xiaoli

2023, 29(4):  572-573.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.030

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On September 4, 2022, one patient with left heart failure and atrial fibrillation was treated in Shouguang People's Hospital. Coronary angiography showed severe stenosis of the anterior descending artery, scattered plaque in the spiral branch, and congenital deficiency of the right coronary artery; one stent was implanted in the anterior descending branch.

Rare RET fusion and MET amplification double mutations in a case of lung cancer with brain metastasis

Xing Shujing, Hua Lanlan

2023, 29(4):  574-576.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.031

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This was a rare case of brain metastases from lung cancer with RET fusion and MET amplification double mutations. After double target treatment with crizotinib and cabotinib combined with whole brain radiotherapy, clinical remission had been achieved.

Experience Exchange

Value applying DRGs performance evaluation indicators in medical service of departments of tertiary general hospitals

Shao Lin

2023, 29(4):  577-580.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.032

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Objective　To study the value applying disease diagnosis related groups (DRGs) performance evaluation indicators in the medical services in the departments of tertiary general hospitals. Methods　From July 2017 to December 2018, 20 521 inpatients admitted by Qingyuan People's Hospital were taken as the research objects, including 10 521 males and 10 000 females who were (40.26±3.17) years old. With the performance evaluation system and hospital quality management as the platform, DRGs performance evaluation indicators were used to compare various situations. Results　The number of hospital groups increased from 610 in 2017 to 660 in 2018; the total weight also showed an upward trend; the case mix index (CMI), time consumption index, and low-risk mortality showed downward trends; the cost consumption index showed an upward trend in these two years. There were 8 departments in the tertiary general hospital in the study. The number of cases included in the above departments showed a significant upward trend, while the number of DRGs in department 2 showed a downward trend. Through the analysis of the total weight, all the departments showed upward trends. Conclusion　The application of DRGs performance evaluation indicators in the medical services of the departments of tertiary general hospitals has significant value.

Nursing Research

Effect of stigma on caregivers' burden of patients with Alzheimer's disease

Zhang Jun, Zhou Jing

2023, 29(4):  581-587.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.033

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Objective　To explore the current status of stigma, care burden, and social support in the family caregivers of patients with Alzheimer's disease, and to analyze the correlation between them. Methods　From January 2020 to January 2021, convenience sampling was used to select 172 elderly patients with early Alzheimer's disease treated in The First Affiliated Hospital of Nanyang Medical College and Nanyang City Central Hospital as the research objects for the cross-sectional investigation. All the patients with Alzheimer's disease were married and had intact family structure. The General Information Questionnaire, Perceived Demeaning-Discrimination Scale, Caring Burden Scale, and Social Support Rating Scale were used for the investigation. The SPSS 20.0 and AMOS 20.0 statistical softwares were used to process the relevant data. The enumeration data were expressed as percentage and frequency. The measurement data of normal distribution were compared between the groups by independent sample t test and analysis of variance. Pearson correlation was used to analyze the correlation between stigma, social support, and care burden of the caregivers. The path relationship model was established to analyze the relationship between stigma, social support, and care burden of the caregivers; the maximum likelihood estimation method was used to fit the model. When P<0.05, there is a statistical difference. Results　The patients were (68.34±10.40) years old; there were 84 males (48.84%) and 88 females (51.16%). The total scores of stigma, social support, and caring burden of the caregivers was (49.15±7.90), (35.97±7.89), and (52.04±8.68), respectively. Stigma had a significant positive predictive effect on the caregivers' burden (B=1.586, P<0.001). Stigma had a negative predictive effect on social support (B=-1.497, P<0.001). When stigma affected care burden, social support also had a mediating effect. The 95% confidence interval did not include 0 (95%CI 0.451-1.059); the mediating effect of social support accounted for 47.3% of the total effect. Conclusions　Primary family caregivers of patients with Alzheimer's disease have a high level of stigma, a low level of social support, and heavy care burden. Stigma can directly predict social support and care burden, and plays an indirect predictive effect on care burden through social support. Primary health care workers should attach importance to the paths influencing the care burden by the family caregivers' stigma, actively build related intervention plans, strengthening the caregivers' economy help, emotional support, and social support to reduce the caregivers' stigma and burden, so as to promote the patients' prognosis.

Early warning effect of continuous peripheral blood perfusion index on pressure injury

Song Liyan, Zang Zhengming, Ma Fangfang

2023, 29(4):  588-592.  DOI: 10.3760/cma.j.issn.1007-1245.2023.04.034

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