Table of Content

01 June 2023, Volume 29 Issue 11

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New Medical Advances

Research progress of programmed cell death-1 inhibitors in the treatment of thyroid carcinoma

Wang Yifei, Xue Haibo

2023, 29(11):  1481-1485.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.001

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Programmed cell death-1 (PD-1) / programmed cell death-ligand 1 (PD-L1) are important immune checkpoints, which play pivotal roles in suppressing anti-cancer immunity and are involved in immune escape mechanism of tumor cells. PD-1/PD-L1 inhibitors have achieved remarkable therapeutic effects in non-small-cell lung cancer, advanced melanoma, thyroid carcinoma, and other tumors by blocking the binding of PD-1 on activated T-cells to PD-L1 expressed on tumor cells. This paper mainly reviews the progress in PD-1 inhibitors in the treatment of thyroid carcinoma.

Research progress of epinephrine saline flushing solution in improving the visual field of arthroscopic surgery

Sun Yue, Gong Ronghua

2023, 29(11):  1485-1488.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.002

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This paper reviews the application research progress of epinephrine diluted flushing solution to improve the surgical field in arthroscopic surgery from the aspects of configuration, perfusion method, application scope, application effect, complications, and precautions, in order to provide evidences for clinical practices of improving the surgical field in arthroscopic surgery.

Progress and feasibility analysis of clinical application of hyperbaric oxygen chamber rehabilitation therapy

Zan Xingchun, Xu Jixiang, Zhou Xiaomei

2023, 29(11):  1489-1493.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.003

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This paper aimed to summarize the clinical application research progress, feasibility analysis, and mechanism research contents of hyperbaric oxygen chamber therapy synchronous rehabilitation therapy, discuss the existing research results, analyze the feasibility, and determine the next research direction. Literatures on rehabilitation in hyperbaric oxygen chamber was retrieved from CNKI and PubMed databases from January 2006 to December 2022, and the included literatures were analyzed from the aspects of research contents and research methods (experimental design, rehabilitation therapy techniques, research mechanisms, and evaluation methods). According to the research contents of the included literatures, they were roughly divided into 5 different directions according to the function: sports rehabilitation, cognitive rehabilitation, respiratory rehabilitation, musculoskeletal rehabilitation, and rehabilitation nursing. The hyperbaric oxygen in-cabin rehabilitation techniques involved in this study included comprehensive rehabilitation exercise training, motor ideation therapy, occupational cognitive therapy, neuromuscular electrical stimulation, bionic electrical stimulation, right median nerve electrical stimulation, acupuncture, artificial nose, and traction therapy, among which in-cabin physical therapy, occupational therapy, and traditional rehabilitation were the most common. In recent 10 years, the number of such studies had been increasing, and the experimental designs were diverse, including randomized controlled trials and paired trials. The subjects of the studies were mainly common patients in the rehabilitation department, and the curative effect evaluation methods were mainly various rehabilitation evaluation scales. The main mechanisms involved were: ① significantly improving the hemorheological indicators; ② promoting the repair of neurovascular units; ③ enhancing the central nerve plasticity; ④ activating related protease enzymes, growth factors, and triphosadenine (ATP). At present, the quantity and quality of clinical application researches of hyperbaric oxygen chamber rehabilitation therapy need to be improved, the clinical research contents are relatively simple, and the research methods are still in the exploratory stage. Most of the results of these studies focus on the clinical efficacy of dysfunction in the early post-traumatic brain injury and sequelae stage, and it is urgent to reveal the exact mechanism of action of hyperbaric chamber rehabilitation therapy through these studies. The effect of rehabilitation therapy in hyperbaric oxygen chamber still needs to be verified by further clinical mechanism research.

Special Column of Uterine Artery Embolization

Efficacy of simple uterine artery embolization in the treatment of placenta accreta after vaginal delivery

Ren Kunhai, Zheng Xiuqiong, Xu Rongli, Lin Jinxiao

2023, 29(11):  1494-1497.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.004

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Objective　To evaluate the clinical efficacy of simple uterine artery embolization for placenta accreta after vaginal delivery. Methods　A total of 33 patients with placenta accreta after vaginal delivery in Fujian Maternal and Child Health Hospital from January 2017 to December 2021 were retrospectively selected as the subjects, with an age of (31.21±3.64) years old, the number of pregnancies of (3.21±0.68), and the number of births of (0.79±0.12). The diagnosis timing, prenatal management, intrapartum management, postpartum management, and recovery time of human chorionic gonadotropin (HCG) were observed for the patients with placenta accreta after vaginal delivery. The patients' qualities of life before and after treatment were compared. Paired t test was used. Results　The 33 patients received targeted treatment and intervention according to their actual disease conditions at different stages of prenatal, intrapartum, and postpartum, and the time for HCG returning to normal was (35.24±6.13) d. After treatment, the patients' scores of physiological function [(81.09±3.17) points], mental state [(81.16±4.25) points], overall health [(81.34±3.07) points], vitality [(81.29±4.22) points], somatic pain [(83.48±3.08) points], physiological function [(81.56±4.35) points], emotional function [(81.54±4.27) points], and social function [(81.88±3.52) points] were higher than those before treatment [(73.24±4.55) points, (73.17±3.87) points, (73.28±5.43) points, (73.44±4.87) points, (75.49±5.27) points, (73.15±4.88) points, (74.28±3.48) points, and (74.48±3.84) points], with statistically significant differences (t=8.131, 7.985, 7.422, 6.997, 7.519, 7.390, 7.571, and 8.160; all P<0.001). Conclusion　Simple uterine artery embolization can produce ideal clinical efficacy in the treatment of patients with placenta accreta after vaginal delivery, and optimize the quality of life, so it is worthy of popularization and application.

Efficacy of dysmenorrhea after high intensity focused ultrasound vs uterine artery embolization for treatment of adenomyosis: a comparative study

Zhu Kejun, Fu Lipu, Li Xiaozheng, Hao Shihui, Zhang Zongcheng

2023, 29(11):  1497-1500.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.005

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Objective　To study the difference in the postoperative dysmenorrhea relief degrees of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) in the treatment of patients with adenomyosis. Methods　A retrospective analysis was conducted on the patients with adenomyosis and dysmenorrhea with complete clinical data who received HIFU treatment [40 cases, aged (38.10±3.23) years] or UAE treatment [36 cases, aged (38.22±3.30) years] from Liwan Central Hospital of Guangzhou from January 2018 to June 2021. All the patients were diagnosed as adenomyosis by MRI, and their dysmenorrhea degree was evaluated by the Visual Analogue Scale (VAS). The degrees of dysmenorrhea relief 1, 3, 6, and 12 months after surgery was observed. t test and χ² test were used. Results　The follow-up time of the HIFU treatment group [(15.3±1.3) months] and the UAE treatment group [(15.1±0.9) months] showed no statistically significant difference (t=1.325, P=0.134). There was no statistically significant difference in the VAS score between the two groups before surgery and 1, 3, and 12 months after surgery (all P>0.05). The VAS score of the UAE treatment group [(3.19±0.19) points] was lower than that of the HIFU treatment group [(3.68±0.14) points] 6 months after surgery, with a statistically significant difference (t=2.746, P=0.006). Conclusion　For patients with adenomyosis and dysmenorrhea, the short-term (6 months after treatment) efficacy of dysmenorrhea relief after UAE treatment is better than that of HIFU treatment.

Literature Analysis

Efficacy and safety of moxibustion for cancer-related fatigue: an overview of systematic reviews

Liu Jingyuan, Zhang Fan, Bai Yan, Zhou Wenqin

2023, 29(11):  1501-1506.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.006

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Objective　To overview the systematic reviews of efficacy and safety of moxibustion for cancer-related fatigue. Methods　The CNKI, VIP, Wanfang, CBM, PubMed, Web of Science, EMBASE, EBSCO, and OVID databases were searched to collect the systematic reviews on intervention of moxibustion on cancer-related fatigue from the establishment of databases to October 26, 2022. After literature screening and data extraction by two researchers, the AMSTAR 2 was used to evaluate the methodological quality of the included literatures, and the evidence quality of outcome indicators of the included literatures was evaluated by the GRADE system. Results　A total of 7 systematic reviews were included. Three studies were of low methodological quality and 4 studies were of very low methodological quality according to AMSTAR 2 scale. GRADE results showed that among the 25 outcome indicators, there were 1 moderate-quality indicators, 7 low-quality indicators, and 17 very-low-quality indicators. Conclusions　Moxibustion has a positive effect on cancer-related fatigue, but the methodological quality and evidence quality of relevant literatures are not high. More standardized and rigorous research still need to be further verified in the future. Clinical application of moxibustion has good safety, but the original studies have reported simple adverse reactions. The occurrence time of adverse reactions and the plan of preventive treatment methods should be reported in detail in the future.

Research hotspots and visualization analysis of return to work among cancer patients

An Ran, Huang Qinli, Liu Meizi, Li Minyan, Chen Wenfeng, Wu Zitong

2023, 29(11):  1506-1513.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.007

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Objective　To analyze the current research status, hot spots, and frontiers in the field of researches related to return to work for cancer patients. Methods　Using the Web of Science core collection database as the data source, we searched the literatures related to return to work of cancer patients from the establishment of the database to August 2022, and analyzed the countries/institutions, authors, and keywords of related studies using CiteSpace and VOSviewer. Results  A total of 2 172 relevant papers were included, and the number of publications had been increasing year by year in general. The United States, the United Kingdom, and the Netherlands had the most publications in this field, and the important research institutions were the University of Amsterdam in the Netherlands, the Harvard University in the United States, and the University of London in the United Kingdom. The research directions were mainly in oncology, public environmental and occupational health, and rehabilitation. The most published journal was Supportive Care in Cancer. The researches mainly focused on the impact of return to work with breast cancer on the quality of life, the patients' experiences and feelings of return to work with breast cancer, prostate cancer, leukemia, and head and neck cancer, and the long-term outcomes of return to work for cancer survivors. Qualitative meta-analysis, occupational therapy interventions, and mental health status of return to work with breast cancer and head and neck cancer were at the forefront of research. Conclusions  Developed countries in Europe and the United States, led by the United States, hold a leading position in research related to return to work of cancer patients, but there is still little research in this field in China. It is suggested that domestic scholars should refer to foreign experiences and management systems to promote return to work of cancer patients based on our national conditions.

Scientific Research

Investigation of KPC produced by Escherichia coli and Klebsiella pneumoniae in nosocomial infection in Xiamen area

Wang Suxin, Di Yueying, Zou Huiqing, Chen Xu, Zhang Yongxiang, Zhang Ling

2023, 29(11):  1514-1518.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.008

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Objective　To investigate the status of Klebsiella pneumoniae carbapenemase (KPC) production and its molecular epidemiological characteristics of Escherichia coli and Klebsiella pneumoniae isolated from nosocomial infection in Xiamen area. Methods　The antimicrobial susceptibility of isolates was assessed by using the VITEK 2 COMPACT 15 automated microbiological analysis system. The screening of carbapenemase phenotypes was performed using the modified Hodge experiments with imipenem as a guideline. The genotypes of KPCs were analyzed by polymerase chain reaction (PCR) and sequencing. The genotypes of Klebsiella pneumoniae and Escherichia coli were detected by pulsed field gel electrophoresis (PFGE). The cluster analysis was performed to investigate whether there was nosocomial dissemination or not. Results　Eighteen strains of Escherichia coli and Klebsiella pneumoniae which produced KPC in Xiamen, were highly resistant to common antibiotics and were sensitive to polymyxin only. The KPC genotype was KPC-2. The results of PFGE showed that 88.9% (16/18) of Klebsiella pneumoniae belonged to 16 genotypes and 11.1% (2/18) of Escherichia coli belonged to 2 genotypes. Conclusions　KPC-2 type Klebsiella pneumoniae in hospital in Xiamen area is resistant to common antibiotics, and there is no regional outbreak. It is necessary to strengthen the monitoring of nosocomial infection.

Efficacy of bone morphogenetic protein combined with parathyroid hormone in the evaluation of effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis

Ye Xiaoyan, Yu Jinlan, Song Xinxia, Yang Ling, Li Junjuan

2023, 29(11):  1518-1522.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.009

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Objective　To analyze the efficacy of bone morphogenetic protein (BMP) combined with parathyroid hormone (PTH) in the evaluation of effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis. Methods　A total of 120 patients with renal osteodystrophy after hemodialysis admitted to Yantai Laiyang Central Hospital from January 2019 to June 2021 were retrospectively selected as the study objects, including 63 males and 57 females, aged 20.52-78.96 years. After hemodialysis combined with hemoperfusion, clinical data such as BMP and PTH were collected and followed up for 1 year. The curative effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis during the follow-up period were recorded. The factors that affected the curative effect of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment were analyzed. The values of BMP and PTH in evaluating the ineffectiveness of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment were analyzed. Independent sample t test, χ² test, and multiple logistic regression analysis were used. Results　Among the 120 patients with renal osteodystrophy after hemodialysis, 20 patients (16.67%) were ineffective after hemodialysis combined with hemoperfusion treatment, and the remaining 100 patients (83.33%) were effective. There were no statistically significant differences in the gender, age, hypertension, hyperlipidemia, diabetes, smoking, drinking, systolic blood pressure, and albumin between the ineffective and effective groups (all P>0.05). The levels of BMP and PTH in the ineffective group were higher than those in the effective group (t=3.538 and 19.018, both P<0.001). Multifactor analysis showed that BMP and PTH were the factors affecting the efficacy of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment (OR=2.849, P=0.032; OR=2.770, P<0.001). The receiver operating characteristic curve (ROC) analysis results showed that the sensitivities of BMP, PTH, and their combination were 73.91%, 73.91%, and 86.95%, respectively, and the areas under the curves (AUCs) were 0.763, 0.758, and 0.860, respectively; the sensitivity of BMP combined with PTH was higher than those of BMP and PTH alone (both P<0.001). Conclusions　The levels of BMP and PTH are related to renal osteodystrophy in hemodialysis patients after hemodialysis combined with hemoperfusion treatment, and the risk of renal osteodystrophy is higher when BMP is at a high level. BMP combined with PTH to evaluate the efficacy of hemodialysis combined with hemoperfusion in patients with renal osteodystrophy after hemodialysis has a high efficacy.

Study on the therapeutic effect of ultra picosecond dual wavelength fractional laser on melisma

He Shiqi, Ma Shaoyin, Li Yueming, Li Peisi, Wang Yanfang, Zhu Huilan, Gong Yeqing

2023, 29(11):  1523-1527.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.010

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Objective　To study the efficacy and safety of ultra picosecond dual wavelength (1 064 nm combined with 532 nm) fractional laser in the treatment of melasma. Methods　A retrospective analysis was conducted on 45 patients with melasma, all female, aged (40.6±2.4) years, in the Laser Department of Guangzhou Institute of Dermatology from January 2019 to December 2022. They received treatment with ultra picosecond dual wavelength (1 064 nm combined with 532 nm) fractional laser every 4 weeks, a total of 3 times. The Melasma Area and Severity Index (MASI) was scored, and the VISIA was used to detect the positive UV spot, brown spot, spot, and erythema counts. The efficacy was observed by the Physician Global Assessment (PGA), and the adverse reactions were evaluated. Analysis of variance for repeated data and paired t test were used. Results　After 3 treatments, the PGA score showed that it was complete clearance in 2 cases (4.4%), basic clearance in 2 cases (4.4%), significant improvement in 5 cases (11.1%), moderate improvement in 19 cases (42.2%), mild improvement in 15 cases (33.3%), no improvement in 1 case (2.2%), and aggravation in 1 case (2.2%), with an improvement rate of 95.6%. There was a statistically significant difference in the MASI score before treatment and after 1, 2, and 3 treatments (F=7.287 0, P=0.000 2); compared with the baseline value [(19.32±10.36) points], the MASI score decreased significantly after 2 treatments [(12.13±7.27) points, t=2.919 0, P=0.004 9] and after 3 treatments [(9.49±6.65) points, t=4.372 0, P<0.000 1]. There was a statistically significant difference in the VISIA brown spot count before and after treatment (F=5.361 0, P=0.000 5); after 3 treatments, there was a decrease compared to the baseline value [(22.24±7.84) points vs. (29.06±8.72) points] (t=3.579 0, P=0.000 7). There was a statistically significant difference in the erythema count before and after treatment (F=5.072 0, P=0.000 7); compared with the baseline value [(18.80±9.51) points], the erythema count was significantly decreased after 2 treatments [(14.09±7.18) points, t=3.164 0, P= 0.0022] and after 3 treatments [(13.26±8.49) points, t=3.229 0, P=0.001 9]. The patients experienced mild pain during the surgery, followed by mild erythema, edema, and pigmentation, all of which subsided within 2-7 days, without any blister scar. Conclusion　The treatment of melasma with ultra picosecond dual wavelength fractional laser is effective and safe.

Analgesic effects of different doses of ropivacaine assisted epidural anesthesia in parturient delivery

Xing Yawei

2023, 29(11):  1528-1532.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.011

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Objective　To observe the effects of different doses of ropivacaine assisted epidural anesthesia in parturients' labor analgesia. Methods　This was a prospective randomized controlled trial. A total of 125 parturients who underwent painless labor in Pingdingshan First People's Hospital from March 2021 to June 2022 were included into the study. They were divided into two groups by lot drawing. Sixty-two parturients who were given conventional dose ropivacaine + epidural anesthesia were set as the control group, with an age of (29.15±0.33) years old and a gestational age of (37.55±0.23) weeks, including 37 primiparas and 25 multiparas. Sixty-three parturients who were given low-dose ropivacaine + epidural anesthesia were set as the observation group, with an age of (29.12±0.14) years old and a gestational age of (37.52±0.14) weeks, including 35 primiparas and 28 multiparas. The pain at different time points after medication, labor process, delivery, and medication safety were compared between the two groups. χ² test, Fisher exact probability method, and independent sample t test were used. Results　There were no statistically significant differences in the Visual Analogue Scale (VAS) scores between the two groups before medication, 30, 60, and 120 min after medication, and when the uterine orifice was fully opened (all P>0.05). The first stage of labor in the observation group was shorter than that in the control group [(10.35±0.85) h vs. (10.77±0.33) h] (t=3.631, P<0.001), and the second stage of labor was shorter than that in the control group [(1.33±0.28) h vs. (1.75±0.82) h] (t=3.844, P<0.001). The neonatal asphyxia rate of the observation group was lower than that of the control group [3.17% (2/63) vs. 14.52% (9/62)] (χ²=7.720, P=0.005), and the oxytocin application rate was lower than that of the control group [7.94% (5/63) vs. 17.74% (11/62)] (χ²=4.291, P=0.038). The postpartum modified Bromage score in the observation group was lower than that in the control group [(1.23±0.44) vs. (2.12±0.36)] (t=12.366, P<0.001), the amount of milk secreted within 24 h was higher than that in the control group [(33.15±5.23) ml vs. (30.11±5.16) ml] (t=3.271, P=0.001), and the incidence of adverse reactions was lower than that in the control group [6.35% (4/63) vs. 19.35% (12/62)] (χ²=4.735, P=0.030). Conclusions　The analgesic effect of low dose ropivacaine assisted epidural anesthesia is similar to that of conventional dose. Compared with conventional dose, low dose ropivacaine can shorten the parturients' labor process, and is of positive significance in improving the delivery situation, avoiding the motor nerve block, increasing the postpartum lactation, and reducing the adverse reactions after medication.

Effect observation of arthroscopy in the treatment of knee dislocation complicated with ligament injury

Yan Zhiqiang

2023, 29(11):  1533-1536.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.012

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Objective　To analyze the effect of arthroscopy in the treatment of knee dislocation complicated with ligament injury. Methods　It was a randomized controlled trial. The clinical data of 56 patients with knee dislocation complicated with ligament injury admitted to Department of Orthopedics, Linyi Traditional Chinese Medical Hospital from January 2020 to July 2022 were analyzed, and were divided into two groups by the random number table method. The 28 patients in the control group received routine surgery, including 19 males and 9 females, aged 22-63 (42.52±8.52) years. The 28 patients in the observation group received arthroscopic surgery, including 21 males and 7 females, aged 20-62 (43.51±8.39) years. The Visual Analogue Scale (VAS) score, joint extension angle and flexion angle, International Knee Documentation Committee Knee Function Form (IKDC) score, Lysholm score, and complication rate were compared and analyzed between the two groups. t test and χ² test were used for statistical analysis. Results　After surgery, the VAS score of the observation group was significantly lower than that of the control group [(3.09±0.73) points vs. (3.52±0.69) points], with a statistically significant difference (t=2.265, P=0.028); the flexion angle of the observation group was significantly higher than that of the control group [(116.49±5.62)° vs. (113.25±5.52)°], with a statistically significant difference (t=2.174, P=0.034); the IKDC and Lysholm scores in the observation group [(88.54±9.75) points and (79.56±9.65) points] were significantly higher than those in the control group [(83.25±9.25) points and (73.52±8.52) points], with statistically significant differences (t=2.083 and 2.483, both P<0.05). The complication rate of the observation group was lower than that of the control group [7.14% (2/28) vs. 28.57% (8/28)], with a statistically significant difference (χ²=4.383, P=0.036). Conclusion　The application of arthroscopy in the treatment of patients with knee dislocation complicated with ligament injury can effectively reduce the patients' postoperative pain, improve the level of knee joint functional recovery, at the same time, the incidence of complications is low, and has a high application value.

Study on the efficacy of stored and recovered autotransfusion in orthopedic elective surgery

Huang Aiqun, Wei Shuzhen, Chen Huihong, Ye Sicheng, Sun Kai

2023, 29(11):  1537-1540.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.013

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Objective　To investigate the efficacy and safety of stored and recovered autotransfusion in orthopedic non-tumor elective surgery. Methods　A retrospective analysis was conducted on 40 cases of elective surgery diagnosed as non-tumor diseases in the orthopedic department of the Fifth Affiliated Hospital of Guangzhou Medical University from July 2021 to June 2022, who were divided into an experimental group and a control group, with 20 cases in each group. There were 8 males and 12 females in the experimental group, aged (60.75±23.26) years; there were 12 males and 8 females in the control group, aged (57.00±16.95) years. The experimental group received stored and recovered autotransfusion, while the control group received allogeneic blood transfusion. The differences in hemoglobin (Hb), hematocrit (HCT), platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), blood transfusion volume, total hospital stay, postoperative hospital stay, and transfusion-related adverse reactions were compared between the two groups. t test and χ² test were used. Results　There were no statistically significant differences in the Hb, HCT, PLT, APTT, PT, FIB, blood transfusion volume, total hospital stay, and postoperative hospital stay between the experimental group and the control group (all P>0.05). Conclusion　Compared with allogeneic blood transfusion, stored and recovered autotransfusion is safe and effective in orthopedic elective surgery, which is of great significance to strengthen the patients' blood management during perioperative period and ensure the safety of surgery and clinical blood transfusion.

Study on the effect of total intravenous anesthesia with propofol pump and inhalation anesthesia on general anesthesia in radical gastrectomy

Luo Yun, Xu Guoting

2023, 29(11):  1541-1545.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.014

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Objective　To observe the effects of total intravenous anesthesia with propofol pump and inhalation anesthesia on general anesthesia and immune function in patients undergoing radical gastrectomy. Methods　This was a randomized controlled trial. A total of 136 patients with gastric cancer who received radical surgery for gastric cancer in The First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2022 were included in the study. The patients were divided into two groups by lotting, with 68 patients in each group. The patients who received total intravenous anesthesia with propofol pump were classified as the intravenous group [the ratio of men to women was 35/33, with an age of (55.24±5.17) years old], and the patients who received sevoflurane inhalation anesthesia were classified as the inhalation group [the ratio of men to women was 38/30, with an age of (55.33±5.25) years old]. The analgesic effects during and after surgery, immune function, and occurrence of anesthesia related adverse reactions were compared between the two groups. χ² test and t test were used. Results　Under different anesthesia schemes, the intraoperative heart rate (HR) in the intravenous group was higher than that in the inhalation group [(65.45±5.28) beats/min vs. (62.33±5.17) beats/min] (t=3.482, P<0.001), the mean arterial pressure (MAP) was higher than that in the inhalation group [(90.44±10.27) mmHg (1 mmHg = 0.133 kPa) vs. (85.33±10.16) mmHg] (t=2.917, P=0.004), the blood oxygen saturation was higher than that in the inhalation group [(98.24±5.11)% vs. (95.12±5.36)%] (t=3.474, P<0.001), and the respiratory rate (PR) was lower than that in the inhalation group [(20.26±2.35) times/min vs. (21.37±2.46) times/min] (t=2.691, P=0.008). The Visual Analogue Scale (VAS) scores of the intravenous group 1, 3, and 5 h after surgery were lower than those of the inhalation group (all P<0.05). Before surgery, there were no statistically significant differences in the T lymphocyte subsets, immunoglobulin (Ig), and other immune indexes between the two groups (all P>0.05). After surgery, the immune function of both groups was inhibited to some extent, but the CD3+ in the intravenous group was higher than that in the inhalation group [(38.77±5.16)% vs. (36.33±5.25)%] (t=2.733, P=0.007), the CD4+ was higher than that in the inhalation group [(45.15±5.24)% vs. (42.27±5.16)%] (t=3.229, P=0.002), the IgM was higher than that in the inhalation group [(1.22±0.35) g/L vs. (0.95±0.64) g/L] (t=3.052, P=0.003), and the IgA was higher than that in the inhalation group [(1.52±0.76) g/L vs. (0.96±0.61) g/L] (t=4.739, P<0.001). The incidence of anesthesia-related adverse reactions in the intravenous group was slightly higher than that in the inhalation group [7.35% (5/68) vs. 5.88% (4/68)] (χ²=0.175, P=0.676). Conclusions　Total intravenous anesthesia with propofol pump assisted radical gastrectomy can play more significant analgesic effect during and after surgery. Compared with inhalation anesthesia, total intravenous anesthesia has less inhibitory effect on patients' immune function, and does not significantly increase the risk of anesthesia related adverse effects in patients.

Basic Research

Investigating the protective mechanism of galangin against ulcerative colitis in mice based on the pathway of pyroptosis

Wang Haokun, Liu Chengxia

2023, 29(11):  1546-1552.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.015

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Objective　To explore the protective effect and possible mechanism of galangin on dextran sulfate sodium (DSS)-induced ulcerative colitis in mice, and provide a new method for the treatment of ulcerative colitis. Methods　Thirty C57BL/6 mice were divided into 5 groups with 6 mice in each group, namely the normal control group, the model group, the galangin group (40 mg·kg^-1·d^-1), the mesalazine group (0.5 g·kg^-1·d^-1), and the galangin combined with mesalazine group (galangin 40 mg·kg^-1·d^-1 and mesalazine 0.5g·kg^-1·d^-1). A mouse model of acute ulcerative colitis was established by continuous intervention with 3.5% DSS solution for 7 days, and drug intervention was performed at the same time as the model was established. The disease activity index (DAI) was calculated. All the mice were sacrificed after anesthesia on the 8th day, and the histological index (HI) score was performed. The levels of interleukin (IL)-1β and IL-18 in serum were detected by enzyme-linked immunosorbent assay (ELISA). The expressions of NLRP3 and cysteinyl aspartate specific proteinase (Caspase)-1 in the colon tissue were detected by immunohistochemistry. One-way ANOVA was used. Results　The DAI and HI scores in the model group were significantly increased, while those in the other treatment groups were decreased to varying degrees (all P<0.05). Immunohistochemical results showed that galangin reduced the expressions of NLRP3 and Caspase-1 (both P<0.01), and the combined effect of mesalazine was more significant (both P<0.05). ELISA results showed that galangin could inhibit the expressions of IL-1β and IL-18 (both P<0.05), and the combined effect of mesalazine was more significant (both P<0.05). Conclusion　Galangin can alleviate DSS-induced ulcerative colitis in mice, especially in combination with mesalazine, and its protective effect is partly achieved by inhibiting the pyroptosis.

Treatises

Phase III clinical study on efficacy and safety of acupuncture combined with conventional antiemesis versus conventional antiemesis in the prevention of CINV induced by hyperemetic chemotherapy regimen in patients with lung cancer

Yan Bingchuan, Ding Changqing, Jiang Peng, Li Xiaoshan, Wu Chuangzhou, Zhang Jie, Ma Lei

2023, 29(11):  1553-1556.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.016

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Clinical effect of low-temperature shock analgesia combined with muscle patch on CT contrast medium extravasation

Xu Jiying, Liang Lianbao, Zhao Zhenhua, Chen Weibiao

2023, 29(11):  1556-1560.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.017

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Objective　To investigate the clinical effect of low-temperature shock analgesia combined with muscle patch on patients with contrast medium extravasation during CT examination. Methods　From July 2016 to December 2021, 60 patients with contrast medium extravasation during CT angiography (CTA) examination were selected from Guangdong Second Provincial General Hospital by the handy sampling method, and were randomly divided into a control group and an observation group, with 30 patients in each group. In the control group, there were 19 males and 11 females, aged 44-74 (61.0±9.6) years; in the observation group, there were 20 males and 10 females, aged 48-72 (60.0±7.4) years. The control group used 50% magnesium sulfate for 1 h, 4 times a day, while the observation group used a low-temperature impact therapy analgesic device, followed by muscle patch. The Visual Analogue Scale (VAS) score, treatment effective rate, significant effective rate, onset time, and cure time were compared between the two groups. Independent sample t test and χ² test were used as statistical methods. Results　The VAS scores of the observation group 24 and 48 h after surgery were lower than those of the control group [(4.13±1.36) points vs. (5.33±1.23) points, t=2.535, P<0.05; (2.93±1.03) points vs. (4.00±1.07) points, t=2.779, P<0.05]. The significant effective rate of the observation group was higher than that of the control group [86.67% (26/30) vs. 63.33% (19/30)], with a statistically significant difference (χ²=4.356, P=0.037); there was no statistically significant difference in the effective rate between the two groups (χ²=0.162, P>0.05). The onset time and cure time in the observation group were shorter than those in the control group [(5.33±1.45) h vs. (6.67±1.35) h, t=2.613, P<0.05; (20.53±4.32) h vs. (23.60±3.80) h, t=2.065, P<0.05], with statistically significant differences. Conclusion　Low-temperature shock analgesia combined with muscle patch has a good effect on pain relief and swelling subsidence in patients with contrast medium extravasation, and is effective and convenient to operate, which is conducive to improving the nursing effectiveness of contrast medium extravasation and is worth further research and promotion.

Effects of Guanxin Ⅱ granules on vascular endothelial function and prognosis in patients after coronary stenting

Wu Kunsheng, Zhong Yujuan, Pan Huijing, Wang Yulin

2023, 29(11):  1560-1564.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.018

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Objective　To investigate the effects of Guanxin Ⅱ granules on vascular endothelial function and prognosis in patients after coronary stenting. Methods　From March 1, 2021 to February 28, 2022, 120 patients with coronary heart disease after coronary stenting in Shunde Hospital of Guangzhou University of Traditional Chinese Medicine were selected and were divided into two groups by the random number table method, with 60 cases in each group. There were 32 males and 28 females in the control group, aged (52.34±7.86) years. There were 35 males and 25 females in the research group, aged (51.63±8.42) years. The control group was treated with conventional western medicine after operation, and the research group took Guanxin Ⅱ granules on the basis of the control group for 6 months. The efficacies of the two groups and the changes of traditional Chinese medicine (TCM) syndrome score, Seattle Angina Questionnaire (SAQ) score, flow-mediated humeral artery endothelial-dependent diastolic function (FMD value), serum nuclear transcription factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), and endothelin-1 (ET-1) before and after treatment were evaluated. Both groups were observed until 6 months after operation to record the incidences of in-stent restenosis (ISR) and major adverse cardiovascular events (MACE). The statistical methods used were independent sample t test, paired t test, and χ² test. Results　The total effective rate of the research group was higher than that of the control group [91.67% (55/60) vs. 73.33% (44/60)], with a statistically significant difference (χ²=6.984, P=0.008). After treatment, the SAQ score, FMD value, and serum NO level in both groups were higher than those before treatment, the TCM syndrome score and serum NF-κB, TNF-α, IL-6, and ET-1 levels were lower than those before treatment, and the improvement was more significant in the research group (all P<0.05). Six months after surgery, the incidences of ISR [1.67% (1/60) vs. 13.33% (8/60)] and MACE [5.00% (3/60) vs. 16.67% (10/60)] in the research group were lower than those in the control group (χ²=4.324, P=0.038; χ²=4.227, P=0.040). Conclusion　Guanxin Ⅱ granules are effective after coronary stenting, which can effectively inhibit the inflammation, improve the vascular endothelial function, relieve the clinical symptoms, reduce the risk of MACE and ISR after operation, and thus improve the prognosis.

Effect of alprazolam on preoperative anxiety level and postoperative stress response in patients undergoing radical operation of lung cancer

Zhao Xiaoyan, Shang Pingping

2023, 29(11):  1565-1568.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.019

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Objective　To observe the effect of alprazolam in radical operation of lung cancer and its effects on preoperative anxiety and postoperative stress response. Methods　This was a prospective randomized controlled trial. A total of 125 patients with lung cancer who received radical resection in The First Affiliated Hospital of Henan University from October 2020 to December 2022 were selected as the subjects, and were divided into two groups by the lottery method. In the control group, there were 42 males and 20 females, aged (60.44±5.36) years. In the observation group, there were 40 males and 23 females, aged (61.25±5.41) years. The control group only received routine intervention, and the observation group received alprazolam tablets assisted surgical treatment before surgery. The preoperative psychological state, preoperative and postoperative stresses, postoperative recovery, and occurrence of adverse drug reactions were compared between the two groups. Independent sample t test, χ² test, and Fisher exact probability method were used for statistical analysis.  Results　The scores of preoperative Self-rating Anxiety Scale (SAS) and state anxiety and trait anxiety of the State-Trait Anxiety Inventory (STAI) in the observation group were lower than those in the control group [(41.22±5.76) points vs. (44.49±5.33) points, (40.36±5.33) points vs. (44.46±5.49) points, (41.35±5.46) points vs. (45.11±5.47) points], with statistically significant differences (t=3.293, 4.237, and 3.846; all P<0.05). Before surgery, there were no statistically significant differences in the stress indexes between the two groups (all P>0.05). After surgery, the levels of norepinephrine (NE), cortisol (Cor), and prolactin (PRL) in the observation group were lower than those in the control group [(4.32±1.06) mg/kg vs. (5.77±1.36) mg/kg, (376.45±50.61) nmol/L vs. (405.33±50.12) nmol/L, (14.23±5.16) mmol/L vs. (17.44±5.28) mmol/L], with statistically significant differences (t=6.655, 3.205, and 3.438; all P<0.05). After surgery, the Visual Analog Scale (VAS) score [(4.11±1.24) points vs. (5.63±1.27) points], intrathoracic drainage volume within 24 after surgery [(88.45±10.47) ml vs. (93.11±10.36) ml], extubation time [(3.61±1.22) d vs. (4.77±1.48) d], and length of hospital stay [(6.64±1.23) d vs. (7.88±1.46) d] in the observation group were all lower than those in the control group, with statistically significant differences (t=6.771, 2.501, 4.785, and 5.174; all P<0.05). The incidence of drug-related adverse reactions in the observation group was slightly higher than that in the control group [6.35% (4/63) vs. 4.84% (3/62)], but the difference was not statistically significant (P>0.05). Conclusion　Alprazolam assisted radical resection of lung cancer can reduce the patients' preoperative anxiety level and postoperative stress response, which is conducive to the patients' postoperative rehabilitation and does not increase the incidence of adverse reactions.

Clinical Research

Effect of thalidomide combined with CHOP chemotherapy regimen on the immune function in patients with B-cell non-Hodgkin lymphoma

Wang Yanjun, Zhang Lei, Sheng Xiuyun, Ye Dejing, Wang Jing

2023, 29(11):  1569-1572.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.020

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Objective　To investigate the effect of thalidomide combined with CHOP chemotherapy regimen on the immune function in patients with B-cell non-Hodgkin lymphoma. Methods　From June 2018 to June 2021, a total of 86 patients with B-cell non-Hodgkin lymphoma who received first-line chemotherapy in The Second People's Hospital of Liaocheng were selected and were divided into two groups by the random number table method. In the control group, there were 21 males and 22 females, ranging in age from 16 to 55 years old, with a median age of 32.7 years old. In the combined group, there were 22 males and 21 females, ranging in age from 16 to 58 years old, with a median age of 33.6 years old. The control group received CHOP chemotherapy regimen [vincristine (1.4 mg/m² d1) + epirubicin (50 mg/m² d1) + cyclophosphamide (750 mg/m² d1) + prednisone (100 mg qd d1-5)], and the combined group was given thalidomide (100 mg/d) on the basis of CHOP chemotherapy regimen, 21 days as 1 treatment cycle. The short-term curative effects, immune function [CD₃⁺ and immunoglobulin G (IgG)], and incidences of adverse reactions of the two groups were compared. t test and χ² test were used for statistical analysis. Results　In the control group, there were 13 cases of complete response, 8 cases of partial response, and 22 cases of no response; in the combined group, there were 22 cases of complete response, 8 cases of partial response, and 13 cases of no response. The effective rate of the combined group was 69.77% (30/43), which was higher than that of the control group [48.44% (21/43)] (χ²=4.900, P=0.027). There were no statistically significant differences in the levels of CD₃⁺ and IgG between the two groups before treatment (t=0.240 and 0.146, P=0.811 and 0.884). After treatment, the levels of CD₃⁺ and IgG in the two groups were higher than those before treatment (all P<0.05), and the levels of CD₃⁺ and IgG in the combined group were higher than those in the control group (t=2.131 and 11.939, P=0.036 and <0.001). The total incidence of adverse reactions was 18.60% (8/43) in the combined group and 16.28% (7/43) in the control group, with no statistically significant difference (χ²=0.081, P=0.776). Conclusion　Thalidomide combined with CHOP chemotherapy regimen can improve the clinical efficacy and immune function in patients with B-cell non-Hodgkin lymphoma, and it is safe and worthy of promotion.

Efficacy evaluation of lenvatinib combined with atezolizumab sequential TACE in the treatment of patients with hepatitis B complicated with advanced liver cancer

Liu Chunhua, Liu Ling, Tao Changming, He Yukai

2023, 29(11):  1573-1578.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.021

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Objective　To investigate the value of lenvatinib combined with atezolizumab sequential transhepatic arterial chemoembolization (TACE) in the treatment of patients with hepatitis B complicated with advanced liver cancer. Methods　This study was a randomized controlled trial. A total of 96 patients with hepatitis B complicated with advanced liver cancer admitted to Liaocheng People's Hospital from January 10, 2019 to September 10, 2022 were selected for the study, and were divided into an observation group and a control group according to the random number table method. In the control group, there were 25 males and 23 females, aged (54.52±7.13) years; in the observation group, there were 28 males and 20 females, aged (53.74±6.55) years. The control group was given conventional TACE treatment, and the observation group was given lenvatinib combined with atezolizumab sequential TACE treatment. The disease remission rate, disease control rate, liver function indexes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL)], cellular immune function indexes [lymphocytes (CD₃⁺, CD₄⁺, and CD₈⁺) and CD₄⁺/CD₈⁺], and infiltrative metastasis indexes [vascular endothelial growth factor (VEGF) and glypican-3 (GPC-3)] before and after treatment, and occurrence of adverse events were compared between the two groups. t test, χ² test, and Ridit test were used for statistical analysis. Results　The disease remission rate and disease control rate of the observation group were higher than those of the control group [72.92% (35/48) vs. 52.08% (25/48), 85.42% (41/48) vs. 62.50% (30/48)] (χ²=4.444, P=0.035; χ²=6.544, P=0.010). After treatment, the CD₃⁺, CD₄⁺, CD₄⁺/CD₈⁺ in the observation group were (64.28±5.35)%, (33.52±2.81)%, and (1.28±0.23), which were higher than those in the control group [(58.92±5.13)%, (28.75±2.63)%, and (1.03±0.19)]; the AST, ALT, TBIL, VEGF, GPC-3, and CD₈⁺ were (38.73±8.41) U/L, (47.62±10.39) U/L, (17.95±2.35) µmol/L, (312.58±33.45) ng/L, (10.75±1.98) µg/L, and (26.19±2.04)%, which were lower than those in the control group [(55.62±7.85) U/L,(67.88±11.55) U/L,  (22.46±2.71) µmol/L, (338.74±35.76) ng/L, (12.46±2.05) µg/L, and (27.91±2.13)%]; the differences were statistically significant (t=15.010, 8.587, 5.806, 10.172, 9.035, 8.711, 3.701, 4.156, and 4.040; all P<0.001). There was no statistically significant difference in the total incidence of adverse events between the observation group and the control group [31.25% (15/48) vs. 25.00% (12/48)] (P>0.05). Conclusion　Lenvatinib combined with atezolizumab sequential TACE has better clinical effect in the treatment of patients with hepatitis B complicated with advanced liver cancer, which can effectively reduce the immune suppression, improve the liver function, and alleviate the disease.

Application effect of whole-body vibration training in stroke patients with hemiplegia

Jiang Hengwei, Yu Liying, You Jian, Zheng Qian

2023, 29(11):  1578-1582.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.022

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Objective　To explore the effects of whole-body vibration training on the balance function, fall risk, and quality of life in stroke patients with hemiplegia. Methods　It was a randomized controlled trial. By the random number table method, 104 stroke patients with hemiplegia admitted to Weihai Central Hospital from January 2020 to September 2022 were divided into a control group (52 cases) and a study group (52 cases). The control group consisted of 31 males and 21 females, aged (63.06±6.54) years. The study group consisted of 29 males and 23 females, aged (63.37±6.59) years. The control group received clinical routine rehabilitation therapy + sham whole-body vibration training, while the study group received clinical routine rehabilitation therapy + whole-body vibration training. The patients' balance function was evaluated by the front-back tilt angle (F-BIA), left-right tilt angle (L-RIA), and standing time of the affected side. The patients' fall risk was assessed by the Morse Fall Risk Assessment Scale (MFS). The patients' quality of life was assessed by the Generic Quality of Life Inventory-74 (GQOLI-74). The balance function, fall risk, and quality of life were compared between the two groups before and after treatment. The measurement data were compared by two independent samples t-test and paired t-test, and the count data were compared by four grid table χ² test. Results　After treatment, the F-BIA, L-RIA, and standing time of the affected side were all higher than those before treatment in both groups, and those in the study group were higher than those in the control group [(1.37±0.76)° vs. (1.03±0.62)°, (3.24±1.36)° vs. (2.11±1.03)°, (4.58±2.17) s vs. (3.12±1.43) s] (all P<0.05). After treatment, the MFS scores in both groups were lower than those before treatment [(31.07±4.12) points vs. (82.57±8.67) points, (43.54±5.26) points vs. (82.15±8.62) points] (both P<0.05), and the MFS score in the study group was lower than that in the control group (t=13.458, P<0.001). After treatment, the scores of physical function, psychological function, material function, and social function and total score of quality of life in both groups were higher than those before treatment, and those in the study group were higher than those in the control group (all P<0.05). Conclusion　Compared with conventional rehabilitation therapy, combined whole-body vibration training can significantly improve the balance function in stroke patients with hemiplegia, reduce their fall risk, and improve their quality of life, which has clinical promotion value.

Case Report

Graves ophthalmopathy caused by durvalumab: one case report

Zhang Shanlan, Liu Xiaohui, Ke Jin, Wang Hengshi, Xiao Sufang

2023, 29(11):  1583-1584.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.023

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Cardiac infiltration in acute lymphoblastic leukemia: a case report

Chu Wenhui, Gao Na, Liu Zengyan, Luo Liqing, Gu Wenrong, Yu Wenzheng

2023, 29(11):  1585-1588.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.024

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Acute leukemia is a malignant clonal disease of hematopoietic stem cells. Leukemic cells proliferate and infiltrate in bone marrow, resulting in inhibition of normal hematopoietic function of bone marrow. At the same time, leukemic cells can also grow and infiltrate in extramedullary tissue. Patients' multiple parts or organs can be involved. The common sites of extramedullary infiltration in acute lymphoblastic leukemia are liver, spleen, lymph nodes, central nervous system, testis and so on. Cardiac infiltration in acute lymphoblastic leukemia is very rare. This paper reports a case of cardiac infiltration in acute lymphoblastic leukemia admitted to Binzhou Medical University Hospital in December 2021, and analyzes the process of diagnosis and treatment, in order to provide some reference for clinic.

A case of plasma cell mastitis misdiagnosed as lactating mastitis

Zhou Bingyu, Hu Pingping

2023, 29(11):  1588-1590.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.025

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Plasma cell mastitis is also known as mammary duct ectasia, and is a chronic breast disease with long course of disease and complex lesions, characterized by plasma cell infiltration and mammary duct ectasia. It is mostly non-nursing and is less common during breastfeeding. Because of its unknown cause, it is mostly confused with diseases such as breast cancer. Its misdiagnosis rate reaches to 56.9%-73.1%. In order to raise the awareness of plasma cell mastitis and reduce the clinical misdiagnosis rate, this paper reviews the clinical data of 1 patient with plasma cell mastitis in Department of Breast Surgery, Weihai Central Hospital Affiliated to Qingdao University.

Nursing Research

Analysis of the correlations between work stress in specialty nurses in tuberculosis and their own factors

Wu Ling, Liu Yumei, Zhou Minjuan, Bao Wanling, Chen Yumei, Zeng Huazhi

2023, 29(11):  1591-1595.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.026

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Objective　To investigate the experiences of work stress for specialty nurses in tuberculosis with different ages, professional titles, and educational backgrounds, to comprehensively evaluate the influences of their own factors on work stress, and to improve their physical and mental adaptabilities. Methods　A cross-sectional study was conducted on 249 nurses aged 18-50 years (average age 32 years old) in Guangzhou Chest Hospital in July 2020. A questionnaire survey was conducted on 35 items of 5 dimensions of the Nurse Job Stressor Scale. Each item was scored with 1-4 points according to the 4-level scoring method of "never encountered or experienced", "sometimes encountered or experienced", "often encountered or experienced", and "encountered or experienced almost every day". The total score of 35 items was divided into three levels, namely 35-70 points, 71-105 points, and 106-140 points, and the work pressure was divided into mild, moderate, or severe degree. The work pressure of nurses in tuberculosis specialty was analyzed descriptively, and the differences among nurses with different ages, professional titles, and educational backgrounds were compared. Statistical methods used were χ² test and Fisher exact probability method. Results　The rates of severe work stress in the ≥ 36-46 years old [22.41% (13/58)] and ≥46 years old groups [18.18% (12/66)] were higher than those in the ≤25 years old [6.78% (4/59)] and 25-36 years old groups [12.12% (8/66)]. When the two groups were combined for comparative analysis of the three age groups, there was a statistically significant difference among the three groups (χ²=6.191, P=0.045), but there was no statistically significant difference in the three work pressure levels (P>0.05). The rate of severe work pressure in the nurse practitioners [20.75% (22/106)] was higher than those in the nurses, supervisor nurses, and deputy chief nurses [6.49% (5/77), 16.67% (9/54), and 0] (P=0.007) (there was only one chief nurse, so ignored). The rates of moderate work stress in the nurses with junior college and undergraduate as the first educational backgrounds were higher than that in the nurses with technical secondary school as the first educational background [70.80% (80/113), 70.97% (22/31) vs. 55.24% (58/105)] (χ²=6.431, P=0.04). The rate of severe work stress in the nurses with technical secondary school as the first educational background was higher than those in the nurses with junior college and undergraduate as the first educational backgrounds [20.95% (22/105) vs. 9.73% (11/113) and 12.90% (4/31)], but there was no statistically significant difference among the three groups (χ²=5.51, P=0.64). There were no statistically significant differences among other groups (all P>0.05). Conclusions　Nurses over 35 years old, with technical secondary school educational background, and with nurse practitioner title have more work stress. So it is essential that hospital managers pay close attention to them for helping them relieve and release the work stress.

Effect of fishbone diagram analysis combined with PDCA in improving the nurses' ability to prevent the pressure injury

Jiang Qiaoxia, Li Liuying, Zuo Man, Zeng Xueling

2023, 29(11):  1595-1598.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.027

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Objective　To explore the effect of fishbone diagram analysis combined with PDCA in improving the nurses' ability to prevent the pressure injury. Methods　This study was a quasi-experimental study. A total of 31 nurses were selected as the research subjects from Heyuan Hospital of Guangdong Provincial People's Hospital in December 2021, with working life of 4-30 years, aged (31.32±7.27) years. Since January 2022, we analyzed the factors that affected nurses' pressure injury risk assessment ability by drawing a fishbone diagram. Then we carried out the PDCA activities: (1)defining the work responsibilities and assessment system of the members of the specialist team; (2)refining the workflow to enhance the high-risk assessment of pressure injury; (3)developing pictorial health education manual and video for pressure injury prevention. The scores of nurses' pressure injury related knowledge and the implementation rate of pressure injury prevention measures for high-risk patients were compared before the implementation (December 2021) and after the implementation (June 2022). Paired t test and χ² test were used for statistical analysis. Results　After the implementation of PDCA activities, the score of nurses' stress injury related knowledge examination was higher than that before the implementation [(87.27±15.53) points vs. (60.45±8.18) points], and the implementation rate of pressure injury prevention measures for high-risk patients was higher than that before the implementation [88.83% (152/172) vs. 77.69% (101/130)], with statistically significant differences (t=-8.74, P=0.02; χ²=6.21, P=0.01). Conclusion　Fishbone diagram analysis and PDCA can improve the nurses' ability to prevent the pressure injury.

Impact of nutrition intervention-oriented prospective nursing for patients with advanced breast cancer

Tian Ruiting, He Jianxin

2023, 29(11):  1599-1603.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.028

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Objective　To analyze the effect of nutrition intervention-oriented prospective nursing for patients with advanced breast cancer treated by chemotherapy combined with disulfiram. Methods　This study was a randomized controlled trial. A total of 80 patients with advanced breast cancer who received chemotherapy combined with disulfiram in The First Affiliated Hospital of Henan University from June 2019 to May 2022 were prospectively selected  and were divided into two groups according to the random number table method. The control group was (52.16±8.27) years old; the pathological types included 36 cases of invasive ductal carcinoma and 4 cases of invasive lobular carcinoma; there were 16 cases of menopause and 24 cases of premenopause; the molecular subtypes included 23 cases of Luminal type, 13 cases of triple-negative type, and 4 cases of human epidermal growth factor receptor-2 (Her-2) overexpression type. The observation group was (53.05±7.29) years old; the pathological types included 34 cases of invasive ductal carcinoma and 6 cases of invasive lobular carcinoma; there were 18 cases of menopause and 22 cases of premenopause; the molecular subtypes included 22 cases of Luminal type, 15 cases of triple-negative type, and 3 cases of Her-2 overexpression type. The control group received routine nursing intervention, and the observation group received nutrition intervention-oriented prospective nursing intervention on the basis of the control group. The two groups were compared in terms of nutritional status and immune function [peripheral blood immunoglobulin A (IgA), IgM, IgG, and T-lymphocyte subsets (CD₃⁺, CD₄⁺, and CD₄⁺/CD₈⁺)] and quality of life [Functional Assessment of Cancer Therapy-Breast (FACT-B)] before and after intervention. Statistical methods used were χ² test, t test, and u test. Results　The rate of good nutrition in the observation group was higher than that in the control group [70.00% (28/40) vs. 55.00% (22/40)] (u=2.240, P<0.05). After intervention, the levels of CD₃⁺, CD₄⁺, CD₄⁺/CD₈⁺, and serum IgA, IgM, and IgG in the observation group were higher than those in the control group [(50.12±3.88) vs. (39.76±4.04), (37.22±3.51) vs. (30.64±2.99), (1.41±0.15) vs. (1.29±0.18), (2.14±0.31) g/L vs. (1.85±0.27) g/L, (1.94±0.33) g/L vs. (1.36±0.28) g/L, (11.62±3.50) g/L vs. (10.07±2.84) g/L], with statistically significant differences (t=11.697, 9.026, 3.239, 4.462, 8.476, and 2.175; all P<0.05). After intervention, the scores of emotional status, physiological status, functional status, social and family status, and additional attention in the observation group were higher than those in the control group [(20.15±3.07) points vs. (16.14±2.58) points, (22.13±3.85) points vs. (17.69±3.24) points, (22.64±3.59) points vs. (17.83±3.12) points, (20.36±4.58) points vs. (17.14±4.09) points, (27.12±7.39) points vs. (20.45±6.80) points], with statistically significant differences (t=6.324, 5.581, 6.396, 3.317, and 4.201; all P<0.05). Conclusion　Nutrition intervention-oriented prospective nursing can improve the nutritional status, immune function, and quality of life in patients with advanced breast cancer treated by chemotherapy combined with disulfiram.

Effects of evaluative nutritional nursing measures on the immune function and quality of life in hemodialysis patients

2023, 29(11):  1604-1608.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.029

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Objective　To explore the effects of medical nutrition nursing model on the immune function and quality of life in hemodialysis patients. Methods　This study was a randomized controlled trial. A total of 60 hemodialysis patients in Xuzhou No.1 People's Hospital from January 2021 to January 2022 were selected as the study objects, and were divided into a control group and an observation group of 30 cases in each group according to the random number table method. In the control group, 19 males and 11 females, aged (50.16±4.87) years, were given routine nursing. In the observation group, 18 males and 12 females, aged (50.49±4.28) years, were given medical nutrition nursing model on the basis of routine nursing. The immune function, self-management behaviors, and qualities of life were compared between the two groups. Independent sample t test and χ² test were used. Results　After intervention, the body mass index [(23.18±3.50) kg/m²], levels of total protein [(63.33±3.17) g/L], albumin [(35.41±6.24) g/L], and hemoglobin [(119.18±18.35) g/L], and scores of physical function [(22.23±1.16) points], psychological function [(22.16±1.05) points], social function [(21.96±1.28) points], environment [(22.13±1.78) points], peer relationship [(14.31±0.55) points], executive self-care [(17.71±0.45) points], problem solving [(19.31±4.34) points], and mood change [(10.23±0.88) points] in the observation group were higher than those in the control group [(21.27±2.54) kg/m², (61.03±3.01) g/L, (32.05±3.57) g/L, (110.59±14.33) g/L, (18.47±1.12) points, (17.84±1.46) points, (17.96±1.34) points, (18.46±1.86) points, (13.94±0.77) points, (17.25±0.60) points, (16.67±3.97) points, and (9.56±0.73) points], with statistically significant differences (t=2.419, 2.882, 2.559, 2.021, 16.488, 16.986, 15.263, 10.079, 2.142, 3.359, 2.458, and 3.209; all P<0.05). Conclusion　The medical nutrition nursing model for hemodialysis patients can improve the immune function and quality of life, and improve their self-management behaviors, which is conducive to their early recovery and is worthy of clinical promotion.

Effect of hyperbaric oxygen combined with thumb-tack needle therapy on pain in patients with calcaneal fracture

Li Yunxiang, Cheng Limin, Huo Xuechen

2023, 29(11):  1608-1611.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.030

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Objective　To study the effect of hyperbaric oxygen combined with thumb-tack needle on the control of perioperative acute pain in patients with calcaneal fracture. Methods　This study was a randomized controlled trial. Ninety cases of calcaneal fracture who were admitted to Department of Traumatic Orthopedics, Yantai Mountain Hospital from October 2021 to August 2022 were selected and were divided into 3 groups with 30 cases in each group according to the random number table method. In the control group, 20 males and 10 females, aged (36.9±6.3) years, were treated with conventional analgesic measures, such as drug analgesia and cold compress. In the hyperbaric oxygen group, 21 males and 9 females, aged (37.4±5.7) years, were treated with hyperbaric oxygen on the basis of the control group. In the combined group, 19 males and 11 females, aged (37.2±5.9) years, were treated with thumb-tack needle on the basis of the hyperbaric oxygen group. The Numerical Rating Scale (NRS) scores of the three groups were compared before and at different time points after surgery. Analysis of variance, SNK-q test, and χ² test were used. Results　There were statistically significant differences in the resting pain score 1 day before surgery [(5.3±0.9) points vs. (4.1±1.1) points vs. (2.6±0.8) points] and 1 day after surgery [(7.5±1.2) points vs. (5.5±1.2) points vs. (3.7±1.2) points] and in the exercise pain score 7 days after surgery [(6.1±0.6) points vs. (4.2±0.7) points vs. (2.8±0.6) points] (all P<0.001). Compared with those in the control group, the resting pain scores 1 day before surgery [(4.1±1.1) points, (2.6±0.8) points vs. (5.3±0.9) points] and 1 day after surgery [(5.5±1.2) points, (3.7±1.2) points vs. (7.5±1.2) points] and the exercise pain scores [(4.2±0.7) points, (2.8±0.6) points vs. (6.1±0.6) points] 7 days after surgery in the hyperbaric oxygen group and the combined group were significantly lower, with statistically significant differences (all P<0.05). The resting pain scores 1 day before surgery and 1 day after surgery and the exercise pain score 7 days after surgery [(2.6±0.8) points, (3.7±1.2) points, and (2.8±0.6) points] in the combined group were lower than those in the hyperbaric oxygen group [(4.1±1.1) points, (5.5±1.2) points, and (4.2±0.7) points], with statistically significant differences (all P<0.05). Conclusion　Hyperbaric oxygen combined with thumb-tack needle therapy can effectively relieve the perioperative pain, improve the quality of life, and promote rapid and good recovery for patients with calcaneal fracture.

Application effect of early rehabilitation nursing in elderly patients with osteoporotic vertebral compression fracture

Wu Yanyan, Ma Sujie

2023, 29(11):  1612-1616.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.031

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Objective　To explore the application effect of early rehabilitation nursing in elderly patients with osteoporotic vertebral compression fracture (OVCF) undergoing surgery. Methods　A total of 96 elderly OVCF patients who underwent surgery in The First Affiliated Hospital of Henan University from January 2020 to October 2022 were prospectively selected, and were divide into two groups according to the time of admission with 48 patients in each group. In the control group, 10 males and 38 females, aged (68.12±2.18) years, were given routine nursing intervention; in the observation group, 9 males and 39 females, aged (67.87±2.59) years, were given early rehabilitation nursing on the basis of routine nursing intervention. The disease indicators (gastrointestinal functional recovery time, first time of getting out of bed, and length of hospital stay), complication rates, and scores of Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Exercise of Self-care Agency Scale (ESCA), and Barthel Index (BI) of the two groups were compared. t test and χ² test were used. Results　The first time of getting out of bed [(47.15±6.58) h], the recovery time of gastrointestinal function [(3.14±0.53) d], and the length of hospital stay [(7.98±1.06) d] in the observation group were shorter than those in the control group [(59.67±6.82) h, (3.76±0.59) d, and (10.11±1.47) d], with statistically significant differences (all P<0.05). The incidence of complications in the observation group was lower than that in the control group [2.08% (1/48) vs. 16.67% (8/48)], with a statistically significant difference (χ²=4.414, P=0.036). The VAS scores of the observation group 3 d after surgery and at discharge [(3.18±0.44) points and (2.06±0.52) points] were lower than those of the control group [(3.52±0.41) points and (2.69±0.53) points], with statistically significant differences (both P<0.05). At discharge, the ODI score of the observation group [(18.97±2.11) points] was lower than that of the control group [(21.36±2.03) points], while the BI score [(75.26±4.67) points] and ESCA score [(123.45±8.22) points] were higher than those of the control group [(69.77±5.03) points and (113.61±7.11) points], with statistically significant differences (all P<0.05). Conclusion　Early rehabilitation nursing can reduce the risk of postoperative complications in elderly patients with OVCF, relieve the pain, promote the recovery of the disease, and help them improve the ability of self-care and life activities.

Application effect of family nursing model in diabetic patients during the COVID-9 outbreak

Li Chen, Ding Juan, Zhang Yujie, Chen Yuyan, Min Qi

2023, 29(11):  1616-1619.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.032

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Application of 4P medical model in artificial airway management of patients with cerebral hemorrhage

Li Hui, Chen Xiaorong, Yang Xiujie, Li Lingling, Li Xia

2023, 29(11):  1620-1624.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.033

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Objective　To investigate the application of 4P medical model in artificial airway management of patients with cerebral hemorrhage. Methods　This was a randomized controlled trial. A total of 122 patients with cerebral hemorrhage admitted to Liaocheng Third People's Hospital from January 2019 to June 2021 were selected and were divided into a control group and an observation group according to the single and even order of admission with 61 cases in each group. The control group included 35 males and 26 females, aged (54.29±7.50) years; the observation group included 38 males and 23 females, aged (53.76±7.42) years. All the patients received artificial airway assisted respiration and routine intervention. On this basis, the patients in the observation group were additionally given 4P medical model intervention. The psychological status [scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD)], sputum viscosity, incidence of complications, quality of life score, and patient satisfaction were compared between the two groups. t test and χ² test were used. Results　After intervention, the scores of HAMA [(14.36±3.19) points] and HAMD [(9.28±2.65) points] in the observation group were lower than those in the control group [(19.55±5.01) points and (15.49±3.29) points], with statistically significant differences (t=6.825 and 11.481, both P<0.05). The phlegm viscosity of the observation group was better than that of the control group (P<0.05). The incidence of complications in the observation group [8.20% (5/61)] was lower than that in the control group [24.59% (15/61)], with a statistically significant difference (χ²=13.511, P<0.001). After intervention, the scores of physical function [(57.88±9.23) points], role physical [(68.01±11.28) points], physical pain [(47.36±9.18) points], vitality [(58.95±10.20) points], social function [(62.17±12.55) points], role emotional [(58.06±10.11) points], mental health [(64.05±10.29) points], and overall health [(66.29±14.80) points] in the observation group were higher than those in the control group [(52.03±7.39) points, (62.50±8.19) points, (44.21±7.30) points, (54.22±8.01) points, (57.90±9.33) points, (53.90±8.77) points, (59.37±7.80) points, and (60.21±12.27) points], with statistically significant differences (t=3.864, 3.087, 2.098, 2.848, 2.133, 2.428, 2.831, and 2.470; all P<0.05). The patient satisfaction rate in the observation group [96.72% (59/61)] was higher than that in the control group [80.33% (49/61)], with a statistically significant difference (χ²=8.069, P=0.005). Conclusion　The application of 4P medical model in artificial airway management of patients with cerebral hemorrhage can relieve the bad mood, improve the sputum viscosity, reduce the incidence of complications, and improve the quality of life.

Medical Education

Application of BOPPPS teaching method in clinical teaching of optometry

Lin Shaojing, Gao Lei, Wang Xu

2023, 29(11):  1625-1628.  DOI: 10.3760/cma.j.issn.1007-1245.2023.11.034

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Objective　To explore the effect of applying the BOPPPS teaching method to clinical teaching of optometry in order to improve the quality of clinical teaching of optometry. Methods　This paper adopted a randomized experimental design. Forty internship students of clinical optometry in The Second People's Hospital of Jinan from June 2022 to January 2023 were selected for the study and were divided into two groups, 18 students in the control group and 22 students in the experimental group. In the control group, 6 males and 12 females, aged (22.0±0.7) years, received the traditional teaching method; in the experimental group, 8 males and 14 females, aged (22.0±0.6) years, received the BOPPPS teaching method. The teaching effects of the two groups were compared by means of theoretical test, experimental operation assessment, and questionnaire survey. Independent sample t test was used for the measurement data and χ² test was used for the count data. Results　The learning enthusiasm, clarity of learning objectives, practical operation opportunity, thinking and analyzing abilities, and learning satisfaction of the experimental group were better than those of the control group, with statistically significant differences (all P<0.05). The practical score [(94.36±4.28) points], theoretical score [(79.55±4.45) points], and total score [(85.47±3.73) points] of the experimental group were higher than those of the control group [(90.28±3.77) points, (75.28±7.70) points, and (81.28±5.20) points], with statistically significant differences (all P<0.05). Conclusion　Compared with the traditional teaching method, BOPPPS teaching method can improve the learning performance and learning effectiveness in the internship students.