Table of Content

01 March 2023, Volume 29 Issue 5

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New Medical Advances

Research status of RAS/ERK signaling pathway in neurofibromatosis

Fu Zhixiong, Zhang Ancheng, Yang Yongjian, Guo Weitao

2023, 29(5):  593-597.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.001

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Neurofibromatosis (NF) is a hereditary disease involving the nervous tissues of the central and peripheral nervous systems, which can be classified as neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and Schwannomatosis (SWN). Previous studies have shown that rat sarcoma protein/extracellular signal-regulated protein kinase (RAS/ERK) signaling pathway is abnormally expressed in many types of tumor tissues. At the same time, our research group has also found similar results in the preliminary experimental studies of familial NF. In order to further explore the link between RAS/ERK signaling pathway and NF, this paper reviews the current research status of RAS/ERK signaling pathway in NF.

Research progress of endovascular repair for abdominal aortic aneurysm of short neck

Xue Ming, Xia Linshuxin, Jin Xing

2023, 29(5):  597-601.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.002

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In recent ten years in China, the increasing demand of endovascular repair for abdominal aortic aneurysm (AAA) has aroused wide concern from clinicians and patients. However, effective repair methods for "complex" aneurysms with complex anatomical structures and different lengths and angles of tumor neck or graft border riveting areas have not been fully studied. In addition, the specific role of endovascular repair technique in the emergency repair of complex aneurysms remains unclear. As a result, many advanced endovascular technologies and devices have been developed to circumvent these problems. These include fenestrated and customized fenestrated grafts; snorkeling programs such as chimney, periscope, and sandwich techniques; branch support device, etc. This paper describes the current use of endovascular repair techniques for complex short cervical AAA and the advantages and disadvantages of each technique.

Research status of wrist-ankle acupuncture in the treatment of acute mastitis pain

Xiao Jingfei, Cui Chenhui, Du Qiaoting

2023, 29(5):  601-605.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.003

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Acute mastitis is one of the common diseases in primipara during the lactation, which belongs to the category of "breast carbuncle" in traditional Chinese medicine. It has a high incidence, rapid progression, and severe pain symptoms, which affects breastfeeding. Wrist-ankle acupuncture is a special acupuncture therapy discovered by Professor Zhang Xinshu in the 1970s. It can significantly reduce the breast pain, promote the milk secretion, and reduce the complications in patients with acute mastitis. In this study, the relevant literatures about the treatment of acute mastitis by wrist-ankle acupuncture in recent years are analyzed and summarized, and the mechanism of pain relief by wrist-ankle acupuncture and the analgesic effect of the current clinical application of wrist-ankle acupuncture are briefly summarized, in order to provide evidences and references for the clinical application of wrist-ankle acupuncture in pain relief.

Meta Analysis

Diagnostic value of serum thymidine kinase 1 in Chinese population with primary liver cancer: a meta-analysis

Pi Airong, Peng Wei

2023, 29(5):  606-613.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.004

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Objective　To evaluate the diagnostic value of serum thymidine kinase 1 (TK1) in Chinese population with primary liver cancer (PLC) by a meta-analysis. Methods　Literatures about serum TK1 for diagnosing Chinese population with PLC were obtained through searching internet databases. The quality of included literatures was evaluated. Meta-analysis was employed by Stata 17.0. The deadline for literature publishing was August 31, 2022. Results　Totally 22 literatures were included. The results of meta-analysis showed that the sensitivity (SE) and specificity (SP) of TK1 for the diagnosis of PLC were 0.73 (95%CI 0.67-0.78, P<0.05) and 0.89 (95%CI 0.85-0.92, P<0.05), the positive likelihood ratio (PLR) was 6.47 (95%CI 4.76-8.80, P<0.05), the negative likelihood ratio (NLR) was 0.31 (95%CI 0.25-0.37, P<0.05), the diagnostic odds ratio (DOR) was 21.22 (95%CI 13.42-33.55, P<0.05), and the area under the summary receiver operating characteristic curve (SROC-AUC) was 0.88 (95%CI 0.85-0.91, P<0.05). The SE of the combination of TK1, alpha-fetoprotein (AFP), and Dickkopf-1 (DKK1) in the diagnosis of PLC was 0.88 (95%CI 0.85-0.90, P<0.05), the SP was 0.91 (95%CI 0.89-0.93, P<0.05), the PLR was 9.89 (95%CI 6.72-14.57, P<0.05), the NLR was 0.11 (95%CI 0.05-0.23, P<0.05), the DOR was 94.52 (95%CI 35.02-255.09, P<0.05), and the AUC was 0.97 (95%CI 0.63-0.99, P<0.05). The Youden index of combined diagnosis was 0.79, which was higher than 0.66 of TK1 alone. Conclusions　The SE of serum TK1 alone as a diagnostic index of PLC in Chinese population is fair, with a high SP, so it has a certain diagnostic value. The diagnostic value of TK1 combined with AFP and DKK1 is higher.

Scientific Research

Analysis of isoniazid-resistant gene mutations in 380 strains of Mycobacterium tuberculosis in South China

Deng Li, Wang Nan, Lei Jie, Niu Qun, Wu Ling, Gong Lan, Xie Bei, Wang Qi, Li Hua, Yang Yu, Liu Zhihui, Meng Fanrong

2023, 29(5):  614-618.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.005

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Objective　To explore the mutation characteristics of five genes (katG, mabA-inhA, oxyR-ahpC, kasA, and ndh) related to isoniazid resistance of Mycobacterium tuberculosis in clinical isolates in South China. Methods　A total of 380 clinical isolates of Mycobacterium tuberculosis from tuberculosis patients in South China which were sampled from the bio-bank of Mycobacteria in Guangzhou, including 236 isoniazid resistant strains and 144 isoniazid sensitive strains. The 5 isoniazid resistant gene fragments of 380 clinical isolates of Mycobacterium tuberculosis were sequenced and analyzed. Results　Twenty-nine gene mutation types at 26 sites in the isoniazid-resistant strains and 17 gene mutation types at 16 sites in the isoniazid-sensitive strains were found respectively. The most common mutations were 315AGC(S)→ACC(T) of katG and -15T→C of mabA-inhA, with the incidences of 48.73%(115/236), 17.37%(41/236), 9.72%(14/144), and 9.72%(14/144), respectively. Five mutations at 3 sites, 5 mutations at 5 sites, 13 mutations at 11 sites, 6 mutations at 6 sites, and 11 mutations at 11 sites were found in katG, mabA-inhA, oxyR-ahpC, kasA, and ndh, respectively. The incidences of five gene mutations in the isoniazid-resistant strains were 52.12%(123/236), 22.46%(53/236), 5.93%(14/236), 1.69%(4/236), and 2.54%(6/236) respectively, while those in the isoniazid-sensitive strains were 11.11%(16/144), 11.11%(16/144), 4.17%(6/144), 1.39%(2/144), and 3.47%(5/144), respectively. The incidences of no gene mutation, single gene mutation, and double gene mutations or more were 27.12% (64/236), 61.44% (145/236), and 11.44% (27/236) in the isoniazid-resistant strains and 76.39% (110/144), 21.53% (31/144), and 2.08% (3/144) in the isoniazid-sensitive strains. Conclusions　The gene mutation of isoniazid-resistant Mycobacterium tuberculosis in South China has its characteristics. It is essential to be studied further on the high gene mutation rate in isoniazid-sensitive strains.

Application of 3D-ASL combined with 3D-TOF MRA in evaluating cerebral perfusion after unilateral internal carotid artery occlusion

Zhou Jianguo, Fu Dayong, Lu Mingcong, Meng Yun

2023, 29(5):  619-622.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.006

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Objective　To analyze the application value of magnetic resonance three-dimensional artery spin labeling (3D ASL) combined with three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) in evaluating the cerebral perfusion status after unilateral internal carotid artery (ICA) chronic occlusion. Methods　A retrospective study was conducted on 40 patients with unilateral ICA occlusion admitted to the Department of Encephalopathy of Nanjing University of Chinese Medicine Affiliated Lianyungang Hospital from January 2018 to March 2022, including 24 males and 16 females, with an age of (52.4±16.9) years old. Routine MRI sequence, 3D ASL, and 3D TOF MRA sequence were performed for all patients, with the 3D ASL post label delay (PLD) of 2 525 ms. According to whether the anterior communicating artery (ACoA) and posterior communicating artery (PCoA) were opened and whether the anterior cerebral artery (ACA) and posterior cerebral artery (PCA) were laterally dominant howed by the 3D TOF MRA sequence, they were divided into a collateral circulation group and a control group. The cerebral blood flow (CBF) values of frontal lobe, parietal lobe, temporal lobe, paraventricular white matter area, and basal ganglia area were measured by CBF pseudo color map. Two independent sample t-test was performed. Results　Among the enrolled patients, there were 22 cases of left ICA occlusion and 18 cases of right ICA occlusion. The CBF values of frontal lobe, parietal lobe, temporal lobe, paraventricular white matter area, and basal ganglia area in the collateral circulation group were (42.14±6.75) ml/min×100 g, (41.47±6.91) ml/min×100 g, (42.85±7.14) ml/min×100 g, (36.82±7.06) ml/min×100 g, and (37.87±7.25) ml/min×100 g, which were higher than those in the control group [(32.09±7.25) ml/min×100 g, (31.16±7.32) ml/min×100 g, (32.53±7.56) ml/min×100 g, (29.37±6.27) ml/min×100 g, and (28.45±6.87) ml/min×100 g], with statistically significant differences (all P<0.05). Conclusion　3D ASL combined with 3D TOF MRA can be used to evaluate the establishment of collateral circulation and cerebral perfusion after unilateral ICA occlusion, and can provide imaging basis for patients' clinical treatment options and prognosis evaluation.

Relationships between carotid artery and cardiac ultrasonography indexes and risk of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes mellitus

Zhao Yao, Wu Hong

2023, 29(5):  623-627.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.007

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Objective　To explore the relationships between carotid artery and cardiac ultrasonography indexes and risk of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes mellitus (T2DM). Methods　The clinical data of 180 T2DM patients who were examined and treated in Bayannur Hospital from September 2019 to December 2021 were selected. Following up for one year, 30 patients suffered from cardiovascular and cerebrovascular events, and 180 T2DM patients were divided into an event group (30 cases) and an event free group (150 cases). The general data [age, gender, body mass index (BMI), blood glucose, blood lipids, blood pressure, smoking, drinking, and drug use] were collected. The carotid intima-media thickness (IMT), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular ejection fraction (LVEF) were examined. The total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), homocysteine (Hcy), and N-terminal probrain natriuretic peptide (NT-proBNP) were measured. Logistic regression analysis was used to screen the risk factors of cardiovascular and cerebrovascular diseases in T2DM patients. χ² test and independent sample t test were used. Results　The smoking rate in the event group was 86.7% (26/30), the BMI was (27.1±3.8) kg/m², the systolic blood pressure (SBP) was (149.7±15.3) mmHg (1 mmHg=0.133 kPa), the diastolic blood pressure (DBP) was (95.1±11.8) mmHg, the non-HDL-C was (6.63±2.21) mmol/L, the NT-proBNP was (542.38±56.73) ng/L, the Hcy was (25.43±5.69) μmol/L, the proportion of antihypertensive drugs used was 36.7% (11/30), the proportion of statins used was 23.3% (7/30), and the differences were statistically significant compared with those in the event free group [30.0% (45/150), (24.9±3.7) kg/m², (137.9±14.9) mmHg, (89.6±8.7) mmHg, (4.42±1.39) mmol/L, (376.51±34.06) ng/L, (13.22±2.31) μmol/L, 60.0% (90/150), and 45.3% (68/150)] (χ²=33.609, P<0.001; t=2.960, P=0.003; t=3.942, P<0.001; t=2.425, P=0.020; t=5.273, P<0.001; t=15.467, P<0.001; t=11.564, P<0.001; χ²=5.527, P=0.019; χ²=4.978, P=0.026). The detection rate of carotid plaque in the event group was 56.7% (17/30), the LVEDD was (59.1±7.2) mm, the LVESD was (45.3±9.4) mm, the LVEF was (44.1±8.2) %, and the differences were statistically significant compared with those in the event free group [33.3% (50/150), (50.8±5.3) mm, (38.3±1.3) mm, and (47.7±6.3) %] (χ²=5.825, P=0.016; t=6.026, P<0.001; t=4.071, P<0.001; t=2.274, P=0.029). Logistic regression analysis showed that smoking (P<0.001), BMI (P=0.014), SBP (P=0.003), DBP (P=0.014), carotid plaque detection rate (P=0.003), use of antihypertensive drugs (P=0.016), use of statins (P=0.019), LVEDD (P=0.011), LVESD (P=0.031), LVEF (P=0.024), non-HDL-C (P<0.001), NT-proBNP (P=0.004), and Hcy (P=0.002) were independent risk factors for cardiovascular and cerebrovascular events in T2DM patients. Conclusion　 Smoking, BMI, SBP, DBP, carotid plaque detection rate, use of antihypertensive drugs, use of statins, LVEDD, LVESD, LVEF, non-HDL-C, NT-proBNP, and Hcy were all independent risk factors for cardiovascular and cerebrovascular events in patients with diabetes.

Application value analysis of ultrasound in the closure of left axillary patent ductus arteriosus guided by transesophageal ultrasound

Zuo Bianjing, Zhai Bo, Song Qiong

2023, 29(5):  628-631.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.008

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Objective　To analyze the application value of ultrasound in the closure of left axillary patent ductus arteriosus (PDA) guided by transesophageal ultrasound. Methods　A total of 42 cases of children with PDA in Children's Hospital Affiliated to Zhengzhou University from January 2020 to January 2022 were retrospectively analyzed. There were 19 males and 23 females, aged (2.62±0.58) years. All of them were examined by transesophageal ultrasound to determine whether the closure of left axillary PDA could be performed or not. The surgical conditions, ultrasound guidance conditions, results, and ultrasound follow-up were analyzed. Results　All of the 42 children did not use X ray, and the closure of left axillary PDA was completed under the transesophageal echocardiography. The occluders were well shaped. There were no complications such as cardiovascular perforation in the children. All of the 42 children successfully completed PDA closure under echocardiography, and the occluder models were XJFD0406-XJFD1618. After the release of the closure umbrella during the operation in 23 cases, the different degrees of leakage were immediately detected by transesophageal ultrasound during the operation, with the largest width of the inner root bundle of the pulmonary artery of 1.9 mm and the fastest leakage velocity of 2.4 m/s. The left pulmonary artery blood flow did not increase rapidly. The flow velocity of some descending aorta increased slightly, and the flow velocity of descending aorta were all down to normal during the follow-up. In the 23 cases of children with leakage during the operation, they underwent chest ultrasound review on the first day after surgery, and 9 cases of children still had leakage. Among the 42 children, 4 cases had a small amount of pericardial effusion. During the follow-up 3 months after operation, 8 cases of leakage disappeared successively, but 1 case of residual leakage remained. At 6 months of follow-up, none of the children had any residual leakage or residual shunt. Conclusion　In the closure of small incision left axillary PDA guided by transesophageal ultrasound alone, transesophageal ultrasound can accurately evaluate the operation condition and ultrasound guidance condition, with small operation incision, good curative effect, and fast recovery, so it has become the first choice for the treatment of PDA at present.

Analysis of prognostic factors in patients with acute paraquat poisoning

Li Feng, Su Yiwei, Wang Zhi

2023, 29(5):  632-637.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.009

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Objective　To explore the main factors affecting the prognosis in patients with acute paraquat poisoning simply and efficiently. Methods　Using the method of retrospective study, 201 patients with acute paraquat poisoning who were hospitalized in Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects, and according to the conditions at discharge and the follow-up results 60 days after poisoning, the subjects were divided into a survival group (78 cases) and a death group (123 cases). The differences of basic information, diagnosis and treatment plans, and laboratory test indicators at admission between the two groups were compared. The binary logistic regression analysis was used to screen out the main influencing factors that could independently predict the outcome of poisoning. The receiver operating characteristic curve (ROC) was used to determine the effectiveness of the main influencing factors in identifying the prognosis in patients with acute paraquat poisoning. t test and χ² test were used. Results　In the survival group, there were 33 males and 45 females, aged (30.41±14.04) years. In the death group, there were 61 males and 62 females, aged (31.86±14.15) years. In the survival group, the paraquat intake [(20.95±23.14) ml], proportion of vomiting symptom [70.51% (55/78)], white blood cell count (WBC) [(12.39±4.93) ×10⁹/L], hemoglobin (Hb) [(136.56±18.04) g/L], prothrombin time (PT) [(12.49±3.52) s], alanine transaminase (ALT) [(18.30±10.76) U/L], aspartate aminotransferase (AST) [(23.44±11.85) U/L], blood glucose [(7.09±2.21) mmol/L], urea nitrogen [(4.96±3.48) mmol/L], creatinine [(98.03±79.33) μmol/L], creatine kinase (CK) [(187.78±178.06) U/L], creatine kinase isoenzyme (CKMB) [(18.88±15.50) U/L], lactate dehydrogenase (LDH) [(190.92±60.50) U/L], and urine protein average ranks (60.65) were lower than those in the death group [(62.07±50.59) ml, 83.74% (103/123), (23.15±12.05) ×10⁹/L, (142.32±20.64) g/L, (13.50±3.13) s, (94.04±144.42) U/L, (130.94±184.19) U/L, (8.43±3.49) mmol/L, (9.55±8.17) mmol/L, (249.98±196.40) μmol/L, (336.36±261.96) U/L, (43.91±43.74) U/L, (346.01±196.50) U/L, and 126.59], with statistically significant differences (all P<0.05). The blood partial pressure of carbon dioxide (PaCO₂) [(4.33±0.58) kPa] and blood bicarbonate (HCO₃^-) concentration [(21.12±2.36) mmol/L] in the survival group were higher than those in the death group [(3.81±1.25) kPa and (16.85±4.75) mmol/L], with statistically significant differences (both P<0.05). Binary logistic regression analysis showed that paraquat intake (OR=1.022, P<0.05), HCO₃^- (OR=0.763, P<0.05), AST (OR=1.059, P<0.05), blood glucose (OR=1.235, P<0.05), and urinary protein (OR=1.878, P<0.05) were key indicators of prognosis in patients with acute paraquat poisoning. Further ROC analysis showed that the five indexes had high efficacies in predicting the prognosis in patients with acute paraquat poisoning, among which AST was the index with the highest predictive value [the area under the curve (AUC) was 0.87, and the optimal diagnostic value was 35.30 U/L], urinary protein was the index with the highest sensitivity (0.94), HCO₃^- and AST were the indexes with the highest specificity (both 0.96), HCO₃^- and AST were the indexes with the highest positive predictive value (both 0.96), and urinary protein was the index with the highest negative predictive value (0.86). Conclusions　Paraquat intake, HCO₃^-, AST, blood glucose, and urinary protein are the main influencing factors for predicting the outcome of acute paraquat poisoning. They have high predictive efficacy, sensitivity, and specificity, and can be used to independently identify the prognosis in patients with acute paraquat poisoning.

Risk factors of late recurrence of atrial fibrillation after radiofrequency ablation

Cui Jinzhen, Dong Aizhi, Jiang Qianqian, Miao Chunbo, Li Lijuan, Fan Yuguang, Chen Baozeng, Chang Yifang

2023, 29(5):  637-642.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.010

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Objective　To explore the risk factors of late recurrence in patients with atrial fibrillation after radiofrequency ablation. Methods　Ninety-five patients with atrial fibrillation treated by radiofrequency ablation in the Third Department of Cardiology of the Second People's Hospital of Liaocheng from May 2018 to July 2021 were selected, including 66 males and 29 females, aged (61.24±7.66) years. The patients were followed up postoperatively for one year and at regular intervals every three months, and the late recurrences were recorded. The general clinical data such as patients' age and gender, whether they had underlying diseases such as diabetes mellitus and hypertension, and ECG indicators were collected. The risk factors affecting patients' postoperative late recurrence were analyzed by univariate analysis (χ² test and independent sample t test) and multivariate logistic regression analysis. Results　There were 27 cases of postoperative late recurrence in the 95 patients who underwent radiofrequency ablation, accounting for 28.42%. Univariate analysis showed that there were no statistically significant differences in the gender, age, smoking history, hypertension, coronary heart disease, blood platelet count, triglyceride (TG), hemoglobin, alanine aminotransferase, fibrinogen, and left ventricular ejection fraction (LVEF) between the two groups (all P>0.05); the duration of disease [(5.81±1.45) years], proportion of diabetes [70.37% (19/27)], body mass index (BMI) [(24.77±2.75) kg/m²], left atrial diameter (LAD) [(41.25±6.16) mm], proportion of persistent atrial fibrillation [59.26% (16/27)], and proportion of intraoperative electrocardioversion [55.56% (15/27)] in the recurrence group were higher than those in the non-recurrence group [(4.97±1.24) years, 17.65% (12/68), (23.31±2.59) kg/m², (38.43±4.81) mm, 11.76% (8/68), and 16.18% (11/68)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that long course of disease (OR=2.147), persistent atrial fibrillation (OR=2.338), and intraoperative electrocardioversion (OR=1.875) were independent risk factors for late recurrence of atrial fibrillation after radiofrequency ablation (all P<0.05). Conclusion　Long disease duration, persistent atrial fibrillation, and intraoperative electrocardioversion are the independent risk factors affecting the occurrence of late recurrence after radiofrequency ablation in patients with atrial fibrillation, therefore, the patients should be treated promptly and the conditions should be controlled clinically.

Effect of acupuncture combined with transcranial magnetic stimulation on patients with cerebral infarction and Parkinson's disease

Guo Shanshan, Li Zhipeng, Zhang Ying

2023, 29(5):  642-646.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.011

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Objective　To observe the effect of acupuncture combined with transcranial magnetic stimulation (TMS) in the treatment of cerebral infarction with Parkinson's disease (PD). Methods　In this prospective study, 127 patients with cerebral infarction complicated with PD admitted to Shangqiu Municipal Hospital from March 2020 to March 2022 were selected as the research objects. All patients were divided into an observation group (64 cases) and a control group (63 cases) after analyzing their clinical data. In the observation group, there were 34 males and 30 females, aged (60.33±0.12) years; in the control group, there were 33 males and 30 females, aged (60.28±0.25) years. Both groups were treated with conventional western medicine and TMS, and the observation group was treated with acupuncture on the basis. The changes of brain-derived neurotrophic factor (BDNF) levels before treatment and 3, 7, and 14 days after treatment and the improvement of cerebral hemodynamics before and after treatment were compared between the two groups. A short-term follow-up of 6 months was conducted after treatment to compare the improvement of motor function and the occurrence of adverse reactions between the two groups after treatment. t test and χ² test were used. Results　After 3, 7, and 14 days of treatment, the levels of BDNF [(4.82±0.33) μg/L, (5.62±0.31) μg/L, and (7.22±0.37) μg/L] in the observation group were higher than those in the control group [(4.02±0.41) μg/L, (4.95±0.47) μg/L, and (6.13±0.25) μg/L], with statistically significant differences (t=12.123, 9.497, and 19.422; all P<0.001). After treatment, the peak systolic blood flow velocity (VP) [(51.33±8.28) cm/s] and end-diastolic blood flow velocity (MFV) [(45.62±0.45) cm/s] in the observation group were higher than those in the control group [(43.16±8.17) cm/s and (40.12±0.33) cm/s], and the resistance index (RI) [(0.36±0.22)] was lower than that in the control group [(0.49±0.15)], with statistically significant differences (t=5.596, 78.443, and 3.885; all P<0.001). After treatment, the Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS-Ⅲ) score of the observation group [(42.45±0.31) points] was lower than that of the control group [(45.85±0.44) points], and the limits of stability (LOS) [(90.25±5.22) cm²] and Berg Balance Scale (BBS) score [(32.16±1.16) points] were higher than those of the control group [(87.62±5.17) cm² and (30.25±1.33) points], with statistically significant differences (t=50.404, 2.852, and 8.629; all P<0.001). The incidence of adverse reactions in the observation group was 7.81% (5/64), which was slightly higher than that in the control group [6.35% (4/63)], without a statistically significant difference (χ²=0.162, P=0.687). Conclusion　At the same time of routine western medicine combined with TMS treatment for patients with cerebral infarction and PD, acupuncture treatment can enhance the efficacy, improve their motor function while promoting the recovery of brain tissue function and cerebral hemodynamics, and it is not easy to cause serious adverse reactions in patients undergoing acupuncture treatment, with high safety.

Effects of different patient-controlled epidural analgesia methods on the pregnancy outcomes in parturients undergoing painless delivery

Ma Chuanyan, Zhang Qiao, Han Haixia, Li Jing, Zhang Jian

2023, 29(5):  647-651.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.012

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Objective　To study the effects of different patient-controlled epidural analgesia methods on the pregnancy outcomes in parturients undergoing painless delivery. Methods　It was a prospective randomized controlled trial. A total of 110 parturients who delivered in Binzhou Central Hospital from January 2019 to August 2022 were selected as the research objects, and were randomly divided into a control group and an observation group with 55 cases in each group by the random number table method. The observation group was 22 to 35 (26.79±3.18) years old, with a gestational age of 37 to 40 (39.15±0.42) weeks, with an American Society of Anesthesiologists (ASA) grade of grade Ⅰ in 30 cases and grade Ⅱ in 25 cases. The control group was 23 to 34 (27.01±3.14) years old, with a gestational age of 37 to 41 (39.24±0.39) weeks, with an ASA grade of grade Ⅰ in 28 cases and grade Ⅱ in 27 cases. The control group used ropivacaine hydrochloride patient-controlled epidural analgesia, and the observation group used sufentanil citrate combined with ropivacaine hydrochloride patient-controlled epidural analgesia. The Visual Analogue Scale (VAS) scores at different time points, labor, pregnancy outcome, Apgar score, amount of postpartum blood loss, lactation function [lactation start time and serum prolactin (PRL) levels 1 d before delivery and 24 h after delivery], serum fibrinolytic function indicators [plasminogen activity inhibitor-1 (PAI-1), tissue type plasminogen activator (t-PA), and D-dimer (D-D)] before and after delivery  were compared between the two groups. t test and χ² test were used. Results　The VAS scores 10 min and 30 min after labor analgesia in the observation group [(4.58±0.36) points and (3.03±0.41) points] were lower than those in the control group [(5.71±0.44) points and (3.96±0.38) points], with statistically significant differences (both P<0.05). The second and third stages of labor in the observation group [(74.26±11.85) min and (6.74±2.63) min] were lower than those in the control group [(90.43±12.57) min and (9.11±3.02) min], with statistically significant differences (both P<0.05). The Apgar score [(9.38±0.17) points] in the observation group was higher than that in the control group [(8.85±0.22) points], and the amount of postpartum blood loss [(218.65±24.39) ml] was lower than that in the control group [(291.07±38.61) ml], with statistically significant differences (both P<0.05). The start time of lactation in the observation group [(27.37±5.18) h] was shorter than that in the control group [(36.02±6.34) h], and the serum PRL level after delivery [(328.09±41.18) μg/L] was higher than that in the control group [(257.63±36.54) μg/L], with statistically significant differences (both P<0.05). After delivery, the levels of PAI-1, t-PA, and D-D in the observation group [(25.92±3.26) μg/L, (13.77±2.06) μg/L, and (151.09±16.77) μg/L] were lower than those in the control group [(39.38±3.74) μg/L, (20.82±3.14) μg/L, and (179.62±18.41) μg/L], with statistically significant differences (all P<0.05). Conclusion　The patient-controlled epidural analgesia of sufentanil citrate combined with ropivacaine hydrochloride for painless delivery can significantly reduce the degree of pain in parturients, shorten the labor process, reduce the amount of postpartum hemorrhage, inhibit the fibrinolysis, improve the lactation function, and reduce the risk of adverse pregnancy outcomes.

Efficacy of montelukast sodium combined with mometasone furoate in patients with allergic rhinitis

Wang Xiaohua, Li Niansheng, Wang Chenxia, Wang Shuting, Li Chengyuan

2023, 29(5):  652-655.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.013

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Objective　To investigate the clinical effect of montelukast sodium combined with mometasone furoate in patients with allergic rhinitis (AR). Methods　It was a prospective randomized controlled trial. Ninety-eight AR patients admitted to Weihai Central Hospital between July 2019 and July 2022 were randomly selected and were divided into two groups of forty-nine patients in each group by the random number table method. In the control group, 27 males and 22 females, aged (35.47±7.09) years, were treated with mometasone furoate; in the combination group, 23 males and 26 females, aged (36.85±7.37) years, were treated with mometasone furoate combined with montelukast sodium. The clinical effect, inflammation level, and adverse drug reactions were compared between the two groups. χ² test and t test were used. Results　The overall response rate of the combination group was 97.96% (48/49), which was significantly higher than that of the control group [83.67% (41/49)], with a statistically significant difference (χ²=4.404, P=0.036). Before treatment, there were no statistically significant differences in the levels of interleukin-4 (IL-4), intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein (CRP) between the two groups (all P>0.05). After treatment, the levels of IL-4 [(115.43±12.83) ng/L], ICAM-1 [(5.74±1.15) μg/L], and CRP [(7.36±1.46) mg/L] in the combination group were significantly lower than those in the control group [(127.45±14.16) ng/L, (6.58±1.32) μg/L, and (8.41±1.68) mg/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the combination group [10.20% (5/49)] and the control group [4.08% (2/49)] (χ²=0.615, P>0.05). Conclusion　The curative effect of montelukast sodium and mometasone furoate in the treatment of patients with AR is significantly improved, the level of inflammation is decreased, and the medication is safe.

Effect of somatostatin needle combined with three-lumen and two-balloon catheter in the treatment of patients with liver cirrhosis complicated with EGVB

Yin Jinge, Wang Shuanduo

2023, 29(5):  655-659.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.014

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Objective　To observe the effect of somatostatin needle + three-lumen and two-balloon catheter on patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding (EGVB). Methods　It was a prospective randomized controlled trial. A total of 65 cirrhosis with EGVB patients admitted to The First Affiliated Hospital of Nanyang Medical College from January 2020 to May 2022 were selected as the research objects. They were divided into an observation group (33 cases) and a control group (32 cases) by the computered random number table method. In the observation group, there were 20 males and 13 females, aged (65.11±0.22) years. In the control group, there were 22 males and 10 females, aged (65.14±0.16) years. The patients in the two groups were treated with three-lumen and two-balloon catheter, and the patients in the observation group were assisted by somatostatin needle. The success rates of hemostasis at different time points after treatment, gastrointestinal hormones and hemodynamic indexes before and after treatment, clinical indexes after treatment, and occurrence of adverse reactions were compared between the two groups. χ² test and independent sample t test were used. Results　Under different treatment regimens, the success rates of hemostasis in the observation group 8, 12, and 24 h after treatment [33.33% (11/33), 60.61% (20/33), and 90.91% (30/33)] were higher than those in the control group [18.75% (6/32), 43.75% (14/32), and 68.75% (22/32)], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the levels of growth hormone (SS), gastrin (GAS), and motilin (MLT) between the two groups (all P>0.05). After treatment, the levels of SS [(15.24±0.12) ng/L], GAS [(80.26±0.32) ng/L], and MLT [(211.32±5.16) ng/L] in the observation group were lower than those in the control group [(15.63±0.82) ng/L, (80.65±0.88) ng/L, and (218.41±5.32) ng/L], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the central venous pressure (CVP) and portal venous pressure (PVP) between the two groups (both P>0.05). After treatment, the CVP [(9.15±0.27) mmHg (1 mmHg=0.133 kPa)] and PVP [(25.14±0.27) mmHg] in the observation group were lower than those in the control group [(9.58±0.82) mmHg and (25.56±0.85) mmHg], with statistically significant differences (both P<0.05). After treatment, the hemostasis time [(20.25±0.33) min], blood transfusion volume [(266.42±10.45) ml], and rebleeding rate [6.06% (2/33)] in the observation group were all lower than those in the control group [(20.77±0.82) min, (275.33±10.28) ml, and 18.75% (6/32)], with statistically significant differences (all P<0.05). After treatment, there was no statistically significant difference in the incidence of adverse reactions between the observation group [12.12% (4/33)] and the control group [9.38% (3/32)] (P>0.05). Conclusions　In the treatment of liver cirrhosis complicated with EGVB patients by three-lumen and two-balloon catheter, the combined application of somatostatin needle can enhance the hemostatic effect, which has positive significance in further inhibiting the gastrointestinal hormones, improving the hemodynamics, shortening the hemostatic time, reducing the blood transfusion volume, and reducing the risk of rebleeding. The combined application of somatostatin needle does not significantly enhance the risk of adverse reactions, with high safety.

Clinical application effect of maternal and infant health guidance center based on the theory of "treating pre-disease" in department of gynecology and obstetrics

Zhou Mei, Tan Guiyun, Mo Yingyin, Xue Liang

2023, 29(5):  660-662.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.015

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Special Column of Urology and Reproduction

Selectively inhibiting Drp1 to attenuate renal injury induced by ischemia-reperfusion in rats

Chen Siqi, Peng Rongdong, Xu Jiaqi, Feng Junxia, Zhou Xiaoying, Zhang Yunfang, Su Yanyan

2023, 29(5):  663-669.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.016

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Objective　To explore the molecular mechanism of dynamin-related protein 1 (Drp1) -mediated mitochondrial energy metabolism involved in renal ischemia-reperfusion injury. Methods　The experiment was conducted on October 14, 2020. Male Wistar rats aged 8-10 weeks were randomly divided into a normal control group, a sham operation group, a model group, and a Drp1 inhibitor group, with 5 rats in each group and weight of 0.25-0.30 kg for each rat. The rat model of acute renal injury induced by renal ischemia-reperfusion was established. The rats in the Drp1 inhibitor group were intraperitoneally injected with mitochondrial division inhibitor 1 (Mdivi-1) of 20 mg/kg body weight, and the other groups were injected with normal saline of the same volume. Serum and kidney tissue were retained 24 hours after the model was made. The serum creatinine level, pathological change of renal tissue, apoptosis of renal tissue cells, mitochondrial ultrastructure, and mitochondrial ATPase activity were compared between the groups. The HK-2 cell hypoxia and reoxygenation models were established in vitro. The changes of mitochondrial membrane potential were detected by JC-1 staining after treatment. Analysis of variance was used. Results　Compared with those in the sham operation group, the serum creatinine in the model group was significantly increased [(41.12±1.895) µmol/L vs. (48.68±2.065) µmol/L], the renal tubule injury score was increased [(1.29±0.426) points vs. (6.50±0.577) points], the number of apoptosis in renal tissue was increased [(2.40±0.547) vs. (10.20±1.095)], the mitochondrial damage was more obvious under electron microscope, and the activity of mitochondrial ATPase was decreased [(6.38±0.321) U/mg prot vs. (4.18±0.198) U/mg prot]; in the HK-2 cell hypoxia and reoxygenation models, the proportion of cells with decreased mitochondrial membrane potential increased in the model group compared with that in the sham operation group [(9.81±0.251)% vs. (4.24±0.598)%], with statistically significant differences (all P<0.05). Compared with those in the model group, the serum creatinine in the Drp1 inhibitor group was decreased [(48.68±2.065) µmol/L vs. (43.28±0.895) µmol/L], the renal tubule injury score was decreased [(6.50±0.577) points vs. (4.50±0.578) points], the number of apoptosis of renal tissue cells was decreased [(10.20±1.095) vs. (6.60±1.140)], the mitochondrial structure damage was reduced, and the activity of mitochondrial ATPase was increased [(4.18±0.198) U/mg prot vs. (5.16±0.628) U/mg prot]; in the HK-2 cell hypoxia and reoxygenation models, the proportion of cells with decreased mitochondrial membrane potential decreased in the Drp1 inhibitor group compared with that in model group [(5.90±0.360)% vs. (9.81±0.251)%], with statistically significant differences (all P<0.05). Conclusion　Selective inhibition of Drp1 can effectively improve the energy metabolism disorder, reduce the cell apoptosis, and alleviate the renal ischemia-reperfusion injury by inhibiting the mitochondrial division.

Etiological analysis on inpatients with congenital anomalies of the kidney and urinary tract in a single centre in 5 years

Ye Guochang, Gao Xiaojie, Ma Yijiao, Jia Shilei, Liu Libing

2023, 29(5):  669-675.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.017

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Objective　To analyze the diagnosis and chief complaints of children with congenital anomalies of the kidney and urinary tract (CAKUT), in order to provide the clues for early diagnosis and treatment of CAKUT. Methods　The clinical data of hospitalized CAKUT cases in Shenzhen Children's Hospital from January 2015 to December 2019 were reviewed. The diagnosis and chief complaints were retrospectively analyzed. χ² test was used. Results　A total of 1 082 children with CAKUT were enrolled, including 702 boys and 380 girls. The proportion of hospitalized CAKUT cases was increased from 0.32% (152/47 227) in 2015 to 0.44% (267/60 280) in 2019 (χ²=11.22, P<0.05). The major CAKUT diseases included ureteropelvic junction obstruction (UPJO), duplex collecting system, vesicoureteric reflux (VUR), and renal dysplasia. A total of 483 cases (44.6%) were found with abnormalities by the prenatal ultrasound examination, among whom 75.4% (364/483) were younger than 1 year-old. A total of 452 cases (41.8%) showed urinary system symptoms, among whom 65.0% (294/452) were older than 1 year-old. A total of 147 cases (13.6%) had no clinical symptoms, and were found by physical examination or other reasons. Ultrasound examination was performed in 1 074 CAKUT patients (99.3%); on the basis of ultrasound results and clinical manifestations, other examinations were performed in 865 cases (79.9%). Conclusions　The proportion of CAKUT in our center shows a slow increasing trend year by year. UPJO, duplex collecting system, VUR, and renal dysplasia are the most common components of CAKUT. Prenatal and postnatal ultrasounography can be considered as the primary means of screening for CAKUT.

Clinical characteristics and risk factors of acute kidney injury in children with nephrotic syndrome

Chen Ranran, Gao Xiaojie, Jia Shilei, Liang Die

2023, 29(5):  675-679.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.018

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Objective　To analyze the clinical characteristics, prognosis, and risk factors of nephrotic syndrome (NS) complicated with acute kidney injury (AKI). Methods　Children with NS were retrospectively enrolled from Shenzhen Children's Hospital from January 2016 to December 2019. Of these, 50 children with AKI were defined as the NS-AKI group, and 50 children without AKI matched by both gender and age as the control group. There were 36 males (72.0%) and 14 females (28.0%) in both NS-AKI group and control group, aged 5.5 (2.0, 8.0) years. The clinical characteristics and laboratory examination indexes of the two groups were compared, and the risk factors and prognosis of NS complicated with AKI were analyzed. χ² test, rank sum test, and multiple logistic regression analysis were used. Results　In the NS-AKI group, the length of hospital stay [16 (9.0, 21.3) d], proportions of hematuria [28.0% (14/50)], hypertension [32.0% (16/50)], infection [72.0% (36/50)], and tacrolimus use [48.0% (24/50)], and levels of urea [17.0 (10.0, 24.7) mmol/L], uric acid [616.8 (476.8, 764.0) μmol/L], cystatin C [1.7 (1.4, 2.4) mg/L], fibrinogen [5.7 (4.7, 7.2) g/L], and triacylglycerol [2.9 (2.0, 4.8) mmol/L] were higher than those in the control group [8 (5.0, 10.0) d, 6.0% (3/50), 4.0% (2/50), 50.0% (25/50), 24.0% (12/50), 4.3 (3.4, 6.0) mmol/L, 329.9 (273.7, 435.8) μmol/L, 0.9 (0.8, 1.0) mg/L, 4.7 (3.5, 5.9) g/L, and 2.0 (1.5, 3.8) mmol/L], and the levels of serum albumin [14.2 (12.5, 16.9) g/L] and serum sodium [131.8 (129.0, 134.2) mmol/L] were lower than those in the control group [17.8 (12.7, 23.6) g/L and 135.3 (133.1, 137.8) mmol/L], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis indicated that urea nitrogen, cystatin C, and fibrinogen were independent risk factors for NS complicated with AKI (OR=1.516, 48.087, and 1.569; all P<0.05). At the discharge of children with NS-AKI, the renal function in 43 cases returned to normal, which was improved in 5 cases and remained unchanged in 2 cases. During the follow-up, except for 1 case developed stage 5 chronic kidney disease, the renal function in other 49 cases was normalized. Conclusions　Independent risk factors for NS complicated with AKI include increased urea nitrogen, cystatin C, and fibrinogen. Renal function can return to normal in most NS-AKI children.

Treatises

Application of dynamic change spatial scanning technique in analyzing the spatial aggregation of tuberculosis in Guangzhou from 2018 to 2021

Jiang Kunhong, He Liqian, Wang Ting, Wu Xiaoying, Cai Xiaoting

2023, 29(5):  680-683.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.019

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Objective　To analyze the spatial distribution characteristics of tuberculosis (TB) and to grasp the key areas where TB aggregation occurs in Guangzhou from 2018 to 2021, and to provide evidences for the disease prevention and control measures. Methods　The information of TB patients whose current address was Guangzhou from 2018 to 2021 was collected through the Tuberculosis Management Information System, a subsystem of the Chinese Disease Prevention and Control Information System. Spatial scans were conducted and spatial distribution maps were drawn at the district level to analyze the spatial aggregation of TB. Results　A total of 34 306 cases of TB were reported in Guangzhou from 2018 to 2021. The average annual incidence was 46.46/100 000. There were 22 891 males and 11 415 females, with a male to female ratio of 2.01:1. The highest proportion of young adults, 25-<35 years old, was 23.06% (7 910/34 306). Among the occupations, the proportion of domestic work and non-working was the highest, at 45.77% (15 701/34 306). The ratio of local domicile to floating population was 1.03:1. TB aggregation areas were mainly in the central urban areas including Yuexiu, Haizhu, Liwan, and Tianhe, and the suburban areas including Baiyun and Huangpu. The aggregation areas had extended to the distant suburban areas of Guangzhou such as Zengcheng and Conghua. Conclusions　TB incidence in Guangzhou displays spatial aggregation at the district level, from 2018 to 2021, and mainly in the central urban areas and suburban areas, with a tendency to spread to the distant suburban areas. Surveillance in the key areas should be strengthened, and scientific, objective, and feasible TB prevention and control measures should be carried out.

Clinical Research

Effect of zinc preparation combined with clostridium butyricum bifunctional viable preparation in children with diarrhea

Liu Haizhen

2023, 29(5):  684-687.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.020

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Objective　To investigate the effect of zinc preparation combined with clostridium butyricum bifunctional viable preparation on clinical symptom relief time and micro inflammation indexes in children with diarrhea. Methods　It was a prospective randomized controlled trial. A total of 79 children with diarrhea who visited Yudu Maternal and Child Health Hospital from March 2021 to May 2022 were divided into a control group (40 cases) and an experimental group (39 cases) by the random number table method. In the control group, there were 22 males and 18 females, with an age of (21.36±4.25) months old. There were 20 males and 19 females in the experimental group, with an age of (21.47±4.35) months old. Both groups were given routine treatment. On the basis of routine treatment, the control group was given zinc preparation, and the experimental group was given zinc preparation combined with clostridium butyricum bifunctional viable preparation for 7 days. The symptom relief time, blood zinc level, immune function [immunoglobulin A (IgA), IgM, and IgG], micro inflammation indicators [interleukin-10 (IL-10), IL-6, and tumor necrosis factor α (TNF-α)], and adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the time of stool examination returning to normal [(5.19±1.26) d], temperature recovery time [(3.63±1.09) d], vomiting relief time [(1.55±0.48) d], and abdominal pain relief time [(1.37±0.40) d] of the experimental group were shorter than those of the control group [(8.35±1.51) d, (5.56±1.18) d, (3.08±0.91) d, and (2.79±0.81) d], with statistically significant differences (all P<0.05). After treatment, the levels of IgA [(1.80±0.55) g/L], IgM [(16.08±1.24) g/L], IgG [(1.63±0.51) g/L], and blood zinc [(66.48±10.14) μmol/L] in the experimental group were higher than those in the control group [(1.49±0.48) g/L, (14.26±1.13) g/L, (1.35±0.40) g/L, and (57.24±9.36) μmol/L], with statistically significant differences (all P<0.05). After treatment, the levels of IL-6 [(14.24±3.66) ng/L] and TNF-α [(1.73±0.53) mg/L] in the experimental group were lower than those in the control group [(19.15±4.50) ng/L and (3.19±0.86) mg/L], and the IL-10 level [(33.09±4.32) ng/L] was higher than that in the control group [(26.76±3.18) ng/L], with statistically significant differences (all P<0.05). Conclusion　Zinc preparation combined with clostridium butyricum bifunctional viable preparation can regulate the blood zinc level and micro inflammatory reaction in children with diarrhea, enhance the body immunity, and accelerate the clinical symptom relief, with good safety.

Risk factors and intervention measures of hemorrhage caused by uterine inertia after cesarean section in elderly primipara

Ding Yanhui

2023, 29(5):  688-691.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.021

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Case Report

Anaphylactic shock caused by iodixanol: a case report

Wu Yanping, Qi Liuying

2023, 29(5):  692-694.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.022

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The clinical data of one case of anaphylactic shock caused by iodixanol in Songjiang District Central Hospital in April 2021 was analyzed, and the literatures related to the high risk factors and possible pathogenesis of anaphylactic shock caused by iodixanol were reviewed, in order to remind clinical pharmacists to pay attention to the safety of medication in the clinical use of iodixanol, and weigh the advantages and disadvantages and strengthen the medication monitoring especially for patients with specific constitution.

Hypersensitivity induced by Dupilumab: a case report and literature review

Luo Yuwu, Lang Dexiu, Zhou Xin, Zhang Shujuan, Ye Qianru

2023, 29(5):  695-697.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.023

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A case of hypersensitivity induced by Dupilumab in the treatment of atopic dermatitis (AD) in Guangzhou Institute of Dermatology was reported, and the relevant literatures were reviewed and summarized. A 58-year-old male patient was treated with Dupilumab for the first time due to AD. Large erythema and blisters appeared on the trunk and limbs 2 days later, and the drug eruption of multiform erythema was diagnosed. He was advised to take systemic methylprednisolone, then tapered slowly based on the response. Hypersensitivity induced by Dupilumab was diverse. We reviewed the literatures and summarized the similar case reports.

Allergic bronchopulmonary aspergillosis: a case report

Xiao Pengfei, Liu Yongping, Zhai Yaodong

2023, 29(5):  698-700.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.024

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Through retrospective analysis of the clinical data and treatment process of an inpatient with allergic bronchopulmonary aspergillosis in Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine, we try to deepen our understanding on the disease and hope to make early diagnosis and treatment. Hyperattenuating mucus plugging on chest CT and aspergillus specific immunoglobulin (Ig) E are specific indicators for the diagnosis of allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis is relatively rare. Clinicians should constantly improve their understanding to avoid misdiagnosis and missed diagnosis.

Myeloid sarcoma of the ovary: a case report and literature review

Liu Wenxin, Li Tongmin, Guo Dongxia, Li Zhenzhen, Zhang Yiqing

2023, 29(5):  700-702.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.025

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Myeloid sarcoma is a highly malignant tumor with poor prognosis. It can occur in any part of the body, but ovarian involvement is particularly rare. Gynecologists have relatively little understanding of it, and it is difficult to be diagnosed before surgery. After surgery, it is mainly diagnosed by pathology and immunohistochemistry. A case of ovarian myeloid sarcoma with pelvic mass as the main manifestation in Dongchangfu Maternal and Child Health Hospital, Liaocheng was reported and the related literatures were reviewed to improve the understanding of ovarian myeloid sarcoma.

Effect of fruit intake on prevention of low potassium arrhythmia in a maintenance hemodialysis patient

Chen Qingli, Song Li, Yin Yan, Cui Dongmei, Zhao Liyan, Chen Cheng, Liang Qizhen, Zhong Chunhua, Quan Zilin

2023, 29(5):  703-707.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.026

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Objective　To analyze the effect of fruit intake during dialysis on a maintenance hemodialysis patient with arrhythmia caused by hypokalemia during dialysis. Methods　A female patient undergoing maintenance hemodialysis in Guangdong Provincial People's Hospital was found to have arrhythmia due to hypokalemia during dialysis, which did not respond well to medication. According to the food composition exchange table, the fruit with potassium content of about 842 mg and sugar content of about 64 g was converted into the total amount, and the total amount was divided into 2/3 and 1/3. The patient was instructed to take 2/3 portions of fruit at the beginning of dialysis and 1/3 portion of fruit at 2 hours of dialysis. The serum potassium and blood glucose levels and electrocardiogram were closely monitored during dialysis and before the next dialysis. Results　After 7 dialysis courses (nearly a month) of follow-up, the patient's serum potassium was stable during dialysis, the arrhythmia and hypoglycemia were improved, and the constipation was relieved. Conclusions　Intake of fruit with potassium content of 842 mg and sugar content of about 64 g during dialysis can improve arrhythmia and constipation during dialysis. However, the efficacy for other dialysis patients should be confirmed by a series of prospective studies.

Nursing Research

Effect of perioperative predictive nursing on patients with liver cancer undergoing radiofrequency ablation

Zhou Yadan

2023, 29(5):  708-713.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.027

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Objective　To observe the effects of perioperative predictive nursing on self-care ability, adverse emotions, and complications in patients with liver cancer undergoing radiofrequency ablation. Methods　A total of 92 patients with liver cancer who underwent radiofrequency ablation in Henan Provincial Hospital of Traditional Chinese Medicine from January 2021 to August 2022 were collected. They were randomly divided into 2 groups according to different nursing methods. In the control group, 46 patients [32 males and 14 females, aged (52.71±5.68) years] received routine nursing during the perioperative period. In the observation group, 46 patients [30 males and 16 females, aged (52.68±5.72) years] received predictive nursing on the basis of routine nursing during the perioperative period. The self-care ability (health knowledge mastery, self-care ability, self-care responsibility, and self-concept) and scores of Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were observed before and after nursing. The first anal exhaust time, bowel sound recovery time, first defecation time, pain intensity 6 h, 12 h, 24 h, and 48 h after surgery, postoperative complications were compared. t test was used for the measurement data, and χ² test was used for the count data. Results　The scores of health knowledge mastery, self-care ability, self-care responsibility, and self-concept in the observation group after nursing were (56.26±6.75) points, (39.15±4.31) points, (22.64±3.62) points, and (25.69±4.19) points, respectively, which were higher than those in the control group [(50.42±6.03) points, (32.19±4.02) points, (18.62±3.45) points, and (22.61±4.05) points], with statistically significant differences between the two groups (t=-4.736, -5.643, -4.183, and -6.582; all P<0.001). The SDS and SAS scores of the observation group after nursing were (39.42±4.21) points and (34.62±3.71) points, respectively, which were lower than those of the control group [(45.26±5.23) points and (40.29±4.65) points], with statistically significant differences between the two groups (t=5.899 and 6.465; both P<0.001). The first anal exhaust time, bowel sound recovery time, and first defecation time in the observation group after nursing were (21.54±2.03) h, (31.28±2.76) h, and (28.19±2.18) h, respectively, which were shorter than those in the control group [(28.36±2.25) h, (46.26±3.15) h, and (37.71±2.64) h], with statistically significant differences between the two groups (t=15.826, 17.526, and 14.625; all P<0.001). The Visual Analogue Scale (VAS) scores of the observation group 6 h, 12 h, 24 h, and 48 h after surgery were (7.05±0.49) points, (5.18±0.43) points, (4.19±0.39) points, and (3.52±0.34) points, respectively, which were lower than those of the control group [(7.56±0.51) points, (6.85±0.48) points, (4.96±0.41) points, and (4.05±0.39) points], with statistically significant differences between the two groups (t=4.891, 9.182, 6.426, and 13.462; all P<0.001). The incidence of postoperative complications in the observation group was 13.0% (6/46), which was lower than that in the control group [54.3% (25/46)] (χ²=17.563, P<0.001). Conclusion　Perioperative predictive nursing can improve the self-care ability in patients with liver cancer after radiofrequency ablation, reduce their depression, anxiety, and pain, and reduce the occurrence of complications.

Application of electric toothbrush massaging Feiyu acupoint in nursing care for newborns with infective pneumonia after birth

Zeng Aihua, Liu Tianfu, Mo Wanqing, Chen Yijiang

2023, 29(5):  714-716.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.028

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Study on the changes of symptom clusters in patients with nasopharyngeal carcinoma during con T2T3 current chemoradiotherapy

Wu Yaofen, Feng Yanying, Shi Guang, Xing Minqing

2023, 29(5):  717-722.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.029

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Objective　To discuss the changes of symptom clusters scores and the correlations between different time points in patients with nasopharyngeal carcinoma during concurrent chemoradiotherapy, so as to provide evidences for continuous symptom management. Methods　Through the prospective study, Memorial Symptom Assessment Scale (MSAS), Medical Coping Modes Questionnaire (MCMQ), European Organization for Research and Treatment of Cancer Quality of Life Core Scale (EORTC QLQ-C30), Medical history questionnaire (MHQ), and Subjective Global Assessment (SGA) were scored as the occurrence frequency and intensity of various symptom clusters in 80 patients [60 males and 20 females, aged (48.43±11.80) years] with nasopharyngeal carcinoma in different periods of concurrent chemoradiotherapy [before treatment (T1), on the 14th day of concurrent treatment (T2), on the 28th day of concurrent treatment (T3), on the day of the end of treatment (T4), and one month after treatment (T5)] in Department of Oncology, Panyu Central Hospital from January 2020 to December 2021, and the patients were grouped according to different periods of concurrent chemoradiotherapy and different clinical stages (stage I and II as early group, stage III as middle group, and stage IV as advanced group). Repeated measure analysis of variance, oneway analysis of variance, and Pearson correlation analysis were used to analyze the score changes and correlations. Results　The scores of MSAS, EORTC QLQ-C30, MHQ, and SGA were significantly different at different time points (MSAS: F=109.295, P<0.001; EORTC QLQ-C30: F=3.526, P=0.019; MHQ: F=195.156, P<0.001; SGA: F=82.605, P<0.001). There were significant correlations between different time points in the scores of multiple symptom clusters (MSAS: T1 to T2, T1 to T3, T2 to T3, T2 to T4, T3 to T4, T3 to T5, T4 to T5: all P<0.05; MCMQ: T3 to T4, T4 to T5: both P<0.001; EORTC QLQ-C30: T1 to T2, T3 to T4, T3 to T5, T4 to T5: all P<0.001; MHQ: T1 to T4, T2 to T3, T2 to T4, T3 to T4, T3 to T5, T4 to T5: all P<0.05; SGA: T2 to T3, T2 to T4, T3 to T4: all P<0.05). Conclusions　The symptom clusters of nasopharyngeal carcinoma patients during concurrent chemoradiotherapy change significantly with different time points of treatment, and there is a time correlation. Clinically, the symptom management can be performed on patients and the individualized intervention can be implemented according to the dynamic changes of symptom clusters, so as to improve the patients' survival time and quality of life while alleviating their symptoms.

Influence of hospital-family-community integrated management strategy on negative emotions and self-care ability in patients with pulmonary tuberculosis complicated with diabetes

Xiao Jingjing, Yao Lei, Zhang Ping

2023, 29(5):  723-728.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.030

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Objective　To explore the application effect of hospital-family-community integrated management strategy in pulmonary tuberculosis patients with diabetes. Methods　It was a prospective study. A total of 130 patients with pulmonary tuberculosis and diabetes admitted to Xinyang Fifth People's Hospital from January 2020 to January 2022 were selected. They were divided into two groups according to the order of admission: 65 cases in the control group and 65 cases in the observation group. In the control group, there were 34 males and 31 females, aged (53.61±6.28) years. In the observation group, there were 33 males and 32 females, aged (54.33±7.02) years. The control group was given routine nursing intervention, and the observation group was given routine nursing care combined with hospital-family-community integrated nursing intervention. The disease-related indicators after intervention, scores of Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), General Self-efficacy Scale (GSES), Generic Quality of Life Inventory 74 (GQOL-74), and self-management ability before and after intervention, and nursing satisfaction were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After intervention, the improvement rate of focus in the observation group was higher than that in the control group [92.31% (60/65) vs. 78.46% (51/65)] (χ²=4.993, P=0.026); the normal rate of blood glucose in the observation group was higher than that in the control group [95.38% (62/65) vs. 83.08% (54/65)] (χ²=5.123, P=0.024); the positive rate of sputum culture in the observation group was lower than that in the control group [13.85% (9/65) vs. 29.23% (19/65)] (χ²=4.552, P=0.033). After intervention, the SDS and SAS scores of the observation group were (32.45±5.17) points and (29.62±6.98) points, respectively, which were lower than those of the control group [(37.94±5.33) points and (33.94±5.94) points], with statistically significant differences (t=5.961 and 3.800; both P<0.001). After intervention, the scores of self-management ability, GSES, and GQOL-74 in the observation group were (99.98±5.03) points, (32.69±4.25) points, and (88.58±4.29) points, respectively, which were higher than those in the control group [(93.58±6.58) points, (27.68±4.38) points, and (79.85±5.68) points], with statistically significant differences (t=6.230, 6.618, and 9.888; all P<0.001). The nursing satisfaction of the observation group was higher than that of the control group [98.46% (64/65) vs. 81.69% (56/65)] (χ²=6.933, P=0.009). Conclusion　The hospital-family-community integrated management strategy can enhance the self-management ability and self-efficacy in patients with pulmonary tuberculosis complicated with diabetes, helps them adjust their negative emotions, improve their quality of life, promote the recovery of the disease, and then improve their satisfaction.

Effect of multi-mode health education combined with fetal heart monitoring on pregnant women with fetal intrauterine distress

Zhang Yanan, Wang Chen, Li Yali

2023, 29(5):  728-732.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.031

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Objective　To discuss the application effect of multi-mode health education combined with fetal heart monitoring on pregnant women with fetal distress based on clinical experiences. Methods　It was a prospective randomized controlled trial. A total of 86 pregnant women with fetal distress admitted to Women and Infants Hospital of Zhengzhou from May 2019 to August 2021 were selected and randomly divided into a combined group and a traditional group. In the combined group, 43 pregnant women were (26.38±3.02) years old and the gestational age was (38.17±3.92) weeks. In the traditional group, 43 pregnant women were (29.64±3.18) years old and the gestational age was (38.21±3.86) weeks. The traditional group was given routine fetal heart monitoring measures, and the combined group was given multi-mode health education combined with continuous fetal heart monitoring intervention. The pregnancy outcomes of the two groups were compared. The fetal heart rate, fetal movement times, and 24 h urinary estriol were compared between the two groups before and after intervention. The incidences of maternal complications in the two groups were counted. The negative emotions were compared between the two groups before and after intervention, and the maternal satisfaction was counted. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The incidences of cesarean section, neonatal jaundice, pregnancy-induced hypertension, and hydramnios in the combined group were lower than those in the traditional group [27.91% (12/43) vs. 53.49% (23/43), 6.98% (3/43) vs. 27.91% (12/43), 18.60% (8/43) vs. 48.84% (21/43), 4.65% (2/43) vs. 20.93% (9/43)], with statistically significant differences (χ²=5.830, 6.541, 8.792, and 5.108; all P<0.05). Before intervention, there were no statistically significant differences in the fetal heart rate, fetal movement times, and 24 h urinary estriol between the two groups (all P>0.05). After intervention, the fetal heart rate, fetal movement times, and 24 h urinary estriol in the combined group were higher than those in the traditional group, with statistically significant differences (all P<0.05). The incidence of maternal complications in the combined group was lower than that in the traditional group [4.65% (2/43) vs. 23.26% (10/43)], with a statistically significant difference (χ²=6.198, P=0.013). After intervention, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the combined group were lower than those in the traditional group (both P<0.05). The total satisfaction of the combined group was higher than that of the traditional group [97.67% (42/43) vs. 86.05% (37/43)], with a statistically significant difference (χ²=12.863, P=0.002). Conclusion　Multi-mode health education combined with fetal heart monitoring can improve the pregnancy outcomes in pregnant women with fetal distress, reduce the incidence of complications, and improve their anxiety and depression moods, with high maternal satisfaction, which is worthy of further application.

Effect of distal limb combined insulation on the rehabilitation in patients after total knee replacement

Huang Liyi, Chen Feiqiang, Li Zhiyong, Zhao Yan

2023, 29(5):  733-736.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.032

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Effect of sprayed acid and cold stimulation on rehabilitation in stroke patients with dysphagia

Han Qiaolin, Xie Man, Wu Xiyan, He Xujia, Chen Xiaohong, Chen Mengyun

2023, 29(5):  737-740.  DOI: 10.3760/cma.j.issn.1007-1245.2023.05.033

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Objective　To investigate the effect of sprayed acid and cold stimulation on improving the swallowing function in stroke patients with dysphagia. Methods　It was a randomized controlled trial. A total of 81 stroke patients with dysphagia admitted to Department of Neurology, Jieyang People's Hospital from November 2020 to June 2022 were selected as the study subjects, and were divided into a control group (40 cases) and an observation group (41 cases) by the random number table method. In the control group, there were 21 males and 19 females, aged (69.85±9.74) years; in the observation group, there were 27 males and 14 females, aged (70.02±9.63) years. On the basis of conventional treatment and nursing, the control group was treated with acid and iced cotton stick stimulation rehabilitation therapy, while the observation group was treated with sprayed acid and cold stimulation rehabilitation therapy. Standardized Swallowing Assessment (SSA) score was used to compare the swallowing function of the two groups before intervention, one week after intervention, and two weeks after intervention, and the differences of comfort level and operation duration were compared between the two groups.Independent sample t test or analysis of variance were used for the measurement data, and χ² test was used for the count data. Results　Before intervention, there was no statistically significant difference in the SSA score between the two groups (P>0.05). One week and two weeks after intervention, the SSA scores of the observation group [(23.90±4.44) points and (21.05±3.32) points] were significantly lower than those of the control group [(27.55±4.64) points and (26.05±4.72) points], with statistically significant differences (both P<0.001). The scores of pharyngeal pain and nausea/discomfort in the observation group [(0.27±0.09) points and (0.60±0.09) points] were significantly lower than those in the control group [(0.80±0.11) points and (1.58±0.20) points], with statistically significant differences (both P<0.001). There was no statistically significant difference in the oropharyngeal discomfort score between the two groups (P>0.05). The operation duration of the observation group [(1 111.29±241.44) s] was significantly shorter than that of the control group [(1 244.25±323.27) s], with a statistically significant difference (t=2.101, P=0.039). Conclusion　Sprayed acid and cold stimulation is simple to operate, can improve the patients' comfort level, shorten the operation duration, and effectively improve the patients' swallowing function, which can provide references for the rehabilitation training in stroke patients with dysphagia.