Table of Content

01 August 2023, Volume 29 Issue 15

Previous Issue   

New Medical Advances

Advances on prevention of venous thromboembolism in patients with bladder cancer

Xu Xi, Li Xiangyang, Zhang Bo, Xiang Yuangang, Yang Pan, Zhang Zhensheng, Xu Chuanliang

2023, 29(15):  2073-2076.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.001

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As we all know, cancer is an important risk factor for thrombosis. Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is the common vascular disease caused by malignant tumors. Studies have shown that patients with bladder cancer have almost 8% probability of developing VTE within 5 years of diagnosis, which is higher than other malignant tumors. The incidence of VTE is associated with specific features, such as age, disease stage, and treatment, but not just with whether surgery. Although the therapy has risks, it can provide guidance and decision for the prognosis in bladder cancer patients.

Research progress of PI3K/AKT signaling pathway in cardiovascular disease

Zhao Jiahao, Shang Xue, Zhu Hui, Li Xinxi, Xu Huipu

2023, 29(15):  2077-2080.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.002

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Cardiovascular disease refers to various lesions of the cardiovascular system, mainly including coronary heart disease, heart failure, hypertension, etc., and has become the first major death disease in China. The phosphatidyl inositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway is one of the important metabolic pathways and plays an important role in the cardiovascular system. This article reviews the research progress of PI3K/AKT signaling pathway in cardiovascular disease.

Experimental research progress of metformin in spinal cord injury

Dong Jinyu, Gong Xingyuan, Ma Yue, Hu Zhongbo, Liu Sheng, Liu Yongliang

2023, 29(15):  2081-2085.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.003

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Spinal cord injury is a devastating disease, which can destroy the anatomical structure of the spinal cord, cause a series of pathological reactions such as axon rupture, neuronal degeneration and necrosis, inflammation, demyelination, etc., and eventually lead to severe neurological dysfunction, seriously affecting the patients' quality of life. Metformin, a classic antidiabetic drug and antioxidant, has been extended to experimental treatment of spinal cord injury as a representative of new use of old drugs. This paper retrospectively analyzes the relevant literature reports in order to improve the understanding on metformin in spinal cord injury.

Advancement in the study of electroacupuncture stimulation in the treatment of sepsis and its related diseases

Sun Xiao, Liu Chengxia, Wang Na, Hao Jiahui, Chu Linlin

2023, 29(15):  2086-2090.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.004

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Sepsis is a disease in which the body loses control of infection and triggers systemic inflammation, which leads to organ dysfunction. In serious cases, multiple organ dysfunction syndrome (MODS) can be included. According to previous studies, approximately 48.90 million cases of sepsis occurred in 2017, of whom approximately 11.00 million resulted in related deaths, accounting for 19.7% of all deaths worldwide. Although the incidence and mortality related to septicemia has decreased since 1990, sepsis remains one of the major threats to human health worldwide. The latest epidemiology shows that there are 47.00 million to 50.00 million cases of sepsis worldwide each year, of whom 11.00 million die each year at least, and one in five deaths worldwide is related to sepsis. Although the treatment of sepsis has made great progress, such as fluid resuscitation, early application of antibiotics, organ support, and drug therapy, the mortality rate of sepsis is still high. The pathogenesis of sepsis is mainly related to excessive inflammatory response and oxidative stress. Sepsis makes the body lose the balance between pro-inflammatory response and anti-inflammatory response. Excessive inflammatory response leads to the formation of "inflammatory storm", and the mass production and release of inflammatory cytokines [such as tumor necrosis factor (TNF) -α, interleukin (IL) -1, etc.]. Sepsis also causes the imbalance of redox homeostasis in the body towards a pro-oxidation state, mitochondrial dysfunction, and excessive production of reactive oxygen species (ROS). A large number of inflammatory cytokines and ROS can cause systemic inflammatory response syndrome (SIRS), gradually destroying body tissues and organs, and eventually leading to the occurrence of MODS. In recent years, with the rise of electroacupuncture therapy, researches about electroacupuncture stimulation of some acupoints in the treatment of sepsis and related diseases become more and more, and electroacupuncture has a very broad prospects in clinical development. Now the regulations of electroacupuncture stimulation on sepsis and related diseases are summarized, in order to provide a more clear direction for the treatment of sepsis and related diseases.

Progress in the diagnosis and treatment of pernicious placenta previa

Liu Ying, Zhang Leilei

2023, 29(15):  2091-2095.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.005

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Pernicious placenta previa is a critical obstetric disease, usually accompanied by placenta accreta, which can easily cause massive intraoperative bleeding. For women with pernicious placenta previa, early diagnosis should be made, perioperative preparations should be improved, and appropriate surgical methods should be selected through multidisciplinary consultation to reduce the intraoperative bleeding and postoperative complications. Based on the latest diagnosis and treatment plans at home and abroad in recent years, this article describes the diagnosis and treatment of pernicious placenta previa, selection of surgical methods, hemostasis methods, blood management, and application of salvage autologous blood transfusion.

Literature Analysis

Clinical analysis of 139 Chinese patients with bilateral medial medullary infarction

Fang Wenli

2023, 29(15):  2096-2101.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.006

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Objective　To investigate the clinical manifestations, neuroradiological features, treatment, and prognosis of bilateral medial medullary infarction (BMMI) in China, so as to improve clinicians' understanding of BMMI. Method　The clinical data of BMMI cases reported in domestic journals from 1991 to 2022 were retrospectively analyzed, including clinical characteristics, imaging findings, treatment, and prognosis. Results　A total of 72 articles were included in this study, and 139 patients with BMMI were collected for analyses. The age of the included cases ranged from 24 to 94 years old, and the ratio of males to females was about 3:1. The most common clinical symptom was motor weakness of limbs [96% (133/139)]. The neuroimaging results revealed that the lesions in the medulla oblongata mainly showed "Y appearance" or "heart appearance", and 71% (78/110) of the patients were observed with vertebrobasilar atherosclerosis. Only 3 patients received thrombolytic therapy. Of the patients, 25% (31/124) did not achieve clinical improvement, and 5% (6/124) died. The misdiagnosis rate of BMMI was 12% (17/139), and patients with BMMI were most easily misdiagnosed as Guillain-Barre syndrome. Conclusions　The clinical manifestations of BMMI are diverse, and it is easy to be misdiagnosed and miss diagnosed, usually with poor prognosis. Brain MRI is helpful for early diagnosis. Clinicians should be aware of BMMI, and help patients get proper treatment in time so as to improve their clinical outcomes.

Scientific Research

Mid- and long- term efficacy of PBC in the treatment of drug-resistant primary trigeminal neuralgia

Zhao Changhai, Rouzi Hanikez, Fa Zhiqiang

2023, 29(15):  2102-2105.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.007

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Objective　To investigate the mid- and long- term efficacy and safety of percutaneous balloon compression (PBC) in the treatment of drug-resistant primary trigeminal neuralgia. Methods　The clinical data of 10 patients with drug-resistant primary trigeminal neuralgia who were treated with PBC in Department of Pain Medicine, The First People's Hospital of Kashgar from May to November 2019 were retrospectively analyzed, including 5 males and 5 females, with an average age of 66.8 years old. The patients were followed up every 6 months after discharge. The Visual Analogue Scale (VAS) and Numerical Rating Scale (NRS) were used to evaluate the patients' pain degree, and the complications and recurrence of primary trigeminal neuralgia were recorded. The curative effect was judged at the last follow-up. Friedman M rank sum test and q test were used. Results　All the 10 PBC surgeries had a smooth operation. At follow-up of 6 months after discharge, 1 patient was found to have facial hypoesthesia, and her prognosis was good without special treatment. During the follow-up, there were no recurrence and no complications such as chewing weakness, perioral herpes, keratitis, or diplopia. The effective rate was 100.0% (10/10) at the last follow-up of 3 years after discharge. The patients' VAS and NRS scores were decreased immediately after surgery and 6 months, 1 year, 1.5 years, 2 years, 2.5 years, and 3 years after discharge compared with those before surgery, with statistically significant differences (all P<0.05). Conclusion　PBC is safe and effective in the treatment of drug-resistant primary trigeminal neuralgia in about 3 years.

Correlation analysis of coagulation function, body immunity, and severity of pneumonia

Li Mingwei, Xiao Huifang, Feng Yulong

2023, 29(15):  2105-2109.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.008

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Objective　To investigate the correlations between coagulation function, cytokines, and lymphocyte subsets and severity in patients with pneumonia, so as to provide reference for clinical evaluation of the severity of pneumonia infection. Methods　It was an experimental study. A total of 80 patients with pneumonia [42 males and 38 females,aged (52.65±7.32) years] who were treated in Henan General Hospital from January 2020 to December 2022 were selected. According to the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), they were divided into 36 critical and above cases (APACHEⅡ score ≥12 points) and 44 non-critical cases (APACHEⅡ score <12 points). In addition, 50 healthy controls [27 males and 23 females, aged(55.21±5.53) years] who underwent physical examination in our hospital were selected as the control group. The cytokines, coagulation factor activity, fibrinogen level, platelet count, and lymphocytes were measured by flow cytometry and thromboelastogram. The correlations between cytokines, coagulation function, and lymphocyte subsets and severity of pneumonia were analyzed by Spearman correlation analysis. χ² test, one-way analysis of variance, and independent sample t test were used. Results　The levels of interferon-γ (IFN-γ) [(26.28±4.63) ng/L], interleukin (IL) -4 [(41.43±4.33) ng/L], IL-10 [(30.35±7.96) ng/L], IL-8 [(121.12±30.53) ng/L], IL-1β [(30.52±3.19) ng/L], IL-6 [(430.47±110.23) ng/L], R time of coagulation factor activity [(10.43±0.85) min], and K time of fibrinogen [(3.92±0.31) min] in the critical group were higher than those in the non-critical group [(13.61±2.44) ng/L, (15.55±3.76) ng/L, (12.44±2.57) ng/L, (27.25±6.91) ng/L, (14.42±2.95) ng/L, (90.55±22.67) ng/L, (7.26±0.64) min, and (2.12±0.29) min] and the control group [(5.22±1.77) ng/L, (6.32±1.50) ng/L, (5.26±1.23) ng/L, (14.42±3.56) ng/L, (7.44±2.72) ng/L, (7.16±2.23) ng/L, (4.22±0.50) min, and (1.28±0.41) min], with statistically significant differences (all P<0.05). The α angle of fibrinogen [(42.62±3.37) deg] and maximum amplitude (MA) of platelet function [(39.61±2.87) mm] in the critical group were lower than those in the non-critical group [(55.38±4.44) deg and (51.23±3.76) mm] and the control group [(72.44±4.82) deg and (71.62±3.54) mm], with statistically significant differences (all P<0.05). The lymphocyte subsets CD3⁺ [(48.42±3.38)%], CD4⁺ [(29.56±1.15)%], and CD4⁺/CD8⁺ [(1.15±0.16)] in the critical group were lower than those in the non-critical group [(62.27±3.21)%, (37.22±2.72)%, and (1.46±0.20)] and the control group [(78.15±4.22)%, (42.32±1.56)%, and (1.85±0.13)], with statistically significant differences (all P<0.05). Conclusions　Coagulation function, cytokines, and lymphocyte subsets have obvious correlations with severity of pneumonia. The degree of infection can be determined by measuring coagulation function, cytokines, and lymphocyte subsets, providing reference for clinical diagnosis and treatment of pneumonia.

Clinical distribution, drug resistance, and infection influencing factors of 1 852 Klebsiella pneumoniae strains

Mai Dongmei, Zhong Jiacheng, Tan Junqing

2023, 29(15):  2110-2116.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.009

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Objective　To study the clinical distribution, drug resistance monitoring, and infection influencing factors of Klebsiella pneumoniae (KP), and to provide an important basis for the clinical diagnosis and treatment of KP infection and the rational use of appropriate antimicrobial drugs. Methods　A total of 1 852 non-repetitive KP strains isolated from specimens collected from Guangdong Second Traditional Chinese Medicine Hospital from January 2019 to December 2021 were selected. There were 1 196 males and 656 females, aged 9-103 years. The retrospective study method was used to calculate the resistance and susceptibility rates of KP according to the specimen type, patient age, and department. The clinical distribution, drug resistance, and infection related factors of KP were analyzed. χ² test and multiple logistic regression analysis were used. Results　The 1 852 clinically isolated KP strains from 2019 to 2021 accounted for 12.61% (1 852/14 691) of all isolates, ranking the third among all isolates, and showing an increasing trend in recent years. The strains were mainly isolated from the respiratory tract, urine, and blood samples. The KP strains detected in general acupuncture rehabilitation ward accounted for 38.66% (716/1 852), followed by 18.41% (341/1 852) in respiratory department and 13.71% (254/1 852) in ICU. The KP strains had high drug resistance rates to commonly used antibiotics such as penicillin and cephalosporins, and the drug resistance rates were more than 50%, showing an increasing trend year by year. As a representative drug of carbapenem antibiotics, the resistance rate to imipenem was less than 50%, showing an increasing trend in recent years. Invasive procedures (puncture, endotracheal intubation, etc.) in patients with respiratory disease, ICU admission, and use of carbapenems were risk factors for bloodstream infection caused by carbapenem resistant Klebsiella pneumoniae (CRKP) (all P<0.05). Conclusions　The detection rate of KP strains was very high, ranking the third among all isolates. There were statistically significant differences in the KP drug resistance rate among different patient age groups, specimen types, and departments. The detection rate of CRKP was very high. We should rationally use the antibiotics, strengthen the environmental monitoring, and reduce the production of drug-resistant bacteria to improve the patients' prognosis.

Effect of digitalis on patients with chronic heart failure and atrial fibrillation through regulating TLR4/NF-κB signaling pathway in the peripheral blood

Xue Yuqiang, Li Wang, Sun Lihong

2023, 29(15):  2117-2120.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.010

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Objective　To investigate the effect of digitalis on Toll like receptor 4 (TLR4) / nuclear factor (NF)-κB signaling pathway in patients with chronic heart failure and atrial fibrillation. Methods　The clinical data of 80 patients with chronic heart failure and atrial fibrillation in Tai'an Disabled Soldiers' Hospital of Shandong Province from January 2019 to December 2022 were retrospectively analyzed. The patients were divided into an observation group (40 cases, low-dose digitalis + low molecular weight heparin) and a control group (40 cases, low molecular weight heparin) according to whether they received the intervention of digitalis. The observation group included 25 males and 15 females, aged (50.38±6.77) years; the control group included 27 males and 13 females, aged (51.48±7.09) years. The therapeutic effects and recurrence rates 6 months after treatment of the two groups were compared. The cardiac function, exercise endurance, and mRNA and protein expressions of TLR4/NF-κB in peripheral blood monocytes of the two groups were recorded before and after treatment. t test and χ² test were used. Results　The recurrence rate of atrial fibrillation in the observation group [10.0% (4/40)] was not significantly different from that in the control group [12.5% (5/40)] (P>0.05). The total effective rate of the observation group was higher than that of the control group [100.0% (40/40) vs. 80.0% (32/40)], with a statistically significant difference (P<0.05). After treatment, the 6-minute walking distance (6MWT), left ventricular ejection fraction (LVEF), and ratio of peak E to peak A in diastolic period (E/A) were all higher than those before treatment in both groups, and the left ventricular end-diastolic inner diameter (LVEDd) was lower than that before treatment (all P<0.05). Moreover, the 6MWT [(434.35±52.61) m], LVEF [(48.84±7.27)%], and E/A [(1.42±0.32)] in the observation group were significantly higher than those in the control group [(402.83±55.56) m, (44.32±6.65)%, and (1.22±0.24)], with statistically significant differences (all P<0.05). After treatment, the TLR4 mRNA [(0.71±0.11)], NF-κB mRNA [(1.22±0.28)], TLR4/β-actin [(1.16±0.21)], and NF-κB/β-actin [(1.05±0.14)] in the observation group were lower than those in the control group [(1.43±0.61), (1.56±0.33), (1.46±0.19), and (1.43±0.20)], with statistically significant differences (all P<0.05). Conclusion　Digitalis can effectively inhibit the mRNA and protein expressions of TLR4 and NF-κB in patients with chronic heart failure and atrial fibrillation, improve their cardiac function, and benefit their prognosis.

Effect of music therapy on negative symptoms in patients with chronic schizophrenia

Qu Ning, Shao Xiuqi

2023, 29(15):  2121-2123.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.011

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Objective　To study the effect of music therapy on negative symptoms in patients with chronic schizophrenia. Methods　By the sampling test, 28 patients with non-hereditary chronic schizophrenia who meet the 3rd edition of Chinese Classification and Diagnosis Criteria for Mental Disorders (CCMD-3), with a duration of disease of 2 years or more and a duration of hospitalization of not less than 2 years were selected from Wuxi Mental Rehabilitation Center in December 2021 as the study objects, including 15 males and 13 females, aged (49.50±13.14) years. They received 12 weeks of regular psychotherapy and music therapy intervention. The score change of Scale for Assessment of Negative Symptoms (SANS) before and after treatment was analyzed, and Rosenberg Self-Esteem Scale (SES) and Social Function Rating Scale (SFRS) were used as auxiliary measures to observe the validity of the experiment. Paired t test was used. Results　After treatment, the SANS and SFRS scores were lower than those before treatment [(14.00±2.07) points vs. (17.13±2.10) points, (72.50±5.21) points vs. (80.88±7.64) points], and the SES score was higher than that before treatment [(27.38±3.02) points vs. (25.50±2.67) points], with statistically significant differences (all P<0.05). There were significant correlations in the scores of SFRS and SES before and after treatment (r=0.716 and 0.805, P=0.046 and 0.016), but no significant correlation in the score of SANS before and after treatment (r=0.624, P=0.098). Conclusion　Music therapy can improve the negative symptoms and social function in patients with chronic schizophrenia, and can effectively improve their self-confidence.

Effect of virtual reality training on the quality of stroke recovery and the levels of serum inflammatory factors

Ye Sen, Mao Hongyu, Zhang Tong

2023, 29(15):  2124-2128.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.012

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Objective　To observe the clinical application value of virtual reality training in the early rehabilitation of stroke. Methods　Sixty stroke patients admitted to Jinan Central Hospital from June 2019 to June 2021 were selected as the research objects to conduct a prospective study, and were randomly divided into an observation group (16 males and 14 females, aged 20-78 years) and a control group (17 males and 13 females, aged 18-77 years) with 30 cases in each group. The control group received conventional rehabilitation treatment, and the observation group received virtual reality training treatment on the basis of the control group, lasting for 2 weeks. The scores of National Institutes of Health Stroke Scale (NIHSS), Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), and modified Barthel index (MBI) were evaluated before and after treatment, the levels of inflammatory factors [interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α)] before and after treatment were compared between the two groups, and the incidence of complications was statistically analyzed. t test and χ² test were used for statistical analysis. Results　The NIHSS score of the observation group and control group after treatment were lower than those before treatment [(10.79±1.46) points vs. (20.18±2.99) points, (15.78±2.26) points vs. (20.83±3.04) points], the BBS, FMA, and MBI scores of the observation group after treatment were higher than those before treatment [(28.34±3.97) points vs. (9.98±1.32) points, (52.83±7.41) points vs. (25.89±3.57) points, (67.84±9.68) points vs. (29.84±4.12) points], the scores of BBS, FMA, and MBI of the control group after treatment were higher than those before treatment [(20.76±2.89) points vs. (10.24±1.51) points, (37.28±5.34) points vs. (26.12±3.61) points, (52.76±7.89) points vs. (28.49±4.01) points], with statistically significant differences (t=3.411, 3.062, 1.897, 3.098, 15.599, 10.291, 9.108, and 5.507; all P<0.05). After treatment, the NIHSS score of the observation group was lower than that of the control group, and the BBS, FMA, and MBI scores were higher than those of the control group, with statistically significant differences (t=15.517, 12.915, 14.244, and 10.103; all P<0.001). The levels of IL-1β, IL-6, and TNF-α in the observation group after treatment were lower than those before treatment [(14.79±2.12) ng/L vs. (28.66±4.54) ng/L, (2.14±0.37) ng/L vs. (6.78±1.12) ng/L, (14.71±2.11) ng/L vs. (26.84±3.78) ng/L], the levels of IL-1β, IL-6, and TNF-α in the control group after treatment were lower than those before treatment [(21.74±3.17) ng/L vs. (28.57±4.32) ng/L, (4.28±0.74) ng/L vs. (6.64±1.07) ng/L, (19.79±2.87) ng/L vs. (25.99±3.67) ng/L], with statistically significant differences (t=5.780, 5.194, 5.227, 6.027, 5.973, and 6.156; all P<0.05). After treatment, the levels of IL-1β, IL-6, and TNF-α in the observation group were lower than those in the control group, with statistically significant differences (t=4.451, 21.641, and 11.932, all P<0.001). The incidence of complications in the observation group was 10.00% (3/30), which was significantly lower than that in the control group [33.33% (10/30)], with a statistically significant difference (χ²=4.812, P=0.028). Conclusion　Virtual reality training can improve the neurological impairment, balance function, physical movement function, and activities of daily living in stroke patients, and reduce the levels of inflammatory factors, with good safety.

Study on the changes of NO and inflammatory factors in the ear effusion in patients with secretory otitis media

Wang Kai, Li Xiaohua, Huang Ligui, Li Yuguang, Xie Kaixuan, Zhao Zhongran, Li Jianhua

2023, 29(15):  2129-2132.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.013

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Objective　To investigate the changes of nitric oxide (NO) and inflammatory factors in the ear effusion in patients with secretory otitis media. Methods　Ninety patients with secretory otitis media admitted to Joint Support Force 908 Hospital from January 2022 to April 2023 were selected as an observation group, and 90 healthy individuals during the same period were selected as a control group. In the observation group, there were 54 males and 36 females, aged (39.18±3.19) years, 58 cases in mucous stage and 32 cases in serous stage, 38 cases in acute stage and 52 cases in chronic stage. In the control group, there were 50 males and 40 females, aged (40.53±4.21) years. The levels of NO, γ-interferon (IFN-γ), and interleukin-2 (IL-2) in the ear effusion and levels of immunoglobulin (Ig) and peripheral blood T lymphocyte subsets were compared. Independent sample t test and χ² test were used for statistical analysis. Results　The levels of IgM, IgG, and IgA in the observation group were higher than those in the control group (all P<0.001). The levels of CD4/CD8, CD4⁺, and CD3⁺ in peripheral blood T lymphocyte subsets were lower than those in the control group, and the level of CD8⁺ was higher than that in the control group (all P<0.001). The levels of IL-2, IFN-γ, NO, IgM, IgG, IgA, CD4/CD8, CD8⁺, CD4⁺, and CD3⁺ in the acute stage patients were (10.79±1.43) mg/L, (75.42±18.67) µg/L, (2.69±0.49) mg/L, (3.81±0.36) g/L, (19.92±2.28) g/L, (3.81±0.33) g/L, (1.59±0.24), (23.40±3.42)%, (42.31±4.23)%, and (61.38±5.17)%, those in the chronic stage patients were (13.35±1.48) mg/L, (108.72±21.34) µg/L, (4.38±0.58) mg/L, (5.41±0.38) g/L, (33.46±2.53) g/L, (4.96±0.41) g/L, (1.32±0.15), (34.23±3.62)%, (38.11±0.04)%, and (55.30±4.94)%, with statistically significant differences (t=8.221, 7.701, 14.557, 20.169, 26.130, 14.239, 6.554, 14.346, 7.175, and 5.655; all P<0.001). The levels of IL-2, IFN-γ, NO, IgM, IgG, IgA, CD4/CD8, CD8+, CD4+, and CD3+ in the mucous stage patients were (15.62±1.65) mg/L, (111.73±22.14) µg/L, (5.08±0.63) mg/L, (34.18±2.49) g/L, (5.13±0.42) g/L, (1.34±0.18) g/L, (1.30±0.14), (35.61±3.59)%, (37.52±4.12)%, and (56.48±4.52)%, those in the serous stage patients were (9.90±1.39) mg/L, (70.42±17.80) µg/L, (2.67±0.52) mg/L, (3.87±0.32) g/L, (20.41±2.35) g/L, (3.93±0.34) g/L, (1.72±0.23), (25.63±3.54)%, (41.92±4.24)%, (60.82±5.24)%, with statistically significant differences (t=16.615, 9.056, 18.438, 68.378, 48.349, 47.347, 10.775, 12.686, 4.800, and 4.118; all P<0.001). Conclusion　For patients with secretory otitis media, the degree of disease can be comprehensively understood by the indicators of immune status and IL-2, IFN-γ, and NO in the ear effusion, with high clinical application value.

Special Column of Laparoscopic Clinical Application

Comparison of laparoscopic transabdominal preperitoneal hernia repair and open mesh repair for occult inguinal hernia

Li Yunlong, Cao Feng, Jin Meng

2023, 29(15):  2133-2136.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.014

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Objective　To investigate the efficacies of laparoscopic transabdominal preperitoneal hernia repair and open mesh repair in the treatment of occult inguinal hernia. Methods　A total of 96 patients with occult inguinal hernia admitted to Affiliated Hospital of Jining Medical University from October 2021 to October 2022 were divided into a conventional group (48 cases) and an observation group (48 cases) according to the random number table method. The age of the conventional group was (63.85±5.65) years old, and that of the observation group was (64.85±5.87) years old. The conventional group was treated with open mesh repair, and the observation group was treated with laparoscopic transabdominal preperitoneal hernia repair. The intraoperative blood loss and length of hospital stay were compared between the two groups, the pain scores before and after treatment were compared between the two groups (Prince-Henry pain score was used to evaluate the degree of pain before and 12 h after treatment), and the urodynamics before and after treatment and complication rate were compared between the two groups. t test and χ² test were used. Results　The intraoperative blood loss in the observation group was less than that in the conventional group [(32.54±3.25) ml vs. (39.63±4.85) ml] (t=8.414, P<0.001), and the length of hospital stay was shorter than that in the conventional group [(6.87±0.63) d vs. (8.25±1.12) d] (t=7.440, P<0.001). There was no statistically significant difference in the Prince-Henry pain score between the observation group and the conventional group before surgery [(3.89±0.58) points vs. (3.85±0.52) points] (t=0.356, P=0.723); the Prince-Henry scores of both groups were decreased 12 h after surgery, and the Prince-Henry score of the observation group was lower than that of the conventional group 12 h after surgery [(1.50±0.61) points vs. (2.96±1.42) points] (t=6.545, P<0.001). Before treatment, there were no statistically significant differences in the bladder compliance and bladder volume during urgent urination between the two groups (both P>0.05); after treatment, the bladder compliance and bladder volume during urgent urination were increased in both groups (all P<0.05), and the bladder compliance and bladder volume during urgent urination in the observation group were higher than those in the conventional group (both P<0.05). The incidence of complications of the observation group was lower than that of the conventional group [6.25% (3/48) vs. 20.85% (10/48)] (χ²=4.360, P=0.037). Conclusion　Laparoscopic transabdominal preperitoneal hernia repair can improve the recovery in patients with occult inguinal hernia, relieve the pain, improve the urodynamics, and reduce the incidence of complications, which is worthy of clinical promotion and application.

Analysis of 2 cases of posterior peritoneal hiatal hernia complicated with intestinal necrosis in children with indirect inguinal hernia after laparoscopy

Bian Jun, Shi Weidong, Ge Ruiyi, Yao Yuan, Zhang Xiangning, Wang Xingcheng

2023, 29(15):  2137-2139.  DOI: 腹腔镜下儿童腹股沟斜疝术后并发后腹膜裂孔疝合并肠坏死2例

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Posterior peritoneal hiatal hernia complicated with intestinal necrosis in children with indirect inguinal hernia after laparoscopy is a new complication after laparoscopic high ligation of the hernia sac in recent years. However, there are few domestic and foreign literatures which study it. The article is based on 2 cases undergoing this operation in Xi'an Children's Hospital. Although the relevance of such complications and peritoneal integrity cannot be fully concluded, the serious consequences caused by this operation are worth discussing.

Effects of laparoscopic and open appendectomy on patients with appendicitis

Shi Jun, Cheng Shichao

2023, 29(15):  2140-2143.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.016

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Objective　To compare the effects of laparoscopic and open appendectomy on patients with appendicitis and their effects on Visual Analog Scale (VAS) score. Methods　Retrospective analysis was performed on the clinical data of 104 patients with appendicitis admitted to Huangshi Maternal and Child Health Care Hospital from October 2021 to October 2022. According to different surgical methods, they were divided into a conventional group (open appendectomy, 52 cases) and an observation group (laparoscopic appendectomy, 52 cases). In the observation group, there were 30 males and 22 females, aged (39.63±7.25) years, and the time from onset to operation was (20.36±5.85) h. In the conventional group, there were 31 males and 21 females, aged (39.89±8.14) years, and the time from onset to operation was (21.58±6.74) h. Surgery related indexes, pain status, nucleotide-binding oligomeric domain-like receptor protein 3 (NLRP3) in peripheral blood mononuclear cells, secretory crimp-associated protein-5 (SFRP-5), and postoperative complications were compared between the two groups. χ² test and t test were used. Results　The operation time, getting out of bed time, exhaust time, and length of hospital stay in the observation group were shorter than those in the conventional group (all P<0.05). Compared with the preoperative results, the VAS scores were decreased in both groups 12 h after surgery (both P<0.05), and the VAS score in the observation group 12 h after surgery was lower than that in the conventional group [(2.59±0.28) points vs. (4.69±0.33) points] (P<0.05). There were no statistically significant differences in the NLRP3 mRNA and SFRP-5 between the two groups before surgery (both P>0.05). Compared with the preoperative results, the NLRP3 mRNA and SFRP-5 in the two groups were decreased 3 d after surgery (all P<0.05), and the NLRP3 mRNA and SFRP-5 in the observation group were lower than those in the conventional group (both P<0.05). The total complication rate of the observation group was lower than that of the conventional group [5.77% (3/52) vs. 21.15% (11/52)] (P<0.05). Conclusion　Laparoscopic appendectomy for appendicitis has good effect, which can shorten the operation time, getting out of bed time, exhaust time, and length of hospital stay, reduce the VAS score, inflammatory reaction, and total incidence of complications, and is worthy of clinical promotion and application.

Special Column of Ultrasound and Imaging

Comparison of the diagnostic significance of ultrasound and MSCT in children with digestive tract duplication

Peng Hongyun, Huang Yubin, Liang Yaoyuan, Liao Wanqi

2023, 29(15):  2144-2148.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.017

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Objective　To analyze the difference in the diagnostic significance of ultrasound and multi-slice spiral CT (MSCT) in children with digestive tract duplication. Methods　The clinical data of 42 children confirmed as digestive tract duplication by surgery and pathology in Guangdong Women and Children Hospital from January 2014 to November 2022 were analyzed retrospectively, including 26 males and 16 females, aged (3.65±2.24) years. All the children were given ultrasound and MSCT examination prior to the surgery. The imaging characteristics of ultrasound and MSCT were analyzed, and the diagnostic significance of the two methods was compared with surgical pathology results as the gold standard. χ² test and corrected χ² test were used. Results　Of the 42 cases, 2 were located in the esophagus, 5 in the jejunum, 20 in the ileum, 8 in the ileocecal region, 1 in the colorectum, 4 in the stomach, and 2 in the duodenum. There were 37 cyst-type cases and 5 tubular-type cases. Compared with the results of surgical pathology, 28 cases were diagnosed met (diagnostic coincidence rate of 66.7%), 9 cases were misdiagnosed (misdiagnosis rate of 21.4%), and 5 cases were missed (missed diagnosis rate of 11.9%) by ultrasound; 34 cases were diagnosed met (diagnostic coincidence rate of 80.9%), 6 cases were misdiagnosed (misdiagnosis rate of 14.3%), and 2 cases were missed (missed diagnosis rate of 4.8%) by MSCT; there were no statistically significant differences in the overall diagnostic coincidence rate, misdiagnosis rate, and missed diagnosis rate between ultrasound and MSCT (all P>0.05). Conclusions　Both ultrasound and MSCT can effectively diagnose digestive tract duplication in children. The overall diagnosis coincidence rate of MSCT is slightly higher than that of ultrasound, and the misdiagnosis rate and missed diagnosis rate are relatively low. However, ultrasound has the advantage of being simple to operate, radiation-free, and real-time dynamic observation, so it can be preferred. The combined application of both methods can provide a powerful reference for clinical determination of the nature and type of the lesion, its specific location, and the formulation of treatment plans.

Analysis of MRI characteristics of intestinal fecalith at different locations

Wang Yan, Qu Lintao

2023, 29(15):  2148-2151.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.018

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Objective　To explore the MRI features and imaging mechanism of intestinal fecalith at different locations, and to raise the diagnosis accuracy rate of intestinal fecalith. Methods　A total of 23 cases of intestinal fecalith (including 13 males and 10 females, with a median age of 67 years old, 20 cases in the small intestine and 3 cases in the colon) underwent MRI examinations in Laiyang Central Hospital of Yantai from March 2016 to August 2022. The MRI features (T1WI and T2WI) of intestinal fecalith were summed up and analyzed combined with intraoperative findings. Results　All 23 cases of intestinal fecalith showed "coke" sign (irregular low signal) on T2WI. The signals on T1WI showed as follows: (1) characteristic "empty shell" sign (internal low signal and peripheral ringlike high signal) in 14 cases, of which 13 cases were located in the small intestine and 1 case was located in the flexura hepatica coli; (2) mixed slightly high signal in 5 cases, all located in the small intestine (4 cases in the jejunum and 1 case in the ileum); (3) homogeneous low signal in 4 cases, 2 cases in the small intestine and 2 cases in the left hemicolon. Conclusions　Intestinal fecalith at different locations show "coke" sign on T2WI. The signals on T1WI are complex and diverse, and are often manifested by "empty shell" sign. It is useful to reduce the misdiagnosis and missed diagnosis by fully recognizing MRI features of intestinal fecalith.

Ultrasound-guided liver biopsy observation of non-viral liver diseases

Shen Rong, Wang Junfang

2023, 29(15):  2152-2154.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.019

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Objective　To study the characteristics of ultrasound-guided liver biopsy in non-viral liver diseases. Methods　The clinical data of 83 patients with non-viral liver diseases admitted to Huangshi Central Hospital from July 2021 to July 2022 were retrospectively analyzed, including 37 males and 46 females, aged (57.79±9.08) years. All the patients received blood routine and electrocardiogram examinations after admission (before treatment), and were instructed by nursing staff to perform breath-holding and expiratory training. Liver biopsy was performed under ultrasound guidance. The complications and results of ultrasound guided liver biopsy and its coincidence rate with clinical diagnosis were observed. Results　All the 83 patients with non-viral liver diseases successfully completed liver biopsy, and their vital signs were basically normal after liver biopsy, among whom 55.42% (46/83) had slight pain at the puncture site, and 4.82% (4/83) of chest tightness and 3.61% (3/83) of blood pressure decreased after puncture. Of the 83 patients, 93.98% (78/83) were confirmed by liver biopsy. Among them, 51.81% (43/83) were autoimmune liver disease, 18.07% (15/83) of non-alcoholic fatty liver disease, 14.46% (12/83) of alcoholic liver disease, 4.82% (4/83) of drug-induced liver injury, 3.61% (3/83) of liver vascular disease, and 1.20% (1/83) of neoplastic disease, and another 6.02% (5/83) failed to identify the cause. The coincidence rates of the above 6 diseases diagnosed by ultrasound-guided liver biopsy with clinical diagnosis were 93.48% (43/46), 100.00% (15/15), 92.31% (12/13), 100.00% (4/4), 100.00% (3/3), and 50.00% (1/2), with the overall coincidence rate of 93.98% (78/83). Conclusions　Ultrasound guided liver biopsy can effectively diagnose autoimmune liver disease, non-alcoholic fatty liver disease, alcoholic liver disease, drug-induced liver injury, liver vascular disease, and neoplastic disease. Autoimmune liver disease and non-alcoholic fatty liver disease are mainly found in female patients, and alcoholic liver disease is mainly found in male patients, which is able to provide help for the diagnosis of non-viral liver diseases.

Application value of PET-CT in preoperative assessment of regional lymph node metastasis in non-small cell lung cancer

Li Xianhao, Lyu Wenqiang, Zeng Guiqing, Wei Wuzhi

2023, 29(15):  2155-2157.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.020

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Objective　To explore the application value of positron emission tomography - computed tomography (PET-CT) in preoperative assessment of regional lymph node metastasis in non-small cell lung cancer. Methods　A total of 60 cases of non-small cell lung cancer in Department of Cardiothoracic Surgery, Jieyang People's Hospital from January to December 2020 were selected as the research objects, including 24 males and 36 females, aged (58.98±7.97) years. All cases completed fludeoxyglucose [¹⁸F] (¹⁸F-FDG) PET-CT and enhanced CT scanning before surgery. Hilar mediastinal lymph node metastasis was recorded in detail. With the postoperative pathological diagnosis as the gold standard, the accuracies, sensitivities, specificities, and positive and negative predictive values of the two methods were calculated and compared. Paired χ² test was used. Results　According to the pathological results, in the 60 cases, there were 22 cases of regional lymph node metastasis and 38 cases without lymph node metastasis. PET-CT correctly diagnosed 52 cases, including 20 cases of hilar mediastinal lymph node metastasis and 32 cases without lymph node metastasis, 6 false positives, and 2 false negatives; the accuracy, sensitivity, specificity, and positive and negative predictive values of PET-CT were 0.87, 0.91, 0.84, 0.77, and 0.94. Enhanced CT scanning correctly diagnosed 38 cases, including 14 cases with hilar mediastinal lymph node metastasis and 24 cases without lymph node metastasis, 14 false positives, and 8 false negatives; the accuracy, sensitivity, specificity, and positive and negative predictive values of enhanced CT scanning were 0.63, 0.64, 0.63, 0.50, and 0.75. The accuracies, sensitivities, and specificities of the two inspection methods were statistically significantly different (all P<0.05). Conclusion　The diagnostic efficiency of PET-CT in preoperative assessment of regional lymph node metastasis in non-small cell lung cancer is better than that of enhanced CT scanning, and is worthy of clinical application.

Value of ultrasound-guided thyroid fine needle puncture smear in the differential diagnosis of benign and malignant thyroid nodules of 4A type

Xie Li, Zhao Changqian, Wang Yuanyuan, Liu Haijuan

2023, 29(15):  2158-2162.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.021

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Objective　To analyze the value of ultrasound-guided thyroid fine needle puncture smear in the differential diagnosis of benign and malignant thyroid nodules of 4A type. Methods　This study included 80 patients with 4A thyroid nodules indicated by ultrasound who were scheduled to receive surgical treatment in Liaocheng Third People's Hospital from January 2021 to January 2023, with a total of 114 nodules. There were 35 males and 45 females, with an age of (42.54±10.54) years old. All patients received ultrasound-guided thyroid fine needle puncture smear before surgery. In addition, the patients' postoperative pathological examination results were recorded as "gold standard", and the proportion of benign and malignant thyroid nodules was calculated. The detection rate of malignant thyroid nodules by ultrasound-guided thyroid fine needle puncture smear was observed. The value of ultrasound-guided thyroid fine needle puncture smear in the diagnosis of 4A thyroid nodules was analyzed. Kappa consistency test was adopted. Results　The pathological results showed that 36 nodules were benign, accounting for 31.58% (36/114), including 1 Hashimoto's thyroiditis, 2 adenomatous hyperplasia, 6 crinkled nodules, 9 subacute thyroiditis, and 18 nodular goiter; 78 nodules were malignant, accounting for 68.42% (78/114), including 73 papillary carcinoma and 5 medullary carcinoma. Kappa consistency test showed that the detection of 4A malignant thyroid nodules by ultrasound-guided thyroid fine needle puncture smear was in good agreement with the "gold standard" results (Kappa value = 0.802, P<0.05). The sensitivity and specificity of ultrasound guided thyroid fine needle puncture smear in the diagnosis of 4A malignant thyroid nodules were 80.77% and 75.00%. Conclusions　Malignant nodules account for a relatively high proportion of 4A thyroid nodules. The ultrasound-guided thyroid fine needle puncture smear has a high diagnostic value for 4A malignant thyroid nodules, which is suitable for clinical application.

Application effect of diversified nursing based on crisis awareness in patients with cerebrovascular disease undergoing MRI

Chen Jing, Zhao Jun

2023, 29(15):  2162-2167.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.022

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Objective　To investigate the application effect of diversified nursing based on crisis awareness in patients with cerebrovascular disease undergoing MRI. Methods　This study was a randomized controlled trial. A total of 500 patients with cerebrovascular diseases who underwent MRI examination in Hubei No. 3 People's Hospital of Jianghan University from 2019 to 2021 were selected, and were assigned to a control group (249 cases) and an observation group (251 cases) according to the random number table method. The control group included 142 males and 107 females, aged (53.23±4.62) years. The observation group included 150 males and 101 females, aged (53.49±4.82) years. The control group received routine MRI examination nursing intervention, and the observation group received diversified nursing intervention based on crisis awareness. The scores of Connor-Davidson Resilience Scale (CD-RISC), the Chinese version of the Perceived Stress Scale (CPSS), and Trait Coping Style Questionnaire (TCSQ), levels of epinephrine (EPH), norepinephrine (NE), and 5-hydroxytryptamine (5-HT), and incidences of adverse events were compared between the two groups. t test and χ² test were used. Results　After intervention, the scores of strength, tenacity, and optimism and the total score of CD-RISC in both groups were significantly increased (all P<0.05), and those in the observation group [(33.45±7.11), (43.46±7.15), (11.76±1.57), and (88.01±9.16) points] were significantly higher than those in the control group [(29.74±6.45), (32.35±8.11), (9.77±1.25), and (71.43±7.17) points] (all P<0.05). After intervention, the scores of tension and feeling of losing control and the total score of CPSS were significantly decreased in both groups (all P<0.05), and those in the observation group [(15.19±2.10), (16.20±4.01), and (31.50±5.13) points] were significantly lower than those in the control group [(20.36±2.36), (21.58±3.73), and (41.05±4.25) points] (all P<0.05). After intervention, the positive coping scores of the two groups were significantly increased, and the negative coping scores were significantly decreased (all P<0.05); the positive coping score of the observation group was significantly higher than that of the control group [(35.16±5.39) points vs. (27.90±4.82) points], and the negative coping score was significantly lower than that of the control group [(17.57±3.12) points vs. (25.71±3.84) points] (both P<0.05). After intervention, the levels of EPH, NE, and 5-HT in both groups were significantly decreased (all P<0.05), and those in the observation group [(51.90±5.63), (199.94±14.17), and (139.41±11.97) ng/L] were significantly lower than those in the control group [(55.71±6.03), (209.01±6.23), and (146.22±3.17) ng/L] (all P<0.05). The incidence of adverse events in the control group was significantly higher than that in the observation group [9.64% (24/249) vs. 4.78% (12/251)] (P<0.05). Conclusion　Diversified nursing based on crisis awareness can relieve the psychological stress in patients with cerebrovascular disease undergoing MRI examination, encourage the positive coping, improve the levels of neurotransmitters, and reduce the incidence of adverse events.

Application of special-topic education video combined with relaxation training in headache patients undergoing CT examination

Cheng Yuanzhen, Xiang Lin

2023, 29(15):  2168-2172.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.023

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Objective　To explore the effect of special-topic education video combined with relaxation training on headache patients undergoing CT examination in department of neurology. Methods　Taking the implementation time of relaxation training in department of neurology of the Third People' s Hospital of Hubei Province, Jianghan University as the dividing line (January 2022), 99 patients with headache who required craniocerebral CT examination and were admitted to department of neurology of our hospital from February 2021 to December 2021 were selected as the control group [56 males and 43 females, with an age of (49.75±7.89) years old] and were given special-topic education video intervention before CT examination and routine nursing during examination, and another 99 patients from January 2022 to December 2022 after the implementation were selected as the observation group [52 males and 47 females, with an age of (50.10±8.21) years old] and were given relaxation training intervention on the basis of the control group. The examination cooperation degree (grade A as very good, grade B as good, and grade C as poor) and the number of cases with examination interruption, anxiety [Self-rating Anxiety Scale (SAS)] and self-perceived burden [Self-perceived Burden Scale (SPB)] before and after intervention, and nursing satisfaction were compared between the two groups. The statistical methods used were independent sample t test, paired t test, χ² test, Fisher exact probability method, and group rank sum test. Results　The examination cooperation degree of the observation group (66 cases of grade A, 23 cases of grade B, and 10 cases of grade C) was better than that of the control group (50 cases of grade A, 34 cases of grade B, and 15 cases of grade C), with a statistically significant difference (Z=2.240, P=0.025). There were 1 case of examination interruption in the observation group and 3 cases in the control group, without statistically significant difference (P>0.05). The degree of SAS anxiety in the observation group after intervention (56 normal cases, 29 mild cases, 13 moderate cases, and 1 severe case) was significantly improved compared with that in the control group (42 normal cases, 35 mild cases, 20 moderate cases, and 2 severe cases) (Z=2.082, P=0.037). Before intervention, there were no statistically significant differences in the scores of economic burden, emotional burden, and physical burden of the SPB between the two groups (all P>0.05); after intervention, the above scores of the observation group were lower than those of the control group [(5.42±1.02) points vs. (6.37±1.15) points, (6.13±1.46) points vs. (7.02±1.39) points, (6.47±1.10) points vs. (7.08±1.04) points] (all P<0.05). The service attitude score of the observation group was higher than that of the control group [(8.26±1.12) points vs. (7.35±1.50) points] (P<0.05); there were no statistically significant differences in the scores of operation technique and education quality between the two groups [(9.02±0.54) points vs. (9.03±0.61) points, (8.39±1.07) points vs. (8.10±1.19) points] (both P>0.05). Conclusion　Special-topic education video combined with relaxation training for headache patients in department of neurology before CT examination can improve their self-perceived burden, and enhance the examination cooperation degree and nursing satisfaction.

Application value of foresight nursing combined with 4R crisis integrated care in patients examined by CT enhancement

Jiang Liyan, Han Weiping, Chen Jianli, Wang Aijie, Jiang Lianhong

2023, 29(15):  2173-2176.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.024

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Objective　To explore the application value of foresight nursing combined with 4R crisis integrated care in patients examined by CT enhancement. Methods　A total of 120 patients who underwent contrast-enhanced CT in Yantai Mountain Hospital between March 2020 and April 2022 were prospectively selected for this study, and all of them were divided into two groups with 60 patients in each group by computerized random number table method. The control group had 25 males and 35 females with an age of (55.90±5.10) years old, who underwent routine nursing intervention. The study group had 21 males and 39 females, with an age of (57.47±4.59) years old, who underwent foresight nursing combined with 4R crisis integrated care based on routine nursing intervention. The occurrence of contrast agent extravasation, psychological status, and adverse reactions were compared between the two groups. The statistical methods used were independent sample t test, paired t test, and χ² test. Results　The overall incidence of contrast agent extravasation in the study group was lower than that in the control group [5.00% (3/60) vs. 20.00% (12/60), χ²=4.876, P=0.027]. After intervention, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) of the study group were lower than those of the control group [(39.10±2.75) points vs. (41.77±3.48) points, (38.13±2.74) points vs. (40.77±5.00) points], with statistically significant differences (t=4.660 and 3.578, both P<0.001). The total incidence of adverse reactions in the study group was lower than that in the control group [6.67% (4/60) vs. 23.34% (14/60), χ²=5.294, P=0.021]. Conclusion　Application of foresight nursing combined with 4R crisis integrated nursing in CT-enhanced examination patients can effectively reduce the incidences of contrast agent extravasation and adverse reactions, and improve their psychological state.

Treatises

Application of 1 470 nm laser in partial nephrectomy

Yu Shichao, He Huibin, Yu Jing

2023, 29(15):  2177-2180.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.025

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Objective　To compare the efficacies of 1 470 nm laser partial nephrectomy and nephron sparing surgery (NSS) in the treatment of renal clear cell carcinoma. Methods　The clinical data of 32 patients with renal clear cell carcinoma admitted to Dongguan Kanghua Hospital from April 2020 to December 2022 were retrospectively analyzed and were divided into a laser group (16 cases) and a NSS group (16 cases) according to different surgical methods. In the NSS group, 10 males and 6 females, aged (58.63±8.34) years, were treated with NSS. In the laser group, 9 males and 7 females, aged (58.06±9.18) years, were treated with 1 470 nm laser partial nephrectomy. The operation time, length of postoperative hospital stay, drainage tube removal time, intraoperative blood loss, creatinine changes before and after surgery, and neutrophil gelatinase-associated lipid carrier protein (NGAL) levels before and after surgery were compared between the two groups. Fisher exact probability method, independent sample t test, and Mann Whitney U test were used for statistical analysis. Results　There was no statistically significant difference in the operation time between the two groups (t=0.124, P>0.05). There were statistically significant differences in the length of postoperative hospital stay (Z=4.786, P<0.001), drainage tube removal time (Z=4.824, P<0.001), intraoperative blood loss (Z=4.768, P<0.001), and creatinine differences before and after surgery (1 week and 3 months) between the two groups (t=12.134 and 4.768, both P<0.001). There was no statistically significant difference in the preoperative NGAL level between the two groups (P>0.05). The NGAL levels in the laser group 2, 4, and 24 h after surgery were lower than those in the NSS group [(59.63±6.35) μg/L vs. (161.31±5.53) μg/L, (54.94±5.24) μg/L vs. (181.63±6.88) μg/L, (48.69±5.67) μg/L vs. (130.00±4.40) μg/L] (t=46.756, 56.782, and 43.898; all P<0.001). Conclusion　1 470 nm laser partial nephrectomy is feasible, and can effectively preserve the kidney function and shorten the hospital stay and extubation time.

Application value of portable sleep monitor in the diagnosis of OSAHS in children

Liang Wenyu, Ye Wanlin, Wu Huimin, Su Yanlan, He Qiuxia

2023, 29(15):  2180-2184.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.026

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Objective　To investigate the application of portable sleep monitor in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Methods　A retrospective study was performed on 80 children suspected with OSAHS who were hospitalized and treated in the outpatient department of Maoming Maternal and Child Health Hospital from February 2020 to August 2021, including 42 boys and 38 girls, aged (10.52±2.31) years. The main complaints were nasal congestion and snoring and mouth breathing during sleep. Simultaneous diagnosis with polysomnography (PSG) and portable sleep monitor was performed. The indexes (mean blood oxygen saturation, minimum blood oxygen saturation at night, and hypoxia index) and the detection rates of children with OSAHS of the two diagnostic methods were compared. The diagnostic efficiency (sensitivity, specificity, and accuracy) of portable sleep monitor  was analyzed. Paired t test was used. Results　There were no statistically significant differences in the mean blood oxygen saturation [(92.33±2.96)% vs. (93.72±3.18)%], minimum blood oxygen saturation at night [(78.02±3.45)% vs. (78.46±3.86)%], and hypoxia index [(26.89±4.03) vs. (26.51±4.21)] between PSG and portable sleep monitor. Among the 80 children suspected with OSAHS, 10 cases were normal, 28 cases were mild, 23 cases were moderate, and 19 cases were severe diagnosed by gold standard PSG; PM diagnosis detected 9 normal cases, 26 mild cases, 21 moderate cases, and 18 severe cases. There were 70 positive cases and 10 negative cases diagnosed by gold standard PSG; there were 65 positive cases and 9 negative cases diagnosed by PM, and the sensitivity, specificity, and accuracy were 92.9%, 90.0%, and 92.5% respectively. Conclusion　The portable sleep monitor has a high detection rate in the diagnosis of OSAHS in children, and the sensitivity, specificity, and accuracy of this diagnostic method are more than 80%, which has a high clinical diagnostic value.

Predictive value of neutrophil-to-lymphocyte ratio and IL-10 combined detection for the prognosis in patients with chronic obstructive pulmonary disease

Hu Pingping, Zhou Bingyu, Song Pengcheng

2023, 29(15):  2184-2188.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.027

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Objective　To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) and interleukin-10 (IL-10) combined detection for the prognosis in patients with chronic obstructive pulmonary disease (COPD). Methods　A total of 216 COPD patients were collected from Weihai Central Hospital Affiliated to Qingdao University from January 2017 to July 2019, and they were divided into a stable COPD group [122 cases, including 76 males and 46 females, aged (68.7±7.1) years] and an acute exacerbation of COPD (AECOPD) group [94 cases, including 58 males and 36 females, aged (69.7±7.6) years] based on their clinical conditions. The levels and correlations of NLR, IL-10, and pulmonary function parameters [forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC] were compared between the two groups. The receiver operating characteristic curve (ROC) was used to predict the severity of COPD, and the diagnostic value of combined detection of NLR and IL-10 in AECOPD was evaluated. Stratified analysis based on the cutoff values of NLR and IL-10 levels was performed to assess their predictive values for the prognosis in COPD patients. t test, χ² test, Pearson correlation analysis, Kaplan-Meier curve analysis, and Log-rank test were used. Results　The level of NLR in the AECOPD group [(9.96±2.87)] was higher than that in the stable COPD group [(4.15±2.84)], and the levels of IL-10 [(46.06±8.42) ng/L], FEV1 [(1.58±0.31)L], FVC [(2.06±0.34) L], and FEV1/FVC [(65.02±9.27)%] were lower than those in the stable COPD group [(68.53±7.49) ng/L, (2.14± 0.45)L, (3.56±0.38) L, and (72.37±5.08)%], with statistically significant differences (all P<0.05). Pearson correlation analysis showed that FEV1, FVC, and FEV1/FVC had a negative correlation with NLR and a positive correlation with IL-10 (all P<0.05). ROC analysis showed that both NLR and IL-10 had good diagnostic values for AECOPD [area under the curve (AUC) of 0.803 and 0.826], and the diagnostic efficiency of combined detection was superior to that of single detection (AUC of 0.875). According to the cut-off values of NLR and IL-10, the 216 COPD patients were divided into group A (NLR >9.15, IL-10 ≤45.72 ng/L) with 64 cases, group B (NLR >9.15, IL-10 >45.72 ng/L) with 72 cases, group C (NLR ≤9.15, IL-10 ≤45.72 ng/L) with 49 cases, and group D (NLR ≤9.15, IL-10 >45.72 ng/L) with 31 cases. Survival analysis using the ROC during the follow-up period showed that the mortality rates of group A, group B, group C, and group D were 35.9% (23/64), 29.2% (21/72), 12.2% (6/49), and 9.7% (3/31), respectively, and the median survival periods were (9.22±0.48) months, (10.04±0.51) months, (13.54±0.60) months, and (16.02±0.76) months, respectively, with statistically significant differences among the four groups (both P<0.05). Conclusions　NLR and IL-10 levels are closely associated with the pulmonary function in COPD patients. The combined detection of NLR and IL-10 has good diagnostic value for AECOPD and can predict the prognosis to a certain extent.

Clinical Research

Epidemiological investigation and influencing factors of depression in patients with hematological malignancies

Tao Yuan, Cheng Shuqin, Xie Bixia, Xie Weicheng

2023, 29(15):  2189-2192.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.028

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Objective　To investigate the relevant influencing factors of depression in patients with hematological malignancies. Methods　In the present cross-sectional study, 102 patients with hematological malignancies admitted to Department of Hematology, Guangzhou Panyu Central Hospital from April 2021 to June 2023 were selected. Their basic information was collected through a questionnaire survey, including gender, age, and education level. Hamilton Depression Rating Scale (HAMD) 17 was used to assess their depression status. The patients were divided into two groups according to whether they suffered from depression or not. Univariate analysis was performed by χ² test to screen out the influencing factors with P<0.05, and multivariate analysis was performed by binary logistic regression analysis to obtain the independent influencing factors. Results　In the 102 patients, males accounted for 56.86% (58/102), and the age was (53.23±16.37) years old. Among them, 64 patients had HAMD 17 score ≥7 points, with the incidence of depression of 62.75%. There were statistically significant differences between the two groups in factors such as education level (χ²=12.004), chemotherapy times (χ²=16.997), and disease status (χ²=8.847) (all P<0.05). The above factors were included in logistic regression analysis, and it was concluded that education level and chemotherapy times were independent influencing factors for hematological malignancies related depression (both OR>1, P<0.05). Conclusions　The occurrence of depressive symptoms in patients with hematological malignancies is closely related to multiple factors. In clinical practice, it is necessary to pay attention to patients with high-risk factors and actively provide intervention measures to prevent the occurrence of depression.

Case Report

A case of cataract complicated with iridoschisis

Li Miao, Chi Qi, Zhang Cuiying

2023, 29(15):  2193-2196.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.029

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Treatment of one case of non-adjacent double-level lumbar disc herniation by one-hole split endoscope

Yu Xiankai, Zhao Zihao, Zhao Jiaqing, Li Yuefei, Geng Xiaopeng

2023, 29(15):  2196-2199.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.030

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Nursing Research

Perioperative care for foldable capsular vitreous body surgery

Liu Rongjiao, Zheng Lingling

2023, 29(15):  2200-2203.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.031

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This article summarized perioperative care points of 46 cases (46 eyes) who underwent foldable capsular vitreous body surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from July 2017 to November 2018. Perioperative care focused on the following key points: preoperative ocular and systemic evaluation, cooperation of the core steps during the surgery, eye protection, complication prevention, psychological supports for patients and their family members, and implementation of continuous care. All symptoms of the 46 patients were relieved after careful treatment and care, without serious complications. The patients recovered well after follow-up.

Rehabilitation effect of nurse-led new bedside exercise mode on stroke patients with hemiplegia

Liu Yuqun, Lin Xiaoxia, Zhao Jingyang, Yang Fuying

2023, 29(15):  2204-2207.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.032

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Objective　To explore the rehabilitation effect of nurse-led new bedside exercise mode on stroke patients with hemiplegia. Methods　This study was a randomized controlled trial. From March 2020 to January 2021, this study included 80 patients with stroke and hemiplegia admitted to Department of Rehabilitation Medicine, Guangzhou First People's Hospital as the research subjects, and they were divided into an experimental group (40 cases) and a control group (40 cases) by the random number table method. The sex ratio of the experimental group was 2.08 and the age was (61.63±8.84) years old. The sex ratio of the control group was 1.86 and the age was (64.40±9.87) years old. The experimental group received the new bedside exercise mode led by nurses (including nurses' training guidance, whole-process supervision, and real-time evaluation feedback) plus routine rehabilitation and nursing education, while the control group only received routine rehabilitation and nursing education. Fugl-Meyer Motor Function Assessment (FMA), Mini-Mental State Examination (MMSE), Barthel index, and National Institutes of Health Stroke Scale (NIHSS) assessments were performed in both groups before and after 8 weeks of training. The statistical methods used were independent sample t test, paired t test, and χ² test. Results　After 8 weeks of training, the FMA upper limb score, FMA lower limb score, and Barthel index of the experimental group were (47.78±24.52) points, (24.23±9.40) points, and (77.25±16.91) points, those in the control group were (36.75±25.92) points, (19.85±10.63) points, and (64.88±22.66) points, and the differences of FMA upper limb score, FMA lower limb score, and Barthel index score (post-training to pre-training) in the experimental group [(4.43±1.48) points, (2.50±1.45) points, and (11.63±7.54) points] were more than those in the control group [(0.68±0.76) points, (0.98±0.92) points, and (3.00±2.73) points], with statistically significant differences (t=14.22, 5.62, and 6.80; all P<0.01). There were no statistically significant differences in the differences of MMSE and NIHSS scores before and after training between the two groups (t=-0.63 and -0.58, P=0.53 and 0.56). Conclusion　The new bedside exercise mode led by nurses can effectively improve the movement ability of the hemiplegia side limbs and daily activity ability in stroke patients with hemiplegia, and its effect is better than the conventional rehabilitation treatment plan without this exercise mode, providing an effective potential new strategy for long-term rehabilitation nursing of stroke patients with hemiplegia.

Clinical Teaching

Application of 3D printing technology based on medical imaging combined with PBL-CBL in nursing teaching of vascular diseases

An Furong, Meng Ranran

2023, 29(15):  2208-2212.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.033

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Objective　To explore the application effect of 3D printing technology based on imaging and PBL (problem-based learning) - CBL (case-based learning) teaching mode in nursing teaching of vascular diseases. Methods　A total of 90 nursing students who practiced in Jining No.1 People's Hospital from September 2020 to September 2021 were divided into an observation group (45 cases) and a control group (45 cases) by the random number table method. In the observation group, there were 3 males and 42 females, aged (20.27±1.71) years. In the control group, there were 4 males and 41 females, aged (20.26±1.50) years. The observation group adopted the teaching process of combining 3D printing technology with PBL-CBL teaching mode, and the control group was given traditional vascular surgery teaching aids combined with PBL-CBL teaching mode. Abdominal aortic aneurysm (AAA) was used as the representative of vascular diseases in both groups. After 4 weeks of nursing teaching, the two groups were evaluated by nursing theory written test, practical operation test, and anonymous questionnaire. The questionnaire included nursing students' interest in learning, mastery of knowledge, spatial imagination, and satisfaction with teaching. The statistical methods used were independent sample t test, paired t test, and χ² test. Results　The scores of nursing theoretical test [(87.78±4.64) points vs. (85.60±3.73) points] and practical operation [(86.69±4.94) points vs. (83.00±2.13) points] and total score [(174.47±7.49) points vs. (169.60±4.84) points] in the observation group were higher than those in the control group, with statistically significant differences between the two groups (all P<0.05). The scores of learning interest [(4.60±0.50) points vs. (3.98±0.75) points], knowledge mastery [(4.51±0.66) points vs. (3.93±0.81) points], spatial imagination [(4.62±0.53) points vs. (3.84±0.71) points], and teaching satisfaction [(4.60±0.58) points vs. (4.31±0.60) points] in the observation group were higher than those in the control group, with statistically significant differences between the two groups (all P<0.05). Conclusion　The application of 3D printing technology based on imaging combined with PBL-CBL teaching mode in nursing teaching of vascular diseases can enhance the students' interest in learning, deepen their cognition of the diseases, significantly improve their spatial imagination ability, and effectively improve their clinical nursing teaching quality and satisfaction.

Practice of student-centered clinical guidance integrated teaching model in clinical pharmacotherapeutics teaching

Tang Linlin, Ding Chuanhua, Li Hongying, Wu Guangxia

2023, 29(15):  2213-2215.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.034

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Clinical pharmacotherapeutics is the bridge between clinical medicine and pharmacy, and the core course of clinical pharmacy. Through the joint teaching of clinical pharmacists in schools and affiliated hospitals, this paper establishes a student-centered clinical guidance integrated teaching model. The selected clinical guidance is explained in combination with cases to guide students to use drugs accurately. At the same time, teachers teach students the inquiry methods of clinical guidance. Students learn the latest treatment plans through the clinical guidance, and develop individualized drug treatment plans for patients by consulting data, so as to improve students' ability to guide rational drug use, and lay a foundation for training clinical pharmacists with qualified pharmaceutical service ability.

Application of BOPPPS combined with CBL+LBL teaching mode in cardiac physical examination teaching

Chen Tao, Xu Riping, Li Ming, Ouyang Mengqian, Wu Jun

2023, 29(15):  2216-2220.  DOI: 10.3760/cma.j.issn.1007-1245.2023.15.035

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Objective　To investigate the effect of BOPPPS combined with CBL (case-based learning) +LBL (lecture based learning) teaching mode on the teaching of cardiac physical examination. Methods　A total of 132 undergraduates majoring in clinical medicine in Grade 2020 of Guangdong Medical University were divided into a control group (65 cases) and an experimental group (67 cases) by the random number table method. The experimental group consisted of 37 males and 30 females, aged (22.37±0.91) years; the control group consisted of 35 males and 30 females, aged (22.68±0.69) years. The experimental group was taught by BOPPPS combined with CBL+LBL teaching mode, while the control group was taught by traditional CBL+LBL teaching mode. At last, a questionnaire was used to evaluate the teaching effect. χ² test and independent-sample t test were used. Results　The satisfaction of the experimental group was higher than that of the control group [98.5% (66/67) vs. 86.2% (56/65)], with a statistically significant difference (P<0.05). In terms of self-evaluation, the students in the experimental group were better than those in the control group in the five items of "whether to stimulate learning interest, whether to improve the mastery of learning key and difficult points, whether to enhance the training of clinical operation skills, rationality of teaching organization, and whether to improve the interest in clinical learning" (all P<0.05); there were no statistically significant differences between the two groups in the five items of "training clinical thinking ability, enhancing ability of problem solving, communication and expression abilities between teachers and students and between doctors and patients, improvement of learning efficiency and ability, and teamwork ability" (all P>0.05). Conclusions　Compared with traditional CBL+LBL teaching method, BOPPPS combined with CBL+LBL teaching mode can improve the learning efficiency, stimulate the students' learning interest and enthusiasm, and enhance the students' clinical thinking and clinical operation skills. Therefore, this teaching mode has good teaching effect and is worth popularizing and applying.