Table of Content

01 July 2023, Volume 29 Issue 13

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New Medical Advances

Advances in the application of machine learning in hemodialysis treatment

Zhou Hongming, Li Yunyi, Li Weilong, Song Zhuoheng, Chen Yu, Cao Rui, Hu Bo, Luan Shaodong, Yin Lianghong

2023, 29(13):  1777-1781.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.001

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Hemodialysis centers are mostly for patients with chronic kidney disease, and most patients choose hemodialysis for treatment. But hemodialysis also imposes a burden of expensive medical costs and adverse reactions on patients. With the development of machine learning, machine learning has shown satisfactory results in vascular access, complications, and prognosis of hemodialysis. Therefore, grasping machine learning and using this tool are beneficial to doctors and nurses in hemodialysis room, which can ultimately improve the quality of life in hemodialysis patients.

Roles of epigenetics and miRNA in depression

Chen Guanhong, Yu Mingzi, Fang Yuhan, Cheng Xuefeng, Li Qi, Li Chen

2023, 29(13):  1782-1786.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.002

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Depression, one of the most important types of modern mental illness, is a common emotional disorder with continuous and long-term depression as its main clinical feature. Recent studies have shown that dysexpression of miRNA is associated with a variety of human diseases, including cancer and psychology-related diseases, and miRNA plays an important role in the pathogenesis of depression and antidepressant treatment. Epigenetics refers to the biological phenomenon of long-term heritable gene function changes without changes in DNA sequence, including histone modification, DNA methylation, and miRNA regulation. Many studies have shown that dysregulation of epigenetic modification is the key to elucidating the pathogenesis of depression. This paper reviews the recent progress in epigenetic pathogenesis of depression and the role of miRNA in depression, in order to provide reference for the pathogenesis study and treatment of depression.

Application progress of non-invasive imaging technology in assessment of blood brain barrier permeability in ischemic stroke 

Zhou Jianguo, Fu Dayong, Wang Yundan

2023, 29(13):  1786-1789.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.003

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The blood brain barrier (BBB) is the main structure of the central nervous system that regulates the entry and exit of molecules and cells. BBB can protect brain tissues from toxins, promote the material transport, and maintain the ion balance. Ischemic stroke (IS) is characterized by high incidence rate, high recurrence rate, and high mortality and disability rate. Based on the characteristics of BBB structure and function damaged and permeability increased in the core area of infarction, the imaging methods for non-invasive assessment of BBB structure and function include: magnetic resonance dynamic contrast enhanced imaging (DCE-MRI), CT perfusion imaging (CTP), magnetic resonance arterial spin labeling (ASL) sequence, etc. The ASL is non-invasive, safe, and convenience, and has attracted extensive clinical attention. This article reviews the clinical application of non-invasive imaging techniques, especially ASL, in BBB assessment of ischemic cerebrovascular disease.

Clinical research progress of miRNA in pancreatic cancer

Zhu Peng, Peng Mingzhu, Wu Lili

2023, 29(13):  1790-1794.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.004

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Pancreatic cancer (PC) is a very common malignant tumor of the digestive system, with obscure onset, high malignancy, and poor prognosis. The pathogenesis of PC is very complex, and many factors play a regulatory role. miRNA is a short strand RNA which does not have coding function, and it can regulate the physiological and pathological functions by directly inhibiting the expression of target genes. A large number of studies have shown that specific miRNAs are abnormally expressed in PC, and these miRNAs play important regulatory roles in the pathogenesis and progression of PC. At the same time, clinical studies have shown that specific miRNAs, as non-invasive biological indicators, also have important potential values in the early diagnosis and clinical prognosis of PC. Scholars have also tried to develop PC therapeutics based on specific miRNAs. Although the results are only basic at present, they still provide an important reference for searching for new PC therapeutics.

Research progress of baicalin in respiratory diseases

Kuang Zheshu, Wu Fuling

2023, 29(13):  1794-1797.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.005

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The pharmacological activity of traditional Chinese medicine baicalin has anti-oxidation, anti-inflammatory, anticancer, and antiviral effects, and its main effects can be used in the treatment of bronchitis, asthma, mycoplasma pneumonia, and other respiratory diseases. In recent years, more and more studies have found that the mechanism of baicalin in treating various lung diseases is different. This paper aims to review the research progress of the latest discovery of baicalin in respiratory diseases.

Meta Analysis

Meta-analysis of early diagnostic value of microRNA-208 in acute myocardial infarction 

Wang Yixiang, Liu Jun

2023, 29(13):  1798-1803.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.006

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Objective　To study the value of microRNA-208 (miR-208) in the early diagnosis of acute myocardial infarction (AMI) in clinical practice. Methods　PubMed, Medline, Web of Science, CNKI, and Wanfang databases were searched for literatures on the diagnosis of AMI by miR-208 from the establishment of the databases to January 20, 2021. Meta-analysis of the literatures was performed by using MetaDisc 1.4 software and RevMan 5.3. Results　Ten studies of moderate to high quality were included. The combined sensitivity of miR-208 for diagnosing AMI was 0.77 (95%CI 0.74-0.79), the specificity was 0.84 (95%CI 0.82-0.86), and the area under the summary receiver operating characteristic curve (SROC-AUC) was 0.894 2. Conclusion　As a novel marker, miR-208 has high sensitivity and specificity for early diagnosis of AMI, which can assist in the early diagnosis of AMI.

Meta analysis of urinary retention after radical resection of cervical cancer treated by warming yang and transforming qi method

Chen Sida, Sun Yanmei, Hu Xiangdan, Xiao Jing

2023, 29(13):  1803-1807.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.007

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 Objective　To evaluate the efficacy of warming yang and transforming qi in the treatment of urinary retention after radical resection of cervical cancer by meta analysis system. Methods　Chinese National Knowledge Infrastructure (CNKI), Wanfang data Medical Information system, VIP Information Resource system (VIP), Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library, and Web of Science were searched from the date of establishment of the databases to January 31, 2023. Cochrane bias risk assessment tool was used to evaluate the quality of included literatures, and RevMan 5.4 software was used for meta analysis. Results　A total of 352 patients were included in 5 literatures. The results of meta analysis showed that the adjuvant therapy of warming yang and transforming qi could reduce the incidence of urinary retention after radical resection of cervical cancer (OR=0.13, 95%CI [0.04, 0.40], Z=3.55, P=0.000 4) and bladder residual urine (WMD=-54.71, 95%CI [-56.10, -53.32], Z=77.05, P<0.000 01), and improve the total effective rate of treatment (OR=1.19, 95%CI [1.05, 1.34], Z=2.77, P=0.006). Conclusion　Compared with routine treatment of western medicine alone, the adjuvant therapy of warming yang and transforming qi may have potential advantages in improving urinary retention after radical resection of cervical cancer, which needs to be verified by more high-quality studies.

Scientific Research

Effect of Mcl-1 gene on anti-apoptosis mechanism of abnormal clones of paroxysmal nocturnal hemoglobinuria

Lin Ying, Zhang Rongdong, Chen Renli, Chen Qi

2023, 29(13):  1808-1812.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.008

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Objective　To investigate the anti-apoptotic effect of abnormal Mcl-1 expression in clones of paroxysmal nocturnal hemoglobinuria (PNH). Methods　Thirteen PNH patients admitted to Department of Hematology, Ningde Municipal Hospital of Ningde Normal University from February 2020 to February 2022 were selected as a case group (7 males and 6 females, with a median age of 27 years old), and fifteen healthy subjects were selected as a control group (8 males and 7 females, with a median age of 38 years old). The expressions of Mcl-1 mRNA in abnormal PNH cloned cells and normal cells were detected by real-time quantitative polymerase chain reaction (RT-PCR), and then the proliferation, apoptosis, and cell cycle distribution of abnormal PNH cloned cells were detected before and after transfection of siRNA-Mcl-1. Fisher exact probability method, independent-sample t test, and rank sum test were used. Results　The expressions of Mcl-1 mRNA in the CD59^- cells, the CD59⁺ cells, and the control group were (2.48±0.25), (1.61±0.19), and (1.21±0.08), respectively, that in the CD59^- cells was significantly higher than those in the CD59⁺ cells and the control group (P=0.031 and 0.022), but there was no statistically significant difference between the CD59⁺ cells and the control group (P=0.126). The relative expression of Mcl-1 mRNA in the PNH patients was positively correlated with the number of CD59^- clone cells (r²=0.523, P=0.012). After Mcl-1 gene silence by siRNA, the Mcl-1 mRNA expression was decreased significantly. The apoptosis rate of the siRNA-Mcl-1 transfection group was significantly higher than those of the siRNA-scr transfection group and the blank control group [(43.12±16.33)% vs. (24.07±15.42)% and (21.56±14.85)%], with statistically significant differences (both P<0.05). The proportion of G₀/G₁ phase cells in the siRNA-Mcl-1 transfection group was higher than those in the siRNA-scr transfection group and the blank control group [(93.16±3.06)% vs. (91.52±4.01)% and (90.78±3.62)%], and the proportion of S-phase cells was lower than those in the siRNA-scr transfection group and the blank control group [(4.96±3.21)% vs. (6.86±3.87)% and (7.05±3.59)%], with statistically significant differences (all P<0.05). Conclusions　The siRNA-Mcl-1 can reduce the proliferation and promote the apoptosis of CD59^- cells in PNH patients. Overexpression of Mcl-1 gene may play a role in the anti-apoptosis of PNH clones.

Effect of edaravone dexcamphenol injection with concentrated solution combined with butylphthalide on acute cerebral infarction

Qian Xuanchen, Li Qingjie, Nie Er

2023, 29(13):  1813-1816.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.009

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Objective　To investigate the effect of edaravone dexcamphenol injection with concentrated solution combined with butylphthalide in the treatment of acute cerebral infarction. Methods　This was a retrospective study. A total of 76 cases of acute cerebral infarction in Affiliated Hospital of Xuzhou Medical University from January 2020 to October 2022 were selected and were divided into a conventional group and a treatment group according to different treatment methods with 38 cases in each group. In the conventional group, there were 20 males and 18 females; the age ranged from 39 to 81 years old, with a mean of (59.36±9.25) years old. In the treatment group, there were 21 males and 17 females; the age ranged from 38 to 80 years old, with a mean of (58.69±9.96) years old. The conventional group was treated with butylphthalide, and the treatment group was treated with edaravone dexcamphenol injection with concentrated solution combined with butylphthalide. The efficacy and neurological function indexes [National Institutes of Health Stroke Scale (NIHSS) score], Barthel indexes (BI), and Ability of Daily Living Scale (ADL) scores before treatment and 2 weeks after treatment were compared between the two groups. The statistical methods used were independent sample t test, paired t test, χ² test, and rank sum test. Results　The total effective rate of the treatment group was higher than that of the conventional group [94.74% (36/38) vs. 78.95% (30/38)], with a statistically significant difference (χ²=4.145, P=0.042). There was no statistically significant difference in the NIHSS score between the two groups before treatment (t=0.194, P=0.847). After 2 weeks of treatment, the NIHSS scores of both groups were decreased (both P<0.05), and the NIHSS score of the treatment group was lower than that of the conventional group [(12.37±3.12) points vs. (19.36±2.96) points, t=10.019, P<0.001]. Before treatment, there were no statistically significant differences in the BI and ADL scores between the two groups (t=0.233, P=0.817; t=0.337, P=0.737). After 2 weeks of treatment, the BI and ADL scores in both groups were higher than those before treatment (all P<0.05), the BI score [(22.98±3.58) points vs. (18.25±3.01) points, t=6.234, P<0.001] and ADL score [(84.21±8.92) points vs. (77.69±7.69) points, t=3.413, P=0.001] in the treatment group were higher than those in the conventional group. Conclusion　In the treatment of patients with acute cerebral infarction, edaravone dexcamphenol injection with concentrated solution combined with butylphthalide can effectively improve the therapeutic effect, neurological function, and daily living ability, which is worthy of popularization and application.

Application of antithrombin Ⅲ activity in combination with conventional coagulation indicators in predicting deep vein thrombosis

Yan Bin, Zhai Suping, Hu Tianxi, Lu Yifei, Wang Ya, Fan Chunhui, Du Weipeng

2023, 29(13):  1817-1822.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.010

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Objective　To investigate the clinical application of plasma antithrombin Ⅲ (AT Ⅲ) activity in combination with conventional coagulation indicators in patients with deep vein thrombosis (DVT). Methods　This was a retrospective study. A total of 163 patients with DVT diagnosed in Department of Vascular Surgery, Nanyang Central Hospital from January 2021 to December 2021 were retrospectively analyzed, including 125 patients newly diagnosed with DVT and 38 patients receiving venous filter removal. During the same period, 137 healthy subjects were selected as the control group. Among the 163 patients with DVT, there were 78 males and 85 females, aged (56.56±13.49) years; among the 137 healthy subjects, there were 92 males and 45 females, aged (42.31±10.32) years. Independent sample t test or Mann-Whitney U test was used to compare the differences of ATⅢ and other measurement data in different populations or DVT subgroups; χ² test was used to compare the gender and other count data. Fisher's discriminant analysis was performed on the relevant detection indicators in the DVT group and the control group, the diagnostic value of reduced AT Ⅲ activity in DVT events was evaluated by the receiver operating characteristic curve, and the risk factors of DVT events were analyzed by logistic regression analysis. Results　The AT Ⅲ activity in the DVT group was lower than that in the healthy control group [(89.79±11.08) % vs. (96.52±8.28) %, t=37.895, P<0.001]. The proportions of history of surgery and history of cardiovascular and cerebrovascular diseases in the reduced AT Ⅲ group (AT Ⅲ ≤80%) were higher than those in normal AT Ⅲ group [71.43% (20/28) vs. 47.42% (46/97), 71.43% (20/28) vs. 48.45% (47/97), χ²=5.024 and 4.612, both P<0.05]. Application of Fisher's discriminant function to assess AT Ⅲ level and traditional coagulation indicators in screening DVT: healthy control group Y1=0.114× age +1.742× prothrombin time -0.176× activated partial thrombin time +6.479× thrombin time +7.798× fibrinogen -0.378× D-dimer +0.021× platelet count +1.035× AT Ⅲ -132.585; DVT group Y2= 0.203× age +1.949× prothrombin time -0.161× activated partial thrombin time +6.246× thrombin time +8.158× fibrinogen +0.105× D-dimer +0.018× platelet count +0.937× AT Ⅲ -127.587, with the overall coincidence rate of 85.11% (223/262). The area under the curve of AT Ⅲ to determine DVT events was 0.706, the cutoff value was 86.5%, and the sensitivity and specificity were 46.77% and 91.24%, respectively. After adjusting for gender and age, AT Ⅲ <86.5% was the main important independent risk factor for DVT events (odds ratio = 10.460, 95% confidence interval = 4.676-23.400). Conclusions　The level of AT Ⅲ in DVT patients is significantly reduced. AT Ⅲ combined with routine coagulation indicators contributes to screen for DVT events. AT Ⅲ <86.5% is the main independent risk factor for DVT events. Attention should be paid to the risk of venous thrombosis in the population with reduced AT Ⅲ level.

Value of HR-MRI image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction

Li Yong, Zhang Hongli, Sun Guangda, Feng Bo

2023, 29(13):  1823-1827.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.011

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Objective　To investigate the value of high-resolution magnetic resonance imaging (HR-MRI) image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction, and analyze its influence on early clinical diagnosis. Methods　This protocol was designed according to the method of controlled trial, prospective, single-blind, and single-center clinical study. A total of 83 patients with transient ischemic attack admitted to Liaocheng Third People's Hospital from March 2020 to March 2022 were selected for HR-MRI examination. According to whether ischemic cerebral infarction occurred within one week, they were divided into an occurrence group [32 patients, 18 males and 14 females, aged (64.81±7.36) years] and a non-occurrence group [51 patients, 28 males and 23 females, aged (65.14±7.53) years]. The HR-MRI image characteristics [plaque distribution and plaque characteristics (plaque area and plaque load)], HR-MRI quantitative parameters [area of the narrowest part of blood vessel (VA_MLN), vascular area (VA_reference), wall area of the narrowest part of blood vessel (WA_MLN), lumen area of the narrowest part of blood vessel (LA_MLN), reference lumen area (LA_reference), and stenosis rate], and reconstruction modes (reconstruction index, positive reconstruction, negative reconstruction, and no significant reconstruction) of the two groups were compared. χ² test was used for plaque distribution and reconstruction mode, and t test for plaque characteristics and HR-MRI quantitative parameters. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of HR-MRI image characteristics and quantitative parameters in the risk of ischemic cerebral infarction. Results　The plaque area [(6.43±3.06) mm²] and plaque load [(29.17±7.42)%] in the occurrence group were higher than those in the non-occurrence group [(5.37±1.02) mm² and (24.18±5.45)%], with statistically significant differences (t=2.287 and 3.525, both P<0.05). The positive reconstruction rate in the occurrence group [81.25% (26/32)] was higher than that in the non-occurrence group [52.94% (27/51)], with a statistically significant difference (χ²=6.827, P=0.009). The WA_MLN [(12.04±2.02) mm²] and stenosis rate [(32.46±2.02)%] in the occurrence group were higher than those in the non-occurrence group [(10.63±1.41) mm² and (21.20±1.35)%], while the LA_MLN [(10.22±1.75) mm²] was lower than that in the non-occurrence group [(11.96±2.07) mm²], with statistically significant differences (t=3.744, 30.462, and 3.949, all P<0.001). The areas under the curve (AUCs) of plaque area, plaque load, WA_MLN, LA_MLN, and stenosis rate for predicting ischemic cerebral infarction were 0.839 (95%CI 0.794-0.942), 0.706 (95%CI 0.598-0.820), 0.773 (95%CI 0.694-0.893), 0.819 (95%CI 0.809-0.894), and 0.812 (95%CI 0.731-0.910), all above 0.7. The AUC value [0.947 (95%CI 0.873-0.961)] of all indexes and parameters combined to predict the risk of ischemic cerebral infarction was the highest. Conclusion　HR-MRI plaque area, plaque load, WA_MLN, LA_MLN, and stenosis rate have high predictive values for the risk of ischemic cerebral infarction, which is helpful for the early diagnosis and intervention of ischemic cerebral infarction.

Clinical effects of different PD-1 inhibitors in the treatment of gastrointestinal tumors

Sha Sha, Yang Qiumin

2023, 29(13):  1828-1831.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.012

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Objective　To observe the clinical effects of different programmed cell death protein receptor-1 (PD-1) inhibitors in the treatment of gastrointestinal tumors and their influences on the long-term survival in patients. Methods　This was a prospective randomized controlled study. A total of 125 patients with gastric cancer admitted to the First People's Hospital of Shangqiu City from October 2020 to January 22 were selected as the study subjects. The patients were divided into group A [63 patients, 32 males and 31 females, aged (60.44±5.23) years] and group B [62 patients, 32 males and 30 females, aged (61.24±5.18) years] by the random number table method. Both groups received standard chemotherapy. Group A was treated with nivolumab in combination with chemotherapy, while group B was treated with pembrolizumab in combination with chemotherapy. The short-term treatment effects of the two groups were compared, and the long-term survival of the two groups were compared through a one-year follow-up. t test and χ² test were used. Results　After treatment, the rate of complete remission [11.11% (7/63)] and partial remission [39.68% (25/63)] in group A were higher than those in group B [1.61% (1/62) and 22.58% (14/62)], and the rate of disease progression [3.17% (2/63)] was lower than that in group B [14.52% (9/62)], with statistically significant differences (χ²=4.706, 4.258, and 5.008; all P<0.05). After 8 weeks of treatment, the tumor growth rate (TGR) [(35.45±10.37)%] in group A was lower than that in group B [(40.33±10.59)%], the time to treatment failure (TTF) [(3.46±1.33) months] was longer than that in group B [(2.72±1.47) months], and the incidence of tumor hyperprogression (HPD) [19.05% (12/63)] was lower than that in group B [38.71% (24/62)], with statistically significant differences (t=2.603 and 2.952, χ²=5.891; all P<0.05). During follow-up, there was no statistically significant difference in the incidence of adverse reactions between the two groups (χ²=0.080, P>0.05). The median progression-free survival (PFS) [(12.47±3.44) months] and the median overall survival (OS) [(15.66±5.25) months] in group A were longer than those in group B [(10.35±3.62) months and (13.36±5.17) months], with statistically significant differences (t=3.357 and 2.468, both P<0.05). Conclusions　Nivolumab and pembrolizumab both can be used as adjunctive standard chemotherapy for gastric cancer patients. But compared with pembrolizumab, the drug toxicity of nivolumab is weaker, which can effectively increase the patients' clinical benefits, and also has a positive role in reducing the risk of HPD and prolonging their life cycle.

Analysis of an occupational health inspection report for radiation workers in a hospital

Zhou Xin, Chen Luqiao, Ni Qianxi, Liu Lichun

2023, 29(13):  1832-1836.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.013

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Objective　To understand the health status of the hospital's radiology staff and to provide valuable advices on health screening for radiology staff. Methods　A total of 254 health examination reports of in-service radiology staff in Hunan Cancer Hospital from January 2021 to December 2022 were collected, including 150 males and 104 females, aged (36.69±8.87) years. The abnormalities in different examination categories among radiation workers with different genders, years of service, job types, departments, and bad habits/medical history were analyzed. χ² test or Fisher exact probability method was used. Results　The abnormal rate of physical examination was 10.6% (27/254); the abnormal rate in males was higher than that in females (χ²=6.284, P<0.05); the abnormal rate increased with the increase of working age (χ²=15.985, P<0.001); the abnormal rate of radiation workers with multiple bad habits and medical history was higher than that of those without bad habits or history (χ²=18.062, P<0.001). The abnormal rate of ophthalmic examination was 9.8% (25/254). The abnormal rate of instrumental examination was 86.6% (220/254); the abnormal rate of 3 or more items in males was higher than that in females (χ²=13.226, P<0.05); the abnormal rate increased with the increase of working age (χ²=20.953, P<0.05). The abnormal rate of laboratory examination was 67.3% (171/254); the abnormal rate of 3 or more items in radiation workers with ≥20 years of service was higher than that with shorter years of service (χ²=16.539, P<0.05); the abnormal rate of 3 or more items in radiation workers with 3 bad habits and medical history was higher than that of other categories (χ²=27.022, P<0.001). There were no statistically significant differences in the abnormal rates of physical, ophthalmic, instrumental, and laboratory examinations among radiation workers with different job types or departments (P>0.05). Conclusion　Long-term exposure to ionising radiation has a definite impact on human health, and enhanced radiation protection and health monitoring can be accompanied by specific health screening advices for different categories of people.

Clinical study of dioscorea glue in the treatment of stable chronic obstructive pulmonary disease

Liang Binghui, Jian Xiaoyun, Lin Zehui, Zou Peng, Jiang Rongbin, Li Jiachun, Wang Jingmin, Zhan Weijie

2023, 29(13):  1837-1840.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.014

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Objective　To evaluate the clinical efficacy of dioscorea glue in the treatment of stable chronic obstructive pulmonary disease (COPD). Methods　This was a prospective randomized controlled trial. From November 2020 to March 2022, a total of 120 patients with stable COPD and qi deficiency of lung and spleen in Department of Respiratory Medicine of Foshan Hospital of Traditional Chinese Medicine were divided into a treatment group (60 cases) and a control group (60 cases) by the random number table method. In the treatment group, there were 42 males and 18 females, aged (65.77±5.59) years. In the control group, there were 40 males and 20 females, aged (64.68±4.92) years. The control group was given conventional western medicine treatment, and the treatment group was given dioscorea glue on the basis of conventional western medicine treatment for 6 months. The changes of tumor necrosis faction-α (TNF-α), CD3⁺, CD4⁺, albumin (ALB), BODE index, and number of acute exacerbations before treatment and 3 and 6 months after treatment were observed in the two groups. t test and χ² test were used. Results　Three and six months after treatment, the TNF-α indexes [(5.89±1.14) ng/L and (5.55±1.21) ng/L] in the treatment group were lower than those in the control group [(6.79±1.11) ng/L and (6.66±1.19) ng/L], and the CD3⁺ [(56.61±5.49)% and (59.89±5.01)%] and CD4⁺ indexes [(34.56±4.49)% and (35.50±4.29)%] were higher than those in the control group [(53.64±5.68)%, (53.28±5.05)%, (30.82±4.20)%, and (30.79±4.20)%], with statistically significant differences (all P<0.05). Six months after treatment, the ALB index [(35.89±0.64) g/L] in the treatment group was higher than that in the control group [(29.14±0.64) g/L], and the BODE index [(1.63±0.95) points] and the number of acute exacerbations [(1.30±0.17) times] were lower than those of the control group [(2.18±1.12) points and (1.62±0.21) times], with statistically significant differences (all P<0.05). Conclusion　Dioscorea glue combined with bronchodilator inhalant is effective in the treatment of stable COPD patients with qi deficiency of lung and spleen, which can eliminate the inflammation, regulate the immune function, improve the clinical symptoms and nutritional status, reduce the number of acute exacerbations, and improve the quality of life.

Treatment of 30 cases of kidney stones with combined traditional Chinese medicine stone expulsion after ultramicro-percutaneous nephrolithotripsy

Liang Jianfeng, Xu Beixun, Xu Jinfeng, Pan Jie, Chen Jufeng, Wu Yuanshun, Ao Dawen, Ye Yinglin, Ruan Yongtong

2023, 29(13):  1841-1844.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.015

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Objective　To evaluate the effect of combined traditional Chinese medicine stone expulsion after ultramicro-percutaneous nephrolithotripsy in the treatment of kidney stones below 2 cm. Methods　This study was a randomized controlled trial. From October 2020 to December 2021, 60 patients with kidney stones who underwent ultramicro-percutaneous nephrolithotripsy in Department of Urology, Yangjiang Hospital of Traditional Chinese Medicine were enrolled. They were grouped according to the random numbering method, with 30 patients in each group. In the treatment group, 12 males and 18 females, with an average age of 37.43 years old, were treated with minimally invasive surgery combined with traditional Chinese medicine stone expulsion. In the control group, 15 males and 15 females, with an average age of 46.20 years old, were not given traditional Chinese medicine stone expulsion. The stone clearance rate and stone expulsion time after surgery were compared between the two groups. χ² test was used. Results　All 60 surgeries were successfully performed. Among them, the effective rate of the treatment group reached to 96.7% (29/30), which was higher than that of the control group [83.3% (25/30)], with a statistically significant difference (P<0.05). Conclusion　In the treatment of kidney stones, the combination of minimally invasive surgery and traditional Chinese medicine stone expulsion is minimally invasive and efficient, and has few complications, which significantly reduces the damage to the body.

Analgesic effects of esketamine combined with different doses of dexmedetomidine in lung cancer surgery

Li Lili, Feng Chenxia, Feng Guizhen, Meng Shuangnan, Li Xilong

2023, 29(13):  1845-1849.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.016

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Objective　To observe the analgesic effects of esketamine combined with different doses of dexmedetomidine in lung cancer surgery. Methods　This was a randomized controlled trial. From August 2020 to January 2022, 128 patients with lung cancer admitted to Kaifeng Cancer Hospital were divided into two groups by the lottery method. Sixty-four patients receiving esketamine assisted anesthesia induction and maintenance of anesthesia with 0.5 µg/(kg·h) dexmedetomidine were classified as the routine group, including 45 males and 19 females, aged (49.12±5.33) years. Sixty-four patients receiving esketamine assisted anesthesia induction and maintenance of anesthesia with 0.3 µg/(kg·h) dexmedetomidine were classified as the low-dose group, including 44 males and 20 females, aged (48.77±5.25) years. The changes of perioperative signs, postoperative recovery quality, cognitive function, and anesthesia-related adverse reactions were compared between the two groups. The statistical methods used were independent sample t test, paired t test, and χ² test. Results　Ten min after anesthesia (T1), the heart rates (HR) and mean arterial pressures (MAP) of the low-dose group and the routine group [(73.33±10.45) beats/min vs. (72.16±10.23) beats/min, (102.44±20.27) mmHg (1 mmHg=0.133) vs. (102.33±20.46) mmHg] showed no statistically significant differences (both P>0.05). At the end of surgery (T2), the HR and MAP of the low-dose group and the routine group [(76.22±5.35) beats/min vs. (74.22±10.35) beats/min, (104.77±8.24) mmHg vs. (103.25±8.31) mmHg] showed no statistically significant differences (both P>0.05). After surgery, there was no statistically significant difference in the Visual Analogue Scale (VAS) score between the low-dose group and the routine group [(3.36±1.25) points vs. (2.77±1.04) points] (P>0.05); the eye opening time [(10.27±2.11) min vs. (12.77±2.36) min] and extubation time [(11.75±2.58) min vs. (13.49±2.49) min] in the low-dose group were shorter than those in the routine group, and the Ramsay sedation score after recovery was lower than that in the routine group [(4.42±1.45) points vs. (5.25±1.33) points], with statistically significant differences (all P<0.05). After surgery, the scores of Mini-Mental State Examination (MMSE) [(25.64±5.28) points vs. (22.33±5.46) points] and Montreal Cognitive Assessment Scale (MoCA) [(25.79±5.18) points vs. (22.69±5.33) points] in the low-dose group were higher than those in the routine group (both P<0.05). The incidence of anesthesia-related adverse reactions in the low-dose group was lower than that in the routine group [4.69% (3/64) vs. 15.63% (10/64)], with a statistically significant difference (χ²=6.556, P=0.010). Conclusion　Esketamine assisted anesthesia induction and maintenance of anesthesia with low-dose dexmedetomidine can produce ideal analgesic effect, and maintain the stability of perioperative signs in lung cancer patients, which has positive significance in promoting their postoperative recovery and avoiding the cognitive function injury, with high safety.

Special Column of Pediatrics

Clinical features, genotypes, and prognosis of Gitelman syndrome in children

Chen Jiemei, Zheng Yuejie, Gao Xiaojie, Nan Xiaojuan

2023, 29(13):  1850-1856.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.017

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Objective　To improve the understanding of clinical features, genotypes, and long-term prognosis of children with Gitelman syndrome (GS). Methods　The clinical characteristics and genotypes of 13 children with GS diagnosed in Shenzhen Children's Hospital Affiliated to Shantou University from January 2015 to December 2019 were retrospectively analyzed, including 6 boys and 7 girls. They were followed for an average of 4.5 years to understand their long-term prognosis. χ² test and rank sum test were used. Results　Among the 13 children with GS, the age of onset was (6.40±3.52) years old and the age of diagnosis was (8.20±3.99) years old. Fatigue was the most common clinical manifestation, accounting for 54% (7/13), short stature accounted for 23% (3/13), and 8% (1/13) were asymptomatic. Disease-causing variants in the SLC12A3 gene were found in all the 13 children, with homozygous mutation in 1 case (8%), compound heterozygous mutation in 9 cases (70%), and only 1 mutation site in 3 cases (23%). Among them, R871H, T63M, and T304M recurrently occurred. During an average follow-up of 4.5 years, all the children receiving standard treatment 69%(9/13) had no clinical symptoms, and 92% (12/13) had growth catch-up after treatment. Conclusions　Fatigue is the most common clinical manifestation in children with GS. The clinical manifestation of GS lacks specificity. Detailed laboratory tests combined with genetic testing is beneficial to timely diagnosis, and standardized management can improve the long-term prognosis and quality of life in children.

Effect of continuous blood purification on children with sepsis and its influence on serum inflammatory indexes

Li Zhen, Zou Sini, Li Cong

2023, 29(13):  1856-1859.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.018

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Clinical analysis of pediatric bronchopneumonia complicated by secondary thrombocytosis

Hou Qiaozhen, He Liya, Cao Xiaojun, Wei Xiaoyan, Zeng Huasong

2023, 29(13):  1860-1863.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.019

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Objective　By analyzing clinical data from pediatric cases of bronchopneumonia complicated by secondary thrombocytosis, to explore the pathogenesis, influencing factors, clinical characteristics, and significance of secondary thrombocytosis in children with pneumonia, and to enhance the understanding of secondary thrombocytosis. Methods　A total of 77 cases of thrombocytosis secondary to bronchopneumonia admitted to Guangzhou Women and Children's Medical Center between January 2020 and December 2021 were selected for retrospective analysis, including 48 boys and 29 girls, aged from 1 month to 6 years. The clinical data were analyzed to summarize the pathogens, gender, age, treatment duration, hemoglobin, C-reactive protein, and platelet characteristics. Results　Among the 77 children with thrombocytosis secondary to bronchopneumonia, the most common pathogens identified were adenovirus (11 cases), respiratory syncytial virus (10 cases), and mycoplasma (7 cases); there was relevance between thrombocytosis and severe pneumonia. Conclusion　Adenovirus, respiratory syncytial virus, and mycoplasma have some relevance in the mechanism of causing secondary thrombocytosis in children with bronchopneumonia.

Analysis of current situation of pediatric oral Chinese patent medicine and its prescription drugs

Hu Jun, Gao Yue

2023, 29(13):  1863-1866.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.020

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Objective　To explore the current situation of pediatric oral Chinese patent medicine and analyze its prescription medication. Methods　A total of 300 pediatric oral Chinese patent medicine prescriptions screened by the hospital information system of Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage) from January 2022 to December 2022 were selected for the research. There were 168 boys and 132 girls, aged ≤12 years old. The dosage form, age distribution, combined use, action category, and unreasonable prescription composition were analyzed. Results　Among the 300 prescriptions in this study, the proportion of granules was the highest [51.77% (322/622)], followed by oral liquid [31.35% (195/622)] and tablets [9.00% (56/622)], and the proportion of capsules was the lowest [7.72% (48/622)]. The proportion of >1 - ≤3 years old group was the highest [29.00% (87/300)], followed by ≤1 year old group [14.67% (44/300)], >3 - ≤6 years old group [27.67% (83/300)], >6 - ≤9 years old group [13.67% (41/300)], and >9 - ≤12 years old group [15.00% (45/300)]. Among the combined medication, the proportion of double combinations was the highest [37.33% (112/300)], followed by single drug [30.67% (92/300)], triple combinations [26.00% (78/300)], and quadruple combinations or more [6.00% (18/300)]. Among the action categories, clearing heat and detoxifying accounted for the highest proportion [37.94% (236/622)], followed by dispelling wind and relieving exterior [26.69% (166/622)], relieving cough, resolving phlegm and relieving asthma [20.10% (125/622)], and regulating spleen and stomach [10.45% (65/622)]. The proportion of irrational prescriptions was 2.00% (6/300) of inappropriate indications, 1.33% (4/300) of inappropriate usage and dosage, 1.00% (3/300) of repeated medication, and 0.67% (2/300) of incompatibility. Conclusions　In pediatric oral Chinese patent medicine prescriptions, there are some unreasonable phenomena such as unreasonable combination of Chinese patent medicine prescriptions. The hospitals need to strengthen the management of the use of oral Chinese patent medicines to ensure the medication safety.

Development and application of perioperative dietary program in orthopedic children under  the concept of enhanced recovery after surgery

Yang Xiaojing, Yan Xiaoyun, Zhao Lei, Wang Shumei, Li Yuwei

2023, 29(13):  1867-1870.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.021

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Objective　Under the concept of enhanced recovery after surgery (ERAS), to explore the feasibility and safety of shortening the fasting time before surgery and early food and water intake after surgery in orthopedic children. Methods　Data of children aged 3-7 years who were admitted to Department of Orthopedics, Luohe Central Hospital from March 2019 to March 2021 were retrospectively analyzed. The 59 children admitted from March 2020 to March 2021 were enrolled in the treatment group, including 25 males and 34 females, aged (4.97±1.35) years, who adopted the method of preoperative fasting and postoperative food and water intake methods formulated under the ERAS concept. The 57 children admitted from March 2019 to February 2020 were enrolled in the control group, including 24 males and 33 females, aged (4.95±1.43) years, who received the traditional preoperative fasting and postoperative food and water intake methods. The preoperative fasting time and time of postoperative food and water intake were compared between the two groups. The scores of thirst and hunger, crying rate, intraoperative aspiration rate, and incidences of postoperative nausea and vomiting and abdominal distension were observed in the two groups. t test and χ² test were used. Results　The preoperative no eating time [(7.78±0.87) h] and no drinking time [(4.50±0.53) h] and the time of postoperative food and water intake [(2.31±0.46) h] in the treatment group were shorter than those in the control group [(12.50±1.49) h, (11.34±0.68) h, and (6.54±0.23) h], with statistically significant differences (t=20.921, 60.542, and 62.302, all P<0.001). The thirst scores [(2.57±1.18) points and (2.99±0.50) points], hunger scores [(5.94±0.39) points and (3.28±0.53) points], and crying rates [23.2% (14/59) and 16.9% (10/59)] of the treatment group before and after surgery were lower than those of the control group [(7.36±1.43)] points, (6.51±0.39) points, (7.79±0.50) points, (6.89±0.49) points, 50.9% (29/57), and 38.6% (22/57)], with statistically significant differences (all P<0.05). No aspiration occurred in both groups during surgery. There were no statistically significant differences in the incidences of nausea and vomiting [6.8% (4/59)] and abdominal distension [1.7% (1/59)] in the treatment group compared with those in the control group [14.0% (8/57) and 3.5% (2/57)] (χ²=1.645 and 0.379, P=0.200 and 0.538). Conclusion　Under the ERAS concept, the diet plan of shortening the fasting time before surgery and early food and water intake after surgery is safe and feasible in orthopedic children, which can reduce their discomfort and accelerate their recovery.

Treatises

Screening of ferroptosis-related genes in sepsis based on bioinformatics and machine learning algorithms

Xu Bo, Shao Bibo

2023, 29(13):  1871-1877.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.022

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Objective　To screen the ferroptosis-related genes (FRGs) in sepsis by public databases and machine learning algorithms and explore their roles in order to provide theoretical basis for diagnosis and treatment of sepsis. Methods　Samples of sepsis patients were obtained from the GEO database, including GSE185263 as the training dataset and GSE154918 as the external validation dataset. Differentially expressed genes (DEGs) associated with ferroptosis were firstly obtained and followed by biofunctional analysis, such as gene ontology (GO) enrichment analysis, Kyotoencyclopedia of genes and genomes (KEGG) pathway analysis, and disease ontology (DO) enrichment analysis. The LASSO regression and SVM-RFE machine-learning algorithms were then used to screen the FRGs. In addition, the construction of a nomogram was based on the expression content of the obtained genes. Finally, the differences in immune cell infiltration between the normal control group and sepsis group were analyzed. Results　A total of 87 ferroptosis-related DEGs were obtained. GO enrichment analysis showed that the biological processes of these DEGs were mainly enriched in oxidative stress, regulatory pathways of apoptotic signaling, cellular senescence, and regulation of neuronal death; cellular components were enriched in autophagosomes, nuclear envelope, and secondary lysosomes; molecular functions were enriched in kinase activity of mitogen-activated protein kinase (MAP kinase) and iron binding. The KEGG pathways were mainly enriched in the FoxO signaling pathway, hypoxia-inducible factor (HIF)-1 signaling pathway, PI3K-Akt signaling pathway, and ferroptosis pathway. DO analysis showed that sepsis was closely related to neurological tumors, neuroblastoma, bone cancer, and other diseases. Machine learning showed that PRDX1, IDH1, DUSP1, YWHAE, and SOCS1 presented as the hub FRGs, and these genes and their nomogram model all had high diagnostic values for sepsis. The immune infiltration results showed that the activities of naive B cells, CD8+ T cells, CD4+ memory resting T cells, follicular helper T cells, resting natural killer (NK) cells, resting dendritic cells, active dendritic cells were suppressed in the sepsis group, and plasma cells, naive T cells, active memory CD4+ T cells, δ T cells, macrophages M0, and neutrophils were active (all P<0.05). Conclusion　PRDX1, IDH1, DUSP1, YWHAE, and SOCS1 are all potentially ferroptosis-related biomarkers for sepsis diagnosis.

Diagnostic values of prenatal ultrasound and MRI in fetal adrenal lesions

Han Penghui, Huang Yubin, Ouyang Chunyan

2023, 29(13):  1877-1881.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.023

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Objective　To investigate the diagnostic values of prenatal ultrasound and MRI in fetal adrenal lesions and analyze the characteristic imaging features of different diseases. Methods　The images of 22 fetuses (the mean gestational age was 30 weeks and the male to female ratio was 15:7) with adrenal lesions found by prenatal ultrasound in Guangdong Women and Children Hospital from March 2013 to December 2022 were retrospectively analyzed, 14 of them underwent MRI examination. Two sonographers and two radiologists with experiences in diagnosing fetal diseases were used to read the images by double-blind method. When the diagnosis results of the same examination were inconsistent between two doctors, the consensus was reached after discussion. Results　Adrenal neuroblastoma (NB) was diagnosed in 14 of 22 cases; the lesions of 2 cases became smaller and disappeared after prenatal and multiple postnatal follow-up, and were diagnosed as adrenal hematoma combined with imaging findings; 5 cases was diagnosed as intraperitoneal pulmonary sequestration (IEPS) by postoperative pathology; 1 case was adrenal teratoma. Both ultrasound and MRI accurately diagnosed NB, adrenal hematoma, and IEPS, and misdiagnosed teratoma as NB. Adrenal NB might present as cystic, complex, or solid mass with partial calcification, might be bilateral, and might develop intrahepatic metastases during the fetal period. In the initial stage of hemorrhage, adrenal hematoma showed hyperechoic on ultrasound, then gradually reduced to anechoic, and finally gradually calcified or disappeared. Lesion stratification could be seen on MRI, and high signal shadow on T1WI. The ultrasonography of IEPS showed homogeneous solid or complex mass, among which solid mass accounted for the majority, and supplied by a branch of systemic arterial. Homogeneous solid or complex high signal shadow showed in single shot fast spin echo (SSFSE) sequence images, with signal intensity higher than or equal to that of lung tissue, and the lesion closely connected with diaphragm. The teratoma showed mixed echo on ultrasound and complex signal mass on SSFSE sequence, and it was difficult to distinguish fat deficient teratoma from NB. Conclusions　Prenatal ultrasound and MRI have high diagnostic values in fetal adrenal lesions. The two kinds of examinations complement each other and can improve the diagnostic accuracy.

Clinical Research

Application effect of ligation of ascending branch of uterine artery combined with uterine balloon tamponade in postpartum hemorrhage of cesarean section

Chen Lifang, Zheng Yu, Li Jianqi

2023, 29(13):  1882-1885.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.024

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Objective　To investigate the application effect of bilateral ascending uterine artery ligation combined with uterine balloon tamponade in postpartum hemorrhage of cesarean section. Methods　A retrospective analysis was made on 100 cases of cesarean section with high risk factors for postpartum hemorrhage treated by bilateral ascending uterine artery ligation combined with uterine balloon tamponade (study group) and 100 cases of cesarean section with high risk factors for postpartum hemorrhage treated by uterine balloon tamponade alone (control group) in The People's Hospital of Lufeng from January 2019 to December 2021. The study group was (28.07±4.78) years old, and the gestational age was 34⁺³ - 40⁺⁵ weeks; the control group was (27.74±3.90) years old, and the gestational age was 34⁺⁴ - 40⁺³ weeks. The differences of postpartum hemorrhage, operation time, hospital stay, and hemoglobin (HGB) change before and after surgery between the two groups were statistically analyzed, and the incidence of postpartum complications and adverse reactions in the two groups were analyzed. Independent sample t test and χ² test were used. Results　The postpartum hemorrhage volume in the study group was (1 208.0±327.3) ml, which was significantly lower than that in the control group [(1 547.8±364.3) ml] (t=6.938 0, P<0.000 1). The postoperative HGB of the study group was (81.2±15.1) g/L, which was significantly higher than that of the control group [(70.8±17.3) g/L] (t=3.219 0, P=0.001 5). The operation time of the study group and the control group were (84.7±15.2) min and (82.7±16.1) min, and the hospitalization time of the study group and the control group were (8.3±1.4) d and (8.0±1.6) d, with no statistically significant differences between the two groups (both P>0.05). There was no statistically significant difference in the incidence of postpartum complications and adverse reactions between the two groups (P>0.05). Conclusion　Bilateral ascending uterine artery ligation combined with uterine balloon tamponade is better than uterine balloon tamponade alone in the treatment of postpartum hemorrhage of cesarean section.

Case Report

Anesthesia management of congenital heart disease combined with thoracic deformity and pulmonary artery hypertension in plateau areas: a case report and literature review 

Ai Juan, Cai Bin, Fan Jingyun, Wang Jing, Long Wenfei, Ling Qiong, Li Xiangyu

2023, 29(13):  1886-1889.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.025

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Congenital heart disease combined with thoracic deformity and pulmonary artery hypertension in plateau areas is a kind of complex clinical case, especially for patients living in plateau areas who undergo surgery in low altitude areas. This article reports on the key points of anesthesia management for one case of congenital heart disease combined with thoracic deformity and pulmonary artery hypertension in plateau areas admitted to The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, and reviews the relevant literatures.

A case of spinal pyogenic osteomyelitis with syndrome of inappropriate antidiuretic hormone

Jiang Le, Gao Yuqing, Li Yuanyuan, Yu Lijun, Liu Shiwei

2023, 29(13):  1890-1893.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.026

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Spinal pyogenic osteomyelitis is rarely seen in clinic, especially in patients with syndrome of inappropriate antidiuretic hormone (SIADH). This paper reports the clinical characteristics, diagnosis, and treatment of a patient with SIADH caused by spinal pyogenic osteomyelitis in Inner Mongolia Autonomous Region People's Hospital, and discusses the pathophysiological mechanism of SIADH caused by spinal pyogenic osteomyelitis to make clinical medical staffs pay attention to this disease.

Experiences about anesthesia management of one morbidly obese patient undergoing stomach capacity reduction surgery

Wang Yan, Duan Zhiqiang, Wang Tengqi

2023, 29(13):  1894-1895.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.027

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In recent years, with the improvement of living standards, the number of morbidly obese patients in China has been increasing. Laparoscopic stomach capacity reduction surgery is the most effective treatment method. But at the same time, the pathophysiological changes caused by morbid obesity have brought many challenges to the anesthesia management. This paper reports the anesthesia experiences of one morbidly obese patient undergoing laparoscopic stomach capacity reduction surgery in Bayannur Hospital, and discusses the anesthesia management in combination with relevant literatures.

Nursing Research

Nursing care for patients with electrical storm after cardiac surgery

Liu Zhichang, Ling Yun, Lin Qiongyu, Zhu Sumin

2023, 29(13):  1896-1899.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.028

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Objective　To summarize the nursing experiences for patients with electrical storm after cardiac surgery. Methods　A total of 7 patients with electrical storm after cardiac surgery admitted to Guangdong Provincial People's Hospital from April 2020 to February 2022 were selected as the study objects, including 6 males and 1 female, aged (51.10±18.67) years. The nursing process for patients with electrical storm after cardiac surgery was retrospectively analyzed, including identification of electrical storm risk factors, hemodynamic monitoring and life support, paying close attention to electrolytes, nursing of antiarrhythmic drug use, moderate sedation and environmental management, skin care, psychological care, and extracorporeal membrane oxygen and supportive treatment to patients with difficult circulation stability. Results　After active treatment and nursing, electrical storm was corrected in 5 patients; 1 patient was treated with extracorporeal membrane oxygenation and returned to sinus rhythm due to recurrent ventricular fibrillation; 1 patient died after rescue. Conclusions　Electrical storm can occur at any time after cardiac surgery. Careful observation on rhythm changes, timely detection, active treatment, and effective nursing measures are the keys to stabilize the patients' illness.

Application of physician - nurse - rehabilitation therapist integrated management model based on SBAR in early rehabilitation of stroke patients

Chen Manhua, Lin Zhuang, Huang Linchun, Lin Chun, Cai Yingying, Zhou Yufen, Huang Xiaodan, Li Yijun, Jiang Nan

2023, 29(13):  1899-1904.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.029

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Objective　To explore the application effect of physician - nurse - rehabilitation therapist integrated management model based on SBAR (Situation, Background, Assessment, and Recommendation) in promoting early rehabilitation of stroke patients. Methods　Using a pre-post control study method with different cases, 30 stroke patients admitted to Jieyang People's Hospital from June 2020 to February 2021 were selected as a control group, including 11 males and 19 females, with an age of (63.77±13.26) years old, who received traditional physician - nurse - rehabilitation therapist integrated management model; 30 stroke patients admitted to Jieyang People's Hospital from March 2021 to December 2021 were as selected an observation group, including 21 males and 9 females, with an age of (59.20±17.20) years old, who received SBAR-based physician - nurse - rehabilitation therapist integrated management model. The modified Barthel index scores (activities of daily living) and simple three-level balance assessment results before and after intervention, and patient satisfaction with nursing services were compared between the two groups. t test and χ² test were used. Results　The modified Barthel index score of the observation group was significantly higher than that of the control group at discharge [(50.23±28.63) points vs. (31.63±23.31) points], with a statistically significant difference (P<0.01). The sitting and standing balance assessment results of the observation group were better than those of the control group at 2 weeks of hospitalization and discharge, with statistically significant differences (all P<0.05). There were 7 dimensions of patient nursing service satisfaction, among which the scores of perceived quality and patient complaint were (42.70±3.76) and (4.47±0.68) points in the control group, and (45.53±0.73) and (4.80±0.41) points in the observation group, respectively, with statistically significant differences (both P<0.05); the scores of hospital brand, disease pressure, patient satisfaction, and patient loyalty were (4.47±0.57), (4.63±0.56), (9.37±1.03), and (9.20±1.00) points in the control group, and (4.90±0.31), (4.93±0.25), (9.97±0.18), and (9.87±0.35) points in the observation group, respectively, with statistically significant differences (all P<0.01); the patient expectation score of the control group was (14.40±1.33) points, and that of the observation group was (14.87±0.35) points, with no statistically significant difference (P>0.05). Conclusion　The physician - nurse - rehabilitation therapist integrated management model based on SBAR can improve the activities of daily living of stroke patients, improve the limb function, and improve the satisfaction of nursing services, which has high clinical promotion value.

Application of neurofunction-oriented individualized intervention in patients recovering from cerebral hemorrhage

Ding Junyan, Wei Mingming, Li Yuxian

2023, 29(13):  1905-1909.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.030

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Objective　To explore the influence of neurofunction-oriented individualized intervention on the mental state and motor function in patients recovering from cerebral hemorrhage. Methods　This study was a randomized controlled trial. A total of 112 cases of cerebral hemorrhage during the rehabilitation period in Nanyang First People's Hospital from February 2020 to January 2022 were selected for a prospective study, and were divided into a guided group and a traditional group according to the random number table method. The guided group consisted of 56 patients, including 34 males and 22 females, aged (64.51±6.79) years; the traditional group consisted of 56 patients, including 33 males and 23 females, aged (65.66±6.03) years. Conventional nursing measures were used in the traditional group, and neurofunction-oriented individualized intervention was used in the guided group. The scores of Nerve Functional Insufficent (NFI), Fugl-Meyer Motor Function Assessment (FMA), and Mini-mental State Examination (MMSE) before and after intervention were compared between the two groups, and the compliance of the two groups was compared. The scores of Self-rating Depression Scale (SDS) and Quality of Life Specific Scale (QSQL) were compared between the two groups, the occurrence of adverse reactions was observed in the two groups, and the nursing satisfaction of the two groups was analyzed. χ² test and t test were used. Results　After intervention, the NFI score of the guided group was lower than that of the traditional group [(9.92±1.06) points vs. (13.88±1.43) points], while the scores of FMA and MMSE were higher than those of the traditional group [(89.32±8.58) points vs. (61.39±5.16) points, (28.39±3.03) points vs. (24.45±2.68) points] (all P<0.05). The scores of healthy diet, medication compliance, rehabilitation exercise, and follow-up visit in the guided group were higher than those in the traditional group (t=17.896, 18.098, 22.591, and 17.028; all P<0.001). The SDS and QSQL scores of the guided group after intervention were lower than those of the traditional group [(41.52±5.37) points vs. (49.38±4.17) points, (13.57±1.22) points vs. (23.32±2.19) points] (both P<0.05). The incidence of adverse reactions in the guided group was significantly lower than that in the traditional group [5.36% (3/56) vs. 19.64% (11/56)] (χ²=5.224, P=0.022). The total nursing satisfaction in the guided group was significantly higher than that in the traditional group [96.43% (54/56) vs. 78.57% (44/56)] (χ²=8.163, P=0.004). Conclusion　The neurofunction-oriented individualized intervention can significantly improve the degree of neurological deficit, motor function, and quality of life, and reduce adverse reactions in patients with cerebral hemorrhage during the rehabilitation period, which is worthy of further promotion and application.

Application of dual-track interactive intervention mode in blood pressure control of hypertensive patients

Zhao Peipei, Jiang Ling, Li Ke, Liu Min

2023, 29(13):  1909-1913.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.031

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Objective　To study the application effect of dual-track interactive intervention mode in blood pressure control of hypertensive patients. Methods　A total of 102 patients with hypertension who received treatment in Henan Provincial People's Hospital from June 2020 to June 2021 were selected as research objects. They were divided into two groups according to the random number table method. In the control group, 1 patient was not accepted due to incorrect questionnaire filling, and in the study group, 1 patient was excluded due to missing follow-up. There were 26 males and 24 females in the control group, aged (50.23±12.36) years, and there were 25 males and 25 females in the study group, aged (49.89±12.29) years. The control group received routine intervention mode, and the study group received dual-track interactive intervention mode. The self-management abilities and blood pressure control of the two groups were observed on the day before discharge and 1 month after discharge. Statistical methods used were t test and χ² test. Results　On the day before discharge, there were no statistically significant differences in the total score and scores of all dimensions of Hypertension Patients Self-Management Behavior Rating Scale (HPSMBRS) between the two groups (all P>0.05). One month after discharge, the total score and scores of all dimensions of HPSMBRS of the study group had no statistically significant differences compared with those on the day before discharge (all P>0.05); the total score and scores of all dimensions of HPSMBRS of the control group were lower than those on the day before discharge (all P<0.05); the total score and scores of all dimensions of HPSMBRS of the study group were higher than those of the control group (all P<0.05). On the day before discharge, there were no statistically significant differences in the systolic and diastolic blood pressures between the two groups (both P>0.05). One month after discharge, the systolic blood pressure [(140.25±12.56) mmHg vs. (141.25±10.28) mmHg (1 mmHg=0.133 kPa)] and diastolic blood pressure [(81.02±3.54) mmHg vs. (82.29±4.52) mmHg] of the study group had no statistically significant differences compared with those on the day before discharge (both P>0.05); the systolic blood pressure [(145.54±10.36) mmHg vs. (141.36±10.26) mmHg] and diastolic blood pressure [(83.26±3.26) mmHg vs. (82.35±4.53) mmHg] of the control group were significantly different from those on the day before discharge (both P<0.05); the systolic blood pressure and diastolic blood pressure of the study group were lower than those of the control group (both P<0.05). Conclusion　The dual-track interactive intervention mode can improve the self-management level of hypertensive patients and facilitate the control of blood pressure.

Evaluation on the cleaning effect of multi-enzyme pretreatment solution combined with ultrasonic cleaning on straw of gynecological abortion

Tan Jiezhen, Cai Hui

2023, 29(13):  1914-1916.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.032

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Objective　To evaluate the cleaning effect of multi-enzyme pretreatment solution combined with ultrasonic cleaning on straw of gynecological abortion. Methods　It was a experimental study. A total of 1 200 straws of gynecological abortion in central sterile supply department of Shenzhen Nanshan District Maternal and Child Health Hospital from January to June 2022 were selected and were randomly divided into two groups. The control group was given multi-enzyme pretreatment solution combined with manual cleaning, while the experimental group was given multi-enzyme pretreatment solution combined with ultrasonic cleaning. The visual observation method and adenosine triphosphate (ATP) biofluorescence detection method were used to compare the qualified rate of cleaning between the two groups. χ² test was used. Results　By the visual observation method, it was found that the qualified rate of straw cleaning in the experimental group was 93.67% (562/600) and that in the control group was 73.33% (440/600), with a statistically significant difference (χ²=90.026, P<0.001). By the ATP biofluorescence detection method, it was found that the qualified rate of straw cleaning in the experimental group was 87.16% (523/600) and that in the control group was 68.67% (412/600), with a statistically significant difference (χ²=59.672, P<0.001). Conclusion　The cleaning effect of multi-enzyme pretreatment solution combined with ultrasonic cleaning is better than that of multi-enzyme pretreatment solution combined with manual cleaning.

Preventive Medicine

Prevalence and risk factors of moderate to severe vision impairment among students in a primary and secondary school of southern Xinjiang 

Zhang Haotian, Huang Yining, Li Yuting, Meng Jie

2023, 29(13):  1917-1921.  DOI: 10.3760/cma.j.issn.1007-1245.2023.13.033

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Objective　To investigate the prevalence and risk factors of moderate to severe vision impairment among students in a primary and secondary school of southern Xinjiang, and to provide real-world evidences for low vision prevention. Methods　A cross-sectional study was conducted in October 2020, when a total of 2 604 students from a primary and secondary school in southern Xinjiang were given a centralized ophthalmic examination. Among them, there were 1 330 boys and 1 274 girls, aged (11.6±2.9) years. Chi-square test was used to compare differences in the prevalence of moderate to severe vision impairment by gender. H test was used to compare differences in the age, gender, and achievement levels between the moderate to severe vision impairment group and the normal vision group. Logistic regression analysis was used to explore the relationships between age, gender, and academic performance and the prevalence of severe visual impairment. Results　A total of 2 604 students in southern Xinjiang participated in the survey, of whom 77 cases had moderate to severe visual impairment, with a prevalence of 2.96%. The main cause of moderate to severe visual impairment was uncorrected ametropia [100.00% (77/77)]. There was no statistically significant difference in the prevalence of moderate to severe visual impairment between boys and girls (35/1 330 vs. 42/1 274) (P=0.317). Inter-group differences showed that the age of the visual impairment group was significantly higher than that of the normal vision group [(13.0±2.0) years old vs. (11.7±2.8) years old] (P<0.001), and the ranking of the visual impairment group was higher than that of the normal vision group [(32.0±29.6)% vs. (65.6±21.8)%] (P<0.001). Logistic regression analysis showed that age and above-average academic performance were risk factors for moderate to severe visual impairment (OR=1.195, P<0.001; OR=34.711, P<0.001), whereas gender was not related (P=0.066). Conclusions　The prevalence of moderate to severe vision impairment among students in a primary and middle school of southern Xinjiang is low. The main cause of moderate to severe visual impairment is uncorrected ametropia. Risk factors include age and above-average academic performance. Strengthening early screening for ametropia, rationalizing study time, and increasing outdoor activities may help to prevent and control moderate to severe vision impairment.