Table of Content

01 February 2022, Volume 28 Issue 3

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Scientific Research

A brief introduction of MARCH2

Yan Da, Wang Nuan, Wang Haokun, Yang Lijuan, Liu Chengxia

2022, 28(3):  298-302.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.001

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The MARCH (membrane-associated RING-CH fingerprotein) family is a class of E3 ubiquitin ligases discovered in the 21 century. It has 11 members and plays a variety of regulatory roles through ubiquitin modification of substrate proteins in organisms. Membrane-associated RING-CH finger protein II, referred to as MARCH2, has common targets's such as TfR (transferrin receptor), STX-6(syntaxin 6), CD86 (B7-2), DLG1 (human Discs large tumor suppressor), CFTR (cystic fibrosis transmembrane conductance regulator), and β 2-AR (β 2-adrenergic receptors). It plays a role in viral immune escape, tumorigenesis, and agonist desensitization. As ubiquitin modification is ubiquitous in mammalian cells and participates in protein modification and ubiquitin degradation, MARCH2 also plays an important role, especially in intracellular vesicle transport and surface receptor regulation. However, at present, there are still many gaps to be filled in the research on the function of MARCH2. In this paper, the origin, structure, and function of MARCH2 are described in order to provide some basis for basic and clinical research in the future.

Research progress of Nrf2 activators and their anti-ultraviolet induced acute photodamage and chronic photoaging of skin

Xu Xia, Li Zhenjie

2022, 28(3):  303-307.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.002

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Ultraviolet (UV) irradiation produces reactive oxygen species (ROS) and free radicals which are closely related to acute photodamage and chronic photoaging of skin. Nuclear factor erythroid 2-related factor 2 (Nrf2) is an important transcription factor regulating antioxidant stress response. Nrf2 transcriptional activity plays a role in coordinating phase Ⅱ detoxification enzyme, inflammatory signal transduction, DNA repair, and antioxidant response. Nrf2 activator can activate Nrf2 pathway, affect mitogen activated protein kinase (MAPK)/activator protein 1 (AP-1) signaling system, and increase skin barrier protein expression.

A comparative study of arterial laterality and high signal in middle cerebral artery after M1 segment occlusion

Zhou Jianguo, Fu Dayong, Lu Mingcong, Chen Yuan

2022, 28(3):  307-310.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.003

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Objective　To investigate the correlation between unilateral middle cerebral artery (MCA) M1 segment occlusion and the unilateral advantages of anterior cerebral artery (ACA) indicated by magnetic resonance angiography (MRA) and posterior cerebral artery (PCA) indicated by 3-dimentional arterial spin labeling (3D ASL). Methods　From January 2018 to July 2021, 60 patients with unilateral MCA M1 segment occlusion indicated by MRA were collected, induding 34 males and 26 females, who were 33-78(51.2±7.6)years old. According to whether there was ACA or PCA unilateral advantages, they were divided into a unilateral advantage group and a control group. Through 3D ASL imaging sequence, the differences between the two groups in intra-arterial high signal display were compared. At the same time, the cerebral blood flow (CBF) of MCA supply area was measured, and the infarct area was calculated according to the DWI sequence. t and χ² tests were used. Results　Among the 60 patients, 87.9% (29/33) of the patients in the lateral dominant group and 48.1% (13/27) of the patients in the control group showed intra-arterial high signal, with a statistical difference (χ²=11.162, P<0.001). The CBF value of the middle cerebral artery blood supply area of the partial advantage group was (56.43±11.65) ml/100 g×min, which was higher than that of the control group [(42.58±14.52) ml/100 g×min], with a statistical difference (t=4.101, P<0.001). Meanwhile, the infarct area of the partial advantage group was smaller than that of the control group [(262.25±86.52) mm² vs. (768.54±168.65) mm²], with a statistical difference (t=-15.017, P<0.001). Conclusions　Both the advantage of cerebral artery lateralization and the high signal in the artery can indicate the establishment of collateral circulation after unilateral MCA M1 occlusion, but the high signal in the artery is more sensitive and accurate. The establishment of collateral circulation has positive significance for the selection of a treatment plan and for the patients' clinical prognosis.

Analgesia effect of different concentrations of sulfentanyl combined with transversus abdominis plane block after cesarean section 

Guo Zheyi, Deng Jiaojiao

2022, 28(3):  311-314.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.004

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Objective　To investigate the analgesia effect of different concentrations of sulfentanyl combined with transverse abdominis plane block after cesarean section. Methods　A total of 150 women taking elective cesarean section under intravertebral anesthesia in Shenzhen Hospital (Futian), Guangzhou University of Traditional Chinese Medicine between January 2020 and June 2021 were selected, and they were 21-35 years old and 151-169 cm tall and of American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ and weighed 54-75 kg. They were divided into group A, group B, and group C by the random number table method, taking patient controlled intravenous analgesia with 0.25, 0.50, 1.00 μg/ml sulfentanyl respectively and ultrasound-guided transverse muscle plane block. The Visual Analogue Scale (VAS) scores 2, 4, 8, 12, 24, and 48 h after cesarean section were observed and recorded. How many times the pumps had been pressed and sulfentanyl usage within 48 h were recorded. The incidences of dizziness, nausea and vomiting, skin pruritus, no exhaust, and complications of transverse abdominis plane block after were recorded. Statistics were performed using statistical methods such as one-way ANOVA and chi-square test. Results　There were no statistical differences in the number the pumps had been used and the total sulfentanyl volume between the three groups (all P>0.05). The sulfentanyl usage was (17.59±3.65) μg in group A, was (33.35±6.30) μg in group B, and was (65.39±6.98) μg in group C (F=123.24, P<0.001). There were no statistical difference in the VAS scores at different time points between the three groups (all P>0.05). The incidence of no exhaust was 6.2% (3/48) in group A, 8.5% (4/47) in group B, and 22.4% (11/49) in group C, with the highest in group C (χ²=6.951, P=0.031) and no statistical difference between group A and group B. Conclusion　After transverse abdominis plane block, patient controlled intravenous analgesia with 0.25~0.50 μg/ml sulfentanyl is effective, with a low incidence of adverse reactions.

Diagnosis and treatment of osteoporosis and current status of treatment with mesenchymal stem cells

Weng Yijie, Li Liangsheng, Zhong Xiangxin, Deng Feifu, Wang Yichang, Wei Jinsong

2022, 28(3):  315-320.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.005

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Osteoporosis is a systemic metabolic bone disease characterized by bone loss and bone microstructure degradation, leading to bone fragility and increased risk of fracture. In adults, bone marrow mesenchymal stem cells mainly differentiate into osteoblasts and adipocytes in bone. When their differentiation is unbalanced, differentiated adipocytes increase and osteoblasts decrease, which leads to osteoporosis. Osteoporosis is increasingly regarded as a major public health problem. It affects more than 200 million people all over the world and causes more than 8.9 million fractures every year, mainly hip fractures. With the aggravation of population aging, the personal and social cost spent on osteoporosis is increasing year by year, which poses a challenge to the public health care system. Therefore, the importance of early prevention and diagnosis of osteoporosis is self-evident. In addition, because mesenchymal stem cells have osteogenic potential and are found to be used for bone repair and maintenance, autologous, and allogeneic or transgenic bone marrow mesenchymal stem cell transplantation can effectively increase bone mass, mineral density, and mechanical strength and correct bone metabolic imbalance, it is expected to become a new strategy and method in the treatment of osteoporosis. This paper focuses on the diagnosis and treatment of osteoporosis and the application of mesenchymal stem cells.

Effect of evidence-based nursing care for preschool children with type 1 diabetes taking long-term insulin pump therapy

Wang Qiuli, Liu Suhua, Zhu Dongmei, Guo You

2022, 28(3):  320-324.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.006

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Objective　To explore the effect of evidence-based nursing care for preschool children with type 1 diabetes taking long-term insulin pump therapy. Methods　From June 2018 to March 2021, 136 preschool children with type 1 diabetes treated at Children's Hospital of Zhengzhou University were selected as experimental subjects. They were divided into an observation group and a control group by the isometric sampling method, with 68 cases in each group. The observation group had 38 boys and 30 girls who were (4.86±1.13) years old, and took evidence-based nursing care. The control group had 36 boys and 32 girls who were (4.75±1.24) years old, and took routine care. The general data, such as blood glucose, body weight, age, gender, and height, in both groups were investigated. The blood glucose levels, Caregiver Burden Scale (CBI) scores, negative emotions, various compliance behaviors, and negative events of insulin pump were compared between the two groups after the nursing care. The measurement data of normal distribution were expressed as (x±s), and compared between the two groups by LSD-t test. The enumeration data were expressed as cases (%), and compared between the two groups by χ² test. Results　Three months after the nursing care, the 2-hour postprandial blood glucose, fast blood glucose, hemoglobin A1C, and scores of Self-rating Depression Scale and Self-rating Anxiety Scale were (6.58±1.39) mmol/L, (5.18±0.11) mmol/L, (6.32±0.27)%, (43.39±2.21), and (42.16±3.37) in the observation group, which were lower than those in the control group (all P<0.05). The scores of CBI 1 and 3 months after the nursing care were (47.36±3.12) and (42.86±3.32) in the observation group, which were lower than those in the control group (both P<0.05). More patients correctly changed the sites, checked the injection sites every day, monitored blood glucose every day, carried backup drugs and tools with them, and safely kept the drugs and tools in the observation group [97.06% (66/68), 98.53% (67/68), 100.00% (68/68), 92.65% (63/68), and 97.06% (66/68)] than in the control group (all P<0.05). The incidence of the negative insulin pump events was 4.41% (3/68) in the observation group, which was lower than that in the control group (P<0.05). Conclusion　Evidence-based nursing care for preschool children with type 1 diabetes can standardize the long-term use of insulin pumps and reduce the incidence of accidents.

Observation and nursing care of patients with paraquat-induced liver damage treated by dual plasma molecular adsorption system

Lyu Minqing, Lan Wei, Cai Jingyan

2022, 28(3):  324-328.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.007

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Objective　To explore the nursing technology of dual plasma molecular adsorption system (DPMAS) in the treatment of liver damage caused by paraquat poisoning. Methods　Sixty-eight patients with paraquat poisoning admitted to Emergency Department, Guangzhou 12th People's Hospital from January 2018 to January 2020 were selected and divided into a control group and an observation group by the random number table method, with 34 cases in each group. The control group had 12 males and 22 females, and were (44.26±8.48) years old. The observation group had 13 males and 21 females, and were (45.33±8.26) years old. All the patients were treated by DPMAS. The control group took routine nursing, and the observation group took targeted nursing. The test indicators, treatment effects, and incidences of complications of the two groups were compared after the nursing. The measurement data of normal distribution were expressed as (x±s) and compared between the two groups by independent-sample t test. The enumeration data were expressed as cases (%) and were compared between the two groups by chi-square test. Results　There were statistical differences in paraquat concentration, total bilirubin (TBIL), total bile acid (TBA), glutamic-pyruvic transaminase (ALT), aspartate aminotransferase (AST), blood NH₃, albumin (Alb), and interleukin-6 (IL-6) between before and after the nursing in both groups (all P<0.05), but no between the two groups (all P>0.05). The effective rate was 88.2% (30/34) in the observation group, and was 76.5% (26/34) in the control group, with no statistical difference (P>0.05). The incidence of hematoma or hemorrhage, pulmonary infection, hypotension, shivering, and coagulation in the observation group was significantly lower than that in the control group (P<0.05). Conclusion　DPMAS as a kind of artificial liver support system applied in the treatment of liver damage caused by paraquat poisoning can effectively remove paraquat and other toxic substances in blood, improve their liver function and treatment safety, cooperate with targeted nursing in treatment, and reduce the incidence of complications.

Effect of polydatin-related AMPK signal pathway on lipidosis in livers of mice with nonalcoholic fatty liver disease 

Zhao Dongbo, Wang Hao, Huang Ying, Gong Xuan, Lu Hao

2022, 28(3):  329-332.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.008

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Acupoint massage by six-meridian manipulation and contralateral collateral needling on Cuosan acupoint in treatment of lumbar disc herniation

Zhao Xiaodong, He Bin

2022, 28(3):  333-336.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.009

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Effect of management mode based on smart medical system in prevention of lymphedema in breast cancer patients after surgery

Yuan Chenye, Zhou Zhiyin

2022, 28(3):  336-340.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.010

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Objective　To explore the effect of the management mode based on the smart medical system in the prevention of lymphedema in breast cancer patients after surgery. Methods　A total of 112 female breast cancer patients admitted to Wuxi Second People's Hospital from January to December 2020 were selected and divided into an observation group and a control group by the random number table method, with 56 cases in each group. The control group were (45.37±6.58) years old, and took conventional management mode. The observation group were (45.52±6.43) years old, and took the management mode based on the smart medical system. The lymphedema knowledge awareness rates, lymphedema prevention behaviors, and incidences of lymphedema were compared between these two groups. The enumeration data were compared between these two groups by χ² test, and the measurement data by independent-sample t test. Results　The awareness rates of disease causes, clinical manifestations, treatment methods, risk factors, and prevention methods in the knowledge of lymphedema after the intervention were 83.93% (47/56), 89.29% (50/56), 92.86% (52/56), 83.93% (47/56), and 87.50% (49.56) in the observation group, and were 66.07% (37/56), 69.64% (39/56), 76.79% (43/ 56), 67.86% (38/56), and 69.64% (39/56) in the control group, with statistical differences between these two groups (all P<0.05). The scores of skin treatment, life style, and avoiding upper limb pression and extreme temperature after the intervention in the observation group were higher than those in the control group (all P<0.001). The behavioral score of mastering lymphedema prevention in the observation group was higher than that in the control group after the intervention [(61.99±3.28) vs. (50.44± 4.20), P<0.05]. The incidence of lymphedema after the intervention was 8.93% (5/56) in the observation group, and was 23.21% (13/56) in the control group, with a statistical difference (χ²=4.236, P=0.040). Conclusion　Applying the management mode based on the smart medical system in patients after breast cancer surgery can significantly improve their cognitive level of lymphedema and preventive behaviors, and effectively reduce the incidence of lymphedema.

Effect of multi-mode analgesia based on rapid recovery concept on postoperative pain control in patients with esophageal cancer

Liu Jing, Su Binglian, Gong Lanjuan, Lin Wanli, Fan Ting

2022, 28(3):  341-344.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.011

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Objective　To analyze the effect of multi-mode analgesia based on rapid recovery concept on postoperative pain control in patients with esophageal cancer. Methods　A total of 100 patients undergoing thoracic laparoscopy and esophageal cancer radical resection in Gaozhou People's Hospital from April 2020 to March 2021 were selected and divided into a control group and an observation group by the lottery method, with 50 cases in each group. There were 27 males and 23 females in the control group, and they were 36-82 (49.68±11.26) years old. There were 26 males and 24 females in the observation group, and they were 35-81 (48.26±11.67) years old. The control group were treated with conventional analgesia, and the observation group with multi-mode analgesia based on rapid recovery concept. The pain, incidences of complications, negative moods, postoperative hospitalization days, exhaust, and other indicators and analgesic satisfaction were compared between the two groups. The measurement data were compared between these two groups by independent-sample t test, and the enumeration data by χ² test. Results　The first defecation time, the first exhaust time, the first time out of bed, and the length of hospitalization in the observation group were lower than those in the control group (all P < 0.05). The scores of Visual Analogue Scale (VAS) 1, 2, 3, and 7 days after the operation in the observation group were lower than those in the control group (all P < 0.05). The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the observation group were lower than those in the control group [(38.69±4.23) vs. (56.89±4.32) and (41.65±4.12) vs. (52.65±4.56); both P < 0.05]. The incidence of postoperative complications in the observation group was lower than that in the control group [4.0% (2/50) vs. 16.0% (8/50), P < 0.05]. The analgesic satisfaction of the observation group was higher than that of the control group [96.0% (48/50) vs. 84.0% (42/50)], with a statistical difference (χ²=4.215, P=0.040). Conclusion　Multi-mode analgesia based on rapid recovery concept for patients with esophageal cancer can effectively relieve their negative moods, improve their postoperative pain and the recovery effect, and shorten their hospital stay.

Effect of diagnosis and treatment pathways based on enhanced recovery after surgery for patients with ankle fracture during perioperative period

Zhou Yexiu, Wei Renjie, Huang Dabo, Wei Jiehe, Wei Liyong, Huang Juanjuan, Lan Wanjie

2022, 28(3):  345-348.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.012

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Objective　To evaluate the effect of diagnosis and treatment pathways based on enhanced recovery after surgery (ERAS) for patients with ankle fracture during perioperative period. Methods　One hundred patients with ankle fracture admitted to Department of Trauma Orthopedics, People's Hospital of Hechi City from June 2019 to June 2020 were selected, and were divided into an ERAS group and a control group by the random number table method, with 50 cases in each group. There were 28 males and 22 females in the control group, and they were (47.25±13.48) years old. There were 24 males and 26 females in the ERAS group, and they were (46.37±11.69) years old. The control group was given routine perioperative intervention, and the observation group developed diagnosis and treatment pathways based on ERAS. The operation times, intraoperative bleeding volumes, postoperative hospital stays, fracture healing times, American Orthopedic Foot and Ankle Society (AOFAS) scores, Baird-Jackson scores, Visual Analogue Scale (VAS) scores, and incidences of complications were compared between the two groups.The measurement data were compared by independent-sample t test and paired t test, and the enumeration data by χ² test. Results　The operation time, intraoperative bleeding volume, postoperative hospital stay, and fracture healing time were (96.45±12.89) min, (52.12±10.48) ml, (7.44±2.18) d, and (12.05±1.33) weeks in the ERAS group, and were (108.62±15.01) min, (64.35±11.92) ml, (9.12±3.04) d, and (13.84±2.12) weeks in the control group, with statistical differences (t=4.898, 7.725, 5.562, and 5.873; all P<0.001). Three months after the surgery, the scores of AOFAS, Baird-Jackson, and VAS were (56.82±5.88), (88.05±9.32), and (1.51±0.39) in the ERAS group, and were (51.34±4.92), (79.84±8.12), and (2.39±0.54) in the control group, with statistical differences (t=3.375, 3.289, and 8.272; all P<0.001). The incidence of complications in the ERAS group was lower than that in the control group [2% (1/50) vs. 14% (7/50); χ²=4.891, P=0.027]. Conclusion　Diagnosis and treatment pathways based on ERAS for patients with ankle fracture during perioperative period can significantly reduce intraoperative bleeding, shorten operation time and hospital stay, promote ankle function recovery, and reduce complications.

Application of diversified training in infection prevention and control training for regular training doctors at ICU

Yang Longzhen, Wu Qiaomei, He Qian, Zhang Lijuan

2022, 28(3):  348-351.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.013

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Objective　To explore the effect applying diversified training in nosocomial infection prevention and control training for regular training doctors at ICU. Methods　Sixty regular training doctors who had been working at ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine for three months or more from October 2019 to May 2020 were selected. According time they started to work at ICU, the 30 ones from October 2019 to January 2020 were set as a control group, and the 30 ones from February to May 2020 were set as an experimental group. The control group took conventional training methods. The experimental group took diversified training, and the department nurses took the lead in the training process; the training was conducted by hand hygiene flow chart, wearing and taking off isolation gown video, self-made micro-films for propaganda of sensory control, WeChat official account column for sensory control, sensory control workshop, theoretical and operational assessment, and real-time feedback. After the training, the hand hygiene compliances, mastery levels of nosocomial infection knowledge and nosocomial infection rates of the two groups were compared and evaluated. The measurement data were compared between these two groups by independent-sample t test, and the enumeration data by χ² test. Results　The hand hygiene compliance and the score of nosocomial infection knowledge in the experimental group were higher than those in the control group [93.3% (56/60) vs. 80.0% (48/60) and 80.0 (75.0, 85.0) vs. 90.0 (80.0, 95.0)], with statistical differences (χ²=4.615, P=0.032; Z=-3.219, P=0.001). The hospital infection rate of the experimental group was lower than that of the control group [6.65% (22/331) vs. 12.8% (47/367)], with a statistical difference (χ²=7.413, P=0.006). Conclusions  The use of diversified training to train regular training doctors at ICU on hospital infection prevention and control can help them systematically and comprehensively master targeted hospital infection prevention and control knowledge, improve their hand hygiene compliance, and reduce the hospital infection rate. It is of great significance to improve the awareness and behaviors of preventing and controlling hospital infections in clinical work.

Laboratory Medicine Column

Isolation, cultivation, and identification of Francisella from near-shore shallow coastal areas

Chen Fu, Li Min, Feng Junhui, Luo Haimin, Li Lianghui, Liao Huanlan, Qu Pinghua, Li Song

2022, 28(3):  353-357.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.014

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Objective　To investigate the distribution of Francisella from near-shore shallow coastal areas in Guangdong, China by analyzing the seawater samples from various sources. Methods　Nineteen and 29 water samples were collected from the near-shore shallow coastal areas at Shuidong Bay at Dianbai District, Maoming City (on October 4, 2019) and Xunliao Bay and Double-Moon Bay in Huizhou City (on August 12, 2019) in Guangdong, China. The early exploratory outcomes of the optimal pretreatment method (concentrate and acid treatment) and culture medium (BHI-2216E-GVPC and BCYEα-2216E-GVPC) were applied to isolate Francisella. The colonies were selected based on Francisella colony morphology and the selected single colonies were cultured separately on plates to get the pure culture for further study, such as traditional morphological features, biochemical/physiological features, and 16S rRNA gene sequencing identification. Results　Fourteen of the 19 samples were positive (73.7%) and were collected from Shuidong Bay, and a total of 60 strains (including facultative intracellular bacteria) were isolated. Seventeen of the 29 samples were positive (58.6%), and were collected from Huizhou City, and a total of 79 strains (including facultative intracellular bacteria) were isolated. We examined the morphological, biochemical and 16S rRNA gene features of all the isolated strains. Among the 60 strains from Shuidong Bay, 12 strains (20.0%, including potential new species) were identified into Francisella, and 2 strains belonged to a potential new family (2.9%). Among the 79 strains from Huizhou City, 22 strains (27.8%, including potential new species) were identified into Francisella, and 18 strains (22.8%) belonged to a potential new family. Conclusion　The Francisella resources, including potential new species, and its neighboring potential new family are abundant in near-shore shallow coastal areas in Guangdong, China.

Meta-analysis of value of serum thymidine kinase 1 in diagnosis of thyroid cancer

Liu Huixuan, He Yajun

2022, 28(3):  357-360.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.015

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Objective　To investigate the value of serum thymidine kinase 1 (S-TK1) in the diagnosis of thyroid cancer. Methods　The relevant literatures on S-TK1 in the diagnosis of thyroid cancer were searched and collected from PubMed, Web of Science, CNKI, VIP, Wanfang Database, and other databases from their establishment to April 2021. Meta-analysis was performed using Metadisc 1.4 and RevMan 5.3. Summary receiver operating characteristic curve plan and Spearman correlation coefficient were used to evaluate the threshold effect. Cochrane-Q test and I² test were used for heterogeneity analysis. The random effect model was used for meta-analysis. Results　Eight literatures met the inclusion criteria, including 820 cases of thyroid cancer and 831 cases normal or of benign thyroid tumors. Heterogeneity exists between the studies. The calculation based on the random effect model showed that the total sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating character curve area under curve were 73% (95%CI 0.70-0.76, 601/820), 75% (95%CI 0.72-0.78, 624/831), 3.63 (95%CI 2.24-5.90), 0.34 (95%CI 0.25-0.45), and 0.84, respectively. Conclusion　S-TK1 is effective in the diagnosis of thyroid cancer, which is beneficial to the early detection and diagnosis of thyroid cancer, and has certain clinical guiding significance in the diagnosis of thyroid cancer.

Effects of siRNA interfering with VNUT gene on insulin secretion in INS-1

Peng Shuying, Wang Zeqi, Chen Liqiang

2022, 28(3):  360-362.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.016

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Objective　To investigate the effect of small interfering RNA (siRNA) on the expression of vesicular nucleotide transporter (VNUT) gene and insulin secretion in rat pancreatic β-tumor cells (INS-1). Methods　From January to June 2021, the effects of siRNA on VNUT gene expression and insulin secretion were detected by reverse transcription-polymerase chain reaction (RT-PCR), Western blotting, and enzyme linked immunosorbent assay (ELISA). The independent-sample t test was applied. When P<0.05, there is a statistical difference. Results　Twenty-four hours after siRNA was transfect into the INS-1, in the control group and the interfering group, the levels of RNA were (0.452±0.218) and (0.319±0.116), and the levels of proteins were (0.514±0.297) and (0.369±0.203), with statistical differences between the two groups (both P<0.05); the levels of insulin secretion were (281.45±24.92) ng/L and (176.54±15.70) ng/L in the control group and the interfering group, respectively, with a statistical difference between the two groups (P<0.05). Conclusion　siRNA obviously inhibits VNUT gene expression and insulin secretion in INS-1, and that deeply studying the effect of VNUT gene on insulin secretion can provide references for the pathogenesis of type 2 diabetes.

LINC01836 is a new biomarker for the diagnosis and prognosis of colorectal cancer 

Zhao Wenzhen, Lin Yuning

2022, 28(3):  363-367.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.017

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Objective　To explore the relationship between LINC01836 and colorectal cancer. Methods　A retrospective study was performed through the Cancer Genome Atlas (TCGA) database. The V23.0 gene expression profile data of colorectal cancer patients released on April 7, 2020 in the TCGA database were downloaded. The relationship between clinicopathological features and LINC01836 expression was evaluated by Wilcoxon rank sum test, chi square test, Fisher test, and logistic regression analysis. Receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic value of LINC01836 for colorectal cancer. Kaplan-Meier survival analysis was used to evaluate the effect of LINC01836 on the prognosis of patients with colorectal cancer. Results　The expression of LINC01836 in colorectal cancer was statistically different in different N stage (χ²=6.68, P=0.035), M stage (χ²=9.32, P=0.002), pathological stage (χ²=12.6, P<0.001), lymphatic invasion (χ²=11.82, P<0.001), and colonic polyps (χ²=4.51, P=0.034). Logistic regression showed that the high expression of LINC01836 was associated with N stage progression (OR=1.469, P = 0.017), M stage progression (OR=2.131, P=0.002), pathological stage progression (OR=1.580, P=0.005), lymphatic invasion (OR=1.826, P<0.001), and colonic polyps (OR=0.576, P=0.025). ROC showed that LINC01836 had significant diagnostic efficacy in distinguishing colorectal cancer tissues from adjacent normal tissue [area under curve (AUC)=0.907] and normal tissue (AUC=0.899). Kaplan-Meier survival analysis showed that the high expression of LINC01836 was associated with the low overall survival rate in the patients with colorectal cancer (P=0.002). Conclusions　LINC01836 is highly expressed in colorectal cancer and is related to a variety of clinicopathological features of colorectal cancer patients. It may become a new biomarker with potential application value for colorectal cancer.

Polymerase chain reaction in detection of salmonella

Li Liwei

2022, 28(3):  368-370.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.018

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This paper mainly summarizes the characteristics of salmonella and other pathogenic bacteria and the resulting harm, compares the traditional detection methods with polymerase chain reaction (PCR) technology professionally, describes the characteristics of different detection methods, and comparatively analyzes the advantages and disadvantages between different detection techniques with the help of real experimental cases, as well as the current development of the practical application systems. Through the analysis of detecting various target genes of salmonella by PCR, this paper discusses the application and progress of PCR in detection of salmonella, and briefly expounds conventional PCR, multi-PCR, and real-time quantitative PCR.

Treatises

Upregulation of NCAPG gene expression promotes lung adenocarcinoma cell proliferation and is associated with poor clinical prognosis 

Yang Yang, Liao Yingying, Chen Futao

2022, 28(3):  371-379.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.019

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Objective　To investigate the expression of the NCAPG gene in lung adenocarcinoma tissue and its relevance to the clinical prognosis and its molecular mechanisms. Methods　From January 2017 to December 2019, the samples of the tumor tissue and the nearby normal tissue were collected from 110 patients with lung adenocarcinoma confirmed and surgically treated at Lianyungang Second People's Hospital. The relationship between NCAPG gene expression and the prognosis of lung adenocarcinoma patients was analyzed using the TCGA database. The NCAPG expressions in the 110 adenocarcinoma samples and normal samples were assessed using immunohistochemistry (IHC). The cell lines stably knocking down NCAPG in lung adenocarcinoma were obtained using a lentivirus-mediated shRNA. CCK-8 and colony formation experiments were used to investigate the proliferative capacity of NCAPG on lung adenocarcinoma cell lines (A549, H1975). The co-expressed genes of NCAPG were explored by protein-protein interaction (PPI) and co-expression analysis, and validated using coimmunoprecipitation (CO-IP). The differences in OS and DFS were judged by the Log-rank test. The correlation between the clinical pathological characteristics and NCAPG expression in the 110 patients was evaluated by chi-square test. Results　NCAPG was upregulated in the TCGA lung adenocarcinoma database and in the 110 samples of lung adenocarcinoma tissue, and was associated with tumor size (P=0.048) and clinical stage (P=0.021) in lung adenocarcinoma patients. Furthermore, the knockdown of NCAPG inhibited lung adenocarcinoma cell proliferation and growth. Mechanistically, we further found that CDK1 had an expression correlation with NCAPG and binds with each other, jointly promoting the progression of lung adenocarcinoma. Conclusion　NCAPG can be used as a marker of poor prognosis in patients with lung adenocarcinoma and as a potential target for the treatment of lung adenocarcinoma.

Neonatal hyperbilirubinemia and intestinal flora homeostasis and related influencing factors

Zhao Shengying, Yu Xiyang, Li Yan, Chen Weizhen, Dong Shulan

2022, 28(3):  380-384.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.020

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Objective  To analyze the related influencing factors of neonatal hyperbilirubinemia (NHB) and the relationship between neonatal NHB and the characteristics of intestinal flora. Methods  From February 2019 to December 2020, 142 NHB neonates were selected as an observation group, including 68 boys and 74 girls who were 1-7 (4.26±1.61) days old and whose birth weight was 2.24-4.01 (3.02±0.52) kg; and 147 healthy neonates during the same period were selected as a control group, including 75 boys and 72 girls who were 1-7 (4.25±1.57) days old and whose birth weight was 2.30-4.12 (3.16±0.46) kg. The levels of forehead and chest bilirubin and serum total bilirubin were measured. The distribution of the bacterial flora in the feces of the two groups was detected. χ² and t tests were applied. Univariate and multivariate logistic regression analyses were used to analyzed the independent risk factor of NHB. Results  There were statistical differences in birth weight, gestational age, peripartum infection, fetal distress, cesarean section, premature rupture of fetal membrane, lack of breast milk, gestational hypertension, and gestational diabetes between these two groups (P<0.05). The numbers of bifidobacteria, lactobacilli, and Escherichia coli were (7.96±0.58), (8.05±0.71), and (7.32±0.83) in the observation group, and were (9.02±0.61), (8.77±0.76), and (6.66±0.62) in the control group, with statistical differences (t=15.129, 8.316, and 7.676; all P<0.001). Cesarean section, premature rupture of fetal membrane, peripartum infection, and the numbers of bifidobacteria, lactobacilli, and Escherichia coli were independent risk factors for the occurrence of neonatal NHB. Conclusions  Neonatal NHB is closely related to many factors. Cesarean section, premature rupture of fetal membrane, fetal distress, peripartum infection, the decrease of bifidobacteria and lactobacilli, and the increase of Escherichia coli all can increase the risk of NHB.

Value of comprehensive geriatric assessment in treatment for elderly patients with diffuse large B cell lymphoma

Ke Jin, Liu Xiaohui, Wang Hengshi, Zhang Shanlan

2022, 28(3):  385-389.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.021

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Objective　To explore the value of comprehensive geriatric assessment (CGA) in treatment for elderly patients with diffuse large B cell lymphoma (DLBCL). Methods　Seventy ≥65 years old patients with DLBCL treated at Department of Oncology and Hematology, Songjiang District Central Hospital from January 2015 to December 2017 were enrolled in the study, and were divided into a fit group, an unfit group, and a frail group according to the CGA criteria. The correlations of the clinical characteristics with the treatment efficacy, prognosis, and adverse reactions in the three groups were analyzed. Chi-square test, Fisher's exact test, and rank sum test were applied. The Kaplan-Meier was used for survival analysis. The log-rank test was used for the comparison between curves. Results　There were 70 patients, including 39 males and 31 females, with a median age of 69 (65-89). According to the CAG criteria, there were 35 (50.0%, 35/70) in the fit group, 13 (18.6%, 13/70) in the unfit group, and 22 (31.4%, 22/70) in the frail group. The patients had worse physical status (ECOG score) and more patients had intermediate-high/high IPI risk class in the frail group than in the fit group and the unfit group, with statistical differences (χ²=38.859 and 13.638, both P<0.01). The overall response rate of chemotherapy was 100.0% (35/35) in the fit group, 100.0% (13/13) in the unfit group, and 36.4% (8/22) in the frail group, with a statistical difference (χ²=38.182,P<0.01). There were no statistical differences in the incidences of hematological and non-hematologic adverse reactions of grade≥3 between the 3 groups. The 2-year follow up showed that 2-year progression-free survival rates in the fit group, the unfit group, and the frail group were 57.1% (20/35), 46.2% (6/13), and 18.2% (4/22), with a statistical difference (χ²=22.919, P<0.01). In the unfit group, there were no statistical differences in the response rate of chemotherapy and 2-year progression-free survival rate between the patients treated by chemotherapy of a standard dosage and the patients treated by chemotherapy of a low dosage. Conclusion　CGA may be more comprehensive in assessing the physical conditions of elderly patients with DLBCL, can effectively predict the therapeutic effect and prognosis, and provide assistance for guiding therapeutic strategies.

Relationships between H-FABP, salusin-β levels and disease severity, prognosis in patients with chronic heart failure

Li Li, Jia Liqing

2022, 28(3):  390-394.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.022

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Objective　To investigate the relationships between heart type fatty acid binding protein (H-FABP), salusin-β levels and disease severity, prognosis in patients with chronic heart failure (CHF). Methods　A total of 160 patients with CHF admitted to Inner Mongolia Baotou Steel Hospital between January 2019 and December 2020 were enrolled as a CHF group [95 males and 65 females, aged (54.23±4.68) years], while other 67 healthy controls during the same period were enrolled as a control group [39 males and 28 females, aged (53.92±4.27) years]. The levels of H-FABP and salusin-β in both groups were detected by enzyme-linked immunosorbent assay. According to the cardiac function grading, CHF patients were divided into grade Ⅰ-Ⅳ, and the levels of H-FABP and salusin-β in patients with different grading were compared. All patients were followed up for 6 months to statistically analyze the occurrence of cardiovascular adverse events. The relationships between H-FABP, salusin-β levels and prognosis were analyzed. For the measurement data, independent sample t test was performed between two groups, one-way ANOVA was performed for comparison among multiple groups, and LSD-t test was performed for pairwise comparison; the count data were tested by χ². Results　The levels of H-FABP and salusin-β in the CHF group were higher than those in the control group (both P<0.05). The receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of H-FABP combined with salusin-β in the diagnosis of CHF was 0.841, greater than that of H-FABP and salusin-β alone (0.787 and 0.738) (P<0.05). With the increase of cardiac function grading, the levels of H-FABP and salusin-β increased, and there were statistically significant differences among patients with different cardiac function grading (all P<0.05). The levels of H-FABP and salusin-β in patients with poor prognosis were higher than those in patients with good prognosis (both P<0.05). Conclusions　The levels of H-FABP and salusin-β are related to the occurrence of CHF, which are of certain diagnostic efficiency, and the diagnostic value of combined detection is relatively higher. H-FABP and salusin-β are positively correlated with cardiac function grading, which can be applied to determine the severity of CHF and are of great significances for prognosis evaluation of CHF.

Evaluation of the relationship between ischemic penumbra, collateral circulation, and prognosis of ischemic stroke patients by multimodal CT

Hu Wei, Liu Liangjin

2022, 28(3):  394-398.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.023

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Objective　To explore the relationship between ischemic penumbra, collateral circulation, and prognosis in ischemic stroke patients by multimodal CT. Methods　A total of 120 patients with ischemic stroke treated in The Third People's Hospital of Hubei Province, Jianghan University were enrolled between December 2018 and December 2020. There were 68 males and 52 females, with an age of (62.96±4.23) years old. The multimodal CT examination was conducted to obtain perfusion parameters such as relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT), relative time to peak (rTTP), and permeability surface (PS). According to the collateral circulation grading system of American ASITN/SIR, the patients were divided into a good collateral circulation group (51 cases) and a poor collateral circulation group (69 cases). The perfusion parameters of core infarct area and ischemic penumbra and infarct range were compared between the two groups. After 6 months of follow-up, the prognosis [modified Rankin scale (mRS) score] was compared between the two groups. The hemorrhagic transformation (HT) was evaluated by CT perfusion (CTP). According to presence or absence of HT, the patients were divided into a HT group (41 cases) and a non-HT group (79 cases), and the perfusion parameters were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The rates of hypertension and diabetes mellitus in the poor collateral circulation group were higher than those in the good collateral circulation group (both P<0.05). The rCBV, rMTT, and rTTP of core infarct area in the good collateral circulation group were (1.57±0.44) ml/100 g, (2.61±0.73) s, and (1.15±0.32) s, respectively, which were higher than those in the poor collateral circulation group [(1.09±0.32) ml/100 g, (1.87±0.51) s, and (0.92±0.15) s] (all P<0.05); there was no statistically significant difference in the rCBF of core infarct area between the two groups (P>0.05). There were no statistically significant differences in the rCBV, rMTT, and rTTP of ischemic penumbra between the good collateral circulation group and the poor collateral circulation group (all P>0.05); the rCBF of ischemic penumbra in the good collateral circulation group was (0.81±0.42) ml/100 g·min^-1, which was higher than that in the poor collateral circulation group [(0.59±0.17) ml/100 g·min^-1] (P<0.05). The infarct range and mRS score of the good collateral circulation group were (5.98±1.47) ml and (1.64±0.35) points, respectively, which were lower than those of the poor collateral circulation group [(18.03±4.21) ml and (4.31±1.13) points] (both P<0.05). There were no statistically significant differences in the CBV and CBF of the affected side between the HT group and the non-HT group (both P>0.05); the MTT of the HT group was (3.25±0.87) s, lower than that of the non-HT group [(5.06±1.29) s], and the PS was (17.15±4.18) ml/min·100 g, significantly higher than that of the non-HT group [(2.03±0.54) ml/min·100 g] (both P<0.05). Conclusions　Multimodal CT examination can effectively evaluate the collateral circulation, ischemic penumbra, and HT in ischemic stroke patients. Establishing and promoting good collateral circulation can reduce the range of infarct lesions and improve the prognosis.

Clinical Research

Effect of TCRP combined with leuprorelin on levels of sex hormones and postoperative recurrence in patients with endometrial polyps

Wang Minxia, Liu Yang, Yu Hanfeng

2022, 28(3):  399-402.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.024

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Objective　To study the effect of transcervical resection of polyps (TCRP) combined with leuprorelin on the levels of sex hormones and postoperative recurrence in patients with endometrial polyps. Methods　The clinical data of 280 patients with endometrial polyps who were treated at Mengyin County People' s Hospital between January 2015 and August 2020 were collected. The patients were divided into a control group (120 cases) and an observation group (160 cases) according to the treatment methods. The control group were 26-55 (40.12±4.18) years old, with a disease course of 4-11 (6.02±1.17) months. The observation group were 28-55 (39.63±4.21) years old, with a disease course of 3-10 (5.76±1.20) months. The control group were treated by TCRP, and the observation group by TCRP and leuprorelin. The levels of sex hormones and postoperative recurrence were compared between the two groups. The enumeration data were compared between these two groups by χ² test, and the measurement data by independent-sample t test. Results　The total clinical effective rate was 95.00% (152/160) in the observation group, and was 88.33% (106/120) in the control group, with a statistical difference (χ²=4.210, P=0.040). Before the treatment, there was no statistical difference in the endometrial thickness between the two groups (P>0.05). One, three, and six months after the treatment, the endometrial thicknesses of the two groups declined, and those in the observation group were lower than those in the control group (all P<0.001). There were no statistical differences in the levels of estradiol (E2), progesterone (P), and follicle-stimulating hormone (FSH) between the two groups before the treatment (all P>0.05); after treatment, the levels of the above indicators of the two groups declined, and those in the observation group were significantly lower than those in the control group (all P<0.001). After the treatment, the recurrence rate and the incidences of complications were significantly lower and more patients had normal menstruation in the observation group than in the control group (all P<0.05). Conclusion　TCRP combined with leuprorelin for patients with endometrial polyps has a significant efficacy and good recovery of postoperative hormones, and can effectively reduce the recurrence rate and complications and maintain the patients' menstruation normal after surgery.

Transesophageal echocardiography in diagnosis of young and middle-aged migraine patients complicated with patent foramen ovale and evaluation of interventional efficacy

Zheng Yujiang, Dong Yanxia, He Liantu

2022, 28(3):  403-405.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.025

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Objective　To investigate the status of transesophageal echocardiography (TEE) in the diagnosis of patent foramen ovale (PFO) in middle-young patients with migraine and to evaluate the effect of interventional blocking. Methods　From February to October 2021, 35 middle-young patients suspected with PFO treated at Anyang People's Hospital were selected, including 12 males and 23 females who were (35.4±6.8) years old. Their clinical manifestation was long-term and repeated migraine. All the patients were examined by TEE to observe PFO. Among them, 22 had PFO, and were treated by interventional blocking. Before and after the surgery, the patients were scored by headache impact test-6 (HIT-6) to evaluate the effect. The measurement data of normal distribution were compared by paired t test. Results　Among the 35 patients, 22 patients were diagnosed with PFO by TEE, accounting for 63%. All these 22 patients received interventional blocking. The HIT-6 score was (43.78±4.23) 6 months after the operation, and was (68.59±4.36) before the operation, with a statistical difference (P<0.05). Conclusions　The proportion of middle-aged and young migraine patients complicated with PFO is high. Interventional blocking can effectively improve the clinical symptoms of migraine patients complicated with PFO.

Pathogen distribution and risk factors of pneumonia combined with diabetic foot infection

Liu Minhuan

2022, 28(3):  406-410.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.026

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Objective　To explore the distribution of pathogenic bacteria in patients with pneumonia and diabetic foot infection and analyze the related risk factors. Methods　A total of 128 patients with pneumonia and diabetes admitted to Shangqiu Municipal Hospital from June 2017 to June 2020 were selected as the study objects. The 42 patients who had diabetic foot ulcer infection were set as an infected group, and the rest 86 patients who did not have infection were set as an uninfected group. The distribution characteristics of pathogenic bacteria in diabetic foot ulcer were analyzed, and the clinical data, such as age, gender, underlying diseases, and infection were collected. The measurement data were compared between these two groups by independent-sample t test, and the enumeration data by χ² test. Single and multivariate logistic regression analyses were used to explore the relevant risk factors of pneumonia combined with diabetic foot infection. Results　There were no statistical differences in gender, age, body mass index, smoking, and underlying diseases between these two groups (all P>0.05). There were 82 strains of pathogenic bacteria in the 42 patients with diabetic foot infection, including 34 strains (41.46%) of gram positive bacteria, 43 strains (52.43%) of gram-negative bacteria strains, and 5 strains (6.10%) of other bacteria. There were statistical differences in diabetic nephropathy, diabetic peripheral neuropathy, diabetic foot course, APCHE Ⅱ score, high density lipoprotein cholesterol (HDL-C), fibrinogen, white blood cell count, C-reactive protein (CRP), albumin, fasting blood-glucose (FBG), and glycosylated hemoglobin (HbAlc) between these two groups (all P<0.05). Multivariate analysis showed that diabetic peripheral neuropathy, longer diabetic foot course, higher APCHE Ⅱ score, lower HDL-C, and higher HbAlc were independent risk factors for diabetic foot infection (all P<0.05). Conclusions　The main pathogens of diabetic foot infection are gram-positive and gram-negative bacteria. Diabetic peripheral neuropathy, disease course, APCHE Ⅱ score, HDL-C, and HbAlc levels are the risk factors inducing infection. Based on the independent risk factors, the reasonable and effective intervention and prevention should be done to reduce the incidence of diabetic foot infection and promote the patients' quality of life and recovery.

Addition and deduction of Liqi Qingchang Fang combined with mesalazine for ulcerative colitis

Xu Ming

2022, 28(3):  410-413.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.027

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Study on the correlations between inflammatory indexes and lung function in patients with acute respiratory distress syndrome 

Gao Linben, Wang Yanqing, Hua Xia

2022, 28(3):  414-418.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.028

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Objective　To explore the correlations between inflammatory indexes and lung function in patients with acute respiratory distress syndrome (ARDS). Methods　A total of 86 cases of ARDS received by The People's Hospital of Haiyang from January 2020 to June 2021 were taken as the research objects, and they were divided into a mild group (18 cases), a moderate group (30 cases), and a severe group (38 cases) according to the condition. In the mild group, there were 10 males and 8 females, aged (56.80±8.18) years; in the moderate group, there were 17 males and 13 females, aged (57.07±8.35) years; in the severe group, there were 21 males and 17 females, aged (57.22±8.43) years. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), FEV₁/FVC, maximum ventilation (MVV), diffusing capacity for carbon monoxide (DLco), procalcitonin (PCT), C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8) levels were compared among the three groups. χ² test was used for the count data; one-way ANOVA was used for the measurement data, LSD method was used for pairwise comparison, and Pearson correlation anlysis was used to analyze the correlations between inflammatory indexes and lung function in ARDS patients. Results　CRP [(32.55±6.20) mg/L vs. (21.40±5.18) mg/L], TNF-α [(72.45±14.22) ng/L vs. (56.75±11.30) ng/L], IL-2 [(451.70±49.35) ng/L vs. (382.30±36.40) ng/L], IL-6 [(176.35±20.44) ng/L vs. (142.60±18.45) ng/L], and IL-8 levels [(265.70±29.40) ng/L vs. (185.35±21.60) ng/L] in the moderate group were higher than those in the mild group; CRP [(43.75±7.28) mg/L vs. (21.40±5.18) mg/L], PCT [(9.70±2.45) µg/L vs. (7.65±1.89) µg/L], TNF-α [(89.80±15.60) ng/L vs. (56.75±11.30) ng/L], IL-2 [(524.85±56.75) ng/L vs. (382.30±36.40) ng/L], IL-6 [(214.35±22.74) ng/L vs. (142.60±18.45) ng/L], and IL-8 levels [(368.9±41.35) ng/L vs. (185.35±21.60) ng/L] in the severe group were higher than those in the mild group; CRP, TNF-α, IL-2, IL-6, and IL-8 levels in the severe group were higher than those in the moderate group; there were statistically significant differences (all P<0.05). FVC [(1.74±0.27) L vs. (1.98±0.31) L], FEV₁ [(1.33±0.26) L vs. (1.56±0.28) L], DLco [(64.30±6.82)% vs. (68.54±7.26)%] in the moderate group were lower than those in the mild group; FVC [(1.55±0.21) L vs. (1.98±0.31) L], FEV₁ [(1.12±0.19) L vs. (1.56±0.28) L], FEV₁/FVC [(71.58±4.86)% vs. (78.58±5.46)%], MVV [(66.80±8.70) L vs. (76.50±10.68) L], and DLco [(61.25±6.35)% vs. (68.54±7.26)%] in the severe group were lower than those in the mild group; FVC, FEV₁, FEV₁/FVC, and MVV of the severe group were lower than those of the moderate group; there were statistically significant differences (all P<0.05). Pearson correlation analysis showed that CRP, PCT, TNF-α, IL-2, IL-6, and IL-8 were significantly negatively correlated with FVC, FEV₁, FEV₁/FVC, MVV, and DLco (all P<0.05). Conclusions　The CRP, PCT, TNF-α, IL-2, IL-6, and IL-8 of ARDS patients are closely correlated with FVC, FEV₁, FEV₁/FVC, MVV, and DLco. The monitoring on inflammatory indexes should be strengthened to prevent the deterioration of lung function in ARDS patients.

Case Report

One case of giant breast adenosquamous carcinoma and literature review

Yu Wenlong, Yin Xiaowei, Yang Yuzhu, Xu Yanmei

2022, 28(3):  419-421.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.029

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Objective　To explore the clinical manifestations, pathological characteristics, treatment, and prognosis of a patient with giant breast adenosquamous carcinoma, and to deepen the understanding. Methods　The clinical data of a patient with giant breast adenosquamous carcinoma admitted into Shanxian Central Hospital in June 2021 were retrospectively analyzed, and the related literatures were reviewed to summarize the pathological characteristics, differential diagnosis, treatment, and prognosis. Results　The patient underwent left enlarged breast resection, axillary lymph node dissection, and chest wound flap metastasis, and was diagnosed with high-grade adenosquamous carcinoma after the surgery, and no metastases in axillary lymph nodes was found. Conclusions　The clinical characteristics and differential diagnosis of breast adenosquamous carcinoma are not different from other breast carcinoma. Surgery is the main treatment, and whether adjuvant chemotherapy is needed after surgery is not confirmed.

One case of acute pancreatitis complicated with gallbladder gangrene and perforation

Xie Ping, Kang Hanwei, Kang Junyang, Yang Fang

2022, 28(3):  422-424.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.030

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A patient with septic shock was admitted to Department of Intensive Care Medicine, Weihai Central Hospital Affiliated to Qingdao University in April 2020. This patient was admitted because of abdominal pain. After the diagnosis and treatment at Emergency Room, the patient was admitted into the Department of Digestive Internal Medicine with acute pancreatitis. The patient's conditions progressed rapidly, and were transferred to Department of Critical Care Medicine for rescue because of shock. The shock causes were evaluated and screened. The patient was confirmed with acute gallbladder necrosis and perforation and acute pancreatitis by laparotomy. After anti-infection, capacity recovery, and viscera function support, the patient was rescued successfully.

Nursing Research

Effect of preoperative hyperbaric oxygen treatment for patients after coronary artery bypass grafting

Li Yi

2022, 28(3):  425-428.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.031

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Objective　To analyze the effect of preoperative hyperbaric oxygen treatment on the serum levels of Tau, phosphorylated Tau (pTau), and β-amyloid 1-42 (Aβ1-42) proteins in patiets after coronary artery bypass grafting. Methods　From January to December 2019, 80 patients who underwent coronary artery bypass grafting in The First Affiliated Hospital of Nanyang Medical College were selected and divided into a control group and an observation group by the random number table method, with 40 cases in each group. There were 27 males and 13 females in the control group, and they were (53.01±8.16) years old. There were 24 males and 16 females in the observation group, and they were (54.51±7.90) years old. The control group took conventional preoperative treatment; in addition, the observation group took hyperbaric oxygen treatment. The serum levels of Tau, pTau, and Aβ1-42 were detected by enzyme-linked immunosorbent assay 1 week after the surgery. The levels of postoperative cognitive function and incidences of postoperative cognitive dysfunction were compared between the two groups according to Montreal Cognitive Assessment Scale (MoCA). The adverse reactions in the two groups were recorded. The measurement data were compared between the two groups by independent-sample t test, and the enumeration data by χ² test. Results　One week after the operation, the levels of Tau and pTau in the observation group were lower than those in the control group (t=5.690 and 7.054; both P<0.001), and the level of Aβ1-42 in the observation group was higher than that in the control group (t=10.300, P<0.001). After the operation, the total score and dimension scores of MoCA in the observation group were higher than those in the control group (t=4.776, 3.688, 2.860, 6.870, 4.308, 2.611, 5.908, and 4.567; all P<0.05). The incidence of cognitive dysfunction in the observation group was significantly lower than that in the control group [12.50% (5/40) vs. 32.50% (13/40)], with a statistical difference (χ²=4.588, P=0.032). There was no significant difference in the incidence of adverse reactions between the two groups (χ²=0.125, P=0.723). Conclusion　Preoperative hyperbaric oxygen treatment can alleviate the abnormal changes of serum levels of Tau, pTau, and Aβ1-42 in patients after coronary artery bypass grafting, improve their postoperative cognitive function, and reduce the incidence of cognitive dysfunction, and is safe.

Efficacy of infrared physiotherapy combined with external application of Glauber's salt on postoperative gastrointestinal dysfunction after surgery for acute appendicitis

Xu Ruihua

2022, 28(3):  429-434.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.032

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Objective　To explore the efficacy of infrared physiotherapy combined with the external application of Glauber's salt on postoperative gastrointestinal dysfunction (PGD) after surgery for acute appendicitis. Methods　One hundred and seventeen patients with PGD after surgery for acute appendicitis admitted to The People's Hospital of Linyi City from June 2020 to May 2021 were divided into a control group A, a control group B, and a study group by the random number table method, with 39 cases in each group. In the control group A, there were 23 males and 16 females, and they were (35.72±6.16) years old. In control group B, there were 26 males and 13 females, and they were (36.86±6.55) years old. There were 25 males and 14 females in the study group, and they were (37.37±6.73) years old. The control group A were treated with infrared physiotherapy, the control group B with the external application of Glauber's salt, and the study group with infrared physiotherapy and the external application of Glauber's salt. The curative effects, the recovery times of bowel sounds, the first postoperative exhaustion times, and the first postoperative defecation times, and the traditional Chinese medicine (TCM) syndrome scores and the levels of motilin (MTL) and gastrin (GAS) before and after treatment were compared between these 3 groups. The measurement data were compared between the groups by independent-sample t test, and the enumeration data by χ² test. Results　On day 1, 2, and 3 after the treatment, the TCM syndrome scores of the study group were lower than those of the control group A and the control group B, with statistical differences (all P<0.01). The total effective rate of the study group was higher than those of the control group A and the control group B [94.87% (37/39) vs. 76.92% (30/39) and 79.49% (31/39)], with statistical differences (both P<0.05). The recovery time of bowel sounds, the first postoperative exhaustion time, and the first postoperative defecation time in the study group were shorter than those in the control group A and the control group B [(20.37±5.70) h vs. (26.58±6.89) h vs. (27.60±7.25) h, (21.33±6.02) h vs. (27.18±6.75) h vs. (29.35±7.68) h, and (35.74±7.79) h vs. (44.33±8.84) h vs. (48.45±9.28) h], with statistical differences (all P<0.001). The levels of MTL and GAS on day 3 after the treatment in the study group were higher than those in the control group A and the control group B [(254.27±42.35) ng/L vs. (220.35±39.10) ng/L and(212.60±38.32) ng/L; (168.42±28.73) ng/L vs. (143.15±27.64) ng/L and (135.60±25.89) ng/L], with statistical differences (all P<0.05). Conclusions　Infrared physiotherapy combined with the external application of Glauber's salt can better alleviate PGD-related symptoms in patients after surgery for acute appendicitis, accelerate gastrointestinal peristalsis, and shorten the recovery time of bowel sounds, the first postoperative exhaustion time, and the first postoperative defecation time.

Efficacy of graded analgesia in care of pain in patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy

Lin Aidan, Lin Min, Zhong Guilian

2022, 28(3):  434-438.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.033

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Objective　To explore the efficacy of graded analgesia in the care of pain in patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy. Methods　Forty-two patient undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy at The 73rd Army Hospital of The Army from October 2019 to July 2020 were set as a control group, including 17 males and 25 females who were 35-66 (43.75±7.69) years old. And 46 patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy from August 2020 to May 2021 were set as an observation group, including 16 males and 30 females who were 32-64 (43.59±7.80) years old. The control group were given routine analgesia care, and the observation group were given graded analgesia care. The pain status (NRS score), application dosages of analgesic drugs, analgesic satisfaction scores, and adverse reactions related to opioid analgesics were compared between the two groups at different times after the surgery. The data were analyzed by SPSS 22.0. χ² and t tests and MANOVA of repeated measuring were used for the analysis. Results　The NRS scores 5, 7, and 10 days after the surgery were (4.73±0.87), (4.03±0.64), and (2.17±0.51) in the observation group, and were (5.18±0.92), (4.67±0.77), and (3.85±0.62) in the control group, with statistical differences (all P<0.05). The postoperative dosages of fentanyl transdermal patches, morphine sulfate sustained-release tablets, tramadol, and acetaminophen tablets in the observation group were lower than those in the control group [(2.840±0.520) mg vs. (3.180±0.585) mg, (135.30±32.60) mg vs. (160.40±38.40) mg, (0.56±0.10) g vs. (0.72±0.07) g, and (8.42±1.69) g vs. (10.60±1.48) g], with statistical differences (t=2.886, 3.314, 8.164, and 6.411; P=0.005 and 0.001, <0.001, and <0.001). The satisfaction score of analgesia in the observation group was higher than that in the control group [(1.84±0.38) vs. (1.62±0.61)], with a statistical difference (t=2.364, P=0.021). The incidence of total opioid adverse reactions in the observation group was lower than those in the control group, with a statistical difference (P<0.05). Conclusions　Using the concept of graded analgesia to manage the pain of patients undergoing Ⅲ-Ⅳ degree mixed hemorrhoidectomy can reduce their pain, the dosages of analgesic drugs, and the incidence of adverse reactions, and improve their analgesic satisfaction score.

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Perioperative application of immune nutrition in patients with esophageal neoplasms

Hong Gengde, Fang Nan, Deng Ying, Gao Ling, Chen Dongping, Huang Yufang

2022, 28(3):  439-444.  DOI: 10.3760/cma.j.issn.1007-1245.2022.03.034

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Esophageal cancer patients are prone to malnutrition, and surgery is still the main treatment for resectable esophageal cancer. Malnutrition is an independent risk factor on the patients' operation prognosis, so the improvement of the nutritional status is beneficial to the perioperative management for esophageal cancer patients. Immune nutrition has two suborders: immunonutrition and ecoimmunonutrition. Immunonutrition is rich in specific nutrients and contains immunomodulatory components. Ecoimmunonutrition refers to the ecological preparations contained in the nutritional formula, which can regulate the intestinal microenvironment and improve the intestinal immune capacity. Although both of them have their own characteristics, the balance of intestinal flora and the maintenance of intestinal barrier function can promote the absorption of nutrients, and improve the perioperative nutritional status of patients with esophageal cancer, reduce their postoperative complications, and shorten their hospital stay. In this paper, the research on the perioperative nutritional therapy of esophageal cancer about immunonutrition and ecoimmunonutrition is reviewed.