Table of Content

01 April 2023, Volume 29 Issue 7

Previous Issue   

Special Column of Plastic Surgery

Progress in autologous fat transplantation in plastic surgery

Zhang Heng, Pan Guangtao, Yin Ming, Zhang Ping, Yin Xia

2023, 29(7):  889-892.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.001

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Autologous fat transplantation is gradually becoming popular in plastic surgery, and it has been supported by increasing evidences in the clinical research of related plastic surgery. Autologous fat transplantation is widely used in cosmetic surgery with its good biological compatibility, availability, easy access to the donor area, natural appearance, and other advantages. This paper mainly discusses the basic principles of autologous fat transplantation and its research progress in facial (facial contour and nose), breast, and hip plastic surgery and reconstruction surgery, and deeply explores the limitations, common complications, and potential future applications of autologous fat transplantation to provide ideas and guidance for the further application and promotion of autologous fat transplantation technology.

Perioperative nursing management strategies of auricular reconstruction with delayed retroauricular flap and autogenous costal cartilage stereoscopic scaffold

Wu Jihong, Liu Wanli, Luo Mingcan, Li Gaofeng, Tan Jun, Liu Xiaojia

2023, 29(7):  893-898.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.002

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Objective　To study the clinical application value of perioperative nursing management strategies in the treatment of congenital microtia (CM) patients with delayed retroauricular flap combined with autogenous costal cartilage stereoscopic scaffold for external ear reconstruction. Methods　It was a randomized controlled trial. A total of 108 CM patients admitted to Hunan Provincial People's Hospital from January 2018 to January 2021 were selected as the objects. They were divided into a control group (54 cases) and a management group (54 cases) with the random number table method. In the control group, there were 33 females and 21 males, aged (13.81±2.13) years. In the management group, there were 34 females and 20 males, aged (14.15±2.42) years. All the patients underwent external ear reconstruction with delayed retroauricular flap and autologous costal cartilage stereoscopic scaffold. Among them, the control group received routine nursing management measures in the perioperative management, while the management group received comprehensive nursing mode including behavior guidance, emotional relief, and other nursing management. The patients' general data (including gender and age), anxiety, pain, quality of life, and satisfaction after intervention were compared under different perioperative nursing strategies. χ² test and t test were used. Results　The satisfaction of humanistic care [94.44% (51/54)], index management [98.15% (53/54)], and follow-up effect [96.30% (52/54)] in the management group were all higher than those in the control group [81.48% (44/54), 85.19% (46/54), and 83.33% (45/54)] (χ²=4.285, 5.939, and 4.960; all P<0.05). After intervention, the scores of Self-rating Anxiety Scale (SAS) [(37.98±3.39) points], Hamilton Anxiety Scale (HAMA) [(8.22±1.25) points], and Visual Analogue Scale (VAS) [(1.13±0.15) points] in the management group were lower than those in the control group [(45.21±3.45) points, (11.78±1.33) points, and (1.41±0.31) points] (t=10.984, 14.333, 5.975; all P<0.001). The incidence of redness and swelling, infection, and other adverse reactions in the management group [5.56% (3/54)] was lower than that in the control group [18.25 (10/54)] (χ²=4.285, P<0.05). The scores of all dimensions of quality of life of the management group after intervention were lower than those of the control group (all P<0.001). Conclusion　For CM patients, the application of perioperative comprehensive nursing management strategies can improve the patients' satisfaction on postoperative rehabilitation effect, relieve their psychological negative emotions, and improve their quality of life.

Influence of psychological nursing intervention on psychological state and surgical satisfaction in patients undergoing facial plastic surgery

Lan Jianzhen, Wu Yanqun, Liu Fei

2023, 29(7):  899-902.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.003

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Objective　To explore the effect of psychological nursing intervention on psychological state and surgical satisfaction in patients undergoing facial plastic surgery. Methods　It was a randomized controlled trial. A total of 130 patients undergoing facial plastic surgery in Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital from January 2020 to September 2021 were randomly divided into two groups. In the control group, there were 23 males and 42 females, aged (32.8±8.7) years. In the observation group, there were 23 males and 42 females, aged (31.7±9.2) years. The control group used conventional nursing, and the observation group used psychological nursing intervention based on the control group. The psychological states, surgical effect indexes, and nursing satisfaction of the two groups were compared. Independent sample t test and χ² test were used. Results　The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the observation group were (37.92±4.16) and (36.87±3.69), respectively, which were significantly lower than those in the control group [(45.49±4.25) and (44.95±3.83)] (both P<0.001). The scores of surgical effect, self-image, self-confidence, and quality of life in the observation group were significantly higher than those in the control group (all P<0.001). The nursing satisfaction rate of the observation group was 96.92% (63/65), which was higher than that of the control group [76.92% (50/65)] (P=0.001). Conclusion　Psychological nursing intervention can significantly improve the psychological state and surgical effect of facial plastic surgery patients, and improve their satisfaction of surgery, with positive clinical significance.

New Medical Advances

Role of microRNAs in colorectal inflammatory cancer transformation

Geng Song, Lu Qingjun, Ren Xiang, Jiang Hong

2023, 29(7):  903-909.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.004

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Colorectal cancer is the third most common cancer in the world, and inflammatory bowel disease is one of the key factors leading to colorectal cancer. MicroRNAs are a class of small non-coding RNAs that play crucial roles in maintaining intestinal homeostasis and regulating various pathophysiological conditions. However, the role of microRNAs in the transformation of colorectal cancer remains unclear. The purpose of this review is to summarize the low expressed (miR-126, miR-320, miR-148/152, miR-146a, miR-370-3p, miR-449a, miR-200b, miR-193a-3p, miR-139-5p, and miR-124) and highly expressed (miR-21, miR-155, miR-31, miR-19a, miR18a, miR-301a, and miR-214) microRNAs, and their roles in the malignant transformation of colitis. Differential expressions of these microRNAs can be used for early prevention, diagnosis, and precise treatment of colitis-associated colorectal cancer.

Clinical application of susceptibility weighted imaging in acute and hyperacute ischemic stroke

Zhou Jianguo, Fu Dayong, Meng Yun, Xu Ming

2023, 29(7):  909-912.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.005

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Susceptibility weighted imaging (SWI) takes the dependence of resting blood oxygen level as the imaging basis and uses different magnetic susceptibility between tissues for imaging. It is highly sensitive to the display of paramagnetic substances such as oxyhemoglobin, methemoglobin, and hemosiderin. In recent years, the clinical application of SWI technology in the imaging diagnosis of central nervous system has gradually expanded, including the imaging diagnosis of brain trauma, stroke, cerebral amyloid angiopathy, venous abnormalities, multiple sclerosis, and brain tumors, especially in the study of pathophysiological mechanism and clinical application of ischemic stroke. SWI technology has significant effects in the clinical diagnosis, treatment, and prognosis evaluation of acute and hyperacute ischemic stroke. This paper gives a summary.

Protective effect of probucol in lung injury induced by paraquat poisoning

Xu Han, Li Wenpeng, Zhang Xiaohui, Zhang Jinying

2023, 29(7):  913-916.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.006

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Paraquat can lead to injury of multiple organs, it can induce a range of adverse effects on various organs, such as the kidneys, heart, liver, gastrointestinal tract, and nervous system. Among them, lung injury is the most common. The current clinical treatment includes emetics, gastric lavage, catharsis, anti-oxidant therapy, immunoregulation, hemoperfusion, et al. The lack of effective antidotes is the significant cause of high mortality in paraquat poisoning. Probucol is a phenolic lipid-lowering agent with antioxidant, anti-inflammatory, and antifibrotic effects, which has been widely used in the clinical treatment and prevention of cardiovascular diseases. Recent studies have discovered that probucol can ameliorate the oxidative stress response and pulmonary fibrosis caused by drugs. The protective significance of probucol in lung injury induced by paraquat poisoning is reviewed in this paper.

Meta Analysis

Meta - analysis on the improvement of gastrointestinal function after abdominal operation by Chinese herbal enema

Yao Ping, Huang Aijun, Liu Dongdong

2023, 29(7):  917-922.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.007

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Objective　To conduct a meta-analysis on clinical study literatures about randomized controlled trials of Chinese herbal enema promoting postoperative gastrointestinal function recovery and evaluate its efficacy in order to provide basis and clinical reference for the recovery of gastrointestinal function after Chinese herbal enema. Methods　PubMed, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI) were searched through computer to collect published randomized controlled trials of Chinese herbal enema promoting gastrointestinal function recovery after abdominal non-gastrointestinal surgery. The deadline for literature publishing was December 31, 2019. Two reviewers independently screened the literatures, extracted the data, and evaluated the bias of included studies. A meta-analysis was conducted for the literatures finally meeting the requirements by RevMan 5.3 software. Results　Totally 13 literatures involving 1 464 cases were selected, including 794 cases in the experimental group and 670 cases in the control group. According to the results of the meta-analysis, taking the first postoperative exhaust time as the outcome index, there was a statistically significant difference between the experimental group and the control group [WMD=-14.40 (-18.95, -9.84), Z=6.19, P<0.000 01]; taking the first postoperative defecation time as the outcome index, there was a statistically significant difference between the experimental group and the control group [WMD=-12.12 (-13.00, -11.24), Z=27.06, P<0.000 01]; taking the postoperative recovery time of bowel sounds as the outcome index, there was a statistically significant difference between the experimental group and the control group [WMD=-8.01 (-8.52, -7.49), Z=30.29, P<0.000 01]; taking the postoperative normal feeding time as the outcome index, there was a statistically significant difference between the experimental group and the control group [WMD=-16.14 (-30.38, -1.90), Z=2.22, P=0.03]; taking the postoperative abdominal distension relief time as the outcome index, there was a statistically significant difference between the experimental group and the control group [WMD=-10.58 (-12.18, -8.97), Z=12.92, P<0.000 01]; taking the number of cases of postoperative abdominal distension, nausea and vomiting as the outcome index, there was a statistically significant difference between the experimental group and the control group [OR=0.14 (0.06, 0.35), Z=4.20, P<0.000 1]. Conclusions　Chinese herbal enema combined with routine postoperative treatment can improve the clinical efficacy of gastrointestinal function recovery after abdominal surgery and can be used as a clinical therapeutic option. However, due to the low quality of the included literatures, there is still certain publication bias. The above results shall be further proved on the basis of the evidence-based medicine in high-quality clinical studies in the future.

Value of normalized iodine concentrations in the diagnosis of lymph node metastasis of colorectal cancer

Wang Fengyan, Wang Shengguo, Yu Chengxiang, Han Zhihao

2023, 29(7):  923-928.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.008

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Objective　To evaluate the value of normalized iodine concentrations (NIC) in energy spectrum enhanced CT in the diagnosis of lymph node metastasis of colorectal cancer by meta analysis. Methods　Pubmed, Embase, Cochrane, Web of Science, CBM, CNKI, Wanfang, and VIP databases were searched from the establishment of the databases to October 2022, and the literatures related to NIC in the diagnosis of lymph node metastasis of colorectal cancer were screened. The risk of bias was evaluated in the literatures using the Quality Assessment of Diagnostic Accuracy Studies tool-2, the Meta-DiSc1.4 was used to perform data statistics, the Spearman correlation coefficient was calculated, and the summary receiver operating characteristic curve (sROC) was plotted to analyze the heterogeneity caused by the presence or absence of threshold effects. Fixed-effects combined effect sizes were used for I² <50%; random-effects combined effect sizes were used for I² ≥50%. The sensitivity analysis was performed by Stata 14.0, and the publication bias was detected by Deeks funnel plot. Results　Seven literatures with 717 lymph nodes were included, including 314 metastatic lymph nodes and 403 non-metastatic lymph nodes. They were divided into two subgroups according to arterial phase (AP) and venous phase (VP) of energy spectrum enhanced CT. Meta DiSc1.4 showed that there was no heterogeneity caused by threshold effects in both groups (both P>0.05). Further, according to the I² results, the corresponding model was selected to combine the effect sizes. The sensitivities of AP and VP were 0.76 (0.71-0.80) and 0.67 (0.61-0.73), the specificities were 0.71 (0.66-0.75) and 0.87 (0.82-0.91), the positive likelihood ratios were 2.83 (1.85-4.31) and 5.39 (3.79-7.67), the negative likelihood ratios were 0.33 (0.23-0.46) and 0.34 (0.22-0.54), the diagnostic odds ratios (DORs) were 10.00 (4.38-22.82) and 17.27 (10.39-28.69), and the areas under the curve (AUCs) were 0.835 4 and 0.894 5. Subgroup-AP and subgroup-VP sensitivity analysis showed stable studies and no publication bias (P>0.05). Conclusions　NIC helps to distinguish metastatic and non-metastatic lymph nodes in patients with colorectal cancer. In terms of sensitivity, the NIC of AP is better; in terms of specificity, positive likelihood ratio, negative likelihood ratio, DOR, and AUC, the NIC of VP has higher diagnostic value.

Scientific Research

Clinical value of MRI combined with CT in the diagnosis of mixed hepatic angiomyolipoma

Mou Renqi, Wang Chunye, Lan Shouchang, Zhang Yafei, Dong Ning

2023, 29(7):  929-931.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.009

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Objective　To explore the clinical diagnostic value of magnetic resonance imaging (MRI) combined with CT in mixed hepatic angiomyolipoma (HAML). Methods　The clinical data of 85 mixed HAML patients, including 34 males and 51 females, with an age of (52.37±7.48) years old, were retrospectively selected from Yantaishan Hospital of Yantai City from August 2019 to May 2022. All the patients underwent MRI and CT examinations after admission. The detection rates of the three examination modalities (MRI, CT, and MRI combined with CT examinations) were compared by χ² test. Results　The detection rate of MRI combined with CT was 98.82% (84/85), which was significantly higher than that of MRI [90.59% (77/85)] and CT [88.24% (75/85)] (both P<0.05). There was no statistically significant difference in the detection rate between MRI and CT (P>0.05). Conclusion　The combination of MRI and CT in the clinical diagnosis of mixed HAML has a higher detection rate, better diagnostic efficacy, and better clinical application value.

Effects of low-temperature plasma radiofrequency ablation and CO₂ laser minimally invasive surgery on the VHI and prognosis in patients with laryngeal cancer 

Li Niansheng, Wang Xiaohua, Wang Shuting, Zhang Junping, Li Chengyuan

2023, 29(7):  932-935.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.010

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Objective　To investigate the effects of low-temperature plasma radiofrequency ablation and CO₂ laser minimally invasive surgery on postoperative voice handicap index (VHI) and prognosis in patients with laryngeal cancer. Methods　A total of 86 cases of laryngeal cancer admitted to Weihai Central Hospital from June 2017 to June 2021 were retrospectively selected and were divided into a study group treated by low-temperature plasma radiofrequency ablation and a control group treated by CO₂ laser minimally invasive surgery. In the control group, there were 29 males and 14 females, aged 43-80 (59.78±9.47) years; in the study group, there were 27 males and 16 females, aged 39-79 (58.85±8.99) years. The intraoperative blood loss, operative time, postoperative VHI score, mucosal recovery 1 month after surgery, and postoperative recurrence rate were compared between the two groups. t test and χ² test were used. Results　Compared with those in the control group, the study group had less intraoperative blood loss (t=8.205, P<0.001) and shorter operation time (t=5.839, P<0.001). The VHI scores of voice function in both groups were decreased 1 month after surgery, and the VHI score in the study group was lower than that in the control group [(4.25±0.57) points vs. (6.85±1.04) points] (t=14.376, P<0.001). The postoperative recurrence rate in the study group was lower than that in the control group [4.65% (2/43) vs. 20.93% (9/43)], with a statistically significant difference (χ²=5.108, P=0.024). The mucosal recovery of the study group was better than that of the control group 1 month after surgery (χ²=4.074, P=0.044). Conclusion　Low temperature plasma radiofrequency ablation in the treatment of laryngeal cancer has short operation time and less blood loss, and can improve the patients' voice and prognosis, which is worth promoting.

Efficacy and safety of nicorandil combined with metformin in the treatment of type 2 diabetes mellitus complicated with coronary heart disease

Kang Jie, Zhang Jianjian, Zhang Weidong, Zhang Yue, Huang Gaode

2023, 29(7):  936-939.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.011

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Objective　To explore the efficacy and safety of nicorandil combined with metformin in the treatment of type 2 diabetes mellitus complicated with coronary heart disease. Methods　It was a randomized controlled trial. A total of 92 patients with type 2 diabetes mellitus complicated with coronary heart disease admitted to Internal Medicine, Jinan Minzu Hospital from June 2021 to January 2022 were selected as the research objects. They were divided into a combined group and a conventional group by the random number table method, with 46 cases in each group. In the conventional group, there were 26 females and 30 males, aged 50-80 years, with an age of (69.41±8.02) years old. In the combined group, there were 25 females and 31 males, aged 56-79 years, with an age of (68.74±7.79) years old. The conventional group was treated with metformin tablets, and the combined group was treated with metformin tablets plus nicorandil. After 2 months of treatment, the blood glucose indexes, cardiac function indexes [left ventricular end-diastolic volume index (LVD-VI) and left ventricular ejection fraction (LVEF)], and efficacies of the two groups were evaluated, and the incidence of adverse drug reactions was recorded. t test, χ² test, and rank sum test were used. Results　After treatment, the 2 h postprandial blood glucose and fasting blood glucose in the combined group were lower than those in the conventional group [(8.14±0.61) mmol/L vs. (9.89±1.04) mmol/L, (6.10±0.78) mmol/L vs. (6.89±0.90) mmol/L] (t=4.499, P<0.001; t=9.844, P<0.001). The LVEF after treatment was higher than that before treatment in both groups, and the LVEF in the combined group was higher than that in the conventional group [(48.37±6.02) % vs. (44.12±5.81) %] (t=2.205, P=0.030). The LVED-VI after treatment was lower than that before treatment in both groups, and the LVED-VI in the combined group was lower than that in the conventional group [(63.42±9.13) vs. (67.29±8.93)] (t=3.696, P<0.001). The rank sum test showed that the efficacy of the combined group was better than that of the conventional group, with a statistically significant difference (Z=2.049, P=0.040). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ²=0.449, P=0.503). Conclusion　Nicorandil combined with metformin in the treatment of type 2 diabetes mellitus complicated with coronary heart disease has superior hypoglycemic effect, and improves the cardiac function, with good safety.

Effect of dolasetron in the prevention and treatment of nausea and vomiting after radical resection of lung cancer

Liu Yunhui, Yang Qiumin, Lin Chunli

2023, 29(7):  940-943.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.012

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Objective　To observe the effect of dolasetron in the prevention and treatment of nausea and vomiting after radical resection of lung cancer and explore its mechanism. Methods　It was a randomized controlled trial. A total of 125 patients with lung cancer who received radical surgery in The First People's Hospital of Shangqiu City from May 2019 to August 2021 were selected as subjects, and were randomly divided into a treatment group (63 cases) and a conventional group (62 cases) by drawing lots. In the treatment group, 40 males and 23 females, aged (55.25±5.15) years, were treated with dolasetron for prevention of postoperative nausea and vomiting. In the conventional group, 42 males and 20 females, aged (55.46±5.23) years, were treated with conventional antiemetic measures. The frequencies of vomiting, Index of Nausea and Vomiting and Retching (INVR) scores, and Kolcaba General Comfort Questionnaire (GCQ) scores 6, 12, 24, and 48 h after surgery, and severity of vomiting symptoms were compared between the two groups. Long-term follow-up was conducted for 1 year after surgery to compare the survival of the two groups. χ² test and t test were used. Results　Six, 12, 24, and 48 h after surgery, the frequencies of vomiting [3.17% (2/63), 4.76% (3/63), 3.17% (2/63), and 0.00% (0/63)] and INVR scores [(20.25±5.41) points, (17.24±3.31) points, (15.25±2.33) points, and (13.11±1.25) points] in the treatment group were lower than that in the conventional group [16.13% (10/62), 17.74% (11/62), 14.52% (9/62), 8.06% (5/62), (23.58±5.86) points, (20.55±3.81) points, (16.83±2.88) points, and (14.92±1.86) points], while the GCQ scores [(73.85±5.83) points, (75.72±3.82) points, (80.75±2.81) points, and (85.88±1.86) points] were higher than those in the conventional group [(70.52±5.31) points, (72.41±3.16) points, (79.39±2.25) points, and (81.52±1.32) points], with statistically significant differences (all P<0.05). The rate of nausea and vomiting in the treatment group was lower than that in the conventional group [11.11% (7/63) vs. 53.23% (33/62)], with a statistically significant difference (χ²=25.470, P<0.001). During the follow-up period, the KPS score [(73.35±5.17) points] and QOL score [(43.71±5.85) points] in the treatment group were higher than those in the conventional group [(70.66±5.28) points and (40.25±5.62) points], while the ZPS score [(2.55±0.33) points] was lower than that of the conventional group [(2.92±0.85) points], with statistically significant differences (all P<0.05). Conclusions　Using dolasetron to pretreat lung cancer patients before anesthesia induction during radical surgery can effectively reduce the risk of postoperative nausea and vomiting, and has a positive effect on improving postoperative symptoms and improving patients' comfort and long-term quality of life. The mechanism of action is reflected in the central and peripheral vagal neurotransmitter receptor blocking.

Effect of Tongxinluo and Shensong Yangxin capsules combined with conventional western medicine on patients with ventricular arrhythmia

Li Huilin

2023, 29(7):  944-947.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.013

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Objective　To explore the therapeutic effect of Tongxinluo combined with Shensong Yangxin capsules on patients with ventricular arrhythmia. Methods　It was a randomized controlled trial. A total of 138 patients with ventricular arrhythmia admitted to Puyang Huimin Hospital from January 2021 to January 2022 were selected and were divided into a control group and an observation group by the random number table method with 69 patients in each group. The control group included 37 males and 32 females, aged (61.48±9.42) years; the observation group included 34 males and 35 females, aged (61.52±9.67) years. The patients in the control group were treated with conventional western medicine, and the patients in the observation group were treated with Tongxinluo and Shensong Yangxin capsules on the basis of the control group. The curative effects, heart function, electrocardiographic indicators, and adverse reactions were compared between the two groups. t test and χ² test were used. Results　The total effective rate of the observation group was 94.20% (65/69), which was higher than that of the control group [69.57% (48/69)], with a statistically significant difference (χ²=14.118, P<0.001). After one month of treatment, the left ventricular ejection fraction (LVEF) in the observation group [(58.98±2.69)%] was higher than that in the control group [(53.58±2.88)%], while the left ventricular end-diastolic diameter (LVEDD) [(51.69±3.47) mm] and left ventricular end-systolic volume (LVESV) [(77.92±11.43) mm] were lower than those of control group [(56.75±3.61) mm and (86.37±12.79) mm], with statistically significant differences (all P<0.05). After one month of treatment, the atrioventricular conduction time (PR interval) in the observation group [(201.28±25.25) ms] was higher than that in the control group [(186.61±20.39) ms], while the time of ventricular depolarization to complete repolarization (QT interval) [(347.11±13.29) ms] and QT dispersion (maximum QT interval - minimum QT interval) [(41.17±9.63) ms] were lower than those in the control group [(363.35±15.58) ms and (52.96±10.13) ms], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group [5.80% (4/69) vs. 4.35% (3/69)] (χ²=0.151, P=0.698). Conclusion　Tongxinluo combined with Shensong Yangxin capsules can achieve the good results in the treatment of patients with ventricular arrhythmia, which can significantly improve their cardiac function and electrical activity, and is safe and reliable, worthy of promotion.

Research on teaching mode of medical imaging based on Internet online teaching platform

Wang Xiaoying, Yang Xinxin

2023, 29(7):  948-951.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.014

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Objective　To study the teaching mode of medical imaging based on Internet online teaching platform. Methods　A total of 410 junior and senior students studying in Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were selected as subjects of this study, and were divided into two groups by the random number table method with 205 students in each group. There were 112 males and 93 females in the control group, aged (21.35±1.27) years. There were 110 males and 95 females in the observation group, aged (21.26±1.19) years. The control group received routine teaching, and the observation group used the Internet online teaching platform for teaching on the basis of routine teaching. The final test scores, students' recognition on teaching, students' satisfaction with teaching methods, and students' learning attitude were compared between the two groups. χ² test was used for the count data and t test for the measurement data. Results　The theoretical score [(90.05±5.02) points] and practical score [(88.26±5.32) points] of the observation group were higher than those of the control group [(88.78±4.59) points and (86.69±4.67) points], with statistically significant differences (t=2.926 and 3.782; both P<0.05). The rates of good communication between teachers and students [97.07% (199/205)], being able to understand content [95.12% (195/205)], and being able to master content [92.20% (189/205)] in the observation group were higher than those in the control group [91.22% (187/205), 88.29% (181/205), and 85.37% (175/205)], with statistically significant differences (all P<0.05). The teaching satisfaction of the observation group was higher than that of the control group [97.56% (200/205) vs. 92.68% (190/205)], with a statistically significant difference (χ²=5.256, P=0.022). The rates of pre-class learning [95.61% (196/205)], after-class learning [98.05% (201/205)], and interclass interaction [66.83% (137/205)] of the observation group were higher than those of the control group [89.76% (184/205), 93.17% (191/205), and 55.12% (113/205)], with statistically significant differences (all P<0.05). Conclusions　Relying on the Internet online teaching platform to carry out the teaching of medical imaging, while improving the efficiency of teaching, the students' scores of all aspects can be improved, so that the students' learning attitude is more active and the students' recognition on teaching is improved. It conforms to the development law of modern society, and can provide convenient conditions for teachers' teaching and students' learning at the same time to meet the needs of both sides.

Treatises

Study on the distribution of cerebral cortex thickness in patients with type 2 diabetes mellitus and its correlation with glycosylated hemoglobin 

Yang Yingliang, Sun Chunyan, Xia Xinjian, Li Ning

2023, 29(7):  952-956.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.015

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Objective　To establish a map of cerebral cortex thickness in patients with type 2 diabetes mellitus (T2DM) without consciousness disorder by brain magnetic resonance imaging and image analysis software, to analyze its distribution rule, and to explore the correlation between cerebral cortex thickness and glycated hemoglobin (HbA1c) in patients with T2DM. Methods　It was a retrospective study. From December 2020 to June 2021, 29 patients with T2DM without consciousness disorder who were diagnosed in Shouguang People's Hospital were included, including 18 males and 11 females, aged (60.43±1.47) years. High resolution three-dimensional T1 images were obtained from the 29 T2DM patients. Freesurfer software with automatic recognition and extraction system was used to calculate the thickness of each gyrus cortex based on the region of interest (ROI) of the gyrus. The obtained cortical thickness data were statistically analyzed, and the average cortical thickness of the brain region was mapped to the brain template to form a brain atlas. Pearson correlation analysis was conducted between the cortical structure data obtained and HbA1c by statistical analysis software. Paired t test was used to analyze the laterality of left and right hemispherical cortical thickness. Results　The brain regions with thicker cortex were temporal pole, entorhinal cortex, head of anterior cingulate gyrus, insula, frontal pole, middle temporal gyrus, and inferior temporal gyrus. The brain regions with thinner cortex were paracalcaneal gyrus, cuneiform lobe, lingual gyrus, posterior central gyrus, transverse temporal gyrus, lateral occipital gyrus, and superior parietal gyrus. The cortical thickness of the left and right cerebral hemispheres in T2DM patients was laterally distributed in the straight gyrus [(2.371±0.352) mm vs. (2.432±0.393) mm], lateral occipital gyrus [(2.141±0.185) mm vs. (2.201±0.221) mm], middle temporal gyrus [(2.662±0.364) mm vs. (2.724±0.353) mm], head of anterior cingulate gyrus [(2.665±0.453) mm vs. (2.791±0.506) mm], and frontal pole [(2.749±0.398) mm vs. (2.616±0.422) mm] (t=-2.613, -3.161, -3.106, -2.317, and 2.771; P=0.014, 0.004, 0.004, 0.028, and 0.010). Laterality: except the thickness of frontal polar cortex to the left, the rest of brain regions were to the right. The cortical thicknesses of left cuneiform lobe, left paracentral gyrus, left anterior central gyrus, left superior parietal gyrus, left superior marginal gyrus, left frontal pole, left transverse temporal gyrus, right cuneiform lobe, right anterior central gyrus, right anterior cuneiform lobe, right superior parietal gyrus, and right transverse temporal gyrus were significantly negatively correlated with HbA1c (r=-0.608, -0.563, -0.546, -0.535, -0.488, -0.524, -0.487, -0.554, -0.552, -0.479, -0.522, and -0.475; all P<0.01). Conclusions　In this study, we found the distribution rule and laterality of cerebral cortex thickness in patients with T2DM without consciousness disorder, which provided the image structure basis for later brain science research. There was a correlation between cerebral cortex thickness and HbA1c in patients with T2DM.

Detection of ABCB1, PON1, and CYP2C19 genotypes in patients with coronary heart disease and their clinical significance of guiding precise drug use after PCI

Chen Jiye, Sun Xiaoqing, Wang Xiangcun, Lu Bo, Zhao Juanjuan

2023, 29(7):  957-961.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.016

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Objective　To explore the distribution characteristics of ABCB1, PON1, and CYP2C19 genotypes in patients with coronary heart disease in Mengyin area and their clinical significance of guiding precise drug use after percutaneous coronary intervention (PCI). Methods　It was a clinical trial. A total of 785 patients with coronary heart disease who were diagnosed and treated in Mengyin County People's Hospital from May 2019 to October 2021 were selected consecutively. The genotype detection was performed for all the patients, and the distribution characteristics of genotype were statistically analyzed. The patients requiring PCI were divided into a normal metabolism group (183 cases) and a slow metabolism group (115 cases) according to the genotype detection results. In the normal metabolism group, 129 males and 54 females, aged 63.0 (53.3, 70.0) years, took clopidogrel 75 mg/d after surgery. In the slow metabolism group, 88 males and 27 females, aged 64.0 (54.0, 70.0) years, took ticagrelor 90 mg/time, twice a day or cilostazol 100 mg/time, twice a day. The two groups both took aspirin 100 mg/d, and other drugs were selected according to the conditions. The main adverse cardiovascular events were followed up within 12 months after operation and were compared between the two groups. Rank sum test and χ² test were used. Results　In the patients, the mutation frequency of ABCB1 gene was 61.14% (480/785); the mutation frequency of PON1 gene was 67.64% (531/785); CYP2C19 fast metabolism genotype accounted for 40.89% (321/785), ultra-fast metabolism genotype accounted for 0.89% (7/785), intermediate metabolism genotype accounted for 43.82% (344/785), and slow metabolism genotype accounted for 14.39% (113/785). The frequency of clopidogrel absorption and metabolism-related gene mutation was higher in patients with coronary heart disease in this region. There was no statistically significant difference in the incidence of adverse events between the patients in the slow metabolism group after precision medication and the normal metabolism group [13.91% (16/115) vs. 9.84% (18/183)] (P>0.05). Conclusion　The mutation rate of clopidogrel absorption and metabolism-related genes is high in patients with coronary heart disease in Mengyin area, and it is of important clinical significance to accurately use drugs after PCI according to the genotypes.

Analysis of the pattern of Cortex Lycii grouping in 6 783 prescriptions of Yin deficiency syndrome based on the TCM heritage computing platform

Hong Zhiyuan, Jiang Chuan, Zhang Liang, Liu Qinghua, Wang Yinghao, Huang Meixia

2023, 29(7):  962-968.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.017

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Objective　To explore the potential rules of Cortex Lycii in 6 783 prescriptions of Yin deficiency syndrome, so as to provide the theoretical basis and reference for clinical application and pharmacological research of Cortex Lycii. Methods　The cases involved in this study were provided by Fujian Provincial People's Hospital. A total of 6 783 prescriptions of Yin deficiency syndrome containing Cortex Lycii from 2018 to 2020 were collected. and input into the traditional Chinese Medicine (TCM) inheritance calculation platform to establish the database. The frequencies of symptom types, main TCM diseases, and main diseases were counted. The overall drugs, the core medicinal materials and their combination rules in the treatment of Yin deficiency syndrome were statistically analyzed under different support degrees when the confidence was 0.9. Finally, the core medicinal materials and their combination rules of Cortex Lycii in high-frequency applied syndrome types were further statistically analyzed by the Apriori association rule algorithm. Results　The Yin deficiency syndrome mainly treated was highly concentrated in the liver and kidney. There were 5 kinds of diseases with frequency ≥200, among which the top three with the highest frequencies were Xiaoke disease, white astringent disease, and gall disease. There were 741 kinds of diseases, the top three with the highest frequencies were type 2 diabetes mellitus, xerophthalmia, and conjunctivitis. Baishao, Radix Rehmanniae, and Huangqi were the top three with the highest compatibility frequency in the prescription of Yin deficiency syndrome. Its core combinations were Cortex Lycii - Baishao, Cortex Lycii – Radix Rehmanniae, and Cortex Lycii - Huangqi. The core compatible herbs in the Qi and Yin deficiency syndrome mainly included Huangqi, Zhimu, Baishao, Poria Cocos, and Chuanxiong. The core combinations were Cortex Lycii - Huangqi - Zhimu, Cortex Lycii - Poria Cocos, Cortex Lycii - Zhimu, Huangqi - Zhimu, Cortex Lycii - Baishao, Cortex Lycii - Huangqi, Cortex Lycii - Chuanxiong. Among which, Cortex Lycii – Chuanxiong and Huangqi - Zhimu had special synergistic significance in the Qi and Yin deficiency syndrome. In the liver Yin deficiency syndrome, the core compatible herbs were Baishao, Radix Scrophulariae, and Radix Rehmanniae (with a support degree up to 60%). Its core combinations were Cortex Lycii – Baishao - Radix Scrophulariae, Cortex Lycii - Baishao - Radix Rehmanniae, Baishao - Radix Scrophulariae, Cortex Lycii – Baishao, Cortex Lycii - Radix Rehmanniae, Cortex Lycii - Radix Scrophulariae, and Baishao - Radix Rehmanniae. In the kidney Yin deficiency syndrome, there were four core compatible herbs, namely Baishao, Maidong, Radix Rehmanniae, and Radix scrophulariae (with a support degree up to 40%). The core combinations were Cortex Lycii – Baishao, Cortex Lycii - Radix Rehmanniae, Cortex Lycii – Maidong, and Cortex Lycii - Radix Scrophulariae. Among which, Radix Rehmanniae - Maidong and Radix Rehmanniae - Radix Scrophulariae were often used in pairs and compatible with Cortex Lycii (with a support degree up to 40%). Conclusion　Based on a large number of clinical prescriptions, this analysis of actual use of Cortex Lycii in the Yin deficiency syndrome shows the prescription law of Cortex Lycii in the treatment of Yin deficiency syndrome and the core combination law of Yin deficiency syndrome of different viscera for the first time, which can provide ideas and basis for modern clinical application and modern pharmacological research of Cortex Lycii.

Clinical value of serum cystatin C, β2-microglobulin, microalbuminuria/urinary creatinine combined detection in the diagnosis of acute kidney injury in children with primary nephrotic syndrome

Wen Jing, Liu Yan

2023, 29(7):  969-972.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.018

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Objective　To investigate the clinical value of serum cystatin C (Cys-C), β2-microglobulin (β2-MG), microalbuminuria/urinary creatinine (mAlb/Cr) combined detection in the diagnosis of acute kidney injury (AKI) in children with primary nephrotic syndrome (PNS). Methods　The clinical data of 60 children with PNS in Department of Nephropathy and Rheumatism, Qianjiang Central Hospital from January 2018 to January 2022 were retrospectively analyzed, including 35 males and 25 females, aged (9.24±2.51) years. The children were divided into an AKI group (27 cases) and a non-AKI group (33 cases) according to the presence or absence of AKI. The clinical data such as gender, age, body mass index (BMI), serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum creatinine (Scr), serum albumin (ALB), uric acid (UA), 24 h urinary protein (24 h Up), hemoglobin (Hb), β2-MG, CysC, and mAlb/Cr were compared between the two groups. The risk factors of AKI in the children with PNS were analyzed by multivariate logistic regression equation, and the clinical value of Cys-C, β2-MG, and mAlb/Cr combined detection in the diagnosis of AKI in children with PNS was analyzed by receiver operating characteristic curve (ROC). t test and χ² test were used. Results　The levels of Scr [(87.04±13.32) µmol/L], UA [(275.53±58.14) µmol/L], 24 h Up [(150.24±37.83) mg/24 h], Cys-C [(2.25±0.53) mg/L], β2-MG [(1.46±0.25) mg/L], and mAlb/Cr [(36.70±10.35) μg/mg] in the AKI group were higher than those in the non-AKI group [(71.95±11.91) µmol/L, (221.07±43.56) µmol/L, (120.52±28.62) mg/24 h, (1.62±0.32) mg/L, (1.18±0.21) mg/L, and (22.32±6.51) μg/mg], while the level of ALB [(34.72±2.34) g/L] was lower than that of the non-AKI group [(37.39±2.72) g/L], with statistically significant differences (all P<0.05). Increased Cys-C, β2-MG, and mAlb/Cr were risk factors for AKI in children with PNS (all P<0.05). The area under the curve (AUC), sensitivity, and specificity (0.885, 88.89%, and 81.82%) of Cys-C, β2-MG, and mAlb/Cr combined detection in the diagnosis of AKI in children with PNS were superior to those of single index detection (all P<0.05). Conclusion　The combined detection of Cys-C, β2-MG, and mAlb/Cr in the diagnosis of AKI in children with PNS has a good clinical value.

Effect and prognosis of extracorporeal membrane oxygenation in the treatment of respiratory failure

Yuan Fawei, Li Bingqi

2023, 29(7):  973-977.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.019

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Objective　To investigate the effect and prognosis of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory failure. Methods　This study was a retrospective study. A total of 84 respiratory failure patients diagnosed and treated in Huangshi Central Hospital from May 2019 to June 2022 were selected as the research objects. According to treatment methods, they were divided into an observation group (receiving ECMO treatment) and a control group (receiving invasive positive pressure mechanical ventilation treatment), with 42 cases in each group. In the observation group, there were 21 males and 21 females, aged (55.82±2.41) years; in the control group, there were 22 males and 20 females, aged (55.62±2.36) years. The airway resistance (RAW), airway peak pressure (P_peak), static compliance (Cst), surplus pulse O₂ (SpO₂), partial pressure of arterial carbon dioxide (PaCO₂), partial pressure of arterial oxygen (PaO₂), forced expiratory volume in 1 second (FEV₁), percentage of forced expiratory volume in 1 second to forced vital capacity (FEV₁/FVC), peak expiratory flow (PEF), endothelin (ET-1), Clara cell secretion protein 16 (CC16), Copeptin, 28 d mortality, withdrawal success rate, and ventilation time were compared between the two groups. Independent sample t test and χ² test were performed. Results　Before treatment, there were no statistically significant differences in the RAW, Cst, P_peak, SpO₂, PaCO₂, PaO₂, FEV₁, FEV₁/FVC, ET-1, CC16, and Copeptin between the two groups (all P>0.05). After treatment, the RAW, Cst, PaCO₂, ET-1, CC16, and Copeptin of the observation group were (16.42±1.78) cmH₂O/L•s (1 cmH₂O=0.098 kPa), (27.41±5.62) cmH₂O, (50.01±6.32) mmHg (1 mmHg= 0.133 kPa), (14.21±2.32) ng/L, (0.18±0.03) ng/L, and (28.62±6.85) ng/L, which were significantly lower than those of the control group [(18.05±2.36) cmH₂O/L•s, (25.05±4.11) cmH₂O, (53.85±8.47) mmHg, (26.65±3.96) ng/L, (0.29±0.08) ng/L, and (35.74±9.52) ng/L] (all P<0.05). The P_peak, SpO₂, PaO₂, FEV₁, FEV₁/FVC, and PEF of the observation group were (14.65±1.44) cmH₂O, (96.45±17.05) %, (70.52±8.96) mmHg, (61.25±8.45) %, (68.74±9.45) %, and (4.89±0.56) L/s, which were significantly higher than those of the control group [(16.05±1.96) cmH₂O, (94.11±15.14) %, (68.01±6.85) %, (48.33±6.45) %, (59.78±6.08) %, and (4.24±0.39) L/s] (all P<0.05). The 28 d mortality rate of the observation group was 9.52% (4/42), which was lower than that of the control group [28.57% (12/42)]; the ventilation time of the observation group was (9.52±2.32) d, which was shorter than that of the control group [(11.36±3.69) d]; the withdrawal success rate of the observation group was 95.24% (40/42), which was higher than that of the control group [73.81% (31/42)] (all P<0.05). Conclusion　ECMO has an ideal effect in the treatment of respiratory failure, which is beneficial to improve the blood gas analysis indexes and reduce the mortality rate.

Clinical Research

Effect of omeprazole injection combined with enteral nutrition support on patients with acute pancreatitis

Zhang Qi, Zhao Yanchao

2023, 29(7):  978-982.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.020

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Objective　To investigate the effect of omeprazole injection combined with enteral nutrition support on the symptom improvement and prognosis in patients with acute pancreatitis. Methods　It was a randomized controlled trial. A total of 96 patients with acute pancreatitis admitted in Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were divided into group A, group B, and group C by the random number table method with 32 patients in each group. There were 16 males and 16 females in group A, with an age of (46.89±7.58) years old; there were 17 males and 15 females in group B, with an age of (45.85±6.99) years old; there were 18 males and 14 females in group C, with an age of (45.02±7.74) years old. Group C received conventional comprehensive therapy, group B received enteral nutrition support therapy on the basis of group C, and group A received omeprazole injection on the basis of group B. The therapeutic effect, clinical symptom improvement time, serum amylase (AMS) and white blood cell count (WBC) before and after treatment, and prognosis were compared among the three groups. One-way analysis of variance, SNK-q test, paired t test, χ² test, and rank sum test were used. Results　The total effective rate of group A [93.75% (30/32)] was higher than those of group B [75.00% (24/32)] and group C [62.50% (20/32)], with a statistically significant difference (χ²=4.857, P=0.032). The abdominal pain relief time, exhaust recovery time, AMS recovery time, and length of hospital stay in group A [(4.63±0.63) d, (5.91±1.01) d, (5.08±0.78) d, and (9.87±1.22) d] were shorter than those in group B [(6.58±0.91) d, (6.89±1.23) d, (8.21±1.49) d, and (11.59±1.89) d] and group C [(8.56±1.54) d, (8.54±1.55) d, (9.28±1.65) d, and (13.55±2.32) d], with statistically significant differences (F=67.971, 22.662, 54.332, and 20.555; all P<0.001). After treatment, the levels of AMS and WBC in group A [(68.75±21.28) U/L and (8.86±1.27) ×10⁹/L] were lower than those in group B [(118.83±38.92) U/L and (10.02±2.13) ×10⁹/L] and group C [(125.74±39.74) U/L and (13.74±2.38) ×10⁹/L], with statistically significant differences (F=8.741 and 2.965; both P<0.05). There was no statistically significant difference in the incidence of poor prognosis among group A [12.50% (4/32)], group B [15.63% (5/32)], and group C [18.75% (6/32)] (χ²=0.258, P=0.784). Conclusion　In the treatment of acute pancreatitis, omeprazole injection combined with enteral nutrition support can promote the recovery of relevant clinical indicators, improve the clinical symptoms, and reduce the length of hospital stay, which is worthy of further study and promotion.

Arthroscopic treatment of tibial insertion avulsion fracture of posterior cruciate ligament with hollow screw internal fixation via very high posterior approach

Pan Jingbo, Zhang Qi, Kong Gang

2023, 29(7):  982-986.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.021

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Objective　To investigate the effect of posterior cruciate ligament (PCL) tibial insertion avulsion fracture treated by hollow screw internal fixation (HSIF) via very high posterior approach under arthroscopy. Methods　A total of 40 patients with tibial insertion avulsion fracture of PCL in Yantai Mountain Hospital from February 2019 to September 2021 were collected and were divided into group A (20 cases) and group B (20 cases) according to different surgical schemes. Group A included 12 males and 8 females, aged (37.33±6.16) years. Group B included 13 males and 7 females, aged (38.14±6.09) years. Group B received open reduction HSIF via modified Burks-Schaffer approach, and group A received HSIF via very high posterior approach under arthroscopy. The operation time, knee joint ranges of motion, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and levels of traumatic stress factors [tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-10, and C-reactive protein (CRP)] before and after operation, and posterior drawer test (PDT) result were compared between the two groups. t test, χ² test, and rank sum test were used. Results　The operation time of group A was longer than that of group B [(65.72±5.83) min] vs. (51.38±4.67) min], with a statistically significant difference (t=8.585, P<0.001). There were no statistically significant differences in the Lysholm and IKDC scores between the two groups before operation and 3 months and 6 months after operation (all P>0.05). One and three days after operation, the levels of serum TNF-α [(49.57±8.19) ng/L and (36.44±5.99) ng/L], IL-1 [(1.52±0.20) mg/L and (1.37±0.16) mg/L], IL-10 [(35.72±6.60) ng/L and (27.57±5.29) ng/L], and CRP [(24.46±3.37) mg/L and (19.42±2.77) mg/L] in group A were lower than those in group B [(66.42±10.68) ng/L, (58.19±7.64) ng/L, (2.33±0.27) mg/L, (2.14±0.22) mg/L, (48.11±8.52) ng/L, (36.37±7.18) ng/L, (32.49±5.83) mg/L, and (23.48±4.10) mg/L] (t=5.566, 10.019, 10.781, 12.659, 5.141, 4.413, 5.333, and 3.670; all P<0.001). There was no statistically significant difference in the PDT result between the two groups (P>0.05). Conclusions　Open reduction HSIF via modified Burks-Schaffer approach is as effective as HSIF via very high posterior approach under arthroscopy in the treatment of PCL tibial insertion avulsion fracture, both of which can effectively improve the function and range of motion of knee joint, but both have their advantages and disadvantages. The former takes less time to operate, and the latter has less impact on the stress of body trauma.

Effect of Quyu Shengxin acupuncture combined with rehabilitation therapy on patients with cerebral infarction

Yu Fengyuan, Liu Cong, Ruan Jiapeng

2023, 29(7):  987-990.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.022

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Clinical effect observation of ecabet sodium combined with rabeprazole quadruple therapy on Hp positive chronic atrophic gastritis patients 

Jiang Hong, Huang Fengyu

2023, 29(7):  990-994.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.023

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Case Report

Rectal mucosal Schwann cell hamartoma: a clinicopathological analysis of 3 cases

Mei Jiaming, Yang Yusheng

2023, 29(7):  995-998.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.024

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目的　探讨黏膜施万细胞错构瘤临床病理特征，以提高病理医生对该病的认识与诊断水平。方法　收集2015年6月至2022年7月上海市松江区中心医院3例直肠黏膜施万细胞错构瘤患者资料，从内镜特征、组织形态学特征及免疫组织化学等方面分析讨论，并复习文献。结果　3例黏膜施万细胞错构瘤患者中，男2例，女1例，年龄47～54岁，3例均发生在直肠。临床症状主要为腹痛或无明显症状。内镜下2例为扁平息肉样隆起，长径0.2～0.3 cm；1例为亚蒂息肉，长径0.8 cm。病理学形态表现为黏膜固有层间质中梭形细胞增生。免疫组化梭形细胞表达S-100、SOX-10。结论　消化道黏膜施万细胞错构瘤是一种罕见的错构瘤性息肉，起源于神经施万细胞，掌握该病的内镜及病理学特征，了解其鉴别诊断，有助于提高病理医生对该病的诊断率。

Cirrhosis with ascites and umbilical hernia incarceration: one case report and literature review

Gao Lijuan, Xiao Xin, Dai Guodong, Guan Chundi, Yu Haisheng

2023, 29(7):  998-1001.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.025

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Umbilical hernia refers to the external abdominal hernia with abdominal contents protruding from the weak area of umbilical cord. Umbilical hernia based on cirrhosis is often accompanied by more complications. Once incarceration and strangulation occur, the risk of death is significantly increased. Its clinical manifestations are insidious and early diagnosis is difficult. This paper reported a case of cirrhosis with ascites and umbilical hernia incarceration in Binzhou Medical University Hospital. During the patient's course, the umbilical hernia appeared similar to the "pidan" appearance, which could not be returned to the abdominal cavity, suggesting incarceration and strangulation. The patient was successful treated through timely operation. The relevant literatures were summarized to discuss the etiology and treatment of this disease, and the diagnosis and treatment experiences of this disease were summarized.

One case of severe hiccups and vomiting caused by levofloxacin injection

Qi Yanzhi, Zhang Yanli

2023, 29(7):  1002-1004.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.026

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A 41-year-old male patient was given levofloxacin hydrochloride sodium chloride injection intravenously because of urinary tract infection and epididymitis in Shanghai Songjiang District Central Hospital on October 6, 2022. Hiccups occurred after 3 days of treatment, but no attention was paid. After 3 days of continuous use of levofloxacin hydrochloride sodium chloride injection, the patient developed uninterruptible hiccups with vomiting. Consideration of drug-induced vomiting was given and the patient was admitted to our hospital on October 12. After admission, levofloxacin hydrochloride sodium chloride injection was stopped, and the patient was given symptomatic treatment such as omeprazole to suppress the gastric acid, antiemetic metoclopramide, and potassium supplement for nutritional support. After 4 days, the patient's symptoms improved and he was discharged.

Analysis and thinking of digestive system reaction caused by Biling Weitong granules

Zhao Zhanwei, Cui Hongxia

2023, 29(7):  1004-1006.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.027

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Biling Weitong granules are an empirical formula summarized on the basis of ancient prescription combined with clinical experiences. They have the effect of acid inhibition and analgesia, and are widely used in the treatment of stomach diseases such as gastritis and gastric ulcer. However, there is a lack of description of adverse reactions in the instructions and few related reports, which cannot provide enough references for clinical treatment and patients. Two patients in Weihai Central Hospital Affiliated to Qingdao University had digestive tract reactions after taking Biling Weitong granules, which was analyzed by the author in order to provide help for the improvement of Chinese patent medicine instructions.

Case report: general management of lung cancer combined with Pneumocystis jiroveci pneumonia

Fan Wancheng, Liang Qiang, Liu Cuizhong, Chen Jinping, Wu Yuan

2023, 29(7):  1007-1010.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.028

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Lung cancer is one of the malignant tumors with the highest mortality rate in the world, and the focus of chronic disease management in China. For patients with advanced lung cancer, radiotherapy, chemotherapy, and immunotherapy will increase the probability of pneumocystis infection. This paper reported a case of stage Ⅳ lung cancer patient who developed pulmonary infection after radiotherapy and chemotherapy combined with targeted drug therapy in Hunan Provincial People's Hospital in October 2020, who was diagnosed as Pneumocystis jirovecii pneumonia (PJP) by sputum next-generation sequencing (NGS). The diagnosis and treatment process of improvement after comprehensive management by the general practitioner team was analyzed and the relevant literatures were reviewed.

Nursing Research

Effect of nursing intervention under the ERAS concept on postoperative rehabilitation in patients with upper urinary tract calculi

Hu Songjia, Cai Lijuan, Zhu Xin, Cheng Xiangchao

2023, 29(7):  1011-1014.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.029

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Objective　To explore the effects of nursing intervention under the concept of enhanced recovery after surgery (ERAS) on the postoperative rehabilitation and nursing satisfaction in patients with upper urinary tract calculi. Methods　It was a prospective study. From May 2019 to July 2020, 80 patients with upper urinary tract calculi in Henan No.3 Provincial People's Hospital were selected and were divided into a control group and an observation group according to the order of admission, with 40 patients in each group. In the control group, there were 19 males and 21 females, aged (50.0±1.5) years; in the observation group, there were 20 males and 20 females, aged (46.5±2.4) years. The patients in the control group received conventional nursing, and the patients in the observation group received nursing intervention under the ERAS concept on the basis of the control group. The psychological emotions, hospitalization time, time of catheter removal, time of getting out of bed, adverse reactions, and nursing satisfaction were compared between the two groups after nursing intervention. Independent sample t test and χ² test were used for statistical analysis. Results　In the observation group, the scores of anxiety and depression after nursing were (32.14±4.23) points and (32.68±3.54) points, the length of hospital stay was (7.69±1.53) d, the time of catheter removal was (47.38±6.43) h, the time of getting out of bed was (59.38±8.39) h, and those in the control group were (47.19±3.82) min, (45.81±2.93) min, (19.42±2.74) d, (87.38±8.29) h, and (72.39±9.74) h, respectively, with statistically significant differences between the two groups (all P<0.05). The total incidence of adverse reactions in the observation group was lower than that in the control group [2.5% (1/40) vs. 15.0% (6/40)], with a statistically significant difference between the two groups (χ²=3.914, P=0.048). The total nursing satisfaction of the observation group was higher than that of the control group [95.0% (38/40) vs. 77.5% (31/40)], with a statistically significant difference between the two groups (χ²=5.165, P=0.023). Conclusions　The nursing intervention under the ERAS concept has good effects in the postoperative care in patients with upper urinary tract calculi. On the one hand, it can help patients alleviate the negative emotions and reduce the occurrence of adverse reactions, on the other hand, it can improve the patients' satisfaction with nursing and promote their physical recovery, which is worth recommending.

Effect of nursing intervention strategies under the ERAS concept on postoperative rehabilitation in patients with prostatic hyperplasia

Huang Yuqi, Liu Ying, Shi Gaihong

2023, 29(7):  1015-1020.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.030

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Objective　To explore the effect of nursing intervention under the concept of enhanced recovery after surgery (ERAS) on patients after prostatectomy. Methods　It was a prospective study. A total of 200 patients with benign prostatic hyperplasia admitted to The First Affiliated Hospital of Henan University of Science and Technology from June 2019 to July 2022 were selected, all of whom were scheduled to undergo resection. They were divided into a control group and an observation group according to the time of admission, with 100 patients in each group. The patients in both groups were male. The control group, aged (65.11±2.38) years, received routine care; the observation group, aged (64.89±2.42) years, received the nursing intervention under the ERAS concept on the basis of the control group. The postoperative rehabilitation, complications, scores of Visual Analogue Scale (VAS), Self-rating Anxiety Scale (SAS), Kolcaba General Comfort Questionnaire (GCQ), and Pittsburgh Sleep Quality Index (PSOI), and satisfaction were compared between the two groups. t test was used for the measurement data, and χ² test for the count data. Results　The time of getting out of bed for the first time, the time of catheter removal, and the length of hospital stay in the observation group were shorter than those in the control group [(19.26±2.15) h vs. (25.69±2.34) h, (35.69±9.48) h vs. (55.14±8.46) h, (5.23±0.75) h vs. (7.14±0.81) h], with statistically significant differences (t=20.234, 15.308, and 17.302; all P<0.001). The incidence of complications in the observation group was lower than that in the control group [8.0% (8/100) vs. 19.0% (19/100)], with a statistically significant difference (χ²=5.181, P=0.023). The VAS scores of the observation group on the first day and the third day after operation were (4.02±0.33) points and (2.23±0.24) points, respectively, which were lower than those of the control group [(4.54±0.41) points and (2.97±0.31) points], with statistically significant differences between the two groups (t=9.880 and 18.875; both P<0.001). The GCQ score of the observation group was higher than that of the control group at discharge [(95.68±5.68) points vs. (81.11±6.98) points], with a statistically significant difference (t=16.191, P<0.001). At discharge, the SAS and PSOI scores of the observation group were (34.68±5.18) points and (6.24±1.26) points, respectively, which were lower than those of the control group [(45.91±4.23) points and (7.12±2.15) points], with statistically significant differences (t=16.792 and 3.531; both P<0.05). The satisfaction of the observation group was higher than that of the control group [97.0% (97/100) vs. 88.0% (88/100)], with a statistically significant difference (χ²=5.838, P=0.016). Conclusion　The nursing intervention guided by the ERAS concept can alleviate the pain in patients after prostatectomy, and reduce the occurrence of complications, thereby improving the patients' sleep quality, regulating the emotional state, improving the comfort, promoting the patients' recovery, and contributing to the improvement of satisfaction.

Influences of health education based on trans-theoretical model guidance on self-management behaviors and quality of life in patients with pulmonary tuberculosis

Feng Shuang, Wu Yuzhuo

2023, 29(7):  1020-1024.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.031

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Objective　To investigate the effect of health education based on trans-theoretical model (TTM) guidance on pulmonary tuberculosis (TB) patients. Methods　It was a prospective randomized controlled trial. Using the random number table method, 80 cases of TB patients admitted to Nanyang Central Hospital from January 2020 to January 2022 were divided into two groups, with 40 cases in each group. In the observation group, there were 23 males and 17 females, with an age of (45.62±4.13) years old and a course of disease of (11.23±2.67) months. In the control group, there were 21 males and 19 females, with an age of (45.47±4.26) years old and a course of disease of (11.41±2.85) months. The observation group received health education based on TTM guidance, and the control group received routine health education. The disease cognition, self-management behaviors, and qualities of life in the two groups before and after intervention were compared, and the satisfaction degrees of nursing in the two groups were investigated. χ² test was used for the count data and t test for the measurement data. Results　After intervention, the disease cognition scores in both groups were higher than those before intervention, and the score in the observation group was higher than that in the control group [(84.31±6.32) points vs. (76.35±7.62) points], with statistically significant differences (all P<0.001). After intervention, the scores of Chronic Disease Self-Management Study Measures (CDSMS) in all dimensions in both groups were higher than those before intervention, and the scores in the observation group was higher than those in the control group (all P<0.05). After intervention, the scores of Generic Quality of Life Inventory 74 (GQOLI-74) in all dimensions in both groups were higher than those before intervention, and the scores in the observation group was higher than those in the control group (all P<0.05). The nursing satisfaction rate of the observation group was higher than that of the control group [95.00% (38/40) vs. 80.00% (32/40)], with a statistically significant difference between the two groups (χ²=4.114, P=0.043). Conclusion　The use of health education based on TTM guidance in TB patients can improve the disease cognition and self-management behaviors, improve the patients' nursing satisfaction, and improve the quality of life.

Effect of extended nursing service under enhanced consciousness mode on patients with indwelling catheterization after urological surgery

Zhang Huan, Li Yali, Huang Yuqi

2023, 29(7):  1025-1029.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.032

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Objective　To study the effect of extended nursing service under the mode of enhanced consciousness in patients with indwelling catheterization after urological surgery. Methods　It was a prospective study. From May 2019 to April 2022, 400 patients with indwelling catheterization after urological surgery in The First Affiliated Hospital of Henan University of Science and Technology were selected and were divided into a control group (200 patients) and an observation group (200 patients) according to the order of treatment. The hospital nursing measures in the two groups were the same. The composition ratio of men and women in the control group was 128/72, with an age of (40.76±5.72) years old, and routine extended nursing was given. The composition ratio of men and women in the observation group was 119/81, with an age of (41.12±5.94) years old, and extended nursing service under the mode of enhanced consciousness was given. The compliance behavior, emotional state [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)], self-care ability [Exercise of Self-care Agency Scale (ESCA)], on-time extubation rate, and complication rate were compared between the two groups. Independent sample t test and χ² test were used. Results　The total compliance rate of the observation group was higher than that of the control group [92.00% (184/200) vs. 85.50% (171/200)], with a statistically significant difference (χ²=4.232, P=0.040). The rate of on-time extubation in the observation group was higher than that in the control group [93.00% (186/200) vs. 86.50% (173/200)], with a statistically significant difference (χ²=4.593, P=0.032). After 1 month of intervention, the SAS and SDS scores of the observation group were lower than those of the control group [(36.84±3.79) points vs. (45.46±4.25) points, (32.42±4.75) points vs. (40.59±5.06) points], and the ESCA score was higher than that of the control group [(112.43±6.14) points vs. (103.72±5.98) points], with statistically significant differences between the two groups (t=21.408, 16.648, and 14.372; all P<0.001). The incidences of urinary tract infection, gross hematuria, lumboabdominal pain, and bladder stinging in the observation group were lower than those in the control group [6.50% (13/200) vs. 12.50% (25/200), 12.50% (25/200) vs. 20.50% (41/200), 11.00% (22/200) vs. 21.00% (42/200), 18.00% (36/200) vs. 28.00% (56/200)], with statistically significant differences (χ²=4.187, 4.645, 7.441, and 5.647; all P<0.05). Conclusion　The extended nursing service under the enhanced consciousness mode is helpful to improve the self-care ability and compliance behavior in patients with indwelling catheterization after urological surgery, regulate their emotional state, effectively prevent the complications, and improve the rate of on-time extubation.

Advantages and disadvantages of narrative nursing in clinical application

Pan Ning, Chen Xiaoyin, Wang Yanfang

2023, 29(7):  1030-1032.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.033

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Based on the internal and external determinants and development strategies of narrative nursing in clinical application in China, this paper discusses the internal advantages and disadvantages of narrative nursing in clinical application in Guangzhou Institute of Dermatology. The advantages of narrative nursing mainly include the theme in personal narrative, diversity of narrative methods, comprehensive health promotion, and humanistic communication between nurses and patients. The shortcomings include the unclear definition, lack of standardized implementation process and structure, and overall time cost. Narrative nursing has both advantages and disadvantages in clinical application in China. It is proposed to seize the opportunity to overcome the shortcomings, strengthen the education, optimize the allocation of human resources, return to the nursing core, create the narrative nursing ecology, and support the research on further development of narrative nursing in China.

Application effect of discharge planning based on mind mapping in elderly patients with brittle hip fracture

Wang Liping, Wang Bilin, Wan Chengcheng, Xiao Nian

2023, 29(7):  1033-1036.  DOI: 10.3760/cma.j.issn.1007-1245.2023.07.034

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Objective　To discuss the application effect of discharge planning based on mind mapping in elderly patients with brittle hip fracture. Methods　It was a prospective study. A total of 200 elderly patients with brittle hip fracture who were admitted to The Third People's Hospital of Hubei Province from October 2021 to November 2022 were divided into a control group (95 cases) and an observation group (105 cases). In the control group, there were 52 males and 43 females, with an age of (65.25±7.01) years old, including 21 patients with left femoral neck fracture, 28 patients with right femoral neck fracture, 21 patients with left femoral intertrochanteric fracture, and 25 patients with right femoral intertrochanteric fracture, and all received routine nursing. In the observation group, there were 65 males and 40 females, with an age of (65.18±7.19) years old, including 25 patients with left femoral neck fracture, 30 patients with right femoral neck fracture, 23 patients with left femoral intertrochanteric fracture, and 27 patients with right femoral intertrochanteric fracture, and all received discharge planning based on mind mapping. The caregivers' discharge preparation score and patients' Harris hip function score, self-care ability, incidence of complications, and quality of life were compared between the two groups. The count data and measurement data were processed by χ² test, analysis of variance, and t test, respectively. Results　There was no statistically significant difference in the caregivers' discharge preparation score between the two groups on the 2^nd day after admission (P>0.05), but the score of the observation group was higher than that of the control group on the day of discharge [(26.39±3.14) points vs. (15.69±2.01) points], with a statistically significant difference (t=28.366, P<0.001). There was no statistically significant difference in the Harris score or Barthel index score between the two groups on the day of admission (both P>0.05). The scores increased 1 month and 3 months after operation, and the scores in the observation group were higher than those in the control group, with statistically significant differences (all P<0.001). The incidence of complications in the observation group was 4.76% (5/105), which was significantly lower than 13.68% (13/95) in the control group, with a statistically significant difference (χ²=4.848, P=0.028). After intervention, the MOS 36-Item Short-Form Health Survey (SF-36) scores of the two groups were significantly improved, and the observation group had higher scores than the control group, with statistically significant differences (all P<0.05). Conclusion　Discharge planning based on mind mapping for elderly patients with brittle hip fracture can improve the caregivers' discharge preparation, promote the recovery of patients' hip function, improve the patients' self-care ability, and reduce the complications, thereby improving the quality of life.