Table of Content

01 November 2023, Volume 29 Issue 21

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New Medical Advances

Research progress of high intensity interval training on chronic heart failure

Wang Wen, Zhao Xianli, Wu Xubo

2023, 29(21):  2985-2989.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.001

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The study on the safety and efficacy of high intensity interval training (HIIT) in chronic heart failure (CHF) has been the hot spot of clinical research. Low and moderate intensity aerobic exercise is chosen for clinical intervention in CHF. It is concerned that more and more sports rehabilitation programs choose HIIT as a means of cardiac rehabilitation. This review summarizes the clinical effect of HIIT intervention on CHF in terms of maximum oxygen consumption (VO₂ max), vascular endothelial function, and cardiac function, and compares HIIT with other exercise training such as moderate intensity continuous training, moderate intensity interval training, and resistance training, in order to provide a reference for the safe and effective treatment of CHF patients with HIIT.

Research progress in optimized adjustment of driving pressure in lung protective ventilation strategies

Chen Jixiang, Lu Jing

2023, 29(21):  2990-2994.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.002

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With the increase in the number of patients with mechanical ventilation and the development of enhanced recovery after surgery (ERAS), lung injury caused by mechanical ventilation has attracted much attention. Traditional views suggest that lung protective ventilation strategies can reduce the incidence of ventilator induced lung injury (VILI), but some studies have shown that non-individualized lung protective ventilation strategies have the risk of exacerbating lung injury. At present, there is still controversy in clinical practice on how to formulate individualized lung protective ventilation strategies. The latest researches have found that optimizing the lung protective ventilation strategies through driving pressure can significantly reduce the lung injury and incidence of postoperative pulmonary complications. This article aims to review the current research status of driving pressure in lung protective ventilation strategies.

Massage as the main treatment for cervical vertigo

Liu Qichang, Yang Qingyu, Zeng Yuping, Gao Dianming, Huang Wenli

2023, 29(21):  2994-2997.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.003

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With the change of people's working environment, the number of patients with vertigo caused by cervical spine diseases is increasing gradually, and the age of onset is becoming younger. The etiology and pathogenesis of the disease are not clear, so the related clinical researches change with each passing day, and the treatment methods emerge in an endless stream. In many therapies after baptism, massage therapy is a classic inheritance of the treatment of this disease and is considered effective by doctors and patients. The authors searched numerous literatures related to vertigo. Therefore, the authors summarized the treatment of cervical vertigo based on massage published in the relevant core journals and papers in the past 5 years (2017.06-2022.06), to understand the treatment progress and existing problems of cervical vertigo based on massage, in order to provide clinical basis.

Diabetes

Effects of glimepiride combined with metformin and rhythmic exercise on islet function and cardiovascular risk in patients with type 2 diabetes mellitus

Wang Lixin, Liu Changhu, Wang Minglei, Liang Jun, Li Min, Gao Linlin

2023, 29(21):  2998-3002.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.004

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To study the effects of glimepiride combined with metformin and rhythmic exercise on islet function and cardiovascular risk in patients with type 2 diabetes mellitus. Methods　A total of 99 patients with type 2 diabetes mellitus treated in Jinan Second People's Hospital from January 2020 to February 2023 were selected and were divided into a control group and an observation group according to the coin toss method. In the control group, 50 patients were treated with metformin combined with rhythmic exercise, including 31 males and 19 females, aged (61.25±2.64) years. In the observation group, 49 patients were treated with glimepiride combined with metformin and rhythmic exercise, including 30 males and 19 females, aged (61.31±2.60) years. The therapeutic effect, islet function, inflammatory factors, blood lipid indexes, and occurrence of adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the levels of fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), and postprandial 2 h blood glucose (2hPG) were decreased in the two groups and the four indexes of the observation group [FPG (6.68±1.21) mmol/L, HbA1c (7.10±0.95) %, FINS (7.68±2.57) μU/ml, and 2hPG (7.34±1.14) mmol/L] were lower than those of the control group [FPG (7.25±1.26) mmol/L, HbA1c (7.71±1.03) %, FINS (8.94±2.96) μU/ml, and 2hPG (8.04±1.23) mmol/L] (all P<0.05). After treatment, the insulin resistance index (HOMA-IR) was decreased in the two groups, and that in the observation group was lower than that in the control group [(2.15±0.39) vs. (2.39±0.40)] (all P<0.05). The insulin sensitivity indexes (ISI) and islet β cell function indexes (HOMA-β) of the two groups after treatment were higher than those before treatment, and those in the observation group [HOMA-β (47.63±2.75) and ISI (2.95±0.43)] were higher than those in the control group [HOMA-β (45.91±2.61) and ISI (2.64±0.47)] (all P<0.05). After treatment, the levels of interleukin-1β (IL-1β), C-reactive protein (CRP), and tumor necrosis factor (TNF) -α were decreased in the two groups, and the levels of IL-1β [(4.86±1.02) ng/L], CRP [(1.34±0.03) mg/L], TNF-α [(8.62±1.36) ng/L] in the observation group were lower than those in the control group [IL-1β (5.48±1.23) ng/L, CRP (1.39±0.04) mg/L, and TNF-α (9.54±1.59) ng/L] (all P<0.05). After treatment, the levels of triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were decreased in the two groups, and the levels of TG [(4.17±1.18) mmol/L], TC [(2.28±0.95) mmol/L], LDL-C [(2.50±0.29) mmol/L] in the observation group were lower than those in the control group [TG (4.73±1.02) mmol/L, TC (2.89±1.13) mmol/L, and LDL-C (2.69±0.32) mmol/L] (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the observation group [14.29% (7/49)] and the control group [10.00% (5/50)] (χ²=0.427, P=0.514). Conclusion　The combination of glimepiride, metformin, and arrhythmic exercise for type 2 diabetes mellitus has better hypoglycemic effect, which can significantly improve the islet function and blood lipid level, with lower inflammatory response and fewer adverse cardiovascular reactions.

Efficacy of dapagliflozin in the treatment of patients with type 2 diabetes mellitus complicated with grade I-III heart failure

Huai Bin, Hu Lin, Du Jie, Xu Xin

2023, 29(21):  3003-3007.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.005

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Objective　To investigate the efficacy and safety of dapagliflozin in patients with type 2 diabetes mellitus complicated with grade I-III heart failure and its effects on antioxidant capacity and cardiac function. Methods　A total of 120 patients with type 2 diabetes mellitus complicated with grade I-III heart failure admitted to Jinan Second People's Hospital from January 2020 to December 2022 were collected and were divided into a control group and an observation group with 60 cases in each group by the random number table method. In the observation group, the ratio of male to female was 33/27, the age was 52-73 (59.27±4.33) years old, the course of disease was 3-14 (7.57±1.42) years, and the New York Heart Association (NYHA) grade showed that there were 13 patients with grade I, 30 patients with grade II, and 17 patients with grade III. In the control group, the ratio of male to female was 32/28, the age was 50-74 (59.34±4.38) years old, the course of disease was 3-15 (7.58±1.44) years, and the NYHA grade showed that there were 12 cases with grade I, 31 cases with grade II, and 17 cases with grade III. The control group was treated with metformin and conventional treatment, and the observation group was treated with dapagliflozin on the basis of the control group. The total effective rate, cardiac function indexes [cardiac output (CO), stroke volume (SV), and left ventricular ejection fraction (LVEF)], antioxidant capacity [malondialdehyde (MDA), superoxide dismutase (SOD), and total antioxidant capacity (TAC)], incidence of adverse reactions, and quality of life of the two groups were compared. χ² test and t test were used. Results　The total effective rate of the observation group [98.33% (59/60)] was higher than that of the control group [88.33% (53/60)] (χ²=4.820, P=0.028). After treatment, the levels of CO [(4.38±0.78) L/min], SV [(59.38±5.27) ml], and LVEF [(59.33±4.85)%] in the observation group were higher than those in the control group [(3.81±0.73) L/min, (55.37±5.31) ml, and (57.18±4.32)%] (t=4.133, P<0.001; t=4.152, P<0.001; t=2.564, P=0.012); the level of MDA in the observation group [(4.67±1.21) nmol/ml] was lower than that in the control group [(6.25±1.37) nmol/ml], but the levels of SOD [(83.26±11.83) U/ml] and TAC [(8.32±1.11) nmol/ml] were higher than those in the control group [(73.51±10.25) U/ml and (7.79±1.03) nmol/ml] (t=6.696, P<0.001; t=4.825, P<0.001; t=2.771, P=0.008). There was no statistically significant difference in the incidence of adverse reactions between the observation group [6.67% (4/60)] and the control group [3.33% (2/60)] (χ²=0.700, P=0.402). The quality of life score of the observation group after treatment was lower than that of the control group [(52.58±3.39) points vs. (62.47±4.45) points] (t=13.694, P<0.001). Conclusion　Dapagliflozin has high efficacy and safety in patients with type 2 diabetes mellitus complicated with grade I-III heart failure, which can significantly improve their cardiac function, antioxidant capacity, and quality of life.

Analysis on influencing factors of health outcomes of type 2 diabetes patients based on social ecological system theory

Zeng Jing

2023, 29(21):  3008-3012.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.006

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Objective　To analyzes the influencing factors of health outcomes of type 2 diabetes patients based on the social ecological system theory in Shanghai. Methods　A retrospective study was conducted to select 987 patients with type 2 diabetes from 4 community health service centers in Pudong New Area and Yangpu District of Shanghai from June to December 2019 as the study subjects, including 431 males (43.67%) and 556 females (56.33%), aged (68.8±7.1) years. Using the Diabetes Self-management Behavior Questionnaire, Chinese version of Diabetes Management Self-Efficacy Scale (C-DMSES), and Social Support Scale, the influencing factors of health outcomes of type 2 diabetes patients were explored by the structural equation model. Results　Social support, self-efficacy, and self-management were included in the model as latent variables, and knowledge mastery and disease course as covariables. After verification, the values of GFI (0.990), RMSEA (0.011), CFI (0.998), and PNFI (0.644) of the final model indicated that the goodness-of-fit of the model was excellent. The non-standardized factor loads of each latent variable and measurement index were statistically significant (all P<0.05). Regression analysis and mesomeric effect analysis showed that self-efficacy and self-management played significant mediating roles in the relationship between social support and health outcomes (glycated hemoglobin), and the total mesomeric effect was -0.038 (P<0.05). Conclusions　Social support has a positive impact on the health outcomes of diabetes through self-efficacy and self-management. The social ecological system theory can be used as the theoretical basis for the implementation of health management for diabetes patients in China. This model can provide support for related health management and health promotion projects of diabetes.

Research on the influence of community-led nurse-teacher cooperation model on improving primary school students' awareness of diabetes mellitus related knowledge

Chen Weifang, Zhang Cheng, Yao Xuanjuan, Lyu Hong

2023, 29(21):  3013-3016.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.007

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Objective　To explore the effect of community-led nurse-teacher cooperation model on the knowledge awareness of diabetes mellitus in primary school students. Methods　A total of 131 students from grade 5-6 in a primary school in Haizhu District from January to December 2022 were selected as the research objects, including 74 boys and 57 girls, aged 9-13 years. An experimental study was carried out on the students with the health education model of community-led nurse-teacher cooperation model. The changes of students' knowledge level and self-behavior awareness before and after intervention were evaluated by self-made questionnaire. Paired t test and χ² test were used to analyze the data. Results　The Cronbach's alpha of the self-made questionnaire used in this study was 0.799, and the KMO coefficient of Bartlett sphericity test was 0.79. The knowledge requirement rate of diabetes mellitus in children was 61.07% (80/131) before intervention and 82.44% (108/131) after intervention; the awareness rate of diabetes type was 26.72% (35/131) before intervention and 82.44% (108/131) after intervention; the awareness rate of typical symptoms of diabetes mellitus was 57.25% (75/131) before intervention and 66.41% (87/131) after intervention; the nervous fear rate for diabetes mellitus was 38.93% (51/131) before intervention and 26.72% (35/131) after intervention; the awareness rate of peer hypoglycemia treatment was 26.72% (35/131) before intervention and 54.20% (71/131) after intervention; the awareness rate of dietary precautions for diabetes mellitus was 67.18% (88/131) before intervention and 76.34% (100/131) after intervention; the awareness rate of exercise precautions was 51.91% (68/131) before intervention and 63.36% (83/131) after intervention; the awareness rate of treatment methods was 22.90% (30/131) before intervention and 78.63% (103/131) after intervention; the change rate of dietary habits was 38.17% (50/131) before intervention and 87.02% (114/131) after intervention. The score of basic mastery degree of diabetes mellitus-related knowledge was (7.44±0.24) points before intervention and (8.13±0.51) points after intervention, the score of partial mastery degree was (6.17±0.44) points before intervention and (6.36±0.32) points after intervention, and the score of non-mastery was (3.81±0.22) points before intervention and (4.71±0.23) points after intervention. After intervention, all indexes were improved compared with those before intervention, with statistically significant differences (all P<0.05). Conclusion　The community-led nurse-teacher cooperation model can effectively improve the awareness of diabetes mellitus related knowledge in primary school students, which is worthy of clinical application.

Efficacy of insulin combined with low molecular weight heparin in patients with gestational diabetes mellitus

Jiang Ling, Yang Haiyan, Liu Ronghui, Jiang Ping, Song Meiyu

2023, 29(21):  3017-3022.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.008

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Objective　To explore the efficacy of insulin combined with low molecular weight heparin (LMWH) in patients with gestational diabetes mellitus. Methods　A prospective study was conducted on 86 patients with gestational diabetes mellitus treated in Yantai Mountain Hospital of Yantai City from February 2019 to January 2020, who were randomly divided into a single group and a combined group with 43 cases in each group. The age of the single group was (28.3±5.6) years old; there were 27 cases of primipara and 16 cases of multipara. The age of the combined group was (27.3±3.5) years old; there were 25 cases of primipara and 18 cases of multipara. The patients in the single group were treated with insulin, and the patients in the combined group were treated with insulin and LMWH. The C-reactive protein (CRP), lipoprotein-associated phospholipase A2 (LpLA2), serum cystatin (CysC), total bilirubin (TBil), total cholesterol (TC), urinary microalbumin (mAlb), fasting insulin (FINS), islet β cell function index (HOMA-β), insulin resistance index (HOMA-IR), glycosylated serum protein (GSP), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) were detected in the two groups and were compared by LSD-t test, and the pregnancy complications and neonatal conditions were recorded in the two groups and were compared by χ² test. Results　After treatment, the levels of serum CRP [(5.46±0.16) mg/L], LpLA2 [(96.25±4.17) U/L], and CysC [(0.73±0.18) mg/L] in the combined group were lower than those in the single group [CRP (8.49±0.38) mg/L, LpLA2 (112.63±9.54) U/L, and CysC (1.03±0.26) mg/L] (t=48.190, 10.320, and 6.221; all P<0.001). After treatment, the level of TBil in the combined group was higher than that in the single group [(11.76±3.87) μmol/L vs. (9.68±2.94) μmol/L], while the levels of TC [(2.64±0.83) mmol/L] and mAlb [(10.25±3.17) mg/L] were lower than those in the single group [TC (3.65±1.12) mmol/L and mAlb (14.66±4.28) mg/L] (t=2.806, 4.751, and 5.430; all P<0.05). After treatment, the levels of FINS [(1.26±0.14) mU/L] and HOMA-IR [(2.57±0.16)] in the combined group were lower than those in the single group [FINS (1.52±0.42) mU/L and HOMA-IR (3.98±0.21)], while the level of HOMA-β was higher than that in the single group [(65.20±5.86) vs. (51.14±4.35)] (t=3.851, 35.022, and 12.633; all P<0.05). After treatment, the levels of GSP [(191.69±10.14) μmol/L], FBG [(3.21±1.06) mmol/L], and HbA1c [(3.98±0.18)%] in the combined group were lower than those in the single group [GSP (252.86±12.25) μmol/L, FBG (5.36±1.56) mmol/L, and HbA1c (5.39±1.46)%] (t=25.224, 7.475, and 6.285; all P<0.05). After treatment, the incidence of pregnancy complications in the combined group [18.60% (8/43)] was lower than that in the single group [39.53% (17/43)] (χ²=4.568, P=0.033); the total incidence of adverse neonatal conditions in the combined group [13.95% (6/43)] was lower than that in the single group [34.88% (15/43)] (χ²=5.103, P=0.024). Conclusion　Insulin combined with LMWH can effectively control the blood glucose and inflammatory factors in patients with gestational diabetes mellitus, reduce the levels of GSP, FBG, and HbA1c, and improve the maternal insulin resistance, pregnancy outcomes, and neonatal conditions.

Scientific Research

Bibliometrics and acupoint selection analysis of electroacupuncture in the prevention and treatment of postoperative cognitive dysfunction

Cao Boning, Chen Liping, Hou Huaijing, Xu Ziqing, Xue Jianjun, Wang Chunai

2023, 29(21):  3023-3029.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.009

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Objective　The research status of randomized controlled trials (RCTs) related to electroacupuncture in the prevention and treatment of postoperative cognitive dysfunction (POCD) was analyzed, and the characteristics of literatures, acupoint selection, and meridian selection were summarized. Methods　We systematacially searched the databases of PubMed, Cochrane library, Web of Science, Embase, CBM, CNKI, VIP, and WanFang, and obtained the related literatures from the establishment of the databases to February 2023. Results　A total of 38 RCT articles were included in the prevention and treatment of POCD by electroacupuncture. According to the characteristics of the literatures included, although the number of studies was still small, the amount of literatures showed an overall increasing trend with time. Most of the journals included were domestic journals, while the international journals of SCI type were few. From the point of view of the support of funding projects, in recent years, the state also had more funding support for the clinical research of electroacupuncture treatment of POCD. From the type of funding, provincial, municipal, and national projects occupied the main part, while the proportion of university projects showed less. According to the clinical observation indexes, it was mainly concerned on reducing the incidence of POCD, improving the cognitive function score, and reducing the expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β, and S100β. From the law of acupoint selection, it was found that the high-frequency acupoints of electroacupuncture for the prevention and treatment of POCD were Neiguan, Baihui, Hegu, Zusanli, Shenting, Shenmen, Sishencong, Sanyinjiao, Taichong, Dazhui, and Benshen acupoints. The high-frequency meridians selected were Governor Meridian, hand Jueyin pericardial Meridian, hand Yang Yin Colorectal Meridian, foot Yangming stomach Meridian, hand Shaoyin Heart Meridian, strange acupoints, foot Shaoyang gallbladder Meridian, foot Taiyin spleen Meridian and Jueyin liver Meridian, and foot Taiyang bladder Meridian and foot Shaoyin Kidney Meridian. Conclusions　This study summarizes the clinical research status of electroacupuncture in the treatment of POCD and the rules of acupoint selection and meridian selection of electroacupuncture in the treatment of POCD, which has a certain guiding significance for clinical application of electroacupuncture in the treatment of POCD, and provides theoretical basis and reference for follow-up researches.

Effect of thoracic paravertebral nerve block combined with general anesthesia on inflammatory response and immune function in patients undergoing thoracoscopic radical resection for lung cancer

Ding Xue, Zou Lifeng, Xu Jun, Jiao Ye

2023, 29(21):  3030-3034.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.010

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Objective　To investigate the effects of thoracic paravertebral nerve block combined with general anesthesia on inflammatory response and immune function in patients undergoing thoracoscopic radical resection for lung cancer. Methods　A total of 86 patients undergoing thoracoscopic radical resection for lung cancer in Pizhou People's Hospital from September 1, 2021 to March 31, 2023 were randomly divided into a conventional group and an observation group, with 43 cases in each group. In the conventional group, there were 23 males and 20 females, aged (49.54±7.23) years. In the observation group, there were 22 males and 21 females, aged (50.11±6.67) years. The conventional group was given general anesthesia combined with serratus anterior plane block, while the observation group was given general anesthesia combined with thoracic paravertebral nerve block. The changes of intraoperative hemodynamic indexes in the two groups were analyzed, the levels of inflammatory C-reactive protein (CRP) and procalcitonin (PCT) and immune function of the two groups were compared, and the occurrence of perioperative anesthesia drug-related adverse reactions in the two groups were analyzed. Results　The changes of heart rate and mean arterial pressure (MAP) before anesthesia induction (T0), 5 minutes after surgery (T1), and 5 minutes after surgery (T2) were observed between the observation group and the conventional group using repeated measure design analysis of variance: (1) there were statistically significant differences in the heart rate and MAP between different time points (all P<0.05); (2) there were statistically significant differences in the heart rate and MAP between the observation group and the conventional group (all P<0.05); compared with those in the conventional group, the heart rate and MAP in the observation group were lower, and the relative hemodynamic change was little; (3) there were statistically significant differences in the change trends of heart rate and MAP between the observation group and the conventional group (all P<0.05). The levels of CRP and PCT in both groups were increased 48 h after surgery (all P<0.05), and the levels of CRP and PCT in the observation group were lower than those in the conventional group 48 h after surgery (both P<0.05). The levels of CD4⁺ and CD4⁺/CD8⁺ in the two groups 48 h after surgery were lower than those before surgery, with statistically significant differences (all P<0.05), and the levels of CD4⁺ and CD4⁺/CD8⁺ in the observation group 48 h after surgery were higher than those in the conventional group (both P<0.05). In the conventional group, there were 5 cases of nausea and vomiting and 3 cases of headache, and the total incidence of adverse reactions was 18.60% (8/43). In the observation group, there was 1 case of nausea and vomiting and 1 case of headache, and the total incidence of adverse reactions was 4.65% (2/43). The incidence of adverse reactions in the observation group was lower than that in the conventional group, with a statistically significant difference (χ²=4.074, P=0.044). Conclusion Thoracic paravertebral nerve block combined with general anesthesia can stabilize the intraoperative hemodynamic indexes, reduce the inflammatory response and immunosuppression, and reduce the incidence of total adverse reactions in patients undergoing thoracoscopic radical resection for lung cancer.

Difference between 3D printed porous titanium alloy Cage and polyether ether ketone Cage in PLIF

Zhou Xianwei, Yu Yang, Liu Yufeng, Zhang Xiaohui, Zhang Wenming, Song Jian, Yan Xiang

2023, 29(21):  3035-3039.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.011

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Objective　To analyze the difference between 3D printed porous titanium alloy interbody fusion Cage (3D Cage) and polyether ether ketone interbody fusion cage (PEEK Cage) in posterior lumbar interbody fusion (PLIF). Methods　A total of 76 patients who planned to undergo PLIF in Henan Luoyang Orthopedic Hospital from February 2021 to February 2022 were selected as the study objects. According to different treatment plans, they were divided into an observation group (38 cases) and a control group (38 cases). In the observation group, there were 20 males and 18 females, aged 27-76 (45.67±9.69) years. In the control group, there were 19 males and 19 females, aged 26-74 (45.48±10.13) years. The observation group was implanted with 3D Cage under PLIF, and the control group was implanted with PEEK Cage under PLIF. The two groups were followed up for 1 year after surgery to compare the surgical indicators and complications. The height of intervertebral space and the degree of intervertebral fusion were compared between the two groups 3 months, 6 months, and 1 year after surgery. The Visual Analogue Scale (VAS) scores were compared between the two groups 12 h and 48 h after surgery. The Oswestry Disability Index (ODI) scores were compared between the two groups 3 months, 6 months, and 1 year after surgery. Independent sample t test, χ² test, and rank sum test were used. Results　The operation time, hospital stay, intraoperative blood loss, and postoperative drainage volume in the observation group were (123.26±23.62) min, (13.78±1.42) d, (316.64±26.79) ml, and (342.21±33.72) ml, respectively, those in the control group were (124.18±23.43) min, (14.16±1.37) d, (321.36±27.63) ml, and (346.38±34.17) ml, respectively, without statistically significant differences between the two groups (t=0.171, 1.187, 0.756, and 0.536; all P>0.05). The intervertebral space heights of the observation group 3 months, 6 months, and 1 year after surgery were (13.36±0.93) mm, (12.98±0.87) mm, and (12.21±0.62) mm, respectively, which were better than those of the control group [(12.78±1.21) mm, (12.33±0.94) mm, and (11.74±0.77) mm] (t=2.343, 3.128, and 2.931; all P<0.05). The intervertebral fusion degree of the observation group was better than that of the control group 3 months, 6 months, and 1 year after surgery (Z=2.734, 2.331, and 2.267; all P<0.05). The VAS scores in the observation group 12 h and 48 h after surgery were (5.18±1.24) and (4.23±1.12) points, respectively, which were lower than those in the control group [(5.87±1.36) and (5.06±1.21) points] (t=2.311 and 3.013, both P<0.05). The ODI scores of the observation group 3 months, 6 months, and 1 year after surgery were (24.62±6.34), (16.33±4.28), and (13.69±3.27) points, respectively, which were better than those of the control group [(28.86±7.21), (19.66±5.87), and (15.82±3.66) points] (t=2.722, 2.826, and 2.675; all P<0.05). Conclusion　There is no significant difference between the two kinds of Cage in the surgical indicators and postoperative complications of PLIF, but the 3D Cage can reduce the postoperative pain, better restore the height of the intervertebral space, and accelerate the intervertebral fusion, with good recovery of dysfunction.

Study on the curative effect of traditional Chinese medicine combined with occluder in reducing ureteral stricture caused by holmium laser lithotripsy

Liao Tuming, Zeng Weifang, Liu Liangjin, He Shen, Guan Gangqiang, Li Xiongcai, Zhu Herong, Wu Jiaqiao, Du Wei

2023, 29(21):  3040-3044.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.012

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Objective　To investigate the effect of traditional Chinese medicine prescription for clearing heat, promoting blood circulation, and softening combined with occluder in reducing ureteral stricture caused by holmium laser lithotripsy. Methods　Clinical data of 200 patients with middle and upper ureteral calculi from Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to March 2023 were retrospectively analyzed, including 144 males and 56 females, aged (52±13.8) years. According to whether the occluder was used during operation and whether traditional Chinese medicine was used after operation, they were divided into group A (66 cases, holmium laser combined with occluder and traditional Chinese medicine), group B (70 cases, holmium laser alone), and group C (64 cases, holmium laser combined with occluder). Self-designed Chinese medicine prescription was as follow: spreading hedyotis herb, sophora, cordate houttuynia, glabrous greenbrier rhizome, epimedium, dogwood, grifola, alisma, motherwort, and radix cyathulae. The incidence of perirenal hematoma, ureteral stenosis, stone clearance rate, and improvement of hydronephrosis were observed 3 months after operation. F test, rank sum test, and χ² test were used. Results　There was no statistically significant difference in the incidence of perirenal hematoma among the three groups (χ²=2.474, P>0.05). There was a statistically significant difference in the incidence of postoperative ureteral stricture among the three groups (χ²=6.412, P<0.05); there was a statistically significant difference between group A and group B (χ²=5.402, P<0.05); there was no statistically significant difference between group A and group C (χ²=0.374, P>0.05); there was no statistically significant difference between group C and group B (χ²=3.331, P>0.05). There was a statistically significant difference in the stone clearance among the three groups (χ²=12.842, P<0.05); there was a statistically significant difference between group A and group B (χ²=9.597, P<0.05); there was no statistically significant difference between group A and group C (χ²=0.374, P>0.05); there was a statistically significant difference between group C and group B (χ²=7.022, P<0.05). There was no statistically significant difference in the improvement degree of hydronephrosis among the three groups (H=2.894, P>0.05). Conclusion　The treatment of middle and upper ureteral calculi with heat-clearing, blood-activating, and helping softening prescription combined with occluder can reduce the incidence of ureteral stricture or atresia caused by ureteral holmium laser lithotripsy, reflecting the effect of traditional Chinese medicine prescription on ureteral wall regeneration and repair, promoting blood circulation, clearing heat, reducing dampness, and promoting softening.

Diagnostic value of myocardial zymogram and cardiac color ultrasound in acute myocardial infarction

Zhao Fulei, Zhang Hui, Li Binke

2023, 29(21):  3045-3049.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.013

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Objective　To study the diagnostic value of myocardial zymogram and echocardiography in acute myocardial infarction. Methods　A total of 100 patients with acute myocardial infarction who came to the Third People's Hospital of Liaocheng City from January 2021 to February 2023 were selected as the observation group, and 83 healthy subjects who came to our hospital for physical examination during the same period were selected as the control group. In the observation group, there were 61 males and 39 females, aged (56.47±8.65) years; in the control group, there were 56 males and 27 females, aged (56.58±9.02) years. The general data such as gender, age, and occupation were compared between the two groups. The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and myocardial enzyme indexes were compared between the two groups. Independent sample t test, χ² test, and Pearson correlation analysis were used. Results　There were no statistically significant differences in the body mass index, age, gender, smoking history, drinking history, marital status, occupation, residence address, systolic blood pressure (SBP), and serum triglyceride (TG) and fasting blood glucose (FPG) levels between the two groups (all P>0.05). The LVEF of the observation group was lower than that of the control group [(55.48±3.16)% vs. (65.42±3.37)%], while the LVEDD of the observation group was higher than that of the control group [(53.85±7.22) mm vs. (47.20±2.83) mm], with statistically significant differences (both P<0.05). There were no statistically significant differences in the serum lactate dehydrogenase (LDH) and homocysteine (HCY) levels between the two groups (both P>0.05), while the serum creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) levels in the observation group were higher than those in the control group, with statistically significant differences (both P<0.05). Pearson correlation analysis showed that LVEF was negatively correlated with CK-MB in patients with acute myocardial infarction (P<0.05), while LVEDD was positively correlated with CK-MB (P<0.05). The areas under the curves of LVEF, LVEDD, CK-MB, and their combination in the diagnosis of acute myocardial infarction were 0.917, 0.800, 0.929, and 0.953, the sensitivities were 0.861, 0.816, 0.893, and 0.904, respectively, and the specificities were 0.825, 0.889, 0.795, and 0.764, respectively. Conclusions　The levels of LVEF and serum CK and CK-MB in patients with acute myocardial infarction decrease, while the LVEDD increases. The combination of LVEF, LVEDD, and CK-MB in the diagnosis of acute myocardial infarction is more advantageous than that of single diagnosis, and better diagnostic efficacy can be obtained.

Treatises

Construction and evaluation of EGFR prediction model by ultrasound combined with MRI parameters before breast cancer treatment

Cheng Chen, Zhou Jianguo, Li Xueping, Li Hong'e, Zhao Hongyan

2023, 29(21):  3050-3055.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.014

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Objective　To establish a model for predicting the expression of epidermal growth factor receptor (EGFR) in breast cancer by ultrasound signs/parameters combined with non-morphological (functional and hemodynamic) magnetic resonance imaging (MRI) parameters and evaluate the diagnostic efficiency of the model. Methods　A retrospective study was conducted on 167 female patients with breast cancer aged 21-79 (45.23±11.72) years who underwent surgical resection after neoadjuvant chemotherapy (NAC) in Lianyungang First People's Hospital from January 2015 to December 2021. Before NAC treatment, all patients underwent breast mass biopsy, and their histopathological and EGFR analysis results were obtained. All patients underwent ultrasound and MRI examination before puncture (the interval between the two examinations was not more than 5 days). The parameters recorded were EGFR, apparent diffusion coefficient (ADC) value, Max Slope, time to peak (TTP), signal enhancement rate (SER), early enhancement rate (EER), time-signal strength curve (TIC), tumor maximum diameter, tumor margin and boundary, aspect ratio, microcalcification, color Doppler flow imaging (CDFI) grading, resistance index (RI), axillary lymph node metastasis (ALNM). Statistical analysis was conducted in R language 4.0.3 (https://www.r-project.org). All data were randomly divided into a modeling group and a verification group by the ratio of 7:3, and the random seeds were set. The comparison between the modeling group and the verification group was conducted according to the above variable types by independent sample t test, Mann-Whitney U test, and χ² test, respectively, to analyze the differences in the ultrasound parameters/signs, MRI non-morphological parameters, and EGFR expression. The random forest (RF) model was used to select variables in the EGFR modeling group. Generalized linear modeling (GLM) was used to obtain regression coefficient, odds ratio (OR), and 95% confidence interval for each modeling variable in the modeling group, and a colored nomogram was drawn. The model discrimination was evaluated by receiver operating characteristic curve (ROC), and the model effectiveness was evaluated by decision curve method (DCA). Results　ADC, maximum diameter, EER, and TTP were selected as the variables to construct the model for predicting EGFR. The model discrimination evaluation: ROC analysis showed that the area under the curve (AUC) of the modeling group was 0.815 (95%CI 0.726-0.905); in the verification group, the AUC was 0.805 (95%CI 0.660-0.949); AUC >0.80 indicated high discrimination. Model effectiveness evaluation: DCA analysis showed that the diagnosis probability in the patients of the modeling group was in the range of 0%-50%, and that of the verification group was in the range of 15%-55%. Conclusions　Based on machine learning, DCA, and other methods, the prediction model of EGFR expression by ultrasound signs/parameters combined with MRI non-morphological parameters before breast cancer treatment is proved to have good diagnostic efficacy. It is expected to produce higher clinical benefit and better clinical application in improving preoperative diagnosis and curative effect evaluation of immune factors for breast cancer.

Targeted monitoring of postoperative pneumonia of spinal surgery

Ji Gui'an, Xiao Bin, Wang Hui, Zou Shan, Wu Mingcheng, Yao Jinli, Feng Ke

2023, 29(21):  3056-3060.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.015

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Objective　By conducting targeted monitoring of postoperative pneumonia (POP) of spinal surgery, to analyze the incidence and risk factors of POP in spinal surgery patients. Methods　A total of 300 patients who underwent spinal surgery in China Guihang Group 302 Hospital from January 2021 to June 2022 were selected for retrospective analysis, who were all given targeted monitoring of spinal surgery POP. They were divided into 21 cases in the POP group and 279 cases in the non-POP group based on the presence or absence of POP. In the POP group, there were 13 males and 8 females, 9 cases <60 years old and 12 cases ≥60 years old. In the non-POP group, there were 161 males and 118 females, 156 cases <60 years old and 123 cases ≥60 years old. The risk factors of POP of spinal surgery were analyzed. χ² test was used for the count data, and binary logistic regression analysis was used for risk factor analysis. Results　Univariate analysis showed that there were no statistically significant differences in the age, gender, body mass index (BMI), surgical site, surgical approach, dural incision, bone grafting, cerebrospinal fluid leakage, secondary surgery, hypertension, cardio-cerebrovascular disease, liver disease, kidney disease, anemia, smoking history, and drinking history between the two groups (all P>0.05); operation time, operation type, standardized use of antibiotics, internal fixation, allogeneic blood transfusion, length of hospital stay, and diabetes mellitus might be the influencing factors of POP of spinal surgery (χ²=10.603, 13.177, 8.170, 5.666, 14.338, 12.079, and 5.172; all P<0.05). Binary logistic regression analysis showed that operation time ≥3 h, allogeneic blood transfusion, hospital stay ≥10 d, and diabetes were the risk factors for POP of spinal surgery (all OR>1, P<0.05), while selective surgery and standardized use of antibiotics were the protective factors for POP of spinal surgery (both OR<1, P<0.05). Conclusion　The occurrence of POP in spine surgery is related to operation time ≥3 h, allogeneic blood transfusion, hospital stay ≥10 d, and diabetes. Selective surgery and standardized use of antibiotics can reduce the occurrence of POP in spine surgery.

Clinical analysis of bedside CRRT combined with prone position ventilation in severe ARDS patients

Zhu Mingyang

2023, 29(21):  3061-3065.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.016

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Objective　To investigate the efficacy of continuous renal replacement therapy (CRRT) combined with prone position ventilation in patients with severe acute respiratory distress syndrome (ARDS). Methods　Twenty two patients with severe ARDS who were admitted to Huaihe Hospital of Henan University from August 2020 to March 2023 and needed to be treated with bedside CRRT combined with prone position ventilation were selected, including 8 males and 14 females, aged (61.2±10.2) years. The patients' oxygenation index, hemodynamics, and inflammation indexes before and after treatment were compared. Paired t test was used for the measurement data. Results　After treatment, the arterial partial oxygen pressure (PaO₂) [(92.23±10.08) mmHg] (1 mmHg=0.133 kPa), blood oxygen saturation (SpO₂) [(94.62±1.16)%], and oxygenation index (PaO₂/FiO₂) [(280.02±25.64) mmHg] were all higher than those before treatment [(56.25±7.14) mmHg, (85.07±2.69)%, and (176.62±15.42) mmHg], while the arterial partial carbon dioxide pressure (PaCO₂) [(35.65±5.20) mmHg] was lower than that before treatment [(47.72±8.69) mmHg], with statistically significant differences (t=8.944, 2.134, 11.012, and 4.113; all P<0.05). The heart rate [(90.55±2.26) beats/min] after treatment was lower than that before treatment [(102.50±5.52) beats/min], and the mean arterial pressure (MAP) [(80.05±5.35) mmHg] was higher than that before treatment [(62.26±4.50) mmHg], with statistically significant differences (t=2.375 and 5.125, both P<0.05). There was no statistically significant difference in the central venous pressure (CVP) before and after treatment (t=0.608, P>0.05). After treatment, the levels of C-reactive protein (CRP) [(37.87±10.68) mg/L], interleukin (IL)-1 [(25.75±7.18) ng/L], IL-6 [(20.87±8.47) ng/L], and IL-10 [(31.03±7.24) ng/L] in serum were all lower than those before treatment [(120.56±40.78) mg/L, (42.25±6.26) ng/L, (58.32±9.06) ng/L, and (65.75±7.62) ng/L], with statistically significant differences (t=10.177, 3.241, 6.262, and 6.014; all P<0.05). The overall fatality rate at 28 days was 22.7% (5/22). Conclusion　The combination of bedside CRRT and prone position ventilation significantly improves the oxygenation, hemodynamics, and inflammatory indicators in severe ARDS patients, buying time for the treatment of primary diseases in ARDS patients and promoting their recovery.

Perioperative effects of video-assisted thoracoscopic extended thymectomy via intercostal and subxiphoid approaches

Li Xiapeng, Zhang Haifeng, Zhang Feng, Hu Baoli, Wei Haitao

2023, 29(21):  3066-3069.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.017

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Objective　To compare the clinical efficacy and safety of intercostal video-assisted thoracic surgery (VATS) and subxiphoid video-assisted thymectomy surgery (SVATS) in the treatment of thymomas. Methods　A retrospective analysis was conducted on 100 patients with thymomas in the Department of Thoracic and Cardiovascular Surgery, Huaihe Hospital of Henan University from November 2018 to November 2022. All patients underwent total thymectomy and mediastinal fat removal, who were divided into a SVATS group and a VATS group according to the surgery approaches. There were 20 males and 21 females aged (62.22±5.85) years in the VATS group. There were 29 males and 33 females aged (60.06±8.06) years in the SVATS group. The clinical data and perioperative indicators [operation time, intraoperative blood loss, postoperative Visual Analogue Scale (VAS) score, and postoperative hospital stay] of the two groups were compared. t test and χ² test were used. Results　There were no statistically significant differences in the clinical data and operation time between the two groups (all P>0.05). The intraoperative blood loss [(53.68±4.39) ml] in the SVATS group was less than that in the VATS group [(87.71±28.50) ml], the postoperative hospital stay [(2.63±0.65) d] was shorter than that in the VATS group [(3.71±0.67) d], and the VAS score 48 h after operation [(3.63±1.49) points] was lower than that in the VATS group [(4.98±1.65) points], with statistically significant differences (t=9.260, 8.154, and 4.312; all P<0.05). Conclusion　SVATS has advantages over VATS in safety, less intraoperative bleeding, less postoperative pain, and significantly shortened postoperative hospital stay for treating thymomas.

Clinical Research

Intervention effect of group cognitive behavioral therapy based on self-control training in adolescents with depressive disorders

Wang Xiaoni, Chen Hongsheng, Wang Yuping

2023, 29(21):  3070-3076.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.018

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Objective　To explore the intervention efficacy of group cognitive behavioral therapy (GCBT) based on self-control training in adolescents with depressive disorders. Methods　This study was a randomized controlled trial. A total of 86 adolescents with depressive disorders admitted to the Third People's Hospital of Foshan City from January to May 2022 were randomly divided into a control group and a study group by convenience sampling method with 43 cases in each group. After calculation of shedding, withdrawal, and elimination, 38 cases in the control group and 40 cases in the study group were included in the analysis. The control group included 16 males and 22 females, aged (16.24±2.69) years; the study group included 14 males and 26 females, aged (16.30±2.75) years. The control group received routine health education once a week for 7 weeks. The study group received GCBT based on self-control training once a week for 7 weeks. The self-control ability and depression degree were evaluated by Self-control Ability Questionnaire for Middle School Students and Hamilton Depression Scale 24 - item (HAMD-24) at the time of enrollment and 2 months after enrollment. The memory function (MF), executive function (EF), and attention function (AT) were evaluated at the time of enrollment and 2 months after enrollment. t test and χ² test were used for statistical analysis. Results　Two months after enrollment, the scores of emotional control dimension, behavioral control dimension, and thinking control dimension and total score of the Self-control Ability Questionnaire for Middle School Students of the study group were higher than those of the control group [(35.28±3.37) points vs. (30.50±3.28) points, (45.68±5.36) points vs. (39.74±5.13) points, (32.70±3.35) points vs. (28.78±3.07) points, (113.66±10.73) points vs. (99.02±9.86) points], with statistically significant differences (t=6.343, 4.995, 5.407, and 6.265; all P<0.05). Two months after enrollment, the HAMD-24 score of the study group was lower than that of the control group [(21.40±3.14) points vs. (23.18±3.52) points], with a statistically significant difference (t=2.359, P<0.05). Two months after enrollment, the scores of MF, EF, and AT in the study group were higher than those in the control group [(23.93±1.54) points vs. (21.68±1.75) points, (27.50±2.16) points vs. (24.87±2.32) points, (79.83±8.16) points vs. (72.55±9.27) points], with statistically significant differences (t=6.036, 5.185, and 3.686; all P<0.05). Conclusion　Compared with conventional health education, the GCBT based on self-control training can improve the self-control ability, reduce the depression degree, and enhance the MF, EF, and AT in adolescents with depressive disorders.

Effect of Rehmannia leaf glycoside capsules combined with L-carnitine on hemodialysis patients 

Wang Chunying, Zhang Qian, Liao Yingchun, Luo Lan, Tian Feizhen, Wang Sufeng, Dong Xiangwu, Lin Mengyuan

2023, 29(21):  3076-3080. 

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Objective　To explore the effects of Rehmannia leaf glycoside capsules combined with L-carnitine on inflammatory factors, residual renal function (RRF), and oxidative stress in hemodialysis patients. Methods　A total of 124 patients with chronic renal failure who received hemodialysis treatment in the People's Hospital of Xiangxiang from January 2020 to December 2022 were prospectively selected in this study and were divided into a control group and a combination group by the random number table method, with 62 cases in each group. The control group included 35 males and 27 females, aged (49.29±5.43) years; the combination group included 37 males and 25 females, aged (49.58±5.46) years. The control group received L-carnitine treatment, and the combination group received Rehmannia leaf glycoside capsules + L-carnitine treatment, continuous treatment for 2 months. The inflammatory factors [hypersensitive C-reactive protein (hs-CRP), interleukin-2 (IL-2), and tumor necrosis factor-α (TNF-α)], renal function indexes [serum creatinine, urea nitrogen, and RRF], and oxidative stress indexes [malondialdehyde (MDA), reactive oxygen species (ROS), and advanced oxidation protein products (AOPP)] before treatment and 2 months after treatment and adverse reactions were compared between the two groups. t test and χ² test were used. Results　After 2 months of treatment, the levels of inflammatory factors in both groups were decreased compared with those before treatment (all P<0.05), and the levels of hs-CRP [(4.03±1.13) mg/L], IL-2 [(8.26±1.34) ng/L], and TNF-α [(31.46±4.53) ng/L] in the combination group were lower than those in the control group [(7.05±1.59) mg/L, (11.05±2.02) ng/L, and (44.29±5.24) ng/L], with statistically significant differences (t=12.191, 9.063, and 14.585; all P<0.05). After 2 months of treatment, the levels of renal function indexes in both groups were decreased compared with those before treatment (all P<0.05), the levels of serum creatinine [(464.33±21.16) μmol/L] and urea nitrogen [(15.58±2.46) mmol/L] in the combination group were lower than those in the control group [(514.26±28.25) μmol/L and (19.27±3.15) mmol/L], and the level of RRF [(4.29±1.13) ml/min] was higher than that in the control group [(2.54±0.76) ml/min], with statistically significant differences (t=17.162, 7.270, and 10.119; all P<0.05). After 2 months of treatment, the levels of oxidative stress indexes in both groups were decreased compared with those before treatment (all P<0.05), and the levels of MDA [(5.02±1.13) nmol/L], ROS [(192.35±17.59) μmol/L], and AOPP [(89.45±9.58) μmol/L] in the combination group were lower than those in the control group [(8.15±2.10) nmol/L, (264.16±21.47) μmol/L, and (112.04±12.67) μmol/L], with statistically significant differences (t=10.335, 20.372, and 11.198; all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the combination group and the control group [8.06% (5/62) vs. 11.29% (7/62)] (χ²=0.369, P=0.544). Conclusion　Rehmannia leaf glycoside capsules combined with L-carnitine has definite efficacy in the treatment of hemodialysis patients, which can reduce the production of inflammatory factors, relieve the oxidative stress, and protect the RRF, and has good safety and clinical application value.

Effects of hypnotherapy combined with mindfulness therapy on depressive mood and sleep quality in patients with postpartum depression

Liu Ting, Huang Suzhen, Zhou Aihua

2023, 29(21):  3081-3084.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.020

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Objective　To explore the effect of hypnotherapy combined with mindfulness therapy on depressive mood and sleep quality in patients with postpartum depression. Methods　This was a randomized controlled trial. A total of 80 patients with postpartum depression treated in First Affiliated Hospital of Gannan Medical University from August 2022 to August 2023 were prospectively selected as the study objects, and were divided into a control group and an observation group by the random number table method, with 40 cases in each group. The control group was (28.20±3.62) years old, and the observation group was (26.20±3.12) years old. All pregnant women were scored using Edinburgh Postpartum Depression Scale (EPDS), and those with a score of >9 points were included in the study. Before the study began, the Pittsburgh Sleep Quality Index (PSQI) was also used to score and record. The control group was treated with mindfulness therapy, and the experimental group was treated with hypnotherapy on the basis of mindfulness therapy. Both groups were scored and recorded with the EPDS and PSQI again after 6 weeks of treatment. The differences of depression score, sleep index, and patients' satisfaction were compared between the two groups before and after treatment. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the score of EPDS or PSQI between the two groups (both P>0.05). After treatment, the EPDS score [(8.732±1.523) points] and PSQI score [(8.533±1.541) points] in the observation group were lower than those in the control group [(9.871±1.194) points and (11.532±1.913) points], with statistically significant differences (t=3.412 and 7.721, both P<0.05). The treatment satisfaction in the observation group [87.5% (35/40)] was higher than that in the control group [67.5% (27/40)], with a statistically significant difference (χ²=4.872, P=0.027). Conclusion　Hypnotherapy combined with mindfulness therapy can effectively improve the depressive mood and sleep disorder in postpartum depression patients, and the combined therapy can achieve better results than the single therapy and can improve the patients' satisfaction.

Medication Research

Overview of pharmacological and toxicological studies on the composition of Dingtong Ointment

Wong Cheokkin, Kou Sengka, Lei Kitnang, Li Jianheng, Shen Jian

2023, 29(21):  3085-3089.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.021

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Dingtong Ointment is a characteristic orthopedic medicine for external use in TCM Department of Kiang Wu Hospital in Macau. It has been used clinically for more than 20 years and has a good curative effect on acute and chronic soft tissue injuries. It is widely used and favored by patients in Macau. Its components have analgesic, anti-inflammatory, detumescence, antibacterial, anti-rheumatic, anticoagulant, anti-oxidation, and other effects, and its toxicity of external use is relatively low, with high safety. Through summarizing the pharmacology and toxicology studies on Dingtong Ointment in recent years, it provides a foundation for further research on Dingtong Ointment.

Analysis of ongoing change characteristics of the contents of tectoridin and genistein in Puerariae Lobata (Willd.) Ohwio at different development stages 

Shi Jinmin, Dong Yongqiang, Zhou Can, Yu Xuming, Ke Jing, Wang Linhai

2023, 29(21):  3090-3093.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.022

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Objective　To determine the ongoing change characteristics of the contents of tectoridin and genistein in Puerariae Lobata (Willd.) Ohwio at different development stages (floral bud and flower), so as to provide reference for its rational harvesting and application. Methods　The floral bud and flower parts of Puerariae Lobata (Willd.) Ohwio during different harvesting periods were taken as the research samples. The contents of tectoridin and genistein were determined by high performance liquid chromatography (HPLC). The determination was performed on Inertsil C₁₈ column (250 mm×4.6 mm, 5 µm) with mobile phase consisted of acetonitrile - 0.1% phosphoric acid solution (15:85) at the flow rate of 1.0 ml·min^-1. The column temperature was 40 ℃ with the detection wavelength as 265 nm, and the sample size was 10 µl. Results　The calibration curves of tectoridin and genistein were linear within a range of 0.8-52.0 mg/L (r=1.000 0) and 0.7-44.0 mg/L (r=1.000 0). The average recovery was 98.56% [relative standard deviation (RSD) = 1.97%] and 101.08% (RSD = 1.76%), respectively. The contents of tectoridin in the floral bud and flower samples of Puerariae Lobata (Willd.) Ohwio at different harvesting times showed flower bud > flower, and the content of genistein was flower bud < flower. The highest contents of tectoridin and genistein were from the samples harvested after the beginning of autumn. Conclusion　The best harvesting time of Puerariae Lobata (Willd.) Ohwio is after the beginning of autumn.

Nursing Research

Application of bovine basic fibroblast growth factor gel combined with anal bag negative pressure drainage and flushing device in nursing care for ICU patients with incontinence-associated dermatitis

Lin Lingling, Cai Yingying, Luo Bin, Xie Danling, Huang Qiongshan

2023, 29(21):  3094-3098.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.023

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Objective　To explore the application effect of bovine basic fibroblast growth factor gel combined with anal bag negative pressure drainage and flushing device in nursing care for patients with incontinence-associated dermatitis (IAD) in intensive care unit (ICU). Methods　This study was a randomized controlled trial. A total of 60 IAD patients were selected as research subjects from July 2021 to March 2023 in the ICU of Jieyang People's Hospital. The subjects were divided into a control group (30 cases) and an observation group (30 cases) by the random number table method. In the course of the study, 3 patients withdrew from the study. Finally, 28 cases were included in the control group and 29 cases in the observation group. In the control group, there were 18 males and 10 females, aged (62.43±13.63) years; in the observation group, there were 16 males and 13 females, aged (63.62±14.11) years. The control group was treated with anal bag negative pressure drainage and flushing device on the basis of routine operation, and the observation group was treated with bovine basic fibroblast growth factor gel and anal bag negative pressure drainage and flushing device on the basis of routine operation. The severity of IAD, the reduction rate of the Chinese version of the Incontinence-Associated Dermatitis and Its Severity Instrument (IADS), and the IAD healing time were compared between the two groups. t test, non-parametric test, and χ² test were used.  Results　There was no statistically significant difference in the severity of IAD between the two groups before intervention (Z=-0.154, P=0.878). On the 3rd and 6th day after intervention, the severity of IAD in the control group decreased to 2.0 (3.0) and 0 (0) points, respectively, while that in the observation group decreased to 3.0 (2.0) and 0 (3.0) points, respectively, with statistically significant differences (both P<0.05); the reduction rates of IADS in the control group were 33.33% (19.92%) and 100.00% (42.71%), respectively, and those in the observation group were 57.14% (63.33%) and 100.00% (0), respectively, with statistically significant differences (both P<0.05). The healing time of IAD was (8.04±4.97) days in the control group and (6.10±3.89) days in the observation group, without statistically significant difference between the two groups (t=1.638, P=0.107). Conclusion　The application of bovine basic fibroblast growth factor gel combined with anal bag negative pressure drainage and flushing device in ICU IAD patients can effectively alleviate the severity of IAD and promote the healing of IAD, worthy of clinical promotion.

Application of pestle needle combined with acupoint application in traditional Chinese medicine nursing for patients with cervical vertigo 

Cheng Jianlan, Ding Li, Yuan Hongmei

2023, 29(21):  3099-3102. 

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Objective　To explore the application value of pestle needle combined with acupoint application in traditional Chinese medicine (TCM) nursing for patients with cervical vertigo. Methods　This study was a randomized controlled trial. A prospective study was conducted to select 82 patients with cervical vertigo admitted to Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from July 2020 to July 2022. They were divided into a control group (41 cases) and an observation group (41 cases) according to the random number table method. In the control group, there were 23 males and 18 females, aged (42.59±4.61) years, with a course of disease of (36.91±8.24) months; in the observation group, there were 24 males and 17 females, aged (42.81±4.32) years, with a course of disease of (37.49±8.56) months. The control group received routine nursing care, while the observation group received TCM characteristic nursing techniques (pestle needle combined with acupoint application). Both groups received 21 days of nursing care. The symptoms and function of cervical vertigo, sleep quality, and quality of life were compared and analyzed in the two groups. t test and χ² test were used. Results　After nursing, the scores of shoulder and neck pain [(2.98±0.35)], vertigo [(12.58±1.43)], psychological and social status [(3.01±0.45)], headache [(1.49±0.18)], and daily life and work [(3.08±0.39)] and the total score [(23.14±3.06)] of the Evaluating Score for the Symptoms and Function Rehabilitation of Cervical Vertigo in the observation group were higher than those in the control group [(2.34±0.31), (10.32±1.76), (2.38±0.30), (1.14±0.26), (2.43±0.34), and (18.61±2.97)], the score of quality of life questionnaire was higher than that in the control group [(105.34±9.02) vs. (90.13±8.17)], and the score of Pittsburgh Sleep Quality Index was lower than that in the control group [(7.21±1.23) vs. (9.61±1.83)], with statistically significant differences (t=8.765, 6.381, 7.459, 7.087, 8.044, 6.802, 8.003, and 6.970, all P<0.001). Conclusion　TCM characteristic nursing technique of pestle acupuncture combined with acupoint application can alleviate the clinical symptoms in patients with cervical vertigo, improve their cervical function, reduce the impact on sleep, and improve their quality of life, with high clinical application value.

Application of CDIO teaching mode combined with Balint group in standardized training for new nurses

Yan Jinxia, Yang Yiqin, Kou Lixia, Lin Jian, Du Wei

2023, 29(21):  3103-3107.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.025

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Objective　To explore the application effect of Conceive-Design-Implement-Operate (CDIO) teaching mode combined with Balint group intervention in standardized training for new nurses. Methods　A total of 94 new nurses in Guangdong Second Traditional Chinese Medicine Hospital from January 2020 to December 2021 were selected as the study subjects for a prospective study. They were divided into two groups according to the time of entry. The 46 new nurses who entered the hospital from January to December 2020 were set as the control group for routine training, including 38 females and 8 males, aged (22.48±1.21) years. The 48 new nurses who entered the hospital from January to December 2021 were set as the observation group for CDIO teaching mode combined with Balint group intervention based on the control group, including 41 females and 7 males, aged (22.25±1.19) years. The core competence, professional identity, and training satisfaction of the two groups were compared. t test and χ² test were used. Results　After training, the total score [(173.58±10.67) points] and the scores of legal and ethical practice dimension [(23.58±4.76) points], interpersonal relationship dimension [(26.42±2.53) points], clinical nursing dimension [(34.38±3.21) points], professional development dimension [(19.42±2.05) points], leadership dimension [(26.92±4.63) points], critical thinking and scientific research dimension [(23.85±3.50) points], educational consulting dimension [(19.02±3.04) points] of the Competency Inventory for Registered Nurses in the observation group were higher than those in the control group [(141.17±9.51) points, (18.35±5.04) points, (21.83±4.52) points, (28.17±5.36) points, (15.39±2.95) points, (22.89±5.84) points, (18.91±4.98) points, and (15.63±3.61) points], with statistically significant differences(t=15.526, 5.179, 6.109, 6.841, 7.713, 3.711, 5.581, and 4.931; all P<0.001). After training, the total score [(121.23±9.96) points] and the scores of occupational social support dimension [(23.96±3.60) points], occupational cognitive evaluation dimension [(37.21±5.57) points], occupational self-reflection dimension [(12.02±1.42) points], occupational frustration coping dimension [(24.23±5.42) points], and occupational social skill dimension [(23.81±4.54) points] of the Professional Identity Scale for Nurses in the observation group were higher than those in the control group [(99.76±10.48) points, (19.87±4.91) points, (31.28±6.77) points, (9.5±2.35) points, (19.13±5.04) points, and (19.98±4.78) points], with statistically significant differences (t=10.182, 4.619, 4.644, 6.314, 4.720, and 3.991; all P<0.001). After training, the overall satisfaction rate of the observation group with the training was 91.7% (44/48), higher than 76.1% (35/46) in the control group, with a statistically significant difference (χ²=4.251, P=0.039). Conclusion　CDIO teaching mode combined with Balint group intervention can improve the core competence and professional identity of new nurses, and new nurses are more satisfied with the training method and its quality.

Effect of patients and their families participatory humanistic story sharing meeting on nurses' empathy

Wang Yueying, He Xujia, Fang Genna

2023, 29(21):  3108-3111.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.026

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Objective　To explore the effect of patients and their families participatory humanistic story sharing meeting on nurses' empathy. Methods　A self-contrast method was used in the study. A total of 36 liaison officers from the Nursing Humanistic Group of Jieyang People's Hospital from July 2021 to December 2022 were selected as the research objects, all female, with working years ≥2 years. Among them, 3 cases were 20-25 years old, 9 cases were >25-30 years old, 14 cases were >30-40 years old, and 10 cases were >40-50 years old. The nurses' empathy and professional identity were investigated before and after the implementation of patients and their families participatory humanistic story sharing meeting. Paired t test was used. Results　After the implementation, the scores of viewpoint taking [(6.12±0.57)], emotional care [(6.23±0.78)], and transpositional consideration [(6.23±0.65)] and total score [(18.78±1.23)] of the empathy ability were higher than those before the implementation, with statistically significant differences (all P<0.05). After the implementation, the scores of sense of control and self-efficacy [(35.87±3.87)], sense of agreement [(24.76±4.23)], and sense of significance [(17.56±2.45)], sense of influence [(26.83±3.21)], and sense of self-determination [(16.75±3.76)] and total score [(119.78±21.57)] of the nurses' professional identity were higher than those before the implementation, with statistically significant differences (all P<0.05). Conclusion　The patients and their families participatory humanistic story sharing meeting can improve the nurses' professional identity and empathy, with significant practical value.

Application of pipeline slip risk assessment form in the prevention of unplanned extubation in ICU

Luo Meiyi, Li Hongxia

2023, 29(21):  3112-3115.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.027

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Objective　To explore the application value of pipeline slip risk assessment form in the prevention of unplanned extubation in intensive care unit (ICU). Methods　A total of 100 patients treated with indwelling catheter in ICU, Guangzhou Chest Hospital from May 2022 to April 2023 were selected as the research subjects. They were divided into a control group and an observation group by the random number table method with 50 cases in each group. The control group included 39 males and 11 females, aged (55.10±29.06) years. The observation group included 35 males and 15 females, aged (55.10±29.06) years. The control group was treated with routine ICU nursing measures, and the observation group was treated with a risk assessment table for pipeline slip based on routine nursing. The risk assessment was carried out when the patients were admitted to the department, and targeted pipeline management was carried out after identifying different risk groups. The rate of unplanned extubation and the occurrence of catheter accidents in ICU were compared between the two groups. t test and χ² test were used. Results　The unplanned extubation rates of tracheal intubation (0), gastric tube [2.0% (1/50)], central venous catheter (0), and urinary catheter [4.0% (2/50)] in the observation group were lower than those in the control group [8.51% (4/47), 14.00% (7/50), 8.33% (4/48), and 18.00% (9/50)], with statistically significant differences (χ²=4.265, 4.891, 4.259, and 5.005; P=0.039, 0.027, 0.039, and 0.025). The incidences of catheter blockage [4.0% (2/50)], catheter distortion [8.0% (4/50)], catheter displacement [6.0% (3/50)], and catheter related infection (0) in the observation group were lower than those in the control group [16.0% (8/50), 24.0% (12/50), 20.0% (10/50), and 8.0% (4/50)], with statistically significant differences (χ²=4.000, 4.762, 4.332, and 4.167; P=0.046, 0.029, 0.037, and 0.041). Conclusion　The pipeline slip risk assessment form can help medical staff identify high-risk populations for unplanned extubation, and its application in ICU nursing can effectively reduce the rate of unplanned extubation and reduce the occurrence of catheter hidden dangers, which is worth promoting and applying.

Perioperative care for patients undergoing transoral endoscopic thyroidectomy vestibular approach

Zhu Xiaotong, Mao Xiaoyan, Li Ping, Zhu Lamei, Yan Jingwen

2023, 29(21):  3116-3120.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.028

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Objective　To summarize the nursing points in patients undergoing transoral endoscopic thyroidectomy vestibular approach (TOETVA), and to provide practical experiences for such patients. Methods　A retrospective analysis was conducted on 62 patients with thyroid cancer in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from March 2021 to February 2023 (62 cases of papillary thyroid carcinoma, 4 cases with chronic lymphocytic thyroiditis), including 2 men (3.2%) and 60 women (96.8%), with a median age of 30 (19, 49) years old. These patients underwent thyroid cancer resection under the multidisciplinary participation to formulate treatment and surgery plans. Nurses implemented preoperative oral management, implementation of health education, and psychological counseling, and postoperative strengthened targeted nursing measures for complications. Results　All 62 patients successfully underwent surgery, with a surgical duration ranging from 150 to 300 minutes, with an average of (174.20±28.85) minutes. Postoperatively, 13 cases experienced temporary hypoparathyroidism, 9 cases had temporary mental nerve injury, 3 cases had significant jaw swelling, lip edema, and blistering, 2 cases had recurrent laryngeal nerve injury, 2 cases had fluid accumulation, poor drainage, and infection, 1 case had chyle leakage, and 1 case had subcutaneous emphysema. After appropriate treatment and nursing care, the patients were discharged within 3 to 13 days postoperatively. Conclusion　Controlling the oral environment, paying attention to psychological care, and doing a good job in the observation and treatment of complications, are important measures to ensure that patients go through the perioperative period of TOETVA smoothly.

Application of cluster intervention based on the concept of enhanced recovery after surgery in patients with kinesiophobia after lumbar fusion surgery

Zou Aiyuan, Chen Rongbin, Qin Haibing, Li Chunrong

2023, 29(21):  3121-3126.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.029

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Objective　To explore the effect of cluster intervention based on the concept of enhanced recovery after surgery (ERAS) in patients with kinesiophobia after lumbar fusion surgery. Methods　A total of 80 patients with kinesiophobia after lumbar fusion surgery treated in Zhuhai Branch of Guangdong Provincial Hospital of Chinese Medicine from September 2021 to January 2022 were selected for a prospective cohort study. They were divided into an observation group and a control group by the random number table method, with 40 cases in each group. There were 23 males and 17 females in the observation group, aged (61.65±12.17) years; there were 22 cases of lumbar spinal stenosis, 11 cases of lumbar spinal stenosis with nerve injury, 4 cases of lumbar disc herniation, 1 case of lumbar spondylolisthesis, and 2 other cases. There were 22 males and 18 females in the control group, aged (61.78±9.12) years; there were 22 cases of lumbar spinal stenosis, 7 cases of lumbar spinal stenosis with nerve injury, 6 cases of lumbar disc herniation, 3 cases of lumbar spondylolisthesis, and 2 other cases. The control group received routine intervention after lumbar fusion surgery, and the observation group received cluster intervention based on the ERAS concept for postoperative kinesiophobia based on the control group. The two groups were compared before and 1 week, 1 month, and 3 months after intervention in the scores of Tampa Scale for Kinesiophobia (TSK), General Self-Efficacy Scale (GSES), and Oswestry Disability Index (ODI) and the incidence of complications. t test and ANOVA for repeated measurement were used for the measurement data and χ² test was used for the count data. Results　At 1 week, 1 month, and 3 months after intervention, the TSK score of the observation group was lower than that of the control group [(37.95±3.90) points vs. (42.05±5.08) points, (31.90±4.05) points vs. (36.48±4.11) points, (27.15±2.95) points vs. (31.78±3.59) points], with statistically significant differences (t=4.046, 5.016, and 6.295, all P<0.001). At 1 week, 1 month, and 3 months after intervention, the ODI score of the observation group was lower than that of the control group [(41.93±4.75) points vs. (47.55±5.08) points, (29.23±4.69) points vs. (36.83±4.42) points, (23.08±3.41) points vs. (30.15±3.72) points], with statistically significant differences (t=5.115, 7.461, and 8.855, all P<0.001). At 1 week, 1 month, and 3 months after intervention, the GSES score of the observation group was higher than that of the control group [(23.50±3.46) points vs. (19.68±4.03) points, (29.33±3.08) points vs. (24.23±4.31) points, (33.25±1.81) points vs. (28.98±3.63) points], with statistically significant differences (t=4.558, 6.091, and 6.672, all P<0.001). Repeated measurement ANOVA showed that there were statistically significant differences between the two groups in the TSK, GSES, and ODI scores in grouping factors, time factors, and grouping×time interaction (all P<0.001). The incidence of postoperative complications in the observation group was 7.5% (3/40), lower than that in the control group [25.0% (10/40)], with a statistically significant difference (χ²=4.501, P<0.05). Conclusion　Cluster intervention based on the ERAS concept can effectively improve the self-efficacy in patients with kinesiophobia after lumbar fusion surgery, reduce the degree of kinesiophobia and the incidence of postoperative complications, and promote the patients recovery.

Experience Exchange

Discussion on the construction of management system for clinical trial investigators

Hu Zhiqin, Zheng Sichao, Wang Xiaole, Wang Tenghua, Fang Yi, Li Yongmei

2023, 29(21):  3127-3130.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.030

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Objective　To discuss the construction of management system for clinical trial investigators, in order to reduce the incidence of protocol deviation and improve the quality of clinical trials. Methods　By searching the reports about protocol deviation in the process of clinical trial implementation in China National Knowledge Network (CNKI), Wanfang data knowledge service platform, and VIP database till January 5, 2023, the data of protocol deviation were extracted, the deviation problems were classified and analyzed, and the treatment measures were tailored to reduce the incidence of protocol deviation. Results　A total of 122 literatures were retrieved, and 11 literatures meeting the inclusion/exclusion criteria were finally included, all of which were in Chinese. There were 89 clinical trial protocol deviation problems, which were classified into 8 categories according to the category of protocol deviation. Among them, the top 3 categories of problems with protocol deviation occurrence and incidence were experimental procedures (6 264 cases, 58.72%), management and use of investigational product (IP) (1 594 cases, 14.94%), and inclusion/exclusion criteria (1,362 cases, 12.77%). Conclusion　By establishing the investigator management system, we can standardize the management for investigators, reduce the incidence of protocol deviation, improve the investigators' clinical research level, ensure the subjects' safety and interests, and assure the quality of clinical trials.

Pharmacy Management

Application of quality control circle activities in improving the efficiency of batch number management of anesthetic and psychotropic drugs in smart cabinet 

Zhuang Shaoxiong, Zhou Mengyuan, Long Xiaoqing, Lin Ruijuan, Lin Zhicheng

2023, 29(21):  3131-3134.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.031

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Objective　To improve the efficiency of batch number management of anesthetic and psychotropic drugs by quality control circle activities and ensure the rational application of anesthetic and psychotropic drugs. Methods　Quality control circle method was used to improve the efficiency of batch number management of anesthetic and psychotropic drugs through ten steps such as "current situation grasp, cause analysis, countermeasure formulation, implementation review, and standardization". The average daily batch number of anesthetic and psychotropic drugs in Guangdong Women and Children Hospital from May to October 2022 was analyzed, and the average daily batch number issuing rate of anesthetic and psychotropic drugs from May to July was compared with that from August to October by using t test. Results　The average daily batch number issuing rate of anesthetic and psychotropic drugs was increased from 31.47% (62/197.0) in May to 51.31% (186/362.5) from August to October, with a statistically significant difference (t=2.918, P<0.05). The target achievement rate of quality control circle activities was 98.37%, and the progress rate was 63.03%. Conclusion　The application of quality control circle can improve the issuing rate of batch number, reduce the pharmacists' workload, improve the management efficiency of anesthetic and psychotropic drugs, and ensure the quality of pharmaceutical care.

Clinical Teaching

Application of micro-class integration with traditional teaching in the teaching of MRI principles

Yu Jiaxi, Lin Haibo, Li Xinchun

2023, 29(21):  3135-3138.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.032

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Due to the complexity and abstraction of magnetic resonance imaging (MRI) principles, and the limited teaching time provided by traditional teaching methods, it is difficult for medical students to fully understand and accept MRI in a relatively short time. With the rapid development of information technology and its successful application in medical education, micro-class has become a new supplementary teaching method. Through its diverse forms, it helps to cultivate students' self-learning ability and innovative thinking ability. This article discusses the role of the combination of micro-class and traditional teaching methods in the teaching of MRI principles.

Preliminary study on the distance teaching of 5G+flipped classroom in the undergraduate education of ultrasound diagnostics in the post epidemic era

Shen Hongyuan, Liu Tao, Han Wei, Li Ruolan, Zhou Qiongjuan, Song Siyi, Hong Xiaofang, Hu Yujuan, Liang Weixiang

2023, 29(21):  3139-3142.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.033

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In the post-epidemic era, traditional face-to-face teaching is difficult to meet the needs of undergraduate ultrasound teaching due to a variety of constraints. Distance learning has become the solution, but it has not been effective in the past. This paper analyses and proposes the combination of 5G technology and flipped classroom to explore the advantages, disadvantages, and application value of this new teaching model. It is hoped that through the above teaching reform solution, we can adapt to the normal management of COVID-19 epidemic, deepen students' understanding of basic theoretical knowledge and ultrasound images, improve their practical skills, expand their clinical thinking, mobilize their subjective motivation and interest in learning, to ensure the quality of medical distance learning.

Exploration and practice of clinical nursing student teaching model that highlights the cultivation of core competence of traditional Chinese medicine nursing 

Wang Hui, Wen Guixiang, Gu Yunqing, Yi Chun, Yang Li, Chen Xingxing

2023, 29(21):  3143-3147.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.034

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Objective　To explore the application of the new clinical teaching mode of "dual guidance system" and highlighting the cultivation of core competence of traditional Chinese medicine nursing in improving the teaching quality of traditional Chinese medicine nursing. Methods　A total of 47 nursing interns from Huangpu Branch, The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine from July 2021 to June 2022 were selected as the control group, including 35 females and 12 males, aged 19-22 (20.34±1.07) years. A total of 50 nursing interns from July 2022 to June 2023 were selected as the research group, including 36 females and 14 males, aged 19-23 (20.92±1.34) years. The control group adopted the conventional teaching mode; on the basis of the traditional clinical teaching mode, the research group added online MOOCs, offline flipped classrooms, and problem-based teaching methods (PBL) based on the "dual guidance system". In addition to the original assessment methods, the assessment of traditional Chinese medicine nursing programs for specialized dominant diseases and Objective Structured Clinical Examination (OSCE) were added. The teaching satisfaction scores, results of theoretical assessment and operation assessment, and traditional Chinese medicine nursing practice quality scores of the two groups were compared. χ² test, rank sum test, and t test were used. Results　The satisfaction of clinical teachers in the research group was higher than that in the control group, with a statistically significant difference (Z=-2.884, P=0.004). The results of theoretical assessment and operation assessment of the study group were (88.27±3.70) points and (90.17±3.79) points, respectively, while those of the control group were (83.72±5.51) points and (85.75±5.77) points, with statistically significant differences (t=4.80 and 4.38, both P<0.001). The scores of 9 dimensions of the Self-rating Scale of Traditional Chinese Medicine Nursing Practice Quality in the study group were better than those in the control group (all P<0.05). Conclusion　The clinical teaching mode based on the "dual guidance system" and highlighting the cultivation of core competence of traditional Chinese medicine nursing can effectively improve the independent learning ability and enthusiasm of nursing students, and improve their professional skills and clinical dialectical thinking ability, which provides a new way to cultivate high-quality traditional Chinese medicine nursing talents.

Considerations on the design of multimedia courseware for Clinical Basic Examination teaching based on network

Chen Bo, Huang Haiying, Zhou Qiang, Ji Tianxing, Lin Zhen, Chen Jingnan

2023, 29(21):  3148-3151.  DOI: 10.3760/cma.j.issn.1007-1245.2023.21.035

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The teaching content of network courseware is highly targeted and diversified, which is conducive to students' autonomous learning at any time. At the same time, it can expand students' knowledge and improve the depth of professional knowledge, stimulate students' interest in learning of their own major, thus improving the teaching quality, which is a beneficial supplement to traditional classroom teaching. This paper summarizes the experiences of making network-based multimedia interactive teaching network courseware, characteristics of the network itself, and problems that should be paid attention to in the production process, which is conducive to ensuring the quality of network courseware. With the medical textbook Clinical Basic Examination published by the People's Education Press as the network teaching content, some network courseware has been made. In addition to retaining some teaching content modules of the basic textbook, it further adds network functions such as after-school exercises, reference materials, teaching materials, teacher mailbox, latest teaching and research trends of medicine and laboratory, communication area, and teaching bulletin board module.