Table of Content

01 October 2023, Volume 29 Issue 19

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Special Column of Pediatrics

Learning curve of peroral endoscopic pyloromyotomy for the treatment of infant hypertrophic pyloric stenosis

Chen Zhiwei, Zhang Youxiang, Wang Lina, Ou Qiaoqun

2023, 29(19):  2665-2668.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.001

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Objective　The learning curve of peroral endoscopic pyloromyotomy is discussed by evaluating the surgical efficacy of this surgical approach in infant hypertrophic pyloric stenosis at different stages. Methods　The related data of 86 cases of peroral endoscopic pyloromyotomy performed by the same group of physicians in the digestive endoscopy center of Guangzhou First People's Hospital from August 2006 to June 2020 were analyzed, including 78 males and 8 females, with an age of 26-114 days old at admission, with the body weight of 2.12-6.10 kg. The cumulative sum (CUSUM) analysis method was used to draw the learning curve, with the highest point of the curve as the boundary, and the curve K value was negative till 30 cases. Therefore, the learning curve was crossed after the operation of 30 cases, and the study objects were divided into a pre-learning group (30 cases) and a post-learning group (56 cases). The differences in operation time, postoperative hospital stay, and postoperative feeding recovery time in different stages of the learning curve were compared, and the surgical effects in different stages were analyzed. Independent sample t test, χ² test, and Fisher exact probability method were used. Results　The peak of the curve was reached at 30 cases, and the slope of the curve decreased after a short plateau period. The operation time was (42.23±11.27) min in the pre-learning group and (21.73±6.50) min in the post-learning group, with a statistically significant difference (t=10.710, P<0.001). The postoperative hospital stay of the pre-learning group was (14.60±7.10) d, and the postoperative hospital stay of the post-learning group was (10.42±4.54) d, with a statistically significant difference (t=3.310, P=0.001). Conclusions　The learning curve for peroral endoscopic pyloromyotomy in the treatment of infant hypertrophic pyloric stenosis was calculated using the data from 30 cases. With the accumulation of surgical experience, the operation efficiency was gradually improved, and the operation time and length of hospital stay post-surgery were shortened.

Value of neuron-specific enolase in predicting neurological injury in infants

Qiu Xiaoyan, Wu Yi, Wang Hongwu, Feng Xueyong

2023, 29(19):  2669-2673.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.002

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Objective　To investigate the value of serum neuron-specific enolase (NSE) in predicting neurological injury in infants. Methods　A total of 63 febrile infants (more than 28 days old but less than 1 year old) who had been hospitalized in Department of Pediatrics, The Second Affiliated Hospital of Shantou University Medical College from November 2019 to November 2020 and had undergone lumbar puncture were selected as the subjects. Serum NSE level was measured in all the subjects. The infants were divided into two groups according to the serum NSE level. In group A, serum NSE <33 µg/L was observed in 52 cases, including 28 males and 24 females, aged 2.00 (1.00, 4.00) months. In group B, serum NSE ≥33 µg /L was observed in 11 cases, including 6 males and 5 females, aged 2.00 (1.00, 6.75) months. The clinical manifestations, routine and biochemical examination levels of cerebrospinal fluid, levels of peripheral blood routine examination, coagulation indexes, and imaging results of the two groups were compared. t test, Mann-Whitney U test, and χ² test were used. Results　The incidence of convulsive seizures in group A was 18/52, and that in group B was 8/11, with a statistically significant difference between the two groups (χ²=5.441, P=0.020). The platelet count in peripheral blood, fibrinogen, and prothrombin time of group A were (406.70±121.17) ×10⁹/L, (3.79±0.95) g/L, and 13.20 (12.40, 15.10) s, respectively, and those of group B were (304.50±165.28) ×10⁹/L, (2.66±1.08) g/L, and 15.00 (13.33, 16.45) s, respectively, with statistically significant differences between the two groups (all P<0.05). The blood calcium level of group A was 2.38 (2.23, 2.43) mmol/L, and that of group B was 2.21 (1.95, 2.33) mmol/L, with a statistically significant difference between the two groups (P=0.003). There were 12 cases of abnormal imaging in group A and 6 cases in group B, with a statistically significant difference between the two groups (χ²=4.406, P=0.036). Conclusion　Serum NSE level is an important marker of neurological injury in infants, and can be used as one of the indicators for early diagnosis and prognosis evaluation.

Application effect of home-sleep monitor in children with obstructive sleep apnea-hypopnea syndrome

Lin Chunqin, Wang Jianxin, Lin Qiansen

2023, 29(19):  2674-2677.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.003

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Objective　To study the application effect of home-sleep monitor in children with obstructive sleep apnea-hypopnea syndrome. Methods　A total of 100 children with obstructive sleep apnea-hypopnea syndrome treated in Quanzhou First Hospital from April 2020 to April 2022 were selected, including 58 boys and 42 girls, aged (6.58±1.04) years. The home-sleep monitor and symptomatic treatment were applied. Children's treatment outcomes were evaluated through the oxygen desaturation index 4 (DI4), lowest oxygen saturation (LSaO₂), mean oxygen saturation (MSaO₂), respiratory disturbance frequency, hypoxia frequency, and scores of sleep quality and MOS item short from health survey (SF-36). Paired t test was used. Results　The DI4, LSaO₂, and MSaO₂ after treatment were (2.55±1.04) times/h, (96.27±5.11)%, and (98.23±2.36)%, respectively, and those before treatment were (62.09±3.58) times/h, (83.14±4.25)%, and (94.05±1.87)%, respectively, with statistically significant differences (t=159.710, 19.755, and 13.882; all P<0.001). After treatment, the number of hypoxia and respiratory disorders were (2.15±0.60) and (1.16±0.27) times, which were lower than those before treatment [(53.36±4.15) and (40.09±3.28) times] (t=122.128 and 118.289, both P<0.001). After treatment, the scores of sleep efficiency, fall-sleep time, hypnotic drug usage, sleep time, daytime dysfunction, and sleep disorder were lower than those before treatment (all P<0.001), and the scores of role physical, health condition, physiological function, body pain, and vitality were higher than those before treatment (all P<0.001). Conclusion　Home-sleep monitor is applicable to properly know about the illness states and recovery conditions in children with obstructive sleep apnea-hypopnea syndrome, worthy of clinical promotion and application.

Exploration of the relevant influencing factors of efficacy in children with developmental dysplasia of the hip aged 6-18 months based on the content analysis method

Hua Shuisheng, Yu Xijing, Huang Hesheng, Wan Chunhu

2023, 29(19):  2678-2683.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.004

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Objective　To analyze the relevant influencing factors of curative effect in children with developmental dysplasia of the hip (DDH) aged 6-18 months through literature samples. Methods　Based on the content analysis method, CNKI, VIP, WF, CBM, and PubMed journals were used as the data retrieval platforms to analyze the data resources. The keyword of the search was "infant developmental dysplasia of the hip", and the search interval was from the establishment of the databases to October 1, 2022. A total of 40 children with DDH who were treated with closed reduction combined with modified plaster external fixation of hip body position were retrospectively selected from Pediatric Orthopaedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine from January 2020 to January 2022 , including 19 boys and 21 girls, 21 cases aged <12 months and 19 cases aged ≥12 months. According to the effect indexes, they were divided into an effect response group (22 cases) and a non-effect response group (18 cases), and the differences of influencing factors between the two groups were compared and analyzed by two-way analysis. Rank sum test and χ² test were used. Results　After analyzing 84 target samples, it was found that the primary influencing factors of DDH in infants and young children were demographic sociological factors, disease assessment factors, biological information factors, and other influencing factors, including 19 secondary factors. In the effect response group, the rates of aged <12 months, gender (female), Tönnis degree (Ⅰ degree), Grafb classification (D), acetabular index ≥35°, cephalic position of cartilaginous acetabulum, intra-acetabular tissue (right-left diameter <0.9 cm, anteroposterior diameter <1.5 cm, and area <1.4 cm²), medial cisterna space of hip joint <6 mm, glenolabial position head, no hypertrophy of glenoid labrum, femoral head h/b ratio >0.1 (concentric reduction), femoral head anterior cervical inclination <13°, femoral head perfusion change type (type A), no extension or hypertrophy of round ligament, ossified nucleus development, vascular classification (type Ⅲ), traction time before reduction ≥14 d, and fixed time after reduction ≤6 months were higher than those in the non-effect response group (all P<0.05). Conclusion　The clinic should pay attention to the relevant influencing factors of DDH children aged 6-18 months, and further explore the unknown influencing factors and the influencing depth and width of the combination of various factors, so as to optimize the targeted treatment scheme that can effectively treat DDH children aged 6-18 months.

Application of multisensory stimulation combined with repetitive transcranial magnetic stimulation in language development delay/disorder in children

Nan Hui, Feng Yanting, Zhou Li, Zhu Dan, Zhao Jinxia

2023, 29(19):  2683-2687.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.005

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Objective　To investigate the effect of multi-sensory stimulation combined with repetitive transcranial magnetic stimulation in the treatment of children with language development delay/disorder. Methods　Ninety-one children with language development delay/disorder who were treated in Liaocheng People's Hospital from April 2019 to June 2022 were selected as the study objects, and were divided into a control group and an observation group according to the envelope method. In the control group, there were 28 boys and 17 girls, aged (2.89±0.79) years; in the observation group, there were 27 boys and 19 girls, aged (2.85±0.82) years. The control group received repetitive transcranial magnetic stimulation, and the observation group received multi-sensory stimulation on the basis. The therapeutic effect, oral motor score, pediatric Neuropsychological Development Scale (Gesell) score, verbal behavior score, and daily living ability score were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　The total effective rate was 95.65% (44/46) in the observation group and 80.00% (36/45) in the control group, with a statistically significant difference (χ²=5.244, P=0.022). After intervention, the scores of lip movement, jaw movement, and tongue movement in the two groups were higher than those before intervention (all P<0.05), the scores in the observation group were (17.62±3.15) points, (13.95±3.24) points, and (21.66±4.34) points, respectively, and the scores in the control group were (15.56±3.03) points, (12.07±3.12) points, and (19.30±3.94) points, respectively, with statistically significant differences (t=3.178, 2.819, and 2.714; P=0.002, 0.007, and 0.008). After intervention, the scores of motor ability, verbal ability, physical ability, and human ability of the two groups were higher than those before intervention (all P<0.05), the scores of the observation group were (85.87±3.68) points, (85.84±5.57) points, (81.54±7.13) points, and (84.56±6.81) points, respectively, and those of the control group were (83.46±3.70) points, (83.21±5.36) points, (75.37±7.22) points, and (81.01±6.73) points, respectively, with statistically significant differences (t=3.115, 2.294, 4.102, and 2.501; P=0.002, 0.024, <0.001, and 0.014). After intervention, the scores of verbal behavior and daily living ability of the two groups were higher than those before intervention (both P<0.05), and the scores of verbal behavior and daily living ability of the observation group were (42.26±5.63) points and (75.69±5.56) points, which were higher than those of the control group [(38.97±5.54) points and (72.39±5.37) points], with statistically significant differences (t=2.809 and 2.879, P=0.006 and 0.005). Conclusion　Multi-sensory stimulation combined with repetitive transcranial magnetic stimulation has better therapeutic effect in the treatment of children with language development delay/disorder, has higher oral motor score, developmental quotient, and verbal behavior score, and better daily living ability.

Analysis of the effect of non-invasive sputum aspiration combined with acetylcysteine on children with bronchopneumonia

Zhou Ranran, Pu Haibo, Wang Yuan

2023, 29(19):  2688-2692.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.006

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To observe the effect of noninvasive sputum aspiration combined with acetylcysteine on children with bronchopneumonia and its effect in improving clinical symptoms and inflammation. Methods　In this study, 136 children with bronchopneumonia admitted to the First Affiliated Hospital of Nanyang Medical College from January 2021 to June 2022 were selected as the research objects, and they were randomly divided into two groups by lottery, 68 cases in each group. In the control group, 35 boys and 33 girls, aged (4.96±1.05) years, with a duration of disease of (1.45±0.21) d, were treated with conventional treatment plus aerosol inhalation of acetylcysteine. In the observation group, 38 boys and 30 girls, aged (4.24±1.36) years, with a duration of disease of (1.57±0.45) d, were treated with noninvasive sputum aspiration combined with conventional treatment and aerosol inhalation of acetylcysteine. The symptom improvement, inflammation, pulmonary arterial blood gas, and immunity were compared between the two groups. Independent sample t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the inflammatory indexes, arterial blood gas indexes, and immune function indexes between the two groups (all P>0.05). After treatment, the cough relief time, fever remission time, lung rale disappearance time, and asthma disappearance time of the observation group were (5.24±1.23) d, (1.45±0.27) d, (4.24±1.25) d, and (1.88±0.27) d, respectively, which were shorter than (6.77±1.36) d, (2.06±0.77) d, (5.37±1.82) d, and (2.46±0.85) d in the control group, with statistically significant differences (t=6.880, 6.165, 4.220, and 5.363; all P<0.001). After treatment, the C-reactive protein, interleukin-6, procalcitonin, arterial partial pressure of oxygen, blood oxygen saturation, and partial pressure of carbon dioxide in the observation group were (7.44±2.32) mg/L, (112.25±20.18) ng/L, (0.82±0.23) µg/L, (70.25±10.44) mmHg (1 mmHg = 0.133 kPa), (95.77±5.36)%, (45.25±10.33) mmHg, and those in the control group were (9.15±2.48) mg/L, (127.42±20.62) ng/L, (1.16±0.47) µg/L, (64.41±10.82) mmHg, (92.31±5.11)%, and (51.77±10.46) mmHg, with statistically significant differences (t=4.152, 4.336, 5.358, 3.287, 3.853, and 3.657; all P<0.001). After treatment, the immunoglobulin E (IgE), IgG, and respiratory rate of the observation group were (62.35±10.33) g/L, (14.35±5.14) g/L, and (22.37±2.49) times/min, those in the control group were (71.34±10.25) g/L, (17.27±5.17) g/L, and (24.48±2.16) times/min, with statistically significant differences (t=5.094, 3.303, and 5.279; all P<0.05). Conclusion　Noninvasive sputum aspiration combined with aerosol inhalation of acetylcysteine can promote the recovery of symptoms in children, and has positive significance in improving the inflammatory response, arterial blood gas indexes, and immunity.

Effect of cyclic adenosine glucosamine on viral myocarditis in children and its influence on the recovery of cardiac function

2023, 29(19):  2692-2696.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.007

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Objective　To observe the effect of cyclic adenosine glucosamine on viral myocarditis in children and its influence on the recovery of cardiac function. Methods　This article was a prospective study. A total of 119 children with viral myocarditis in the First Affiliated Hospital of Nanyang Medical College from January 2021 to December 2022 were divided into an observation group (60 cases) and a control group (59 cases) by the random number table method. In the control group, 34 males and 25 females, aged (9.02±2.17) years, were given routine treatment; in the observation group, 32 males and 28 females, aged (9.25±2.23) years, were treated with cyclic adenosine glucosamine combined with routine treatment. The improvement of immune function, myocardial injury markers, and cardiac function indexes before and after treatment were compared between the two groups, and the occurrence of drug-related adverse reactions after treatment was statistically analyzed and compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　Before treatment, there were no statistically significant differences in the immune function, myocardial injury markers, and cardiac function indicators between the two groups (all P>0.05). After treatment, the CD3, CD4, and CD8 in the observation group were (65.77±10.26)%, (43.39±10.11)%, and (30.15±5.28)%, which were higher than those in the control group [(58.24±10.16)%, (37.88±10.21)% and (27.66±5.19)%], with statistically significant differences (t=4.022, 2.958, and 2.594; all P<0.05). After treatment, the levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase in the observation group were (42.33±10.15) U/L, (43.15±10.61) U/L, and (85.22±10.17) U/L, respectively, which were lower than those in the control group [(49.25±10.27) U/L, (50.44±10.22) U/L, and (91.22±10.46) U/L], with statistically significant differences (t=3.697, 3.816, and 3.173; all P<0.05). After treatment, the cardiac index of the observation group was (3.37±0.88) L/(min·m²), the ventricular short axis shortening fraction was (38.25±8.41)%, and the ejection fraction was (66.78±10.62)%, which were higher than those in the control group [(2.72±0.65) L/(min·m²), (33.41±8.26)%, and (60.32±10.27)%], with statistically significant differences (t=4.577, 3.167, and 3.372; all P<0.05). After treatment, the total incidence of drug-related adverse reactions in the observation group was 8.33% (5/60), which was slightly higher than that in the control group [6.78% (4/59)], without statistically significant difference (χ²=0.172, P=0.678). Conclusion　The combination of cyclic adenosine glucosamine and routine treatment can effectively improve the immune function and alleviate the myocardial injury in children with viral myocarditis, and has a positive effect on promoting the recovery of cardiac function in children but does not significantly increase the risk of adverse reactions.

Clinical effect of Miya cupping combined with conventional symptomatic treatment on children with exogenous fever

Zhang Xiaochun, Chen Li, Zheng Shanzhen, Chen Feng, Wang Haiyan, Li Zhiya

2023, 29(19):  2697-2701.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.008

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Objective　To investigate the clinical effect of Miya cupping combined with conventional symptomatic treatment in children with exogenous fever. Methods　This study was a randomized controlled trial. A total of 208 children with exogenous fever admitted to the fever clinic of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2021 to June 2022 were selected, including 120 boys and 88 girls, aged 1.5-8.0 years. The children were divided into an experimental group and a control group using a simple random method, with 104 cases in each group. The control group adopted conventional symptomatic treatment, and the experimental group was given Miya cupping on the basis of conventional symptomatic treatment. The cooling efficacy and traditional Chinese Medicine (TCM) syndrome score of the two groups were compared. χ² test, independent sample t test, paired t test, repeated measure ANOVA, and rank sum test were used. Results　One case was withdrawn from each of the experimental group and the control group, and 103 cases were finally included in each group for analysis. Before treatment, the body temperatures of the two groups were higher than normal, and there were no statistically significant differences in the body temperature and TCM syndrome score between the two groups (all P>0.05). At 30 min, 1 h, 2 h, 4 h, and 6 h after treatment, the body temperatures of the experimental groups were (37.91±0.68) ℃, (37.64±0.58) ℃, (37.30±0.44) ℃, (36.97±0.32) ℃, and (36.89±0.30) ℃, respectively, those of the control group were (38.38±0.54) ℃, (38.15±0.45) ℃, (37.72±0.38) ℃, (37.39±0.28) ℃, and (37.20±0.23) ℃, respectively, and repeated measurement ANOVA showed that there was a statistically significant difference in the body temperature between the two groups (F=289.244, P<0.001). At 6 h after treatment, the effective rate of cooling was 99.0% (102/103) in the experimental group and 92.2% (95/103) in the control group, with a statistically significant difference between the two groups (χ²=5.693, P=0.017). The scores of fever, chills, red pharynx, nasal congestion, runny nose, cough, headache, and thirst in the experimental group were lower than those in the control group (all P<0.05). Conclusion　Conventional symptomatic treatment combined with Miya cupping in the treatment of children with exogenous fever can effectively improve the clinical symptoms of fever, chills, red pharynx, nasal congestion, runny nose, cough, headache, and thirst, which has good efficacy and safety.

Risk prediction of neonatal hyperbilirubinemia complicated with brain injury using Nomogram model

Chen Bingying, Zhang Rui, Zhang Hongri

2023, 29(19):  2702-2707.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.009

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Objective　To explore the risk factors of neonatal hyperbilirubinemia (NHB) complicated with brain injury and establish a Nomogram model for its risk prediction. Methods　A total of 133 children with NHB admitted to the First People's Hospital of Shangqiu City from February 2021 to February 2023 were selected as the research objects for a prospective study, including 77 boys and 56 girls, with a gestational age of (39.07±1.24) weeks and an age of (4.55±0.73) days old. They were divided into a brain injury group (25 cases) and a non-brain injury group (108 cases) based on whether they were complicated with brain injury or not. The clinical data of the two groups were compared. Univariate analysis (independent sample t test and χ² test) and multivariate logistic regression analysis were used to screen the influencing factors for brain injury in children with NHB, and R software was used to further construct the Nomogram model. Receiver operating characteristic curve (ROC) and calibration curve were used to verify the predictive efficacy of the model, and decision curve analysis (DCA) was used to evaluate the clinical net benefit of the model. Results　Among the 133 cases of NHB, 25 cases were complicated with brain injury, with an incidence of 18.80% (25/133). The results of multivariate logistic regression analysis showed that preterm birth, duration of NHB, serum unconnect bilirubin (UCB) level, bilirubin/albumin (B/A) level, bilirubine induced neurological dysfunction (BIND) score, and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency were all independent risk factors for brain injury in NHB children (OR=2.798, 3.525, 4.563, 5.496, 3.800, and 3.963; all P<0.05). A Nomogram model was established based on the results of multivariate logistic regression analysis. The concordance index (C-index) of the verified prediction model was 0.875, the calibration curve was well fitted to the ideal curve, the area under ROC curve (AUC) was 0.835, the sensitivity was 88.00%, and the specificity was 73.15%. DCA evaluated the clinical application value of the model, and the results showed that the model had a high net benefit value when the threshold probability was in the range of 3% to 100%. Conclusions　Premature birth, duration of NHB, serum UCB level, serum B/A level, BIND score, and G-6-PD deficiency are independent risk factors for brain injury in children with NHB. The Nomogram model constructed on this basis has good predictive power and clinical application value.

Application effect of Standardized SBAR communication model combined with diversified nursing in children with thrombocytopenic purpura

Dong Xinyuan, Li Jinxia

2023, 29(19):  2708-2712.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.010

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Objective　To evaluate the application effect of standardized SBAR (situation, background, assessment, and recommendation) communication model combined with diversified nursing in children with thrombocytopenic purpura (ITP). Methods　The data of 88 children with ITP admitted to Children's Hospital Affiliated to Zhengzhou University from August 2020 to August 2022 were retrospectively analyzed. They were divided into two groups according to different nursing methods. In the control group, there were 26 boys and 18 girls, aged (9.59±1.04) years, with a body mass index of (22.21±0.34) kg/m²; there were 15 males and 29 females of the family members, aged (34.21±1.25) years, with years of education of (10.08±1.05) years. In the observation group, there were 25 boys and 19 girls, aged (9.56±1.02) years, with a body mass index of (22.19±0.32) kg/m²; there were 12 males and 32 females of the family members, aged (34.19±1.23) years, with years of education of (10.05±1.03) years. The control group took routine nursing, while the observation group implemented SBAR communication model combined with diversified nursing. Both groups received continuous nursing until the children were discharged, and the children were followed up for 1 month. The two groups were compared in terms of medical compliance, coagulation function, family members' mastery condition of health knowledge, incidence of adverse events, quality of life, and family satisfaction degree. t test and χ² test were used. Results　The medical compliance rate of the observation group was 95.45% (42/44), which was higher than that of the control group [79.55% (35/44)], with a statistically significant difference (χ²=5.091, P=0.024). After nursing, the platelet count in the observation group was (224.87±21.46)×10⁹/L, the mean platelet volume was (9.19±0.53) fl, and the hemoglobin was (152.29±5.42) g/L, which were higher than those in the control group [(179.95±21.42)×10⁹/L, (7.04±0.42) fl, and (134.67±5.39) g/L], with statistically significant differences (t=9.827, 21.089, and 15.290; all P<0.05). After nursing, the scores of disease monitoring, diet guidance, complication prevention, medication guidance, and health care knowledge of family members' mastery condition of health knowledge in the observation group were (12.25±1.05), (12.33±1.14), (12.47±1.09), (12.28±1.18), and (12.27±1.05) points, respectively, and the total score was (62.35±3.16) points, which were higher than those in the control group [(8.98±1.02), (9.02±1.08), (8.76±1.06), (9.92±1.15), (8.99±1.02), and (42.79±3.12) points], with statistically significant differences (t=14.817, 13.982, 16.186, 9.501, 14.863, and 29.217; all P<0.05). The incidence of adverse events in the observation group was 6.82%, lower than 22.73% in the control group (χ²=4.423, P=0.035). After nursing, the scores of sleep [(23.37±2.46) points], energy [(18.69±2.63) points], loneliness [(21.14±2.09) points], physical activity [(14.35±1.10) points], and mood [(22.38±2.14) points] of the Nottingham Health Profile (NHP) in the observation group were all lower than those in the control group [(28.68±2.50), (26.37±2.69), (26.67±2.15), (17.63±1.16), and (27.24±2.19) points] (t=10.043, 13.541, 12.234, 13.610, and 10.528; all P<0.05). The satisfaction rate of family members in the observation group was 95.45% (42/44), which was higher than that in the control group [81.82% (36/44)], with a statistically significant difference (χ²=4.062, P=0.044). Conclusion　SBAR communication model combined with diversified nursing can improve the medical compliance of ITP children, improve the children's blood coagulation function, enhance the family members' health knowledge mastery, reduce the occurrence rate of adverse events, promote the improvement of quality of life, and thus obtain higher family satisfaction degree.

Labeling of children's medication in commonly used pediatric drug manuals

Qiu Xiaowen, Bi Tingting, Huang Yuhui, He Dahua

2023, 29(19):  2713-2716.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.011

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Objective　To investigate the labeling of children's medication in commonly used pediatric drug manuals, analyze the existing problems, and provide reference for standardizing the rational use of medication in clinical pediatrics. Methods　Statistical analysis was made on the part of children's medication in the instructions of 269 kinds of drugs commonly used in Department of Pediatrics, Guangdong Maternal and Child Health Hospital, and the labeling of children's medication was compared according to the type of basic drugs, dosage forms, and domestic and foreign drugs. χ² test was used. Results　The complete labeling rate of children's drugs in the instructions of commonly used drugs in our hospital was only 42.00% (113/269), including 36.81% (53/144) of basic drugs and 48.00% (60/125) of non-basic drugs, 39.58% (57/144) of oral drugs, 59.15% (42/71) of injectable drugs, and 13.04% (6/46) of topical drugs, 35.94% (78/217) of domestic drugs and 67.31% (35/52) of foreign-related drugs. There was a statistically significant difference in the children's medication precautions between basic drugs and non-basic drugs (χ²=6.371,P=0.012). The remaining 3 dosage forms (injectable, oral, and topical drugs) were compared. The results showed that there were statistically significant differences in the dosage, complete medication information, and lack of labeling rate (no dose and no description of children's precautions) among the 3 dosage forms (χ²=12.240, 24.740, and 26.249; all P<0.05). There was no statistically significant difference in the children's medication precautions among the 3 dosage forms (P>0.05). Domestic drugs had higher children's medication precautions than foreign-related drugs, and the completeness of drug use information was lower than that of foreign-related drugs, with statistically significant differences (χ²=4.276 and 16.937, both P<0.05). The lack of labeling of domestic drugs was as high as 24.42%. Conclusions　At present, the labeling rate of children's drug items in the clinical children's drug instructions in our hospital is low, which leads to the common off-label use in clinical pediatrics. The children's drug instructions of basic drugs, external agents, and domestic drugs should be improved.

Application effect of nursing intervention model based on Omaha system in children with hypospadias

Shao Jingna, Qu Yanying, Li Ying

2023, 29(19):  2716-2719.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.012

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Objective　To explore the role of Omaha system-based nursing in children with hypospadias. Methods　The clinical data of 92 children with hypospadias admitted to Children's Hospital Affiliated to Zhengzhou University from May 2019 to May 2022 were retrospectively analyzed. According to the different nursing methods, they were divided into a control group (46 cases) and an observation group (46 cases). The control group was (8.91±1.19) years old and received routine nursing. The observation group was (8.95±1.23) years old and received Omaha system-based nursing. The nursing intervention lasted until the children were discharged from hospital. The postoperative rehabilitation condition, pain degree, occurrence rate of complications, and nursing satisfaction degree were compared between the two groups. χ² test and t test were used. Results　The first defecation time [(30.49±3.27) h], urinary catheter removal time [(8.64±2.06) d], and length of hospital stay [(11.35±2.19) d] in the observation group were shorter than those in the control group [(43.68±5.21) h, (10.52±2.13) d, and (14.85±2.32) d], with statistically significant differences (t=14.543, 4.303, and 7.441; all P<0.001). The Visual Analogue Scale (VAS) score of the observation group [(1.59±0.21) points] was lower than that of the control group [(2.79±0.24) points] after intervention, with a statistically significant difference (t=25.521, P<0.05). The incidence of complications in the observation group [4.35% (2/46)] was lower than that in the control group [17.39% (8/46)], with a statistically significant difference (χ²=4.039, P<0.05). The nursing satisfaction of the observation group [95.65% (44/46)] was higher than that of the control group [82.61% (38/46)], with a statistically significant difference (χ²=4.039, P<0.05). Conclusion　The nursing intervention model based on Omaha system for children with hypospadias can promote their postoperative rehabilitation, decrease the postoperative pain degree, reduce the occurrence risk of complications, and thus improve the nursing satisfaction degree.

New Medical Advances

Research progress on the role of β -adrenergic receptor in tumor immunomodulation

Qin Mei, Yuan Xiaoli, Mi Tingtong, Wang Zhenbo

2023, 29(19):  2720-2723.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.013

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Immunotherapy is a new anti-tumor therapy, but due to the existence of immunosuppression, some immunotherapy patients have immune resistance. Immunomodulators are one of the important ways to overcome and delay the immune resistance. At present, the methods of improving immunotherapy mainly include activating immune costimulatory signals, blocking co-immunosuppressive signals, regulating tumor microenvironment, and targeting T cell activation. More and more clinical studies have showed that there is a relationship between β -adrenergic signal-mediated stress and tumor immunity. β -adrenergic receptors are widely expressed on the surface of immune cells related to immunity, and are regulated by their corresponding neurotransmitters, thus affecting the immune response of tumors. It is found that inhibiting β -adrenergic receptor, especially β2- adrenergic receptor, can significantly improve the tumor immune microenvironment and enhance the efficacy of immunotherapy such as checkpoint inhibitors and tumor vaccines. This paper reviews the research progress of immunoregulation of β -adrenergic receptor.

Research progress in chronic liver disease and iron metabolism

Ma Xiaoying, Yang Juan, Zheng Sheng

2023, 29(19):  2724-2727.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.014

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Chronic liver diseases include alcoholic fatty liver, non-alcoholic fatty liver, chronic viral hepatitis B, chronic liver failure, cirrhosis, liver cancer, etc. Liver is an important synthesis, metabolism, and storage organ of iron metabolism. When liver lesions occur, iron metabolism will be impeded, affecting the occurrence and development of various chronic liver diseases. This article reviews the characteristics of iron metabolism in different types of chronic liver diseases.

Sepsis and neutrophil function

Yang Xueyuan, Hao Dong

2023, 29(19):  2728-2732.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.015

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Sepsis is a series of life-threatening organ disorders caused by dysregulated host responses to infections. Neutrophils are the most abundant type of white blood cells, which are the first line of defense of the host against invaded pathogens. Under the action of chemokines, neutrophils are recruited to the site of infection to eradicate the pathogens through phagocytosis, degranulation, production of reactive oxygen species (ROS) and cytokines, and formation of neutrophil extracellular traps (NETs). Overactivation of neutrophils under the inflammatory state may induce unnecessary tissue damage and organ dysfunction. Neutrophil function is impaired to varying degrees during sepsis, so assessing the pathophysiology that how sepsis affects neutrophil function help to identify new strategies for sepsis treatment.

Research progress on the mechanism of sulforaphane in the treatment of digestive system tumors

An Jiaqi, Xie Qingzhi

2023, 29(19):  2732-2736.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.016

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The mortality rate of digestive system cancer is among the highest in the world. Traditional treatment methods, including surgery, chemotherapy, and radiotherapy, have the disadvantages of poor efficacy and drug resistance. In recent years, sulforaphane, as a natural anti-tumor compound, has been widely studied in digestive system tumors. It can treat cancer by promoting cancer cell death, hindering cancer cell proliferation, inhibiting cancer cell invasion and metastasis, anti-angiogenesis, strengthening immunotherapy, and weakening drug resistance. This article reviews the research progress of sulforaphane in the treatment of digestive system tumors in domestic and foreign research institutions, so as to provide new ideas for the treatment of digestive system tumors.

Scientific Research

Application of network pharmacology to elucidate the potential mechanism of Astragalus - Scutellaria barbata D.Don (SBD) against colorectal cancer

Li Jingchun, Long Qixiong, Feng Feng, Sun Wei

2023, 29(19):  2737-2745..  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.017

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Objective　To explore the effective components and molecular mechanism of Astragalus - Scutellaria barbata D.Don (SBD) in the treatment of colorectal cancer based on network pharmacology analysis methods. Methods　The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) was used to search for the effective components and targets of action of Astragalus and SBD. Colorectal cancer related targets were screened through databases such as GeneCards. A drug component potential target network relationship diagram was constructed using Cytoscape (Version 3.9.1) software. A protein-protein interaction (PPI) network diagram was built through the String database platform, and the functional and signal pathway enrichment analysis on potential targets were performed by the Metascape database. Results　Through database screening, 17 active components of Astragalus and 28 active components of SBD were identified. A total of 24 potential protein targets were intersected between Astragalus-SBD and colorectal cancer targets. The gene ontology (GO) enrichment analysis showed that Astragalus-SBD was mainly related to biological functions such as DNA damage, cell apoptosis, and enzyme activity regulation. The Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that the main pathways included PI3K/AKT signaling pathway, mitogen activated protein kinase (MAPK) signaling pathway, tumor necrosis factor (TNF) signaling pathway, etc. Conclusions　The effective ingredients and potential mechanism of Astragalus-SBD in the treatment of colorectal cancer are reflected through network pharmacology analysis methods. It may intervene in colorectal cancer through multiple components, targets, and pathways, providing a theoretical basis for the treatment of colorectal cancer with Astragalus-SBD.

Efficacy of telmisartan combined with conventional anticoagulant therapy in AMI patients with hypertension

Feng Hongya

2023, 29(19):  2745-2749.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.018

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Objective　To observe the effect of telmisartan combined with conventional anticoagulant therapy on improving clinical features and cardiac function in patients with acute myocardial infarction (AMI) and hypertension. Methods　This was a randomized controlled trial. A total of 123 AMI patients with hypertension admitted to Nanyang First People's Hospital from January 2021 to February 2023 were divided into two groups by the random number table method, with 62 cases in the observation group and 61 cases in the control group. In the observation group, there were 32 males and 30 females, aged (60.44±5.27) years. In the control group, there were 33 males and 28 females, aged (61.25±5.16) years. The control group only received conventional anticoagulation treatment, and the observation group received telmisartan combined with conventional anticoagulation treatment. The changes in blood pressure levels, cardiovascular endothelial function, and cardiac function indicators before and after treatment and medication safety were compared between the two groups. χ² test and t test were used. Results　After treatment, the systolic blood pressure and diastolic blood pressure in the observation group were (115.25±20.33) mmHg (1 mmHg = 0.133 kPa) and (80.25±10.61) mmHg, which were both lower than those in the control group [(130.27±20.16) mmHg and (87.62±10.24) mmHg], with statistically significant differences (both P<0.05). After treatment, the blood flow mediated vasodilation (FMD) of the observation group was (12.21±3.16)%, and the nitroglycerin mediated vasodilation (NMD) was (9.44±2.16)%, which were both higher than those of the control group [(10.45±3.28)% and (8.76±2.15)%]; the pulse wave velocity (PWV) was (10.33±3.26) m/s, which was lower than that of the control group [(12.28±3.15) m/s], with statistically significant differences (all P<0.05). After treatment, the left ventricular ejection fraction (LVEF) of the observation group was (55.25±10.27)%, which was higher than that of the control group [(49.36±10.27)%]; the left ventricular end-diastolic diameter (LVDD) was (40.33±10.27) mm, and the left ventricular posterior wall thickness (LVPW) was (9.52±3.46) mm, which were lower than those of the control group [(46.62±10.31) mm and (11.45±3.46) mm], with statistically significant differences (all P<0.05). After treatment, the incidence of drug-related adverse reactions in the observation group was 6.45% (4/62), which was slightly higher than that in the control group [4.92% (3/61)], with no statistically significant difference (P>0.05). Conclusions　Telmisartan combined with conventional anticoagulant therapy can lower the blood pressure level in patients with AMI and hypertension, and has positive significance in improving their cardiovascular endothelial function and cardiac function. The combined use of this drug does not significantly increase the risk of drug-related adverse reactions in patients, with high safety.

Effect of mediating TGF-β1 - PI3K/AKT signaling pathway on proliferation and stemness features of osteosarcoma cells

Ma Kun, Zhang Chuan

2023, 29(19):  2750-2756.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.019

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Objective　To investigate the role of transforming growth factor-β1 (TGF-β1) in malignant proliferation and stemness features of osteosarcoma MG-63 cells and possible mechanism. Methods　The study ran from June to December 2021. Overexpression and knockdown of TGF-β1 in osteosarcoma cell lines was performed using lentiviral vector- TGF-β1 (Lv-TGF-β1) and siRNA- TGF-β1 (si- TGF-β1), respectively. Reverse transcription-polymerase chain reaction (qRT-PCR) and Western blotting were used to defect the siRNA interference efficiency. The clone formation assay and methyl thiazolyl tetrazolium (MTT) assay were used to investigate the proliferation of osteosarcoma MG-63 cells. The flow cytometry was used to detect the ratio of CD133 positive cancer stem cells (CSCs). Mammosphere-formation assay was used to determine the self-renewal ability. Apoptosis and stemness-related proteins were detected by Western blotting. t test was used for comparison between groups. Results　Compared with normal human hFOB1.19 osteoblasts, TGF-β1 increased in the osteosarcoma cell lines to varying degrees. Among which, the U2OS cells had the highest degree of upregulation (t=8.76, P<0.05), and the MG-63 cells had the least degree of upregulation (t=4.33, P<0.05). Therefore, the U2OS cells were used for gene silencing experiments, and the MG-63 cells were used for gene overexpression experiments. qRT-PCR and Western blotting experiments showed that si-TGF-β1#1 had the highest gene silencing efficiency (t=10.88, P<0.05). Therefore, si-TGF-β1#1 was used in subsequent experiments. The results of MTT assay and flow cytometry showed that the cell viability of osteosarcoma cells decreased significantly and the apoptosis increased after TGF-β1 expression was inhibited; overexpression of TGF-β1 increased the cell viability and decreased the apoptosis. Inhibition of TGF-β1 expression significantly reduced the microsphere-forming ability of osteosarcoma cells (t=6.88, P<0.05) and the proportion of CD133-positive cells (t=9.37, P<0.05). Conversely, overexpression of TGF-β1 enhanced the stemness expression of osteosarcoma stem cells. Meanwhile, in vivo experiments in nude mice also confirmed that Lv-TGF-β1 could expand the volume and weight of tumors. On the contrary, after si-TGF-β1 pretreatment, the tumor volume and weight of tumors were decreased (t=9.27, P<0.05). Conclusions　TGF-β1 plays an oncogenic role in osteosarcoma. TGF-β1 enhances the malignant proliferation and stemness features of osteosarcoma cells, and the mechanism of action may be related to phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway.

Relationship between the severity of renocardiac syndrome and serum BNP and FGF-23 levels

Lyu Jie, Zhang Jingjing, Xu Yaguang, Liu Lu, Jiang Qianqian

2023, 29(19):  2757-2761.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.020

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Objective　To investigate the relationship between the severity of renocardiac syndrome and serum levels of brain natriuretic peptide (BNP) and fibroblast growth factor 23 (FGF-23). Methods　A total of 60 patients with renocardiac syndrome admitted to Liaocheng Second People's Hospital from January 2021 to March 2023 were selected as the observation group, and 25 healthy individuals who underwent physical examination during the same period as the control group and 15 patients with chronic kidney disease as the chronic kidney disease group. In the observation group, there were 33 males and 27 females, aged (68.79±8.58) years. In the control group, there were 13 males and 12 females, aged (69.48±8.11) years. In the chronic kidney disease group, there were 9 males and 6 females, aged (70.12±8.09) years. Serum BNP and FGF-23 levels were detected and compared among the 3 groups by variance analysis, and the values of serum BNP and FGF-23 levels in predicting the severity of renocardiac syndrome were analyzed by receiver operating characteristic curve (ROC). Serum levels of BNP and FGF-23 were compared in patients with renocardiac syndrome with different cardiac function grading and renal function grading by variance analysis, and the correlations between serum BNP and FGF-23 levels and renal function grading and cardiac function grading were analyzed by Spearman rank correlation analysis. Results　Serum levels of BNP and FGF-23 [(456.48±64.48) mmol/L and (61.15±5.15) ng/L] in the observation group were higher than those in the chronic kidney disease group [(248.89±54.47) mmol/L and (47.48±4.78) ng/L] and the control group [(75.52±10.45) mmol/L and (30.44±4.49) ng/L], with statistically significant differences (F=448.625 and 346.409, both P<0.001). ROC analysis confirmed that serum levels of BNP and FGF-23 could predict the severity of renocardiac syndrome, with the areas under the curve of 0.690 and 0.941 (both P<0.05). Serum levels of BNP and FGF-23 [(346.48±34.14) mmol/L and (68.14±5.46) ng/L] in the patients with grade Ⅱ cardiac function were significantly lower than those in the patients with grade Ⅲ cardiac function [(651.15±86.15) mmol/L and (72.18±6.48) ng/L] and grade Ⅳ cardiac function [(819.15±94.58) mmol/L and (81.15±6.79) ng/L], with statistically significant differences (F=180.981 and 19.070, both P<0.001). Serum levels of BNP and FGF-23 [(348.48±32.45) mmol/L, (68.45±5.48) ng/L] in the patients with stage I renal function were significantly lower than those in the patients with stage II renal function [(456.18±45.15) mmol/L and (74.45±6.15) ng/L], stage III renal function [(784.15±56.15) mmol/L and (78.15±6.89) ng/L], and stage IV renal function [(826.45±64.15) mmol/L and (86.15±6.89) ng/L], with statistically significant differences (F=327.325 and 20.322, both P<0.001). Serum levels of BNP and FGF-23 were positively correlated with renal function grading and cardiac function grading (all P<0.05). Conclusions　Serum levels of BNP and FGF-23 are positively correlated with renal function grading and cardiac function grading in patients with renocardiac syndrome. Clinicians should closely monitor these indicators to predict the occurrence and progression of the disease.

Predictive value of monitoring the change of serum HBV RNA level for the relapse of CHB after withdrawal of NAs

Liu Hong, Wang Pengyan, Liu Youde

2023, 29(19):  2762-2766.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.021

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Objective　To explore the value of serum hepatitis B virus RNA (HBV RNA) level in predicting the relapse of chronic hepatitis B (CHB) after withdrawal of nucleoside (acid) drugs (NAs) antiviral treatment. Methods　A total of 160 patients with CHB who were treated in Yantai Qishan Hospital from January 2017 to January 2021 were selected, including 105 males and 55 females, with an age of (43.32±8.81) years old, all of whom received NAs antiviral treatment and met the drug withdrawal criteria. The patients' relapse after drug withdrawal was followed up, and the differences in the clinical data and HBV RNA between the patients with and without relapse after drug withdrawal were analyzed. t test and χ² test were used to analyze the differences in indicators between groups. Logistic regression analysis was used for multivariate analysis of risk factors of relapse after drug withdrawal, and the predictive value was analyzed by the receiver operating characteristic curve (ROC). Results　Followed up until February 2023, 46 patients had relapse after drug withdrawal, with a relapse rate of 28.75% (46/160). The age, rate of diabetes, baseline HBV DNA, baseline HBV RNA, and HBV RNA at the time of drug withdrawal in the relapse patients after drug withdrawal were (45.58±9.23) years old, 45.65% (21/46), (7.10±1.10) log copies/ml, (6.30±1.02) log copies/ml, and (2.40±0.87) log copies/ml, respectively, which were significantly higher than those in the patients without relapse after drug withdrawal [(40.12±9.11) years old, 19.30% (22/114), (6.15±1.03) log copies/ml, (5.17±1.00) log copies/ml, and (1.93±0.81) log copies/ml], with statistically significant differences (all P<0.05). Logistic regression analysis showed that age, diabetes, and HBV RNA at the time of drug withdrawal were the influencing factors for relapse in CHB patients after drug withdrawal (OR=1.939, 2.667, and 3.102; all P<0.05). The area under the curve of HBV RNA at the time of drug withdrawal predicting relapse in CHB patients after drug withdrawal was 0.777 (95%CI 0.706-0.849, P<0.05), the cutoff value was 1.61 log copies/ml, and the sensitivity and specificity were 88.50% and 54.80%, respectively. There were no statistically significant differences in the hepatitis B virus e antigen (HBeAg) negative, HBV DNA negative, and HBV RNA negative rates in the HBeAg positive relapsed and non-relapsed patients after treatment for 24 weeks, 48 weeks, and 72 weeks (all P>0.05). HBV DNA conversion was faster, while HBeAg and HBV RNA conversion was slower and more synchronous. Conclusion　The level of HBV RNA at the time of drug withdrawal is related to the relapse of CHB patients after NAs drug withdrawal, which has certain application value in predicting the relapse after drug withdrawal.

Research on the prevention of abdominal distension after cesarean section by traditional Chinese medicine external treatment technology

Su Jing, Wu Jianmei, Chen Yijuan, Yang Kun, Zhong Yan

2023, 29(19):  2767-2770.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.022

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Objective　To explore the prevention of abdominal distension after cesarean section based on traditional Chinese medicine (TCM) external treatment technology. Methods　A total of 1 000 cases of cesarean section in Xindu District Maternal and Child Health Hospital from May 2020 to September 2021 were numbered according to the order of treatment, and were randomly grouped by SPSS software, who were divided into a control group and a treatment group with 500 cases in each group. The control group was (28.26±3.95) years old, and the treatment group was (29.30±4.28) years old. The control group was given contractions, fluid supplementation, turning over, and other conventional treatment, and the treatment group was added with fennel heat package on the basis of conventional treatment. The safety and efficacy of intervention were compared between the two groups, and the gastrointestinal function of the effective parturients was followed up. t test and χ² test were used. Results　There were no systemic reactions or local skin adverse reactions in the two groups after treatment intervention. The postoperative bowel sound recovery time [(15.47±2.14) h], the first anal exhaust time [(17.32±2.75) h], and the first defecation time [(50.12±4.62) h] in the treatment group were shorter than those in the control group [(21.25±2.32) h, (25.75±2.78) h, and (58.64±5.55) h], and the abdominal distension score [(1.35±0.63) points] and TCM syndrome efficacy score of gastrointestinal diseases [(7.39±2.59) points] were significantly lower than those in the control group [(3.20±0.74) points and (19.64±4.16) points], with statistically significant differences (t=41.434, 49.168, 26.326, 43.886, and 55.294; all P<0.05). The incidence of complications in the treatment group [0.00% (0/500)] was significantly lower than that in the control group [1.40% (7/500)], with a statistically significant difference (χ²=7.049, P=0.008). The length of hospital stay in the treatment group was (3.9±0.7) d, which was significantly shorter than that in the control group [(7.2±1.4) d], with a statistically significant difference (t=47.143, P<0.001). Follow-up showed that the treatment effects in the effective parturients of the two groups were good, and there was no recurrence or adverse reactions. Conclusion　Based on TCM external treatment technology, the use of TCM heat package to prevent abdominal distension after cesarean section has significant therapeutic effect and high safety, and can shorten the parturients' length of hospital stay and save the costs, which is worthy of promotion.

Basic Research

Effects of curcumin on the levels of MMP-9 in cerebrospinal fluid and plasma and the permeability of blood-brain barrier in rats with chronic medial temporal lobe epilepsy

Guo Caifeng, Tan Yan, Zhang Yuefeng, Zhou Huarong, Chen Guohua, Fang Yaxiu, Lan Xiaofeng

2023, 29(19):  2771-2775.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.023

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Objective　To investigate the effects of curcumin on the levels of matrix metalloproteinase (MMP)-9 in cerebrospinal fluid (CSF) and plasma and the permeability of blood-brain barrier in rats with chronic medial temporal lobe epilepsy. Methods　The study was carried out in the Affiliated Brain Hospital of Guangzhou Medical University from February 2021 to February 2023. Among 32 rats (6-8 weeks, female, body mass 160-180 g), 17 rats were successfully constructed with the model of medial temporal lobe epilepsy. Seventeen rats with chronic medial temporal lobe epilepsy were randomly divided into a curcumin treatment group (n=9) and a normal saline treatment group (n=8). The rats in the curcumin treatment group were intraperitoneally injected with curcumin (100 mg/kg), while the rats in the normal saline treatment group were intraperitoneally injected with normal saline. The levels of albumin and MMP-9 in CSF and plasma were detected before and after intervention. t test, one-way ANOVA, and multiple comparisons after ANOVA were used. Results　The albumin quotient (ratio of CSF albumin/plasma albumin) of the rats in the curcumin treatment group decreased from (14.443±1.700) before intervention to (12.822±1.450) after intervention (P<0.05), and the level of MMP-9 in CSF decreased from (43.753±3.787) μg/L before intervention to (39.507±4.015) μg/L after intervention (P<0.05). There were no significant changes in the albumin and MMP-9 levels in CSF and plasma and the albumin quotient in the normal saline treatment group before and after intervention (all P>0.05). Conclusion　Curcumin might change the permeability of blood-brain barrier in rats with chronic medial temporal lobe epilepsy by changing the level of MMP-9 in CSF, and play a certain role in repairing the damaged blood-brain barrier.

Effect of aerobic exercise on the expression of Cry1 in ApoE^-/- mice and its anti-atherosclerotic mechanism

Cheng Jinfeng, Sun Dakang, Wang Qianqian, Li Yang, Zhen Mengmeng, Cheng Yanli

2023, 29(19):  2776-2781.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.024

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Objective　To observe the effect of aerobic exercise on the expression of aortic clock gene Cry1 in ApoE^-/- mice and explore the mechanism of its anti-atherosclerotic effect. Methods　The study was conducted from March 2022 to November 2022. Twenty-two 8-week-old male ApoE^-/- mice on a high-fat diet were randomly divided into two groups: an exercise group (n=11) and a model group (n=11). The exercise group did treadmill running for 12 weeks. Weight changes of all ApoE^-/- mice were monitored regularly (every 2 weeks). The serum levels of triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were determined by colorimetric method. The serum levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF) -α were detected by enzyme-linked immunosorbent assay (ELISA). The degrees of aortic plaque formation and lipid deposition were observed by histochemical staining. The expression of Cry1 gene in the aorta was detected by real-time PCR and immunohistochemical staining. Independent sample t test or one-way analysis of variance were used. Results　Compared with those in the model group, the body mass of the mice in the exercise group was decreased (P<0.01), the contents of LDL-C, TC, TG, IL-1β, IL-6, and TNF-α in serum were decreased (all P<0.01), the content of HDL-C was increased (P<0.01), the aortic plaque area and lipid deposition were decreased (all P<0.01), and the mRNA and protein expression levels of Cry1 gene were increased in the aorta (all P<0.01). Conclusion　Aerobic exercise increases the expression level of Cry1 in the aorta of ApoE^-/- mice, decreases the levels of serum lipids and inflammatory cytokines, and reduces the formation of atherosclerosis plaques, which suggests that the anti-atherosclerotic effect of aerobic exercise may be related to the up-regulation of Cry1 expression in the aortic wall.

Protective effect of taurine against LPS-induced liver injury in septic mice based on AKT/NF-κB pathway

Hu Yulian, An Baili, Liu Chao, Gao Huijie

2023, 29(19):  2782-2788.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.025

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Objective　To investigate the anti-inflammatory and antioxidant effects of taurine on liver injury induced by lipopolysaccharide (LPS) in septic mice and elucidate the underlying mechanisms. Methods　The study was conducted from February to July 2022. Fifty ICR mice (4-5 weeks old, body weight 18-22 g) were randomly divided into five groups: control group, LPS group, and taurine-treated groups with low, mid, and high doses (100, 200, and 400 mg/kg). Taurine was injected intraperitoneally for 7 days, and LPS was injected intraperitoneally on the 7th day to establish the sepsis model. The indices of liver, kidney, and lung were measured. Blood routine analysis was conducted. The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in the liver were determined. Serum concentrations of interleukin (IL)-1β, IL-6, and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA). The expressions of nuclear factor (NF) -κB, nuclear factor κB inhibitory protein (IκB), and protein kinase B (AKT) in the liver were detected by Western blot and immunohistochemistry (IHC). t test or one-way analysis of variance were used. Results　The taurine-treated groups exhibited significantly lower indices of liver, kidney, and lung compared with the LPS group (P<0.05, P<0.01, P<0.001). Blood routine analysis demonstrated significantly lower white blood cell count and granulocyte ratio and significantly higher lymphocyte ratio in the taurine-treated groups compared with the LPS group (P<0.05, P<0.001). The taurine-treated groups had significantly higher SOD activity and significantly lower MDA content compared with the LPS group (P<0.05, P<0.01). Moreover, ELISA results showed significantly lower levels of IL-1β and IL-6 and significantly higher level of IL-10 in the taurine-treated groups compared with the LPS group (P<0.05, P<0.01, P<0.001). Compared with the control group, the protein expressions of NF-κB and AKT increased and the protein expression of IκB decreased in the liver tissues of the LPS group. Compared with the LPS group, the protein expressions of NF-κB and AKT decreased and the expression protein of IκB increased in the low dose taurine-treated group. Conclusions　Taurine could mitigate the levels of inflammatory cytokines and enhance the antioxidant capacity of the liver in septic mice, thereby alleviating the liver damage induced by LPS. This effect may be related to the inhibition of AKT/NF-κB pathway, which contributes to its anti-inflammatory activity. These findings provide a scientific basis for the clinical application of taurine as an effective anti-inflammatory and antioxidant drug in the treatment of sepsis.

Clinical Research

Analysis of 3 cases of severe placental abruption and literature review

Jiang Mingxia, Jiang Xuguang

2023, 29(19):  2789-2793.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.026

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Objective　To explore the early diagnosis of placental abruption, and to provide reference experiences for future early diagnosis and early treatment, improving the survival rate and quality of life of maternal and perinatal infants, and effectively ensuring the maternal and infant safety. Methods　Three cases of placental abruption admitted to Yantai Laiyang Central Hospital were reviewed, and the relevant literatures were reviewed. Results　Three pregnant women had different degrees of vaginal bleeding, abdominal pain or plate abdomen upon admission, and fetal heart monitoring indicated mild baseline variant or variable disappearance, fetal bradycardia, late deceleration, abnormal contraction wave, etc. One of them developed into disseminated intravascular coagulation (DIC) and one developed into shock. After timely surgical termination of pregnancy and high-quality neonatal resuscitation, the mothers and infants were safe, and the maternal fertility was preserved. The three infants developed well during follow up, and no obvious sequelae were found. Conclusion　Correct interpretation of fetal heart monitoring is conducive to the early diagnosis of placental abruption.

Case Report

One case of ovarian cancer-associated paraneoplastic nephrotic syndrome

Gao Benxue, Li Mianli, Geng Haitao, Sun Lin

2023, 29(19):  2794-2798.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.027

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This article reported one case of ovarian cancer with paraneoplastic nephrotic syndrome (PNS) in Binzhou Medical University Hospital. The patient presented primarily with proteinuria, hematuria, and hypoalbuminemia. The positron emission tomography - computerized tomography (PET-CT) showed a mass in the left adnexa with multiple lymph node metastases in the abdominal and pelvic cavity. Lymph node biopsy pathology considered the possibility of high-grade serous carcinoma metastasis of the ovaries. Renal biopsy showed stage Ⅰ membranous nephropathy with focal globular sclerosis. After symptomatic treatment such as anti-infection, inducing diuresis to reduce edema, kidney protection, and urine protein reduction, the patient received neoadjuvant chemotherapy with paclitaxel and cisplatin for 4 cycles (paclitaxel 180 mg d1 and cisplatin 400 mg d1). There were no obvious abnormalities in blood routine and renal function tests, radical ovarian cancer was performed, and the recovery was good after surgery.

A case of eosinophilic gastroenteritis with thoracoabdominal hydrops and literature review

Cai Changhong, Liang Xiaodi

2023, 29(19):  2798-2801.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.028

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Eosinophilic gastroenteritis is a rare clinical inflammatory disease of gastrointestinal tract, with a low incidence and a variety of clinical manifestations. The symptoms are mainly digestive tract symptoms, lack of specificity, difficult diagnosis, easy to be miss diagnosed and misdiagnosed. This article aims to review the diagnosis and treatment of one case of eosinophilic gastroenteritis admitted to Weihai Central Hospital Affiliated to Qingdao University, systematically review the diagnosis and treatment of this disease, strengthen the medical staff's understanding on the disease, and reduce the missed diagnosis and misdiagnosis.

Nursing Research

Application of progressive early rehabilitation training in patients after tracheal intubation surgery

Xie Junli, Zhang Yuerong, Wang Hong

2023, 29(19):  2802-2806.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.029

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Objective　To observe the impact of progressive early rehabilitation training on the prognosis and rehabilitation outcomes in patients after tracheal intubation surgery. Methods　Eighty patients with tracheal intubation who were admitted to Lianyungang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 2021 to December 2022 were selected as the study subjects. According to the random number table method, they were divided into an observation group and a control group, with 40 patients in each group. In the control group, the ratio of male to female was 20∶20, and the age was (67.45±4.45) years old. In the observation group, the ratio of male to female was 22∶18, and the age was (67.05±4.33) years old. The control group used conventional nursing (including physical sign detection, respiratory tract care, environmental control, and rehabilitation training), while the observation group received progressive early rehabilitation training (including program development, the first stage, the second stage, and the third stage). On the day of admission and one day before discharge, the blood gas and clinical treatment indicators of the two groups were compared, and the treatment effects of the two groups were evaluated by the Functional Assessment of Cancer Therapy for Lung Cancer (FACT-L). t test and χ² test were used. Results　One day before discharge, the arterial partial pressure of carbon dioxide (PaCO₂) [(36.54±4.55) mmHg (1 mmHg=0.133 kPa)], buffuer excess (BE) [(2.79±0.79) mmol/L], and arterial partial pressure of oxygen (PaO₂) [(101.66±7.77) mmHg] of the observation group were higher than those of the control group [(34.28±4.17) mmHg, (2.33±0.71) mmol/L, and (97.88±6.99) mmHg], with statistically significant differences between the two groups (P=0.023, 0.008, and 0.025). The tracheal extubation time [(3.21±0.42) d], length of ICU stay [(7.65±0.75) d], and total length of hospital stay [(13.55±2.65) d] in the observation group were shorter than those in the control group [(3.55±0.55) d, (8.22±0.88) d, and (14.99±2.99) d], with statistically significant differences between the two groups (P=0.003, 0.003, and 0.026). The scores of physiological health [(26.89±3.67) points], psychological state [(27.13±3.46) points], independent ability [(25.67±3.55) points], and social relation of the FACT-L [(26.77±3.49) points] of the observation group were higher than those of the control group [(25.22±3.49) points, (24.47±3.46) points, (23.35±3.31) points, and (24.99±3.24) points], with statistically significant differences between the two groups (P=0.040, 0.001, 0.003, and 0.021). Conclusion　Implementing progressive early rehabilitation training can improve the postoperative intubation time in patients with tracheal intubation, and gradually improve their lung function, worthy of clinical promotion.

Influence of nasoenteral feeding by blind insertion of nasoenteric tube on the nutritional status and prognosis in patients with dysphagia after stroke

Xue Yanjie, Wang Dan

2023, 29(19):  2807-2810.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.030

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Objective　To investigate the effect of nasoenteral feeding (EN) by blind insertion of nasoenteric tube in patients with dysphagia after stroke (DAS). Methods　The random number table method was prospectively used to divide 80 cases of DAS patients admitted to Zhumadian Central Hospital from January 2020 to June 2022 into two groups, with 40 patients in each group. In the observation group, there were 23 males and 17 females, aged (62.37±3.69) years. In the control group, there were 22 males and 18 females, aged (62.58±3.87) years. The control group was treated with nasogastric tube EN, and the observation group was treated with EN by blind insertion of nasogastric tube, intervening for 14 days. The nutritional statuses of the two groups before and after intervention were compared, the postoperative complications of the two groups were counted, and the prognosis [Fugl-Meyer Motor Function Assessment (FMA) score and Barthel index] of the two groups were evaluated. χ² test and t test were used. Results　After intervention, the score of Nutrition Risk Screening Score Summary (NRS2002) was lower than that before intervention in both groups, and the score in the observation group was lower than that in the control group [(2.68±0.61) points vs. (4.60±0.53) points] (all P<0.001). After intervention, the levels of hemoglobin (Hb), albumin (Alb), and prealbumin (PA) were higher than those before intervention in both groups, and those in the observation group [(95.06±5.67) g/L, (39.78±4.14) g/L, and (193.46±22.36) mg/L] were higher than those in the control group [(89.73±5.06) g/L, (35.73±4.06) g/L, and (172.38±20.67) mg/L] (all P<0.001). The complication rate of the observation group was lower than that of the control group [2.50% (1/40) vs. 20.00% (8/40)] (χ²=4.507, P=0.034). After intervention, the FMA score and Barthel index were higher than those before intervention in both groups, and the scores in the observation group [(72.68±5.97) points and (72.31±6.54) points] were higher than those in the control group [(63.14±5.37) points and (55.69±6.13) points] (all P<0.001). Conclusion　Nasoenteric tube EN by blind insertion of nasogastric tube for patients with DAS can effectively improve their nutritional status, reduce the risk of complications, and improve the prognosis.

Qualitative study on the KAP of invasive intracranial pressure monitoring in neurocritical nurses

Gao Min, Meng Xiaojing, Li Xiang, Fan Jingli, Huang Lulu, Du Yu

2023, 29(19):  2811-2815.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.031

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Objective　To understand the current status of knowledge, attitude, and practice (KAP) of invasive intracranial pressure (ICP) monitoring in neurocritical nurses, and to provide a reference for standardized training intervention on weak links in invasive ICP monitoring in neurocritical nurses. Methods　The phenomenological research method was applied. Semi-structured in-depth interview was conducted on 12 neurocritical nurses in Henan Provincial People's Hospital from June to July 2022, including 3 males and 9 females, aged 26-39 (33.58±3.97) years. The data were analyzed by Nvivo 10.0 software. Results　Three themes were summarized for the current status of KAP of invasive ICP monitoring in neurocritical nurses. (1) The knowledge of invasive ICP monitoring in neurocritical nurses was not solid and comprehensive. (2) Neurocritical nurses had a positive attitude towards invasive ICP monitoring. (3) Neurocritical nurses had good practical ability in invasive ICP monitoring. Conclusions　Neurocritical nurses should strengthen the learning of invasive ICP monitoring. Managers should improve the training mode for nurses, and provide a basis for the formulation of visual standard processes with multidisciplinary medical and nursing joint management, so as to obtain accurate monitoring data for disease diagnosis and treatment.

Nursing care for patients with intracranial aneurysm rupture with subarachnoid hemorrhage and neurogenic pulmonary edema

Zhang Chun, Feng Juanjuan, Liu Jie, Chen Min, Fang Yan, Zhao Chang, Li Xuefang, Liao Liangjun

2023, 29(19):  2816-2819.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.032

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Objective　To summarize the nursing process of 3 patients with intracranial aneurysm rupture and neurogenic pulmonary edema, and improve the nurses' ability of emergency treatment. Methods　Three patients (all female,aged 42-53 years) with intracranial aneurysm rupture with subarachnoid hemorrhage and neurogenic pulmonary edema admitted to Neurosurgery, The Third People's Hospital of Hubei Province from February to July 2022 were reviewed, and the related literatures were searched. The nursing and treatment experiences were summarized from the aspects of process and responsibility management, primary disease treatment points and condition observation, nursing and treatment of pulmonary edema, circulatory system management, and nursing of intracranial aneurysm. Results　All the 3 patients were successfully treated. After effective treatment and nursing, 3 patients with deep coma before operation were clear in mind and took care of themselves completely. Conclusion　Reasonable and timely diagnosis and treatment and effective nursing can greatly reduce the occurrence of complications in patients with intracranial aneurysm rupture and neurogenic pulmonary edema, improve their quality of life, and reduce the burden of family and society.

Application of neck stretching training in home rehabilitation after carotid endarterectomy

Fang Gengna, Lu Libing, Xie Mengna, Xie Man, Huang Qiongshan, Lin Chudong, Wang Yusheng, Lin Fang

2023, 29(19):  2819-2823.  DOI: 10.3760/cma.j.issn.1007-1245.2023.19.033

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Objective　To explore the application of neck stretching training in home rehabilitation after carotid endarterectomy. Methods　A comparative study method was used to select patients who underwent carotid endarterectomy (CEA) by the same group of doctors in Neurosurgery Zone 3, Jieyang People's Hospital as the study subjects. From December 2018 to June 2021, 20 patients discharged after CEA were included in the control group, and from August 2021 to June 2023, 20 patients discharged after CEA were included in the observation group. The control group [9 females and 11 males, aged (70.15±9.49) years] received routine health education before discharge and routine neck activity and follow-up after discharge, and the observation group [7 females and 13 males, aged (70.22±9.55) years] received home rehabilitation intervention of neck stretching training on the basis of control group. The differences in neck dysfunction index, pain score, satisfaction, and compliance between the two groups were collected and compared. Statistical methods were χ² test and independent sample t test. Results　On the 30th day of training, the neck dysfunction index of the observation group was lower than that of the control group [(4.28±3.37) vs. (8.73±4.97)], with a statistically significant difference (t=3.314, P=0.002); the pain score of the observation group was lower than that of the control group [(2.13±0.31) vs. (4.85±0.64)], with a statistically significant difference (t=17.016, P<0.001). The nursing satisfaction of the observation group was significantly higher than that of the control group [100.00% (20/20) vs. 60.00% (12/20)], with a statistically significant difference (χ²=10.286, P=0.006). The compliance of the observation group was significantly higher than that of the control group [100.00% (20/20) vs. 70.00% (14/20)], with a statistically significant difference (χ²=7.222, P=0.027). Conclusion　Neck stretching training has significant application value in home rehabilitation after CEA, which can be promoted.