Table of Content

15 April 2023, Volume 29 Issue 8

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New Medical Advances

Ultrasonography in diagnosis of extrathyroidal extension of papillary thyroid carcinoma

Han Wei, Liang Weixiang, Liu Tao, Li Ruolan

2023, 29(8):  1037-1040.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.001

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Thyroid papillary carcinoma (PTC), as the most common pathological type of thyroid cancer, has a high incidence of extracapsular extension (ETE), which will affect the treatment and prognosis. At present, conventional ultrasound is the first choice for the diagnosis of thyroid diseases. Contrast-enhanced ultrasound has been widely used in the diagnosis and treatment of thyroid diseases because of its ability to display microvessels. Ultrasonic elastography is a relatively novel ultrasound technique, and can reflect the soft and hard degree of the diseased tissue. This article reviews the research progress of different ultrasonic diagnostic techniques in the diagnosis of ETE of PTC.

Advances on continuous quality improvement strategies in reducing intracranial hemorrhage of premature infants

Tian Junli, Li Mingxia, Zhu Yanping, Wang Li

2023, 29(8):  1041-1044.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.002

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Intracranial hemorrhage (ICH) is a common serious complication in preterm infants. It is associated with abnormal neurodevelopmental outcomes and increased mortality, seriously reduces preterm infants' quality of life, and brings great pressure and heavy economic burden to their families and society. At present, many neonatal intensive care units (NICU) in developed countries are implementing various strategies to optimize the related adverse outcomes, so as to reduce the proportion of brain injury and mortality in preterm infants and improve their prognosis by evidence-based interventions. This article reviews the current status of intracranial hemorrhage researches and the introduction, development, achievements, challenges, and prospects of quality improvement.

Advances in targeted drug therapy for acute myeloid leukemia

Wang Zechuan, Huang Yueqin

2023, 29(8):  1045-1048.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.003

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 Acute myeloid leukemia (AML) is a malignant clonal disease of myeloid cells. In recent years, the emergence of new targeted drugs has revolutionized cancer treatment and is expected to make a breakthrough in the treatment of AML. These new drugs include second-generation DNA methyltransferase inhibitors, B cell lymphoma factor 2 (BCL-2) inhibitors, FMS-like tyrosine kinase 3 (FLT3) inhibitors, isocitrate dehydrogenase inhibitors, anti-CD33 monoclonal antibodies, smoothened inhibitors (SMO), tumor protein p53 targeting drugs, anti-CD47 monoclonal antibodies, and exportin 1 (XPO1) inhibitors. This article reviews the latest targeted therapies for AML.

Cytology of bronchoalveolar lavage fluid in diagnosis and treatment of pediatric lung diseases

Ma Kun, Wang Daobin, Li Shujun

2023, 29(8):  1049-1052.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.004

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Lung diseases have significant impact on children's health. The application of bronchoscopy plays a key role in the diagnosis and treatment of children with pulmonary diseases, especially in severe and refractory pediatric patients. Analysis of bronchoalveolar lavage fluid (BALF) has improved the diagnostic level of lung diseases. Present researchs focus on the main components of BALF and their relationship with diseases. The characteristics of BALF have not been fully elucidated due to different disease mechanisms. This review provides a summary of the recent researches on the cytology of BALF and lung diseases in children, and provides more evidences for the diagnosis and treatment of pediatric lung diseases.

Application and progress of CT pulmonary angiography in diagnosis and treatment of pulmonary embolism

Xu Shijie, Luo Zebin, Chen Xiaodong

2023, 29(8):  1053-1056.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.005

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Pulmonary embolism (PE) is a life-threatening disease. CT pulmonary angiography (CTPA) is a widely available, rapid, and noninvasive technique, can directly display PE, and is the first choice for imaging examination of patients with suspected PE.

Scientific Research

Expression of Nexilin in bladders of smooth muscle specific YAP1-knockout mice and its regulatory mechanism

Chen Yinghan, Shao Lin, Zhou Lilin, Gong Guoyi, Zeng Jianwen, Jiang Chonghe, Zhu Baoyi

2023, 29(8):  1057-1062.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.006

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Objective　To explore the mechanism of Yes associated protein 1 (YAP1) in  the regulation of the expression of Nexilin in bladder smooth muscle cells. Methods　The smooth muscle specific YAP1-knockout mice (SMMHC-Cre^ERT2/YAP^F/F) were bred; twelve of them were selected and were randomly divided into a YAP1 knockout group and a wild type group, with 6 in each group. The Yap1 knockout group were treated by the intraperitoneal injection of tamoxifen dissolved in ethanol, and the wild type group were treated with ethanol. Two weeks later, the protein levels of total YAP (tYAP) and Nexilin in the urinary bladders were detected by Western blot. The human bladder smooth muscle cells were cultured in vitro. The cells were: treated with sphingosine-1-phosphate (S1P) dissolved in sterile ultrapure water containing 4% BSA for 2 and 4 h; or transduced with recombinant adenovirus to overexpress YAP1; or transfected with siRNA to knockdown YAP/TAZ (YAP1/WWTR1) and then treated with S1P. The negative control (NC) and solvent control (BSA) were set up throughout the experiments. The expression level of NEXN was detected by real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR). t test and one-way analysis of variance were applied. Results　The expression levels of tYAP and Nexilin in the bladder smooth muscle of the YAP1 knockout group were (0.19±0.05) time and (0.34±0.04) time those of the wild-type group, respectively, with statistical differences (both P<0.05). In human bladder smooth muscle cells, the expression levels of NEXN mRNA in the S1P group were (1.32±0.13) times and (2.11±0.44) times those in the BSA group at hour 2 and 4, respectively, with statistical differences (both P<0.05). The expression level of NEXN in the YAP1 overexpression group was (1.78±0.15) times that in the empty vector group (P<0.05). The expression level of NEXN in the siYAP/TAZ+BSA group was (0.75±0.05) time that in the NC+BSA group (P<0.05). The expression level of NEXN in the siYAP/TAZ+S1P group was significantly lower than that in the NC+S1P group (P<0.05), and there was no statistical difference in the NEXN expression between the siYAP/TAZ+S1P group and the siYAP/TAZ+BSA group (P>0.05). Conclusions　YAP1, a transcription coactivator, plays a regulatory role in the expression of Nexilin in bladder smooth muscle cells. YAP1 may affect the contractile properties of bladder smooth muscle by regulating the expression of Nexilin.

Clinical efficacy and cancer pain control of microwave ablation and radiofrequency ablation under neoadjuvant chemotherapy for non-small cell lung cancer

Wang Wenjun, Wang Shouzhong, Kong Haiyan, Yang Wenjing

2023, 29(8):  1062-1067.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.007

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Objective　To investigate the clinical efficacy and cancer pain control of microwave ablation (MWA) and radiofrequency ablation (RFA) under neoadjuvant chemotherapy in the treatment of non-small cell lung cancer. Methods　The medical records of 81 patients with non-small cell lung cancer who received neoadjuvant chemotherapy combined with MWA or RFA in Zaozhuang Chest Hospital between January 2017 and January 2021 were retrospectively analyzed. Of the 81 patients, 39 took RFA (an RFA group), and 42 MWA (an MWA group). There were 22 males and 17 females in the RFA group; they were (62.34±4.78) years old. There were 23 males and 19 females in the MWA group; they were (61.79±4.92) years old. The short-term efficacies, tumor marker levels, postoperative pain scores, usages of painkillers, and incidences of complications were compared between the two groups and analyzed. t test, χ² test, and Fisher's exact test were used for the statistical analysis. Repeated measure analysis of variance was used to evaluated the change trend of each indicator. Results　There were no statistical differences in the disease control rate and objective response rate between the MWA group and the RFA group [90.48% (38/42) vs. 92.31% (36/39) and 83.33% (35/42) vs. 82.05% (32/39); both P>0.05]. After the treatment, the serum levels of neuron specific enolase (NSE), squamous cell carcinoma antigen (SCCA), cytokeratin fragment 21-1 (CYFRA21-1), and carcinoembryonic antigen (CEA) decreased in both groups, but there were no statistical differences between the two groups (all P>0.05). There was no statistical difference in the score of Visual Analogue Scale (VAS) between the two groups before the treatment (P>0.05); with the prolongation of time, the VAS scores in both group decreased; the VAS scores 24 and 72 h and 4 weeks after the treatment in the MWA group were significantly lower than those in the RFA group, with statistical differences (P<0.05). After the treatment, the usage rate of analgesics in the MWA group was significantly lower than that in the RFA group [7.14 % (3/42) vs. 23.08% (9/39)], with a statistical difference (P<0.05). The incidences of complications in the MWA group and the RFA group were 26.19% (11/42) and 30.77% (12/39), respectively, with no statistical difference (P>0.05). Conclusions　MWA has a similar clinical efficacy with RFA in treating non-small cell lung cancer. MWA is better in controlling postoperative cancer pain than RFA, and can improve the quality of life of patients taking palliative treatment, so it has great potential in the treatment of lung cancer.

Effect of rapid response team combined with early warning scoring system in treatment of obstetric patients with severe diseases

Xu Yi, Zhang Xiaodan, Li Xiujuan

2023, 29(8):  1067-1070.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.008

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Objective　To explore the effect of rapid response team combined with early warning scoring system in the treatment of obstetric patients with severe diseases. Methods　One hundred and two obstetric patients with severe diseases admitted to Zhengzhou Maternal and Child Health Hospital from November 2019 to November 2021 were selected for the randomized control led trial, and were divided into a combined group and a control group by the random number table method, with 51 cases in each group. The combined group were 21-40 (32.36±5.25) years old, and the control group 22-42 (33.58±5.35). The control group were given routine nursing care; in addition, the combined group adopted rapid response team combined with early warning scoring system. The occupancy rates of intensive care unit (ICU) were compared between the two groups. The treatment times and effective treatment rates in the two groups were recorded. The nursing satisfactions of the patients' family members in the two groups were compared. t and χ² tests were applied. Results　The ICU occupancy rate after surgery in the combined group was lower than that in the control group [11.76% (6/51) vs. 29.41% (15/51); t=4.857, P=0.028]. The treatment time and effective treatment rate in the combined group were better than those in the control group (t=11.692, P<0.001; χ²=5.718, P=0.017). The satisfaction of the combined group was higher than that of the control group [94.12% (48/51) vs. 76.47% (39/51); χ²=6.331, P=0.012]. Conclusion　Rapid response team combined with early warning scoring system in the treatment of obstetric patients with severe diseases can effectively reduce the occupancy rate of ICU, shorten the treatment time of emergency early warning, and improve the effective treatment rate and their family members' satisfaction, so it is worthy of further promotion.

Value of esophageal manometry combined with 24 h pH monitoring in diagnosis of gastroesophageal reflux associated chest pain

Hai Hua, Chen Jinjin, Lusuriguga

2023, 29(8):  1071-1074.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.009

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Objective　To investigate the value of esophageal manometry combined with 24 h pH monitoring in the diagnosis of gastroesophageal reflux associated chest pain. Methods　One hundred and forty-five patients with chest pain suspected to be caused by gastroesophageal reflux admitted to Tongliao City Hospital from June 2017 to December 2021 were selected for esophageal manometry and 24 h esophageal pH monitoring, including 92 males and 53 females. According to whether they had gastroesophageal reflux, they were divided into a gastroesophageal reflux group and a no reflux group. The data, such as age, gender, peristaltic contraction percentage, reflux times with pH<4, and longest reflux duration, in both groups were collected. The diagnostic results of the two groups were compared by t and χ² tests. The correlations of chest pain caused by gastroesophageal reflux with the above indicators were anyazed by multivariate logistic regression analysis and receiver operating characteristic curve (ROC). Results　Among the 145 patients, 36 ones were diagnosed as gastroesophageal reflux, and the rest 109 had no reflux. Multivariate logistic regression analysis showed that the percentage of peristaltic contraction, the number of reflux with pH < 4, and the longest duration of reflux were the influencing factors of gastroesophageal reflux related chest pain (OR=3.155, 2.998, and 3.459; P=0.003, 0.012, and 0.001). According to the ROC analysis, the sensitivity and area under curve (AUC) of the combination of esophageal manometry, the number of reflux with pH < 4, and the longest duration of reflux in the prediction of gastroesophageal reflux related chest pain were higher than those predicted by each indicator alone (P=0.001, 0.001, and 0.004); the specificity of the combination had no statistical difference from that predicted by each indicator alone (P=0.852). Conclusion　Esophageal manometry combined with 24 h pH monitoring is of great significance for the diagnosis and treatment of gastroesophageal reflux related chest pain and is worthy of clinical application.

Acupuncture along the meridians based on yin and yang balance theory for patients with spastic hemiplegia after ischemic stroke

Liu Wanlei, Mao Zhiyong, Guo Yongjun

2023, 29(8):  1075-1079.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.010

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Objective　To explore the effect of acupuncture along the meridians based on yin and yang balance theory for patients with spastic hemiplegia after ischemic stroke. Methods　A total of 90 patients with spastic hemiplegia after ischemic stroke who were admitted to Zhumadian Hospital of Traditional Chinese Medicine from April 2020 to April 2022 were selected for the random control trial, including 48 males and 42 females. They were 42-75 (58.25±10.10) years old. They were divided into a control group and an observation group by the random number table method. Both groups were treated with conventional western medicine, while the observation group also received acupuncture along the meridians based on yin and yang balance theory. The Ashworth classifications before and after the treatment, clinical effects, incidences of adverse reactions, degrees of neurological deficit, limb motor function, and self-care abilities were compared between these two groups. t and χ² tests were applied. Results　After the treatment, the proportions of the patients of Ashworth grade 0, 1-1+, 2-3, and 4 were 35.56% (16/45), 40.00% (18/45), 22.22% (10/45), and 2.22% (1/45) in the observation group, and were 15.56% (7/45), 31.11% (14/45), 40.00% (18/45), and 13.33% (6/45) in the control group, respectively, with statistical differences between before and after the treatment in both groups (Z=6.207, P=0.010; Z=4.935, P=0.038) and between the two groups after the treatment (Z=4.712, P=0.041). After the treatment, the obviously effective, effective, and ineffective rates were 57.78% (26/45), 35.56% (16/45), and 6.67% (3/45) in the observation group, and were 33.33% (15/45), 44.44% (20/45), and 22.22% (10/45) in the control group, respectively, with a statistical difference in the distribution of clinical efficacy between the two groups (Z=5.421, P=0.020). The total effective rate in the observation group was higher than that in the control group [93.33% (42/45) vs. 77.78% (35/45); χ²=4.406, P=0.036]. After the treatment, the scores of National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer, and Barthel Index (BI) were (8.71±1.89), (68.22±8.92), and (70.11±8.67) in the observation group, and were (10.13±2.02), (58.71±8.35), and (60.58±8.43) in the control group; the NIHSS score in the observation group was lower than that in the control group (t=3.443, P=0.001), and the Fugl-Meyer and BI scores were higher than those in the control group (t=5.221 and 5.287, both P<0.001). The incidences of adverse reactions in the observation group and control group were 8.89% (4/45) and 4.44% (2/45), respectively, with no statistical difference (correction χ²=0.179, P=0.673). Conclusion　Acupuncture along the meridians based on yin and yang balance theory in the treatment of patients with spastic hemiplegia after ischemic stroke can reduce their symptoms and neurological deficit degree, enhance the curative effect, and improve their limb motor function and ability of daily life.

Clinical features and hot issues of ovarian mass in 34 children

Shi Juanjuan, Du Chao, Han Shanshan, Yang Hui, Zhang Dan, Zhang Jiuyan, Cui Xiujuan

2023, 29(8):  1080-1085.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.011

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Objective　To investigate the clinical features and treatment of ovarian mass in children. Methods　The data of 34 children with ovarian mass treated in Department of Gynecology, Tengzhou Central People's Hospital from January 2012 to December 2021 were retrospectively analyzed. The clinical and pathological features were summarized; the hot clinical problems of the children with ovarian mass, including the classification of ovarian mass, accessory torsion, malignant tumor, and the characteristics of the children without operation, were analyzed. Results　Among the 34 children, 29 underwent surgical treatment and 2 had malignant tumors; 5 did not undergo surgery. Selective surgery was performed on 17 cases, and emergency surgery on 12 cases, including 6 cases of ovarian cyst pedicle torsion and 1 case of luteal cyst with hemorrhage. There were 30 children who had symptoms; the most common symptom was lower abdominal pain (80.0%, 24/30); 4 children were asymptomatic. The most common pathological type was cystic mature teratoma of the ovary (48.3%, 14/29); the coincidence rate of ultrasonic diagnosis with pathological diagnosis was 82.8% (24/29). The ovarian mass disappeared in the 5 children who did not undergo surgery and they did not undergo surgery. Conclusions　For girls with abdominal pain as the main symptom, it is necessary to be vigilant about the diagnosis of ovarian mass. Ultrasound examination is of great value for the diagnosis and treatment. Most ovarian masses in children are benign lesions, and surgery for the torsion of ovarian masses can preserve their fertility function as much as possible. It is helpful to improve clinical management strategies to discuss the problems of ovarian mass in children.

Distribution and drug resistance of pathogenic bacteria in patients with diabetic foot infection in a hospital of traditional Chinese medicine

Cai Donghao, Liu Canhua, Li Xiaojun, Tan Xueqiu, Jiang Jinhong, Tan Junqing

2023, 29(8):  1086-1089.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.012

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Objective　To investigate the clinical distribution and drug resistance of pathogenic bacteria in wound secretions of diabetic foot patients in Guangdong Second Traditional Chinese Medicine Hospital, and to provide bases for clinical medication planning. Methods　A retrospective analysis was performed in this study. The bacterial culture and drug sensitivity results of wound secretions of the hospitalized patients with diabetic foot diagnosed in Guangdong Second Traditional Chinese Medicine Hospital from January 2020 to December 2021 were derived through the laboratory information system; the distribution and drug resistance of pathogenic bacteria were analyzed. Excel was used for data processing and presentation. Results　A total of 102 patients with diabetic foot were hospitalized in Guangdong Second Traditional Chinese Medicine Hospital from January 2020 to December 2021; among which, 60 patients were complicated with pathogen infection, and the infection rate was 58.82%. There were 41 males (68.33%) and 19 females (31.67%); they were 33-87 years old. A total of 65 pathogenic bacteria were detected, including 21 strains of Gram-positive bacteria (32.31%) and 44 strains of Gram-negative bacteria (67.69%). The top three were Staphylococcus aureus (15.38%, 10/65), Escherichia coli (13.85%, 9/65), and Pseudomonas aeruginosa (10.77%, 7/65). Conclusions　Gram-negative bacteria are the main bacteria isolated from patients with diabetic foot infection in Guangdong Second Traditional Chinese Medicine Hospital; Staphylococcus aureus accounts for the highest proportion of pathogenic microorganism distribution. Antibiotics can be used according to the distribution of bacteria empirically; medication strategies should be adjusted timely according to drug sensitivity results to reduce the generation of multidrug-resistant bacteria.

Hydroxychloroquine sulfate, dexamethasone, and transfer factor for patients with oral lichen planus

Shi Wanying, Cheng Guozhen, Du Xingjun

2023, 29(8):  1090-1094.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.013

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To explore the clinical effect of hydroxychloroquine sulfate, dexamethasone, and transfer factor (TF) for patients with oral lichen planus (OLP). Methods　A total of 180 patients with OLP treated in Mengyin County People's Hospital from January 2018 to January 2022 were selected for the random control trial. They were divided into an observation group and a control group by the random number table method, with 90 cases in each group. There were 41 males and 49 females in the observation group; they were (48.96±5.73) years old. There were 39 males and 51 females in the control group; they were (49.13±5.64) years old. The control group were treated with hydroxychloroquine sulfate and dexamethasone, and the observation group with hydroxychloroquine sulfate, dexamethasone, and TF. The curative effects, scores of Visual Analogue Scale (VAS), erosion areas, levels of nitrite ion (NO₂^-), inflammatory factors [interleukin-10 (IL-10), interleukin-17 (IL-17), and interferon-γ (IFN-γ)], immune function (CD3+, CD4+, CD8+, and CD4+/CD8+), and adverse reactions were compared between the two groups.t and χ² tests were applied. Results　The treatment efficacy of the observation group was higher than that of the control group [95.56% (86/90) vs. 85.56% (77/90); P<0.05]. After the treatment, the scores of VAS and Reticulation-Erosion-Ulcer Scale (REU) and the vesicular area in the observation group were lower than those in the control group [(0.64±0.15) vs. (1.21±0.23), (0.78±0.16) vs. (1.33±0.27), and (1.52±0.23) cm² vs. (1.74±0.27) cm²; all P<0.05]. After the treatment, the levels of NO₂^-, IL-17, and IL-10 in the observation group were lower than those in the control group [(10.31±1.65) µmol/L vs. (13.89±1.44) µmol/L, (0.18±0.06) ng/L vs. (0.31±0.09) ng/L, and (8.67±1.83) pg/L vs. (12.01±1.64) pg/L; all P<0.05]; the IFN-γ level in the observation group was higher than that in the control group [(12.03±2.62) pg/L vs. (8.52±2.12) µmol/L; P<0.05]. After the treatment, the CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the observation group were higher than those in the control group [(56.16±5.71)% vs. (51.73±5.20)%, (38.56±3.97)% vs. (36.21±3.74)%, and (1.46±0.27) vs. (1.32±0.25); all P<0.05]; the CD8⁺ in the observation group was lower than that in the control group [(26.26±3.20)% vs. (27.68±3.39)%; P<0.05]. There were no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　The clinical curative effect of hydroxychloroquine sulfate, dexamethasone, and TF for patients with OLP is good and can effectively adjust the level of NO₂^- in saliva, improve their immune function and inflammatory response, and relieve their pain.

Qualitative research on sexual life experience of patients taking peritoneal dialysis

Lu Huijuan, Jiang Sufang, Wan Biyu, Lin Pinli, Tang Fang, Wang Lingzhen, Liu Xusheng, Deng Lili

2023, 29(8):  1095-1099.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.014

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Objective　To explore the sexual life experience of patients taking peritoneal dialysis, to arouse medical staff's attention to these patients' sexual health status, and to provide references for the development of relevant clinical measures. Methods　The patients taking peritoneal dialysis in Guangdong Provincial Hospital of Traditional Chinese Medicine from June to December 2022 were selected as the research objects by the objective sampling method. The phenomenological research method of qualitative research was used to conduct semi-structural interviews with the patients. The interview data were collated by the QSR Nvivo12.0 software. The Colaizzi 7-step analysis method was used for data analysis. Results　A total of 23 respondents were included, including 14 men and 9 women who were (44.9±7.92) years old; four themes were summarized: patients' sexual perception, sexual life changes, social changes, and patient coping strategies. Conclusion　The sexual life experience of patients taking peritoneal dialysis deserves attention. Medical staff should pay attention to the patients sexual health.

Gender and age distribution of newly diagnosed patients with positive sputum tuberculosis culture at Songjiang District, Shanghai from 2018 to 2021

Yang Liyuan, Dai Wanqin

2023, 29(8):  1099-1101.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.015

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Objective　To analyze the age and gender distribution characteristics of patients positive in sputum mycobacterium tuberculosis culture in regional tuberculosis (TB) laboratory tests of first diagnosis, and to understand the prevalence of TB at Songjiang District, Shanghai recently. Methods　The TB culture results of newly diagnosed patients recorded in the regional TB laboratory at Songjiang District, Shanghai from 2018 to 2021 were collected. The age and gender information of the patients positive in sputum culture were consulted and analyzed for frequency distribution. Results　A total of 767 newly diagnosed TB patients positive in sputum culture were collected from 2018 to 2021. The overall composition ratio of male to female was 2.58∶1. The trend of composition ratio was not obvious during the 4 years. Both male and female patients with positive culture showed the highest peak when they were 20-29 years old; there was no statistical difference between the 4 years. The overall data showed that the proportion of the patients with positive sputum culture who were 20-<35 years old was 53.3%. Conclusions　The peak age of pulmonary TB at Songjiang District, Shanghai is 20-<30 years old. More males have TB than females.

Treatises

Lycorine interferes with bleomycin-induced pulmonary fibrosis in mice by inhibiting endoplasmic reticulum stress

Yu Qingqing, Song Qingyue, Bai Jianfeng

2023, 29(8):  1102-1107.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.016

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Objective　To study lycorine in interfering with bleomycin-induced pulmonary fibrosis in mice by inhibiting endoplasmic reticulum stress. Methods　From January to February 2022, 50 male mice, weighing 22-26 g, were divided into a normal group, a model group, a low-dose lycorine group, a medium-dose lycorine group, and a high-dose lycorine group by the random number table method, with 10 in each group. The mouse models of pulmonary fibrosis were replicated by oropharyngeal tracheal instillation of bleomycin normal saline solution, and all the mice were administered for 28 days. Hematoxylin and eosin staining (HE staining) and Masson's trichrome staining were used to detect the pathological changes of mouse lung tissue. Western Blotting was used to detect the protein expression levels of Bip, PERK, α-SMA, and p-eIF2α in lung tissue. Results　The lung tissue of the mice in the model group had structural disorder, thickening of alveolar wall, severe inflammatory cell infiltration in alveoli, and a lot of collagen deposition in alveolar interstitium. And the pathological improvement of lung tissue in the medium-dose lycorine group and the high-dose lycorine group was the most obvious. The collagen area of Masson in the model group was significantly lower than that in the normal group [(34.42±5.13) mm² vs. (5.15±1.16) mm²]; the collagen area in the high-dose lycorine group was significantly lower than that in the medium-dose lycorine group [(15.70±4.09) mm² vs. (19.83±3.14) mm²]; there were statistical differences (both P<0.05). The protein expression levels of Bip, PERK, α-SMA, and p-eIF2α in the lung tissue of the model group were significantly higher than those of the normal group. The protein expression levels of Bip, PERK, α-SMA, and p-eIF2α in the lung tissue of the medium-dose lycorine group and the high-dose lycorine group were significantly lower than those of the model group. The protein expression levels of Bip, PERK, α-SMA, and p-eIF2α in the lung tissue of the high-dose lycorine group were significantly lower than those of the medium-dose lycorine group. Conclusion　Lycorine can interfere with bleomycin-induced pulmonary fibrosis in mice, and its mechanism of action may be the inhibition of endoplasmic reticulum stress.

Correlation between changes in physical and mental state of patients with malocclusion and choices of appliance types

Qiu Qianqian, Chen Juanjuan, Yu Qiaolong, Chen Xin

2023, 29(8):  1107-1111.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.017

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Objective　To observe the correlation between different personality characteristics of orthodontic patients and the choices of appliance types, and to explore the influence of different appliance types on the changes of patients' psychological state during orthodontic treatment. Methods　Five hundred malocclusion patients treated in Department of Stomatology, The 73rd Group Army Hospital of Chinese People's Liberation Army from February 2019 to April 2022 were prospectively selected as the study objects. They were divided into a non-orthodontic treatment group (200 cases) and an orthodontic treatment group (300 cases) according to whether or not orthodontic treatment was performed. There were 167 males and 133 females in the orthodontic treatment group; they were (24.98±4.09) years old. There were 113 males and 87 females in the non-orthodontic treatment group; they were (25.14±3.77) years old. The orthodontic treatment group were divided into a labial ligation wing fixed appliance group (S1), a labial self-locking fixed appliance group (S2), an invisible and removable fixed appliance group without brackets (S3), a lateral ligation and wing fixation appliance group (S4), and a lingual self-locking fixation appliance group (S5), with 60 cases in each group. The Eysenck Personality Questionnaire (EPQ) and Frost Multidimensional Perfectionism Questionnaire (CFMPS) were used to assess the patients' personality characteristics. The psychological states of different stages were evaluated by the Symptom Checklist 90 (SCL-90) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). The Spearman correlation test was used to analyze the correlation between different appliance types and the changes of the patients' physical and mental states. t test and one-way ANOVA were applied. Results　The scores of EPQ and CFMPS in the orthodontic treatment group were higher than those in the non-orthodontic treatment group [(45.14 ± 8.52) vs. (42.89 ± 8.29) and (77.37 ± 7.46) vs. (64.87 ± 6.95)], with statistical differences (t=2.92 and 9.81; both P<0.05). There statistical differences in the scores of EPQ and CFMPS between the orthodontic groups (F=4.33 and 13.44; both P<0.05). The scores of EPQ and CFMPS in group S3 were (46.47±7.25) and (81.26±7.89), the highest. The SCL-90 scores of the 5 orthodontic groups reached the maximum value at T5 during the treatment period, indicating that as the orthodontic treatment time prolonged, it first increased and then decreased; the scores in group S3 were higher than those in the other 4 groups (all P<0.05). The PIDAQ score gradually increased with the orthodontic treatment time; the scores in group S3 were higher than those in the other 4 groups; the scores in group S4 and S5 were higher than those in group S1 and S2. Spearman correlation test showed that the type of appliance was correlated with SCL-90 and PIDAQ scores (r=0.236 and 0.176, both P<0.05). Conclusions　The changes of physical and mental states of patients with malocclusion during orthodontic treatment are related to the choices of appliance types. It is recommended to choose a targeted diagnosis and treatment plan according to the patients' personality characteristics.

Growth and developmental status and clinical characteristics of 10 children with Crohn's disease 

Pan Cong, Fu Simao, Yang Zhuling

2023, 29(8):  1111-1116.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.018

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Objective　To explore the growth and development status, clinical characteristics, treatment, and outcomes of children with Crohn's disease (CD). Methods　The clinical data of children diagnosed with CD at Zhongshan City People's Hospital from January 2020 to September 2022 were retrospectively analyzed, including general data (age, gender, and physical and sexual developmental status), clinical manifestations, laboratory examinations, imaging performance, endoscopy, pathological features of endoscopic mucosal biopsy, clinical classifications, activity evaluation, therapeutic options, and outcomes. There were 7 boys and 3 girls; they were 10.4～14.3 (12.65±1.08) years old. Results　The typical clinical manifestations were weight loss [90% (9/10)], abdominal pain [80% (8/10)], and diarrhea [40% (4/10)]. The atypical clinical manifestations were anemia [80% (8/10)], oral ulcers [60% (6/10)], fever [50% (5/10)], and perianal lesions [50% (5/10)]. The colonoscopy features were ulcer [100% (10/10)], pebble-like appearance [40% (4/10)], polypus [40% (4/10)], anal fistula [30% (3/10)], and stenosis [20% (2/10)]. The most common lesion site was ileocolon type [80% (8/10)], followed by the mixed upper gastrointestinal and ileocolon type [20% (2/10)]. The most common manifestation was non-stenosis and non-penetration [80% (8/10)], followed by stenosis and non-penetration [20% (2/10)]. The activity was evaluated by the pediatric Crohn's disease activity index (PCDAI). There were 7 cases in moderate/severe active stage; 5 of which were complicated with perianal lesions; anti-tumor necrosis factor-α monoclonal antibody (TNF-α) was used to induce remission and maintain remission treatment. During the follow-up period, 4 cases entered the clinical remission stage, and their clinical manifestations, endoscopy and perianal lesions, and growth and development status were improved. Two cases without perianal lesions were treated with prednisone-induced remission + azathioprine to maintain remission; when the disease recurred in the late follow-up period, both patients were upgraded to TNF-α re-induced remission and maintenance remission. Three cases of mild activity were treated with total enteral nutrition + azathioprine for induced remission and maintenance remission; then they were in clinical remission; 1 case achieved mucosal healing under endoscope. Conclusions　In-depth and comprehensive understanding of pediatric Crohn's disease is expected to identify and diagnose CD early, to avoid delay in diagnosis and treatment, and to develop accurate and personalized treatment programs to reduce the incidence of complications such as growth and development disorders in children and improve their quality of life.

Prognostic factors of primary immune thrombocytopenia in children

Huang Yutao, Wang Hongwu

2023, 29(8):  1117-1121.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.019

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Objective　To investigate the prognostic factors of primary immune thrombocytopenia (ITP) in children. Methods　One hundred and twenty-three children with ITP hospitalized in Department of Pediatrics, Jieyang People's Hospital from January 2017 to March 2021 were selected for the retrospective analysis. Their clinical data were collected. According to their conditions, they were divided into a chronic ITP (CITP) group (20 cases) and a non-chronic ITP (NCITP) group (103 cases). There were 14 boys, 6 girls, 7 cases who were <3 years old, and 13 cases who were ≥3 years old in the CITP group. There were 61 boys, 42 girls, 74 cases who were <3 years old, and 29 cases who were ≥3 years old in the NCITP group. The demographic data, platelet counts at first diagnosis, initial absolute lymphocyte counts (ALC), bleeding scores, initial treatment, platelet peak values after treatment, and lymphocyte subsets before and after the treatment were analyzed and compared between the two groups. The related factors affecting their prognosis were analyzed by univariate analysis. χ2 test, t test, and nonparametric U test were applied. Results　There was no statistical difference in the platelet count at first diagnosis between the two groups (Z=-3.45，P<0.05). There was a statistical difference in the platelet count after the treatment between the two groups (Z=-2.85，P<0.05). The percentage of Th cells after the treatment in the CITP group were obviously lower than that in the NCITP group [(30.52±5.66)% vs. (35.82±9.08)%], with a statistical difference (t=2.51，P<0.05). When they were first diagnosed, the ALC in the CITP group was lower than that in the NCITP group [(2.17±1.03)×109/L vs. (4.68±2.45)×109/L], with a statistical difference (t=15.07，P<0.05). Eight percent (8/100) of the children with ITP who took symptomatic treatment and immunoglobulin (IVIG) had CITP, 52.9% (9/17) of the children with ITP who took symptomatic treatment only, and 50.0% (3/6) of the children with ITP who took symptomatic treatment, IVIG, and glucocorticoid, with statistical differences (both P<0.05). After the treatment, the percentage of helper T cells in the CITP group was obviously lower than that in the NCITP group [(30.52 ± 5.66)% vs. (35.82 ± 9.08)%], with a statistical difference (t=2.51, P<0.05). Conclusions　≥ 3 years old, high platelet count and low ALC at first diagnosis, and low platelet peak and low Th cell percentage after treatment may be the risk factors for chronic ITP. IVIG treatment has good significance for the prognosis of children with ITP.

Clinical Research

High-dose vitamin C combined with vitamin B1 for patients with septic shock

Wang Yuliang, Liu Jianhua, Tang Qiyun

2023, 29(8):  1122-1126.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.020

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Objective　To explore the effect of high-dose vitamin C combined with vitamin B1 for patients with septic shock. Methods　Ninety patients with septic shock who were diagnosed and treated in ICU, Hexian Memorial Hospital of Panyu District from January 2022 to August 2022 were selected for the random control trial. They were divided into a control group (normal saline) and an experimental group (vitamin C + vitamin B1) by the random number table method, with 45 cases in each group. There were 25 males and 20 females in the control group; they were 43-97 (74.0±16.64) years old. There were 33 males and 12 females in the experimental group; they were 35-94 (68.0±13.44) years old. The control group were treated with fluid resuscitation, anti-infective therapy, and primary disease treatment according to the latest guidelines for sepsis and septic shock; in addition, the experimental group were treated with high-dose vitamin C and vitamin B1. The left ventricular ejection fractions (LVEF), cardiac outputs (CO), tricuspid systolic displacements (TAPSE), and other ultrasonic results, CD3+ T lymphocyte counts, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts, CD4+/CD8+ ratios, and tumor necrosis factor α (TNF-α) levels at admission to ICU (T0) and 72 hours after the treatment (T1) and the prognostic outcomes during ICU stay were compared between the two groups. χ², rank sum, and t tests were applied. Results　The TNF-α level at T1 in the experimental group were lower than that in the control group [12.96 (10.72, 19.6) vs. 17.95 (11.015, 34.75)], with a statistical difference (Z=-1.96, P<0.05). The CD3+, CD4+, and CD8+ in the experimental group were higher than those in the control group, with statistical differences (Z=-3.58, -3.15, and -3.43; all P<0.05). The CD8+ at T1 was lower than that at T0 in the control group (Z=-2.26, P<0.05). The CD3+, CD4+, and CD8+ at T1 were higher than those at T0 in the experimental group, with statistical differences (Z=-3.77, -3.89, and -2.91; all P<0.05). The improved rate in the experimental group was higher than that in the control group [71.11% (32/45) vs. 51.11% (23/45)], with a statistical difference (χ²=8.407, P<0.05). Conclusion　High-dose vitamin C combined with vitamin B1 for patients with septic shock can improve their numbers of T lymphocyte subsets, immune function, and prognosis, and reduce the production of TNF–α to some extent.

Practice and application of enhanced recovery after surgery of integrated traditional Chinese and western medicine in perioperative period of MIS-TLIF

Zhou Weijun, Tian Tianzhao, Shi Min, Cai Yingfeng, Zhou Jianpeng

2023, 29(8):  1127-1131.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.021

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Objective　To explore and analyze the practice and application of enhanced recovery after surgery (ERAS) of integrated traditional Chinese and western medicine in perioperative period of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods　This was a prospective study. Eighty-nine patients who underwent perioperative treatment of MIS-TLIF in Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University from January 2018 to January 2022 were selected and were divided into an ERAS of integrated traditional Chinese and western medicine group (ERAS group; 46 cases) and a traditional group (43 cases) by drawing lots. There were 20 males and 26 females in the ERAS group; they were (63.76±8.42) years old. There were 19 males and 24 females in the traditional group; they were (62.30±9.48) years old. The scores of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) in different perioperative periods, incidences of postoperative complications, and patient satisfactions were compared between the two groups. χ² and t tests were applied. Results　There were statistical differences in the scores of VAS 1, 7, and 30 d after the surgery between these two groups (t=-2.451, -2.097, and -2.305; all P<0.05). Thirty days after the surgery, the scores of ODI in both groups decreased; the score in the ERAS group was lower than that in the control group [(11.8±4.28)) vs. (13.9±3.83)], with a statistical difference (t=-2.383, P<0.05). The incidence of postoperative complications in the ERAS group was lower than that in the control group [13.0% (6/46) vs. 32.6% (14/43)], with a statistical difference (χ²=4.858, P<0.05). Conclusions　The ERAS of integrated traditional Chinese and western medicine has been widely used; it effectively integrates and optimizes the perioperative treatment measures and procedures of various disciplines, significantly improves patient compliance and clinical efficacy of surgery, and shortens postoperative recovery period. It has high patient satisfaction with treatment. Therefore, it is worthy of clinical application.

Changes and clinical significance of related biochemical indicators in AECOPD patients with respiratory failure 

Lu Xiufang, Tian Jinjing, Kang Yali

2023, 29(8):  1131-1134.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.022

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Objective　To investigate the changes and clinical significance of lymphocyte ratio (NLR), procalcitonin (PCT), carbohydrate antigen 125 (CA125), and D-dimer (D-D) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by respiratory failure. Methods　A total of 160 patients with AECOPD who were admitted to Liaocheng Second People's Hospital from August 2019 to June 2022 were retrospectively selected. According to whether they were combined with respiratory failure, they were divided into an observation group (AECOPD combined with respiratory failure) of 60 cases and a control group (AECOPD non-respiratory failure) of 100 cases. In the observation group, there were 40 males and 20 females; they were 56-85 (67.54±5.67) years old; the course of COPD was 2-16 (5.03±1.49) years. In the control group, there were 65 males and 35 females; they were 57-84 (66.94±5.61) years old; the course of COPD was 2-17 (5.12±1.57) years. The acid-base (pH) values, partial pressures of oxygen (PaO₂) partial pressures of arterial blood carbon dioxide (PaCO₂), percentages of forced expiratory volume in the first second (FEV1%) of the expected value, and serum levels of NLR, PCT, D-D, and CA125 in the two groups were detected and analyzed. t test was applied. Results　The PaCO₂ was higher and the PaO₂, FEV1%, and pH were lower in the observation group than in the control group (t=30.19, 24.53, 18.72, and 27.24; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 in the observation group were higher than those in the control group (t=39.40, 142.09, 25.56, and 12.45; all P<0.05). The serum levels of NLR, PCT, D-D, and CA125 were negatively correlated with PaO₂ and pH (r=-0.733, -0.666, -0.695, -0.549, -0.762, -0.742, -0.673, and -0.598; all P<0.05), and positively with PaCO₂ (r=0.651, 0.679, 0.784, and 0.684; all P<0.05). Conclusion　The higher the serum levels of NLR, PCT, D-D, and CA125 in patients, the higher the PaCO₂, the lower the PaO₂ and pH, and the more serious the disease. The detection of the above serum factors can be used in clinic to assist clinicians in making auxiliary judgment on the severity of AECOPD patients with respiratory failure, so as to give the patients targeted treatment as early as possible and improve their prognosis.

Effects of home delivery room combined with epidural analgesia on delivery mode and outcomes of primiparae

Wang Yuwei, Liu Chao, Li Rui, Liu Jing, Zhang Yali, Liang Kuixiang

2023, 29(8):  1135-1140.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.023

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Objective　To explore the effects of family delivery room combined with epidural analgesia on the delivery mode, duration of labor, and maternal and infant outcomes of primiparae. Methods　From October 2019 to February 2022, 805 primiparae with single term cephalic presentation who met the conditions for trial delivery in Binzhou Medical University Hospital were collected as the research objects. According to their wishes, they were divided into a home-based delivery room combined with epidural delivery analgesia group (group A, 226 cases), a home-based delivery room group (group B, 177 cases), an epidural delivery analgesia group (group C, 198 cases), and a conventional delivery group (group D, 204 cases). Group A were 21-34 (27.77±2.87) years old, group B 17-33 (27.77±3.05), group C 20-36 (27.21±3.15), and group D 19-35 (27.16±3.01). By comparing the general clinical data, labor process times, rates of conversion from natural labor to cesarean section, delivery bleeding, HGB differences before and after delivery, lateral episiotomy rates, incidence rates of postpartum urinary retention, fever rates during delivery, and various indicators of the newborn, the influence of family delivery room combined with epidural analgesia on the delivery mode, delivery process, and maternal and infant outcomes was studied. One-way analysis of variance and χ² test were applied. Results　The rates of conversion from natural labor to cesarean section in group A [9.73% (22/226)] and group C [10.61% (21/198)] were lower than those in group B [33.33% (59/177)] and group D [33.33% (68/204)]; the rate of conversion from natural labor to cesarean section was the lowest in group A. The total labor processes of group A [(8.83±3.44) h] and group C [(9.56±3.98)] h were longer than those of group B [(6.78±2.72) h] and group D [(7.24±3.12) h], with a statistical difference between the 4 groups (F=21.88, P<0.05). The total labor process, the first labor process, and the second labor process of group B were the shorter than those of the other three groups. The rate of lateral resection in group C 61.58% (109/177) was significantly higher than those in group A [45.10% (92/204)] and group B [44.07% (52/118)], with a statistical difference between the four groups (χ²=13.12, P<0.05). The urinary retention rate in group C [28.28% (56/198)] was significantly higher than those in group A [11.95% (27/226)], group B [7.91% (14/177)], and group D [5.88% (12/204)], with a statistical difference between the four groups (χ²=52.26, P<0.05). Stratified analysis of labor process intervention also showed that the total labor process, the first labor process, and the second labor process of the family delivery room group were relatively shorter than those of the other three groups; the application of epidural labor analgesia could prolong the total labor process, the first labor process, and the second labor process, but had different effects on the third labor process. Conclusions　The rate of conversion from natural labor to cesarean section and the rate of lateral episiotomy of primiparae taking home delivery room and epidural labor analgesia are lower. Epidural labor analgesia relatively prolongs the total labor process, the first labor process, and the second labor process, but they are within the normal range. There is no significant difference between the third labor process and the neonatal outcomes. It has no effect on the amount of labor bleeding and the rate of fever during labor. Therefore, this mode is worthy of promotion.

Determination of mycobacterium tuberculosis types and drug sensitivity in patients with different pulmonary tuberculosis

Zhu Xiulan, Luo Yongqiang, Deng Yuling, Mo Liying

2023, 29(8):  1140-1143.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.024

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Objective　To study the determination of mycobacterium tuberculosis types and drug sensitivity in patients with different pulmonary tuberculosis. Methods　From June 2019 to June 2021, 256 sputum samples of the patients with pulmonary tuberculosis were collected from Dongguan Songshanhu Central Hospital, including 114 females and 141 males who were 20-78 (46.59±4.67) years old. After isolation and culture, the mycobacterium tuberculosis type determination and drug sensitivity test were conducted to analyze the status of anti-tuberculosis drug resistance and single drug resistance in the patients with different tuberculosis. χ² test was applied. Results Two hundred and twenty-eight strains of Mycobacterium tuberculosis were isolated from the 256 sputum samples. According to the results of mycobacterium tuberculosis type determination, the human mycobacterium tuberculosis accounted for the highest proportion, 82.46%(188/228). Other types of bacteria accounted for the lowest proportion, 2.19%(5/228). The drug sensitivity test showed that among the 256 cases of tuberculosis, 153 cases were resistant to the first-line anti-tuberculosis drugs, accounting for 59.77%; the drug resistance rate against isoniazid was the highest [22.27% (57/256)]; the drug resistance rate against ethambutol was the lowest [6.25% (16/256)]. Thirty cases were resistant to the second-line anti-tuberculosis drugs, accounting for 11.72%; the drug resistance rate against ofloxacin was the highest [4.69% (12/256)]; the drug resistance rate against Amikacin sulfate was the lowest [1.95% (5/256)]. The drug sensitivity test showed that among the 256 cases of tuberculosis, 76 cases had single drug resistance against the first-line anti-tuberculosis drugs, accounting for 29.69%; the single drug resistance rate against isoniazid was the highest [10.16% (26/256)]; the single drug resistance rate against ethambutol was the lowest [5.47% (14/256)]. Fifteen cases had single drug resistance against the second-line anti-tuberculosis drugs, accounting for 5.86%; the single drug resistance rate against ofloxacin was the highest [3.13% (8/256)]; the single drug resistance rate against Amikacin sulfate was the lowest [0.39% (1/256)]. Conclusions　Human mycobacterium tuberculosis is the main form of mycobacterium tuberculosis in patients with tuberculosis. The drug resistance of tuberculosis patients is relatively serious, and their drug resistance to first-line anti-tuberculosis drugs is higher. The clinical resistance monitoring of anti-tuberculosis drugs should be strengthened.

Case Report

One case of type A aortic dissection presenting with intestinal obstruction

Huang Jie, Jiang Yabin

2023, 29(8):  1144-1146.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.025

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One case of acute type A aortic dissection with intestinal obstruction as the main manifestation treated at First Hospital, Jinan University was retrospectively analyzed. The clinical data of the patient were collected and analyzed according to related literatures. The causes of misdiagnosis of aortic dissection with abdominal pain as the precursor were analyzed, and the corresponding preventive measures were put forward.

Aortic dissection with paraplegia as the main symptom: a case report and literature review

Gong Feng, Wufuer·Yimaer , Zhu Fan, Aliya·Tayier , Wang Huguo

2023, 29(8):  1146-1148.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.026

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This paper discusses the diagnosis and treatment of atypical aortic dissection through the case of aortic dissection with limb weakness as the main symptom in First Hospital, Xinjiang Medical University and literature study, so as to avoid misdiagnosis and missed diagnosis.

The inferior vena cava filter came off and traveled to the right ventricle in one case

Dong Shunjun, Liu Shen

2023, 29(8):  1149-1151.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.027

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Misdiagnosis of one case of dermatomyositis positive in anti-MDA5 antibody and literature review

Zhu Fapan, Wu Yuan, Jiang Haodong, Wang Yanhui, Zeng Aoguo, Liu Cuizhong

2023, 29(8):  1151-1154.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.028

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Anti-MDA 5 antibody-positive dermatomyositis is a rare, with mild early clinical symptoms. The patients of initial diagnosis mainly have skin lesions and respiratory symptoms, so it is easy to cause misdiagnosis and missed diagnosis. The diagnosis and treatment process of a patient with anti-MDA 5 antibody-positive dermatomyositis admitted to Hunan Provincial People's Hospital  in June 2020 is reported as below.

Nursing Research

Multi-dimensional psychological intervention supported by wisdom theory for patients with hemoptysis caused by tuberculosis 

Xiao Jingjing, Yao Lei, Zhang Ping

2023, 29(8):  1155-1159.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.029

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Objective　To study the effect of multi-dimensional psychological intervention supported by the wisdom theory for patients with hemoptysis caused by tuberculosis. Methods　One hundred and ten patients with hemoptysis caused by tuberculosis treated at Xinyang Fifth People's Hospital from June 2020 to May 2022 were selected for the random control trial. They were divided into a control group and a resourceful group by the random number table method, with 55 cases in each group. There were 31 males and 24 females in the control group; they were (38.26±4.85) years old. There were 34 males and 21 females in the resourceful group; they were (37.72±5.14) years old. The control group received routine nursing intervention; in addition, the resourceful group received multi-dimensional psychological intervention supported by the wisdom theory. The levels of resourcefulness [Resourcefulness Scale (RS)], self-efficacies [General Self-Efficacy Scale (GSES)], psychological status [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)], treatment compliances, and qualities of life [EuroQol Five Dimensions Questionnaire (EQOL-5D)] were compared between these two groups. t and χ² tests were applied. Results　After 3 months' intervention, the scores of RS and GSES in the resourceful group were higher than those in the control group [(108.42±11.25) vs. (94.58±10.87) and (32.45±2.76) vs. (26.74±3.28); both P<0.05]. After 3 months' intervention, the scores of SAS and SDS in the resourceful group were lower than those in the control group [(44.26±2.98) vs. (48.72±3.07) and (47.83±3.62) vs. (52.74±3.49); both P<0.05]. The treatment compliance of the resourceful group was higher than that of the control group [98.18% (54/55) vs. 85.45% (47/55); P<0.05]. After 3 months' intervention, the EQOL-5D score in the resourceful group was higher than that in the control group [(91.28±4.49) vs. (85.36±5.02); P<0.05]. Conclusion　Multi-dimensional psychological intervention supported by the wisdom theory for patients with hemoptysis caused by tuberculosis can improve their psychological status, resourcefulness, self-efficacy, treatment compliance, and quality of life.

Intensive nursing mode based on Green model for patients with unstable angina pectoris of coronary heart disease

Mo Linqin, Li Xing, Zhang Zhan, Su Yanlin, Sun Yanbin

2023, 29(8):  1160-1166.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.030

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Objective　To explore the value of intensive nursing mode based on the Green model for patients with unstable angina pectoris (UAP) of coronary heart disease. Methods　One hundred and eighteen patients with UAP of coronary heart disease treated in Department of Cardiology, Wuxi Second People's Hospital from April 2020 to January 2022 were selected for the random control trial. They were divided into an enhancement group and a control group by the random number table method, with 59 cases in each group. There were 32 males and 27 females in the enhancement group; they were (61.37±10.81) years old. There were 34 males and 25 females in the control group; they were (61.52±10.64) years old. The enhancement group implemented the intensive nursing mode based on the Green model. The control group implemented the routine nursing mode. The fuzzy comprehensive evaluation method was used to evaluate their health behavior level; the Simple Coping Style Questionnaire (SCSQ) was used to evaluate their coping style; the Seattle Angina Questionnaire (SAQ) was used to evaluate their body status and quality of life; echocardiography was used to observe their left ventricular ejection fractions (LVEF), left ventricular end diastolic diameters (LVEDD), and left ventricular end systolic diameters (LVESD). t and χ² tests were applied. Results　After the intervention, the scores of taking reexamination regularly, quitting smoking and drinking, exercise, diet, and medication compliance and total score of health behaviors were higher than those before the intervention in the two groups (all P<0.05); the above scores of the enhancement group were higher than those of the control group [(17.37±2.49) vs. (16.42±2.34), (18.64±1.33) vs. (17.58±1.27), (17.61±2.43) vs. (16.75±2.19), (16.90±2.74) vs. (15.71±2.46), (18.68±1.23) vs. (17.46±1.14), and (89.20±14.63) vs. (83.92±14.19); t=2.136, 4.427, 2.019, 2.482, 5.588, and 1.990; all P<0.05]. After the intervention, the scores of positive coping style in the two groups were higher than those before the intervention (both P<0.05), while the scores of negative coping style were lower than those before the intervention (both P<0.05); the score of positive coping style in the enhancement group was higher than that in the control group [(22.78±2.83) vs. (19.54±2.44); t=6.660, P<0.05], while the score of negative coping style was lower than that in the control group [(7.36±1.05) vs. (9.81±1.17); t=11.971, P<0.05]. After the intervention, the scores of disease cognition, stable state of angina pectoris, angina pectoris attack, physical activity limitation, and satisfaction in the two groups were higher than those before the intervention (all P<0.05); the above scores of the enhancement group were higher than those of the control group [(84.07±4.15) vs. (73.42±5.23), (87.63±3.91) vs. (75.71±4.57), (89.29±3.58) vs. (72.86±5.62), (86.24±4.07) vs. (77.53±4.65), and (93.29±2.69) vs. (87.93±4.36); t=12.253, 15.223, 18.939, 10.826, and 8.036; all P<0.05]. The incidence of cardiovascular adverse events during nursing period and rehospitalization rate in the enhancement group were lower than those in the control group [3.39% (2/59) vs. 16.95% (10/59) and 1.69% (1/59) vs. 13.56% (8/59); χ²=4.546 and 4.330, both P<0.05)]. After the intervention, the LVEF's in the two groups were higher than those before the intervention, and the LVEDD's and LVESD's were lower than those before the intervention (all P<0.05); the LVEF of the enhancement group was higher than that of the control group [(56.94±8.02)% vs. (51.42±7.56)%; t=3.847, P<0.05], and the LVEDD and LVESD were lower than those of the control group [(51.87±5.37) mm vs. (55.24±5.13) mm and (42.06±4.31) mm vs. (45.46±4.68) mm; t=3.486 and 4.105, both P<0.05]. Conclusion　Intensive nursing mode based on Green model for patients with UAP of coronary heart disease can more effectively improve their health behaviors, coping style, body state, and quality of life, reduce the incidence of cardiovascular adverse events and rehospitalization rate, and improve the rehabilitation effect.

Integrated management guided by professional medical staff for elderly patients with severe pneumonia

Mo Xi, Ping Ping, Fu Yifei

2023, 29(8):  1166-1170.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.031

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Objective　To explore the effect of integrated management guided by professional medical staff for elderly patients with severe pneumonia. Methods　Eighty elderly patients with severe pneumonia admitted to First Hospital, Henan University of Science and Technology from July 2020 to July 2022 were divided into a control group and an observation group according to the admission order, with 40 cases in each group. There were 23 males and 17 females in the control group; they were 62-85 (73.56±4.15) years old. There were 21 males and 19 females in the observation group; they were 63-87 (74.11±4.32) years old. The control group were given routine nursing intervention; in addition, the observation group were given integrated management guided by professional medical staff. The symptom improvement, pulmonary function, scores of Self-Rating Anxiety Scale (SAS) and Comprehensive Quality of Life Questionary-74 (GQOL-74), and satisfaction were compared between the two groups. t and χ² tests were applied. Results　The times for the disappearance of anhelation, cough, and wheezing sound in the observation group were shorter than those in the control group [(2.86±0.53) d vs. (3.45±0.61) d, (2.67±0.46) d vs. (3.57±0.59) d, and (4.76±0.68) d vs. (6.01±0.73) d; t=4.618, 7.608, and 7.924; all P<0.001]. After the nursing, the forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the observation group were higher than those in the control group [(2.87±0.18) L vs. (2.55±0.12) L and (2.31±0.16) L vs. (2.05±0.17) L; t=9.355 and 7.044; both P<0.001]; the score of SAS in the observation group was lower than that in the control group [(41.68±3.58) vs. (46.82±4.15); t=5.931, P<0.001], and the score of GQOL-74 was higher [(82.46±6.28) vs. (76.59±5.93); t=4.298, P<0.001]. The satisfaction in the observation group was higher than that in the control group [97.50% (39/40) vs. 80.00% (32/40); χ²=4.507, P=0.034]. Conclusion　Integrated management guided by professional medical staff for elderly patients with severe pneumonia can promote their recovery of pulmonary function, improve their clinical symptoms and quality of life, reduce their bad emotions, and also enhance their recognition to medical staff.

Main nursing diagnosis and intervention points of children with systemic juvenile idiopathic arthritis and macrophage activation syndrome

Song Yuli, Zhang Shuqiao, Nan Yuanyuan

2023, 29(8):  1171-1175.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.032

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Objective　To investigate the main nursing diagnosis and intervention points of children with systemic juvenile idiopathic arthritis (SJIA) and macrophage activation syndrome (MAS). Methods　Seven children with SJIA and MAS who were treated in Children's Hospital Affiliated to Zhengzhou University from May 2020 to June 2021 were included in this study. There were 4 males and 3 females; they were 3-11 (7.08±1.06) years old. All the children were given personalized treatment measures according to their clinical characteristics, including glucocorticoids, cyclosporine A, interleukin 6 (IL-6) receptor antagonists, and nursing interventions (disease monitoring, infection, bleeding, joint, oral, fever, and psychological care). The therapeutic effect, clinical symptoms, changes in laboratory indicators, and follow-up results were observed. t test were applied. Results　Three cases were treated with methylprednisolone, 2 cases with methylprednisolone and cyclosporine A, and 2 cases with IL-6 receptor antagonist. After the treatment, the conditions of all the children were relieved; their body temperature gradually returned to normal in 1-3 weeks; their blood routine levels gradually returned to normal in 2-3 months. There was no death case. However, one child treated with IL-6 receptor antagonist had an elevated total cholesterol (TC) level. Four weeks after the treatment, the numbers of swollen, tender, and restricted joints were (2.03±0.30), (1.58±0.23), and (2.44±0.36), which were significantly lower than those before the treatment [(5.87±0.88), (5.45±0.81), and (5.16±0.77)] (t=10.927, 12.160, and t=8.466; all P<0.001); the erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and ferritin were (9.59±1.43) mm/h, (8.25±1.23) mg/L, and (347.08±52.06) μg/L, which were lower than those before the treatment [(46.45±6.96) mm/h, (95.13±14.26) mg/L, (549.12±82.36) μg/L] (t=13.933, 16.059, and 5.486; all P<0.001); the hemoglobin (Hb) level was higher than that before the treatment [(131.88±19.78) g/L vs. (110.30±16.54) g/L; t=2.214, P=0.046]. The numbers of swollen, tender, and motility limited joints 8 weeks after the treatment were (1.28±0.19), (0.42±0.06), and (1.13±0.16), which were significantly fewer than those before the treatment (t=13.489, 16.384, and 13.557; all P<0.001). The ESR and levels of CRP and ferritin 8 weeks after the treatment were (10.01±1.50) mm/h, (7.63±1.14) mg/L, and (163.15±24.47) μg/L, which were significantly lower than those before the treatment (t=13.541, 16.182, and 11.885; all P<0.001). The Hb level 8 weeks after the treatment was (136.65±20.49) g/L, which was significantly higher that before the treatment (t=2.647, P=0.021). After discharge, the children went to the outpatient department for reexamination every 1-2 months, and there were no abnormal clinical symptoms and laboratory indicators of SJIA-MAS again. Conclusion　SJIA-MAS is a critical and severe disease in pediatrics. Timely and effective treatment and nursing intervention can effectively reduce the mortality rate and improve the children's prognosis.

Effect of nutrition and weight management during pregnancy in maternal health care and its influence on neonatal pregnancy outcomes

Zhang Yannan, Li Yali

2023, 29(8):  1175-1179.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.033

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Objective　To explore the effect of nutrition and weight management during pregnancy in maternal health care and its influence on neonatal pregnancy outcomes. Methods　A total of 320 pregnant women who delivered in Zhengzhou Maternal and Child Health Hospital from February 2020 to January 2021 were selected and divided into a management group and a conventional group by the random number table method. There were no statistical differences in age, gestational age, education level, and other general information between the two groups (all P>0.05). The conventional group were given traditional nursing measures; in addition, the management group took prenatal nutrition and weight management interventions. The maternal and neonatal outcomes in both groups were observed. The body mass indexes (BMI), blood glucose levels before and after the intervention, and nursing satisfactions were compared between these two groups. t and χ² tests were applied. Results　The women's BMI's when they were 20 and 30 weeks pregnant and delivered in the management group were lower than those in the conventional group [(20.65±2.19) kg/m² vs. (22.05±2.27) kg/m², (21.35±2.38) kg/m² vs. (23.73±2.54) kg/m², (25.64±2.25) kg/m² vs. (27.32±2.27) kg/m²], with statistical differences (all P<0.001). After the intervention, the levels of fasting blood glucose and glycosylated hemoglobin in the management group were significantly lower than those in the conventional group [(4.32±0.23) mmol/L vs. (4.81±0.31) mmol/L and (5.26±0.43) mmol/L vs. (5.89±0.72) mmol/L], with statistical differences (both P<0.05). The proportions of preeclampsia, cesarean section, postpartum hemorrhage, premature rupture of membranes, and polyhydramnios in the management group were significantly lower than those in the conventional group [3.13% (5/160) vs. 11.25% (18/160), 14.38% (23/160) vs. 31.88% (51/160), 5.00% (8/160) vs. 15.63% (25/160), 4.38% (7/160) vs. 16.25% (26/160), and 5.63% (9/160) vs. 17.50% (28/160)], with statistical differences (all P<0.05). The proportions of premature birth, neonatal asphyxia, macrosomia, and low birth weight in the management group were significantly lower than those in the conventional group [6.88% (11/160) vs. 15.00% (24/160), 4.38% (7/160) vs. 10.63% (17/160), 3.13% (5/160) vs. 9.38% (15/160), and 5.63% (9/160) vs. 11.88% (19/160)], with statistical differences (all P<0.05). The satisfaction scores of professional nursing, self-care guidance, information support, and pregnancy observation of the pregnant women in the management group were significantly higher than those in the conventional group, with statistical differences (all P<0.05). Conclusions　The application effect of pregnancy nutrition and weight management in maternal health care is good; it can improve the pregnant women's BMI and pregnancy outcomes and the newborns' outcomes, control the pregnant women's blood glucose level, with high satisfaction, so it is worthy of further promotion and application.

Clinical Teaching

Application of blended teaching mode based on outcome-based education and multi-assessment in practice teaching of obstetrics

Cui Jinhui, Li Ling, Ouyang Liping, Wang Qingqing, Li Ping, Fan Jianhui, Hou Hongying, Wu Lingling

2023, 29(8):  1180-1184.  DOI: 10.3760/cma.j.issn.1007-1245.2023.08.034

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Objective　To explore the effect applying the blended teaching mode based on the outcome-based education (OBE) and multi-assessment in the practice teaching of obstetrics. Methods　The experimental control method was used. Ninety five-year program students majoring in clinical medicine of Sun Yat-sen University who practiced in Department of Obstetrics, Third Hospital Affiliated to Sun Yat-sen University from August 2021 to August 2022 were selected as the research objects. They were divided into an experimental group and a control group by the envelope random method, with 45 in each group. There were 27 males and 18 females in the experimental group; they were (22.24±0.57) years old. There were 25 males and 20 females in the control group; they were (22.24±0.88) years old. The control group adopted the traditional offline practice teaching method of teacher teaching and ward practice. The experimental group adopted the blended teaching mode based on OBE concept, offline teaching combined with WeChat Rain classroom online teaching. In the mid-term evaluation of practice, the two groups' students were evaluated by the Mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedure Skills (DOPS), and Clinical Communication Skill Scale. At the end of practice, they were finally evaluated by the comprehensive assessment. The teaching effects of the two groups were compared. The measurement data were analyzed by t test, and the count data by χ² test or the Fisher's exact probability method. Results　In the mid-term evaluation of practice, the excellent rate of Mini-CEX in the experimental group was higher than that in the control group[15.6% (7/45) vs. 0; P<0.05]; the score of Clinical Communication Skill Scale in the experimental group was higher than that in the control group [(91.93±3.60) vs. (85.13±3.62); t=-8.938, P<0.001]. In the final evaluation, the score of the comprehensive examination in the experimental group was higher than that in the control group [(82.15±4.14) vs. (80.18±4.46); t=-2.177, P<0.05]. Conclusion　In the practice teaching of obstetrics, the application of the blended teaching mode based on OBE concept and multi-assessment has a good teaching effect on the training of clinical diagnosis and treatment thinking ability and communication ability.