Table of Content

15 May 2023, Volume 29 Issue 10

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Special Subject:Pulmonary Tuberculosis

Treatment delay of patients with pulmonary tuberculosis among permanent residents at Yuexiu District, Guangzhou from 2018 to 2022

Liang Zhiqiang, Liu Guobiao, Chen Qichen, Du Yuhua, Wu Guifeng, Lei Yu, Bao Wanling, Li Hua, Liu Zhihui

2023, 29(10):  1333-1337.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.001

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Objective　To analyze the characteristics of diagnosis and treatment delay of patients with tuberculosis in recent years at Yuexiu, and to provide the basic basis for the formulation of control strategies for the early detection of tuberculosis cases and the optimization and improvement of the implementation measures. Methods　The online reporting data of tuberculosis patients at Yuexiu District, Guangzhou from 2018 to 2022 were derived from the Tuberculosis Management Information System of China Information System for Disease Control and Prevention. Whether the intervals between the first diagnosis date and present symptom date and between the present diagnosis date and the present first diagnosis date were over 14 days were referred to as delay in seeing a doctor and diagnosis delay, respectively. The data of these two kinds of delay were statistically analyzed by day, week, month, and year. And the delays between male and female, between the juvenile group (< 18), the youth group (18-45), the middle-aged group (45-60), and the elderly group (≥60), and between the delay of each street were compared. χ² test and rank sum test were applied. Results　In the 2 504 cases of pulmonary tuberculosis, the rates of delay in seeing a doctor and diagnosis delay were 41.5% (1 028/2 504) and 30.71% (769/2 504), respectively. The ranges and medians of the two kinds of delays were 1-7 664 days and 27 days and 1-1 100 days and 14 days, respectively; the percentages of delay for one month, one year, and over one year were 52.72% (542/1 028), 43.29% (445/1 028), and 3.99% (41/1 028) and 77.76% (598/769), 21.59% (166/769), and 0.65% (5/769), respectively. The delay in seeing a doctor and diagnosis delay occurred in 662 cases (40.89%) and 482 cases (29.96%) among the 1 619 male patients, respectively, while 366 cases (41.36%) and 287 cases (32.43%) experienced the delays among the 885 female patients, respectively, with no statistical differences between the males and the females (all P˃0.05). The rates of delay in seeing a doctor and diagnosis delay in the juvenile group, the youth group, the middle-aged group, and the elderly group were 36.36% (16/44), 38.31% (321/838), 41.81% (268/641), and 43.12% (423/981) and 31.82% (14/44), 33.77% (283/838), 28.55% (183/641), and 29.46% (289/981), respectively, with no statistical differences (all P˃0.05). In the 18 sub-districts of Yuexiu District, the ranges of the rates of delay in seeing a doctor and diagnosis delay were 32.91%-50.79% and 21.52%-34.73%, respectively, with statistical differences (U=96.0 and 41.5; both P<0.05). Conclusions　There are high proportions of delay in seeing a doctor and diagnosis delay among patients with pulmonary tuberculosis at Yuexiu District. How to shorten delay in seeing a doctor by strengthening the active case finding and to reduce diagnosis delay by improving clinical diagnosis and treatment is an urgent problem to be solved.

Epidemiological analysis of pulmonary tuberculosis in floating population at Yuexiu District, Guangzhou from 2018 to 2022

Bao Wanling, Liu Yumei, Liang Zhiqiang, Liu Guobiao, Chen Qichen, Du Yuhua, Wu Guifeng, Lei Yu, Li Hua, Liu Zhihui

2023, 29(10):  1338-1342.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.002

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Objective　To understand the latest epidemiological status of tuberculosis in floating population at Yuexiu District and to provide scientific basis for continuous improvement and optimization of measures of tuberculosis prevention and control for floating population. Methods　Basing on the data of Tuberculosis Management Information System, a subsystem of China Disease Prevention and Control Information System, the online data of the patients with pulmonary tuberculosis at Yuexiu District floating between districts, cities, and provinces from 2018 to 2022 were collected and collated. The epidemiological status in the 3 floating populations with different gender, age, case finding model, treatment delay, pathogenic test results, and treatment classification were descriptively analyzed. Results　In the five years, 1 267 cases of pulmonary tuberculosis at Yuexiu District were reported, including 829 males (65.43%) and 438 females (34.57%). Among them, 80.58% (1 021/1 267) patients went directly to the tuberculosis prevention and treatment institution for medical treatment. In the patients, 713 cases (56.27%) were pathogenic positive, and 554 cases (43.73%) pathogenic positive. There were 1 188 first treated cases (93.76%) and 79 re-treated cases (6.24%). The median of the reported incidence rates of pulmonary tuberculosis in the floating population was 71.1/100 000 in 2020. The rates of delay in seeing a doctor and diagnosis delay were 75.30% (854/1 267) and 77.19% (978/1 267), respectively. The percentages of the patients <18 years old, 18-45 years old, ≥45-59 years old, and ≥60 years old were 3.28% (2/61), 50.82% (31/61), 22.95% (14/61), and 22.95% (14/61), respectively. Conclusions　The incidence of tuberculosis and rates of delay in seeing a doctor and diagnosis delay in the floating population at Yuexiu are all at a high level. Therefore, it is urgent to strengthen tuberculosis control in floating population.

Change in serum expression level of IFN-γ during pulmonary tuberculosis treatment

Gong Lan, Xu Wanhua, Xie Bei, Yang Yu, Wu Ling, Wang Nan, Liu Zhihui, Li Hua, Meng Fanrong, Dong Haiping

2023, 29(10):  1343-1348.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.003

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Objective　To evaluate the change trend of serum interferon-γ (IFN-γ) level during pulmonary tuberculosis treatment, to explore the possible influencing factors, and to provide evidences for the significance of serum IFN-γ level monitoring in the course of pulmonary tuberculosis treatment. Methods　The serum of 56 patients with pulmonary tuberculosis treated at Guangzhou Chest Hospital from September 2020 to December 2022 was collected and measured by flow cytometry before the treatment and after 2 and 6 months' treatment. The measurement data not of normal distribution were compared by Kruskal-Wallis and Mann-Whitney tests. Friedman test was used for the paired samples. Results　The serum concentration of IFN-γ in the patients with pulmonary tuberculosis decreased during the treatment, with a statistical difference (P=0.004). Before the treatment, the serum concentration of IFN-γ in the patients with pulmonary cavity was higher than that in the patients without pulmonary cavity, with a statistical difference. When the serum concentration of IFN-γ was used to distinguish between before and 2 months after the treatment and between before and 6 months after the treatment, the areas under receiver operating characteristic curves (ROC) were 0.582 and 0.646; the cut-off values were 1.520 and 2.345 ng/L; the sensitivities were 91.10% and 44.60%; the specificities were 32.10% and 69.60%. Binary logistic regression analysis showed that whether serum IFN-γ concentration fell below 1.520 ng/L after 2 months' treatment was related to whether the patients had diabetes. When the enrolled cases were limited to the positive etiopathogenesis before the treatment and when the serum concentration of IFN-γ was used to distinguish between before and 2 months after the treatment and between before and 6 months after the treatment, the areas under ROC were 0.762 and 0.770; the cut-off values were 1.725 and 1.705 ng/L; the sensitivities both were 93.75%; the specificities both were 50.00%. Conclusion　The concentration of serum IFN-γ before pulmonary tuberculosis treatment is related to whether or not there is a cavity in the lungs, and the overall trend of decrease during the treatment is related to whether the patients are complicated with diabetes and the patients' etiological results before treatment.

Linezolid combined with HRZE antituberculosis regimen in treatment of pulmonary tuberculosis and its effect T lymphocyte subsets

Shi Junxia, Wang Xinyu, Shi Tiantian, Wang Decui

2023, 29(10):  1348-1352.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.004

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Objective　To investigate the value of linezolid combined with HRZE (isoniazide, rifampicin, pyrazinamide, and ethambutol) antituberculosis regimen in the treatment of pulmonary tuberculosis. Methods　Eighty patients with pulmonary tuberculosis admitted to Binzhou Central Hospital from May 2021 to November 2022 were selected for the randomized controlled trial. They were divided into a study group and a control group by the random number table method, with 40 cases in each group. There were 22 males and 18 females in the study group; they were 30-65 (45.68±4.15) years old. There were 24 males and 16 females in the control group; they were 32-63 (45.50±4.20) years old. The study group were treated with linezolid and HRZE antituberculosis regimen, and the control group with HRZE antituberculosis regimen. The T lymphocyte subsets, clinical indicators (absorption reduction time, cavity closure time, and sputum culture negative time), and laboratory indicators [interferon-γ, interleukin-6 (IL-6), and transforming growth factor-β (TGF-β)] before and after the treatment, clinical efficacies, and adverse reactions were compared between the two groups. χ² and t tests were applied. Results　Before the treatment, there were no statistical differences in CD3⁺, CD4⁺, and CD4⁺/CD8⁺ between the two groups (all P>0.05); after the treatment, the CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the study group were higher than those in the control group [(55.16±5.46)% vs. (50.41±5.11)%, (39.64±4.55)% vs. (33.26±4.12)%, and (1.87±0.40) vs. (1.55±0.39); all P<0.05]. The absorption reduction time, cavity closure time, and sputum culture negative time in the study group were shorter than those in the control group [(42.55±5.68) d vs. (56.36±7.10) d, (89.65±6.38) d vs. (116.20±8.12) d, and (45.22±5.41) d vs. (52.02±5.69) d; all P<0.05]. Before the treatment, there were no statistical differences in the levels of interferon-γ, IL-6, and TGF-β between the two groups (all P>0.05); after the treatment, the INF-γ level was higher and the levels of IL-6 and TGF-β were lower in the study group than in the control group [(40.13±5.22) ng/L vs. (31.05±4.68) ng/L, (25.16±2.24) ng/L vs. (33.20±2.66) ng/L, and (33.16±4.14) μg/L vs. (45.25±5.31) μg/L; all P<0.05]. The total effective rate of the study group was higher than that of the control group [95.00% (38/40) vs. 77.50% (31/40); P<0.05]. There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Linezolid combined with HRZE antituberculosis regimen in the treatment of pulmonary tuberculosis is effective and safe and can improve the patients' levels of T lymphocyte subsets, reduce inflammation, and optimize clinical indicators, so it has high clinical value.

New Medical Advances

Research progress of traditional Chinese sports in rehabilitation of patients with chronic obstructive pulmonary disease

Yao Rongqi, Deng Yu, Pan Guangtao

2023, 29(10):  1353-1358.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.005

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Chinese traditional sports health skills are unique traditional rehabilitation techniques in China and are widely used in the rehabilitation of patients with various chronic diseases. Lung rehabilitation is an important part of non-drug therapy for patients with chronic obstructive pulmonary disease. Chinese traditional sports health preservation techniques, such as Taijiquan, Five-Animal Exercises, Yi Jin Jing, Baduan Jin Exercise, Six-Character Formula, etc., are valued at home and abroad. PubMed, Elsevier, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP, China Biomedical Literature Database, and other domestic and foreign databases were systematically searched, and the Chinese traditional sports health skills and chronic obstructive pulmonary disease related researches were summarized. This article aims to provide theoretical basis for the better promotion and application of Chinese traditional sports health skills at home and abroad.

Risk factors of children with Kawasaki disease resistant to intravenous immunoglobulin

Yang Chengyang, Fan Xue, Xu Mingguo

2023, 29(10):  1358-1360.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.006

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Kawasaki disease is an acute systemic vasculitic disease that tends to occur in children. At present, high-dose intravenous immunoglobulin combined with oral aspirin is the standard treatment for Kawasaki disease, but some cases are not sensitive to intravenous immunoglobulin clinically. Such patients are prone to coronary artery lesions, which may lead to myocardial infarction and death in severe cases. This article mainly reviews the risk factors of children with Kawasaki disease resistant to intravenous immunoglobulin.

Research progress of effects of aerobic exercise and biological clock on coronary atherosclerosis

Zhen Mengmeng, Cheng Jinfeng, Wu Yuting, Cheng Yanli

2023, 29(10):  1361-1365.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.007

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Aerobic exercise is defined as an activity in which aerobic metabolism is the main mode of energy supply for the body during exercise, such as jogging, brisk walking, swimming, cycling, etc. Atherosclerosis is a dynamic process that begins with endothelial dysfunction and inflammation and culminates in life-threatening atheromatous plaques. The biological clock is the intrinsic rhythm of an organism's life activities, and is determined by the structural sequence of time in the organism. In recent years, numerous studies have found that moderate aerobic exercise and a proper biological clock have a key role in reducing coronary plaque formation. This article reviews the effects of aerobic exercise and biological clocks on coronary atherosclerosis.

Application of deep convolution neural network in colonoscopy

Shi Zexuan, Fu Zilong, Liu Junna, Li Jinglu, Niu Qiong

2023, 29(10):  1365-1369.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.008

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Recently, the success of deep learning, especially deep convolution neural network (CNN), has promoted the development of polyp recognition and segmentation based on image and video. At present, most diagnostic colonoscopy rooms use artificial intelligence methods. Through extensive research and testing, the feasibility of classifying and monitoring colorectal lesions in colonoscopy has been verified. This paper reviews the application of CNN in the characteristics of tumors or precancerous lesions, automatic anatomical classification of colonoscopy images, variable intestinal preparation / colonoscopy automatic quality control system, as well as the shortcomings and future prospects of CNN in colonoscopy diagnosis.

Research progress of bilateral hippocampal anatomy, common lesions, and pathogenesis

Zhao Ruiqing, Kang Guowei, Wang Qian, Feng Bo

2023, 29(10):  1370-1374.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.009

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The hippocampus is one of the critical structures in the cerebral hemispheres. The hippocampus is the core of human memory research. A variety of nervous system diseases can involve the bilateral hippocampus, and directly or indirectly lead to abnormal hippocampal structure and function through various mechanisms. This paper collates and summarizes the origin and basic anatomy of the hippocampus and common nervous system diseases that lead to bilateral hippocampal lesions and analyzes the pathogenesis, so as to provide new ideas for the prevention and treatment of nervous system diseases related to bilateral hippocampal lesions.

Iosocitrate dehydrogenase inhibitors as precision medicine for acute myeloid leukemia 

Liu Wanyi, Guo Jianxin

2023, 29(10):  1375-1378.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.010

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The treatment of acute myeloid leukemia (AML) has improved dramatically over the past decades, with the development of new drugs that target specific genetic mutations associated with the disease. One of these, iosocitrate dehydrogenase (IDH) inhibitors, has achieved significant efficacy for patients with IDH1 or IDH2 mutations. This article reviews the researches on IDH inhibitors as precision medicine for AML.

Meta Analysis

Meta-analysis on effect of sevoflurane-maintained anesthesia on intrapulmonary shunt fraction in patients during one-lung ventilation

Wang Yewen, Liu Shupeng, Zhang Quanyi, Ye Ting

2023, 29(10):  1379-1384.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.011

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Objective　To systematically evaluate the effect of sevoflurane-maintained anesthesia on intrapulmonary shunt fraction in patients during one-lung ventilation. Methods　Randomized controlled trials (RCTs) related to sevoflurane, propofol, and one-lung ventilation were retrieved from PubMed, Embase, the Cochrane Library, CBM, CNKI, and Wanfang Database from their establishment to March 2022. Two independent researchers screened the literatures according to the inclusion and exclusion criteria and extracted the data of intrapulmonary shunt fraction and arterial partial pressure of oxygen (PaO₂). The RevMan 5.3 software was used to conduct a meta-analysis on the included RCTs. Results　Six RCTs with 244 patients were included, including 122 cases in the sevoflurane group and 122 cases in the propofol group. The results suggested that the intrapulmonary shunt fraction had a higher increase in the sevoflurane group than in the propofol group (MD=1.90, 95%CI 0.61-3.19, P=0.004). There was no statistical difference in PaO₂ between these two groups (MD=2.23, 95%CI -10.78-15.24, P=0.74). Conclusion　Compared with propofol, sevoflurane-maintained anesthesia for patients undergoing one-lung ventilation can increase their intrapulmonary shunt fraction.

Scientific Research

Reference intervals of EB-VCA-IgA and EB-EA-IgA were established quantificationally by an indirect method

Mai Dongmei, Shen Le, Tan Junjing

2023, 29(10):  1385-1391.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.012

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Objective　The biological reference intervals of epstein-barr virus capsid antigen antibody (EBV-VCA-IgA) and epstein-barr virus early antigen antibody (EBV-EA-IgA) in our laboratory were established by an indirect method using the data from the laboratory information management system (LIS) of Guangdong Second Traditional Chinese Medicine Hospital. Methods　The results of EBV-VCA-IgA and EBV-EA-IgA in 2 160 healthy people (998 males and 1 162 females) who were 20 to 100 years old with normal aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (T-BILI), direct bilirubin (D-BILI), indirect bilirubin (I-BILI), creatinine (CR), and urea nitrogen (BUN) were retrospectively analyzed by the LIS data. The results were grouped by gender and age. Kolmogorov Smirnov test (K-S test) was used to test the normality of each group. When P>0.05, it was regarded as normal distribution; when P<0.05, it was regarded as non-normal distribution. For non-normal distribution data, the data larger than P₂₅-3×IQR and less than P₇₅+3×IQR were excluded. The non-parametric test was used to analyze the data after elimination. The statistical differences between the groups were analyzed. The biological reference intervals of EBV-VCA-IgA and EBV-EA-IgA were established by the P_2.5-P_97.5 intervals, and the reference intervals were verified. Results　There was a statistical difference in the EBV-VCA-IgA reference interval between the males and the females (P<0.001), but no statistical difference between the age groups (P=0.087). There was no statistical difference in the EBV-EA-IgA reference interval between the males and the females (P=0.127), but was between the age groups (P=0.004). The EBV-EA-IgA reference intervals in the 20-50 years old group and the ≥50-70 years old group were statistically different from that in the ≥70 years old group (P=0.002 and <0.001). There was no statistical difference in the EBV-EA-IgA reference interval between the 20-50 years old group and the ≥50-70 years old group (P=0.043), so these two groups were united as one group (20-70 years old) to build a reference interval, and it was statistically different from that in the ≥70 years old group (P=0.001). Accordingly, the EBV-VCA-IgA reference interval was 0.34-3.88 AU/ml in the males, and was 0.32-3.71 AU/ml in the females; the EBV- EA-IgA reference interval was 0.01-1.39 AU/ml in the 20-70 years old group, and was 0.01-1.52 AU/ml in the ≥70 years old group. Conclusion　The indirect method was used to establish the biological reference intervals of EBV-VCA-IgA and EBV-EA-IgA in our laboratory, which could provide more accurate results for the clinical diagnosis of diseases caused by EB virus, such as nasopharyngeal carcinoma.

Effect of Fufang Danshen Diwan combined with clopidogrel in treatment of outpatients with coronary heart disease

Liu Ning, Jiang Lihua, Yin Chenghua

2023, 29(10):  1392-1395.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.013

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Objective To study the efficacy of Fufang Danshen Diwan combined with clopidogrel in the treatment of outpatients with coronary heart disease. Methods　A total of 122 outpatients with coronary heart disease admitted to Jinan Second People's Hospital from January 2018 to November 2020 were selected as the research objects for the prospective study. According to the random number table method, they were divided into a combination group and a control group, with 61 cases in each group. There were 30 males and 31 females in the control group; they were 32-81 (55.67±7.21) years old. There were 31 males and 30 females in the combination group; they were 39-76 years old. The control group were treated with clopidogrel, and the combination group with clopidogrel and Fufang Danshen Diwan. The clinical efficacies and platelet function [platelet membrane glycoprotein GpⅡb /Ⅲa complex (PAC-1) and maximum platelet aggregation rate] and coagulation function [D-dimer (D-D) and antithrombin Ⅲ (AT-Ⅲ)] before and one month after the treatment were evaluated. The data were compared between these two groups by t and χ² tests. Results　Before the treatment, there were no statistical differences in PAC-1 and maximum platelet aggregation rate between the two groups (both P>0.05). After the treatment, the PAC-1 and platelet maximum aggregation rates decreased in both group as compared with those before the treatment (all P<0.05); and those in the combined group was lower than those in the control group (both P<0.05). The clinical efficacy of the combined group was better than that of the control group [95.08% (58/61) vs. 77.05% (47/61)], with a statistical difference (P<0.05). After 1 month's treatment, the levels of D-D in the 2 groups were higher than those before the treatment (both P<0.05), and that in combination group was higher than that in control group (P<0.05); the AT-Ⅲ levels were lower than those before the treatment (both P<0.05), and that in the combination group was lower than that in the control group (P<0.05). Conclusion　Fufang Danshen Diwan combined with clopidogrel in the treatment of outpatients with coronary heart disease can improve the therapeutic effect and their platelet function and coagulation function.

Application of dexmedetomidine and low-dose sufentanil in elderly patients taking painless gastroenterology and its effect on cognitive function 

Wen Hairu, Zhang Le, Zhang Qin

2023, 29(10):  1396-1399.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.014

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Objective　To explore the effect applying dexmedetomidine and low-dose sufentanil in elderly patients taking painless gastroenterology and its effect on cognitive function. Methods　A total of one hundred and ten elderly patients who underwent painless gastrointestinal endoscopy in Bayannur Hospital between March 2020 and May 2022 were selected for the randomized controlled trial, and were divided into a control group and a combination group by the random number table method, with 55 cases in each group. In the control group, there were 31 males and 24 females; they were 60-89 years old. In the combination group, there were 28 males and 27 females; they were 60-89 years old. The control group took small-dose sufentanil (0.1 μg/kg), and the combination group dexmedetomidine (0.5 μg/kg) and low-dose sufentanil (0.1 μg/kg). The anesthesia effects, cognitive function, and incidences of clinical adverse reactions were compared between the two groups. t and χ² tests were applied. Results　The anesthesia onset time, examination time, and time to wake up in the combination group were lower than those in the control group [(1.57±0.39) min vs. (1.87±0.46) min, (21.58±4.32) min vs. (24.57±4.91) min, and (21.47±4.29) min vs. (27.31±5.46) min], with statistical differences (t=3.689, 3.391, and 6.237; all P<0.05). There were no statistical differences in the scores of Lovingston Homework Therapy Cognitive Assessment (LOTCA) before the examination and 60 min after waking up between the two groups. The scores of LOTCA 15 and 30 min after waking up in the combination group were higher than those in the control group [(65.43±4.36) vs. (63.27±4.22) and (71.23±4.75) vs. (69.12±4.61)], with statistical differences (t=2.640 and 2.364; both P<0.05). There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Dexmedetomidine combined with low-dose sufentanil for elderly patients undergoing painless gastroenteroscopy has a better anesthetic effect, has less effect on patients' cognitive function, and is safe to use.

Reduced glutathione in relieving oxidative stress and hepatotoxicity of chemotherapy for patients with liver cancer

Hou Jingjing, Hao Rui, Yang Qiumin

2023, 29(10):  1400-1403.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.015

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Objective　To observe the clinical effect of reduced glutathione on reducing oxidative stress and hepatotoxicity in patients with liver cancer undergoing chemotherapy. Methods　One hundred and three patients with liver cancer admitted to Shangqiu First People's Hospital from March 2020 to August 2021 were selected for the prospective study. They were divided into an observation group (52 cases) and a control group (51 cases) by drawing lots. In the observation group, there were 30 males and 22 females; they were (60.44±5.25) years old. In the control group, there were 31 males and 20 females; they were (61.25±5.47) years old. Both groups received chemotherapy uniformly. The observation group used reduced glutathione as the adjuvant chemotherapy. The changes of liver function and oxidative stress reaction between the two groups before and after the treatment were compared. All the patients were followed up for one year after the treatment. The incidences of chemotherapy related complications and survival rates were compared between the two groups. The data were compared between these two groups by χ² and t tests. Results　Before the treatment, there were statistical differences in liver function and oxidative stress reaction between the two groups (all P>0.05). After the treatment, the levels of glutamic oxaloacetic transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), malondialdehyde (MDA), and catalase (CAT) in the observation group were lower than those in the control group [(50.25±5.33) U/L vs. (53.44±5.17) U/L, (50.16±5.23) U/L vs. (53.11±5.16) U/L, (30.22±5.14) μmol/L vs. (33.16±5.33) μmol/L, (4.88±0.24) nmol/L vs. (5.02±0.33) nmol/L, and (72.33±5.27) Ku/L vs. (75.31±5.62) Ku/L], with statistical differences (t=3.082, 2.850, 2.881, 2.466, and 2.777; all P<0.05); the level of superoxide dismutase (SOD) in the observation group was higher than that in the control group [(325.44±10.27) U/L vs. (319.42±10.36) U/L; t=2.962, P=0.004]. During the follow-up, the incidence of chemotherapy related complications in the observation group was lower than that in the control group [5.77% (3/52) vs. 19.61% (10/51); χ²=4.471, P=0.035]; the scores of living quality (QLQ-C30) and life quality (QLQ-HCC) in the observation group were lower than those in the control group [(57.73±5.28) vs. (60.12±5.32) and (22.47±3.15) vs. (24.15±3.44); t=2.288 and 2.586, P=0.024 and 0.011]. Conclusion　Reduced glutathione adjuvant chemotherapy can reduce the oxidative stress reaction and liver function damage in patients with liver cancer, and has positive significance in reducing the risk of chemotherapy related complications and improving the living and life qualities.

Therapeutic effect of entecavir combined with Fufang Biejia Ruangan tablets for patients with HBeAg-positive decompensated cirrhosis

Tian Hao, Gong Xuelian, Ding Kun

2023, 29(10):  1404-1408.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.016

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Objective　To investigate the clinical efficacy of entecavir combined with Fufang Biejia Ruangan tablets in the treatment of patients with HBeAg-positive decompensated cirrhosis. Methods　One hundred patients with HBeAg-positive decompensated cirrhosis admitted to Yantai Qishan Hospital from September 2017 to September 2021 were prospectively selected as the study objects, and were randomly divided into an observation group and a control group, with 50 cases in each group. There were 30 males and 20 females in the control group; they were (43.29±5.02) years old. There were 26 males and 24 females in the control group; they were (40.16±6.25) years old. The control group were treated with entecavir, and the observation group with entecavir and Fufang Biejia Ruangan tablets. The therapeutic efficacies, liver function indicators, such as alanine aminotransferase (ALT), aspartate transferase (AST), albumin (ALB), and total bilirubin (TBiL), and liver fibrosis indicators, such as laminin (LN), procollagen type Ⅲ (PC Ⅲ), collagen type Ⅳ (CⅣ), and hyaluronic acid (HA) before and after the treatment were compared between the two groups. The changes in portal vein diameter and spleen thickness scores, as well as drug safety were also compared. t test was used for the measurement data, and χ² test for the counting data. Results　The total clinical efficacy in the observation group was higher than that in the control group [92.00% (46/50) vs. 70.00% (35/50); χ²=7.862, P=0.005]. After the treatment, the levels of ALT, AST, and TBiL in the observation group were significantly lower than those in the control group [(90.35±35.52) U/L vs. (127.96±48.32) U/L, (62.27±30.28) U/L vs. (100.91±42.21) U/L, and (35.09±15.23) μmol/L vs. (51.15±20.57) μmol/L; t=4.435, 5.259, and 4.437; all P<0.05]; the ALB level in the observation group was significantly higher than that in the control group [(34.98±8.34) g/L vs. (28.33±6.35) g/L; t=4.486, P<0.05]. After the treatment, the levels of LN, PCⅢ, CⅣ, and HA in the observation group were significantly lower than those in the control group [(103.25±32.52) μg/L vs. (129.36±60.33) μg/L, (96.17±30.28) μg/L vs. (120.08±52.16) μg/L, (56.12±26.19) µg/L vs. (78.33±30.22) μg/L, and (155.42±72.71) μg/L vs. (194.34±100.29) μg/L; t=2.694, 2.803, 3.927, and 2.222; all P<0.05]. After the treatment, the portal vein diameter and spleen thickness of the observation group were significantly lower than those of the control group [(1.03±0.18) cm vs. (1.35±0.27) cm and (3.27±0.39) vs. (4.33±0.31); t=6.973 and 15.045, both P<0.05]. There was no statistical difference in the incidence of adverse reactions between the two groups. Conclusions　Entecavir combined with Fufang Biejia Ruangan tablets in the treatment of patients with HBeAg-positive decompensated cirrhosis is significantly effective, an can improve their liver fibrosis and control the disease progress. At the same time, the medication has a high safety profile and does not significantly increase adverse reactions.

Dose adjustment strategy of vancomycin in one patient with augmented renal clearance taking extracorporeal membrane pulmonary oxygenation support

Hou Jia, Zhang Min, Zhang Lina, Li Jinfeng

2023, 29(10):  1408-1412.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.017

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One patient with fulminant myocarditis was treated with extracorporeal membrane pulmonary oxygenation (ECMO) and was complicated with augmented renal clearance (ARC); the physician applied vancomycin (1 000 mg q12h) to prevent catheter-associated bloodstream infection; the clinical pharmacist measured the initial vancomycin concentration of 5.99 μg·ml^-1 and the ratio of the area under the serum drug concentration-time curve (AUC) to the minimum bacterial inhibitory concentration (MIC) 312, suggesting that it was lower than the bactericidal concentration. The literatures show that the principle of ECMO machine construction and the pathophysiological state of ARC both alter the pharmacokinetics of antimicrobial drugs, which in turn affects the blood concentration. The clinical pharmacist used the Stanford Vancomycin Calculator to simulate the pharmacokinetic parameters at steady state and speculated that the appropriate dosing regimen would be 1 000 mg q8h. After adjustment, the retest concentration increased to 18.39 μg·ml^-1, the AUC/MIC increased to 498, the vancomycin blood concentration reached the standard, and the patient's infection index decreased significantly.

Therapeutic effect of tofetib combined with methotrexate in treatment of rheumatoid arthritis

Li Huiying, Jiang Guoping, Lyu Yingchun

2023, 29(10):  1413-1416.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.018

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Objective　To explore the therapeutic effects of tofetib combined with methotrexate, recombinant human tumor necrosis factor receptor Ⅱ IgG Fc fusion protein for injection combined with methotrexate, and methotrexate in the treatment of rheumatoid arthritis (RA). Methods　Ninety RA patients treated in Jilin Provincial People's Hospital from January 2020 to January 2022 were divided into groups A, B, and C by the random number table method, with 30 cases in each group. In group A, there were 18 males and 12 females; they were (60.06±4.27)years old. In group B, there were 16 males and 14 females; they were (60.25±4.33) years old. In group C, there were 18 males and 12 females; they were (59.43±4.06) years old. Group A were treated with methotrexat, group B with tropinib and methotrexate, and group C with recombinant human tumor necrosis factor receptor Ⅱ IgG Fc fusion protein and methotrexate, for 24 consecutive weeks. The clinical efficacies, clinical symptoms and laboratory indicators before and after the treatment, and adverse reactions of the three groups were compared. χ², t, and F tests were applied. Results　The total effective rate of group B was 93.33% (28/30), higher than those of groups C [83.33% (25/30)] and A [66.67% (20/30)], with a statistical difference (P<0.05). The morning stiffness times, joint tenderness numbers, and joint swelling numbers 8 and 24 weeks after the treatment in group B were lower than those before the treatment, and were lower than those in groups C and A (all P<0.05). The levels of erythrocyte sedimentation rate (ESR), rheumatoid factors (RF), and C-reactive protein (CRP) 8 and 24 weeks after the treatment in group B were lower than those in groups C and A (all P<0.05). The incidence of adverse reactions in group B was 6.67% (2/30), which was lower than those in groups C [13.33% (4/30)] and A [20.00% (6/30)], with no statistical difference between the three groups (P>0.05). Conclusions　Tofatib combined with methotrexate in the treatment of patients with RA can effectively improve their clinical symptoms and inhibit the indicators of disease activity. The clinical efficacy is better than that of methotrexate alone and recombinant human tumor necrosis factor receptor Ⅱ IgG Fc fusion protein combined with methotrexate, and the safety is good.

Treatises

Value of serum procalcitonin, neutrophil-to-lymphocyte ratio, and pediatric early warning score in evaluation of prognosis in children with severe pneumonia 

Chen Qianqian, Liu Shunan

2023, 29(10):  1417-1420.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.019

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Objective　To investigate the clinical value of serum procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and pediatric early warning score (PEWS) in the evaluation of prognosis in children with severe pneumonia. Methods　The medical records of 87 children with severe pneumonia hospitalized in Department of Pediatrics, Daye People's Hospital from January 2018 to June 2022 were retrospective analyzed. The children were divided into a death group (22 cases) and a survival group (65 cases) according to whether they died 28 days after hospitalization. The gender, ages, lengths of stay, courses of disease, basic diseases, scores of Acute Physiology Andchronic Health Evaluation Scoring System (APACHE Ⅱ), PCT levels, PEWS, and NLR's of the two groups were compared. The influencing factors were analyzed by multivariate logistic regression. The evaluation value of the combined indicators was analyzed by receiver operating characteristic curve (ROC). χ² and t tests were applied. Results　There were statistical differences in APACHE Ⅱ score, PCT, PEWS, and NLR between the survival group and the death group (t=6.68, 5.93, 6.05, and 6.32; all P<0.05). The APACHE Ⅱ score ≥ 21.53, PCT level ≥3.42 μg/L, PEWS ≥ 2.24, and NLR ≥ 4.76 were risk factors affecting the children's prognosis (all P<0.05). The area under curve (AUC) of serum PCT and NLR combined with pediatric PEWS in the evaluation of the children's prognosis was significantly higher than that of each indicator (all P<0.05). Conclusion　The combination of serum PCT, NLR, and pediatric PEWS has a good clinical value in the evaluation of prognosis in children with severe pneumonia.

Clinical and pathological analysis of 35 children taking renal puncture

Yan Ran, Guo Chunna

2023, 29(10):  1421-1424.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.020

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Objective　To analyze the results of kidney puncture biopsies in 35 children and to understand their histopathological types. Methods　Thirty-five children admitted to Kaifeng Children's Hospital for percutaneous renal puncture biopsy from November 2019 to June 2022 were selected as the study objects, including 24 boys and 11 girls who were 1-18 (8.25±3.30) years old. Their pathology was examined by light microscopy, immunofluorescence, and electron microscopy, and their pathological types were analyzed. A questionnaire was conducted to understand the acceptance of renal puncture biopsy by the children and their guardians. Results The puncture success rate was 100.00%; there were 27 cases (77.14%) of primary glomerular disease, mainly IgA nephropathy, and 8 cases (22.86%) of secondary glomerular disease, mainly lupus nephritis. Primary glomerular disease occurred in 19 boys (70.37%) and 8 girls (29.63%); secondary glomerular disease occurred in 5 boys (62.50%) and 3 girls (37.50%); primary glomerular disease occurred in 17 cases (62.96%) during school age, and 6 cases (22.22%) during adolescent period; secondary glomerular disease occurred in 4 cases (50.00%) during adolescent period. In this study, 35 questionnaires were sent out; the children and guardians obtained information about the knowledge related to renal puncture biopsy from the medical staff [85.71% (30/35)]; most of the children were satisfied with the renal puncture biopsy [88.57% (31/35)]; the children had more concern about the renal puncture biopsy during the examination. Conclusions　The success rate of renal biopsy and acceptance were high in the 35 children; in which, primary glomerular diseases were mainly IgA nephropathy, which occurred mostly in school-age children; secondary glomerular diseases were mainly lupus nephritis, which occurred mostly during adolescent period; both primary and secondary glomerular diseases were higher in boys than in girls.

Clinical Research

Memory changes in patients with chronic obstructive pulmonary disease during 1 year follow-up

Xue Cui, Wu Ye, Li Ya

2023, 29(10):  1425-1430.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.021

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Objective　To explore the memory changes in patients with chronic obstructive pulmonary disease (COPD) during 1 year follow-up and the correlation of memory with lung function, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of CO₂ (PaCO₂), and haemoglobin (Hb). Methods　This was a prospective cohort study. The subjects were divided into a healthy control (HC) group and a COPD group. During the 1 year follow-up, the data of 72 cases in the HC group were collected; the data of 89 cases in the COPD group were collected. Both groups were tested for memory function at entry and at 1 year of followed-up using the Digit Span-Reversed Order (DS-RO) and the Chinese Auditory Verbal Learning Test (CAVLT). Pulmonary function was measured at the time of enrollment and at 1 year of follow-up, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and FEV₁/FVC. The PaCO₂, PaO₂, and Hb of the COPD patients were detected at the time of enrollment and at 1 year of follow-up. t, χ², and U tests were applied. Results　At the time of enrollment and at 1 year of follow-up, the scores of DS-RO [(6.21±0.94 vs. (6.54±1.08) and (6.02±0.91) vs. (6.44±1.06)] and CAVLT instantaneous recall [(8.12±1.23) vs. (8.58±1.46) and (7.86±1.18) vs. (8.43±1.43)] in the COPD group were lower than those in the HC group, with statistical differences (t=2.07, 2.70, 2.17, and 2.88; all P<0.05). The changes of DS-RO and CAVLT instantaneous recall between 1 year follow-up and enrollment were positively correlated with PaO₂ (r=0.480 and 0.362) and Hb (r=0.327 and 0.231). Conclusions　The differences between COPD patients and healthy adults in delayed memory and long term memory are small. COPD patients show a decrease in transient memory function. There are positive correlations of transient memory function with PaO₂ and Hb: the more significant the decrease in PaO₂ and Hb, the more severe the decrease in transient memory in COPD patients.

Clinical characteristics of patients with unipolar and bipolar depressions and effect analysis of drug combined with psychotherapy

Gao Lan, Wang Tingting, Cui Fuxin, Zhang Qingqing, Wang Xiangli

2023, 29(10):  1430-1434.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.022

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Objective To investigate the clinical characteristics of patients with unipolar and bipolar depressions and the clinical effect of drug combined psychotherapy. Methods　From January 2020 to January 2022, 46 patients with unipolar depression treated at Linyi Mental Health Center were selected as a unipolar depression group, and 46 patients with bipolar depression as a bipolar depression group. In the unipolar depression group, there were 20 males and 26 females; they were 14-43 (27.64±6.31) years old; they took 5-14 (8.31±3.21) years education. In the bipolar depression group, there were 19 males and 27 females; they were 15-44 (27.91±6.14) years old; they took 4-15 (8.65±3.07) years education. The unipolar depression group were treated with antidepressants and emotional stabilizers, and the bipolar depression group with mood stabilizer, antidepressant and sedative hypnotic drugs. Both groups were treated with drugs and psychological intervention. The clinical features, cognitive impairment, and Hamilton Depression Scale (HAMD) scores before and after drugs combined with psychological therapy were compared between the two groups. t and χ² tests were applied. Results　The proportions of the patients with family history of bipolar disorder, mood instability and scores of Hamilton Anxiety Scale and Life Events Scale (LES), and the age of first episode were 19.57% (9/46), 32.61% (15/46), (13.42±2.13), (42.32±4.58), and (25.41±3.78) years in the bipolar depression group, and were 2.17% (1/46), 13.04% (6/46), (7.73±1.24), (28.69±4.16), and (32.58±3.41) years in the unipolar depression group, with statistical differences (χ²=7.20 and 5.00; t=15.66, 14.94, and 9.55; all P<0.05). The numbers of errors, persistent errors, and random errors were higher, the numbers of correct reactions and completed classification were lower, and the TMT-A time was longer in the bipolar depression group than in the unipolar depression group [(19.63±2.54) times vs. (15.41±2.67) times, (13.76±2.71) times vs. (9.46±1.38) times, (7.12±1.68) times vs. (4.89±0.74) times, (28.63±3.26 times vs.(32.58±3.47) times, (2.45±0.34) times vs. (5.41±0.69) times, and (62.36±7.18) s vs. (48.69±5.24) s], with statistical differences (t=7.77, 9.90, 8.24, 5.63, 26.10, and 10.43; all P<0.05). Before the treatment, there was no statistical difference in the score of HAMD between the unipolar depression group and the bipolar depression group [(24.56±4.63) vs. (25.37±4.52)]. After medication combined with psychotherapy, the scores of HAMD in both groups decreased, and the score in the bipolar depression group was higher than that in the unipolar depression group [(12.54±1.32) vs. (8.23±1.74)], with a statistical difference (t=13.38, P<0.05). Conclusions There are obvious differences in clinical characteristics between patients with unipolar and bipolar depressions. The latter has high genetic tendency and early onset, and can be distinguished to a certain extent through questionnaire survey. Moreover, patients with bipolar depression have more serious cognitive impairment and are more difficult to treat, with relatively poor prognosis. Patients with unipolar and bipolar depressions should be clinically treated in different ways and intervened targetedly.

Jianpi Chushi Jiangzhuo Zhongyao Daichayin combined with needle-sleeve pot in treatment of simple obesity patients

Wang Yan, Fang Wei, Zhang Wenxi, Gan Wenxuan

2023, 29(10):  1435-1439.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.023

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Objective　To study the effects of Jianpi Chushi Jiangzhuo Zhongyao Daichayin combined with needle-sleeve pot in treatment of simple obesity patients on their insulin resistance and body composition. Methods　In this prospective study, 103 patients with simple obesity treated in Korla Hospital, Second Division, Xinjiang Production and Construction Corps and 30th Regiment Hospital, Second Division, Xinjiang Production and Construction Corps from January 2022 to July 2022 were randomly divided into a control group (51 cases) and an observation group (52 cases). There were 30 females and 21 males in the control group; they were 20-56 (38.46±5.69) years old. There were 30 females and 22 males in the observation group; they were 21-56 (39.16±5.93) years old. The control group were treated with orlistat, and the observation group with Jianpi Chushi Jiangzhuo Zhongyao Daichayin combined with needle-sleeve pot. The clinical efficacies, obesity indicators, insulin resistance, body composition, and adverse reactions were compared between the two groups. χ² and t tests were applied. Results　After the treatment, the body weight, body mass index (BMI), and waist circumference (WC) of the observation group were lower than those of the control group [(70.24±4.16) kg vs. (75.32±4.21) kg, (26.39±2.15) kg/m² vs. (28.45±2.33) kg/m², and (93.42±2.53) cm vs. (96.02±2.75) cm], with statistical differences (t=6.16, 4.67, and 5.00; all P<0.05). After the treatment, the percentage of body fat and area of visceral fat in the observation group were lower than those in the control group [(34.11±1.87)% vs. (36.13±2.12)% and (122.64±3.24) cm² vs. (126.54±3.22) cm²], with statistical differences (t=5.13 and 6.13; both P<0.05). After the treatment, the basal metabolic rate of the observation group was higher than that of the control group [(1 523.43±121.35) kcal vs. (1 461.32±132.43) kcal], with a statistical difference (t=2.48, P<0.05). After the treatment, the fasting insulin (FINS) level and insulin resistance index (Homa-IR) in the observation group were lower than those in the control group [(20.21±2.54) mU/L vs. (27.32±2.21) mU/L and (2.28±0.41) vs. (3.41±0.43)], with statistical differences (t=15.14 and 13.65; both P<0.05). The effective rate of the observation group was higher than that of the control group [92.31% (48/52) vs. 74.51% (38/51)], with a statistical difference (χ²=4.70, P<0.05). Conclusion　Jianpi Chushi Jiangzhuo Zhongyao Daichayin combined with needle sleeve pot in the treatment of simple obesity patients is effective, can reduce their obesity and improve insulin resistance, and has high safety.

Clinical value of patch test in diagnosis of dermatitis and eczema

Gao Donghao, Xu Duanni, Yu Yong, Lu Yanjun

2023, 29(10):  1440-1445.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.024

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Objective　To investigate the role of 20 allergens (cobalt chloride, etc.) in the disease process of dermatitis and eczema, and to evaluate the value of testing these allergens in the diagnosis and treatment. Methods　A total of 248 patients with dermatitis or eczema who were treated in Guangzhou Institute of Dermatology from 2016 to 2020 and had basically complete clinical diagnosis and treatment data were selected as the analysis objects. Among them, there were 144 patients with dermatitis, including 17 males and 127 females who were 4-75 years old, and 95 patients with eczema, including 27 males and 68 females who were 2-78 years old. The 72 h observation results of 20 kinds of allergen patch tests, such as cobalt chloride, hydrophobic compounds, imidazolyl urea, p-phenylenediamine, N-cyclohexyl thiophthalide lactone, and Quartet 15, were retrospectively analyzed. χ² test was applied. Results　The allergen positive rates of nickel sulfate, cobalt chloride, and aromatic mixture I were the top three, and were 29.17% (42/144), 19.44% (28/144), and 9.72% (14/144) in the 144 patients with dermatitis and were 21.05% (20/95), 16.84% (16/95), and 11.58% (11/95) in the 95 patients with eczema, respectively. In the patients with dermatitis, the ratio of male to female was 1.00∶7.47, and the positive rates of all allergens were 47.06% (8/17) and 66.93% (85/127), respectively; the ratio of adolescents to young adults to middle-aged adults to the elderly was 1.00∶23.00∶3.80∶1.00, and the positive rates of all allergens were 20.00% (1/5), 66.09% (76/115), 57.89% (11/19), and 100.00% (5/5), respectively, with a statistical difference (χ²=9.02, P<0.05); the positive rates of one, two, and three or more kinds of allergens were 29.17% (42/144), 19.44% (28/144), and 15.97%(23/144), respectively, with a statistical difference (χ²=7.98, P<0.05). In the patients with eczema, the ratio of male to female was 1.00:2.52, and the positive rates of all allergens were 51.85%(14/27) and 64.71%(44/68) respectively; the ratio of adolescents to young adults to middle-aged adults to the elderly was 1.00:14.25:5.75:2.75, and the positive rates of all allergens were 25.00% (1/4), 63.16%(36/57), 52.17% (12/23), and 81.82% (9/11), respectively; the positive rates of one, two, and three or more kinds of allergens were 36.84% (35/95), 8.42% (8/95), and 15.79% (15/95), respectively, with a statistical difference (χ²=25.50, P<0.05). Conclusions　Nickel sulfate, cobalt chloride, and aromatic mixture I are the high-risk causes of dermatitis and eczema. However, for all allergens, there are different characteristics of variability between allergen positive detection rates in different gender, age, and quantities, so the application of patch test for allergens is helpful for diagnosis and differential diagnosis.

Case Report

A case of rhabdomyolysis with right lower limb weakness secondary to severe hypokalemia

Hu Xiaoping, Lei Yingying, Li Rui

2023, 29(10):  1446-1448.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.025

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A case of rhabdomyolysis due to hypokalemia with weakness in the right lower limb was reported. On November 2, 2022, due to "sudden right lower limb weakness for 3 hours and 12 minutes", the patient was admitted by Second Hospital, Guizhou University of Traditional Chinese Medicine as "acute stage of cerebral infarction?". The physical examination on admission showed the right lower limb muscle strength level Ⅲ, slightly decreased shallow sensation of the right lower limb, and right Babinski sign (±). He had a history of hypertension and regularly took irbesartan hydrochlorothiazide tablets. During the hospitalization,the patient had intractable hypokalemia. After the third day, the patient gradually developed weakness in both lower limbs and brown urine, and the highest creatine kinase (CK) level was 6 955 U/L; he was confirmed as rhabdomyolysis caused by hypokalemia. The CK, K⁺, and clinical symptoms returned to normal after massive potassium supplementation, and the patient was discharged.

Nursing Research

Effect of enhanced recovery after surgery combined with psychological nursing intervention for patients undergoing urological surgery

Zhang Huan, Li Yali, Huang Yuqi

2023, 29(10):  1449-1453.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.026

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Objective　To study the effect of enhanced recovery after surgery (ERAS) combined with psychological nursing intervention for patients undergoing urological surgery. Methods　Four hundred patients who underwent urological surgery in First Hospital, Henan University of Science and Technology from May 2019 to April 2022 were selected for the random ized control led trial. They were divided into a control group and an observation group by the random envelop method, with 200 cases in each group. There were 129 males and 71 females in the control group; they were 28-59 (44.26±5.34) years old. There were 125 males and 75 females in the observation group; they were 25-59 (43.89±5.06) years old. The control group received routine nursing; in addition, the observation group received ERAS and psychological nursing. The pain degrees [Visual Analogue Scale (VAS)], self-efficacies [General Self-Efficacy Scale (GSES)], postoperative recovery indicators, incidences of complications, and quality of life [Generic Quality of Life Inventory 74 (GQOL-74)] were compared between the two groups. t and χ² tests were applied. Results　The scores of VAS 1, 3, and 5 days after the operation of the observation group were lower than those of the control group [(4.84±0.58) vs. (5.46±0.64), (3.95±0.49) vs. (4.73±0.53), and (1.64±0.35) vs. (2.26±0.38)], with statistical differences (t=10.15, 15.28, and 16.97; all P<0.05). The first exhaustion time, recovery time of bowel sounds, first eating time, and hospitalization time in the observation group were shorter than those in the control group [(16.35±3.24) h vs. (22.54±4.36) h, (15.02±2.37) h vs. (20.76±3.15) h, (6.68±1.28) h vs. (12.46±2.49) h, and (6.38±0.59) d vs. (7.54±0.84) d], with statistical differences (t=16.12, 20.59, 29.20, and 15.98; all P<0.05). Five days after the operation, the scores of GSES and GQOL-74 in the observation group were higher than those in the control group [(34.16±2.58) vs. (29.16±2.74) and (89.65±4.36) vs. (82.44±4.52)], with statistical differences (t=18.79 and 16.24; both P<0.05). The incidence of complications in the observation group was lower than that in the control group [4.00% (8/200) vs. 9.00% (18/200)], with a statistical difference (χ²=4.11, P<0.05). Conclusion　ERAS combined with psychological nursing for patients undergoing urological surgery can improve their self-efficacy, prevent postoperative complications, reduce postoperative pain, promote postoperative rehabilitation, and improve their quality of life.

Application of traditional Chinese medicine characteristic nursing combined with continuous health guidance in patients with early diabetic kidney disease and deficiency of both qi and yin

Geng Jingjing, Ren Lili, Li Xinrui

2023, 29(10):  1454-1458.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.027

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Objective　To explore the effect of traditional Chinese medicine characteristic nursing combined with continuous health guidance for patients with early diabetic nephropathy (DKD) and deficiency of both qi and yin. Methods　This was a prospective study. From January 2020 to February 2022, 108 patients with early DKD and deficiency of both qi and yin were selected from Zhoukou Traditional Chinese Medicine Hospital. They were divided into a control group and an observation group according to the admission order, with 54 cases in each group. There were 29 males and 25 females in the control group; they were 41-68 (52.36±4.36) years old. There were 31 males and 23 females in the observation group; they were 42-68 (52.44±4.17) years old. The control group were routinely cared; in addition, the observation group took traditional Chinese medicine characteristic nursing and continuous health guidance. The levels of 24 h urine protein, fasting blood glucose (FPG), and creatinine (Scr), health knowledge, scores of Self-rating Anxiety Scale (SAS), Comprehensive Quality of Life Questionary-74 (GQOL-74), and Self-rating Depression Scale (SDS), and satisfaction were compared between the two groups. t and χ² tests were applied. Results　After the intervention, the FPG level in the observation group was lower than that in the control group [(5.31±0.92) mmol/L vs. (5.87±0.83) mmol/L], with a statistical difference (t=3.321, P=0.001). After the intervention, the Scr and 24 h urine protein levels in the observation group were lower than those in the control group [(83.59±6.77) µ mol/L vs. (96.81±6.73) µ mol/L and (1.64±0.13) g vs. (1.85±0.11) g], with statistical differences (t=10.177 and 9.062, both P<0.001). After the intervention, the mastery of health knowledge in the observation group was higher than that in the control group [94.44% (51/54) vs. 77.78% (42/54)], with a statistical difference (χ²=6.27, P<0.05). After the intervention, the scores of SAS and SDS in the observation group were lower than those in the control group [(36.81±4.55) vs. (43.15±5.28) and (33.85±4.28) vs. (42.97±5.26)], with statistical differences (t=6.684 and 9.883, both P<0.001). After the intervention, the GQOL-74 score in the observation group was higher than that in the control group [(82.67±4.98) vs. (72.69±6.18)], with a statistical difference (t=9.240, P<0.001). The satisfaction of the observation group was higher than that of the control group [98.15% (53/54) vs. 81.48% (44/54)], with a statistical difference (χ²=8.20, P<0.05). Conclusion　Traditional Chinese medicine characteristic nursing combined with continuous health guidance for patients with early DKD and deficiency of both qi and yin can improve their disease indicators, knowledge mastery, mental health, quality of life, and satisfaction.

Application of six thinking hats thinking mode in nursing at support center

Cheng Yuanzhen, Xiang Lin

2023, 29(10):  1459-1462.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.028

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Objective　To explore the application effect of the six thinking hats thinking mode in nursing at support center. Methods　Three hundred and seventy-six patients admitted to Support Center, Hubei Third People's Hospital Affiliated to Jianghan University from January 2020 to February 2022 were selected as the research objects. They were divided into a control group (186 cases) and an observation group (190 cases) by the random number table method. In the control group, there were 101 males and 85 females; they were (45.26±4.96) years old; 56 patients had junior high school or lower diplomas, 80 high-school diplomas, and 50 junior college or higher diplomas. In the observation group, there were 110 males and 80 females; they were (45.61±4.85) years old; 60 patients had junior high school or lower diplomas, 75 high-school diplomas, and 55 junior college or higher diplomas. The control group received routine nursing. The observation received six thinking hats thinking mode of nursing. The success rates of auxiliary examination, compliance rates, the incidences of adverse events, and nursing satisfaction were compared between the two groups. The count data and measurement data were processed by χ² and t test. Results　The success rate and compliance rate of auxiliary examination in the observation group were higher than those in the control group [90.53% (172/190) vs. 80.65% (150/186) and 94.74% (180/190) vs. 76.34% (142/186)], with statistical differences (both P<0.05). The incidence of adverse nursing events in the observation group was significantly lower than that in control group [2.64% (5/190) vs. 8.06% (15/186)], and nursing satisfaction rate was higher than that in control group [92.11% (175/190) vs. 78.49% (146/186)], with statistical differences (both P<0.05). Conclusion　The application of six thinking hats thinking mode in nursing at support center can improve the success rate and compliance rate of auxiliary examination, reduce adverse events, and improve nursing satisfaction.

Nursing interns' medical narrative ability and its influencing factors

Xu Fengmin, Feng Shushuang, Wei Ruihong, Lu Junhong

2023, 29(10):  1463-1467.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.029

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Objective　To investigate the current situation of medical narrative ability of nursing interns, to explore its influencing factors, and to provide evidences for making educational program to improve the medical narrative ability of nursing interns. Methods　From October to December 2021, a total of 144 nursing interns who were 16-25 years old were selected from First Hospital, Medical College, Shantou University, Second Hospital, Medical College, Shantou University, and Guangzhou Red Cross Hospital as the research objects by the convenient sampling method. The medical Narrative Ability Scale (NCS) was used to investigate the nursing interns, and the influencing factors were analyzed. χ² test, t test, and analysis of variance were applied. The multilinear regression analysis was used for the multivariate analysis. Results　The nursing interns' score of medical narrative ability of was (140.50±19.19). The scores of attentive listening, reflective representation, and understanding response were (5.27±0.75), (5.21±0.78), (5.15±0.83). The scores of medical narrative ability of the nursing interns with recognition of nursing industry, familiarity with medical narrative ability, and care for friends had statistical significance (P<0.05). Multilinear regression analysis showed that the recognition degree of nursing industry, the familiarity degree of medical narrative ability, and the care degree of friends were the main factors affecting their medical narrative ability. Conclusions　The medical narrative ability of nursing interns is at a low level, so nursing interns' vocational identity education and school education of narrative nursing should be strengthened.

Application of nursing intervention of empowerment mode of family-center care in rectal cancer patients taking enterostomy after Miles' operation

Sun Jinke, Guo Jiawei, Yang Li

2023, 29(10):  1468-1473.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.030

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Objective　To explore the effect of nursing intervention of empowerment mode of family-center care (FCC) for patients taking enterostomy after radical resection of colorectal cancer (Miles' operation). Methods　From June 2020 to June 2022, 80 patients with rectal cancer who underwent enterostomy after Miles' operation in First Hospital, Henan University of Science and Technology were selected for the prospectively study, and were divided into a control group and an observation group according to the admission order, with 40 case in each group. The control group had 21 males and 19 females who were 43-75 (57.98±5.69) years old, and received routine nursing care. The observation group had 23 males and 17 females who were 42-76 (58.19±6.04) years old, and were given routine nursing care and FCC empowerment mode intervention. The compliances, scores of Readiness for Hospital Discharge Scale (RHDS), Self-rating Anxiety Scale (SAS), Self-Care Ability Scale for the Elderly (ESCA), and Quality of Life C-30 (QLQ-C30), and satisfaction of the two groups were compared. t and χ² tests were applied. Results　The compliance of the observation group was higher than that of the control group [95.00% (38/40) vs. 75.00% (30/40)], with a statistical difference (χ²=6.28, P<0.05). After the nursing, the scores of ESCA and SAS in the observation group were better than those in the control group [(98.45±5.26) vs. (86.46±6.28) and (41.69±4.58) vs. (46.82±4.68)], with statistical differences (t=9.26 and 4.96; both P<0.05). After the nursing, the scores of role, body, cognition, social function, emotion, and overall health of QLQ-C30 in the observation group were higher than those in the control group [(73.45±5.25) vs. (67.14±4.38), (75.68±5.82) vs. (68.49±5.91), (82.94±6.33) vs. (73.58±5.69), (81.68±4.68) vs. (72.68±5.74), (89.45±5.21) vs. (74.54±6.88), and (77.94±5.28) vs. (72.69±8.26)], with statistical differences (t=5.84, 5.48, 6.96, 7.66, 10.93, and 3.39; all P<0.05). After the nursing, the scores of personal status, expectant support, and adaptability and total score of RHDS in the observation group were higher than those in the control group [(25.47±1.05) vs. (21.45±2.38), (42.51±2.45) vs. (38.94±3.15), (33.67±0.89) vs. (30.67±2.82), and (101.65±2.36) vs. (91.06±4.53)], with statistical differences (t=9.77, 5.66, 6.42, and 13.11; all P<0.05). The satisfaction of the observation group was higher than that of the control group [97.50% (39/40) vs. 80.00% (32/40)], with a statistical difference (χ²=4.51, P<0.05). Conclusion The nursing intervention of FCC empowering mode can promote the completion of the patients' discharge preparation, compliance after discharge, and quality of life, increase their self-care ability, reduce their negative emotions, and deepen their recognition of nursing work.

Practice of combining "PAD class + workshop" with traditional Chinese medicine cultural literacy in clinical teaching

Wan Biyu, Peng Lu, Li Hanzhan, Huang Qiuyuan, Tang Fang, Lin Pinli, Deng Lili

2023, 29(10):  1473-1476.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.031

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In order to effectively connect clinical nursing with clinic, to command traditional Chinese medicine technology, and to improve the learning effect, we will carry out the teaching activities through "PAD (presentation, assimilation, and discussion) class + workshop" taking the moxibustion method as an example and focus on training clinical practice nursing students' clinical thinking and basic operation skills, so as to achieve the purpose of teaching and learning. At the same time, it is required that teachers should enhance the subject consciousness of traditional Chinese medicine cultural literacy in the process of imparting knowledge and technology, and guide nursing students in the new era to establish a good career conception and values.

Application of WeChat public account one-stop service in outpatients

Liu Yanfen, Li Minhua, Zhang Tianmin

2023, 29(10):  1476-1480.  DOI: 10.3760/cma.j.issn.1007-1245.2023.10.032

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Objective　To explore the influence of WeChat public account one-stop service on outpatient waiting time and the incidence of complaints. Methods　A total of 310 outpatients in Henan Provincial People's Hospital from October 2020 to October 2021 were selected, and were divided into a control group and an observation group according to the treatment order, with 155 cases in each group. In the control group, there were 82 males and 73 females; they were 20-65 (41.98±7.69) years old; there were 59 cases from Department of Internal Medicine, 38 from Department of Obstetrics and Gynecology, 29 from Department of Dermatology, 17 from Department of Orthopedics, and 12 from Reproductive Department. In the observation group, there were 79 males and 76 females; they were 21-65 (43.95±8.26) years old; there were 61 cases from Department of Internal Medicine, 36 from Department of Obstetrics and Gynecology, 24 from Department of Dermatology, 19 from Department of Orthopedics, and 15 from Reproductive Department. The control group received on-site medical treatment, and the observation group WeChat public account one-stop service. The treatment times, treatment satisfaction, incidences of complaints, and scores of Self-rating Anxiety Scale (SAS) were compared between the two groups. t test was used for the measurement data, and χ² test for the enumeration data. Results　The registration time, payment time, waiting time, report time, and medicine collection time of the observation group were all shorter than those of the control group [(1.38±0.42) min vs. (12.24±3.14) min, (2.05±0.37) min vs. (26.35±3.28) min) min, (11.63±2.08) min vs. (46.35±12.06) min, (6.38±1.82) min vs. (27.39±3.18) min, and (10.36±2.39) min vs. (19.38±6.37) min], with statistical differences (t=42.679, 91.654, 35.321, 71.390, and 16.506; all P<0.001). The satisfaction of the observation group was higher than that of the control group [98.71% (153/155) vs. 89.03% (138/155)], with a statistical difference (χ²=12.615, P<0.001). The incidence of complaints in the observation group was lower than that in the control group [1.29% (2/155) vs. 9.03% (14/155)], with a statistical difference (χ²=9.490, P=0.002). After the nursing, the SAS score of the observation group was lower than that of the control group [(16.28±1.25) vs. (51.26±3.42)], with a statistical difference (t=119.600, P<0.001). Conclusion　The WeChat public account one-stop service can shorten the consultation time, relieve patient anxiety, reduce complaints, and improve patient satisfaction.