Table of Content

15 January 2022, Volume 28 Issue 2

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Scientific Research

Exploring the systematic error of radiotherapy equipment in intensity-modulated radiotherapy for patients with cervical cancer

Fang Yongwen, Liu Biaoshui, Xiao Liangjie, Wang Yuliu, Yao Wenyan, Lin Xiaosheng, Lin Chengguang, Fang Jianlan

2022, 28(2):  150-153.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.001

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Objective To analyze the systematic and random errors of different treatment linear accelerators in intensity-modulated radiotherapy (IMRT) for patients with cervical cancer. Methods From October 2019 to November 2021, 320 cervical cancer patients who were 32-75 years old and received IMRT with Varian Vital_Beam accelerator and Elekta Versa_HD accelerator in Sun Yat-sen University Cancer Center were selected. After the design of the radiotherapy plan was completed, we performed the X-ray simulation positioning machine reset verification according to the bed moving parameters of the treatment plan for each patient, and used the cone beam CT (CBCT) for body position verification during the treatment, including 960 CBCT positioning error data. The body position error data after CBCT calibration were recorded and analyzed by paired t-test. Results The positioning errors of the Varian Vital_Beam and Elekta Versa_HD linear accelerators in the superior-inferior (SI), left-right (LR), and anterior-post (AP) translation directions were (0.00±0.32) cm, (0.00±0.25) cm, (0.04±0.24) cm and (0.08±0.40) cm, (0.02±0.33) cm, (0.04±0.25) cm; there were statistically significant differences in the SI and AP directions (both P<0.05), while there was no statistically significant difference in the LR direction (P> 0.05). The positioning errors of the Varian Vital_Beam and Elekta Versa_HD linear accelerators in the RTN, Pitch, and Roll rotation directions were (0.12±1.00)°, (0.81±1.33)°, (0.32±0.64)° and (0.24± 0.73)°, (0.28±1.64)°, (0.01±0.80)°; there were statistically significant differences (all P<0.05). The total systematic error errors of Varian Vital_Beam linear accelerator in the SI, LR, AP, RTN, Pitch, and Roll directions were 0.29 cm, 0.22 cm, 0.22 cm, 0.81°, 1.46°, and 0.63°; the total systematic error errors of Elekta Versa_HD linear accelerator in the SI, LR, AP, RTN, Pitch, and Roll directions were 0.37 cm, 0.30 cm, 0.23 cm, 0.69°, 1.44°, and 0.72°. The total random errors of Varian Vital_Beam linear accelerator in the SI, LR, AP, RTN, Pitch, and Roll directions were 0.23 cm, 0.18 cm, 0.14 cm, 0.98°, 0.87°, and 0.55°; the total random errors of Elekta Versa_HD linear accelerator in the SI, LR, AP, RTN, Pitch, and Roll directions were 0.28 cm, 0.23 cm, 0.15 cm, 0.54°, 1.02°, and 0.56°. Conclusions The systematic errors of different radiotherapy equipment are different. In the SI, LR, AP, and Roll directions, the systematic error of Varian Vital_Beam is smaller than that of Elekta Versa_HD; while in the RTN and Pitch directions, the systematic error of Varian Vital_Beam is greater than that of Elekta Versa_HD.

A comparative study of cerebral perfusion and prominent vessel sign after unilateral middle cerebral artery M1 segment chronic occlusion

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

2022, 28(2):  154-157.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.002

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Objective To investigate the value of prominent vessel sign (PVS) in the evaluation of cerebral perfusion and clinical prognosis after unilateral middle cerebellar artery (MCA) M1 segment chronic occlusion. Methods A total of 42 patients with unilateral MCA M1 segment chronic occlusion in Nanjing University of Chinese Medicine Affiliated Lianyungang Hospital from January 2018 to May 2021 were collected, including 24 males and 18 females, aged (53.2±8.9) years. They were divided into a PVS positive group (17 cases) and a PVS negative group (25 cases) according to the PVS display difference of T2 star weighted anatomy (SWAN) sequence. The frontal lobe, parietal lobe, temporal lobe, and paraventricular white matter region of interest [ROI=(200±20) mm2 ] of occlusive MCA were selected by the cerebral blood flow (CBF) pseudo-color images of 3D arterial spin labeling (3D ASL) sequence. The CBF values of the two groups were compared, and the incidences of ischemic cerebrovascular diseases in the two groups were followed up within 6 months. Independent sample t test was used for measurement data, and rank sum test was used for ranked data. Results The CBF values of frontal lobe, parietal lobe, temporal lobe, and paraventricular white matter region of interest in the PVS positive group were (33.54±6.40) ml/min×100 g, (32.68±7.13) ml/min×100 g, (33.79±6.87) ml/min×100 g, and (29.81± 5.94) ml/min×100 g, which were lower than those in the PVS negative group, with statistically significant differences (all P<0.05). The incidence of ischemic cerebrovascular diseases in the PVS positive group within 6 months was 70.59% (12/17), which was higher than that in the PVS negative group, with a statistically significant difference (P<0.05). Conclusion After M1 segment occlusion of unilateral MCA, PVS is closely related to cerebral blood flow perfusion, which has an important value in clinical prognosis evaluation.


Research progress of propolis in inflammatory bowel disease

Wang Haokun, Wang Aili, Yan Da, Wang Na, Liu Chengxia

2022, 28(2):  158-162.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.003

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Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is characterized by chronic recurrent bowel disease. The cause of the disease is currently unknown, and there are no effective targeted drugs at the moment, so it's really hard to completely cure the patients. Propolis is a kind of natural mixture with various biological activities and pharmacological effects. Studies have shown that polyphenol-rich propolis extracts exhibit significant anti-inflammatory effects, possibly blocking inflammatory responses by regulating the production of key inflammatory mediators. Therefore, propolis is expected to become a new treatment for IBD. This article will elaborate the relevant mechanisms and treatment strategies of propolis in IBD.

Relationships between serum chromogranin A, Apelin, and H-FABP and myocardial injury in children with sepsis

Xiao Haiping , Cui Junhao

2022, 28(2):  163-166.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.004

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Objective To explore the relationships between serum chromogranin A (CHGA), plasma Apelin, and heart-type fatty acid binding protein (H-FABP) levels and myocardial injury in children with sepsis. Methods A total of 100 children with sepsis, 60 boys and 40 girls, aged 7-12 years, with a course of disease of 2-24 d, who were admitted to Children's Hospital Affiliated of Zhengzhou University between April 2018 and April 2021 were selected, and were divided into a myocardial injury group (53 cases) and a non-myocardial injury group (47 cases) according to the echocardiography results within 3 hours after admission. The levels of CHGA, Apelin, and H-FABP 3 and 6 hours after admission were compared between the two groups.Independent sample t test was used for measurement data, and χ2 test was used for count data. The relationships between CHGA, Apelin, and H-FABP levels and myocardial injury in children with sepsis were analyzed through multivariate logistic regression analysis. Results The myocardial injury group had higher CHGA levels, and lower Apelin and H-FABP levels than the non-myocardial injury group 3 and 6 hours after admission (all P<0.05). Multivariate logistic regression analysis showed that the levels of CHGA, Apelin, and H-FABP in children with sepsis were risk factors for myocardial injury (all OR>1, P<0.05). Conclusion Higher CHGA level and lower Apelin and H-FABP levels are related to myocardial injury in children with sepsis.

Analysis of the related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures in the young and middle-aged with "L"-shaped incision

Liu Yu, Li Huijin, Song Qilin, Ye Cong, Zhu Qunfang

2022, 28(2):  166-170.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.005

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Objective To investigate the related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures in the young and middle-aged with "L" -shaped incision, and to provide references for clinical improvement of the prognosis of calcaneal fractures. Methods All patients with closed calcaneal fractures who met the selection criteria and were treated with traditional "L"-shaped approach surgery in the Department of Lower Extremity Traumatology and Orthopedics of Heyuan City Hospital of Traditional Chinese Medicine from September 2017 to December 2020 were selected, including 42 males and 18 females, 25 cases of 15-44 years old and 35 cases of 45-59 years old. Among them, patients suffered from foot swelling 6 weeks after the operation were regarded as a swelling group, and patients without foot swelling as a non-swelling group. Based on the data of the two groups, the analysis and discussion were carried out. Based on patients' follow-up data, the factors that might affect chronic swelling of the foot after calcaneal fracture surgery were selected, including patients' age, gender, body mass index, smoking, and other general conditions, as well as fracture classification, surgical conditions, and early postoperative wound healing. χ2 test was used and multivariate logistic stepwise regression analysis was performed based on the univariate analysis results to screen out the related factors of chronic swelling of foot after calcaneal fracture surgery. Results A total of 60 patients were enrolled, including 45 patients in the swelling group and 15 patients in the non-swelling group. Logistic regression analysis showed that usage time of tourniquet over 80 min, type Ⅳ fracture, poor fracture reduction quality, and wound complications were related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures with "L" -shaped approach surgery (all OR>1, P<0.05). Conclusions In the clinical treatment of young and middle-aged patients with closed calcaneal fractures through the traditional "L" -type approach, foot swelling is likely to occur during the postoperative rehabilitation period. Further analysis of related factors has found out that the intraoperative tourniquet used for a long time, the degree of injury as serious as type Ⅳ fracture, poor fracture reduction, and wound complications are the main factors. By circumventing these factors during the perioperative period, the incidence of foot swelling during the postoperative rehabilitation period can be greatly reduced.

Study on the mechanism of lemon-dark plum extract in preventing renal calcium oxalate calculus

Lin Fujia, Ou Caiwen, Ke Peifeng, Chen Qubo, Xu Jianhua

2022, 28(2):  171-175.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.006

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Objective This paper aimed to study the synergistic effect and mechanism of lemon-dark plum extract on the prevention of renal calcium oxalate calculus, so as to provide a theoretical basis for further research and clinical application in the prevention and treatment of renal stone. Methods A total of 50 rats (body weight 200-250 g) were divided into five groups by the random number table method: group A (control group), group B (calculus group), group C (lemon extract group), group D (dark plum extract group), and group E (lemon-dark plum extract group). After modeling and dosing for 4 weeks, 24-hour urine volume and urine related indexes, blood creatinine, urea nitrogen, and other biochemical indexes were measured. The crystal deposition and pathological changes of rat kidney were detected. The expression of osteopontin in renal tissue was detected by immunohistochemistry. Independent sample t test was used for measurement data, and rank sum test was used for ranked data. Results The urine volume and urine creatinine in group B decreased significantly [(11.42±1.70) ml and (4.94±1.23) mmol/24 h], while the three kinds of extracts restored the urine volume and increased the urine creatinine level [(15.58±1.61) ml, (15.70±1.69) ml, (16.43±1.55) ml; (6.21±1.17) mmol/24 h, (6.86±2.06) mmol/24 h, (7.40±1.26) mmol/24 h] (all P<0.05). Urinary calcium, uric acid, and oxalic acid in the urine of group B increased significantly [(80.57±12.00) μmol/24 h, (2.20±0.39) mmol/24 h, and (76.98±11.89) μmol/24 h], and the lemon-dark plum extract reduced the three indexes [(35.85± 5.57) μmol/24 h, (1.68±0.16) mmol/24 h, and (56.85±8.34) μmol/24 h], and its effect was significantly better than that of single drug extract (all P<0.05). The three kinds of extracts all reduced the levels of blood creatinine and urea nitrogen in stone rats. The renal tubular lumen of the rats in group B was significantly expanded, and flake or mass calcium oxalate crystals could be seen; the three kinds of extracts significantly improved the crystal deposition and lumen expansion. The extracts of lemon and dark plum significantly down-regulated the expression of osteopontin induced by lithogenesis. Conclusion The lemon-dark plum extract may reduce the occurrence of renal calculus and prevent the recurrence of renal calculus by reducing the content of blood urea nitrogen and creatinine, increasing the level of urine pH, increasing the micturition and creatinine excretion of rats, and inhibiting the formation of renal calcium oxalate crystals.

Special Subject

Clinical observation of verapamil combined with prednisone in the preventive treatment of cluster headache

Men Shuang

2022, 28(2):  176-179.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.007

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Objective To explore the clinical efficacy and safety of verapamil hydrochloride combined with prednisone in the preventive treatment of cluster headache. Methods A total of 43 patients with cluster headache in Shenyang Red Cross Hospital from March 2020 to March 2021 were randomly divided into an observation group (22 cases) and a control group (21 cases) with the random number table method. There were 17 males and 5 females in the observation group, aged (42.26±12.75) years; there were 14 males and 7 females in the control group, aged (39.26±11.38) years. The observation group was treated with verapamil combined with prednisone, while the control group was treated with verapamil. After two weeks of treatment, the durations of cluster period, headache frequencies, and adverse reactions of the two groups were recorded. Independent sample t test was used for inter-group comparison of measurement data, paired t test was used for intra-group comparison of measurement data, and χ2 test was used for count data. Results Compared with that before the treatment, the pain degree of patients in the observation group and the control group relieved after the treatment, with the total effective rate of 90.91% (20/22) in the observation group and 61.90% (11/21) in the control group, with a statistically significant difference between the two groups (P<0.05). Compared with those before the treatment, the frequencies of headache attack and the durations of cluster period in the two groups decreased after the treatment, and the differences of the two groups before and after the treatment were statistically significant (all P<0.05), and there were statistically significant differences between the observation group and the control group after the treatment (both P<0.05). No serious adverse reactions occurred in both groups during the treatment. Conclusions Verapamil combined with prednisone can prevent cluster headache, and can obviously reduce the duration of cluster period and the frequency of pain attack, and improve the clinical symptoms. Meanwhile, it has good safety and better effect than verapamil alone.

Scientific Research

Effect of kettlebell training on elderly women with sarcopenia

Chen Juan, Feng Wenhua, Hou Xiaojun, Cheng Junhua

2022, 28(2):  180-184.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.008

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Objective To study the effects of kettlebell training on muscle strength, lung function, and chronic low-grade inflammatory markers in elderly women with sarcopenia. Methods A total of 200 female patients with sarcopenia who received treatment in Nanyang City Center Hospital from December 2018 to December 2019 with complete follow-up records were selected and were divided into an observation group and a control group by the random drawing. Among them, 100 patients of the observation group [age (65.57±2.95) years old and body weight (66.83±7.48) kg] received kettlebell training for 8 weeks, and 100 patients of the control group [age (66.12±3.57) years old and body weight (67.65±6.66) kg] were treated without kettlebell training. The body composition, muscle strength, lung function, and chronic low-grade inflammatory markers levels were compared between the two groups. Independent sample t test was used for inter-group comparison of measurement data, paired t test was used for intra-group comparison of measurement data, and χ2 test was used for count data. Results There were no statistically significant differences in the body mass, skeletal muscle mass loss (SMM), visceral fat area, appendicular skeletal muscle (ASM), or forced vital capacity (FVC) between the observation group and the control group before training, at the 8th week after training, and at the 4th week after cessation (all P>0.05). The muscle reduction index of the observation group was significantly higher than that of the control group at the 8th week after training and the 4th week after cessation [(5.65± 0.16) points vs. (5.39±0.21) points, (5.66±0.16) points vs. (5.37±0.17) points], with statistically significant differences (both P<0.05). The left hand gandle, right hand gandle, back strength, and peak expiratory flow (PEF) in the observation group at the 8th week after training were significantly higher than those in the control group [(21.15±2.20) kg vs. (16.27±2.25) kg, (21.10±2.45) kg vs. (16.11±2.56) kg, (51.95±5.34) kg vs. (46.36±6.43) kg, (5.86±0.69) L/s vs. (5.09±0.45) L/s], with statistically significant differences (all P<0.05). The back strength and PEF of the observation group were significantly higher than those of the control group at the 4th week after cessation [(51.94± 5.23) kg vs. (46.43±6.63) kg, (5.85±0.68) L/s vs. (5.09±0.49) L/s], with statistically significant differences (both P<0.05). There were no statistically significant differences in the levels of interleukin-6 (IL-6) and tumor necrosis factor -α (TNF-α) between the observation group and the control group before training, at the 8th week after training, and at the 4th week after cessation (all P>0.05). Conclusion Eight-week kettlebell training helps to improve the muscle strength of elderly women with sarcopenia, increase the grip strength and back strength, improve the lung function, and reduce the chronic low-grade inflammation

Study on the effect of combined application of pain and psychological care on patients with advanced cancer pain

Tang Zhenzhen, Wang Manman, Li Yanwei

2022, 28(2):  185-189.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.009

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Objective To explore the effect of combined application of pain and psychological care on patients with advanced cancer pain. Methods A total of 80 patients with advanced cancer pain admitted to Affiliated Cancer Hospital of Zhengzhou University from March 2019 to March 2020 were selected. By the simple randomization, they were divided into a control group and an observation group with 40 cases in each group. In the control group, the ratio of male: female was 19:21, aged (59.22±7.36) years, including 9 cases of lung cancer, 13 cases of colon cancer, 12 cases of gastric cancer, and 6 cases of others. In the observation group, the ratio of male: female was 18: 22, aged (58.37±7.24) years, including 8 cases of lung cancer, 11 cases of colon cancer, 14 cases of gastric cancer, and 7 cases of others. The control group received psychological care, and the observation group received standardized pain nursing and psychological care. The nursing effects of the two groups were compared, including pain degree [Visual Analogue Scale (VAS)], negative moods [Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and quality of life [Functional Assessment of Cancer Therapy-Generic Scale (FACT-G)]. Independent sample t test was used for inter-group comparison of measurement data, paired t test was used for intra-group comparison of measurement data, and χ2 test was used for count data. Results After nursing, the VAS score in both groups decreased compared with those before nursing (both P<0.05), and the VAS score of the observation group [(1.87±0.21) points] was lower than that of the control group [(2.15±0.27) points] (P<0.05). After nursing, the SDS and SAS scores of the two groups decreased compared with those before nursing (all P<0.05), and the SDS and SAS scores of the observation group [(46.64± 4.19) and (42.38±4.05) points] were lower than those of the control group [(49.42±5.90) and (45.71±4.96) points] (both P<0.05). After nursing, the scores of sleep latency, sleep duration, sleep quality, sleep efficiency, daytime function, sleep disorder, and hypnotic drugs of PSQI in the observation group were (1.28±0.30), (1.39±0.33), (1.56±0.37), (1.41±0.27), (1.31±0.26), (1.44± 0.31), and (1.38±0.34) points, which were significantly lower than those in the control group [(1.51± 0.32), (1.58±0.36), (1.77±0.41), (1.66±0.35), (1.49±0.29), (1.68±0.39), and (1.65±0.41) points] (all P<0.05). After nursing, the scores of social/family status, physiological status, emotional status, and functional status of FACT-G in both groups increased compared with those before nursing (all P< 0.05), and the scores of the observation group were (25.08±6.21), (24.11±6.34), (22.67±6.18), and (24.18±6.19) points, which were higher than those in the control group [(21.74±5.63), (20.27±4.98), (19.81±5.32), and (20.51±5.52) points] (all P<0.05). Conclusion For patients with advanced cancer pain, standardized pain nursing combined with psychological nursing intervention can significantly reduce patients' pain course and negative emotions, improve their quality of sleep and life, with a high application value.

Application of clinical pathway teaching method with "standardized medical order" as the core in obstetric clinical teaching

Liu Rongxin, Bao Zhimin, Qu Shouhui, Yuan Xuelian, Li Sha

2022, 28(2):  189-192.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.010

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Objective To explore the application effect of clinical pathway teaching method with "standardized medical order" as the core in obstetric clinical teaching. Methods A total of 100 clinical obstetric interns in Zhengzhou First People's Hospital from November 2020 to April 2021 were selected, and were simply randomly divided into a traditional teaching group and an standardized medical order teaching group, with 50 interns in each group. There were 30 males and 20 females in the traditional teaching group, and there were 32 males and 18 females in the standardized medical order teaching group. The traditional teaching method was used in the traditional teaching group, and the clinical pathway teaching method with "standardized medical order" as the core was used in the standardized medical order teaching group. According to the unified arrangement of the hospital, the interns were trained for 8 weeks, and the interns were assessed according to the requirements of the syllabus. The scores of theoretical knowledge, case analysis ability, and skill operation of the two groups were compared, as well as their satisfaction on obstetric teaching. Independent sample t test was used for measurement data, and χ2 test was used for count data. Results The scores of theoretical knowledge, case analysis ability, and skill operation of the standardized medical order teaching group [(90.10±2.61) points, (91.34±3.60) points, and (91.50±3.18) points] were higher than those of the traditional teaching group [(87.26±4.33) points, (88.90±3.26) points, and (89.20±3.47) points], with statistically significant differences (all P<0.05). The satisfaction of the standardized medical order teaching group on obstetric teaching methods, teaching contents, teaching interaction, and self-improvement [88% (44/50), 92% (46/50), 96% (48/50), and 90% (45/50)] were higher than those of the traditional teaching group [70% (35/50), 76% (38/50), 76% (38/50), and 74% (37/50)], with statistically significant differences (all P<0.05). Conclusion The application of clinical pathway teaching method with "standardized medical order" as the core in obstetric clinical teaching can not only improve the interns' performance in all aspects, improve their satisfaction degree, which is worthy of promotion in clinical teaching.

Construction and practice of artificial intelligence in the pre-review system of children's inpatient medical orders

Wu Juan, Wang Juping

2022, 28(2):  193-195.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.011

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Objective To explore the construction and practice of artificial intelligence in the pre-review system of children's inpatient medical orders. Methods A total of 100 hospitalized children in Children's Hospital of Zhengzhou University from January 2019 to April 2020 were select as a control group, and received routine pre-review of medical orders; 100 hospitalized children from May 2020 to May 2021 were select as an observation group, and received pre-review of medical orders based on artificial intelligence system. The observation group was (4.52±1.12) years old, including 76 males and 24 females; the control group was (4.96±1.45) years old, including 77 males and 23 females. The safety of drug use was compared between the two groups. Independent sample t test was used for measurement data, and χ2 test was used for count data. Results The proportion of irrational medical orders in the observation group was 32.00% (32/ 100), which was lower than 50.00% (50/100) in the control group (P<0.05). The satisfaction degree of family members in the observation group was 95.00% (95/100), which was higher than 70.00% (70/100) in the control group (P<0.05). Conclusion Artificial intelligence has a high application value in the pre-review system of children's inpatient medical orders, which can promote the clinical rational use of drugs, improve the safety of children's drug use, and has a good application effect.

Current situation and research progress of imaging diagnosis of acute intestinal ischemia

Wang Xinyu, Ba Chenghui, Jiang Xingyue

2022, 28(2):  196-199.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.012

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Acute intestinal ischemia is a kind of intestinal disease, which is caused by a variety of causes and risk factors, such as lack of mesenteric blood supply or backflow obstruction, resulting in varying degrees of intestinal wall lesions and damage. Early diagnosis and treatment are very important for the prognosis of patients. The continuous development of medical imaging technology provides an important value for the diagnosis of intestinal ischemia. This paper briefly summarizes the current status and research progress of imaging diagnosis of the disease.

One case of interstitial pneumonia caused by gefitinib

Sun Chunhua, Guo Xuedan, Xiao Xia, Wang Qi, Hua Hongxia, Zhao Fan, Huang Pei

2022, 28(2):  199-201.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.013

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A 67-year-old male patient took 250 mg gefitinib daily because of epidermal growth factor receptor (EGFR) gene 21 exon mutation in lung cancer. Three months later, the patient developed cough, shortness of breath, and high fever. The chest computerized tomography (CT) suggested pneumonia, and anti-infection treatment was ineffective. After that, gefitinib was discontinued, and oxygen inhalation, intravenous drip of glucocorticoids, liver protection and other treatments were given. His symptoms were significantly relieved one week later.

Preemptive analgesic effects of different doses of flurbiprofen axetil during radical resection of cervical cancer and their effects on serum CXCL13, IL-6, and lung protection effect

Feng Meiling, Tian Xiaona

2022, 28(2):  202-207.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.014

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Objective To explore the preemptive analgesic effects of different doses of flurbiprofen axetil during radical resection of cervical cancer and their effects on serum chemokine CXC ligand 13 (CXCL13), interleukin-6 (IL-6), and lung protection effect. Methods A total of 136 patients with cervical cancer admitted to Weihai Central Hospital from February 2018 to August 2020 were selected as the research objects, and were grouped according to the random number table method, with 34 cases in each group. The age of the control group was (44.08±5.02) years old, the age of the observation group 1 was (45.26±4.95) years old, the age of the observation group 2 was (44.89±5.33) years old, and the age of the observation group 3 was (43.25±5.12) years old. All patients underwent laparoscopic radical resection. The control group was given normal saline 30 min before the operation, the observation group 1 was given 0.5 mg/kg of flurbiprofen axetil 30 min before the operation, the observation group 2 was given 1.0 mg/kg of flurbiprofen axetil 30 min before the operation, and the observation group 3 was given 1.5 mg/kg of flurbiprofen axetil 30 min before the operation. The hemodynamic indexes [heart rate (HR) and mean arterial pressure (MAP)] and lung protection effect indexes [dynamic lung compliance (Cdyn) and peak airway pressure (Ppk)] at 4 time points [entering the room (T1), immediately after intubation (T2), immediately after extubation (T3), and 5 min after extubation (T4)], serum CXCL13 and IL-6 levels before and after the operation, analgesic effects 2 h, 4 h, 8 h, 12 h, and 48 h after the operation [Visual Analogue Scale (VAS) score and comfort level score (BCS)], and the incidence of postoperative additional analgesic drugs and incidence of adverse reactions were compared among the 4 groups. One-way ANOVA was used for comparison of the measurement data among multiple groups, LSD-q test was used for further comparison between groups, and χ2 test was used for the count data. Results The fluctuation ranges of HR and MAP of the observation group 3 and the observation group 2 at T3 and T4 were smaller than those of the observation group 1 and the control group (all P<0.05). The Cdyn in the observation group 3 and the observation group 2 at T2, T3 and T4 were higher than those in the observation group 1 and the control group, while the Ppk was lower than that in the control group, with statistically significant differences (all P<0.05). The serum levels of CXCL13 and IL-6 in the observation group 3 and the observation group 2 were lower than those in the observation group 1 and the control group 2 h, 12 h, and 48 h after the operation, with statistically significant differences (all P<0.05). The VAS scores of the observation group 3, observation group 2, observation group 1, and control group decreased successively, and the BCS scores increased successively 2 h, 4 h, 8 h, 12 h, and 48 h after the operation, with statistically significant differences (all P<0.05). The incidence of postoperative additional analgesic drugs in the observation group 3 was 11.76% (4/34), which was lower than 32.35% (11/34) in the observation group 2, 47.06% (16/34) in the observation group 1, and 52.94% (18/34) in the control group, with a statistically significant difference (P<0.05); there was no statistically significant difference in the incidence of postoperative additional analgesic drugs among the observation group 2, the observation group 1, and the control group (P>0.05). Conclusions 1.0 mg/kg or 1.5 mg/kg of flurbiprofen axetil can reduce the hemodynamic fluctuation during radical resection of cervical cancer, has a good lung protection effect, and can reduce the body's inflammatory response; 1.5 mg/kg of flurbiprofen axetil can provide a better postoperative analgesia effect, reduce additional postoperative analgesic drugs, ensure patients' comfort, with good safety.

Efficacy of letrozole co-treatment with antagonist protocol in PORs during in-vitro fertilization treatment

Sun Yan, Luo Xiaoqing, Yu Fubing, Lai Wenyao, Lin Qianxia

2022, 28(2):  208-211.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.015

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Objective To investigate the efficacy of letrozole co-treatment with antagonist protocol in poor ovarian response (POR) patients under in-vitro fertilization treatment. Methods Twenty-six patients diagnosed with POR at POSEIDON criterion group 3 and 4 in Dongguan Maternal and Child Health Hospital from October 2019 to October 2020 were divided into two groups with the random number table method. The letrozole group was (35.69±4.25) years old with a body mass index (BMI) of (21.21±2.50) kg/m2 ; the control group was (33.15±4.02) years old with a BMI of (21.35±2.16) kg/m2 . The 13 patients in the letrozole group received letrozole 5 mg/d combined with gonadotropin (Gn) (300 U/d) for ovulation induction from the second day of menstrual cycle to night acupuncture day; the 13 patients in the control group received Gn (300 U/d) for ovulation induction from the second day of menstrual cycle to night acupuncture day. In both groups, serum luteinizing hormone (LH), estradiol (E2), and maximal follicular meridian were observed during the process of ovulation induction, adding 0.25 mg/d of cetrorelix acetate powder for injection as antagonist until night acupuncture day as appropriate. After Gn initiation, follicular development and sex hormone changes were monitored by B ultrasound in both groups. When follicles matured, 10 000 U of human chorionic gonadotropin (HCG) was intramuscularly injected, and the oocytes were harvested at 36 h. The total amount of Gn, number of oocytes harvested, number of available embryos, fertilization rate, fresh embryo transplantation rate, and clinical pregnancy rate were compared between the two groups. Independent sample t test was used for measurement data and Fisher exact probability method for count data. Results The total amount of Gn and the number of oocytes harvested in the letrozole group and the control group were (2 930.77±809.78) U, (6.69±3.52), and (2 838.46±538.96) U, (4.92±2.87), respectively, with no statistically significant differences (both P>0.05); the number of available embryos in the letrozole group [(3.00±1.41)] was higher than that in the control group [(1.77±1.01)], with a statistically significant difference (P<0.05). The fertilization rates of the two groups were (82.29±18.74)% and (78.76±26.83)%, respectively, with no statistically significant difference (P>0.05). The fresh embryo transplantation rate of the letrozole group [69.23% (9/13)] was higher than that of the control group [23.08% (3/13)], with a statistically significant difference (P<0.05); the clinical pregnancy rate of the letrozole group [66.67% (6/9)] was higher than that of the control group [33.33% (1/3)], with no statistically significant difference (P>0.05). Conclusion In PORs, the number of oocytes harvested, available embryos, and fresh embryo transplantation rate are significantly increased by letrozole co-treatment during the entire stimulation course.

Level of circulating tumor cells in patients with non-small cell lung cancer and its relationships with tumor markers

Zhao Jiemin , Zuo Wanli , Liao Yuehua

2022, 28(2):  212-214.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.016

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Clinical study on the treatment of traumatic osteomyelitis with soft tissue defect with flap covering, antibiotic bone cement filling, and negative pressure sealing perfusion irrigation

Hu Shurong , Feng Ruiqiang , Rong Yingchao , Huang Junwen , Pan Yuefan , Jiang Rui

2022, 28(2):  215-218.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.017

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Objective To explore the clinical effect of the treatment of traumatic osteomyelitis with soft tissue defect with flap covering, antibiotic bone cement filling, and negative pressure sealing perfusion irrigation. Methods Forty-two patients with traumatic osteomyelitis and soft tissue defect admitted to Jiangmen Second People's Hospital from March 2018 to August 2019 were selected and were divided into a control group (21 cases) and an observation group (21 cases) by the random number table method. There were 13 males and 8 females in the control group, aged (39.75±15.34) years; there were 15 males and 6 females in the observation group, aged (38.80±15.41) years. The control group received conventional flap covering and negative pressure sealing perfusion irrigation, and the observation group received the treatment of flap covering, negative pressure sealing perfusion irrigation combined with antibiotic bone cement filling. Both groups were followed up for one year. The therapeutic effect, surgical effects (operation time, hospital stay, dressing change times, wound healing time, and reactive protein change rate), and bone defect length and soft tissue defect area before treatment and 1, 3, and 6 months after treatment were compared between the two groups. Independent sample t test was used for measurement data, and χ2 test was used for count data. Results The total effective rate of the observation group [90.48% (19/21)] was significantly higher than that of the control group [61.90% (13/21)] (P<0.05). The hospital stay, dressing change times, and wound healing time of the observation group were less than those of the control group, the operation time was longer than that of the control group, and the change rate of reactive protein was significantly higher than that of the control group (all P<0.05). The length of bone defect and the area of soft tissue defect in the observation group were significantly less than those in the control group 1, 3, and 6 months after treatment (all P<0.05). Conclusion The treatment of traumatic osteomyelitis with soft tissue defect with flap covering, antibiotic bone cement filling, and negative pressure sealing perfusion irrigation has significant clinical effect, which can significantly improve the patients' bone defect and soft tissue defect, with postoperative fast recovery and small economic burden, and is worthy of clinical promotion.

Application of self-made single-port laparoscopy with conventional instruments in the treatment of benign ovarian cysts during pregnancy

Zhao Hang, Li Yuping, Wu Junjiao, Huang Xiaolan

2022, 28(2):  219-222.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.018

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Objective To study the safety and feasibility of self-made single-port laparoscopic surgery with conventional laparoscopic instruments in the treatment of benign ovarian cysts during pregnancy. Methods Ten cases of benign ovarian cysts during pregnancy in Department of Gynecology, 73rd Army Hospital of PLA Army from January 2017 to January 2020 were treated with self-made single-port laparoscopic cystectomy. The age was (28.7±3.2) years old, the body mass index (BMI) was (21.39±1.12) kg/m2 , the median cyst diameter was 11 (9-15) cm, and the gestational age was 12+2 -14+3 weeks. Conventional laparoscopic instruments were used during the operation. The operation time, intraoperative blood loss, the Visual Analogue Scale (VAS) score on the first day after the operation, postoperative hospital stay, and pregnancy outcomes were analyzed. Results All the 10 patients completed the operation successfully. There was no cyst content flowing into the abdominal cavity and no conversion to laparotomy or multi-port laparoscopic surgery. The operation time was (80.30±24.33) min, the intraoperative blood loss was (25.00±17.80) ml, and the VAS score on the first day after the operation was (1.50±0.53) points. There was 1 case of threatened abortion after the operation, pregnancy continued after fetal protection treatment, and no other intraoperative or postoperative complications occurred. All the 10 patients delivered smoothly after the operation. Conclusions Self-made single-port laparoscopic surgery with conventional instruments is safe and feasible in the treatment of benign ovarian cysts during pregnancy, with few complications. It has obvious advantages over conventional laparoscopy and laparotomy and is worth popularizing.

Analysis of the results of pulmonary tuberculosis screening in key groups in Haizhu District of Guangzhou City

Wu Xiaoying, Jiang Kunhong, He Gang, Song Tao, Cai Xiaoting, He Liqian

2022, 28(2):  223-228.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.019

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Objective To analyze the situation of tuberculosis screening among key groups in Haizhu District of Guangzhou City between 2016 and 2020 "The 13th Five-Year Plan for Tuberculosis Control", evaluate the effectiveness of tuberculosis prevention and control, and provide scientific basis for formulating tuberculosis prevention and control strategies. Methods By means of retrospective study, sociological and economic evaluation, the screening of family members of patients with etiologically positive tuberculosis, patients above 65 years old, diabetic patients, and close contacts of tuberculosis in schools in Haizhu District of Guangzhou City from January 2016 to December 2020 were analyzed. The count data were compared by χ 2 test. Results (1)A total of 2 911 cases of pulmonary tuberculosis were registered, 8 714 cases of close family contacts were screened, with a screening rate of 99.86%, and the positive rate was 0.24% (21/8 714). The positive rate of pulmonary tuberculosis in subjects with clinical symptoms was higher than that in subjects without clinical symptoms. (2)A total of 8 606 subjects above 65 years old were screened for suspicious symptoms of pulmonary tuberculosis, with a screening rate of 1.26% (8 606/682 011). A total of 10 472 diabetic patients were screened for suspicious pulmonary tuberculosis symptoms, 4 964 cases were screened by chest radiograph, 211 cases of pulmonary tuberculosis were screened out by symptom screening and chest radiograph, with a positive rate of 1.11% (211/19 078). (3)A total of 3 741 cases of pulmonary tuberculosis were screened for human immunodeficiency virus (HIV), 11 cases of them were positive for HIV, with a positive rate of 0.29% (11/3 741). A total of 6 697 HIV infected patients were screened for pulmonary tuberculosis, with a positive rate of 0.82% (55/6 697). (4)A total of 445 cases of pulmonary tuberculosis were enrolled in schools, 14 304 cases of close contact were screened, with a screening rate of 92.53%, 13 cases of pulmonary tuberculosis were screened out, all of them were students, with a positive rate of 0.09% (13/14 304). (5)Results of sociological evaluation: the reported incidence of pulmonary tuberculosis decreased from 78.04/100 000 in 2016 decrease to 53.76/100 000 in 2020. There were 5 697 cases of pulmonary tuberculosis managed by standardized method, with a standardized management rate of 95.76%; 6 015 cases of pulmonary tuberculosis were successfully treated, with a success rate of 95.31%. (6) Results of economic evaluation: a total of 768 lives were saved in disability adjusted life year (DALY) 63 392, and 60 150-90 225 healthy people were protected from tuberculosis infection. It reduced the number of new cases of infectious pulmonary tuberculosis by 3 008-4 512, avoided the loss of new cases by31702-47551,and recovered theloss ofgross domestic product(GDP)by961022.72Yuan. Conclusions The benefits of tuberculosis screening among key groups in Haizhu District of Guangzhou City have been achieved. The mode of active detection of key groups should be promoted, in order to reduce the spread of tuberculosis and accelerate the decline of tuberculosis epidemic.

Analysis on MPT64 protein or antigenic analog secreted by common bacteria of respiratory tract infection

Xu Jieping , Liu Xueling , Huang Tuxing , Chen Longhui , Li Xiuqun , Du Qinglin

2022, 28(2):  228-231.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.020

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Objective To confirm further common bacteria of respiratory tract infection that may secrete MPT64, a special secretion protein of M.tuberculosis, or its antigenic analog, and to provide evidence-based basis for tuberculosis experiment diagnosis. Methods Eighty qualified sputum samples from Qingxin District People's Hospital from March 2019 to December 2020 were selected for culture isolates. According to the bacterial separation time, the samples were divided into a training set sample group (50 strains) and a test set sample group (30 strains). Seven reference strains, including S. aureus (ATCC25923), S. aureus (ATCC29213), E. coli (ATCC25922), E. coli (ATCC35218), P. aeruginosa (ATCC27853), E. faecalis (ATCC29212), and S. maltophilia (ATCC1766), and eighty clinical separation strains from sputum, including K. peumoniae, P. aeruginosa, S.maltophilia, E.coli, S.aureus, A.baumannii, S.epidermidis, P.mirabilis, E.sakazakii, and E. cloacae, were selected as research objects. Their MPT64 in normal saline rinsing fluid of bacteria colony separated from blood culture were detected by the colloidal gold method. The frequency distribution was used to statistically describe the training set sample, test set sample, and all test samples, and the MPT64 positive detection rate was calculated. Results MPT64 was positive in normal saline rinsing fluid of E.faecalis (ATCC29212) among the seven reference strains. Of eighty clinical separation strains, MPT64 was positive in normal saline rinsing fluid of K. peumoniae, P. aeruginosa, S.maltophilia, and S.aureus, and their positive rates were 24.0% (6/25), 15.0% (3/20), 35.7% (5/14), and 40.0% (2/5), respectively. MPT64 from the other strains, including E.coli (9 strains), A. baumannii (3 strains), S. epidermidis (1 strain), P. mirabilis (1 strain), E. sakazakii (1 strain), and E.cloacae (1 strain), were all negative. The overall positive rate of MPT64 was 20.0% (16/80). Conclusions The common bacteria of respiratory tract infection can cause MPT64 detection positive. It is essential that preferred to combine their ordinary bacterial test results for tuberculosis diagnosis and treatment by detecting MPT6 of respiratory samples.

Effect of preoperative body position intervention on patients with closed fractures of the distal tibiofibula

Huang Jieying, Lu Hu, Zhu Jianwei

2022, 28(2):  232-236.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.021

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Objective To explore the effect of body position intervention on detumescence in the preoperative nursing of patients with closed fractures of the distal tibiofibula. Methods A total of 60 patients with closed fractures of the distal tibiofibula who were treated in Guangzhou First People's Hospital from June 2019 to February 2021 were selected as the study subjects, including 39 males and 21 females, aged 18-65 years. The patients were divided into 4 groups (15°, 30°, and 45° plaster splint external fixation group and 30° modified plaster fixation group) according to different elevation angles and plaster fixation methods of the affected limb, with 15 cases in each group. The patients in the 15°, 30°, and 45° plaster splint external fixation group were given different elevation angles of the affected limb after plaster splint external fixation, and the patients in the 30° modified plaster fixation group had plaster fixation to the proximal metatarsal bone. After taking different detumescence nursing methods, the detumescence degree, detumescence time, and pain score of patients in the four groups were observed. The independent sample t test and one-way ANOVA were used for the measurement data among groups, and χ2 test was used for the count data. Results The preoperative detumescence time of the 15°, 30°, and 45° plaster splint external fixation group were (6.60±0.74) d, (5.73±0.46) d, and (5.67±0.69) d, respectively, with a statistically significant difference (F=3.43, P=0.04); the preoperative detumescence time of the 30° modified plaster fixation group was (4.53±0.52) d, and there was a statistically significant difference compared with the 30° plaster splint external fixation group (t= 6.69, P<0.05). The swelling degrees of the affected limb of the four groups reached the highest value about 2 days after admission, which were (5.30±0.79) cm, (4.98±0.56) cm, (5.09±0.62) cm, and (4.90±0.60) cm, respectively. Compared with elevating the affected limb 15° and 45°, elevating the affected limb 30° had the advantages of faster and better swelling resolution, better pain improvement, and better comfort of the affected limb. At the same time, modified foot plaster fixation and increased foot movement could further promote detumescence treatment. Conclusion Elevating the affected limb 30° and modified plaster fixation can effectively reduce the swelling degree of the affected limb and the degree of pain in the preoperative detumescence of the affected limb of patients with closed fractures of the distal tibiofibula.

Atrial autonomic neural remodeling and the effects of statins in atrial fibrillation

Li Wenlei , Huang Jie , Zhang Bei

2022, 28(2):  237-240.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.022

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Atrial fibrillation (AF) is one of the most common rapid arrhythmia, which can cause various complications, including thromboembrays, heart failure, cognitive dysfunction, etc, severely threatening human health. Studies have indicated that the autonomic neural remodeling, electrical remodeling, and atrial structure remodeling are involved in the occurrence of AF. In particular, the intrinsic autonomic neural remodeling plays an important role in the development of AF, but its intrinsic mechanism is still unclear. At present, the prevention and treatment effects of statins on arrhythmia have become hot spots of research. Statins can improve atrial structural remodeling after heart failure and over distribution of sympathetic nerves after myocardial infarction, but also have prevention and treatment effects on atrial arrhythmias such as atrial fibrillation. However, the mechanism of statins has not been fully clarified. This article mainly reviewed the relationship between atrial autonomic neural remodeling and AF, as well as the effects of statins on atrial autonomic neural remodeling and AF, to provide references for the clinical treatment of AF.

Application value of ultrasonography in the diagnosis and clinical classification of appendicitis in children

Wang Xiaoping, Yan Xiaoqiang

2022, 28(2):  241-243.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.023

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Objective To explore the value of ultrasonography in the diagnosis and clinical classification of appendicitis in children. Methods This study was a retrospective study. Eighty children with suspected appendicitis admitted to Pingxiang Maternal and Child Health Hospital from June 2015 to December 2020 were included, including 47 boys and 33 girls, with an age of (6.35±2.48) years old. All children were examined by ultrasound. The results of surgical pathology and ultrasonography were compared. χ2 test was used to evaluate the accuracy of diagnosis. Results Of the 80 children, 79 cases (98.75%) were diagnosed by surgical pathology, and 74 cases (92.50%) were diagnosed by ultrasound. There was no statistically significant difference between the results of ultrasonic diagnosis and surgical pathology (χ2 =3.754, P=0.053). Conclusion Ultrasonography has significant clinical application value in the diagnosis and clinical classification of appendicitis in children, which can provide a reliable reference for clinical disease diagnosis and later treatment.

Treatises

Comparative study on the application of fiber and electronic flexible ureteroscopes in urological surgeries

Zhang Min, Li Fangfang, Deng Biyi, Feng Qiuxia, Sun Hongling

2022, 28(2):  244-247.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.024

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Objective To compare and analyze the application of electronic flexible ureteroscope and fiber flexible ureteroscope in urological surgeries, in order to maximize their performance. Methods A retrospective analysis was conducted on the maintenance of 7 Olympus flexible ureteroscopes purchased in the Operating Room, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2018. At the same time, the efficacies of electronic flexible ureteroscope (URF-V1, SN: 2240126) and fiber flexible ureteroscope (URF-P5, SN: 2344111), which were used by the same doctors at the same time, were retrospectively analyzed in terms of the causes, locations, and times of failures. URF-V1 (SN: 2240126) was used for 407 times, including 277 male cases and 130 female cases, with an average age of 48.93 years old; URF-P5 (SN:2344111) was used for 556 times, including 333 male cases and 223 female cases, with an average age of 49.21 years old. The cost of fiber and electronic flexible ureteroscopes in surgeries was calculated. Independent sample t test was used for the measurement data, and χ2 test was used for the count data. Results The flexible ureteroscopy was successfully performed in urological surgeries using URF-V1 (SN: 2240126) or URF-P5 (SN: 2344111). The intraoperative performance of lens was stable, the imaging effect was clear, and the doctors were satisfied with the effect. In the analysis of the failure maintenance report, it was found that water leakage of flexible ureteroscope was the most common failure reason, accounting for 56.5% (26/46) of all failure reasons, and water leakage of insertion channel accounted for 69.2% (18/26). In terms of surgery cost, URF-V1 (SN: 2240126) failed for 8 times, 1 times of maintenance every 51 times of usage, and the cost of each surgery was about 5 020 Yuan; URF-P5 (SN: 2344111) failed for 15 times, 1 times of maintenance every 37 times of usage, and the cost of each surgery was about 2 190 Yuan. Conclusions Both electronic and fiber flexible ureteroscopes are safe and effective methods for urinary surgeries. Electronic flexible ureteroscope has high resolution of image quality, easy operation, and good durability, with high safety especially for biopsy operations for urinary tumors. Fiber flexible ureteroscope has a thinner lens and lower cost, which can meet the needs of urinary calculi surgery.

Influencing factors of high on-treatment platelet reactivity after coronary artery bypass grafting

Zhang Binbin

2022, 28(2):  247-250.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.025

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Objective To study the related influencing factors of high on-treatment platelet reactivity (HTPR) in patients after coronary artery bypass grafting (CABG) in order to provide references for postoperative drug application. Methods A total of 144 patients who successfully completed CABG and were treated with clopidogrel and aspirin after surgery in The First Affiliated Hospital of Henan University of Science and Technology from January 2017 to June 2020 were selected as the research subjects, including 110 males and 34 females, aged (55.85± 7.18) years. The clinical data of all patients were collected. According to the inhibition rate of platelet aggregation, they were divided into a normal on-treatment platelet reactivity (NTPR) group (116 patients) and a HTPR group (28 patients). Independent sample t test was used for comparison of the measurement data between groups, χ2 test or Fisher's exact probability method was used for comparison of the count data between groups, and univariate and multivariate analysis were used to screen the possible risk factors of HTPR in patients. Results The age of patients undergoing CABG was significantly different between the two groups (χ2 =19.153, P<0.001). The preoperative serum creatinine level in the HTPR group was (74.52±9.84) μmol/L, which was lower than that in the NTPR group [(83.68±13.47) μmol/L], with a statistically significant difference (P<0.05). There were statistically significant differences in the operation time and 24 h drainage volume between the two groups (χ2 =8.329, 12.758, both P<0.05). The blood clot motility (K) and blood clot intensity (MAADP) of the HTPR group were (1.50±0.37) min and (49.84±6.28) mm, respectively, which were higher than those of the NTPR group [(1.21±0.24) min and (37.54±5.41) mm]; the blood clot dynamics (Alpha), blood clot intensity (MAthrombin), coagulation composite index (CI), and the inhibition rate of arachidonic acid (AA) were (69.47±2.41)° , (64.24±2.51) mm, (1.85±0.54), and (63.28±18.63)% , respectively, which were lower than those of the NTPR group [(72.85±2.31)° , (66.86±2.74) mm, (2.97±0.92), and (79.74±16.59)%], with statistically significant differences (all P<0.05). Multivariate analysis showed that age, gender, AA inhibition rate, and serum creatinine were risk factors for HTPR (all P<0.05). Conclusion Age, gender, AA inhibition rate, and serum creatinine are risk factors for HTPR in patients after CABG, and corresponding prevention should be carried out to reduce the risk of HTPR in patients.

Clinical Research

Clinical efficacy observation on acupoint intradermal acupuncture combined with Yaotongning capsules in the treatment of elderly patients with chronic low back pain

Li Ling , Ding Yuanzhen , Shi Tingqi

2022, 28(2):  251-255.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.026

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Objective To explore the clinical efficacy of acupoint intradermal acupuncture combined with Yaotongning capsules in the treatment of elderly patients with chronic low back pain. Methods A total of 120 elderly patients with chronic low back pain accepted by the Department of Traditional Chinese Medicine of Feixian People's Hospital of Linyi City from May 2019 to December 2020 were divided into a control group and an observation group with the random number table method, 60 cases in each group. There were 28 males and 32 females in the control group, with an age of (68.42±6.09) years old; there were 26 males and 34 females in the observation group, with an age of (68.05±6.26) years old. The control group was treated with Yaotongning capsules orally on the basis of life guidance and exercise guidance; the observation group was treated with acupoint intradermal acupuncture combined with Yaotongning capsules. The course of treatment was 2 weeks.After 1 course, the efficacy, the scores of Numerical Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) lumbar spine scores before and after the treatment were compared between the two groups. Independent sample t test was used for inter-group comparison of the measurement data, paired t test was used for intra-group comparison of the measurement data, and χ2 test was used for the count data. Results The total effective rate of the observation group was higher than that of the control group [91.67% (55/60) vs. 76.67% (46/60)], with a statistically significant difference (χ2 =5.065, P<0.05). After the treatment, the NRS scores of waist and legs in the two groups were lower than those before the treatment, and the NRS scores of waist and legs in the observation group were (2.95±0.73) points and (3.03±0.78) points, respectively, lower than (3.54±0.92) points and (3.69±0.95) points in the control group, with statistically significant differences (all P<0.05). The scores of subjective symptoms, clinical symptoms, limit of daily activities, and bladder function of JOA lumbar spine score in the two groups after the treatment were all higher than those before the treatment, and the scores of subjective symptoms, clinical symptoms, limit of daily activities, and bladder function in the observation group after the treatment were (6.30±0.65) points, (5.25± 1.04) points, (11.08±1.54) points, and (-1.02±0.21) points, respectively, higher than (5.63±0.74) points, (4.76±0.93) points, (9.81±1.61) points, (-1.33±0.28) points in the control group, with statistically significant differences (all P<0.05). Conclusion Acupoint intradermal acupuncture combined with Yaotongning capsules in the treatment of elderly patients with chronic low back pain can reduce the pain degree, improve the lumbar function, and improve the treatment efficiency.

Value of color Doppler ultrasound in the diagnosis of ureteral calculi in different parts in emergency

Liu Meijuan , Sun Jianglian , Gao Yuxing , Zhang Jihong

2022, 28(2):  255-257.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.027

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Objective To investigate the diagnostic value of color Doppler ultrasound in ureteral calculi in different parts in emergency. Methods A total of 246 cases of ureteral calculi in emergency admitted to Chashan Hospital of Dongguan between January 2019 and December 2020 were selected as the research objects, including 142 males and 104 females, aged (46.62±3.77) years. They all received routine ultrasound examination and color Doppler ultrasound examination. The calculus detection rates of different parts of the ureter of the two methods were compared. The count data were compared by χ2 test. Results The detection rates of calculi and hydronephrosis by color Doppler ultrasound were 98.47% (258/262) and 98.70% (152/154), respectively, which were significantly higher than those by conventional ultrasound [90.08% (236/262) and 93.51% (144/154)], with statistically significant differences (both P<0.05). The detection rates of upper ureteral calculi by conventional ultrasound and color Doppler ultrasound were both 100.00% (101/101), with no statistically significant difference (P>0.05). The detection rates of middle and lower ureteral calculi, left and right ureteral calculi by color Doppler ultrasound were 98.77% (80/81), 96.25% (77/80), 98.41% (124/126), and 98.53% (134/136), respectively, which were significantly higher than those by conventional ultrasound [80.25% (65/81), 87.50% (70/80), 91.27% (115/126), and 88.97% (121/136)], with statistically significant differences (all P<0.05). Conclusion Strengthening the application of color Doppler ultrasound in the diagnosis of ureteral calculi in emergency can achieve accurate detection of calculi in different parts, especially for the diagnosis of middle and lower ureteral calculi, and is not affected by the left and right sides of the ureter, worthy of promotion. 

Nursing Research

Application of Self-rating Anxiety Scale in the follow-up for patients after transurethral resection of the prostate

Jiang Tao, Ding Yalan, Gao Jing, Chen Xuelian, Zhan Hailun

2022, 28(2):  258-261.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.028

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Objective To assess the change of anxiety state of patients after transurethral resection of the prostate during the follow-up with the Self-rating Anxiety Scale (SAS), and provide a basis for formulating reasonable psychological interventions. Methods This was a prospective observational research. Patients with benign prostatic hyperplasia who were admitted to the Department of Urology of Lingnan Branch, The Third Affiliated Hospital of Sun Yat-sen University from January to June 2020 were selected as the subjects, and 32 patients who underwent transurethral resection of the prostate were subjected to SAS evaluation before surgery, at discharge, 1 week after discharge, 2 weeks after discharge, and 1 month after discharge. Additionally, International Prostate Symptom Score (IPSS) and quality of life (QOL) score were collected at the same time. The scores of each scale before and after treatment were statistically analyzed by ANOVA, and the relationships between SAS score, IPSS score, and QOL score were analyzed by Pearson correlation analysis. Results The age of included patients was (60.0±1.6) years old, the prostate volume was (51.5±4.2) ml, and the post-voiding residual volume (PVR) was (93.6±50.1) ml. The SAS, IPSS, and QOL scores 1 month after operation were significantly lower than those before operation [(29.3±3.3) points vs. (46.5±3.8) points, (7.5±3.0) points vs. (22.3±1.9) points, (0.9±0.6) points vs. (4.0±0.6) points], with statistically significant differences (all P<0.05). There was a significant linear correlation between SAS score and IPSS score (r 2 =0.683, P<0.05). Conclusion The SAS can effectively assess the change in the anxiety state of patients after transurethral resection of the prostate, and provides a scientific basis for reasonable psychological intervention.

Effect of three different suction pressures on the amount of aspirated secretions in patients with endotracheal intubation

Ning Fei

2022, 28(2):  261-265.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.029

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Application of health education pathway based on empowerment theory in patients discharged with biliary drainage tube after percutaneous transhepatic one-step biliary fistulation

Wu Dongling, Liu Wanming, Cai Yinyan, Liu Lin

2022, 28(2):  266-269.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.030

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Objective To explore the application effect of health education pathway based on empowerment theory in patients discharged with biliary drainage tube after percutaneous transhepatic one-step biliary fistulation (PTOBF). Methods The purpose sampling method was adopted. A total of 86 patients discharged with biliary drainage tube after PTOBF in The First Affiliated Hospital of Guangzhou Medical University from January to December 2019 were selected and were divided into an experimental group and a control group according to the time of admission, with 43 cases in each group. In the control group, there were 14 males and 29 females, with an age of (53.50±12.35) years old; there were 16 males and 27 females in the experimental group, with an age of (52.50±11.26) years old. The control group received routine health education, and the experimental group received health education pathway based on empowerment theory. The self-care ability, biliary drainage tube self-management behavior, satisfaction, and indwelling biliary drainage tube related complications within 1 month in the two groups were evaluated by Self-Care Ability Measurement Scale, Biliary Drainage Tube Self-Management Behavior Questionnaire, and Patient Satisfaction Questionnaire. The independent sample t test was used for comparison of the measurement data between groups, and χ2 test was used for comparison of the count data between groups. Results After the intervention, the score of self-care ability in the experimental group was (124.74±4.09), which was significantly higher than (110.81±4.45) in the control group; the scores of biliary drainage tube self-management behavior and satisfaction of the experimental group were (5.28±0.91) and (95.80 ±2.37), which were higher than (4.09±1.27) and (91.70 ±4.15) in the control group, with statistically significant differences (all P<0.05). The total incidence of biliary drainage tube blockage, unplanned extubation, infection of biliary tract in the observation group was 9.3% (4/43), which was lower than 25.58% (11/43) in the control group, with a statistically significant difference (P<0.05). Conclusions Health education pathway based on empowerment theory can reduce the incidence of biliary drainage tube related complications in patients discharged with biliary drainage tube after PTOBF, improve the patients' self-management behavior, and improve their satisfaction.

Meta-analysis of patient-related factors of medical adhesive related skin injury in ICU

Pan Chunliu, Huang Zhihua

2022, 28(2):  270-277.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.031

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Objective To investigate the patient-related factors of medical adhesive related skin injury (MARSI) in ICU. Methods The domestic and foreign literature database service systems were searched by the computer for literatures on the patient-related factors of MARSI in ICU, such as foreign PubMed, Web of Science, and ProQuest, and domestic CnKI, China Biomedical Literature Service System, Wanfang Data Paper Retrieval System, Baidu Academic, and VIP, from the establishment of the database to September 2020. Appropriate literatures were selected, the data of the literatures were extracted, and the quality evaluation was carried out. Meta-analysis was conducted by RevMan 5.3 and SPSS 22.0 software. The effect statistics of dichotomous variables were in the form of odds ratio (OR), weighted mean difference was selected for continuity variables, and 95% confidence interval (95%CI) was used for interval estimation. Results A total of 7 literatures with 2 967 patients were included, including 1 English article and 6 Chinese literatures, 6 experimental studies and 1 cross-sectional study. Meta-analysis results showed that age, body mass index (BMI), state of consciousness, fever, dry skin, skin moisture, skin edema, history of allergy, serum albumin level, low Barden /Waterlow score, and the score of Acute Physiology and Chronic Health Evaluation Scoring System (APACHE Ⅱ) higher than 10 points were all patient-related factors of MARSI in ICU (all P<0.01). Conclusion The incidence of MARSI in ICU is high, which is caused by a variety of factors. As internal factors of MARSI, patient-related factors need to be attached great importance to by medical staff.

Analysis of comprehensive nursing intervention in patients with acute renal failure

Zhou Shanshan , Wu Zhidan

2022, 28(2):  278-280.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.032

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Research progress of the assessment tools for fear of complications in diabetic patients

Dai Yu , Guo Jia , Yin Chongwang , Mao Xia , Liu Yangchun

2022, 28(2):  280-283.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.033

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We review the main content, reliability, validity, application, and limitations of the assessment tools for fear of complication in diabetic patients at home and abroad, so as to provide a reference for the development of assessment tools for fear of complication of diabetic patients in China and provide some useful information about the research on fear of complications of diabetic patients.

Analysis of Helicobacter pylori infection and related factors among public officials in Guangzhou

Guan Ruoping, Dai Guokui, Jiang Guli, Li Yue, Xu Yan

2022, 28(2):  284-287.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.034

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Objective To analyze the Helicobacter pylori (Hp) infection and related influencing factors among public officials in Guangzhou, so as to provide decision-making basis for the scientific prevention and treatment of Hp. Methods The physical examination data of 6 436 public officials in Guangzhou who underwent physical examination and 13C urea breath test in Guangzhou Cadre Health Management Center from January to December 2020 were collected and analyzed retrospectively, including 3 535 males and 2 901 females, aged (45.33±11.38) years. The situation of Hp infection and the relationships between Hp infection and gender, age, body mass index (BMI), blood pressure, blood glucose, blood lipid, urea, creatinine, uric acid, and other factors were analyzed by Chi square test and binary logistic regression analysis. Results The infection rate of Hp was 30.53% (1 965/6 436) among 6 436 subjects, of which the male infection rate was 31.40% (1 110/3 535), and the female infection rate was 29.47% (855/2 901). The positive rates of Hp in males and females were 32.27% (384/1 190) and 27.06% (204/754) in the 40-49 years old group, respectively, with a statistically significant difference (P=0.015); there was no statistically significant difference in the positive rate of Hp between males and females in the other age groups (P>0.05). The male and female BMI of the Hp positive group were (24.86±2.94) kg/m2 and (22.42±2.81) kg/m2 , respectively, which were higher than those of the Hp negative group [(24.65±2.82) kg/m2 and (22.19±2.87) kg/m2 ]; the diastolic blood pressure and triglyceride in the male Hp positive group were (74.75±10.20) mmHg (1 mmHg=0.133 kPa) and (1.74±1.62) mmol/L, respectively, which were higher than those in the Hp negative group [(74.02±9.89) mmHg and (1.60±1.58) mmol/L]; the level of uric acid in the female Hp positive group was (326.22±76.27) μmol/L, which was higher than that in the Hp negative group [(318.54±71.84) μmol/L], with statistically significant differences (all P< 0.05). Multivariate logistic regression analysis showed that Hp infection had no correlation with gender, age, BMI, blood pressure, blood glucose, blood lipid, or uric acid (all P>0.05), but blood urea (OR=0.920, P<0.01) and creatinine (OR=1.007, P<0.05) were affected. Conclusions There are no significant gender or age differences in the infection rate of Hp among public officials in Guangzhou, and there are no significant differences in the metabolic indexes among Hp infected population, but the blood urea level and creatinine level are affected.

Summary

Research progress of hypoxia-inducible factor-1ɑ in ischemic heart disease

Zhai Miaobo, Du Xin, Dong Binchang, Xu Huipu

2022, 28(2):  288-292.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.035

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Hypoxia-inducible factor-1 (HIF-1), a heterodimer consisting of alpha and beta subunit, is induced by hypoxia and expressed in a variety of cells. The alpha subunit of HIF-1 is the active one, which plays a key role in response of cells to hypoxia. Current studies have shown that pathology and physiology of myocardial metabolism, myocardial protection, angiogenesis, and atherosclerosis are all implicated with HIF-1ɑ. These lead to the suggestion that HIF-1ɑ can be a target for effective myocardial protection therapy. Meanwhile, our previous studies have indicated that expression of HIF-1ɑ is up-regulated in the early stage of acute myocardial infarction, implying that HIF-1ɑ can be a potential cardiac marker and serves as an auxiliary index of the diagnosis of acute myocardial infarction.

Application of target training in a sterile and supply center

Wei Qiong , Lin Xiaozhu , Zheng Yunci , Xie Man

2022, 28(2):  293-295.  DOI: 10.3760/cma.j.issn.1007-1245.2022.02.036

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Objective To explore the effect applying the target training method in equipment training of staff at a sterile and supply center. Methods This was a random control trial. Twenty females who worked at Sterile and Supply Center, Jieyang People's Hospital from April to July 2021 and were 33-45 years old were selected as the training objects, and were divided into a control group and an observation group by the random number table method, with 10 in each group. The control group were traditionally trained, and the observation group took target training. After the training, the examination results of operation skills, training satisfaction, washing quality, and qualified rates of packing laparoscopic instruments were compared between the two groups. The measurement data of normal distribution were expressed as (xˉ ± s) and compared between these two groups by independent-sample t test. The enumeration data were expressed as cases (%) and compared between these two groups by χ2 test. If P＜0.05, there is a statistical difference. Results The examination result, training satisfaction, washing quality, and qualified rate of packing quality of the basic laparoscopic instruments in the observation group were all significantly higher than those in the control group [(90.2±6.1) vs. (77.0±7.5), (90.0±6.0) vs. (72.1±9.8, 487 (97.4%) vs. 453 (90.6%), and 492 (98.4) vs. 472 (94.4)], with statistical differences (all P＜0.05). Conclusion The application of target training in the equipment training of staff at a sterile and supply center can effectively improve their examination results and training satisfaction, the washing quality, and the qualified rate of the laparoscopic basic instrument package, and ensure patients' safety.