Table of Content

01 September 2023, Volume 29 Issue 17

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New Medical Advances

Research progress on the roles of aqueous humor inflammatory factors in the pathogenesis of diabetic macular edema

Niu Huan, Cong Chenyang

2023, 29(17):  2369-2372.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.001

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Diabetic retinopathy (DR) is an important cause of vision loss in diabetic patients. Globally, 6.8% of diabetics aged 20 to 79 years develop diabetic macular edema (DME). Studies have found that DME is mediated by inflammatory factors and vascular endothelial growth factor (VEGF), and the effects of the two are correlated. Inflammation plays an important role in the pathogenesis of DME, involving a variety of chemokines and cytokines. The levels of inflammatory factors in aqueous humor are closely related to the severity of DME. This article reviews the roles of inflammatory factors in aqueous humor in the pathogenesis of DME.

Research progress and clinical application of intestinal bacteriophage and human health

Luo Meijuan, Zhang Youxiang, Ou Qiaoqun, Wang Lina

2023, 29(17):  2373-2377.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.002

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Intestinal microorganisms, known as "invisible organs" of human beings, play an important role in maintaining the health of the body, covering bacteria, viruses, fungi, and other components, among which bacteriophage is the main member of enterovirus group. With the application of metagenomics and the increase of bacterial resistance in recent years, the impact of intestinal bacteriophage on human health and the clinical application of bacteriophage therapy have become an important research direction worldwide. In this paper, the research status of intestinal bacteriophage is summarized, and the impact of bacteriophage on human health and clinical application are reviewed.

Research progress of m⁶A demethylase in leukemia

Zhou Xinyu, Zhang Ting, Jia Xiuhong

2023, 29(17):  2378-2380.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.003

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Methylation of m6-methyladenosine purines is the most common method of RNA chemical modification, and demethylase can demethylate bases that have undergone m6A methylation modification to affect the stability of cellular mRNA. Demethylase is abnormally highly expressed in leukemia and has carcinogenic effects by modulating the stability of downstream target gene transcripts. Therefore, molecular inhibitors targeting demethylase could be developed to treat leukemia, which provides a new direction for the treatment of leukemia.

Hirschsprung's Disease

Identification of a novel heterozygous mutation in EDNRB in a Chinese family with Hirschsprung's disease: a case report and literature review

Ding Huiyang, Lei Wen, Xu Lu, Xiao Shangjie, Zhou Jialiang, Yuan Like, Huang Rong, Zhang Liang, Zhu Xiaochun

2023, 29(17):  2381-2386.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.004

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Objective　Hirschsprung's disease (HSCR) caused by mutations in the endothelin receptor B (EDNRB) gene has been found in many familial cases. This report of familial HSCR was aimed to clarify the relationship between genetic mutations and clinical phenotype by whole exome sequencing (WES). Methods　In April 2021, Guangdong Women and Children Hospital admitted a newborn with HSCR whose mother had a history of megacolon. Peripheral blood samples of the newborn's parents and maternal grandmother were collected, and WES was performed to analyze the genetic genes. The relevant literatures on HSCR and EDNRB gene mutations published on Wanfang, VIP, CNKI, PubMed, and Medline databases till October 2022 were searched and analyzed. Results　WES revealed a heterozygous mutation in EDNRB, c.367delinsTT(p.L123Fter32), in a newborn index case, proband's parents and grandmother. Two carriers with this mutation had clinical symptoms, other two carriers stayed healthy. Based on literature review, 15 related articles containing 25 plausible mutations had been documented. Conclusions　We identified a novel EDNRB mutation, c.367delinsTT(p.L123FTer32), which resulted in a premature stop codon at amino acid position 155 and produced a protein whose functional domains were completely missing. This mutation might be potentially pathogenic for HSCR.

Clinical significance of Neuroligin2 and GAP-43 changes in Hirschsprung's disease complicated with enterocolitis 

Shi Yucheng, Zhang Xuying, Qin Daofeng, Wang Xianghua

2023, 29(17):  2386-2389.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.005

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Objective　To investigate the relationship between Neuroligin2 and growth-associated protein 43 (GAP-43) and Hirschsprung associated enterocolitis (HAEC) after surgery in children with Hirschsprung's disease and their combined predictive value. Methods　Seventy-nine children with Hirschsprung's disease who underwent megacolonectomy in Zhoukou Central Hospital from July 2020 to July 2022 were selected as the study group, and 79 children who underwent health checkups in Zhoukou Central Hospital from July 2020 to July 2022 were selected as the control group. Seventy-nine children with Hirschsprung's disease were followed up for 6 months after operation, and according to whether they were complicated with HAEC during the postoperative follow-up, they were divided into a HAEC group (23 cases) and a non-HAEC group (56 cases). There were 43 males and 36 females in the study group, aged (8.92±0.84) months. There were 45 males and 34 females in the control group, aged (8.84±0.88) months. The relative expression levels of serum Neuroligin2 and GAP-43 were detected after admission, and their correlations with the complication of HACE and their predictive values for postoperative HAEC in children with Hirschsprung's disease were analyzed. χ² test was used for the count data, independent sample t test was used for the measurement data, Spearman correlation analysis was performed, logistic regression equation was used to analyze the related influencing factors, and receiver operating characteristic curve (ROC) was used for predictive value analysis. Results　The relative expression levels of serum Neuroligin2 and GAP-43 in the study group [(0.35±0.03) and (1.52±0.31)] were lower than those in the control group [(0.79±0.07) and (2.47±0.39)], with statistically significant differences (t=51.351 and 16.949, both P<0.001). The relative expression levels of serum Neuroligin2 and GAP-43 in the HAEC group [(0.12±0.03) and (0.74±0.06)] were lower than those in the non-HAEC group [(0.44±0.05) and (1.84±0.12)], with statistically significant differences (t=28.587 and 41.756, both P<0.001). The relative expression levels of Neuroligin2 and GAP-43 in serum were negatively correlated with concurrent HACE (both P<0.05). Serum Neuroligin2 relative expression level (>0.35) and GAP-43 relative expression level (>1.52) were protective factors for postoperative HAEC in children with Hirschsprung's disease (both P<0.05). The area under the curve (AUC) of the combination of serum Neuroligin2 and GAP-43 in predicting HAEC in children with Hirschsprung's disease was 0.802, with the best predictive sensitivity and specificity of 86.96% and 73.21%, respectively. Conclusion　The relative expression levels of serum Neuroligin2 and GAP-43 in children with Hirschsprung's disease can be used in the assessment and prediction of postoperative HAEC, providing a reference basis for early and targeted clinical intervention to improve the prognosis.

Respiratory Disease

Significance of peripheral blood miR-126 in the progression of respiratory syncytial virus infected bronchiolitis to bronchial asthma 

Wang Jun, Zhang Guangchao, Chen Dan, Sun Xiaomin

2023, 29(17):  2390-2393.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.006

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Objective　To investigate the significance of peripheral blood miR-126 in the progression of respiratory syncytial virus (RSV)-infected bronchiolitis to bronchial asthma. Methods　A total of 126 children with RSV-infected bronchiolitis admitted to Children's Hospital Affiliated to Zhengzhou University from June 2018 to June 2019 were collected, including 77 males and 49 females. The relative expression level of miR-126 was detected by RT-PCR. According to the results of 2-year follow-up, they were divided into a non-asthmatic group (94 cases) and an asthmatic group (32 cases). The receiver operating characteristic curve (ROC) was used to analyze the prognostic value of miR-126 in the progression of RSV-infected bronchiolitis to bronchial asthma, and logistic regression analysis was used to analyze whether miR-126 was an influencing factor in the progression of RSV-infected bronchiolitis to bronchial asthma. χ² test and independent sample t test were used. Results　The expression level of miR-126 in peripheral blood of the asthmatic group was significantly higher than that of the non-asthmatic group [(8.43±5.14) vs. (5.03±3.88)] (P<0.001). ROC analysis showed that the area under the curve of miR-126 was 0.691, the sensitivity was 88.30%, and the specificity was 59.38% in predicting the progression of RSV-infected bronchiolitis to bronchial asthma. miR-126 was an independent risk factor of the progression of RSV-infected bronchiolitis to bronchial asthma [OR=9.878 (3.752-26.007), P<0.001]. Conclusion　miR-126 in peripheral blood has a certain predictive value for the progression of children with RSV-infected bronchiolitis to bronchial asthma.

Application value of medical and nursing integrated management and refined airway management in patients with respiratory tract infection

Zhang Wenfeng, Wu Guimin

2023, 29(17):  2393-2397.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.007

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Objective　To explore the application value of medical and nursing integrated management and refined airway management in patients with respiratory tract infection. Methods　A total of 62 patients with respiratory tract infection admitted to Shangqiu Central Hospital from January 2020 to January 2022 were selected as the study objects, and were randomly divided into a combined group (31 cases) and a conventional group (31 cases). In the combined group, there were 20 males and 11 females, aged (69.36±8.36) years. In the conventional group, there were 21 males and 10 females, aged (70.36±9.25) years. The conventional group received refined airway management, and the combined group received medical and nursing integrated management based on the conventional group. The self-management abilities [Rating Scale of Health Self-management Skill for Adults (AHSMSRS)], blood gas indexes [oxygenation index (PaO₂/FiO₂)], and training compliance of the two groups were compared. t test, χ² test, and rank sum test were used. Results　After management, the AHSMSRS scores in both groups were higher than those before management (both P<0.05), and that in the combined group was higher than that in the conventional group [(118.71±14.51) points vs. (103.26±12.04) points], with a statistically significant difference (t=5.051, P<0.001). After management, the PaO₂/FiO₂ values in both groups were higher than those before management (both P<0.05), and that in the combined group was higher than that in the conventional group [(436.25±20.32) mmHg vs. (403.20±15.68) mmHg (1 mmHg = 0.133 kPa)], with a statistically significant difference (t=7.169, P<0.05). The management compliance rate of the combined group was higher than that of the conventional group [93.55% (29/31) vs. 70.97% (22/31)] (χ²=5.415, P<0.05). After management, the serum levels of interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) were decreased in both groups, and were lower in the combined group (all P<0.05). Conclusion　The application of medical and nursing integrated management in patients with respiratory tract infection can improve the ability of self-management, further improve their blood gas index, and improve the compliance, which is worthy of popularization and application.

Correlations between FTO expression and airway inflammation and prognosis in patients with severe asthma

Zhang Xinling, Gan Wenyun

2023, 29(17):  2398-2401.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.008

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Objective　To analyze the correlations between fat mass and obesity-associated gene (FTO) expression and airway inflammation and prognosis in patients with severe asthma. Methods　In this study, 124 patients with severe asthma from Zhumadian Central Hospital from January 2021 to October 2022 were selected as research objects. According to the results of FTO detection, 62 patients with FTO relative expression >1.0 were classified as an overexpression group, and 62 patients with FTO relative expression ≤1.0 were classified as a low expression group. In the low expression group, the ratio of male to female was 40/22, and the age was (55.23±5.16) years old. In the overexpression group, the ratio of male to female was 42/20, and the age was (56.15±5.23) years old. The levels of airway inflammatory factors and prognostic scores were compared between the two groups, and the correlations between FTO expression and airway inflammation and prognosis in patients with severe asthma were verified by Spearman correlation analysis. χ² test and independent sample t test were used. Results　The level of tumor necrosis factor-α (TNF-α) in the low expression group was higher than that in the overexpression group [(30.45±8.76) ng/L vs. (23.39±5.47) ng/L], the level of interleukin (IL)-6 was higher than that in the overexpression group [(31.44±8.77) ng/L vs. (25.15±5.35) ng/L], and the level of IL-1β was higher than that in the overexpression group [(28.77±8.42) ng/L vs. (22.36±5.18) ng/L], with statistically significant differences (all P<0.05). After evaluation, the score of Asthma Control Questionnaire (ACQ) in the low expression group was higher than that in the overexpression group [(2.63±0.26) vs. (1.21±0.47)], and the score of Asthma Control Test (ACT) was lower than that in the overexpression group [(19.44±5.37) vs. (22.72±5.46)], with statistically significant differences (both P<0.05). According to Spearman correlation analysis, the expression level of FTO in patients with severe asthma was negatively correlated with airway inflammation indexes such as TNF-α, IL-6, and IL-1β and ACQ score, and positively correlated with ACT score (all P<0.05). Conclusion　The expression level of FTO in patients with severe asthma is closely related to airway inflammation and prognosis.

Scientific Research

Subspecialty differentiation practices and considerations in hyperbaric oxygen medicine

Zan Xingchun, Xu Jixiang, Qi Yinliang, Zhou Xiaomei

2023, 29(17):  2402-2406.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.009

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Guidelines for Medical Service Capacity of Tertiary General Hospitals (2022 edition) (Draft for comments) issued by the National Health Commission requires the addition of hyperbaric oxygen medicine. The history of hyperbaric oxygen medicine is reviewed and the development status of hyperbaric oxygen medicine is analyzed in this paper. Hyperbaric oxygen medicine can treat a wide range of diseases. The medical industry has a stable and urgent demand for hyperbaric oxygen. At the same time, it has several subspecialties that can be classified. The subspecialties of hyperbaric oxygen, such as coma awakening promotion, severe neurological diseases, and hyperbaric oxygen therapy for internal and surgical diseases, have also been recognized by the academic community. It is very important for the development of related subspecialties to pay attention to hyperbaric oxygen disease spectrum. In this paper, the differentiation of hyperbaric oxygen subspecialties combined with the problems existing in the practice mode of hyperbaric oxygen medicine in our hospital are sorted out and summarized, and the necessity of the differentiation of hyperbaric oxygen subspecialties is expounded, in order to provide certain enlightenment and ideas for the adjustment of the direction of subspecialty in the future.

Study on quality standard of carbonized Scutellariae Radix

Chen Zhi

2023, 29(17):  2407-2413.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.010

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Objective　To establish the quality standard of carbonized Scutellariae Radix and provide reference for its quality control. Methods　The samples of carbonized Scutellariae Radix were selected for character observation and thin layer chromatography (TLC) identification. The water content, total ashcontent, and alcohol-soluble extract were determined according to the general rules of Chinese Pharmacopoeia (2020 Edition). The content of baicalin in the samples was detected by high performance liquid chromatography (HPLC), and the specific chromatogram was established. Results　Carbonized Scutellariae Radix was round or irregularly shaped segment or piece, one side black brown, inside yellow brown, crisp quality. It had a burnt smell and a bitter taste. In the TLC diagram of test samples, fluorescence spots of the same color were shown on corresponding positions of the chromatographs of the control products (baicalein and wogonin). In 10 batches of carbonized Scutellariae Radix, the water content, total ashcontent, and alcohol-soluble extracts were 2.60%-7.36%, 5.03%-8.92%, and 23.08%-48.92%, respectively, with the average values of 5.20%, 6.39%, and 32.84%, respectively. The content of baicalin ranged from 1.61% to 4.33%, with an average of 2.67%. Conclusions　In this study, the water content, total ashcontent, alcohol-soluble extract, and specific chromatogram of carbonized Scutellariae Radix were added to the existing quality standards. The minimum limits of water content, total ashcontent, and alcohol-soluble extract in carbonized Scutellariae Radix were determined. Three characteristic peaks should be detected, which were consistent with the retention time of reference peaks of baicalin, baicalein, and wogonin, respectively. The established quality standard could provide reference for the quality control of carbonized Scutellariae Radix.

Correlations between malnutrition and regulatory T cell imbalance and prognosis in elderly patients with community-acquired pneumonia

Liu Lu, Shen Xiaozhu, Miao Lei, Liao Jingxian

2023, 29(17):  2413-2419.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.011

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Objective　To investigate the risk factors for death in elderly patients with community-acquired pneumonia, and to analyze the predictive value of ratio of regulatory T cells /T lymphocytes for their prognosis. Methods　A total of 115 patients over 90 years old who were diagnosed with community-acquired pneumonia and hospitalized in Department of Geriatrics, The Second People's Hospital of Lianyungang from January 2020 to August 2022 were selected, including 67 males and 48 females. According to the score of Mini Nutritional Assessment - Short Form (MNA-SF), they were divided into a malnutrition group (MNA-SF score ≤7 points) and a non-malnutrition group (MNA-SF score ≥8 points). Regulatory T cells, total T lymphocytes, and cytokines [interleukin (IL)-6 and IL-8] were detected within 24 hours after admission. After 28 days of follow-up, the patients were divided into a survival group and a death group according to different clinical outcomes. The risk factors for death and the predictive value of ratio of regulatory T cells /T lymphocytes for prognosis were explored. Independent sample t test, Kruskal-Wallis method, χ² test, Spearman rank correlation analysis, logistic regression analysis, receiver operating characteristic curve, and Kaplan-Meier survival analysis were used. Results　In the elderly patients with community-acquired pneumonia, 92 patients survived and 23 died, with a mortality rate of 20.00%. The Charlson Comorbidity Index (CCI), IL-6 and IL-8 in the death group were significantly higher than those in the survival group (all P<0.05), while the MNA-SF score, inflammatory-nutritional index (INI), regulatory T cells, total T lymphocytes, and ratio of regulatory T cells /T lymphocytes in the survival group were significantly higher than those in the death group (all P<0.05). According to the MNA-SF nutrition score, 64 cases were included in the malnutrition group and 51 cases were included in the non-malnutrition group, with an incidence of malnutrition of 55.65%. The mortality rate of the malnutrition group was significantly higher than that of the non-malnutrition group [34.40% (22/64) vs. 2.00% (1/51), P<0.05]. The levels of inflammatory cytokines IL-6 and IL-8 in the malnutrition group were significantly higher than those in the non-malnutrition group (both P<0.05), and the levels of regulatory T cells, total T lymphocytes, and ratio of regulatory T cells /T lymphocytes in the malnutrition group were significantly lower than those in the non-malnutrition group (all P<0.05). The MNA-SF score was positively correlated with the number of regulatory T cells and total T lymphocytes (r = 0.695 and 0.568, both P<0.05). Logistic regression analysis showed that ratio of regulatory T cells /T lymphocytes and malnutrition were the main risk factors for prognosis (OR=20.978 and 12.614, both P<0.05). The area under the curve of ratio of regulatory T cells /T lymphocytes + MNA-SF score + INI combined predicted prognosis was 0.931 (95%CI 0.885-0.976). According to whether the ratio of regulatory T cells /T lymphocytes was greater than the cut-off point of 16.21, the patients were divided into two groups. K-M curve analysis showed that there was a statistically significant difference in the 28-day survival rate between the two groups [98.41% (62/63) vs. 57.69% (30/52), χ²=30.449, P<0.001]. Conclusions　Malnutrition and imbalance of regulatory T cells are closely related to the poor outcomes of elderly patients with community-acquired pneumonia. Early nutritional intervention and immune regulation may improve the prognosis of elderly patients with community-acquired pneumonia.

Diagnostic value of combined detection of D-dimer, fibrinogen degradation product, and mean platelet volume in deep vein thrombosis after fracture surgery 

Ge Qinghua, Li Xuefu, Zhao Shunfeng, Xu Guangyin

2023, 29(17):  2420-2424.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.012

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Objective　To detect the levels of D-dimer (DD) and fibrinogen degradation product (FDP) in plasma and mean platelet volume (MPV) in whole blood, and to evaluate the diagnostic value of their combined detection in deep vein thrombosis (DVT) after fracture surgery. Methods　Using a retrospective case control study, the clinical data of 158 patients with fracture who stayed in Department of Orthopedics, Liaocheng Third People's Hospital between June 2018 and October 2021 were retrospectively analyzed, including 73 patients with DVT [35 males (47.9%) and 38 females (52.1%), aged (63.81±15.28) years] and 85 patients without DVT (control group) [41 males (48.2%) and 44 females (51.8%), aged (60.27±15.79) years]. The differences in the levels of DD, FDP, and MPV were compared between the two groups. The receiver operating characteristic curve (ROC) was drawn to evaluate the values of DD, FDP, MPV, and their combination in diagnosing DVT in the fracture patients. Independent sample t test, Wilcoxon rank sum test, and χ² test were used. Results　The DD level in the DVT group was 4.68 (2.13, 12.26) mg/L, the FDP level was 16.47 (6.15, 40.63) mg/L, and the MPV level was 10.00 (9.40, 10.70) fl, which were significantly higher than those in the non-DVT control group [2.13 (0.86, 4.84) mg/L, 6.91 (2.92, 14.93) mg/L, and 9.70 (9.10, 10.35) fl], with statistically significant differences (Z=-4.550, -4.193, and -2.797; all P<0.01). The area under curve (AUC), sensitivity, and specificity of DD level for diagnosing DVT after fracture surgery were 0.710, 86.3%, and 45.9%, those of FDP level were 0.694, 52.0%, and 77.6%, those of MPV level were 0.613, 68.5%, and 52.9%, and those of DD+FDP+MPV were 0.733, 95.9%, and 82.4%. Conclusions　DD, FDP, and MPV have a significantly high level in DVT patients after fracture surgery. The combined detection of DD, FDP, and MPV has potential application value in the early diagnosis, early intervention, and better prognosis for DVT after fracture surgery.

Relationships between FGF21 and IGF-1 levels and coronary atherosclerosis in elderly patients with coronary heart disease

Liu Ning, Ju Han, Gao Chengzhi

2023, 29(17):  2425-2429.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.013

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Objective　To analyze the relationships between fibroblast growth factor 21 (FGF21) and insulin-like growth factor 1 (IGF-1) levels and coronary atherosclerosis in elderly patients with coronary heart disease (CHD). Methods　Retrospective analysis was made on the clinical data of 96 CHD patients who were treated in Jinan Second People's Hospital from January 2020 to December 2021, including 54 males and 42 females, aged (72.24±8.93) years, 46 cases of mild sclerosis, 28 cases of moderate sclerosis, and 22 cases of severe sclerosis. Another 60 healthy people who were examined in the physical examination center of Jinan Second People's Hospital during the same period were selected as the control group, including 36 males and 24 females, aged (70.43±8.56) years. The relationships between serum FGF21 and IGF-1 levels and coronary atherosclerosis were analyzed. F test, independent sample t test, χ² test, receiver operating characteristic curve (ROC) analysis, multiple logistic regression analysis, and Spearman rank correlation analysis were used. Results　The level of FGF21 in the severe sclerosis group was higher than that in the moderate sclerosis group, the level of FGF21 in the moderate sclerosis group was higher than that in the mild sclerosis group, the level of IGF-1 in the severe sclerosis group was lower than that in the moderate sclerosis group, and the level of IGF-1 in the moderate sclerosis group was lower than that in the mild sclerosis group (all P<0.05). The serum level of FGF21 in the CHD patients was higher than that in the control group, and the level of IGF-1 was lower than that in the control group (both P<0.05). The ROC analysis proved that serum FGF21 and IGF-1 levels could be used in clinical evaluation of CHD, with the areas under the curve of 0.794 and 0.813, respectively, both P<0.05. Multivariate logistic regression analysis showed that FGF21≥590.68 ng/L and IGF-1≤82.67 µg/L were risk factors for CHD [both odds ratio (OR) >1, P<0.05]. Correlation analysis showed that serum FGF21 level was positively correlated with the degree of coronary atherosclerosis (r=0.753, P<0.05), and IGF-1 was negatively correlated with the degree of coronary atherosclerosis (r=-0.712, P<0.05). Conclusions　Both elevated serum FGF21 and reduced IGF-1 are related to the severity of coronary atherosclerosis. Clinically, FGF21≥590.68 ng/L and IGF-1≤82.67 µg/L can be used as biological indicators for clinical diagnosis of CHD in the elderly, providing references for clinical evaluation and treatment of the disease.

Effect of platelet-rich fibrin on promoting bone regeneration in bone defect around implant

Cao Baiyu, Lin Yi

2023, 29(17):  2429-2433.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.014

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Objective　To investigate the effect of platelet-rich fibrin (PRF) in promoting bone tissue regeneration in patients undergoing external maxillary sinus lifting without bone graft concurrent implantation. Methods　A prospective study method was adopted in this study, and 40 patients(40 teeth) who underwent external maxillary sinus lifting without bone graft concurrent implantation in Fujian Provincial Hospital from November 2020 to November 2021 were selected as the study objects, including 22 males and 18 females, aged (29.28±2.63) years. According to the patients' outpatient number after admission, under the guidance of random numbers, the above patients were randomly divided into a study group and a control group, with 20 cases in each group. The control group was filled with Bio-oss bone meal, and the study group was filled with Bio-oss bone meal mixed with PRF. Independent sample t test was used to compare the alveolar bone height, implant stability, and gingival crevicular fluid inflammatory factors between the study group and the control group, and χ² test was used to compare the difference of adverse reactions. Results　There were no statistically significant differences in the alveolar bone height between the two groups before and immediately after surgery (both P>0.05); the alveolar bone height of the study group was higher than that of the control group 6 and 12 months after surgery [(8.70±0.54) mm vs. (6.63±0.84) mm, (7.96±0.97) mm vs. (6.32±1.15) mm] (both P<0.05). The implant stability of the study group was higher than that of the control group 6 and 12 months after surgery [(55.55±5.37) vs. (50.52±5.75), (73.56±2.65) vs. (71.66±2.99)] (both P<0.05). Six months and 12 months after surgery, the levels of tumor necrosis factor (TNF-α) and nuclear factor κB (NF-κB) of the study group were (30.42±3.21) ng/L, (25.03±3.18) ng/L, (29.09±2.80) ng/L, and (28.79±2.67) ng/L, those of the control group were (35.70±3.07) ng/L, (28.34±3.73) ng/L, (46.01±2.50) ng/L, and (30.72±2.61) ng/L, with statistically significant differences between the two groups (all P<0.05). There were no statistically significant differences in the risk of local swelling and bleeding between the two groups (both P>0.05). Conclusion　In patients undergoing external maxillary sinus lifting without bone graft concurrent implantation, PRF treatment shows significant bone tissue regeneration in bone defects around the implant, and the implant shows high height of new bone and stability, suggesting clinical promotion.

Application of triamcinolone acetonide pretreatment combined with ESD in the treatment of colorectal cancer and its prevention and treatment effect on intestinal stenosis

Dou Cailing, Wang Chenyu

2023, 29(17):  2434-2437.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.015

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Objective　To observe the application value of triamcinolone acetonide pretreatment assisted with endoscopic submucosal dissection (ESD) in the treatment of colorectal cancer and its prevention and treatment effect on intestinal stenosis. Methods　This was a prospective randomized controlled trial. This study selected 120 colorectal cancer patients admitted to Henan University Huaihe Hospital between June 2020 and October 2022 as the study subjects. By using the random number table method, 50 patients who only received ESD were included in the control group, and 70 patients who received triamcinolone acetonide pretreatment as an auxiliary ESD treatment were included in the observation group. In the control group, there were 30 males and 20 females, aged (65.25±5.31) years; in the observation group, there were 42 males and 28 females, aged (66.16±5.28) years. All patients were followed up for 6 months to compare the treatment status, postoperative complications, postoperative intestinal stenosis, postoperative recovery, and occurrence of adverse reactions between the two groups. Independent sample t test, χ² test, and rank sum test were used. Results　Under different treatment plans, the operation time of the observation group was (61.15±10.27) minutes, and there was no statistically significant difference compared to that of the control group [(58.44±10.26) minutes] (P>0.05). The number of repeated expansions in the observation group was (1.44±0.27), which was lower than that in the control group [(3.35±1.02)], and the interval between expansions in the observation group was (20.33±8.26) weeks, which was longer than that in the control group [(14.15±5.41) weeks], with statistically significant differences (t=14.972 and 4.626, both P<0.001). After treatment, the incidence of postoperative complications in the observation group was 7.14% (5/70), and the incidence of intestinal stenosis was 7.14% (5/70), which were both lower than those in the control group [20.00% (10/50) and 22.00% (11/50)], with statistically significant differences (χ²=7.050, P=0.008; Z=-2.360, P=0.018). After treatment, the excellent and good recovery rate of dysphagia in the observation group was 91.43% (64/70), higher than that in the control group [76.00% (38/50)], with a statistically significant difference (χ²=8.732, P=0.003). The incidence of adverse reactions in the observation group was 13.33% (4/70), and there was no statistically significant difference compared to that in the control group [6.00% (3/50)] (P>0.05). Conclusions　The use of triamcinolone acetonide pretreatment combined with ESD treatment can enhance the surgical efficacy, reduce the risk of repeated expansions, complications, and intestinal stenosis, and promote the postoperative recovery of dysphagia symptoms in patients. Triamcinolone acetonide is safe and does not significantly increase the risk of adverse reactions in patients.

Effect of lamina replantation and internal fixation combined with staged exercise in treating intraspinal tumors

Xia Liheng, Wang Zhongren

2023, 29(17):  2438-2441.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.016

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Objective　To observe the therapeutic effect of lamina replantation type mini titanium plate internal fixation combined with staged functional rehabilitation exercise on patients with lumbosacral intraspinal tumors and its impact on rehabilitation. Methods　In this study, 123 patients with intraspinal tumors in the lumbosacral region who underwent tumor resection treatment in Jiaozuo People's Hospital from January 2020 to September 2021 were selected as the study subjects. The enrolled patients were divided into two groups by lot drawing. In the control group, there were 31 males and 30 females, aged (50.44±5.37) years; in the observation group, there were 30 males and 32 females, aged (51.24±5.62) years. The control group was treated with tumor resection with vertebral lamina replantation and internal fixation with mini titanium plate, followed by routine rehabilitation exercise; the observation group was given staged functional rehabilitation exercise after surgery on the basis of surgical treatment in the control group. A one-year follow-up was conducted to compare the vertebral Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA), and Fugl Meyer Lower Limb Motor Function Assessment (FMA) scores of the two groups, and observe the changes in Cobb angle in patients. Independent sample t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the VAS score and Cobb angle of the injured vertebra between the two groups (both P>0.05). After 15 days, 1 month, and 3 months of treatment, the VAS scores of the observation group were (4.42±1.33) points, (3.77±0.25) points, and (2.55±0.21) points, the Cobb angles were (25.12±5.33)°, (18.45±4.36)°, and (12.27±2.37)°, and those of the control group were (5.68±1.24) points, (4.82±1.33) points, (3.77±0.82) points, (28.44±5.15)°, (21.33±5.17)°, and (15.44±4.49)°. The VAS scores and Cobb angles of the observation group were lower than those of the control group at all time points (t=5.432, 6.108, 11.344, 3.512, 3.342, and 4.908; all P<0.05). During the follow-up period, the lumbar JOA score of the observation group was higher than that of the control group [(23.47±3.72) points vs. (20.44±2.37) points], and the FMA lower limb score was higher than that of the control group [(29.25±5.11) points vs. (25.44±5.36) points] (t=5.378 and 4.036, both P<0.001). Conclusion　Based on the treatment of vertebral lamina replantation and mini titanium plate internal fixation assisted tumor resection, combined with staged functional exercise has a significant effect, which has a positive significance in enhancing the rehabilitation effect in patients.

Application and safety study of astragalus polysaccharides for injection assisted chemotherapy for primary liver cancer

Liu Yunhui, Yang Qiumin, Lin Chunli, Hao Rui

2023, 29(17):  2442-2445.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.017

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Objective　To observe the application of astragalus polysaccharides for injection in oxaliplatin chemotherapy regimen for primary liver cancer and its preventive and therapeutic effects on bone marrow depression. Methods　This was a randomized controlled trial. A total of 120 patients with primary liver cancer who received chemotherapy in Shangqiu First People's Hospital from January 2020 to October 2021 were selected as the research objects, and were divided into two groups by drawing lots. In the control group, 40 males and 20 females, aged (50.33±1.26) years, were treated with oxaliplatin chemotherapy regimen. In the observation group, 38 males and 22 females, aged (51.42±1.35) years, were treated with astragalus polysaccharides for injection on the basis of chemotherapy regimen in the control group. The chemotherapy and changes of peripheral hemogram indexes were compared between the two groups. All the patients were followed up for 1 year to compare the occurrence of bone marrow depression and the degree of toxic reaction after chemotherapy between the two groups. χ² test and t test were used. Results　After treatment, the disease control rate of the observation group was higher than that of the control group [83.33% (50/60) vs. 58.33% (35/60)], and the timed and quantitative completion rate of chemotherapy within 1 month was higher than that of the control group [93.33% (56/60) vs. 75.00% (45/60)], with statistically significant differences (χ²=9.076 and 9.190, both P<0.05). After treatment, the white blood cell count in the observation group was higher than that in the control group [(6.25±2.44) ×10⁹/L vs. (4.39±1.33) ×10⁹/L], the percentage of neutrophils was higher than that in the control group [(53.34±8.31)% vs. (48.45±5.42)%], the T lymphocyte subsets CD3+CD4+ was higher than that in the control group [(29.11±8.43)% vs. (25.42±5.36)%], and the CD3+CD8+ was lower than that in the control group [(25.45±5.44)% vs. (28.76±5.16)%], with statistically significant differences (t=5.185, 3.818, 2.861, and 3.420; all P<0.05). During the follow-up period, the incidence of bone marrow suppression in the observation group was lower than that in the control group [25.00% (15/60) vs. 46.67% (28/60)], with a statistically significant difference (χ²=6.125, P<0.05). Conclusion　Astragalus polysaccharides for injection combined with oxaliplatin chemotherapy regimen has positive significance in improving the peripheral hemogram indexes and reducing the incidence of bone marrow depression in patients with primary liver cancer.

Basic Research

Experimental study on the effect of ossotide on the development of jaw bone in rats after condylar fracture

Jiang Qian, Chen Yifei, Chen Yaqiu, Zhu Zhidan, Zhang Jiajie, Sun Xiaojing

2023, 29(17):  2446-2451.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.018

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Objective　To observe the effects of compound ossotide injection on the development of jaw bone and expressions of serum insulin-like growth factor 1 (IGF-1) and platelet-derived growth factor BB (PDGF-BB) in rats with unilateral condylar neck fracture. Methods　The experiment began on October 25, 2019. In this study, a surgical model of unilateral condylar neck fracture was created in male SD rats. Three groups were established, including a surgical group, a surgical administration group receiving 0.9 mg/kg of compound ossotide injection daily, and a blank control group, with 24 rats in each group. The rats were observed and sacrificed after 1, 3, 5, and 9 weeks, 6 rats in each group each time, and changes in occlusal symmetry, mandibular length, mandibular ramus height, and serum levels of IGF-1 and PDGF-BB were evaluated. Analysis of variance and LSD test were used. Results　After unilateral condylar neck fracture, the mandible of the normal side developed more than that of the affected side in the surgical group, and the mandible showed deviation phenomenon. The mandible in the surgical administration group showed less deviation than that in the surgical group, and the healing of the fracture on X-ray was accelerated. Serological results showed that the levels of PDGF-BB in the surgical group, the surgical administration group, and the blank control group 1 week after surgery were (104.21±15.01) ng/L, (241.69±22.49) ng/L, and (406.47±26.88) ng/L, respectively, with statistically significant differences between two of the three groups (all P<0.001); the levels of IGF-1 5 weeks after surgery were (2 109.95±181.74) ng/L, (2 714.89±180.21) ng/L, and (2 499.27±186.04) ng/L, respectively, with statistically significant differences between two of the three groups (all P<0.05). Conclusions　Both unilateral condylar neck fracture and the use of ossotide affect the growth and development of the mandible and the contents of PDGF-BB and IGF-1 in serum of male SD rats at peak growth. There is arrested or slower mandibular development and skewed mandible on the affected side after fracture, while the healing of broken ends of the fracture will be accelerated and the degree of mandibular skewing will be decreased after injection of compound ossotide, and the changes of the two factors in serum are dynamic, with different contents at different time points.

Treatises

Comparison of the efficacies and safety of sodium acetate succinyl gelatin electrolyte injection and succinyl gelatin injection in perioperative period 

Chen Hai, Deng Haibo, Zhang Xing, Wang Lingzhi, Yang Hanyu

2023, 29(17):  2452-2459.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.019

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Changes and clinical significance of insulin related indexes in pregnant women with gestational diabetes mellitus

Yu Chunmei, Li Wushan, Wang Qing

2023, 29(17):  2459-2462.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.020

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Therapeutic effect of blocking entrapment fixation with three Kirschner wires in the treatment of bone mallet finger

Yuan Yunhua, Yu Tao, Tan Fang, Zhang Xingpeng, Wang Jian, Li Kai

2023, 29(17):  2463-2466.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.021

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Objective　To introduce a method and its effect of blocking entrapment fixation with three Kirschner wires in the treatment of bone mallet finger. Methods　From June 2019 to June 2022, 23 patients with bone mallet finger and avulsion fracture at the base of phalangeal phalanges in Shanghai Pudong New Area People's Hospital were retrospectively analyzed, including 16 males and 7 females, aged (32.17±7.99) years. After closed reduction, one Kirschner wire was used to fix the distal interphalangeal joint in overextension position, and two Kirschner wires were used to block the avulsion block with continuous entrapment. The three Kirschner wires were removed 6 weeks after surgery, and the activity of distal interphalangeal joint and fracture healing were observed and recorded during follow-up. Results　The average follow-up was (11.22±5.72) months, and the operative time was (46.91±11.78) minutes. One patient was cured satisfactorily after dressing change due to local skin necrosis caused by the compression of the finger dorsal side by blocking Kirschner wire. No needle tract infection or skin necrosis was found in the other patients. All patients had bone healing and good finger movement. At the last follow-up, according to the Grawford functional evaluation criteria, 13 cases were excellent, 9 cases were good, and 1 case was fair, with an excellent and good rate of 95.65%. Conclusion　Blocking entrapment fixation with three Kirschner wires in the treatment of bone mallet finger is stable and reliable, with simple operation, satisfactory effect, and clinical significance.

Two cases of Kawasaki disease with onset of macrophage activation syndrome and literature review 

Zhou Xin, Guan Yuqiang, Li Xinxiang, Zhang Xin, Dong Rui, Li Lei

2023, 29(17):  2467-2471.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.022

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Objective  To analyze the clinical features of Kawasaki disease (KD) with onset of macrophage activation syndrome (MAS), and to discuss the diagnosis and treatment of KD complicated with MAS. Methods  The clinical data of two children with KD with onset of MAS in Children's Hospital Affiliated to Shandong University were retrospectively analyzed, and the relevant literatures were reviewed. Results  Child 1, boy, 3 years and 10 months old, was admitted to our hospital on March 8, 2022. With the onset of fever and rash, he had persistent hyperthermia after admission, accompanied by systemic rash, lactate dehydrogenase and aspartate transaminase (AST) progressive elevation. The child was diagnosed with KD complicated by MAS and was given intravenous immunoglobulin (IVIG) twice, followed by methylprednisolone shock therapy for 3 days, and treatment was sequentially discontinued for 1 month. The child's body temperature dropped to normal, and the rash gradually subsided. Child 2, girl, 1 year and 2 months old, was admitted to our hospital on July 27, 2022. With fever and anemia as the first symptoms, she was complicated by thrombocytopenia, fibrinogen reduction, and elevated ferritin. She was given IVIG twice, and followed by intravenous methylprednisolone for 11 days and oral methylprednisolone for 14 days. The child's body temperature dropped to normal, anemia was corrected, and platelets and ferritin returned to normal. Conclusions  The prognosis in children with KD with onset of MAS is good when they are actively treated. At present, there are no guidelines for the treatment of this disease, which requires long-term clinical observation and the establishment of more refined diagnostic criteria and treatment plans.

Case Report

A case of dyskeratosis congenita with obvious splenomegaly and hypoxemia as the first manifestations

Liu Lijuan, Niu Qiong, Cheng Xianyong, Gao Yu, Liu Chengxia

2023, 29(17):  2472-2475.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.023

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Dyskeratosis congenita is a rare genetic disease. This paper reported a case of adolescent with dyskeratosis congenita with obvious splenomegaly, portal hypertension, and hypoxemia as the first manifestations in Binzhou Medical University Hospital, and discussed the diagnostic thinking of dyskeratosis congenita and the doubts and difficulties of this case.

One case of prurigo pigmentosa misdiagnosed as tinea corporis

Long Lan

2023, 29(17):  2476-2478.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.024

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A 26-year-old male patient presented with erythema, and desquamation on the back and back of the neck, with some blisters and pruritus for 2 months. At the time of admission, patchy erythema was seen on the neck and back, and multiple rice-to-nail large red papules and maculopapules were seen in the central part, which fused into a network or sheet, with dark color. There was no scale on the surface, no telangiectasia, and atrophy was not seen. The results of routine blood test, four tests of coagulation, two pairs of hepatitis B, acquired immune deficiency syndrome (AIDS), and syphilis screening were all normal. Fungal test was negative. The histopathological changes of the skin lesions were consistent with prurigo pigmentosa. A diagnosis of prurigo pigmentosa was made. After 1 week, the pruritus disappeared and the red papules mostly subsided, leaving pigmentation. Follow-up was conducted.

A case of glaucoma secondary to iridoschisis

Wang Jing, Yu Shui, Song Yu

2023, 29(17):  2478-2483.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.025

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A rare case of binocular temporal iridoschisis admitted to Weihai Central Hospital was reported. The patient had secondary glaucoma in one eye with larger iridoschisis range, while no glaucoma occurred in the other eye with smaller iridoschisis range during follow-up. Therefore, it is believed that during the occurrence and development of iridoschisis, the occurrence of secondary glaucoma is due to the depigmentation of iris tissue blocking the angle of anterior chamber.

Nursing Research

Observation on the effect of directional transdrug therapy at Tianshu acupoint in preventing abdominal distension after lumbar surgery under general anesthesia

Lyu Jimin

2023, 29(17):  2484-2488.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.026

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Influence of Taijiquan exercise combined with nursing intervention on blood glucose level and quality of life in elderly patients with type 2 diabetes mellitus 

Zhang Cunnyu, Wan Ning, Zhao Dan

2023, 29(17):  2489-2493.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.027

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Objective　To investigate the influence of Taijiquan exercise combined with nursing intervention on blood glucose level and quality of life in elderly patients with type 2 diabetes mellitus (T2DM). Methods　A prospective study was conducted and 72 cases of elderly patients with T2DM admitted to Zhumadian Central Hospital from January 2020 to June 2022 were divided into an observation group (36 cases, Taijiquan exercise combined with nursing intervention) and a control group (36 cases, routine nursing intervention) by the random number table method. In the observation group, there were 20 males and 16 females, aged (68.42±2.73) years. In the control group, there were 19 males and 17 females, aged (68.52±2.69) years. The baseline data and blood glucose levels [glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial 2 h blood glucose (2hPBG)], blood lipid levels [low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG)], and quality of life [36-item Short-Form Health Survey (SF-36) score] before and after intervention were compared between the two groups. t test and χ² test were used. Results　After intervention, the levels of FBG [(6.38±1.06) mmol/L], 2hPBG [(9.41±2.40) mmol/L], and HbA1c [(5.43±0.52)%] in the observation group were lower than those in the control group [(7.42±1.43) mmol/L, (11.55±2.73) mmol/L, and (6.10±0.57)%], with statistically significant differences (all P<0.05). After intervention, the levels of LDL-C [(2.26±0.40) mmol/L], TC [(4.12±0.48) mmol/L], and TG [(2.26±0.44) mmol/L] in the observation group were lower than those in the control group [(2.79±0.48) mmol/L, (4.47±0.47) mmol/L, and (2.95±0.53) mmol/L], while the HDL-C level [(1.92±0.47) mmol/L] was higher than that in the control group [(1.52±0.33) mmol/L], with statistically significant differences (all P<0.05). After intervention, the scores of physiological role [(75.52±7.06) points], physical pain [(68.47±7.62) points], mental health [(75.68±7.08) points], vitality [(69.68±7.23) points], physiological function [(73.18±6.70) points], social function [(69.65±9.32) points], emotional function [(69.11±8.88) points], and overall health [(82.45±6.81) points] in the observation group were higher than those in the control group [(65.38±7.26) points, (62.81±8.23) points, (63.47±7.52) points, (62.13±6.45) points, (65.11±7.24) points, (63.62±8.43) points, (56.37±8.26) points, and (72.08±8.26) points], with statistically significant differences (all P<0.05). Conclusion　Taijiquan exercise combined with nursing intervention can effectively regulate the blood glucose and blood lipid levels in elderly T2DM patients, and improve their quality of life.

Effect of warning preventive nursing on risk coefficient and clinical outcomes in patients with severe pneumonia

Pan Haiping, He Ping

2023, 29(17):  2494-2498.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.028

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Objective　To explore the clinical effect of warning preventive nursing in patients with severe pneumonia. Methods　It was a prospective study. Sixty patients with severe pneumonia admitted to Department of Intensive Care Medicine, Wuxi Second People's Hospital from April 2021 to July 2022 were selected as the research objects, and were divided into a control group and an intervention group according to the random number table method with 30 cases in each group. In the control group, 16 males and 14 females, aged (66.42±3.51) years, were given routine nursing measures; in the intervention group, 18 males and 12 females, aged (66.33±3.42) years, were given warning preventive nursing measures. The risk coefficients and respiratory function 1 day after admission and 1 day before discharge and complications were compared between the two groups. t test and χ² test were used. Results　One day before discharge, the CURB-65 (confusion, uremia, respiratory, BP, age 65 years) score [(2.03±0.12) points] and pneumonia severity index (PSI) [(84.43±5.33) points] in the intervention group were lower than those in the control group [(2.19±0.21) points and (88.21±5.32) points], with statistically significant differences (both P<0.05). One day before discharge, the forced expiratory volume in one second (FEV1) [(84.24±1.42)%], partial oxygen pressure (PaO₂) [(86.21±1.33) mmHg (1 mmHg=0.133 kPa)], maximum ventilatory volume (MVV) [(85.35±1.42)%], and forced vital capacity (FVC) [(85.23±1.42)%] in the intervention group were higher than those in the control group [(83.49±1.33)%, (85.32±1.42) mmHg, (84.33±1.44)%, and (84.41±1.41)%], with statistically significant differences (all P<0.05). The complication rate in the intervention group was 3.33% (1/30), which was lower than that in the reference group [23.33% (7/30)], with a statistically significant difference (χ²=5.192, P=0.023). Conclusion　The implementation of warning preventive nursing measures for severe pneumonia patients is helpful to reducing the level of risk coefficient, improve the status of respiratory lung function, and reduce the incidence of complications.

Effects of position management based on patient role experience on position placement score and surgical efficiency

Zhao Yan, Cui Siqiu, Xu Zhenzhen

2023, 29(17):  2499-2502.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.029

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Objective　To explore the effects of position management based on patient role experience on position placement score and surgical efficiency. Methods　A total of 82 patients who underwent surgery in Nanyang First People's Hospital from January 2018 to December 2021 were selected and were divided into 2 groups by the random number table method, with 41 patients in each group. In the study group, there were 20 males and 21 females, aged (41.25±5.68) years. In the routine group, there were 23 males and 18 females, aged (43.52±6.74) years. The study group performed position management based on patient role experience, while the routine group performed routine position nursing. The position placement scores, pain [Visual Analogue Scale (VAS) score], and anxiety [Hamilton Anxiety Scale (HAMA) score] of the two groups were evaluated, and the amounts of blood loss during and after surgery and the operation time of the two groups were recorded. t test and χ² test were used. Results　The scores of respiratory circulation [(22.85±3.58) points], protection of patient privacy [(20.52±3.42) points], selection of body positions [(23.85±4.12) points], and surgical field exposure [(25.32±4.25) points] in the study group were higher than those in the routine group [(18.25±3.01) points, (17.52±2.85) points, (19.25±3.11) points, and (22.25±3.50) points], with statistically significant differences (t=6.297, 4.315, 5.706, and 3.570; all P<0.001). The HAMA score [(16.98±3.11) points] and VAS score [(3.06±0.48) points] of the study group were lower than those of the routine group [(19.98±3.87) points and (5.52±0.59) points], with statistically significant differences (t=3.869 and 9.994, both P<0.001). The amount of intraoperative blood loss [(112.58±16.58) ml] and postoperative blood loss [(35.24±5.25) ml] in the study group were less than those in the routine group [(123.52±17.51) ml and (40.36±6.14) ml], and the operation time [(1.02±0.14) h] was shorter than that in the routine group [(1.35±0.21) h], with statistically significant differences (t=2.905, 4.058, and 8.372, all P<0.001). Conclusion　Position management based on patient role experience is beneficial to improve the position placement score, relieve the pain, and improve the adverse moods and surgical efficiency, which is worth promoting.

Effects of nursing intervention based on outcome classification on postoperative urinary incontinence and quality of life in patients with benign prostatic hyperplasia

Zhang Li, Xu Chun'e, Jin Xin

2023, 29(17):  2503-2507.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.030

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Objective　To explore the effects of nursing intervention based on outcome classification on the incidence of postoperative urinary incontinence and quality of life in patients with benign prostatic hyperplasia. Methods　A randomized controlled trial was conducted on 88 male patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate (TRUP) in Bayannur Hospital from March 2018 to March 2021. They were divided into a control group and an observation group according to the random number table method. Forty-four patients with benign prostatic hyperplasia aged (71.25±7.21) years who received traditional nursing care were assigned to the control group, and 44 patients with benign prostatic hyperplasia aged (73.12±6.81) years who received nursing intervention based on outcome classification were assigned to the observation group. The incidence and duration of postoperative urinary incontinence were analyzed. The International Consultation on Incontinent Questionnaire - Short Form (ICIQ-SF)  was used to compare the postoperative quality of life between the two groups. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the psychological statuses of the two groups. t test and χ² test were used. Results　The incidence of urinary incontinence in the observation group [4.54% (2/44)] was lower than that in the control group [20.45% (9/44)], and the duration of urinary incontinence [(3.25±1.12) d] was shorter than that in the control group [(5.64±1.23) d], with statistically significant differences (χ²=5.090, P=0.024; t=9.530, P<0.001). The scores of social function [(58.64±16.20) points], emotional function [(58.73±6.42) points], role function [(60.67±11.98) points], and physical function [(66.65±13.56) points] in the observation group were higher than those in the control group [(50.20±14.80) points, (46.36±21.68) points, (53.56±16.73) points, and (56.13±16.54) points], with statistically significant differences (t=2.551, 3.629, 2.292, and 3.263; all P<0.05). After nursing, the SAS score [(43.25±3.68) points] and SDS score [(42.51±3.26) points] in the observation group were lower than those in the control group [(50.11±6.20) points and (51.27±7.34) points], with statistically significant differences (t=6.311 and 7.235, both P<0.05). Conclusion　For patients undergoing TRUP, nursing intervention based on outcome classification can significantly reduce the incidence of postoperative urinary incontinence and improve the patients' quality of life, which is worthy of application in daily nursing for TRUP patients.

Analysis of factors influencing enhanced recovery after lumbar fusion surgery in middle-aged and elderly patients

Li Tian, Hong Quan, Lin Jiayang, Lin Kexin, Li Xiaohong

2023, 29(17):  2507-2512.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.031

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Objective　To investigate the factors influencing enhanced recovery after lumbar fusion surgery. Methods　Using the method of prospective cohort study, 147 patients with lumbar degenerative diseases who were diagnosed and treated in Jieyang People's Hospital from January 2021 to December 2022 were selected as the research objects. Using the randomized grouping method of block randomization, they were divided into 70 patients in the ERAS (enhanced recovery after surgery) group and 77 patients in the non-ERAS group. There were 32 males and 38 females in the ERAS group, aged (69.45±6.25) years; there were 35 males and 42 females in the non-ERAS group, aged (69.27±6.35) years. All patients received lumbar fusion surgery. The demographic characteristics, complications, surgical data, and postoperative recovery parameters of the two groups were analyzed. Clinical outcomes included the length of hospital stay, postoperative complications, and postoperative pain [Visual Analogue Scale (VAS) score]. t test and χ² test were used, and multivariate logistic regression analysis was used to analyze the risk factors of hospital stay and postoperative complications. Results　The length of hospital stay in the ERAS group [(13.6±4.0) d] was shorter than that in the non-ERAS group [(15.6±3.9) d], with a statistically significant difference (t=3.068, P=0.003). The incidence of complications in the ERAS group [7.1% (5/70)] was lower than that in the non-ERAS group [18.2% (14/77)], and the proportions of early ground walking [70.0% (49/70)], early oral feeding [88.6% (62/70)], early removal of bladder catheter [80.0% (56/70)], and nutritional support [45.7% (32/70)] were higher than those in the non-ERAS group [11.7% (9/77), 7.8% (6/77), 16.9% (13/77), and 20.8% (16/77)], with statistically significant differences (χ²=3.970, 52.191, 96.243, 58.648, and 10.367; all P<0.05). On day 1, day 2, and day 3 after surgery, the VAS scores (low back pain and leg pain) in the ERAS group were lower than those in the non-ERAS group [(3.8±1.7) points vs. (5.7±2.3) points, (3.6±1.9) points vs. (4.5±2.2) points, (3.1±1.2) points vs. (3.8±1.7) points, (3.2±1.5) points vs. (3.8±1.7) points, (2.5±1.6) points vs. (3.5±1.2) points, (2.0±1.3) points vs. (2.5±0.9) points], with statistically significant differences (t=5.649, 2.642, 2.858, 2.260, 4.311, and 2.731; all P<0.05). On day 4 after surgery, the VAS score (low back pain) in the ERAS group was lower than that in the non-ERAS group [(2.7±0.5) points vs. (3.2±0.9) points], with a statistically significant difference (t=4.107, P<0.05); there was no statistically significant difference in the VAS score (leg pain) between the ERAS group and the non-ERAS group [(1.8±0.8) points vs. (2.0±1.0) points] (t=1.330, P>0.05). Multivariate logistic regression analysis showed that the length of hospital stay was correlated with ERAS program and preoperative Oswestry Disability Index (ODI) (both P<0.05), but was not related to age, body mass index (BMI), operative segments ≥3, American Society of Anesthesiologists (ASA) grade ≥3, or operative time (all P>0.05); implementation of ERAS program was associated with a decrease in complications (P<0.05). Conclusion　ERAS after lumbar fusion may be related to early normal activities (including early walking, early removal of bladder catheter, and early oral feeding), multimodal analgesia, and other factors.

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Study on the disinfection performance of a hydroxide ion disinfectant

Yao Songyin, Gao Qiong, Wu Yuanni, Yin Xiaochen, Xiao Lijia, Yin Jin

2023, 29(17):  2513-2516.  DOI: 10.3760/cma.j.issn.1007-1245.2023.17.032

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Objective　To evaluate the disinfection effect and safety of a kind of hydroxide ion disinfectant whose main active component is potassium carbonate, and to provide data support for its practical application. Methods　Combined methods of suspension quantitative killing test, physicochemical analysis method, and toxicological testing were used to observe the disinfection effect, physicochemical indicators, and safety performance of a certain hydroxide ion disinfectant against a variety of pathogenic microorganisms. Results　After the disinfection solution acted for 1.0 min, the killing logarithms of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus in the suspension were all >5.00, and the killing logarithm of Candida albicans in the suspension was >4.00. After 0.5 min of action, the average inactivation logarithm of poliovirus in the suspension was >5.00. The killing logarithms of natural bacteria on wood surface were all >1.00. After the disinfectant stock solution was placed in a 54 ℃ incubator for 14 days, and its efficacy in killing Candida albicans was basically the same after 1.0 min of action. The original solution of this disinfectant had no irritating effects through one skin irritation on damaged skin or multiple irritation tests on undamaged skin, and irritation index of 0.34 for one irritation test on vaginal mucosal of white rabbits. Conclusion　The hydroxide ion disinfectant has a rapid killing effect on bacterial propagule, fungi, and viruses, and has no irritating effect on animal skin and mucosa.