Table of Content

15 August 2023, Volume 29 Issue 16

Previous Issue   

New Medical Advances

NLRP3 inflammasome and diabetic cardiomyopathy

Zhang Cui, Liu Zhen, Liu Jingyang, Shi Xinye, Liu Zhiqiang, Sun Jingwu

2023, 29(16):  2221-2225.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.001

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Diabetic cardiomyopathy (DCM) is a specific heart disease caused by diabetes, and is independent from other cardiovascular diseases. The pathogenesis of DCM is not very clear. Studies have found that inflammation plays an important role in the occurrence and development of DCM. With the discovery of NLRs family, more and more studies have been conducted on NLRP3 inflammasome and DCM. A large amount of evidence suggests that NLRP3 is involved in the pathophysiological process of DCM by mediating the release of pro-inflammatory factors and pyrodeath of cells. In this article, we systematically review the basic knowledge of NLRP3 inflammatories, the relationship between NLRP3 and DCM, and the therapeutic drugs targeting NLRP3 in DCM.

Relationship between intestinal floras and metabolic diseases

Fang Jianfeng

2023, 29(16):  2225-2229.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.002

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Metabolic diseases refer to the general name for metabolic disorders, including obesity, diabetes, non-alcoholic liver disease, etc. There are tens of billions of bacteria in human gut; their metabolites can interact with the human hosts and affect human health. The gut microbiotas are closely related to the human hosts' metabolic health; in abnormal situations, they may lead to a variety of common metabolic diseases, such as obesity, type 2 diabetes, non-alcoholic liver disease, cardio-pulmonary metabolic diseases, malnutrition, etc. In this review, we discuss the relationship of gut microbiotas with common metabolic diseases, the pathogenic mechanisms leading to these diseases, and the treatment and prevention methods of metabolic diseases from the perspectives of gut microbiotas, so as to provide new directions for the treatment of metabolic diseases.

Risk factors of osteoporosis and fractures and application of assessment tools

Long Lingmei, Liu Weiwang, Wu Yuan

2023, 29(16):  2230-2234.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.003

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The aging in China is serious, and the population structure is dominated by the elderly, so osteoporosis has become one of the main problems faced by the society. The probability of fractures caused by osteoporosis is increasing year by year. The corresponding high medical expenditure has great impact on individuals, families, and society. In recent years, osteoporosis and fracture risk assessment tools have become a hot topic. Simple, economical, and practical assessment tools can effectively prevent and treat osteoporosis and osteoporotic fractures. This article reviews the risk factors of osteoporosis and fractures and the application of related risk assessment tools.

Meta Analysis

Meta-analysis on relationship between gastrointestinal bleeding before TIPS and hepatic encephalopathy after TIPS 

Wang Fengyan, Wang Shengguo, Gu Shanshan, Han Zhihao

2023, 29(16):  2235-2239.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.004

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Objective　To explore the relationship between gastrointestinal bleeding before transjugular intrahepatic portosystemic shunt (TIPS) and postoperative hepatic encephalopathy (HE) after TIPS by meta-analysis. Methods　The databases, PubMed , Embase, Cochrane, and Web of Science, were searched, and the literatures from the establishment of the databases to October 2022 were screened. RevMan 5.3 and Stata 16 were used to analyze the data. Results Nine English literatures with 2 063 patients were included, including 1 341 patients with bleeding and 1 341 patients without bleeding. The results of overall analysis were not statistically significant (P>0.05; OR=0.84, 95%CI 0.68-1.04). After 2016, the cumulative OR value showed a trend of moving to the left (the trend was stable). Subgroup analysis further confirmed that the proportion of HE after TIPS in the patients with gastrointestinal bleeding before TIPS decreased significantly after 2017 (P<0.05; OR=0.66, 95%CI 0.47-0.93). Conclusions　After 2016, the cumulative OR of HE in patients with gastrointestinal bleeding before TIPS continues to improve; the promotion of TIPS guidelines may be an important reason.

Special Column of Pediatrics

Therapeutic effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on motor and cognitive function of children with spastic cerebral palsy

Li Shuidi, Yang Yun, Zeng Liuyuan, Zhou Dalong, Huang Zhenbo

2023, 29(16):  2240-2245.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.005

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Objective　To explore the effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on motor and cognitive function in children with spastic cerebral palsy. Methods　Ninety children with spastic cerebral palsy treated at Guangdong Women and Children Hospital from January 2021 to December 2022 were recruited and randomly divided into a scalp acupuncture group, an LF-rTMS group, and an associative group by the random number table method, with 30 cases in each group. The three groups were treated with conventional rehabilitation therapy. On this basis, the scalp acupuncture group took scalp acupuncture, the LF-rTMS group low-frequency repetitive transcranial magnetic stimulation, and the associative group scalp acupuncture and low-frequency repetitive transcranial magnetic stimulation. All the three groups were continuously treated 1 time/day and 6 times/week for 12 weeks. Before and after 12 weeks' treatment, the three groups were evaluated using the Gross Motor Function Measure (GMFM-88), Modified Asthworths Scale (MAS), and Gesell Developmental Schedules (Gesell). Analysis of variance, paired t test, χ² test or Fisher exact probability, Z test, and paired rank sum test were applied. Results　Before the treatment, there were no statistical differences of MAS, D and E divisions of GMFM, and 5 divisions of Gesell between the three groups (all P>0.05). After the treatment, there were statistical differences in the MAS score [(2.13±0.63) vs. (1.93±0.64) vs. (1.50±0.57),F=8.332], the D [(14.10±5.30) vs. (11.83±3.95) vs. (14.70±4.56), F=3.196] and E [(8.96±4.02) vs. (9.60±4.26) vs. (11.88±3.72), F=4.416] scores of GMFM, and the adaptation [(52.69±19.05) vs. (52.45±21.25) vs. (63.33±10.35), F=3.772], motor [(31.53±12.65) vs. (30.32±12.49) vs. (38.18±11.99), F=3.513], and language [(50.01±19.38) vs. (50.92±19.60) vs. (60.73±11.76), F=3.541] scores of Gesell between the scalp acupuncture group, the LF-rTMS group, and the associative group (all P<0.05); the MAS scores, and E scores of GMFM, and the adaptation, motor, and language scores of Gesell of the associative group were significantly better than those of the scalp acupuncture group and the LF-rTMS group , with statistical differences (all P<0.05).The D score of GMFM of the associative group was significantly better than that of the LF-rTMS group (P<0.05). Conclusions　Scalp acupuncture combined with low-frequency repetitive transcranial magnetic stimulation for children with spastic cerebral palsy can effectively reduce their muscle tension and promote their motor and cognitive function.

Neurological manifestations of children infected with COVID-19

Wang Jie, Liu Fangfang, Ma Kai, Liu Guiling, Liu Yong, Jin Ruifeng

2023, 29(16):  2245-2250.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.006

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Objective　To explore the neurological manifestations of children infected with COVID-19. Methods　The clinical data of 109 children with COVID-19 infection and neurological symptoms who were treated at Department of Neurology and ICU of Children's Hospital Affiliated to Shandong University from December 1, 2022 to January 31, 2023 were retrospectively analyzed, including 58 boys and 51 girls. Their onset age was (55.5±43.9) months. Results　Among the 109 children, 85 children (78.0%) had convulsive seizures, including 13 cases (11.9%) of status epilepticus; 10 (9.2%) experienced consciousness disorders; 3 (2.8%) had deviation of mouth angles; 4 (3.7%) had walking lability; 4 (3.7%) had language disorders, 3 (2.8%) had muscle pain. Finally, 36 cases (33.0%) were diagnosed as febrile seizures, 25 (22.9%) as encephalitis, 12 (11.0%) as acute necrotizing encephalopathy [including 5 ones (4.6%) who gave up the treatment and 2  (1.8%) who died], 8 (7.3%) as febrile seizures plus, and 3 (2.8%) as peripheral facial paralysis. Conclusions　The most common neurological symptom in children infected with Omicron is convulsive seizures, followed by impaired consciousness. The most common neurological disorders are febrile seizures, encephalitis, and acute necrotizing encephalopathy; of which, acute necrotizing encephalopathy can lead to death in children.

Clinical characteristics and endoscopic manifestations of Helicobacter pylori gastritis in children

Zheng Bingsheng, Wang Huan, Li Wenwen, Bai Daming, Zhang Dali, Dai Dongling

2023, 29(16):  2251-2254.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.007

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Objective　To raise awareness of Helicobacter pylori (Hp) gastritis in children by the investigation of clinical characteristics and endoscopic manifestations in these children. Methods　A total of 1 028 children who underwent gastroscopy and were confirmed with chronic gastritis in Shenzhen Children's Hospital from 2020 to 2022 were selected; they were 1-18 years old. According to the results of immunohistochemistry, the children were divided into an Hp-positive group and an Hp-negative group. The clinical data were collected. χ² test and Fisher's exact test were used to analyze the clinical manifestations and endoscopic features. Results　Among the 1 028 children, there were 216 children in the Hp-positive group and 812 children in the Hp-negative group; the overall prevalence of Hp infection in this investigation was 21.01%. The incidences of mucosal micronodules, mucosal swelling, and poor contraction of pyloric canal in the Hp-positive group were higher than those in the Hp-negative group [75.46% (163/216) vs. 6.15% (50/812), 83.79% (181/216) vs. 44.70% (363/812), and 4.62% (10/216) vs. 1.10% (9/812)], with statistical differences between the two groups (all P<0.05). The detection rates of activity +, chronic inflammation reaction ++, and lymphoid follicles in the Hp-positive group were significantly higher than those in the Hp-negative group [12.50% (27/216) vs. 0.74% (6/812), 7.87% (17/216) vs. 0.49% (4/812), and 24.53% (53/216) vs. 6.28% (51/812)], with statistical differences between the two groups (all P<0.05). There were no statistical differences in the incidences of abdominal pain, abdominal distension, nausea/hiccups, vomit, and anorexia between two groups the (all P>0.05). Conclusions　More Hp-positive children are found with micronodular changes, poor contraction of pyloric canal, and mucosal swelling under endoscope, with no specific clinical findings. Hp infection mainly reflect gastric mucosal activity and chronic inflammation. Lymphoid follicle is the histopathological feature. Gastric mucosa atrophy and intestinal metaplasia are rare in children.

Changes of serum uric acid and growth indicators in children before and after treatment with recombinant human growth hormone and their correlation

Li Cunjiao, Zhang Rui, Zhang Chong, Shang Yiyi, Cao Huifang, Yang Zhaochuan, Shan Yanchun

2023, 29(16):  2255-2258.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.008

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Objective　To observe the serum uric acid and growth indicators in children before and one year after treatment with recombinant human growth hormone (rhGH), and to explore the effect of rhGH on serum uric acid metabolism. Methods　Sixty prepubertal children treated with rhGH for one year at Hospital Affiliated to Qingdao University from February 2019 to August 2022 were enrolled in this study, including 20 cases of growth hormone deficiency and 40 cases of idiopathic short stature (ISS); there were 39 boys and 21 girls, with an average age of 8.9 years. The therapeutic dose of rhGH was in accordance with the clinical guidelines. The heights, body weights, and body mass indexes (BMI) were recorded before and one year after the treatment. The height Z scores (HAZ) and BMI Z scores (BMI Z) before and after one year's treatment were calculated with by the World Health Organization (WHO) anthropometer; the △HAZ and △BMI Z were calculated after one year's rhGH treatment. The uric acid values were collected before and after one year's rhGH treatment. The heights, weights, BMI's, and serum uric acid values were compared between before and after the treatment. Paired t test and univariate correlation analysis were applied. Results　After one year's treatment with rhGH, the HAZ increased [(-0.91±1.01) vs. (-1.88±1.06), P<0.05], the BMI Z decreased [(-0.53±1.15) vs. (-0.28±1.14), P<0.05], and the serum uric acid level increased slightly [(303.09±75.39) μmol/L vs. (295.38±70.15) μmol/L, P>0.05]. The uric acid level was positively correlated with the children's height, body weight, BMI, and BMI Z before the initial treatment of rhGH (all P<0.05). The serum uric acid level was positively correlated with height, body weight, and BMI before the treatment and height and body weight after one year's treatment (all P<0.05). Conclusions　After one year's treatment with rhGH, the height catch-up growth of children with GHD and ISS was significant; there was no effect on serum uric acid metabolism. There are correlation between serum uric acid metabolism and growth indicators before and after rhGH treatment.

Special Subject:Treatment for Lung Cancer

Inflammatory reaction and postoperative complications of patients taking thoracoscopic radical resection of lung cancer assisted by different flow volumes of continuous oxygen in their contralateral lungs 

Guo Jing, Zhao Tianzeng

2023, 29(16):  2259-2263.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.009

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Objective　To observe the auxiliary effect of different flow volumes of oxygen in the healthy side lungs for thoracoscopic radical operation of lung cancer and the prevention and treatment effect on patients' inflammatory reaction and postoperative complications. Methods　This study was a prospective study. One hundred and twenty-eight patients who received thoracoscopic radical surgery for lung cancer in First Hospital, Nanyang Medical College from January 2021 to June 2022 were selected as the research objects, and were divided into groups A and B by the lottery method, with 64 cases in each group. There were 40 males and 24 females in group A; they were (60.25±5.33) years old. There were 42 males and 22 females in group B; they were (61.36±5.28) years old. Group A were continuously given 1-2 L/min oxygen delivery through their non-operative healthy lungs during the operation, and group B 3-4 L/min oxygen. The operation status, treatment status, blood gas indicators, inflammation indicators, and postoperative complications were compared between the two groups. χ² and t tests were applied. Results　After the treatment, the operation time and the time of single lung ventilation in group B were (180.45±20.26) min and (170.33±20.29) min, and those in group A were (178.44±20.32) min and (168.44±20.27) min (both P>0.05). The time staying in the monitoring treatment room after anesthesia and hospital stay in group B were shorter than those in group A [(80.33±10.27) min vs. (86.65±10.32) min and (10.22±5.31) d vs. (13.39±5.28) d; both P<0.05]. Thirty minutes after the operation beginning (T1), the arterial partial pressures of O₂ (PO₂) in both groups decreased, and the arterial partial pressures of CO₂ (PaCO₂) increased in both groups; however, there were no statistical differences between these two groups (both P>0.05). One hour after the one-lung ventilation (T2), the PO₂ in group B was higher than that in group A [(185.44±50.32) mmHg (1 mmHg=0.133 kPa) vs. (147.44±50.37) mmHg], and the PaCO₂ in group B was lower than that in group A [(38.25±5.36) mmHg vs. (41.27±5.28) mmHg]. On the first day after the surgery, the white blood cell count, neutrophil count, and level of serum amyloid protein A in group B were lower than those in group A [(6.25±1.45) ×10⁹/L vs. (7.88±1.27) ×10⁹/L, (4.45±1.06) ×10⁹/L vs. (5.77±1.36) ×10⁹/L, and (8.25±2.32) mg/L vs. (10.47±3.61) mg/L; all P<0.05]. After the treatment, the postoperative complication rate of group B was lower than that of group A [6.25% (4/64) vs. 18.75% (12/64); P<0.05]. Conclusions　Continuous oxygenation of 3-4 L/min to the healthy lungs during single lung ventilation in patients undergoing radical resection of lung cancer does not affect surgical indicators and can promote postoperative recovery. It has positive effects on improving blood gas indicators, reducing inflammatory reaction and risk of postoperative complications.

Shenqi Fuzheng Liquid for improving cancer-induced fatigue, immune function, and adverse chemotherapy reactions in patients with lung cancer

Li Shanshan, Liang Bing

2023, 29(16):  2264-2267.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.010

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Objective　To observe the effect of Shenqi Fuzheng Liquid on improving cancer-induced fatigue, immune function, and adverse chemotherapy reactions in patients with lung cancer. Methods　This was a prospective study. A total of 123 patients with lung cancer who received treatment in Nanyang First People's Hospital from January 2021 to May 2022 were included as the study objects. The patients were divided into a control group (61 cases) and an observation group (62 cases) by the lottery method. There were 40 males and 21 females in the control group; they were (60.44±5.18) years old. There were 42 males and 20 females in the observation group; they were (60.27±5.35) years old. Both groups took routine chemotherapy; in addition, the observation group took Shenqi Fuzheng Liquid. The immune function before and after the treatment was compared between the two groups. The improvement of cancer-induced fatigue 7, 14, and 30 days after the treatment was observed. The occurrence of chemotherapy related adverse reactions and quality of life of the two groups were analyzed and compared through 6-month short-term follow-up. χ² and t tests were applied. Results　Before the treatment, there were no statistical differences in the immune function and score of Piper Fatigue Scale (PFS) between the two groups (all P>0.05). After the treatment, the CD3+ and CD4+ T lymphocyte subsets were higher and the CD8+ was lower in the observation group than in the control group [(70.35±10.46)% vs. (65.44±10.27) %, (40.22±8.47)% vs. (35.25±8.33)%, and (35.44±5.36)% vs. (38.25±5.46)%; all P<0.05]. The PFS scores 1,5, and 10 d after the treatment in the observation group were lower than those in the control group [(28.44±4.69) vs. (31.22±4.33), (23.39±5.37) vs. (26.44±5.82), and (20.27±2.28) vs. (23.47±4.15); all P<0.05]. During the follow-up period, the incidence of adverse chemotherapy reactions in the observation group was lower than that in the control group [9.68% (6/62) vs. 21.31% (13/61)]. The scores of Karnofsky Performance Status (KPS), quality of life (QOL), and Zubrod Performance Status (ZPS) in the observation group were better than those in the control group [(75.22±5.31) vs. (72.19±5.28), (48.44±5.23) vs. (45.15±5.19), and (2.12±0.75) vs. (3.32±1.26); all P<0.05]. Conclusion　Shenqi Fuzheng Liquid can effectively improve the immune function and cancer-induced fatigue level in patients with lung cancer chemotherapy, and has positive significance in reducing the risk of chemotherapy-related adverse reactions and improving the quality of life.

Scientific Research

Expression of IGSF9 in epithelial ovarian cancer and its effect on metastasis of ovarian cancer cells

Ding Baijuan, Zhang Liwei, Yang Hui, Cui Xiujuan, Li Nan

2023, 29(16):  2268-2272.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.011

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Objective　To study the expression of immunoglobulin superfamily member 9 (IGSF9) in epithelial ovarian cancer (EOC), to analyze its relationship with prognosis and clinicopathological characteristics of EOC patients, and to explore the effect of IGSF9 on the metastatic ability of ovarian cancer cells. Methods　The expression of IGSF9 mRNA was analyzed by dynamic analysis website of gene expression profile data (GEPIA). The relationship between IGSF9 expression and the patients' survival time was analyzed by the Kaplan-Meier Plotter database. A total of 76 paraffin samples from the primary lesions of the EOC patients who were treated in Department of Gynecology, Tengzhou Central People's Hospital from June 2010 to June 2020 and 30 paraffin samples from the normal ovarian tissue removed due to other diseases during the same period were selected. The expressions of IGSF9 in the EOC patients' tissue and normal tissue were detected by the immunohistochemical staining; the correlation between IGSF9 expression and clinicopathological characteristics was analyzed. The SKOV3 ovarian cancer cell line interfered by IGSF9 was constructed by shRNA. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to identify the interference effect. The Transwell chamber method was used to detect the metastasis ability of SKOV3 cell line after IGSF9 interference. t test, analysis of variance, and χ² test were applied. Results　The GEPIA database showed that the expression level of IGSF9 in EOC was 21.8 times that in normal tissue. The 5-year overall survival and progression-free survival of the patients with high IGSF9 expression were poor. The high expression rates of IGSF9 in the EOC tissue and normal ovarian tissue were 69.7% and 16.7%, respectively. The expression of IGSF9 protein was correlated with FIGO stage, peritoneal metastasis, and serum carbohydrate antigen (CA-125) level in the EOC patients. Interference with IGSF9 expression resulted in decreased metastatic ability of ovarian cancer cells. Conclusions　The increased expression of IGSF9 in EOC is related to poor prognosis and poor clinicopathological characteristics of EOC patients. IGSF9 can promote the metastasis of ovarian cancer cells. IGSF9 may promote the progress of EOC, and has certain value for the diagnosis, treatment, and prognosis evaluation of EOC patients.

Effect of hysteroscopic cervical "thumbtack" resection on pregnancy outcomes in patients with high-grade cervical squamous intraepithelial lesions

Liu Jin, Wang Zhenzhen, Wang Hui, Xu Chen, Yue Qingling

2023, 29(16):  2273-2276.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.012

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Objective　To investigate the effect of hysteroscopic cervical "thumbtack" resection on pregnancy outcomes in patients with high-grade cervical squamous intraepithelial lesions. Methods　One hundred and sixty pregnant women with high-grade cervical squamous intraepithelial lesions admitted to Liaocheng Third People's Hospital from June 2017 to June 2022 were selected. According to the surgical methods, they were divided into an observation group (88 cases) and a conventional group (72 cases). The observation group were (30.01±6.02) years old and (36.11±0.93) weeks pregnant. The conventional group were (30.22±6.12) years old and (36.25±0.96) weeks pregnant. The observation group took hysteroscopic cervical "thumbtack" resection. The conventional group took cervical cold-knife conical resection. The perioperative recovery indicators of the two groups were analyzed. The pregnancy and neonatal outcomes were compared between the two groups. t and χ² tests were applied. Results　The postoperative recovery time and spontaneous breathing recovery time of the observation group were shorter than those of the conventional group (both P<0.05). The incidences of preterm delivery, amniotic fluid contamination, postpartum hemorrhage, intrauterine infection, and fetal distress in the observation group were significantly lower than those in the conventional group (all P<0.05). The incidences of asphyxia, pneumonia, pathological jaundice, and infection in the neonates of the observation group were significantly lower than those in the conventional group [2.27% (2/88) vs. 16.67% (12/72), 2.27% (2/88) vs. 19.44% (14/72), 2.27% vs. (2/88) 18.06% (13/72), and 4.55% (4/88) vs. 19.44% (14/72); all P<0.05]. Conclusion　Hysteroscopic cervical "pushtack" resection in the treatment of high-grade cervical squamous intraepithelial lesions can shorten the postoperative recovery time and spontaneous respiratory recovery time, and does not increase the risk of adverse pregnancy and neonatal outcomes, so it is worthy of promotion.

Application of cisatracurium by different administration methods in renal transplantation

Deng Qun, Jiang Jingjing

2023, 29(16):  2277-2280.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.013

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Objective　To observe the effects of total intravenous anesthesia with cisatracurium in different ways for renal transplantation on the anesthetic amount and the patients' recovery indicators. Methods　One hundred and twenty-three patients who took renal transplantation at Zhengzhou Seventh People's Hospital from January 2021 to October 2022 were selected for the randomized controlled trial. They were divided into groups A (62 cases) and B (61 cases) by lottery. There were 30 males and 32 females in group A; they were (62.58±5.33) years old. There were 31 males and 30 females in group B; they were (60.46±5.29) years old. Group A took target-controlled infusion, and group B continuous infusion. The anesthesia, operation, postoperative recovery, and anesthesia safety of the two groups were compared. t and χ² tests were applied. Results　After the anesthesia by different administration methods, the onset time of muscle relaxation in group A was shorter than that in group B, and the maintenance time was longer than that in group B (both P<0.05); the maintenance dose of anesthesia in group A was lower than that in group B [(27.22±5.13) mg vs. (30.77±5.48) mg, t=3.710, P<0.001)]. There were no statistical differences in the intraoperative bleeding volume and operation time between the two groups (both P>0.05). The postoperative eye opening time and extubation time in group A were shorter than those in group B [(7.45±2.28) min vs. (8.82±2.36) min and (9.27±2.46) min vs. (10.49±2.39) min; t=3.274 and 2.789; P=0.001 and 0.006)]. The times for the recovery of muscle relaxation (TOF) ≥ 25% and ≥ 75% in group A were shorter than those in group B (both P<0.05). The incidence of anesthesia related complications in group A was lower than that in group B [4.84% (3/62) vs. 14.75% (9/61); χ²=5.558, P=0.018]. Conclusion　Target controlled infusion of cisatracurium has high application value in total intravenous anesthesia for renal transplantation, can shorten the onset time of anesthesia and enhance the muscle relaxation effect, and has positive significance in reducing the amount of drug in maintaining anesthesia, improving the recovery of muscle relaxation, and reducing the risk of anesthesia related complications.

Fumigation and washing with Shengji Zhitong Fang combined with antibacterial drugs for patients with perianal abscess 

Wang Hui, Sun Yafeng, Chen Minghuan, Wang Qian, Liu Ping

2023, 29(16):  2281-2285.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.014

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Objective　To observe the effect of fumigation and washing with Shengji Zhitong Fang combined with antibacterial drugs for patients with perianal abscess. Methods　One hundred and twenty-three patients with perianal abscess treated at Shangqiu First People's Hospital from October 2020 to February 2023 were selected for the randomized controlled trial. They were divided into a control group (60 cases) and a combined group (63 cases) by the computer randomization method. There were 35 males and 25 females in the control group; they were (50.25±5.31) years old. There were 37 males and 26 females in the combined group; they were (50.33±5.25) years old. The control group received regular antimicrobial treatment. The combined group took fumigation and washing with Shengji Zhitong Fang combined with antibacterial drugs. The wound healing, improvement of inflammatory factors and pain indicators, and recovery of anal function were compared between the two groups. t test was applied. Results　Before the treatment, there were no statistical differences in epidermal growth factor (EGF), inflammatory factors, pain mediators, and anal function indicators between the two groups (all P>0.05). After the treatment, the wound healing time and scab shedding time in the combined group were shorter than those in the control group [(20.45±5.17) d vs. (23.75 ± 5.31) d and (4.33±1.25) d vs. (5.26±1.49) d], and the EGF level in the combined group was higher than that in the control group [(0.75±0.12) μg/L vs. (0.58±0.11) μg/L], with statistical differences (t=3.492, 3.757, and 8.178; all P<0.05). After the treatment, the levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin 1β (IL-1β) in the combined group were lower than those in the control group [(7.44±2.31) mg/L vs. (10.33±3.82) mg/L, (20.33±5.41) ng/L vs. (23.72±5.18) ng/L, and (60.45±10.27) ng/L vs. (67.44±10.25) ng/L], with statistical differences (t=5.105, 3.546, and 3.777; all P<0.05). After the treatment, the levels of 5-hydroxytryptamine (5-HT) and serum P substance (SP) and the score of Visual Analogue Scale (VAS) in the combined group were lower than those in the control group [(0.31±0.12) μmol/L vs. (0.55±0.23) μmol/L, (8.45±2.33) ng/L vs. (10.76±3.25) ng/L, and (3.13±0.26) vs. (4.77±1.27)], with statistical differences (t=7.305, 4.547, and 10.033; all P<0.05). The Wexner scores 3, 7, 14 d after the treatment in the combined group were lower than those in the control group [(10.35±2.27) vs. (12.25±3.49), (7.66±2.13) vs. (10.28±3.16), and (5.04±1.32) vs. (7.79±2.45)], with statistical differences (t=3.596, 5.415, and 7.800; all P<0.05). Conclusion　Fumigation and washing with Shengji Zhitong Fang combined with antibacterial drugs for patients with perianal abscess can promote their wound healing and anal function, and alleviate their inflammation and pain.

Effect of modified Fangji Huangqi Decoction on drainage volume and inflammation in patients after laparoscopic tension-free inguinal hernia repair

You Lixiang, Wu Xinjun, Du Shengwang, Shi Chunqiang

2023, 29(16):  2285-2288.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.015

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Objective　To explore the effect of modified Fangji Huangqi Decoction on drainage volume and inflammation in patients after laparoscopic tension-free inguinal hernia repair. Methods　A total of 102 patients after taking laparoscopic tension-free inguinal hernia repair at Lianyungang Hospital of Traditional Chinese Hospital from March 2020 to March 2021 were selected for the randomized controlled trial, and were divided into an observation group and a conventional group by the random number table method, with 51 cases in each group. In the observation group, there were 31 males and 20 females; they were (65.98±5.02) years old; their bleeding volume was (60.38±6.36) ml. In the conventional group, there were 30 males and 21 females; they were (64.38±5.48) years old; their bleeding volume was (59.38±6.10) ml. The conventional group were treated with Huangqi Jianzhong Decoction, and the observation group with modified Fangji Huangqi Decoction, for 3 d. The clinical efficacies, levels of interleukin-4 (IL-4) and C-reactive protein (CRP), drainage volumes, and drug safety were compared between the 2 groups. t and χ² tests were applied. Results　There was no statistical difference in the total effective rate between the two groups (P > 0.05). After the treatment, the levels of IL-4 and CRP and the drainage volume in the observation group were lower than those in the conventional group [(92.15±12.76) ng/L vs. (99.13±12.24) ng/L, (7.89±1.98) mg/L vs. (9.53±1.21) mg/L, and (71.36±13.58) ml vs. (89.63±15.36) ml; all P<0.05]. There was no statistical difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Modified Fangji Huangqi Decoction can reduce the drainage volume and inflammation in patients after laparoscopic tension-free inguinal hernia repair.

Efficacy and safety of bronchoalveolar lavage combined with glucocorticoids in treatment of patients with acute exacerbation of idiopathic pulmonary fibrosis 

Zhang Meng, Li Wei, Xu Jingjing

2023, 29(16):  2289-2292.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.016

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Objective　To observe the efficacy and safety of bronchoalveolar lavage (BAL) combined with glucocorticoids in the treatment of patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF). Methods　One hundred and twenty-three patients with acute exacerbation of IPF who received treatment at Zhumadian Central Hospital from January 2021 to October 2022 were selected for the randomized controlled trial. The patients were divided a control group (61 cases) and an observation group (62 cases) by lottery. There were 40 males and 21 females in the control group; they were (60.45±5.25) years old. There were 42 males and 20 females in the observation group; they were (61.25±5.36) years old. The control group took glucocorticoids, and the observation group BAL and glucocorticoids. The improvement and prognosis of pulmonary fibrosis were compared between the two groups before and after the treatment. t and χ² tests were applied. Results　Before the treatment, there were no statistical differences in the pulmonary fibrosis score (Ashcroft) and pulmonary fibrosis indicators between the two groups (all P>0.05). Three, seven, and fourteen days after the treatment, the Ashcroft scores in the observation group were lower than those in the control group [(4.45±1.22) vs. (5.33±1.25), (3.05±0.27) vs. (4.24±1.33), and (2.28±0.47) vs. (3.31±0.46); all P<0.05]. After the treatment, the levels of heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1), and hyaluronic acid (HA) in the observation group were lower than those in the control group [(45.25±10.37) ng/L vs. (51.72±10.36) ng/L, (64.48±10.45) ng/L vs. (70.44±10.28) ng/L, and (9.25±2.36) μg/L vs. (12.75±3.44) μg/L; all P<0.05]. The incidence of adverse events in the observation group was lower than that in the control group [9.68% (6/62) vs. 21.31% (13/61); P<0.05]. The incidence of treatment related complications in the observation group was slightly higher than that in the control group [8.06% (5/62) vs. 6.56% (4/61); P>0.05]. Conclusion　BAL combined with glucocorticoids in the treatment of patients with acute exacerbation of IPF is of great significance in improving their conditions and prognosis, does not significantly increase the risk of complications, and has high safety.

Treatises

Results of screening eye diseases in 0-6 years old children in north Jiangsu

Liu Yalu, Guan Lina, Li Yanlian, Wang Mei, Sun Yanmei, Cai Liming, Zou Quan

2023, 29(16):  2293-2296.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.017

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Objective　To analyze the results of screening eye diseases in 0-6 years old children in north Jiangsu. Methods　A total of 1 804 children who were screened for eye diseases at Xuzhou First People's Hospital from May 2020 to April 2022 were selected for the retrospective study. The children were divided into a guideline-based group, a non-guideline-based group, and a strabismus-amblyopia group. There were 568 cases in the guideline-based group, including 301 boys and 267 girls; their birth weight was < 2 000 g, or they were born < 32 gestational weeks. There were 1 021 cases in the non-guideline-based group, including 603 boys and 418 girls; their birth weight was ≥2 000 g, or they were born ≥ 32 gestational weeks. There were 215 cases in the strabismus-amblyopia group, including 119 boys and 96 girls; they took fundus examination because of strabismus-amblyopia. The various groups, ages, and years were compared and analyzed. χ² test was applied. Results　In the guideline-based group, 108 cases (19.01%) had 6 eye diseases; retinopathy of prematurity (ROP) developed in 81 infants (14.26%). In the non-guideline-based group, 87 cases (8.52%) had 18 eye diseases; ROP developed in 21 infants (2.06%). There statistical differences in the incidences of eye diseases and ROP between the two groups (χ²=37.325 and 33.137, both P<0.05). In the strabismus -amblyopia group, 50 cases (23.26%) had 23 eye diseases. The main ocular disorders in the 0-6 months old infants included ROP, retinal hemorrhages, familial exudative vitreoretinopathy, choroidal pigmentation, white peripheral retina without pressure, etc. The main eye diseases in the 6 months-6 years old children included congenital cataract, congenital glaucoma, persistent fetal vasculature, congenital ptosis, etc. Conclusion　Early planned grading eye disease screening system can effectively reduce the incidence of avoidable blindness and low vision in children.

Transperineal 4-dimensional ultrasound imaging in diagnosis of early postpartum stress urinary incontinence in primiparous women

Jiang Anyun, Zheng Baoqun, Chen Shaoyu, Xie Haipeng

2023, 29(16):  2297-2301.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.018

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Objective  To investigate the value of transperineal 4-dimensional ultrasound imaging in the diagnosis of early postpartum stress urinary incontinence (SUl) in primiparous women. Methods  A total of 110 primiparous women who had vaginal delivery and underwent transperineal 4-dimensional ultrasound 6-10 weeks after delivery at Jieyang People's Hospital were selected for the retrospective analysis. Among them, the 58 cases with SUI were set as a case group (SUI group) who were (29.00±3.88) years old, and the rest 50 cases without SUI as a control group (non-SUI group) who were (28.28±4.37) years old. Both groups underwent perineal 4-dimensional ultrasound examination. The structural parameters of the anal raphe were compared between the two groups at rest, retraction, and maximal Valsalva. The receiver operator characteristic curves (ROC) were drawn to assess the diagnostic efficacy of each parameter for SUI. t test and non-parametric test were used. Results  In the resting state, there were no statistical differences in the area and circumference of the anal raphe fissure, the thickness of the anal raphe at the level of the anal sphincter, and area of the anal raphe between the two groups (all P>0.05). In the contracted state, there were no statistical differences in the area and circumference of the anal raphe fissure between the two groups (both P>0.05). The thickness of the anal raphe at the level of the anal sphincter and area of the anal raphe in the case group were lower than those in the control group [7.5 (7.0, 7.9) mm vs. 8.4 8.0, 8.6) mm and (10.98±1.79) cm² vs. (11.90±2.22) cm²], with statistical differences (Z=-6.064 and t=-2.341; both P<0.05). Under the maximal Valsalva manoeuvre, there was no statistical difference in the anal raphe fissure circumference between the two groups (P>0.05); the anal raphe fissure area in the case group was bigger than that in the control group [23 (20, 28) cm² vs. 17 (15, 20) cm²], with a statistical difference (Z=-6.005, P<0.05); the thickness of the anal raphe at the level of the anal sphincter and area of the anal raphe in the case group were less than those in the control group [6.2 (5.9, 6.4) mm vs. 6.5 (6.3, 6.7) mm and (10.14±3.21) cm² vs. (12.02±2.80) cm²], with statistical differences (Z=-4.264 and t=-3.218; both P< 0.05). The sensitivities of the fissure area of the anal raphe >19.5 cm², the thickness of the anal raphe <6.0 mm, and the area of the anal raphe <8.5 cm² under the maximal Valsalva maneuver and the thickness of the anal raphe <7.5 mm, and the area of the anal raphe <12.5 cm² under the contracted state were 82.8%, 82.8%, 37.9%, 79.3%, and 79.3%, respectively; the specificities were 72.0%, 54.0%, 90.0%, 78.0%, and 46.0%, respectively; the areas under their curves (AUC) were 0.835, 0.738, 0.673, 0.839, and 0.625, respectively; the AUC for the combined analysis of the above five parameters was 0.924, with a sensitivity of 91.4% and a specificity of 80.0%. Conclusions  Transperineal 4-dimensional ultrasound has high application value in the diagnosis of early postpartum SUI in primiparous women. The combined analysis of multiple ultrasound parameters can significantly improve the diagnostic efficacy of SUI.

Clinical Research

Clinical effect of pantoprazole sodium combined with alprostadil in treatment of patients with severe acute pancreatitis

Nie Huichao

2023, 29(16):  2302-2305.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.019

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Objective　To investigate the clinical effect of pantoprazole sodium combined with alprostadil for patients with severe acute pancreatitis (SAP) and its influence on levels of amylase (AMY), alanine aminotransferase (ALT), and creatinine (Cr). Methods　Seventy-four patients with SAP diagnosed and treated in Xincai County People's Hospital from June 2019 to January 2020 were selected and divided into a control group and a study group according to the standard of randomization, with 37 patients in each group. There were 25 males and 12 females in the control group; they were (47.5±2.1) years old. There were 24 males and 13 females in the observation group; they were (47.1±2.2) years old. The control group were treated with pantoprazole sodium, and the study group with pantoprazole sodium and alprostadil. The levels of relevant indicators for restoring gastrointestinal function were compared between the two groups. The serum levels of ALT, AMY, and Cr before and after the treatment were compared between the two groups. The scores of acute physiology and chronic health evaluation (APACHE-Ⅱ) at different time points after the treatment were compared between the two groups. t and χ² were applied. Results　The clinical treatment efficacy of the study group was higher than that of the control group [81.08% (30/37) vs. 54.05% (20/37)], with a statistical difference between the two groups (P<0.05). The recovery times of relevant indicators of gastrointestinal function in the study group were shorter than those in the control group (all P<0.05). The serum levels of ALT, AMY, and Cr in the study group were significantly lower than those in the control group (all P<0.05). The APACHE-Ⅱ scores at different time points after the treatment in the study group were significantly lower than those in the control group (all P<0.05). The incidence of adverse reactions in the study group was lower than that in the control group, but with no statistical difference (P>0.05). Conclusions　The combination of pantoprazole sodium and alprostadil for patients with SAP can significantly shorten the time for them to recover gastrointestinal function, and reduce their levels of AMY, ALT, and Cr and the APACHE-Ⅱ score. The clinical effect is significant, and the adverse reaction rate is lower. Therefore, it is worth being generalized.

Serum sodium ion in evaluation of severity and prognosis in patients with acute heart failure and decreased ejection fraction

Zhu Yaming, Liu Helian

2023, 29(16):  2306-2310.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.020

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Objective　To explore the value of serum sodium ion in evaluating the severity and prognosis of patients with acute heart failure and decreased ejection fraction. Methods　From January 2020 to January 2022, 120 patients with acute heart failure and decreased ejection fraction treated in Liaocheng Third People's Hospital were selected as the study objects, including 73 males and 47 females. They were 62-81 (69.17±4.36) years old. All the patients' serum sodium level and cardiac function were detected. The serum sodium levels and left ventricular ejection fractions (LVEF) of the patients with different concentric function grades were compared. The correlations between serum sodium level and cardiac function grades and LVEF were analyzed. All the patients were followed up for six months, and were divided into a poor prognosis group and a good prognosis group; all-cause death or adverse cardiovascular events were set as the observation endpoint. The clinical characteristics of the two groups were compared. The prognostic factors were analyzed by logistic regression. Results　The levels of serum sodium in the patients with grade Ⅱ, Ⅲ, and Ⅳ cardiac function were (128.64 ± 8.34) mmol/L, (117.34 ± 10.05) mmol/L, and (104.13 ± 10.56) mmol/L, respectively, with statistical differences (all P<0.05). The LVEF of the patients with grade Ⅱ, Ⅲ, and Ⅳ cardiac function were (39.46±3.73)%,(33.19±5.58)%, and (28.69±5.21)%, respectively, with statistical differences (all P<0.05). The results of correlation analysis showed that serum sodium was negatively correlated with cardiac function grading (r=-0.644, P<0.05), and positively with LVEF (r=0.395, P<0.05). All the patients were followed up for 6 months; all-cause death or adverse cardiovascular events were set as the end point; 37 patients had poor prognosis and 83 patients had good prognosis. The results of univariate analysis showed that there were statistical differences in age, cardiac function grade, LVEF, hypertension, diabetes, sodium ion level, and diuretics between the poor prognosis group and the good prognosis group (all P<0.05). Logistic regression analysis showed that after adjusting the age, cardiac function grade, LVEF, hypertension, and diabetes, there was still a statistical difference in the serum sodium level between the two groups (OR=0.589,95%CI 0.264-0.903,P<0.05). The receiver operating characteristic curve analysis showed that sodium ion had significant predictive value for the patients' prognosis (the area under the curve=0.822, 95% CI 0.744-0.899). Conclusion　Serum sodium level can be used as an effective indicator in evaluating the severity and prognosis of patients with acute heart failure and decreased ejection fraction.

Correlation between coagulation function and intraocular pressure in patients with ocular trauma

Qiu Tingting, Li Tingjun, Dong Yanjin

2023, 29(16):  2311-2315.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.021

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Objective　To explore the correlation between coagulation function and intraocular pressure in patients with ocular trauma. Methods　Eighty-four patients with ocular trauma admitted to Department of Ophthalmic Surgery, Second People's Hospital of Jinan City from January 2020 to July 2022 were set as the study objects. There were 49 males and 35 females, with an age of (45.80±15.41) years. There were 62 cases with normal intraocular pressure and 22 cases with high intraocular pressure. The next day after admission, their fasting venous blood was collected to test their blood routine and coagulation function. The Goldman pressure flattening intraocular pressure meter was used to test their intraocular pressures. If the pressure is >21 mmHg (1 mmHg=0.133 kPa), the intraocular pressure is high. χ² test, t test, and Pearson correlation analysis were used. Results　The 84 patients' intraocular pressure was 11 to 42 mmHg, with an average of 18.76 mmHg. The prothrombin time (PT), thrombin time (TT), and plasma D-dimer (D-D) in the patients with high intraocular pressure were higher than those in the patients with normal intraocular pressure [(18.95±3.10) s vs. (15.82±2.94), (25.79±4.24) s vs. (21.68±4.05) s, and (0.65±0.12) mg/L vs. (0.42±0.09) mg/L]; the fibrinogen (Fib) in the patients with high intraocular pressure was lower than that in the patients with normal intraocular pressure [(1.92±0.55) g/L vs. (2.45±0.61) g/L]; there were statistical differences (t=4.227, 4.043, 8.975, and 3.510; all P<0.05). The intraocular pressure was positively correlated with TT, activated partial thromboplastin time (APTT), and D-D (r=0.377, 0.291, and 0.444), and negatively with Fib (r=-0.233) in the patients. Conclusions　The intraocular pressure is positively correlated with TT, activated partial thromboplastin time (APTT), and D-D, and negatively with Fib in patients with ocular trauma. Abnormal coagulation factors need to be considered when controlling intraocular pressure in patients with ocular trauma.

Case Report

One case of pancreatic duct stones diagnosed by ultrasound and literature review

Ning Xianghong, Han Bing, Li Peng, Zhang Degang, Du Gangqiang, Wang Jing, Cui Guanghe, Sun Jian

2023, 29(16):  2316-2319.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.022

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Pancreatic duct stones are often accompanied by chronic pancreatitis, and they are mutually causal. The clinical incidence is low, and multiple pancreatic duct stones are rarer. Binzhou Medical University Hospital admitted a 43-year-old male patient with multiple pancreatic duct stones in June 2020. Misdiagnosis or missed diagnosis often cause serious consequences, even induce cancer, so early detection, early diagnosis, and immediate treatment should be done as far as possible. Its diagnosis mainly depends on imaging examination. Different examination methods have their advantages and disadvantages. Ultrasound inspection is easy, economical, non-invasive, repeatable, and easy to popularize, and has real-time dynamic observation of the conditions. With the improvement of ultrasound examination technology and the accumulation of experience, it is worth for taking it as the first clinical choice as the routine method to screen multiple pancreatic duct stones, so as to provide reliable diagnostic basis for clinical treatment as soon as possible.

One case of epileptiform seizures caused by cefmetazole sodium for injection 

Zhang Na, Gao Yue

2023, 29(16):  2319-2321.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.023

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Cefmetazole is a semi-synthetic antibiotic of cephalosporins, and is widely used in clinical practice. Its common adverse reactions mainly include glutamic oxaloacetic transaminase and glutamic-pyruvic transaminase elevation, rash, nausea, vomiting, allergic reaction, etc. This paper reports a patient with epileptic seizures during intravenous infusion of cefmetazole sodium at Songjiang District Central Hospital. According to the evaluation method of adverse drug reactions, the epileptic seizures in the patient might be caused by the use of cefmetazole sodium. Through the report of this case, we hope that the clinical staff pay attention to epileptic seizures possibly caused by cefmetazole and hope to provide clinical references.

One case of severe neonatal hemolysis caused by anti-Dib incompatibility

Su Heng

2023, 29(16):  2322-2324.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.024

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A report on the diagnosis and treatment process of a patient with severe neonatal hemolytic disease (HDN) caused by anti-Dib incompatibility was made. The full-term male neonate developed severe yellow staining 4 hours after birth; its local serum total bilirubin level was 239.2 mmol/L; its hemoglobin (Hb) level was 102 g/L; its blood type was A,with Rh (D) (+). The neonate was referred to NICU, Guangzhou Women and Children's Medical Center in September 2019; the results of direct anti-human globulin test, serum free antibody test, and red cell release antibody test were positive; blood group monospecific antibody anti-Dib was detected in the maternal serum sample, so it was diagnosed as HDN caused by anti-Dib. The neonate was treated by immunoglobulin blocking antibody therapy and blue light therapy; during partial transfusion, the Dib- red blood cells was used to correct its anemia; it was cured and discharged 15 days after birth. It was followed up until it was 1 year old, and its growth and development are similar to healthy children of the same age.

One case of extraosseous chondroma in parapharyngeal space

Zhao Weixia, Yu Zhiliang

2023, 29(16):  2325-2327.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.025

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Extraosseous chondroma, also known as soft tissue chondroma, is a relatively rare benign cartilage tumor originating from extraosseous soft tissue, mostly occurring in hands and feet. Cases have also been reported in abdominal wall, lung, esophagus, liver, skin, and other sites. Extraosseous chondroma originating in parapharyngeal space is very rare. In May 2021, a patient with extraosseous chondroma in the parapharyngeal space was admitted to Department of Otolaryngology, Weihai Central Hospital Affiliated to Qingdao University. The clinical characteristics, diagnosis, treatment, and prognosis are summarized as below.

Nursing Research

Application of mobile health intervention based on COX's Interaction Model of Client Health Behaviors in patients taking hemodialysis

Wu Xiaoqiong, Lyu Wei, Yi Yaqi, Wu Biyi

2023, 29(16):  2328-2332.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.026

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Objective　To explore the impact of mobile health intervention based on COX's Interaction Model of Client Health Behaviors (IMCHB) on the health literacy and self-management behaviors of patients taking hemodialysis. Methods　One hundred and fourteen patients with end-stage renal disease who were treated by maintenance hemodialysis in Blood Purification Center, Huizhou Central People's Hospital from July 2021 to June 2022 were selected for the prospective study. They were divided into a control group and an observation group by the random number table method, with 57 cases in each group. In the control group, there were 31 males and 26 females; they were (49.70±8.58) years old. In the observation group, there were 33 males and 24 females; they were (50.98±7.46) years old. The control group took routine nursing, and the observation group mobile health intervention based on IMCHB. The health literacy levels, self-management behaviors, and quality of life (KDQ) of the two groups were compared. t, χ² and Z tests were applied. Results　After the intervention, the total score and the scores of functional health literacy, interactive health literacy, and critical health literacy of the health literacy questionnaire in the observation group were higher than those in the control group [(22.47±1.38) vs. (18.25±2.21), (7.68±0.95) vs. (6.47±1.42), (6.14±0.69) vs. (4.63±1.05), and (8.65±0.94) vs. (7.14±1.53)], with statistical differences (t=12.242, 5.365, 9.080, and 6.356; all P<0.05). After the intervention, the total score and the scores of self-care activities, problem solving, emotional processing, and partnership of the self-management behavior scale in the observation group were higher than those in the control group [(68.79±3.86) vs. (60.49±5.35), (23.77±2.96) vs. (21.63±3.37), (17.49±1.59) vs. (15.11±2.19), (13.68±1.36) vs. (11.46±2.09), and (13.68±1.26) vs. (12.30±1.95)], with statistical differences (t=9.503, 3.605, 6.644, 6.744, and 5.007; all P<0.05). After the intervention, the score of KDQ in the observation group was higher than that in the control group [(135.96±17.48) vs. (124.09±19.30)], with a statistical difference (t=3.444, P<0.05). Conclusion　Mobile health intervention based on IMCHB for patients taking hemodialysis can improve their level of health literacy, self-management behaviors, and quality of life.

Effect of vascular access group nursing on mood disorders in patients taking hemodialysis

Shi Kuanfan, Wen Yongshuang, Wei Yaqiong

2023, 29(16):  2333-2337.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.027

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Objective　To explore the influence of vascular access group nursing on mood disorders in patients taking hemodialysis. Methods　Sixty outpatients taking hemodialysis at Lianyungang Traditional Chinese Medicine Hospital from September 2021 to September 2022  were selected as the study objects. They were divided into a control group and an observation group by the random number grouping method, with 30 cases of each groups. There were 19 females and 11 females in the control group; they were 31-65 (50.16±4.87) years old. There were 18 males and 12 females in the observation group; they were 30-67 (50.49±4.28) years old. The control group took routine nursing, and the observation group vascular access group nursing. The scores of Self-Perceived Burden (SPB), Medical Coping Method Questionnaire (MCMQ), and Self-Management Behavior Scale were compared between these two groups. t test was applied. Results　After the intervention, the score of SPB in the observation group was lower than that in the control group [(17.49±3.20) vs. (19.64±3.73)], with a statistical difference (t=2.396, P<0.05). After the intervention, the score of facing of MCMQ in the observation group was higher than that in the control group [(18.20±3.30) vs. (16.04±3.10)], and the scores of avoiding and surrender of MCMQ were lower than those in the control group [(13.67±2.12) vs. (14.79±2.20) and (6.10±1.02) vs. (6.94±1.09)], with statistical differences (t=2.613, 2.008, and 3.082; all P<0.05). After the intervention, the scores of partnership, self-care, problem solving, and emotional coping of self-management behaviors in the observation group were higher than those in the control group [(14.31±0.55) vs. (13.94±0.77), (17.71±0.45) vs. (17.25±0.60), (19.31±4.34) vs. (16.67±3.97), and (10.23±0.88) vs. (9.56±0.73)], with statistical differences (t=2.142, 3.359, 2.458, and 3.209; all P<0.05). Conclusion　Vascular access group nursing for outpatients undergoing hemodialysis can improve their self-management burden and coping style, self-management behaviors, and prognosis and reduce their psychological barriers when facing diseases, so it is worth being learnt from and adopted by various departments.

Application of health management based on mobile medical APP in community rehabilitation of elderly patients with hip fractures

Song Yuanzheng, Shen Bing, Song Min, Liu Zhi, Zhang Yudong

2023, 29(16):  2337-2343.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.028

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Objective　To investigate whether a telemedicine solution (using an APP on a pad or a smartphone) can help elderly patients with hip fractures taking functional recovery at home after hospital discharge and meet the needs of individual learning and self-care. Methods　A prospective study was conducted on 100 patients with intertrochanteric fracture of femur who received traumatic orthopedic treatment in Tengzhou Central People's Hospital from January to December 2021. According to the random number method, the patients were divided into an observation group and a control group, with 50 cases in each group. There were 13 males and 37 females in the observation group; they are (82.00±10.68) years old. There were 19 males and 31 females in the control group; they were (81.24±8.29) years old. The observation group used the mobile medical APP for health management after discharge. The control group were treated with oral and written follow-up rehabilitation exercise programs only at the time of discharge, and took outpatient or telephone follow-up 1, 2, and 3 months after discharge. The baseline data of the two groups were compared. The functional rehabilitation indicators of the two groups were analyzed 1, 2, and 3 months after the surgery. t test, repeated measure analysis of variance, χ² test, or Freeman-Halton test were applied. Results　All the patients in both groups were followed up; no one missed the follow up or died. One, two, and three months after the surgery, the scores of Function Independent Measure (FIM) and Short Physical Performance Battery (SPPB) in the observation group were lower than those in the control group [(63.38±3.78) vs. (56.50±4.47), (76.44±3.41) vs. (65.72±4.13), (98.68±8.89) vs. (89.20±8.22), (4.32±0.59) vs. (2.84±0.62), (7.10±0.58) vs. (4.90±0.51), and (9.38±0.70) vs. (7.40±0.67)]; the scores of FIM and SPPB of the two groups gradually improved with time; there were statistical differences (F_{between groups}=135.585 and 484.430; F_time=904.260 and 2 011.030; all P<0.05). One, two, and three months after the surgery, the TUG test times and scores of Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Scale (VAS) in the observation group were lower than those in the control group [(66.70±5.41) s vs. (97.84±3.99) s, (39.92±4.24) s vs. (63.24±6.28) s, (12.58±3.05) s vs. (23.78±4.23) s, (8.18±0.87) vs. (10.70±1.43), (4.66±0.82) vs. (7.70±0.99), (1.24±0.87) vs. (4.74±0.78), (3.44±0.54) vs. (4.48±0.50), (1.42±0.50) vs. (2.54±0.50), and (1.40±0.49) vs. (1.56±0.73)]; the TUG test times and scores of HADS and VAS of the two groups gradually decreased with time; there were statistical differences (F_{between groups}=1 599.893, 503.140, and 177.898; F_time=4 836.303, 1 060.010, and 943.972; all P<0.05). The interaction effect of time and group on TUG test and scores of SPPB and HADS were statistically significant (F_interaction=118.780, 11.830, and 6.060; all P<0.05). Conclusions　Tele-rehabilitation intervention based on mobile medical APP application provides a new feasible and effective home rehabilitation option for elderly patients with hip fractures, and greatly improves the effect of community rehabilitation after discharge, so it is worthy of clinical application.

Application of individualized rehabilitation exercise guided by motor function evaluation in patients with femoral neck fractures

Wang Xiaoyan, Hu Bo

2023, 29(16):  2343-2347.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.029

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Objective　To observe the effect of individualized rehabilitation exercise guided by motor function evaluation on postoperative functional rehabilitation of patients with femoral neck fractures. Methods　This was a prospective study. One hundred and twenty-three patients with femoral neck fractures treated at First Hospital, Nanyang Medical College from June 2019 to January 2022 were selected as the research objects. The patients were divided into an observation group (62 cases) and a control group (61 cases) by lottery. There were 31 men and 30 women in the control group; they were (52.33±0.15) years old. There were 32 men and 30 women in the observation group; they were (52.47 ± 0.11) years old. The control group implemented routine rehabilitation management, and the observation group did individualized rehabilitation exercise under the guidance of motor function evaluation based on Fugl-Meyer Motor Function Scale (FMA). The hip joint activities of the two groups before and after the intervention were compared. The patients were followed up for 8 months after the intervention. The scores of Harris Hip Joint Scoring (Harris) and Visual Analogue Scale (VAS) at 1, 4, and 8 months of the intervention were compared between the two groups. The adverse events of the two groups during the follow-up period were compared. χ² and t test were applied. Results　After the intervention, the ranges of extending, bending, and inward rotation of their hip joints in the observation group were bigger than those in the control group [(33.72±0.85)° vs. (33.41±0.22)°, (133.66±0.83)° vs. (133.35±0.27)°, (30.55±0.81)° vs. (30.21±0.16)°], with statistical differences (t=2.759, 2.776, and 3.217; all P<0.05). During the follow up, the Harris scores at 1, 4, and 8 months of the intervention in the observation group were higher than those in the control group [(68.77±0.82) vs. (68.42±0.16), (72.65±0.83) vs. (72.33±0.21), and (85.59±0.82) vs. (85.25±0.27)], with statistical differences (t=3.273, 2.920, and 3.078; all P<0.05). The scores of VAS at 1, 4, and 8 months of the intervention in the observation group were lower than those in the control group [(4.11±0.25) vs. (4.42±0.83), (3.36±0.25) vs. (3.68±0.85), and (2.77±0.21) vs. (3.04±0.88)], with statistical differences (t=2.814, 2.842, and 2.349; P<0.05). During the follow up, the incidence of adverse events in the observation group was lower than that in the control group [4.84% (3/62) vs. 16.39% (10/61)], with a statistical difference (χ²=7.030, P<0.05). Conclusion　The implementation of individualized rehabilitation exercise based on the comprehensive evaluation of the lower limb motor function by FMA in patients with femoral neck fractures can significantly improve their recovery of hip joint range of motion and joint function, alleviate their hip joint pain, and reduce the risk of adverse events.

Effect of PDCA care on reducing PICC-associated infection in elderly tumor patients

Liang Mulan, Wuyun Tana

2023, 29(16):  2348-2352.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.030

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Objective　To analyze the effect of PDCA care on reducing peripherally inserted central catheter (PICC)-associated infection in elderly tumor patients. Methods　This was a prospective study. One hundred and ten elderly tumor patients treated at Inner Mongolia People's Hospital from October 2020 to October 2021 were selected as the study objects. They were divided into a control group and a study group by the double chromosphere method, with 55 cases in each group. There were 15 males and 40 females in the control group; they were 65-85 (75.36±1.25) years old. There were 13 males and 42 females in the study group; they were 65-84 (75.23±1.14) years old. The control group took routine care, and the study group PDCA care. The subjective feelings and emotions, the retention times and placement of PICC, the incidences of complications of PICC catheterization, and the nursing compliance were compared between the 2 groups. χ² and t teste were applied. Results　After the intervention, the scores of depression, anxiety, and stress in the study group were lower than those in the control group [(2.03±0.45) vs. (2.31±0.52), (2.04±0.36) vs. (2.23±0.23), and (1.85±0.41) vs. (2.05±0.35)], with statistical differences (t=3.020, 3.298, and 2.751; all P<0.05). The retention time of PICC, catheter blockage times, and catheter shedding times in the study group were better than those in the control group [(25.34±4.26) d vs. (22.52±4.25) d, (4.75±1.12) times vs. (5.52±1.24) times, and (3.85±1.24) times vs. (4.63±1.52) times], with statistical differences (t=3.475, 3.418, 2.949; all P<0.05). The incidence of PICC-related infection, mechanical phlebitis, puncture point bleeding, and thrombotic complication in the study group was lower than that in the control group [3.64% (2/55) vs. 14.55% (8/55)], with a statistical difference (χ²=3.960, P<0.05). The nursing compliance in the study group was higher than that in the control group [98.18% (54/55) vs. 87.27% (48/55)], with a statistical difference (χ²=4.853, P<0.05). Conclusion　PDCA care for elderly tumor patients taking PICC can effectively improve their subjective feelings and compliance, and reduce the adverse reactions, catheterization retention time, and incidence of complications during the catheterization period.

Application of health guidance based on IMB and free body position in delivery

Miao Xile, Hu Jing, Zhang Jun

2023, 29(16):  2353-2358.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.031

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Objective　To explore the effect applying health guidance based on information-motivation-behavior skill model (IMB) combined with free body position in parturients' delivery. Methods　A total of 98 parturients who gave birth in Zhumadian Central Hospital from July 2020 to July 2022 were selected for the prospective study. They were divided into a control group and an observation group by the random number table method, with 49 cases in each group. There were 34 primiparas and 15 multiparas in the control group; they were 25-37 (29.95±2.09) years old. There were 35 primiparas and 14 multiparas in the observation group; they were 25-37 (29.98±2.11) years old. The observation group took routine nursing, and the observation group health guidance based on IMB and free posture delivery. Both groups received continuous nursing until the end of delivery. The mastery degrees of health knowledge, psychological states, self-efficacies, labor process times, delivery modes, occurrence rates of adverse maternal and infant outcomes, and maternal satisfactions of the two groups were evaluated. χ² and t tests were applied. Results　After the nursing, the scores of the mastery of physical changes during pregnancy, natural delivery advantages, cesarean section indications, and important factors affecting the labor process in the observation group were higher than those in the control group [(86.98±3.55) vs. (81.15±3.46), (85.95±3.79) vs. (82.26±3.67), (83.94±4.17) vs. (80.08±4.11), and (83.36±4.14) vs. (80.67±4.02)], with statistical differences (t=8.232, 4.896, 4.615, and 3.263; all P<0.05). The scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) after the nursing in the observation group were lower than those in the control group [(10.22±1.67) vs. (15.53±1.89) and (11.79±2.04) vs. (16.63±2.08)], with statistical differences (t=14.738 and 11.629; both P<0.05). The total score of delivery self-efficacy scale (CBSEI-C32) after the nursing in the observation group was higher than that in the control group [(228.87±6.56) vs. (196.69±6.05)], with a statistical difference (t=25.242, P<0.05). The total stage of labor in the observation group was shorter than that in the control group [(422.95±20.27) min vs. (500.57±25.54) min], with a statistical difference (t=16.664, P<0.05). The conversion cesarean section rate and vaginal delivery rate in the observation group were lower than those in the control group [6.12%(3/49) vs. 20.41%(10/49) and 4.08%(2/49) vs. 18.37%(9/49)], with statistical differences (χ²=4.346 and 5.018; both P<0.05). The incidence of adverse maternal and infant outcomes in the observation group was lower than that in the control group [4.08%(2/49) vs. 20.41%(10/49)], with a statistical difference (χ²=6.078, P<0.05). The satisfaction rate of the observation group was higher than that of the control group [95.92%(47/49) vs. 83.67%(41/49)], with a statistical difference (χ²=4.009, P<0.05). Conclusion　Health guidance based on IMB combined with free body position in parturients' delivery can improve their mastery of health knowledge, unhealthy psychological state, and self-efficacy, help delivery smoothly, shorten their labor process time, and decrease the conversion cesarean section rate and incidence of adverse maternal and infant outcomes, with high satisfaction.

Rehabilitation forward mode nursing for patients with chronic suppurative otitis media

Tang Lijun, Chen Jinhui, Tang Chanjuan, Xiao Huan

2023, 29(16):  2358-2363.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.032

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Objective　To explore the effect of rehabilitation forward mode nursing for patients with chronic suppurative otitis media. Methods　This study adopted a quasi-experimental research method. One hundred and forty-six patients with chronic suppurative otitis media who received surgical treatment in Department of Otolaryngology, Hunan Provincial People's Hospital from May 2018 to June 2021 were conveniently selected. According to the sequence of admission, the patients were grouped. The 74 patients admitted from May 2018 to December 2019 were set as a control group, including 28 males and 46 females who were (42.26±10.34) year old. The rest 72 patients admitted from January 2020 to June 2021 were set as an observation group, including 31 males and 41 females who were (37.01±12.17) years old. The control group took the conventional nursing; the observation group took rehabilitation forward mode nursing, including psychological rehabilitation forward nursing, exercise rehabilitation training forward, postoperative pain nursing guidance forward, and postoperative complication nursing guidance forward. The postoperative anxiety, pain symptoms, self-efficacies, total hospital stays, and incidences of postoperative complications were compared between the two groups. χ² and t tests were applied. Results　After the intervention, the postoperative anxiety score and the pain scores 6, 24, and 48 h after the operation in the observation group were lower than those in the control group [(43.93±3.95) vs. (48.03±2.54),(4.49±1.04) vs. (5.15±1.09), (3.60±0.97) vs. (4.69±0.98), and (1.88±0.86) vs. (2.82±0.98)], with statistical differences (t=7.436,3.758, 6.759, and 6.215; all P<0.05). After the intervention, the score of self-efficacy in the observation group was higher than that in the control group [(27.39±2.27) vs. (25.86±2.38)], with a statistical difference (t=-3.956, P<0.05). The total hospital stay in the observation group was shorter than that in the control group[(5.83±2.91) d vs. (7.86±2.72) d], with a statistical difference (t=4.360, P<0.05). There was a statistical difference in the incidence of complications between the two groups (χ²=4.622, P<0.05). Conclusion　Rehabilitation forward mode nursing for patients with chronic suppurative otitis media can effectively relieve their postoperative pain and anxiety, improve their self-efficacy, shorten their hospital stay, and reduce the occurrence of postoperative complications, so it is worthy of clinical promotion.

Traditional Chinese Medicine

Current knowledge and attitudes and influencing factors of patients about prevention of diseases in grass-root institutes of traditional Chinese medicine

Chen Jinyun, Mo Yingyin, Liu Ailing, Gao Jing, Zheng Shaomin, Li Jiani

2023, 29(16):  2364-2368.  DOI: 10.3760/cma.j.issn.1007-1245.2023.16.033

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