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    01 May 2023, Volume 29 Issue 9
    Special Column of Psoriasis Research

    Clinical application of biologics in psoriasis

    Wen Shiyu, Wen Ju, Feng Yingjun, Li Mujin, Qin Si
    2023, 29(9):  1185-1188.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.001
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    Advances on pathogenesis of psoriasis complicated with metabolic diseases

    Xie Shenghua, Wu Xuemei, Zhang Yujie
    2023, 29(9):  1189-1192.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.002
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    Psoriasis is a common immune-mediated chronic inflammatory skin disease, and its pathogenesis is related to genetic, immune, infectious, environmental, and other factors. In recent years, the incidence of psoriasis complicated with metabolic diseases has increased significantly. A large number of domestic and foreign studies have shown that there may be common pathogenesis between psoriasis and metabolic diseases, especially involving inflammatory factors, adipokines, and susceptibility genes. A thorough understanding of pathogenesis of psoriasis complicated with metabolic diseases is of great significance for the treatment of psoriasis and the prevention of its complications.

    New Medical Advances

    Research progress on ferroptosis in diabetic kidney disease

    Cai Rongdan, Liu Jianshuai, Feng Junxia, Zhang Yunfang, Liu Yunqi, Wang Yaning
    2023, 29(9):  1193-1197.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.003
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    Ferroptosis, a newly discovered non-apoptotic iron-dependent cell death pattern, plays an essential role in the development of acute kidney injury, tumors, liver disease, Parkinson's disease, and other diseases. More recently, it has been shown that ferroptosis is also involved in the development of diabetic kidney disease (DKD). In this paper, we review the mechanism of ferroptosis and its progress in DKD to provide a basis for the regulation using ferroptosis.

    Research progress on clinical treatment and innovative therapy of osteosarcoma

    Zhan Zeyu, Lin Sien, Wei Bo
    2023, 29(9):  1197-1200..  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.004
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    Osteosarcoma (OS) is a highly malignant tumor occurring in bone tissue with a high tendency to metastasize, the underlying mechanism of which is still largely unknown. Clinical treatment of OS has a poor prognosis, and improving the survival rate in patients with OS remains a challenge. In recent years, with the development of molecular biology and tissue bioengineering, treatment methods have also made rapid progress, especially in the aspect of comprehensive limb salvage therapy, which significantly improves the postoperative quality of life and 5-year survival rate in patients with malignant tumors. This article reviews the surgical method, chemotherapy, and immunotherapy of OS, to provide reference for the current clinical treatment of OS.

    Progress of chondroitin polymerization factor in breast cancer

    Hou Changran, Jiang Jingru, Hua Yitong
    2023, 29(9):  1201-1204.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.005
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    Breast cancer is the most common cancer in women worldwide and has become a global health problem. Researches in the latest field of oncology have revealed the potential role of chondroitin polymerization factor (CHPF) in the various biological behaviors of breast cancer. CHPF is a type II transmembrane protein, an enzyme involved in the extension of chondroitin sulfate, and a new key molecule with poor prognosis in many cancers. At present, the mechanism of CHPF in genesis and development of breast cancer has become a research hotspot. In the future, deeply exploring the role of CHPF and its molecular mechanism in breast cancer can provide new ideas for the prevention and treatment and targeted treatment of breast cancer. This paper provides an overview of CHPF and its role in various malignancies, focusing on the biological function of CHPF in breast cancer, which is expected to provide new therapeutic targets for anti-tumor drug research and provide new ideas for tumor treatment.

    Research progress of integrated traditional Chinese and Western medicine in the treatment of postpartum myofascial pelvic pain

    Liu Yujiao, Wang Chao, Liu Fei
    2023, 29(9):  1204-1207.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.006
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    Meta Analysis

    Safety and efficacy of anticoagulation with low-molecular-weight heparin in patients with intracerebral hemorrhage: a meta-analysis

    Xu Yucheng, Yuan Lijuan, Fu Xiaoyu, Mao Liantao, Zhang Zhiqiang
    2023, 29(9):  1208-1213.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.007
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    Objective To evaluate the safety and efficacy of anticoagulation with low molecular weight heparin in patients with intracerebral hemorrhage (ICH). Methods Clinical trials related to anticoagulation with low molecular weight heparin in patients with ICH were collected by searching PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang databases. The deadline of retrieval period was October 16, 2022. After judging the heterogeneity by χ2 test, a meta-analysis was performed on the collected clinical trials using RevMan 5.4. Results The meta-analysis results showed that there was no statistically significant difference in the incidence of rebleeding between the patients with ICH treated with low molecular weight heparin and the control group [RR=0.97 (0.55, 1.73)], the risk of deep vein thrombosis (DVT) was significantly reduced compared with that in the control group [RR=0.22 (0.14, 0.33)], and the risk of pulmonary embolism (PE) was also significantly reduced compared with that in the control group [RR=0.24 (0.08, 0.68)]. Conclusion It is safe and effective to use low-molecular-weight heparin in the prevention of thrombosis in patients with ICH.

    Scientific Research

    Detection and analysis of CYP2C19*2/*3/*17 allele in 318 patients with suspected invasive fungal infection to be treated with voriconazole in Guangzhou

    Yang Jianliang, Su Duohua, Li Xiang, Zhou Xiaowen, Zhi Jialing, Xing Zhenjian, Zhong Honglan
    2023, 29(9):  1214-1217.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.008
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    Objective To understand the polymorphisms of CYP2C19*2/*3/*17 alleles 9154G>A, 7948G>A, and 806C>T in Guangzhou population, and to provide reference for the clinical application of voriconazole in the treatment of invasive fungal infections. Methods A total of 318 patients with suspected invasive fungal infection who were scheduled to be treated with voriconazole and were tested for CYP2C19*2/*3/*17 allele in Guangzhou Chest Hospital from January 2022 to February 2023 were selected for analysis, including 249 males and 69 females, aged 19-94 years (with a mean age of 58 years old). The polymorphism of CYP2C19*2 (9154G>A), CYP2C19*3 (7948G>A), and CYP2C19*17 (806C>T) in the patients was detected by digital fluorescence molecular hybridization sequencing. The distribution frequencies of genotypes and haplotypes in patients with fast, medium, and slow voriconazole metabolism types were analyzed. Results GG, AG, and AA genotypes were detected on the CYP2C19*2 (9154G>A) locus, with the distribution frequencies of 47.80% (152/318), 42.45% (135/318), and 9.75% (31/318), respectively. GG, GA, and AA genotypes were detected on the CYP2C19*3 (7948G>A) locus, with the distribution frequencies of 90.88% (289/318), 8.81% (28/318), and 0.31% (1/318), respectively. CC and CT genotypes were detected on the CYP2C19*17 (806C>T) locus, with the distribution frequencies of 99.37% (316/318) and 0.63% (2/318), respectively. In the 318 patients to be treated with voriconazole, there were 135 (42.45%), 140 (44.03%), and 43 (13.52%) patients with fast, medium, and slow voriconazole metabolism types, respectively. The haplotypes of the 3 gene loci were 2 fast metabolism haplotypes of GG-GG-GC and GG-GG-CT, with the distribution frequencies of 99.26% (134/135) and 0.74% (1/135), 3 medium metabolism haplotypes of AG-GG-CC, GG-GA-CC, and AG-GG-CT, with the distribution frequencies of 87.86% (123/140), 11.43% (16/140), and 0.71% (1/140), and 4 medium metabolism haplotypes of AA-GG-CC, AG-GA-CC, AA-GA-CC, and GG-AA-CC, with the distribution frequencies of 69.77% (30/43), 25.58% (11/43), 2.33% (1/43), and 2.33% (1/43). Conclusions From the genetic background of CYP2C19 gene, although most people in Guangzhou are fast and medium voriconazole metabolism types, slow voriconazole metabolism type account for a certain proportion. Therefore, the attention should be paid to the detection of its gene polymorphism in clinical diagnosis and treatment, so as to guide the reasonable clinical application of voriconazole.

    Effect of transanal endoscopic microsurgery and traditional laparotomy on patients with rectal cancer

    Peng Jianliang, Sun Yongan, Yang Jiafu, Yuan Zhilu, Zhang Zhongbao, Liang Benjia, Zhang Zhimin
    2023, 29(9):  1218-1222.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.009
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    Objective To investigate the effects of transanal endoscopic microsurgery (TEM) and traditional laparotomy on the postoperative recovery of gastrointestinal function in patients with rectal cancer. Methods It was a randomized controlled trial. A total of 80 patients with rectal cancer treated in The Third People's Hospital of Liaocheng from May 2019 to May 2022 were selected as research objects and were randomly divided into an observation group and a control group, with 40 cases in each group. In the observation group, there were 26 males and 14 females, aged (49.25±7.63) years; in the control group, there were 24 males and 16 females, aged (50.63±7.24) years. The observation group received TEM, and the control group received traditional laparotomy. The surgery related indexes, levels of gastrointestinal hormones (motilin and gastrin) before and after surgery, postoperative gastrointestinal function recovery, anal function before and after surgery, and incidences of complications were compared between the two groups. Independent sample t test, paired t test, and χ2 test were used for statistical analysis. Results The operation time [(60.57±11.29) min vs. (143.35±32.54) min], blood loss [(62.93±15.43) ml vs. (137.69±36.47) ml], and hospital stay [(7.45±1.26) d vs. (12.37±3.13) d] in the observation group were all better than those in the control group (all P<0.001), but there were no statistically significant differences in the number of lymph nodes dissected and length of specimens between the two groups (both P>0.05). The motilin and gastrin levels in both groups after surgery were lower than those before surgery (all P<0.05); the levels of motilin [(253.16±30.57) ng/L vs. (219.25±29.52) ng/L] and gastrin [(141.24±11.17) µmol/L vs. (103.65±10.43) µmol/L] in the observation group were higher than those in the control group (both P<0.001). The recovery of gastrointestinal function in the observation group was better than that in the control group (P<0.001). After surgery, the Wexner scores of fecal incontinence severity of the two groups were higher than those before surgery, the anal canal resting pressure (ARP) and anal canal maximum systolic pressure (MSP) were lower than those before surgery, with statistically significant differences (all P<0.05). The Wexner score of the observation group was lower than that of the control group [(7.23±1.56) points vs. (9.58±1.94) points, t=5.970, P<0.001], and there were no statistically significant differences in the levels of ARP and MSP between the two groups (both P>0.05). The total incidence of complications in the observation group was lower than that in the control group [5.00% (2/40) vs. 20.00% (8/40)], with a statistically significant difference between the two groups (χ2=4.114, P=0.043). Conclusion Both TEM and traditional laparotomy can effectively treat rectal cancer, among which TEM has little effect on gastrointestinal hormone levels, is more conducive to shorten the recovery time and further promote the recovery of gastrointestinal function and anal function, and has a lower incidence of postoperative complications and high clinical application value.

    Comparison of down regulation protocol and GnRH antagonist protocol in women with diminished ovarian reserve aged more than 40 years

    Li Hui, Guo Yanxia, Sun Xinhui, Guo Hongmin, Hou Dongsheng
    2023, 29(9):  1223-1227.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.010
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    Objective To compare the effects of using down regulation protocol and gonadotropin-releasing hormone (GnRH) antagonist protocol in women with diminished ovarian reserve aged more than 40 years during in vitro fertilization-embryo transfer (IVF-ET). Methods The clinical data of patients with diminished ovarian reserve aged more than 40 years undergoing in vitro fertilization/intracytoplasmic sperm injection - embryo transfer in Department of Reproductive Medicine, Liaocheng People's Hospital from January 2017 to May 2021 were retrospectively analyzed. A total of 142 women with 151 cycles were collected according to the inclusion criteria, and were divided into two groups according to the controlled ovulation induction protocols: a down regulation group (29 women with 31 cycles) and a GnRH antagonist group (113 women with 120 cycles). The general data, clinical treatment, laboratory data, outcomes of clinical assisted pregnancy outcomes were compared between the two groups. Independent sample t test, Wilcoxon rank sum test, Fisher exact probability method, and χ2 test were used for statistical analysis. Results There were no statistically significant differences in the age, infertility years, body mass index, basal follicle stimulating hormone (FSH), basal estradiol (E2), anti-Mullerian hormone, and antral follicle count between the two groups (t=1.204, -1.634, 0.741, -0.643, 1.491, 1.868, and 1.270; all P>0.05). The number of Gn days [(10.16±2.85) d vs. [8.60±2.79) d], blastocyst formation rate [77.78% (14/18) vs. 39.47% (15/38)], and high quality blastocyst formation rate [50.00% (9/18) vs. 13.16% (5/38)] of the down-regulation group were higher than those of the GnRH antagonist group, with statistically significant differences (t=2.722, χ2=7.177 and 8.842; all P<0.05). There were no statistically significant differences in the fertilization rate, 2PN rate, and high-quality embryo rate between the two groups (χ2=0.018, 0.662, and 2.375; all P>0.05). The clinical pregnancy rate [22.73% (5/22) vs. 11.11% (3/27)] and live birth rate [13.64% (3/22) vs. 3.70% (1/27)] of the down-regulation group were higher than those of the GnRH antagonist group, and the abortion rate of the down-regulation group was lower than that of the GnRH antagonist group [40.00% (2/5) vs. 75.00% (2/3)], but there were no statistically significant differences (all P>0.05). Conclusion For patients with diminished ovarian reserve aged more than 40 years, the down regulation protocol has a trend to increase the clinical pregnancy rate and reduce the abortion rate.

    Effects of alfentanil and nalbuphine combined with propofol in patients undergoing oocyte retrieval in reproductive center

    Chen Fangwei, Tuo Peng, Jie Yingxi, Wang Shouping
    2023, 29(9):  1228-1234.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.011
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    Objective To compare the safety and efficacies of different doses of alfentanil combined with propofol in patients undergoing oocyte retrieval under general anesthesia in reproductive center. Methods It was a randomized double-blind controlled trial. From June 2021 to December 2021, a total of 200 patients who underwent oocyte retrieval under general anesthesia in Department of Anesthesiology, The Third Affiliated Hospital of Guangzhou Medical University, aged 22-40 years, with American Society of Anesthesiologists (ASA) grade I, were randomly divided into 4 groups with 50 cases in each group: the control group (group C), nalbuphine group (group N), alfentanil group 1 (group A1), and alfentanil group 2 (group A2). Group N was intravenously injected with 0.1 mg/kg of nalbuphine 5 min before surgery, group A1 was intravenously injected with 5 µg/kg of afentanil and group A2 with 10 µg/kg of afentanil 3 min before surgery, diluted to 20 ml in all the 3 groups, and group C was given the equivalent volume of normal saline. All patients in the 4 groups were given 4.48 mg of tropisetron intravenously, 2 mg/kg of propofol intravenously before ovarian puncture, and 0.5 mg/kg of propofol was added if body movement occurred during surgery. At time of entering the room (T0), 1 min after intravenous injection of alfentanil or nalbuphine (T1), after induction of anesthesia (T2), during procedure (T3), at recovery (T4), 5 min after surgery (T5), and 30 min after surgery (T6), the 4 groups were recorded for changes in heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2). The propofol use, operation time, recovery time, discharge time, intraoperative body movement, and Visual Analogue Scale (VAS) scores and Ramsay sedation scores from T4 to T6 were compared among the 4 groups. The patients were followed up for adverse reactions such as abdominal pain, nausea and vomiting, drowsiness, dizziness, and skin itching on the day after surgery, and the physical mobility was observed. One-way analysis of variance, Kruskal-Wallis test, Mann-Whitney test, and χ2 test were used for statistical analysis. Results There were no statistically significant differences in the HR and SpO2 among the 4 groups at each time point (all P>0.05), and no patients in the 4 groups had SpO2 below 0.90. The recovery time of group A1 and A2 were shorter than those of group C and N, and the numbers of body movement were lower than those of group C and N (all P<0.05). The propofol use in group C was higher than those in the other 3 groups (all P<0.05). At T3, the MAP in group C was lower than those in the other 3 groups (all P<0.05). The VAS scores of group A1 and A2 at T6 and 6 h after surgery were lower than those of group C (all P<0.05). The incidences of drowsiness in group A1 at T4, T5, and T6 were lower than those in group C [22.0% (11/50) vs. 52.0% (26/50), 18.0% (9/50) vs. 38.0% (19/50), 0 vs. 20.0% (10/50)], and the incidence of drowsiness in group N at T4 was lower than that in group C [32.0% (16/50) vs. 52.0% (26/50)], with statistically significant differences (all P<0.05). The incidence of drowsiness in group A2 at T4 [52.0% (26/50)], T5 [48.0% (24/50)], and T6 [20.0% (10/50)] were higher than those in group A1 (all P<0.05). The incidences of dizziness in group N at T4 and T5 were higher than those in the other 3 groups (all P<0.05). The incidences of nausea and vomiting in group N at T5 and T6 were higher than those in the other 3 groups (all P<0.05). Conclusions Alfentanil combined with propofol can be used in patients undergoing oocyte retrieval under general anesthesia in reproductive center. The recommended dose of 5 µg/kg is effective for analgesia without affecting the patients' postoperative recovery, with few adverse reactions.

    Correlations between hemorheology and blood lipids in elderly patients with sudden deafness

    Yang Zhongchun, Zeng Ruifang, Cai Yuexiang
    2023, 29(9):  1234-1238.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.012
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    Objective To investigate the correlations between hemorheology and blood lipids in elderly patients with sudden deafness (SD). Methods A total of 82 elderly SD patients admitted to Changsha Central Hospital from August 2020 to August 2022 were selected, including 50 males and 32 females, aged (68.73±5.17) years. Another 60 healthy individuals who came to our hospital for physical examination during the same period were selected as a control group, including 34 males and 26 females, aged (69.01±5.33) years. The hemorheology indexes and blood lipid indexes of the two groups of subjects were detected, and according to the type of hearing loss, the elderly SD patients were divided into a low-frequency decline type (18 cases), a high-frequency decline type (22 cases), a flat decline type (33 cases), and a total deafness type (9 cases). The differences of hemorheology and blood lipid levels among all groups were compared, and the correlations between impaired frequency hearing threshold and hemorheology and blood lipid levels were analyzed. χ2 test, t/F test, and Spearman correlation analysis were used for statistical analysis. Results The levels of whole blood viscosity (WBV) [(5.75±1.24) mPa·s vs. (3.50±0.87) mPa·s], red cell assembling index (RCAI) [(4.69±1.01) vs. (2.83±0.58)], fibrinogen (Fib) [(4.25±0.94) g/L vs. (2.30±0.55) g/L], total cholesterol (TC) [(5.36±1.12) mmol/L vs. (3.12±0.88) mmol/L], triglyceride (TG) [(4.25±1.08) mmol/L vs. (2.40±0.75) mmol/L], and low density lipoprotein cholesterol (LDL-C) [(3.22±1.06) mmol/L vs. (1.90±0.74) mmol/L] in the SD group were higher than those in the control group, and the level of high density lipoprotein cholesterol (HDL-C) [(0.94±0.33) mmol/L vs. (1.15±0.40) mmol/L] was lower than that in the control group (all P<0.05). The levels of WBV, RCAI, Fib, TC, TG, and LDL-C in the total deafness type group were (6.92±1.39) mPa·s, (5.45±1.26), (5.09±1.15) g/L, (7.06±1.40) mmol/L, (5.48±1.30) mmol/L, and (4.45±1.29) mmol/L, those in the flat decline type group were (5.81±1.43) mPa·s, (4.85±1.08), (4.48±1.01) g/L, (5.89±1.16) mmol/L, (4.82±1.11) mmol/L, and (3.83±1.09) mmol/L, those in the high-frequency decline type group were (5.30±1.20) mPa·s, (4.46±0.92), (3.73±0.90) g/L, (5.07±1.07) mmol/L, (4.07±0.98) mmol/L, and (3.12±0.98) mmol/L, and those in the low-frequency decline type group were (4.05±0.99) mPa·s, (3.52±0.87), (2.89±0.75) g/L, (3.12±0.88) mmol/L, (3.45±0.90) mmol/L, and (2.86±0.87) mmol/L; the levels of WBV, RCAI, Fib, TC, TG, and LDL-C in the total deafness type group were higher than those in the other three groups (all P<0.05). The HDL-C level in the total deafness type group was lower than that in the flat decline type, high-frequency decline, and low-frequency decline type groups [(0.61±0.20) mmol/L vs. (0.78±0.29) mmol/L, (0.87±0.33) mmol/L, (1.02±0.38) mmol/L], with a statistically significant difference (P<0.05). Spearman correlation analysis showed that the impaired hearing thresholds of low-frequency decline and high-frequency decline types were positively correlated with WBV (r=0.510 and 0.562, both P<0.05); the impaired hearing thresholds of low-frequency decline, high-frequency decline, flat decline, and total deafness types were negatively correlated with HDL-C (r=-0.539, -0.443, -0.495, and -0.683; all P<0.05). Conclusions Elderly SD patients have abnormal hemorheology and blood lipids. The impaired hearing threshold is positively correlated with WBV and negatively correlated with HDL-C. Monitoring the above indicators is beneficial to the diagnosis and treatment of elderly SD patients.

    Clinical value of ultrasonography in the diagnosis of Morel-Lavallée lesions

    Ning Xianghong, Sun Jian, Zhang Degang, Zhang Zhiwei, Li Mengqi, Yang Zhi, Yang Shuye, Zhang Kai, Li Peng
    2023, 29(9):  1239-1244.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.013
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    Objective To explore the clinical application value of ultrasound in the diagnosis of Morel-Lavallée lesions, and to provide a convenient and effective diagnosis method for clinic surgeons. Methods The clinical data of 48 patient with Morel-Lavallée lesions who received preoperative ultrasound and magnetic resonance examination in Binzhou Medical University Hospital from January 2012 to January 2022 were retrospectively analyzed, including 20 males and 28 females, aged (45.6±5.8) years, 26 cases of lower limbs, 9 cases of upper limbs, 8 cases of pelvis and hips, and 5 cases of lumbar back. The lesion size range (maximum transverse diameter and maximum longitudinal diameter) of Morel-Lavallée lesions on preoperative ultrasound and magnetic resonance examination and the lesion size range (maximum transverse diameter and maximum longitudinal diameter) of clinical surgical exploration were analyzed and compared. The diagnostic accuracies of preoperative ultrasound and magnetic resonance examination for Morel-Lavallée lesions were calculated. The consistency test of Kappa coefficient was used to evaluate the diagnostic coincidence rate between the results of ultrasound and magnetic resonance examination and postoperative pathological results. Results By comparing the size of lesions detected during clinical operation with the results of preoperative ultrasound diagnosis, it was found that 45 cases were basically identical, and 3 cases had an error of about 2 cm in the longitudinal and axial distance, with a diagnostic accuracy of 93.75%. By comparing the size of lesions detected during clinical operation with the results of preoperative MRI diagnosis, it was found that the size of lesions diagnosed by MRI was almost identical in 46 cases, and there was an error of about 2 cm in the horizontal axis in 2 cases, with a diagnostic accuracy of 95.83%. The diagnostic coincidence rate of ultrasound examination and postoperative pathological results was 97.92%. The diagnostic coincidence rate of MRI and postoperative pathological results was 100.00%. Among them, one patient had a long time of lesion, and the postoperative pathological results suggested the malignant transformation of cyst wall histiocytes, which could not be confirmed by ultrasound diagnosis, but the magnetic resonance diagnosis suggested the possibility of malignant transformation of cyst wall histiocytes. Conclusions Ultrasound is of great value in the diagnosis of Morel-Lavallée lesions, especially for patients with residual metal in the body who cannot complete magnetic resonance examination. It can not only clarify the size of and nature of lesions, has a high diagnostic accuracy. The diagnostic operation is simple, convenient for patients to complete the examination in time, worthy of clinical application.

    Qualitative diagnostic efficacy of BRAF V600E gene mutation detection combined with US-FNAB in thyroid nodules

    Yue Caiyun, Tian Long
    2023, 29(9):  1244-1248.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.014
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    Objective To explore the diagnostic value of serine/threonine specific kinase gene V600E (BRAF V600E) detection combined with ultrasound-guided fine needle aspiration biopsy (US-FNAB) in thyroid nodules, so as to provide reference for early clinical qualitative diagnosis. Methods A total of 90 patients with suspected malignant thyroid nodules in Chengwu County People's Hospital from August 2019 to August 2022 were selected as the study subjects, including 51 males and 39 females, aged (56.27±2.84) years. After admission, the BRAF V600E gene mutation detection and US-FNAB examination were performed. With the surgical or pathological biopsy results as the gold standard, the diagnostic efficacies of BRAF V600E gene mutation detection and US-FNAB alone and combined were compared. The BRAF V600E gene mutation types and US-FNAB classification in patients with different thyroid nodule diameters were compared. χ2 test was used. Results The results of operation or pathological biopsy showed that among the 90 patients with suspected malignant thyroid nodules, 62 cases were malignant and 28 cases were benign. The results of BRAF V600E gene mutation detection showed that 51 cases were malignant and 39 cases were benign. The results of US-FNAB showed that 50 cases were malignant and 40 cases were benign. The combined diagnosis showed that 61 cases were malignant and 29 cases were benign. Compared with BRAF V600E gene mutation detection and US-FNAB diagnosis alone, the sensitivity and accuracy of combined diagnosis were higher at 95.08% (59/62) and 94.38% (85/90), while the missed diagnosis rate was lower at 4.92% (3/62) (all P<0.05). There were no statistically significant differences in the BRAF V600E gene mutation types among patients with different thyroid nodule diameters (all P>0.05). There were statistically significant differences in the class Ⅲ and class Ⅵ by US-FNAB examination among patients with different thyroid nodule diameters, among which class Ⅵ was more significantly different (all P<0.05). Conclusion BRAF V600E gene mutation detection combined with US-FNAB examination can effectively improve the diagnostic accuracy of thyroid nodules, which is conducive to early qualitative diagnosis and can provide a basis for early clinical intervention.

    Application of ceftazidime injection as adjuvant chemotherapy for lung cancer and its effect on prevention and control of lung infection

    Hou Jingjing, Hao Rui, Yang Qiumin
    2023, 29(9):  1249-1253.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.015
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    Objective To observe the application of ceftazidime injection in adjuvant chemotherapy for lung cancer and its prevention and control effect of lung infection. Methods It was a randomized controlled trial. A total of 98 patients with lung cancer admitted to The First People's Hospital of Shangqiu City from January 2020 to August 2021 were included as the research objects. They were divided into an observation group and a control group by the lottery method, with 49 cases in each group. In the observation group, there were 30 males and 19 females, aged (55.33±5.16) years; in the control group, there were 33 males and 16 females, aged (55.25±5.32) years. Both groups received chemotherapy, and the observation group received ceftazidime injection as adjuvant chemotherapy. The changes of serum inflammatory factors and blood gas indexes before and after treatment, the changes of Clinical Pulmonary Infection Score (CPIS) after 1, 3, and 7 days of treatment, and the incidence of pulmonary infection were compared between the two groups. A 1-year follow-up was conducted after treatment to compare the long-term survival of the two groups. χ2 test and independent sample t test were used. Results Before treatment, there were no statistically significant differences in the serum inflammatory factors and blood gas indexes between the two groups (all P>0.05). After treatment, the levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and other inflammatory factors were increased in both groups, but the above indexes in the observation group were lower than those in the control group (all P<0.05); the partial pressure of arterial oxygen (PaO2), oxygen saturation (SaO2), oxygenation index (PaO2/FiO2), and other blood gas indexes were decreased in both groups, but the above indexes in the observation group were higher than those in the control group (all P<0.05). The CPIS of the observation group after 1, 3, and 7 days of treatment were lower than those of the control group [(6.97±1.21) points vs. (7.62±1.35) points, (5.82±0.74) points vs. (6.33±0.65) points, (4.52±0.45) points vs. (5.03±0.17) points], and the incidences of pulmonary infection were lower than those of the control group [10.20% (5/49) vs. 20.41% (10/49), 4.08% (2/49) vs. 14.29% (7/49), 0.20% (1/49) vs. 10.20% (5/49)], with statistically significant differences (all P<0.05). During the follow-up period, the scores of all dimension of Functional Assessment of Cancer Therapy - Lung cancer (FACT-L) in the observation group were higher than those in the control group (all P<0.05). Conclusion The use of ceftazidime injection as an adjuvant therapy during chemotherapy for lung cancer patients can promote the recovery of inflammatory response and arterial blood gas indicators, which has positive significance in reducing the risk of lung infection and improving the long-term quality of life.

    Therapeutic effect of carboprost trometamol on dangerous placenta previa and its effect on pregnancy outcomes

    Zhang Limin
    2023, 29(9):  1253-1257.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.016
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    Objective To observe the therapeutic effect of carboprost trometamol on dangerous placenta previa and its effect on pregnancy outcomes. Methods It was a randomized controlled trial. A total of 65 patients with dangerous placenta previa admitted to Tongxu County Hospital of Traditional Chinese Medicine from January 2019 to May 2022 were taken as the research objects. They were divided into a treatment group (33 cases) and a control group (32 cases) by the random number table method. The age of the treatment group was (29.12±0.41) years old, and the gestational age was (36.15±0.27) weeks. The age of the control group was (29.15±0.33) years old, and the gestational age was (36.11±0.32) weeks. Both groups were treated with cesarean section + conventional oxytocin injection + uterine gauze packing, the control group was treated with mifepristone on the basis, and the treatment group was treated with carboprost trometamol on the basis of the above treatment. The hemostasis, uterine arterial hemodynamics, pregnancy outcomes, and adverse drug reactions of the two groups were compared under different treatment schemes. χ2 test and independent sample t test were used. Results After different treatments, the bleeding volumes 3, 6, 9, and 12 hours after operation in the treatment group were lower than those in the control group (all P<0.05). The hemostatic time in the treatment group was shorter than that in the control group [(2.25±0.31) d vs. (4.15±0.27) d] (t=26.317, P<0.001), and the success rate of hemostasis was higher than that in the control group [84.85% (28/33) vs. 68.75% (22/32)] (χ2=7.274, P=0.007). There were no statistically significant differences in the uterine arterial hemodynamic indexes between the two groups before treatment (all P>0.05). After treatment, the pulsation index (PI) of the treatment group was higher than that of the control group [(0.84±0.11) vs. (0.72±0.14)] (t=3.849, P<0.001), the peak systolic flow velocity/diastolic flow velocity (S/D) of the uterine artery was higher than that of the control group [(2.35±0.85) vs. (2.02±0.13)] (t=2.171, P=0.034), and the resistance index (RI) was lower than that of the control group [(0.53±0.12) vs. (0.69±0.41)] (t=2.149, P=0.036). The incidence of adverse pregnancy outcomes in the treatment group was lower than that in the control group [15.15% (5/33) vs. 28.13% (9/32)] (χ2=4.968, P=0.026). The incidence of adverse drug reactions in the treatment group was higher than that in the control group [18.18% (6/33) vs. 15.63% (5/32)], but the difference was not statistically significant (χ2=0.232, P=0.630). Conclusions In addition to routine hemostatic measures and mifepristone treatment for patients with dangerous placenta previa, the combined application of carboprost trometamol can enhance its hemostatic effect, which has positive significance in improving the uterine arterial hemodynamics and the patients' pregnancy outcomes. Moreover, the combined application of this drug does not significantly increase the risk of adverse drug reactions in patients, with high safety.

    Treatises

    Clinical analysis of immune-related adverse events induced by camrelizumab

    Ke Jin, Wang Hengshi, Zhang Shanlan
    2023, 29(9):  1258-1262.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.017
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    Objective To analyze the occurrence of immune-related adverse events (irAEs) induced by camrelizumab among cancer patients. Methods The clinical data of 70 patients with malignant tumors who received treatment of camrelizumab in Shanghai Songjiang Central Hospital from January 2020 to February 2022 were retrospectively analyzed, including 50 males and 20 females, aged 48-87 years. The incidence and treatment plans of irAEs were demonstrated. Results Among the 70 patients, 43 cases (61.4%) developed irAEs, and of them 15 cases (21.4%) simultaneously appeared adverse events involving multiple systems. Thirty-eight patients (54.3%) had grade Ⅰ-Ⅱ irAEs; 5 patients (7.1%) had grade Ⅲ-Ⅳ irAEs, including 2 cases of immune-related pneumonitis, 1 case of colitis, 1 case of myocarditis, and 1 case of skin toxicity. The adverse reactions were completely relieved after glucocorticoid shock therapy in 5 patients. Conclusions The incidence of irAEs induced by camrelizumab is high, and the adverse events affect multiple organs, but the symptoms are not severe. The incidence of ≥grade Ⅲ adverse reactions is low.

    Establishment of a bleeding prediction model for mixed hemorrhoids after PPH

    Chen Pei, Yang Feng, Li Bingbing, Guo Dekai, Zhang Junhua
    2023, 29(9):  1262-1267.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.018
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    Objective To find out the risk factors of postoperative bleeding after procedure for prolapse and hemorrhoids (PPH) combined with several examination indicators, and to formulate its bleeding prediction model in order to reduce the postoperative bleeding after PPH, improve the patients' prognosis, and alleviate the patients' pain. Methods This study was a retrospective observational study. The clinical data of 258 patients who underwent PPH in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage) from December 2016 to May 2021 were retrospectively analyzed. Among them, there were 115 males and 143 females, with an average age of 45.64 years old. The main observation indicators were whether there were complications of hypertension and diabetes, anal tube placement time, hemoglobin, leukocytes, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, uric acid, platelets, activated partial thrombin time (APTT), international normalized ratio (INR), prothrombin time (PT), thrombin time (TT), whether the intestinal preparation was adequate, whether the stool was dry, and whether the antibiotics are used. Univariate analysis was performed using t test and χ2 test, and multivariate analysis was performed using logistic regression analysis. A predictive model for postoperative bleeding was established, and the receiver operating characteristic curve (ROC) was used to verify the predictive efficacy of the model. Results In the multivariate analysis, dry stool (P=0.01), anal tube placement time (P=0.02), antibiotic use (P=0.02), intestinal preparation (P<0.01), and TT (P=0.01) all had statistically significant differences in predicting postoperative bleeding after PPH. The predictive model of postoperative bleeding after PPH was Y=1/[1+EXP (2.16× anal tube placement time -2.24× dry stool +1.97× no antibiotic use +2.92× inadequate intestinal preparation +1.64×TT -35.29)], the predictive power of the model was tested by ROC, and the area under the curve (AUC) was 0.987. Conclusions Dry stool, anal tube placement time, antibiotic use, intestinal preparation, and TT are independent risk factors for postoperative bleeding after PPH, which are closely related to bleeding. The establishment of this predictive model is helpful to reduce the occurrence of this complication in clinical practice.

    Perioperative effect of blood transfusion guided by thromboelastography in cardiac surgery with cardiopulmonary bypass

    Li Yuqiu, Ye Xiaofang
    2023, 29(9):  1268-1271.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.019
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    Objective To investigate the perioperative effect of blood transfusion guided by thromboelastography in cardiac surgery with cardiopulmonary bypass. Methods It was a randomized controlled trial. A total of 84 patients undergoing cardiac surgery with cardiopulmonary bypass admitted in The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force from June 2020 to June 2022 were divided into an observation group and a control group according to the random number table method. In the control group, there were 24 males and 18 females, aged 19-71 (51.78±7.56) years. In the observation group, there were 25 males and 17 females, aged 19-71 (53.12±7.29) years. The control group received blood transfusion guidance according to the routine coagulation test, and the observation group received blood transfusion guidance according to the thromboelastography. The blood transfusion situation, blood transfusion effects, and clinical outcomes of the two groups were observed. Independent sample t test, χ2 test, and Fisher exact probability method were used for statistical analysis. Results The amounts of autologous blood and erythrocyte input were (734.62±61.78) ml and (549.16±87.47) ml in the observation group, and (748.25±67.96) ml and (559.94±92.35) ml in the control group, without statistically significant differences between the two groups (both P>0.05). The amounts of fresh frozen plasma and platelet input were (321.39±65.53) ml and (523.27±152.45) ml in the observation group, and (375.44±71.83) ml and (655.29±187.63) ml in the control group, respectively, with statistically significant differences between the two groups (both P<0.05). The level of hemoglobin in the observation group was higher than that in the control group at the time of operation completion and transfer out of intensive care unit (ICU) [(105.77±10.34) g/L vs. (91.23±9.75) g/L, (118.35±10.57) g/L vs. (105.59±9.23) g/L], the platelet elevation index (CCI) was higher than that in the control group 1 h and 24 h after transfusion [(15.24±4.48) vs. (12.62±3.47), (13.87±2.19) vs. (10.58±2.54)], and the effective rate of blood transfusion was higher than that in the control group [83.33% (33/42) vs. 61.90% (24/42)], with statistically significant differences between the two groups (all P<0.05). The time of tracheal intubation [(19.27±5.56) h vs. (21.75±5.21) h], the length of ICU stay [(21.17±4.64) h vs. (23.83±5.13) h], and the length of hospital stay [(16.52±4.57) d vs. (19.21±5.17) d] in the observation group were all shorter than those in the control group, with statistically significant differences (all P<0.05). There were no statistically significant differences in the rate of re-operation within 24 h after operation and mortality rate between the observation group and the control group (both P>0.05). Conclusion The application of blood transfusion guided by thromboelastography in the perioperative period of cardiac surgery with cardiopulmonary bypass is helpful to reduce the amount of blood transfusion, enhance the effect of blood transfusion, shorten the time of tracheal intubation, length of ICU stay, and length of hospital stay, and improve the prognosis.

    Clinical Research

    Diagnostic value of SWI combined with DWI in acute cerebral hemorrhage

    Ding Suying, Li Lingling, Ding Yang
    2023, 29(9):  1272-1275.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.020
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    Objective To explore the application value of susceptibility weighted imaging (SWI) combined with diffusion weighted imaging (DWI) in the diagnosis of acute cerebral hemorrhage, so as to provide basis for early detection of hemorrhage focus in clinical and prevent secondary hemorrhage and other serious diseases. Methods A total of 82 patients with suspected cerebral hemorrhage in The People's Hospital of Ruichang from July 2020 to April 2022 were selected, including 48 males and 34 females, aged (64.32±2.85) years. The SWI and DWI examinations were performed after admission, and the diagnostic results of SWI and DWI alone and in combination were statistically compared with the CT examination results as the gold standard. The imaging features of SWI and DWI in acute cerebral hemorrhage during different time periods were observed. Independent sample t test and χ2 test were used for statistical analysis. Results The results of CT examination showed that 53 of 82 patients with suspected cerebral hemorrhage in the acute phase were diagnosed, and the other 29 patients were diagnosed as acute cerebral infarction. When the onset of cerebral hemorrhage was <6 hours, 6-12 hours, and >12-24 hours, the apparent diffusion coefficients (ADC) [(3.62±0.53) ×104 vs. (6.24±0.85) ×104, (3.42±0.59) ×104 vs. (5.86±0.74) ×104, (3.61±0.68) ×104 vs. (4.92±0.84) ×104] and phase values (PV) [(-0.71±0.15) vs. (-0.32±0.08), (-0.68±0.21) vs. (-0.35±0.12), (-0.74±0.18) vs. (-0.29±0.14)] of the patients with acute cerebral hemorrhage were lower than those of the patients with acute cerebral infarction (t=17.189, 16.341, 7.665, 13.002, 7.782, and 11.659; all P<0.001). Taking acute cerebral hemorrhage as positive cases, 39 cases were positive on DWI, 42 cases were positive on SWI, and 52 cases were positive on the combination of DWI and SWI. Compared with those of DWI and SWI alone, the sensitivity and accuracy of the combined diagnosis were higher by 92.45% (49/53) and 91.46% (75/82), and the missed diagnosis rate was lower by 7.55% (4/53), with statistically significant differences (χ2=9.952, 7.408, and 9.952; all P<0.05). Conclusions SWI and DWI can be used in the clinical diagnosis of acute cerebral hemorrhage. The combination of SWI and DWI can effectively improve the early detection rate of acute cerebral hemorrhage, provide a basis for early clinical screening and diagnosis, and formulating targeted interventions to improve the prognosis.

    Efficacy of isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure

    Dou Dongfeng, Liu Hongguang, Zhang Lifen
    2023, 29(9):  1276-1280.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.021
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    Objective To analyze the short-term efficacy of isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure and its effects on serum levels of growth differentiation factor-15 (GDF-15) and soluble growth stimulation-expressed gene 2 protein (sST2). Methods It was a randomized controlled trial. A total of 120 elderly patients with chronic heart failure admitted to The Third People's Hospital of Liaocheng from February 2019 to January 2021 were divided into two groups by the random number table method, with 60 cases in each group. In the control group, there were 35 males and 25 females, aged (70.96±3.85) years. In the observation group, there were 38 males and 22 females, aged (71.55±4.03) years. After admission, both groups were given routine treatment. The control group received oral perindopril tert-butylamine treatment before meals in the morning, and the observation group was additionally given oral isosorbide mononitrate treatment on this basis. Both groups received continuous treatment for 1 month. The clinical efficacies, cardiac function and serum markers of heart failure [N-terminal precursor brain natriuretic peptide (NT-proBNP), blood insulin growth faction-1 (IGF-1), troponin T (cTnT), GDF-15, and sST2] before and after treatment, and adverse reactions during treatment were compared between the two groups. χ2 test and t test were used. Results The total effective rate of the observation group was 85.00% (51/60), and that of the control group was 70.00% (42/60), with a statistically significant difference between the two groups (χ2=3.871, P=0.049). After treatment, the left ventricular end-systolic diameter (LVESD) [(42.55±5.31) mm], left ventricular end-diastolic diameter (LVEDD) [(46.78±8.10) mm], NT-proBNP [(274.20±102.11) ng/L], cTnT [(76.21±9.28) ng/L], GDF-15 [(554.87±23.54) ng/L], sST2 [(8.28±2.47) μg/L] in the observation group were lower than those in the control group [(51.69±4.27) mm, (54.63±8.14) mm, (824.33±412.74) ng/L, (85.77±10.58) ng/L, ( 845.98±20.14) ng/L, and (45.14±6.22) μg/L], and the left ventricular ejection fraction (LVEF) [(59.78±5.01) %], cardiac output (CO) [(5.57±0.68) L/min], stroke output (SV) [(70.81±6.51) ml], and IGF-1 [(119.87±20.98) μg/L] were all higher than those in the control group [(47.63±6.15) %, (5.09±0.64) L/min, (65.76±6.83) ml, and (110.47±23.58) μg/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2=0.120, P=0.729). Conclusion Isosorbide mononitrate combined with perindopril tert-butylamine in the treatment of elderly patients with chronic heart failure can better improve their clinical symptoms and signs, promote the improvement of cardiac function, and regulate their serum biomarker levels, which is responsive and safe.

    Effect of clopidogrel combined with edaravone dexamphetamine on patients with acute cerebral infarction

    Wen Tong, Feng Guiping, Wang Zefeng
    2023, 29(9):  1280-1286.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.022
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    Objective To investigate the clinical effect of clopidogrel combined with edaravone dexamphetamine in the treatment of acute cerebral infarction (ACI). Methods It was a randomized controlled trial. A total of 124 ACI patients admitted to The People's Hospital of Xiangxiang from July 2020 to June 2022 were selected, and were divided into two groups by the random number table method with 62 cases in each group. In the control group, there were 36 males and 26 females, aged (57.47±4.25) years; in the observation group, there were 33 males and 29 females, aged (58.23±4.45) years. After routine supportive treatment, the control group was given clopidogrel, and the observation group was given clopidogrel combined with edaravone dexamphetamine, for a period of 2 weeks. The serum inflammatory factors [hypersensitive C-reactive protein (hs-CRP), pentraxin 3 (PTX3), and lipoprotein-associated phospholipase A2 (Lp-PLA2)], hemodynamic indexes [resistance index (RI), peak systolic blood velocity (Vmax), and mean blood velocity (Vmean)], oxidative stress indexes [superoxide dismutase (SOD), reactive oxygen species (ROS), and malondialdehyde (MDA)], neurological function indicators [neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF)], degrees of neurological impairment, walking ability, and ability of daily living were compared between the two groups before and after treatment. The clinical efficacies and adverse reactions of the two groups were evaluated. t test and χ2 test were used. Results After treatment, the total effective rate of the observation group was 91.94% (57/62), which was higher than that of the control group [75.81% (47/62)], with a statistically significant difference (χ2=5.962, P=0.015). The levels of serum hs-CRP [(7.47±2.34) mg/L], PTX3 [(1.97±0.88) ng/L], Lp-PLA2 [(6.64±1.04) μg/L], SOD [(123.38±14.62) U/mg], ROS [(502.42±49.88) μmol/L], MDA [(40.12±5.02) μmol/L], and NSE [(9.76±1.22) μg/L], RI [(0.67±0.08)], score of National Institutes of Health Stroke Scale (NIHSS) [(7.28±0.43) points], and walking ability score [(1.77±0.12) points] in the observation group were lower than those in the control group [(10.12±3.32) mg/L, (2.64±1.25) ng/L, (8.52±1.22) μg/L, (147.65±16.26) U/mg, (557.39±52.34) μmol/L, (46.34±5.24) μmol/L, (13.55±2.34) μg/L, (0.78±0.12), (9.12±0.54) min, and (2.44±0.17) min], with statistically significant differences (all P<0.05). In the observation group, the Vmean [(62.82±5.47) cm/s], Vmax [(87.94±9.78) cm/s], level of BDNF [(6.64±0.87) μg/L], and BI [(69.64±7.14) points] were higher than those in the control group [(58.62±5.34) cm/s, (84.14±8.66) cm/s, (5.03±0.82) μg/L, and (62.38±6.72) points], with statistically significant differences (all P<0.05). Conclusion Clopidogrel combined with edaravone dexamphetamine is more effective in the treatment of ACI, which can effectively inhibit the inflammatory response and scavenge oxygen free radicals, thus improving the flow of blood in the brain, rapidly restoring the blood supply to the ischemic hemispheric zone, and contributing to the recovery of neurological function and enhancing the self-care ability, with higher safety.

    Case Report

    Congenital pulmonary airway malformation with pseudomonas aeruginosa pneumonia in an infant

    Zhang Songlin, Ding Cong, Hou Jie, Guo Yanjun
    2023, 29(9):  1287-1290.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.023
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    A case of misdiagnosis of atypical uterine rupture in the second trimester

    Wang Lijun, Liu Yu, Ma Xuefeng
    2023, 29(9):  1290-1293.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.024
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    Uterine rupture is a rare and critical acute abdominal disease in obstetrics, and occurs mostly in the late pregnancy and delivery period. If the disease is not diagnosed and treated in time, it may endanger the lives of the puerpera and the fetus. The typical clinical symptoms are lower abdominal pain and hemorrhagic shock in patients with a history of uterine surgery. The First Affiliated Hospital of Jinan University admitted a patient with scar uterus rupture at the non-scar part in the second trimester. The characteristic of this case was that the patient had a history of taking dirty food, and the initial clinical symptom was lower abdominal pain after nausea and vomiting, which was relieved after vomiting. This case was misdiagnosed as acute gastroenteritis. The features of the disease were found in this case and the causes of misdiagnosis were discussed based on literature review, to arouse medical attention.

    Nursing Research

    Application of continuing care intervention in discharge follow-up of critically ill neonates under the framework of Omaha system

    Duanmu Yanyan, Xie Fangfang, Chen Yu, Jiang Mingli, Li Danfeng
    2023, 29(9):  1294-1299.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.025
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    Objective To explore the application effect of continuous nursing intervention in the discharge follow-up of critically ill neonates under the framework of Omaha system. Methods It was a prospective randomized controlled trial. From July 2020 to July 2022, 84 critically ill neonates and their main guardians in neonatal intensive care unit (NICU) of Children's Hospital Affiliated of Zhengzhou University were enrolled in the study. According to the random number table method, they were divided into a control group [24 males and 18 females in 42 neonates; 37 males and 5 females in 42 guardians, aged (31.14±4.46) years] and an observation group [21 males and 21 females in 42 neonates; 39 males and 3 females in 42 guardians, aged (31.30±3.38) years]. Routine continuous nursing intervention was given to the control group. On the basis of the control group, the observation group carried out continuous nursing intervention based on the framework of Omaha system. The main guardians' mental status [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) as comprehensive assessment tools], sense of uncertainty of disease and attachment emotion [the Chinese version of the Revised Parental Uncertainty Scale (PPUS) and the Chinese version of the Parent Peer Attachment Scale (IPPA-R) as assessment tools], and nursing ability [Simple Coping Style Scale (SCSQ) as an assessment tool] and critically ill neonates' nursing problems, quality of life [Universal Core Quality of Life Scale (PedsQLTM 4.0) as an assessment tool], and adverse events at the time of discharge and 4 weeks of follow-up were compared between the two groups. t test and χ2 test were used. Results After nursing, the SAS score [(32.64±6.27) points], SDS score [(33.69±4.82) points], and PPUS score [(59.47±7.33) points] in the observation group were all lower than those in the control group [(43.61±9.97) points, (45.16±8.15) points, and (73.42±6.99) points], and the IPPA-R score [(101.28±11.89) points] was higher than that in the control group [(87.24±12.27) points], with statistically significant differences (all P<0.05). After nursing, the positive coping score of the SCSQ [(39.82±3.48) points] in the observation group was higher than that in the control group [(34.73±6.63) points], and the negative coping score [(17.23±3.10) points] was lower than that in the control group [(21.76±2.94) points], with statistically significant differences (both P<0.05). After nursing, the rates of environmental [9.52% (4/42)], social psychological [14.29% (6/42)], physiological [16.67% (7/42)], and health behavioral nursing problems [14.29% (6/42)] in the observation group were lower than those in the control group [28.57% (12/42), 35.71% (15/42), 42.86% (18/42), and 40.48% (17/42)], with statistically significant differences (all P<0.05). After nursing, the PedsQLTM 4.0 score [(69.34±11.88) points] in the observation group was higher than that in the control group [(60.26±6.24) points], and the incidence of adverse events [7.14% (3/42)] was lower than that in the control group [26.19% (11/42)], with statistically significant differences (both P<0.05). Conclusion The application of continuous nursing intervention under the framework of Omaha system in the discharge follow-up is helpful to improve the main guardians' mental state, reduce the uncertainty of disease, enhance the attachment, and significantly improve their nursing ability, which can also reduce the critically ill neonates' nursing problems, improve their quality of life, and reduce the occurrence of adverse events.

    Nursing experiences of a patient with acute renal failure after surgery for aortic dissection

    Wang Yu, Tang Jiamin, Xia Yanling, Li Xiaohui, Su Yanyan
    2023, 29(9):  1300-1303.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.026
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    This paper mainly analyzed the clinical process of a patient with acute renal failure after surgery for aortic dissection treated in Guangzhou First People's Hospital in October 2021, aiming at strengthening the medical staff's knowledge of patients with acute renal failure after surgery for aortic dissection, increasing related nursing experiences, and achieving better nursing effect. Nursing points included closely observing the changes of the disease, carrying out hemodialysis treatment, postoperative nursing, dialysis nursing, medication nursing, and prevention of complications. Through the implementation of the above nursing measures, the patient's residual kidney function and quality of life had been improved, and the patient had safely survived the perioperative period.

    Effect of parental participatory nursing on psychological resilience and caring ability in parents of premature infants in NICU

    Liu Yanyan, Zhao Shaoli, Xie Fangfang, Jiang Mingli, Li Danfeng
    2023, 29(9):  1303-1307.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.027
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    Objective To explore the effect of parental participatory nursing on the psychological resilience and caring ability in parents of premature infants in neonatal intensive care unit (NICU). Methods It was a randomized controlled trial. A total of 84 premature infants admitted to NICU of Henan Children's Hospital from January 2020 to December 2021 were divided into two groups by the random number table method, with 42 cases in each group. There were 23 males and 19 females in the control group, with a gestational age of (34.21±1.74) weeks. There were 25 males and 17 females in the observation group, with a gestational age of (33.71±2.26) weeks. At the same time, the 168 parents of preterm infants were divided into a control group [84 cases, mothers aged (29.64±5.75) years, fathers aged (31.02±3.39) years] and an observation group [84 cases, mothers aged (28.29±6.73) years, fathers aged (30.64±5.52) years]. The control group was given routine nursing intervention measures, and the observation group was given parental participatory nursing. The growth and development indicators (body mass, body length, and head circumference) of the two groups were compared at admission and one month after discharge. The caring ability and psychological resilience of the parents of the two groups were evaluated at admission and discharge. χ2 test and t test were used for analysis. Results One month after discharge, the premature infants' body length [(60.69±1.73) cm], head circumference [(43.43±1.73) cm], and body weight [(6.53±0.34) kg] of the observation group were higher than those of the control group [(54.39±1.99) cm, (39.99±1.97) cm, and (5.81±0.33) kg], with statistically significant differences (t=15.450, 8.490, and 9.866; all P<0.001). At discharge, the scores of parental caring knowledge [(31.48±2.86) points], skills [(30.64±2.62) points], and ability [(16.83±1.97) points] in the observation group were higher than those in the control group [(29.32±1.19) points, (25.38±3.92) points, and (13.67±2.15) points], with statistically significant differences (t=6.372, 10.217, and 9.963; all P<0.001). At discharge, the scores of tenacity [(40.12±2.32) points], self-improvement [(21.29±2.15) points], and optimism [(11.68±1.50) points] and total score [(73.15±6.35) points] in the parents of preterm infants of the observation group were higher than those of the control group [(34.56±1.97) points, (18.31±3.44) points, (8.24±1.56) points, and (61.24±2.96) points], with statistically significant differences (t=16.713, 6.726, 14.518, and 15.589; all P<0.001). Conclusion Parental participatory nursing can effectively promote the premature infants' growth and development, and is beneficial to improving the psychological resilience and caring ability of premature infants' parents.

    Effect of target management under chronic disease trajectory framework on postoperative recovery of stroke patients

    Xiang Lin, Cheng Yuanzhen
    2023, 29(9):  1308-1313.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.028
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    Objective To investigate the effect of target management mode under chronic disease trajectory framework on recovery of stroke patients after interventional operation, so as to provide new management strategies for clinical nursing. Methods A total of 152 patients who underwent interventional operation for stroke in The Third People's Hospital of Hubei Province Affiliated to Jianghan University from February 2021 to February 2022 were reviewed. The 76 patients admitted from February to July 2021 were selected as a control group [39 males and 37 females, aged (57.85±6.33) years], who were given routine nursing intervention. The other 76 patients admitted from August 2021 to February 2022 were selected as an observation group [40 males and 36 females, aged (58.29±7.44) years], who were given target management mode under chronic disease trajectory framework on the basis of the control group. The postoperative recovery, neurocognitive function, self-management ability, and quality of life were compared between the two groups. t test and χ2 test were used. Results The time of first anal exhaust [(26.48±5.44) h], the time of eating [(1.05±0.37) d], the time of out-of-bed activities [(7.35±2.15) d], and the hospital stay [(10.25±1.43) d] in the observation group were all shorter than those in the control group [(30.06±4.83) h, (1.33±0.45) d, (9.26±2.33) d, and (12.48±2.52) d], with statistically significant differences (all P<0.05). After intervention, the score of National Institutes of Health Stroke Scale (NIHSS) [(8.01±1.54) points] in the observation group was lower than that in the control group [(10.33±1.46) points], and the score of Montreal Cognitive Assessment Scale (MoCA) [(24.30±2.54) points] was higher than that in the control group [(20.16±2.80) points], with statistically significant differences (both P<0.05). After intervention, the scores of self-responsibility [(20.05±4.52) points], self-care knowledge [(30.33±4.95) points], self-care concept [(20.01±2.01) points], and self-care skills [(39.38±5.22) points] in the observation group were higher than those in the control group [(18.05±3.25) points, (26.46±3.87) points, (17.96±1.94) points, and (36.34±5.11) points], with statistically significant differences (all P<0.05). After 2 and 4 weeks of intervention, the life quality scores of the observation group [(82.31±5.27) points and (125.48±8.46) points] were higher than those of the control group [(78.46±4.33) points and (114.36±7.94) points], with statistically significant differences (both P<0.05). Conclusion Applying target management mode under chronic disease trajectory framework to stroke patients after interventional operation can not only shorten the hospital stay and promote the recovery, but also improve the patients' neurocognitive function, perception of healthy behaviors, and negative emotion management, thereby improving the quality of life.

    Application effect of measure-classified nursing mode in patients with acute myeloid leukemia undergoing chemotherapy after remission

    Li Dongmei, Shi Jian, Qi Xinxin
    2023, 29(9):  1313-1317.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.029
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    Objective To explore the application effect of measure-classified nursing mode in patients with acute myeloid leukemia undergoing chemotherapy after remission. Methods It was a randomized controlled trial. A total of 72 patients with acute myeloid leukemia undergoing chemotherapy after remission were selected from The People's Hospital of Anyang City from January 2020 to December 2021 as the research subjects, and were divided into two groups by the random number table method with 36 cases in each group. In the control group, there were 22 males and 14 females, aged (39.51±5.67) years. In the observation group, there were 23 males and 13 females, aged (39.46±5.39) years. The control group received the basic nursing model, and the observation group added classified nursing measures on the basis of the control group. The scores of Cancer Fatigue Scale (CFS) and quality of life before and after nursing and incidence of adverse reactions were compared between the two groups. t test and χ2 test were used. Results After intervention, the scores of physical fatigue [(29.64±2.04) points], cognitive fatigue [(35.88±1.75) points], and emotional fatigue [(24.36±1.76) points] in the observation group were lower than those in the control group [(30.97±1.35) points, (36.91±2.52) points, and (25.20±1.15) points], with statistically significant differences (t=3.262, 2.014, and 2.397; all P<0.05). After intervention, the scores of physical pain [(83.46±2.92) points], physiological role [(82.21±2.78) points], emotional role [(84.18±2.81) points], physiological function [(83.14±2.74) points], mental health [(84.16±2.91) points], energy [(85.13±2.87) points], social function [(84.27±2.86) points], and overall health [(85.13±2.87) points] in the observation group were higher than those in the control group [(81.81±2.77) points, (80.67±2.84) points, (82.61±2.66) points, (81.64±2.83) points, (82.63±2.87) points, (83.58±2.93) points, (82.71±2.65) points, and (83.59±2.93) points], with statistically significant differences (t=2.460, 2.325, 2.435, 2.285, 2.246, 2.267, 2.400, and 2.253; all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [8.33% (3/36) vs. 27.78% (10/36)], with a statistically significant difference (χ2=4.599, P=0.032). Conclusion Classified nursing measures for patients with acute myeloid leukemia undergoing chemotherapy after remission can effectively improve their mental fatigue, improve their quality of life, improve the incidence of adverse reactions, and is beneficial to the prognosis.

    Effect evaluation of project management to reduce the incidence of inpatients' falls

    Wang Guilian, Chen Qiongfang, Fang Jiexin, Wang Cuiyan
    2023, 29(9):  1318-1322.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.030
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    Objective To reduce the incidence of inpatients' falls by using project management method. Methods A total of 117 cases of falls among all patients in 31 inpatient departments of Shunde Hospital of Southern Medical University from January to December 2019 were selected as a control group by the cluster sampling method, including 58 males and 59 females, aged (64.52±17.04) years. A total of 80 hospitalized fall patients from January to December 2021 after fall project management were included in the experimental group, including 47 males and 33 females, aged (65.19±16.51) years. In 2020, a project management team for inpatients' fall prevention was set up, responsible for the technical support and quality management, process training, and data analysis of fall prevention and fall event treatment for the inpatients in the whole hospital. Nurses, doctors, and pharmacists participated in the management together and conducted the integrated ward rounds and educational measures, and the general logistics and equipment departments solved the environmental and facility problems. By analyzing the data of inpatients' fall from 2017 to 2019, safe medication and safe toilet use were selected as the key points of project improvement. On the basis of routine fall risk assessment, balance ability test, start-up timing test, postural hypotension test, independent risk factor management of falls, regular inspection and supervision by project team members, and organization of nursing consultation were added to strengthen the fall prevention management in the departments. The interviews and root cause analysis were conducted on fall cases, and the effective improvement measures were formulated to avoid the recurrence of similar events. χ2 test was used. Results The incidence of falls among the inpatients decreased from 0.197‰ in 2019 to 0.151‰ in 2021, the proportion of falls caused by toilet related activities decreased from 50.4% (59/117) in 2019 to 35.0% (28/80) in 2021, the proportion of fall caused by drug use decreased from 68.4% (80/117) in 2019 to 51.3% (41/80) in 2021, and the injury rate of falls decreased from 67.5% (79/117) in 2019 to 38.8% (31/80) in 2021, with statistically significant differences (all P<0.05). Conclusion Multi-department cooperative fall project management can effectively reduce the incidence and injury rate of falls, and improve the management effect of inpatients' fall prevention.

    Analysis on nursing work stresses in a tuberculosis special hospital

    Wu Ling, Liu Yumei, Zhou Minjuan, Bao Wanling, Chen Yumei, Zeng Huazhi
    2023, 29(9):  1323-1327.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.031
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    Objective To understand the stresses faced by tuberculosis special nurses in their daily work and to continuously improve the nursing management measures about how to ease and release all kinds of stresses. Methods It was a cross-sectional study. In July 2020, a questionnaire survey was conducted among 249 in-service nurses aged 18-50 years in a tuberculosis special hospital with the Nurses Job Stressor Scale. From the 5 dimensions of nursing profession and work, time allocation and workload, working environment and equipment, patient care, and management and interpersonal relationship, 35 items were scored from 1 to 4 according to the pressure from small to large. According to the total score of 35 items of each participant, the work stress was divided into three equal grades: mild degree, moderate degree, and severe degree, and the work stress of nurses specialized in tuberculosis was analyzed descriptively. Results Among the 249 participants, the percentages of mild, moderate, and severe stress were 20.88% (52/249), 64.26% (160/249), and 14.86% (37/249), and their scores were (61.04±8.04) points, (87.04±11.14) points, and (113.19±5.94) points, respectively. Among the 35 items in the 5 dimensions, the items scored 1-4 accounted for 13.69% (1 193/8 715), 44.88% (3 911/8 715), 24.91% (2 171/8 715), and 16.52% (1 440/8 715), respectively. In the 5 dimensions of nursing profession and work, time allocation and workload, working environment and equipment, patient care, and management and interpersonal relationship, the descending sort of percentages of scores assigned from 3 to 4 were 53.41% (665/1 245), 50.83% (886/1 743), 47.79% (357/747), 41.04% (1 124/2 739), and 25.84% (579/2 241) in the dimensions of time allocation and workload, nursing profession and work, working environment and equipment, patient care, and management and interpersonal relationship, respectively. Among the 35 items, the top five items with the scores from high to low were too low salary [(3.14±0.92) points], low social status of nursing work [(3.10±0.87) points], too much work [(3.09±0.81) points], poor working environment [(2.87±0.91) points], and too much paper work at work [(2.86±0.92) points], and their percentages of 3-4 points were 70.68% (176/249), 70.28% (175/249), 73.90% (184/249), 59.84% (149/249), and 61.45% (153/249), respectively. Conclusions Tuberculosis special nurses have considerable work stresses. And it is the most basic that their treatment must be improved and the hospital management must be optimized to solve these problems.

    Study on adverse reactions of blood collection in patients with chronic diseases undergoing venous blood collection

    Xiong Yumei, Zuo Lulu, Huang Yanan
    2023, 29(9):  1327-1331.  DOI: 10.3760/cma.j.issn.1007-1245.2023.09.032
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    Objective To investigate the occurrence of adverse reactions of blood collection in patients with chronic diseases undergoing venous blood collection and to explore the influencing factors. Methods A cross-sectional survey was conducted to investigate the occurrence of adverse reactions of blood collection in patients with chronic diseases who were admitted to the Health Management Department of The 73rd Army Group Hospital, PLA from January 2021 to June 2022. The patients' clinical data were collected, and the factors influencing the occurrence of adverse reactions were analyzed by univariate and multivariate binary logistic regression analysis. χ2 test and t test were used. Results (1) A total of 3 246 patients with chronic diseases who had undergone venous blood collection completed the study. There were 1 749 males and 1 497 females, aged 43-94 (69.76±14.46) years. There were 72 cases of adverse reactions, with an incidence of 2.22%. The top three types of adverse reactions were needle sickness in 26 cases (36.11%), oedema at the puncture site in 14 cases (19.44%), and local haematoma/bleeding in 12 cases (16.67%). There were 46 cases (63.89%) of immediate response and 26 cases (36.11%) of delayed response. There were 57 cases (79.17%) of mild adverse reactions, 14 cases (19.44%) of moderate adverse reactions, and 1 case (1.39%) of severe adverse reactions. (2) Multivariate logistic analysis showed that age (OR=1.018, 95%CI 1.011-1.025, P=0.045), gender (OR=1.476, 95%CI 1.145-1.903, P=0.038), cerebrovascular disease (OR=1.306, 95%CI 1.141-1.495, P=0.026), and number of punctures (OR=1.249, 95%CI 1.184-1.317, P=0.034) were the influencing factors of adverse reactions in patients with chronic diseases undergoing venous blood collection. Conclusions The adverse reactions of blood collection in patients with chronic diseases undergoing venous blood collection are mainly mild, while the immediate adverse reactions account for a relatively high proportion. Needle sickness, oedema at the puncture site, and local haematoma/bleeding are the main types of adverse reactions. Advanced age, female, cerebrovascular disease, and number of punctures are the risk factors of adverse reactions of venous blood collection in patients with chronic diseases.