Table of Content

15 November 2023, Volume 29 Issue 22

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New Medical Advances

Role of gut microbiota imbalance in alpha-synuclein induced microglia activation in patients with Parkinson's disease

Cai Jinfeng, Wang Hongcai, Ge Ruli

2023, 29(22):  3153-3157.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.001

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More and more evidences show that gut microbiota is closely related to the development and progression of Parkinson's disease (PD). Recent studies have shown that gut microbiota can activate microglia in the brain by regulating alpha-synuclein (α-syn), aggravate neuroinflammation, and lead to dopamine neuron loss in patients with PD. In this paper, we review how the imbalance of gut microbiota leads to neuroinflammation through α-syn activation of microglia in the pathogenesis of PD.

Research progress of B-ultrasound guided injection of platelet-rich plasma combined with nerve block in treatment of periarthritis of shoulder

Xie Aixia, Li Qiangqiang, He Yanhong, Hua Dewu, Chen Liping, Xue Jianjun

2023, 29(22):  3157-3161.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.002

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Periarthritis of shoulder is a disease characterized by pain and limited range of motion in the shoulder. The underlying pathology is soft tissue fibrosis and inflammation of the shoulder joint, joint capsule, and ligament. It often occurs in middle-aged and elderly people. Nerve block treatment for periarthritis of shoulder's short-term local effect is significant, but the disease is easy to repeat and delay. Platelet-rich plasma (PRP) is increasingly used in many medical fields and in recent years has been used in the treatment of periarthritis of shoulder. Many studies have found that B-ultrasound-guided intraarticular injection of PRP combined with nerve block can effectively improve the symptoms of patients with periarthritis of shoulder. This article mainly reviews the possible pathogenesis of periarthritis of shoulder and the potential mechanism and research progress of PRP combined with nerve block in the treatment of periarthritis of shoulder.

Research progress of intestinal flora and intestinal diseases

Fu Xinnian, Zheng Sheng, Yang Juan

2023, 29(22):  3162-3165.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.003

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Intestinal flora is closely related to the occurrence and development of intestinal diseases and plays an important role in maintaining intestinal homeostasis. In this paper, the research progress of intestinal flora and intestinal diseases, including colorectal polyps, colorectal cancer, inflammatory bowel disease, and irritable bowel syndrome, is reviewed, so as to provide references for the prevention, diagnosis, and treatment of intestinal diseases.

Research progress of Parkinson's disease 7 gene in renal diseases

Tan Junjie, Jiang Xinxin

2023, 29(22):  3166-3170.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.004

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Parkinson's disease 7 (PARK7) gene widely exists in prokaryotes and eukaryotes. PARK7 protein is a functional protein that exists in cells and has a wide range of anti-oxidative stress effects. It mainly involves in neural, reproductive, and cardiovascular diseases and tumors. At present, there are just a few researches on the progress of PARK7 in kidney diseases. This paper mainly focuses on PARK7 gene's structural biology, physiological function, and its relationship with kidney diseases.

Clinical progress in prevention and treatment of osteoporosis associated with endocrine therapy for breast cancer

Li Wenran, Han Mengyu, Long Shuyan, Jiang Yueyang, Ma Yuhang, Zhao Runqi, Cheng Hongju

2023, 29(22):  3170-3176.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.005

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Breast cancer is the most common cancer in Chinese women. Endocrine therapy for hormone receptor-positive breast cancer has a good curative effect, but it can induce osteoporosis, which is a difficult problem that must be solved urgently in clinics. To prevent and treat endocrine therapy-related osteoporosis, clinical researchers have explored a number of measures. Modern medicines mainly include anti-bone absorbent agents, selective estrogen receptor modulators, and receptor activator of nuclear factor kappa B ligand (RANKL) monoclonal antibodies, which are used to treat osteoporosis by inhibiting osteoclast differentiation and maturation. Traditional Chinese medicine regulates bone metabolism by tonifying kidney as the foundation, soothing liver and invigorating spleen, and promoting blood circulation and dredging collaterals; it shows strong therapeutic potential. Early bone health assessment is the key in the prevention and treatment of endocrine therapy-related osteoporosis. Continuous innovation in assessment techniques offers promising prospects for its prevention and control. This paper focuses on the pathogenesis of osteoporosis associated with endocrine therapy for breast cancer, as well as the research progress of prevention and treatment of osteoporosis in modern medicines and traditional Chinese medicines, so as to contribute to its further study and better serve clinical practice.

Research progress on influencing factors and clinical treatment of adolescent scoliosis

Wang Aiying, Ji Zhonglei, Chen Haipeng, Yang Qing, Yang Qi

2023, 29(22):  3176-3180.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.006

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The incidence of adolescent scoliosis is increasing year by year. It has adverse effects on adolescents' physiological and psychological growth. In this paper, the relationship between the time beginning to stand, body weight, amount of exercise, school bag, writing posture, and flat foot and the formation of scoliosis is described. According to the risk factors of scoliosis and adolescents' behaviors and developmental characteristics, regular screening and prevention strategies were implemented. The treatment plan is elaborated from the aspects of exercise therapy, respiratory training, suspension, massage, electrical stimulation, traction, braces, surgery, etc., so as to provide references and direction for the clinical treatment of scoliosis.

Case Report

Two cases of liver sparganosis

Long Xian, He Qiong

2023, 29(22):  3181-3184.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.007

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Sparganosis is a zoonotic parasitic disease caused by the parasitic presence of Sparganum in humans and animals during the middle tapeseed stage of Spirometra mansoni and other schizocephalus tapeworms. Two cases of liver sparganosis treated at First Hospital, Jinan Vniversity in August 2022 are reported in this paper. After the epidemiological history, clinical manifestations, parasite antibodies, CT and B ultrasound images, etc. were analyzed and an infectious disease doctor was consulted, the diagnosis of liver sparganosis was made. After oral quinolone treatment, the patients' clinical symptoms, such as abdominal pain and fever, disappeared. The follow-up after discharge showed that the lesions were reduced in CT images, and their eosinophil counts of blood and liver function returned to normal. Clinical attention should be paid to suspicious epidemiological history, and relevant examinations should be improved. Most importantly, early diagnosis and treatment should be performed.

One case of congenital urethral dysplasia complicated with pseudourethrovaginal fistula

Li Liwen, Yao Lijuan, Cui Jinxiu, Gu Zhenpeng

2023, 29(22):  3184-3186.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.008

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Urogenital fistula is defined as an abnormal channel between the urinary and reproductive system. Congenital urogenital fistula is rare. Now we report a case of congenital urethral dysplasia complicated with pseudourethrovaginal fistula in Binzhou Medical University Hospital. The etiology was analyzed, and some urogenital tract abnormalities in similar anatomical locations were identified from this case, which could provide some references for further study of genitourinary system development abnormality.

Secondary pulmonary tuberculosis in one patient with myelodysplastic syndrome during recovery period of Pneumocystis jirovecii pneumonia

Li Fei, Guo Lijuan, Shi Xinjie

2023, 29(22):  3187-3190.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.009

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Myelodysplastic syndrome (MDS) is characterized by abnormal hematopoiesis of blood cells. Patients with MDS often have low immune function. This paper reports a case of MDS patient with chest tightness as the main symptom. The patient was admitted to Weihai Central Hospital, Qingdao University and diagnosed with Pneumocystis jirovecii pneumonia. After treatment, the conditions were improved. However, the patient was hospitalized again because of fever, and the application of conventional anti-infective drugs was ineffective. After the second-generation sequencing technology, the patient was finally diagnosed as pulmonary tuberculosis. The related literatures were reviewed in order to provide some help to clinical work.

Hormone pulse therapy for one case of hypertrophic pachymeningitis and literature review

Liang Qiuxiong, Zhou Zhengxin, Liang Ruihua, Chen Jiangying

2023, 29(22):  3190-3192.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.010

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Hypertrophic pachymeningitis (HP) is a chronic fibrotic inflammatory disease characterized by thickening of the dura mater and causing a series of symptoms. With the increased utilization of imaging exams and improved understanding of the disease, its diagnosis rate is on the rise. However, there is currently no consensus or guidelines for the treatment of the disease in China. In this report, we present a case of hypertrophic pachymeningitis with symptoms mainly affecting the cavernous sinus, which was treated with hormone pulse therapy  in Guangzhou Red Cross Hospital on October 31, 2022, and reviews the literatures.

A case of De Winter electrocardiogram changes in anterior wall lead caused by subtotal occlusion of right coronary artery

Wang Shuling, Zhang Yanpeng

2023, 29(22):  3193-3195.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.011

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The ST segment of the precordial lead in the De Winter electrocardiogram is not elevated, but is inclined upward and downward; it is not easy to attract attention from medical staff. Coronary angiography in such patients often shows subtotal occlusion or occlusion of the anterior descending branch or left main trunk, which is also the main basis for being considered as a high-risk electrocardiogram such as acute ST segment elevation myocardial infarction. In practice, it has been found that coronary artery lesions in such patients are not only related to the anterior descending branch or left main artery, but also to the circumflex branch and right coronary artery. However, we found that a patient's anterior wall lead De Winter electrocardiogram change was indeed caused by right coronary artery occlusion, and reported it for readers.

Two cases of opening occluded radial arteries using forward or reverse methods 

Lu Jingqian, Zhang Wanliu, Gao Yan, Li Yi

2023, 29(22):  3196-3198.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.012

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Radial artery occlusion is a common problem after transradial artery intervention. In the past, prevention methods were often used in perioperative period, but there are few reports about opening the occluded radial artery. As the distal radial artery puncture develops, patients opening occluded radial artery through the distal radial retrograde approach have been appearing; when the puncture fails, the relatively traumatic anterograde approach through brachial artery can also be used to open it.

A case of polycythemia vera complicated with portal hypertension and literature review

Xie Dihuo, Zhou Hongke

2023, 29(22):  3199-3202.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.013

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Portal hypertension (PHTN) is the clinical syndrome of portal hypertension caused by various reasons. Cirrhosis accounts for 90% of all causes, and polycythemia vera is the main pathogenesis among non-cirrhosis causes. Polycythemia vera is a relatively inert myeloproliferative tumor with increased blood viscosity and complications such as thrombus and bleeding during the disease course. PHTN is a rare complication. This paper reports a case of polycythemia vera complicated with PHTN in First Hospital, Jinan University and summarizes the diagnosis and treatment experience of this disease.

One case of acute pancreatitis caused by Ⅳb congenital choledochal cyst: a case report

Tan Minjun, Huang Wei

2023, 29(22):  3202-3204.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.014

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Biliary tract cysts, also known as congenital choledochal cysts (congenital bile dilatation), mainly manifest as the dilatation of the extrahepatic bile duct. Its global incidence is 1/150 000 – 1/100 000, but it may be as high as 1/1 000 in Asians. In addition, the incidence rate shows that women are dominant, with a female to male ratio of 3:1 to 4:1. Biliary tract cysts often appears in infants and can be diagnosed occasionally, or when it causes biliary pancreatitis accompanied by abdominal pain, jaundice, or even an enlarged liver ^[1]. In recent years, the incidence of the disease has also increased in China. This paper reports a case of Ⅳb congenital choledochal cyst with persistent abdominal pain, elevated blood amylase, and other acute pancreatitis symptom as the first symptoms. The patient was diagnosed as Ⅳb congenital choledochal cyst by imaging examination. When the symptoms of pancreatitis were relieved, the diseased part was removed by surgery, and the patient was cured and discharged. Clinicians should improve the understanding of relevant cases and their diagnosis and treatment to avoid misdiagnosis and treatment errors.

A case of acute severe liver injury caused by Puyuanhewei capsules

He Xiangqin, Zhang Junhua, Yang Fang, Ding Guofeng

2023, 29(22):  3205-3208.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.015

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The clinical data of a patient with severe liver injury caused by Puyuanhewei capsules for chronic atrophic gastritis in Binzhou Medical University Hospital were retrospectively analyzed. The causal relationship between Puyuanhewei capsules and liver injury was evaluated according to the Roussel Uclaf assessment method (RUCAM). Through document retrieval, the components that may cause liver injury in Puyuanhewei capsules were analyzed, and it was found that the possible pathogenic components were corydalis Yanhusuo and Taraxacum. The purpose is to remind clinicians to closely monitor the patients' liver function when using Puyuanhewei capsules and traditional Chinese patent medicines and simple preparations containing corydalis Yanhusuo, and to stop using the drug in time after serious liver damage occurs.

One case of complete hydatidiform mole complicated with pulmonary metastasis in one of twin pregnancy and literature review

Zhao Wan, Chen Hailing, Wu Xiaomei

2023, 29(22):  3208-3211.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.016

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Hydatidiform mole can be divided into complete hydatidiform mole and partial hydatidiform mole. Complete hydatidiform mole occasionally occurs in twin pregnancy, and the other twin is a normal live fetus. This article briefly introduces a case of twin pregnancy in Zhuhai Maternal and Health Care Hospital, one of which is complete hydatidiform mole complicated with lung metastasis, and reviews the relevant literatures on the research status of pregnancy with hydatidiform mole in recent years, so as to provide references for clinical work.

One case of metastases of gastric adenocarcinoma to prostate, seminal vesicle, and groin

Zhang Kun, Ren Lu, Han Xia, Ban Naijin, Hao Jianbin, Chen Shaoshui

2023, 29(22):  3211-3213.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.017

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Gastric cancer is one common malignant tumor. The common metastases of patients with advanced gastric cancer include liver, lung, bone, brain, intra-abdominal dissemination, and pelvic planting. However, metastases to prostate, seminal vesicle, and groin after gastrectomy are rare. This paper reports a case of metastases to prostate, seminal vesicle, and groin after gastric adenocarcinoma surgery, describes its diagnosis and treatment, and reviews the relevant literatures.

One case of acute leukemia complicated with hepatic tuberculosis

Wang Xiaoyi, Yan Fumeng, Yu Jie, Deng Xiuzhi, Wang Yili

2023, 29(22):  3214-3216.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.018

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Patients with acute leukemia are immunocompromised and susceptible to a variety of infections that manifest as fever, especially after chemotherapy. Pulmonary tuberculosis is common in patients with acute leukemia, but hepatic tuberculosis is rare. This article reports a case of acute leukemia complicated with post-treatment hepatic tuberculosis admitted to Weihai Municipal Hospital on June 8, 2020, which may help raise the awareness of this disease and avoid delays in treatment.

Meta Analysis

Efficacy and safety of belizumab in treatment of patients with systemic lupus erythematosus: a meta-analysis

Li Hao, Li Jiangtao, Liu Dan, Li Shunhua

2023, 29(22):  3217-3224.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.019

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Objective　To analyze the clinical efficacy and safety of belizumab in the treatment of patients with systemic lupus erythematosus and conduct a meta-analysis. Methods　The PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Internet (CNKI), China Biomedical Literature Database (CBM), VIP database, and Wanfang database were searched for all the randomized controlled trials related to belizumab and systemic lupus erythematosus from their establishment to February 2023. According to the including and excluding criteria, the literatures were screened, and the data were obtained. The RevMan5.4.1 software and Sata16 software were used for the meta-analysis of the obtained data. Relative risk and weighted mean difference were used to represent the effect indicators. The efficacies and safety of the two groups were compared. The sensitivity and publication bias were analyzed. Results　A total of 9 randomized controlled trials were included, with a total of 2 657 patients, including 1 522 cases in the belizumab group and 1 135 cases in the placebo group. Clinical efficacy: compared with the placebo group, the qualified rate of the systemic lupus erythematosus responder index (SRI4) (RR=1.29, 95%CI 1.17-1.42, P<0.001; I²=0,P=0.91) of belizumab continuous treatment for 52 weeks significantly increased; the patients' clinical symptoms were effectively improved; the severe flare (SF) was reduced (RR=0.68, 95%CI 0.58-0.79, P<0.001; I²=0, P=0.48); the disease activity was effectively reduced; the patients' quality of life was improved; the decrease of the SELENA-SLEDAI score ≥4 points (RR=1.28, 95%CI 1.17-1.40, P<0.001; I²=0%, P=0.95); the systemic lupus erythematosus disease activity index (SLEDAI) score (WMD=-4.77, 95%CI -8.67--0.86, P=0.02; I²=97%, P<0.001). Safety: there were no statistical differences in the total incidence of adverse events (RR=0.99, 95%CI 0.96-1.02, P=0.54; I²=0, P=0.90) and the incidence of serious adverse events (RR=0.85, 95%CI 0.64-1.12, P=0.25; I²=57%, P=0.05) between the two groups. Conclusion　Belizumab as an additional treatment for patients with systemic lupus erythematosus has good efficacy and does not increase the incidence of adverse reactions after medication.

Meta-analysis on value of risk of ovarian malignancy algorithm index in diagnosis of ovarian cancers

Xie Yan, Chen Yuying, Jiang Jinhong

2023, 29(22):  3224-3230.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.020

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Objective　To study the clinical value of the risk of ovarian malignancy algorithm (ROMA) index in the diagnosis of ovarian cancer through the meta-analysis on the ROMA index. Methods　The literatures on the ROMA index in the diagnosis of ovarian cancer were searched from PubMed database and CNKI from January 2009 to December 2021. Two reviewers screened the literatures and extracted the data according to the established inclusion and exclusion criteria. After the quality evaluation of the included literatures was carried out according to the QuadAS-2 scale, the statistical software Stata 12.0 was used for the meta-analysis. Results　A total of 3 167 subjects were included in the 13 literatures, including 1 391 subjects in the ovarian cancer group and 1 776 subjects in the control group (including the patients with benign ovarian disease and healthy people who underwent physical examination). The meta-analysis showed that the literatures had heterogeneity (P≤0.1,I²>50%); the ROMA index in the diagnosis of ovarian cancer had a combined sensitivity of 0.91 (95%CI 0.88-0.94), a combined specificity of 0.93 (95%CI 0.83-0.97), a combined positive likelihood ratio of 12.0 (95%CI 5.1-30.4), a combined negative likelihood ratio of 0.09 (95%CI 0.07-0.13), and a combined DOR of 90.76 (95%CI 46.12-178.60); the probability of diagnosis was 26%, and the probability of missed diagnosis was 0. Conclusion　This meta-analysis confirms that the risk of ovarian malignancy algorithm has some value in diagnosis of ovarian cancer.

Scientific Research

Clinicopathological significance of expression level of tumor-infiltrating lymphocytes in patients with HER2 positive breast cancer

Man Qirong, Zhao Tiantian, Duan Chao, Li Ling

2023, 29(22):  3231-3235.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.021

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Objective　To investigate the relationship between the expression of tumor-infiltrating lymphocytes (TILs) and clinicopathological characteristics, and the effect of TILs on prognosis in patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer. Methods　A total of 94 female patients with HER2 positive breast cancer treated at Tengzhou Central People's Hospital from October 2016 to October 2018 were collected, with a median age of 51 years (32-73 years). Among them, 49 patients took trastuzumab and chemotherapy, and 45 chemotherapy. The degree of TILs in the tumor area of each patient's HE section was evaluated. χ² test was used to analyze the category data. The Kaplan Meier survival curve and Cox proportional hazard regression model were used to analyze the prognostic factors. The relationship between the degree of TILs and the clinicopathological characteristics and the effect of TILs on the patients' recurrence free survival (RFS) were analyzed. Results　Among the 94 patients, 61 had low infiltration, and 33 high infiltration. There were no significant correlations between the degree of TILs and clinical pathological parameters (all P>0.05). In the targeted therapy group, 32 cases had low infiltration, and 17 cases high infiltration. The RFS of the patients with high TILs was longer than that of the patients with with low TILs (P=0.036); TNM stage and the degree of TILs were independent factors for the patients' prognosis (P=0.003 and 0.029). In the general chemotherapy group, 29 cases had low infiltration, and 16 cases high infiltration. The RFS of the patients with high TILs was longer than that of the patients with with low TILs (P=0.049); TNM stage and TILs were independent factors related to the patients' prognosis (P=0.001 and 0.028). Conclusions　TILs can be used as tumor markers in predicting the prognosis and therapeutic effect of patients with HER2 positive breast cancer, and may become new therapeutic targets for tumors.

Clinical significance of mismatch of FVH and FVH-DWI in prognosis of patients with unilateral middle cerebral artery occlusion

Tang Zhi, Yang Lin, Xu Lei, Zhou Jianguo

2023, 29(22):  3236-3240.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.022

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Objective　To explore the clinical significance of magnetic resonance fluid attenuation inversion recovery (FLAIR) sequence vascular high signal intensity (FVH) and prognosis. Methods　A total of 100 patients with acute ischemic stroke (onset time<72 hours) admitted to the outpatient and emergency departments of The First People's Hospital of Guannan County and Lianyungang Hospital, Nanjing University of Chinese Medicine from January 2020 to December 2022 were selected. Based on the presence or absence of FVH signs, they were divided into an FVH positive group and an FVH negative group. There were 40 patients in the FVH negative group, including 22 males and 18 females, with an age of (65.49±12.13) years. There were 60 patients in the FVH positive group, including 33 males and 27 females, with an age of (66.32±15.21) years. At admission and on the 15th day after admission, the National Institutes of Health Stroke Rating Scale (NIHSS) and the 3-month Post Stroke Modified Rankin Scale (MRS) were used to determine the degree of neurological impairment. The infarct sizes of the two groups were compared. The distribution of FVH sign positivity was further matched with the DWI core infarct area, and the patients were divided into a matched group and an unmatched group; the MRS scores of the two groups were compared 3 months after discharge. The t, rank sum, and χ² tests were applied. Results　There were statistical differences in the scores of NIHSS on the day 1 of 15 admission and MRS score 3 months after discharge between the FVH positive group and the FVH negative group [(9.49±1.32) vs. (10.26±1.21), (7.82±1.45) vs. (9.54±1.32), and (3.48±1.22) vs. (4.81±1.32); all P<0.05]. The proportion of large infarcts in the FVH negative group was 55% (22/40), while that in the FVH positive group was 18.33% (11/60); there was a statistical difference in the distribution of core infarct area between the two groups (P<0.05). There were statistical differences in the FVH score and the MRS score 3 months after discharge between the FVH-DWI matched group and the unmatched group [(2.21±0.65) vs. (4.73±0.78) and (2.59±0.42) vs. (3.18±0.54); both P<0.05]. Conclusions　The higher the FVH score, the higher the degree of FVH-DWI mismatch; the closer its relationship with collateral vessel formation, the better its clinical prognosis.

Value of combined detection of vWF antigen and activity in prediction of venous thromboembolic events in patients with cancers

Yan Bin, Du Weipeng, Zhai Suping, Hu Tianxi, Tao Linjing, Ye Yaping, Zhou Yuan, Sun Xing

2023, 29(22):  3240-3244.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.023

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Objective　To investigate the clinical value of plasma von Willebrand factor antigen (VWF:Ag) and activity (VWF:Ac) levels in the prediction of venous thromboembolic events in patients with cancers. Methods　A total of 167 patients with cancers who were treated in Nanyang Central Hospital from June 2020 to December 2021 were selected as a caner group, including 97 males and 70 females who were (52.53±10.58) years old. While 135 healthy volunteers matched with the cancer group during the same period were selected as a healthy control group, including 91 males and 44 females who were (47.56±8.09) years old. Their plasma vWF:Ag and vWF:Ac levels were measured. The differences of vWF were analyzed in the cancer group overall and between each subgroup and the healthy control group by Mann-Whitney U test. Spearman rank correlation was used to analyze the correlation between vWF:Ag and vWF:Ac. Cox proportional risk regression model was used to screen the prognostic influencing factors in the patients. The value of vWF:Ag and vWF:Ac in the prediction of the occurrence of VTE events was assessed by receiver operator characteristic curve (ROC) during the 90 d follow-up. Survival analysis was performed using the Kaplan-Meier method. Results　The plasma vWF:Ag and vWF:Ac levels in the case group were significantly higher than those in the healthy control group [197.38% (143.54%, 328.97%) vs. 117.00% (97.70%, 147.40%) and 191.87% (130.85%, 265.69%) vs. 117.90% (99.50%, 153.00%); Z=8.76 and 7.91; both P<0.001]. The correlation analysis revealed that there was a positive correlation between vWF:Ag and vWF:Ac in the case group (r=0.783, P<0.001). During the follow-up, the vWF:Ag and vWF:Ac levels in the group with VTE events were higher than those in the group without VTE events [432.38% (248.14%, 539.55%) vs. 183.00% (126.96%, 246.02%) and 258.38% (174.11%, 373.84%) vs. 175.42% (122.05%, 251.00%); Z=5.65 and 3.89; both P<0.001]. The Cox multifactorial regression analysis showed that vWF:Ag was an independent influencing factor on the occurrence of VTE events during the 90 d follow up in the patients (hazard rate=1.03, P<0.001). In assessing the diagnostic efficacy for the occurrence of venous thrombotic events in the patients, the areas under the curves (AUC) of vWF:Ag and vWF:Ac were 0.818 and 0.719; the sensitivities were 78.8% and 69.7%; the specificities were 75.4% and 67.9%; for predicting the occurrence of VTE events in the patients, the predictive value of the combined test was higher (AUC=0.825). The patients with vWF:Ag≥244.98% occurred VTE events earlier than the patients with vWF:Ag<244.98% (χ²=20.49, P<0.001). Conclusions　Plasma vWFvWF:Ag and vWF:Ac levels are significantly elevated in patients with cancers, and there is a high concordance between the increases. vWF:Ag is an independent influencing factor in the occurrence of VTE events in patients with cancers; vWF may be a potential marker for predicting venous thrombosis associated with VTE events in patients with cancers.

Effect of tuvaptan combined with hydrochlorothiazide for refractory edema in patients with nephrotic syndrome

Shen Gang, Zhao Weiwei, Wang Mengjun

2023, 29(22):  3245-3249.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.024

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Objective　To explore the effect of tovaptan combined with hydrochlorothiazide forrefractory edema in patients with nephrotic syndrome (NS). Methods　Ninety patients with NS admitted to Liaocheng Third People's Hospital from February 2022 to February 2023 were divided into a routine group and a study group by the random number table method, with 45 cases in each group. There were 15 females and 30 males in the routine group; they were 28-67 (49.02±5.14) years old; their disease course was 6-32 (15.59±4.36) months; there were 29 cases of moderate edema and 16 cases of severe edema; their 24 h urine volume was (698.04±98.75) ml. There were 16 females and 29 males in the study group; they were 30-68 (48.76±4.98) years old; their disease course was 5-33 (16.02±4.15) months; there were 27 cases of moderate edema and 18 cases of severe edema; their 24 h urine volume was (703.45±103.45) ml. The routine group were treated with hydrochlorothiazide, and the study group with tolvaptan and hydrochlorothiazide. Both groups were treated for 14 d. The clinical efficacies, edema resolution times, adverse reactions, body weights before and after the treatment, renal function indicators [urea nitrogen (BUN), urine albumin (Upro), and blood creatinine (Scr)], urine routine [24 h urine volume, urine sodium, and urine potassium excretion], serum cystatin C (Cys-C), N-terminal pro-brain natriuretic peptide (NT-proBNP), and transforming growth factor-β (TGF-β) were compared between the two groups. χ² and t tests were used. Results　The total effective rate of the study group was higher than that in the routine group [91.11% (41/45) vs. 73.33% (33/45)], with a statistical difference (χ²=4.87; P<0.05). After the treatment, the weight and edema resolution time in the study group were lower than those in the routine group [(62.39±2.87) kg vs. (67.96±3.62) kg and (9.04±2.24) d vs.(11.41±3.01) d], with statistical differences (t=8.09 and 4.24; both P<0.05). After the treatment, the levels of BUN, Upro, and Scr in the study group were lower than those in the routine group [(12.46±2.15) mmol/L vs. (16.46±1.89) mmol/L, (1.29±0.32) g/24 h vs. (1.88±0.38) g/24 h, and (217.24±93.26) mmol/L vs. (273.48±101.15) mmol/L], with statistical differences (t=9.37, 7.97, and 2.74; all P<0.05). After the treatment, the 24 h urine volume of the study group was higher than that of the routine group [(1814.58±189.47) ml/24 h vs. (1 340.86±201.32) ml/24 h], with a statistical difference (t=11.50; P<0.05). After the treatment, the levels of NT-proBNP, Cys-C, and TGF-β in the study group were lower than those in the routine group [(5 140.29±25.89) ng/L vs. (6 128.56±30.45) ng/L, (1.87±0.34) mg/L vs. (2.20±0.52) mg/L, and (304.64±62.25) ng/L vs. (409.46±83.57) ng/L], with statistical differences (t=165.87, 3.56, 6.75; all P<0.05). Conclusion　Tovaptan combined with hydrochlorothiazide is effective in the treatment of refractory edema in patients with NS, and can improve their renal function, promote urination, reduce their body weight, and stabilize electrolyte balance.

Application value of standardized management of home page information of inpatient medical records in accurate grouping of DRGs

Yu Ji, Wang Xiaoying

2023, 29(22):  3250-3253.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.025

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Objective　To explore the application value of standardized management of the home page information of inpatient medical records in accurate diagnosis related grouping (DRGs). Methods　One hundred and thirty-two medical cases managed by Department of Internal Medicine, Wuxi Second People's Hospital from January to December 2022 were retrospectively analyzed. The 66 cases under traditional management of conventional DRGs were set as a control group, including 34 males and 32 females; they were 22-49 (38.65±6.36) years old. The 66 cases under the standardized management of the homepage information of inpatient records were set as an experimental group, including 35 males and 31 females; they were 21-48 (38.23±6.25) years old. The accurate grouping of DRGs, and the satisfaction of medical staff, and DRGs grouping error rates were compared between the two groups. χ² and t tests were applied. Results　The experimental group had a higher DRGs grouping standard rate and a lower rate of medical record repair than the control group [81.82% (54/66) vs. 60.61% (40/66) and 6.06% (4/66) vs. 19.70% (13/66)], with statistical differences (χ²=7.246 and 5.469; both P<0.05). The satisfaction score of the experimental group was higher than that of the control group [(25.36±1.38) vs. (20.21±1.14)], with a statistical difference (t=5.854, P<0.05). The total incidence of errors in the experimental group was significantly lower than that in the control group [4.55% (3/66) vs. 18.18% (12/66)], with a statistical difference (χ²=6.092, P<0.05). Conclusions　The application of standardized management of the home page information of inpatient medical records in the accurate grouping of DRGs can improve the quality of medical records and the satisfaction of medical staff, and reduce the total incidence of errors. It is worth being generalized in medical institutions.

Effect of remidazolam on hemodynamics of elderly patients taking surgery under general anesthesia and its safety 

Chen Jia, Wang Junwei

2023, 29(22):  3254-3258.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.026

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Objective　To observe the effect of remidazolam on hemodynamics of elderly patients taking surgery under general anesthesia and its safety. Methods　One hundred and twenty-five elderly patients taking surgery at Zhengzhou Seventh People's Hospital from January 2021 to April 2023 were selected for the randomized controlled trial. They were divided into an observation group and a control group by the a random number table method, with 63 cases in each group. There were 33 males and 30 females in the observation group; they were (75.22±5.27) years old. There were 31 males and 31 females in the control group; they were (76.13±5.33) years old. The control group received routine general anesthesia during surgery, while the observation group received remimazolam assisted general anesthesia. The depths of anesthesia, sedation during induction, hemodynamic indicators before anesthesia (T0), after induction (T1), when bispectral index (BIS) ≤60 (T2), and after tracheal intubation (T3), remdedy of anesthesia, and the occurrences of anesthesia related adverse reactions were compared between the two groups. χ² test, Fisher's exact probability, and t test were applied. Results　The time for BIS getting ≤ 60 after induction and BIS before tracheal intubation in the observation group were lower than those in the control group [(60.25±20.33) s vs. (76.25±20.12) s and (58.11±10.27) vs. (65.22±10.36)], with statistical differences (both P<0.05). There were no statistical differences in heart rate (HR) and mean arterial pressure (MAP) in both groups between at T0 on one hand and at T1 and T2 on the other hand (all P>0.05). The HR and MAP at T3 and the differences of HR and MAP at T0, T1, T2, and T3 in the observation group were lower than those in the control group, with statistical differences (all P<0.05). The remedy rate and dose of the observation group were lower than those of the control group [4.76% (3/63) vs. 16.13% (10/62) and (3.35±0.36) mg vs. (8.26±2.41) mg], with statistical differences (both P<0.05). There were no statistical differences in the time for the patients to come to and the time staying the anesthesia recovery room between the two groups (P>0.05). The scores of Visual Analogue Scale and sedation in the observation group were lower than those in the control group, with statistical differences (both P<0.05). The incidence of anesthesia related adverse reactions in the observation group was slightly higher than that in the control group [7.94% (5/63) vs. 6.45% (4/62)], with no statistical difference (P>0.05). Conclusions　Remazolam assisted general anesthesia is beneficial for elderly surgical patients to achieve a satisfactory depth of anesthesia faster, and has positive significance in maintaining hemodynamic stability during anesthesia and reducing remedial treatment. Combined use of this drug does not significantly increase the risk of adverse reactions, and its safety is relatively high.

Treatises

Relationship between MIRU-VNTR loci and drug resistance changes of multidrug-resistant Mycobacterium tuberculosis in Guangzhou 

Liu Zhenning, Liu Zhihui

2023, 29(22):  3259-3264.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.027

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Objective　To investigate the relationship between Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) and the changes of drug resistance in multi-drug resistant Mycobacterium tuberculosis in Guangzhou. Methods　MIRU-VNTR typing was performed on 105 strains ( 2～8 strains ) isolated from 36 patients with multidrug-resistant tuberculosis in Guangzhou Chest Hospital from 2011 to 2015. The correlation between the changes of drug resistance such as isoniazid, ethambutol, streptomycin, amikacin, levofloxacin and moxifloxacin during treatment and the polymorphism of 16 MIRU-VNTR loci was analyzed. The relationship between the drug-resistant types and VNTR loci was analyzed by χ² test. Results　Sixty-one point one percent (22/36) of the patients had drug resistance changes; among which, 8 trains (5.8%) had isoniazid resistance changes, 18 (26.1%) had ethambutol resistance changes, 8 (11.6%) had streptomycin resistance changes, 8 (11.6%) had amikacin resistance changes, 21 (30.4%) had levofloxacin resistance changes, and 25 (36.2%) had moxifloxacin resistance changes. The percentages of the phenotype changes were as below: moxifloxacin > levofloxacin > ethambutol > streptomycin/amikacin > isoniazid. All the six drug-resistant phenotypes showed that the strains changed from sensitive to resistant or from resistant to sensitive. There was no statistical difference in the correlation between the drug resistance change phenotype of multidrug-resistant Mycobacterium tuberculosis and the VNTR loci (P>0.05). There was a statistical difference in the correlation between the drug resistance change phenotype and the VNTR loci with four drug resistance change phenotypes (P<0.05). There were statistical differences in the ethambutol resistance phenotype-VNTR4348, streptomycin resistance phenotype-VNTR0595, moxifloxacin resistance phenotype-VNTR1907, and moxifloxacin resistance phenotype-VNTR1895 (all P<0.05). Conclusion　The results suggest that the change of drug resistance of pathogenic bacteria in patients with multidrug-resistant tuberculosis is associated with MIRU-VNTR polymorphism, but the specific mechanism remains to be further studied.

Correlation between different degree of placental abruption and coagulation function index

Mo Shipan

2023, 29(22):  3264-3268.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.028

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Objective　To explore the correlation between different degrees of placental abruption and coagulation function indicators. Methods　Seventy-two pregnant women with placental abruption admitted to Pingshan District People's Hospital from January 2019 to September 2021 were collected as an observation group, with an age of (28.67±3.05) years and a gestation period of (33.69±1.35) weeks. According to the severity of placental abruption, they were divided into a mild group (42 cases) and a severe group (30 cases). During the same period, 72 healthy pregnant women were collected as a reference group, with an age of (28.56±3.11) years and a gestation period of (33.42±1.23) weeks. The prothrombin times (PT), activated partial thromboplastin times (APTT), and thrombin times (TT) and levels of fibrinogen (FIB) and D-Dimer (D-D) were compared between the control group and the observation group. The coagulation function indicators and adverse pregnant outcomes were compared between the mild group and the severe group. The efficiencies of the coagulation indicators in predicting different degrees of placental abruption were analyzed. The t test, ANOVA, and χ² test were used. The areas (AUC) under the receiver operating characteristic curves (ROC) were used to evaluate the prediction efficiencies. Results　The PT and D-D levels in the observation group were higher than those in the reference group [(14.22±1.54) s vs. (9.11±0.45) s and (4.46±1.37) μg/L vs. (0.34±0.10) μg/L], with statistical differences (t=27.026 and 25.450, both P<0.001). The FIB level of the observation group was lower than that of the reference group [(3.46±0.42) g/L vs. (4.52±0.97) g/L], with a statistical difference (t=8.509, P<0.001). There were no statistical differences in APTT and TT between the observation group and the reference group (both P>0.05). The D-D level in the severe group was higher than that in the mild group [(5.88±1.73) μg/L vs. (3.05±1.01) μg/L], with a statistical difference (t=8.734, P<0.001); the FIB level in the severe group was lower than that in the mild group [(3.00±0.26) g/L vs. (3.93±0.59) g/L], with a statistical difference (t=8.079, P<0.001). There were no statistical differences in PT, APTT, and TT between the mild group and the severe group (all P>0.05). The AUC's of FIB and D-D in the prediction of mild and severe placental abruption were 0.630 and 0.609, respectively; the sensitivity and specificity of FIB combined with D-D in predicting mild and severe placental abruption were 87.99% and 86.59%, and the AUC was 0.897, which were better than FIB or D-D alone. By DeLong test, the AUC of the combined prediction was better than those of FIB and D-D, with statistical differences (Z=2.983 and 2.784, both P<0.001). The incidence of adverse pregnancy outcomes in the severe group was higher than that in the mild group [70.00% (21/30) vs. 30.95% (13/42)], with a statistical difference (χ²=30.501, P<0.001). Conclusions　The maternal and fetal outcomes of placental abruption are closely related to the severity of placental abruption, and the decrease of FIB level and increase of D-D level in pregnant women with placental abruption are closely related to the severity of placental abruption. The combination of FIB and D-D is effective in predicting the severity of placental abruption.

Clinical Research

Parecoxib as a multimodal analgesia in prevention of postpartum depression in women after cesarean section

Zhang Wenli, Wen Xianjie, Zhuang Jingwen, Lin jinbing, Liu Xingqing, Chen Weijian, Xu Xuejie, Zou Lin, Hu Xudong

2023, 29(22):  3269-3273.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.029

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Objective　To explore the effect of parecoxib on Edinburgh depression scores, postpartum depression, and blood levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT) of puerperants who receive analgesia with single epidural morphine injection combined with dezocine intravenous analgesia after cesarean section. Methods　Eighty full-term pregnant women treated at Department of Obstetrics, Foshan Second People's Hospital from January 2022 to December 2022 were recruited. Their American Society of Anesthesiologists (ASA) grade was Ⅰ-Ⅱ; they were 20-39 years old; their body weight was 50-80 kg; they were 37-41 weeks pregnant. They were divided into a control group and an observation group by the random number table method, with 40 cases in each group. They planned to take selective cesarean section. The single epidural morphine injection combined with intravenous analgesia with dezocine was used in both groups; parecoxib was added in the above analgesic methods in the observation group. The postoperative pain scores [Visual Analogue Scale (VAS)] and analgesic adverse reactions were observed. The maternal Edinburgh Postnatal Depression Scale (EPDS) score was evaluated 1 day before and 3 days and 2 weeks after cesarean section. The incidence of postpartum depression was recorded. The serum levels of BDNF and 5-HT were measured by the enzyme-linked immunization. One-way ANOVA and χ² test were used for the statistical analysis. Results　The scores of VAS 12, 24, and 48 h after delivery in the observation group were lower than those in the control group [(2.23±0.83) vs. (3.05±0.82), (2.98±0.86) vs. (3.78±1.03), and (3.43±0.87) vs. (3.90±0.96)], with statistical differences (all P<0.05). There was no statistical difference in the overall incidence of adverse reactions during the analgesia between the two groups (P>0.05). The scores of EPDS 3 days and 2 weeks after delivery in the observation group were lower than those in the control group [(7.23±2.55) vs. (9.55±3.52) and (8.15±3.09) vs. (9.58±2.78)], with statistical differences (both P<0.05). The incidences of postpartum depression in the observation group 3 days and 2 weeks after delivery were lower than those in the control group [7.50% (3/40) vs. 25.00% (10/40) and 5.00% (2/40) vs. 22.50% (9/40)], with statistical differences (both P<0.05). The serum levels of BDNF and 5-HT 3 days and 2 weeks after delivery in the observation group were higher than those in the control group, with statistical differences (all P<0.05). Conclusion　Parecoxib can enhance the analgesia effect of epidural morphine combined with dezocine intravenous analgesia, reduce the EPDS score and the incidence of postpartum depression after cesarean section, and increase the serum levels of BDNF and 5-HT without increasing adverse reactions.

Value of biomimetic electrical stimulation combined with long-term placement of balloon uterine stent in prevention of recurrence after separation of intrauterine adhesions

Dong Fanghua, Wang Zhidan, Li Miaozhu, Yan Haijie

2023, 29(22):  3274-3279.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.030

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Objective　To explore the value of biomimetic electrical stimulation therapy combined with long-term placement of balloon uterine stents in the prevention of recurrence after intrauterine adhesions (IUA) separation surgery (TCRA). Methods　Ninety patients with IUA who were scheduled to undergo TCRA at Haizhu District Maternal and Child Health Care Hospital from January 2022 to April 2023 were selected for the randomized controlled trial, and were divided into a control group and an experimental group by the random number table method, with 45 cases in each group. The control group were (28.58±5.84) years old, and the experimental group were (28.41±5.08) years old. The control group were treated with long-term placement of balloon uterine stents and artificial cycle therapy after surgery; the experimental group were treated with long term placement of balloon uterine stents, artificial cycle therapy, and biomimetic electrical stimulation therapy after surgery. All the patients were followed up after surgery. The recovery of uterine cavity morphology, endometrial receptivity indicators, recurrence rates of IUA, menstrual improvement, pregnancy rates, and positive cervical secretion culture, and levels of serum inflammatory factors and adhesion factors before and after surgery were compared between the two groups. t and χ² tests were used. Results　The total effective rate of uterine cavity morphology recovery, postoperative pregnancy rate, and menstrual improvement rate in the experimental group were significantly higher than those in the control group. The total postoperative recurrence rate of IUA in the experimental group was significantly lower than that in the control group [(11.11% (5/45) vs. 31.11% (14/45); χ²=5.404, P<0.05]. The endometrial thickness of the experimental group 3 months after surgery was significantly higher than that of the control group [(8.55±0.87) mm vs. (7.01±0.96) mm; t=7.974, P<0.05]. The levels of serum tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) 3 months after surgery in the experimental group were significantly lower than those in the control group [(31.58±8.24) ng/L vs. (47.01±7.66) ng/L and (32.11±5.37) μg/L vs. (38.05±4.62) μg/L; t=9.200 and 5.625, both P<0.05]. Conclusions　The combination of biomimetic electrical stimulation therapy and long-term placement of balloon uterine stents has a good effect in preventing recurrence after TCRA surgery. It can effectively promote the recovery of uterine cavity morphology, improve their menstrual and pregnancy conditions and endometrial receptivity, and reduce the levels of serum TNF-α and TGF-β1.

Effect of hypertonic saline combined with dexmedetomidine on levels of neuroinflammatory factors in patients with craniocerebral injury

Hu Xuwei, Li Zuoshi, Liu Guoyuan

2023, 29(22):  3280-3283.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.031

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Objective　To investigate the inhibitory effects and therapeutic efficacy of 3% hypertonic saline combined with dexmedetomidine on the levels of serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), neuron-specific enolase (NSE), and central nervous system-specific protein (S100B) in patients with severe craniocerebral injury, and to provide new insights and methods for the treatment of patients with severe craniocerebral injury. Methods　The prospective study selected 58 patients with craniocerebral injury admitted to Department of Neurosurgery, Jieyang People's Hospital from September 2022 to August 2023 as the study objects. The patients were randomly divided into a control group and an observation group by the single blind method. The control group took mannitol and other sedative and analgesic drugs; in addition, the observation group took 3% hypertonic saline and dexmedetomidine. The serum levels of IL-6, TNF-α, NSE, and S100B were measured 12 (T₁), 24 (T₂), 48 (T₃), and 72 h (T₄) after injury. The data were compared between the two groups by t and χ² tests. Results　The serum levels of IL-6, TNF-α, NSE, and S100B at T₂, T₃, and T₄ in the observation group were (276.11±18.64) ng/L, (165.07±15.32) ng/L, and (126.07±16.15) ng/L, (1.27±0.21) ng/L, (1.22±0.25) ng/L, and (0.78±0.15) ng/L, (16.74±3.51) μg/L, (19.07±4.91) μg/L, and (14.97±2.21) μg/L, and (0.47±0.15) μg/L, (0.56±0.23) μg/L, and (0.32±0.16) μg/L, and those in the control group were (315.23±19.54) ng/L, (199.05±16.16) ng/L, and (141.02±17.98) ng/L, (1.47±0.25) ng/L, (1.45±0.22) ng/L, and (0.91±0.19) ng/L, (20.17±3.21) μg/L, (24.17±5.61) μg/L, and (17.06±2.98) μg/L, and (0.67±0.28) μg/L, (0.87±0.32) μg/L, and (0.47±0.13) μg/L, the difference between the two groups was statistically significant (all P<0.05). Conclusion　Three percent hypertonic saline combined with dexmedetomidine can inhibit the expression of neuroinflammatory factors in patients with severe craniocerebral injury and alleviate secondary brain injury.

Nursing Research

Application of modified early warning score management in perioperative patients with pancreaticoduodenal diseases

Kong Min, Jin Xin, Wang Zongxia

2023, 29(22):  3284-3287.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.032

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Objective　To analyze the effect of nursing management mode of modified early warning score (MEWS) in perioperative period of laparoscopic pancreaticoduodenal patients. Methods　Eighty laparoscopic pancreaticoduodenal patients treated in Bayannur Hospital from January 2017 to August 2020 were selected for the prospective study. The patients were divided into an observation group and a control group by the random number table method, with 40 cases in each group. There were 26 males and 14 females in the observation group; they were 45-85 (52.26±1.73) years old. There were 24 males and 16 females in the control group; they were 46-85 (52.79±1.97) years old. The control group implemented routine nursing management measures; in addition, the observation group implemented the nursing management measures based on MEWS. The incidences of stress injury and complications were compared between the two groups. χ² test was applied. Results　The incidences of pressure injury and complications in the observation group were lower than those in the control group [7.50% (3/40) vs. 27.50% (11/40) and 5.00% (2/40) vs. 25.00% (10/40)], with statistical differences (χ²=4.155 and 4.705; both P<0.05). Conclusion　Nursing management based on MEWS can reduce the incidences of stress injury and complications in laparoscopic pancreaticoduodenal patients during perioperative period, so it can be clinically popularized.

Effects of different methods of subcutaneous injection of compound anisodine beside superficial temporal arteries in patients with ischemic optic neuropathy

Qian Ximing, Zhou Yuanting, Xiang Yufeng

2023, 29(22):  3288-3292.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.033

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Objective　To explore the effects of different methods of subcutaneous injection of compound anisodine beside the superficial temporal arteries in patients with ischemic optic neuropathy. Methods　One hundred and eighty patients with ischemic optic neuropathy admitted to Central Hospital Affiliated to Jiangnan University from January to June 2019 were selected for the randomized controlled trial. They were divided into a control group and a study group by the random number table method, with 90 cases in each group. There were 45 males and 45 females in the control group; they were 40-78 (60.36±9.12) years old. There were 46 males and 44 females in the study group; they were 39-78 (60.12±9.05) years old. The control group received routine subcutaneous injection, while the study group received modified subcutaneous injection of compound anisodine beside the superficial temporal arteries. The degrees of pain, anxiety, and nursing satisfaction and incidences of complications were compared between the two groups. χ² and rank sum tests were applied. Results　One month after the treatment, the pain degree of the study group was lower than that of the control group; there was a statistical difference in the pain grade between the two groups (Z=5.852, P<0.05). One month after the treatment, there were statistical differences in the mild, moderate, and severe anxiety between the study group and the control group [66.67% (60/90) vs. 24.44% (22/90), 24.44% (22/90) vs. 50.00% (45/90), and 8.89% (8/90) vs. 25.56% (23/90); χ²=32.344, 12.577, and 8.768; all P<0.05]. The satisfaction of the study group was higher than that of the control group [92.22% (83/90) vs. 74.44% (67/90)], with a statistical difference (χ²=10.240, P<0.05). After 6 months' follow-up, the total incidence of complications of the study group was lower than that of the control group [2.22% (2/90) vs. 11.11% (10/90)], with a statistical difference (χ²=5.714, P<0.05). Conclusion　The modified subcutaneous injection of compound anisodine beside the superficial temporal arteries can significantly reduce the patients' pain and anxiety, improve nursing satisfaction, and effectively reduce the incidence of complications.

Effect of a pain self-management program based on Delphi expert consultation for patients with axial spinal arthritis

Xing Xueke, Fan Linlin, Wang Yushan, Han Danying

2023, 29(22):  3292-3297.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.034

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Objective　To explore the effect of pain self-management program based on the Delphi expert consultation for patients with axial spinal arthritis(axSpA). Methods　One hundred and thirteen patients with axSpA treated at Department of Rheumatology and Immunology, First Hospital, Henan University of Science and Technology from January 2021 to October 2022 were selected for the prospective study, and were grouped by the lottery method. During the study, 3 cases were lost to the follow up; at last, there were 54 cases in the control group and 56 cases in the observation group. In the control group, there were 45 males and 9 females; they were 27-37 (30.54±2.77) years old; they were given routine treatment and nursing. In the observation group, there were 48 males and 8 females; they were 27-36 (30.22±3.16) years old; they were given pain self-management based on the Delphi expert consultation. The pain control effects, pain self-management behaviors, and spinal function were compared between the two groups. t test and rank sum test were used. Results　After the intervention, the score of Brief Pain Inventory (BPI) in the observation group was lower than that in the control group [(21.06±4.87) vs. (35.94±5.21)], with a statistical difference (t=15.48, P<0.05). After the intervention, the numbers of mobility period and maintenance period in Pain Stages of Change Questionnaire (PSOCQ) in the observation group were higher than those in the control group [28.57% (16/56) vs. 12.96% (7/54) and 50.00% (28/56) vs. 29.63% (16/54)], with a statistical difference (Z=3.33, P<0.05). Conclusions　Conventional treatment and nursing and the pain self-management program based on Delphi expert consultation for axSpA patients both can improve their pain self-efficacy and spinal function, but the pain self-management program is better in reducing their pain and improving their pain self-management behaviors.

Nursing care for a patient with immunotherapy-associated myocarditis and myositis caused by tirelizumab

Wu Jieyuan, Cao Yingchun, Zhang Yongjun

2023, 29(22):  3298-3300.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.035

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The nursing experience of a patient with immunotherapy-associated myocarditis and myositis caused by tirelizumab was summarized. The nursing key points were as below: the multidisciplinary specialist nursing team was established; a phased and individualized early rehabilitation exercise program was developed; the formulation of endurance exercise prescription, early cardiopulmonary rehabilitation exercise, and limb rehabilitation exercise combined with Borg classification; monitoring the conditions closely; cooperation with the treatment; psychological nursing; posture management; pressure ulcers prevention; early nutritional support. After multidisciplinary treatment and careful nursing, the patient was improved and discharged from the hospital. The follow-up after discharge showed that the patient basically resumed self-care.

Effect of AOFAS quantified rehabilitation training on postoperative rehabilitation of patients with ankle fracture

Sun Hongmei, Xiang Zhaoni, Sun Zhaolian, Li Mingxin, Liu Yun, Li Wenliang

2023, 29(22):  3301-3305.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.036

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Objective　To study the effect of American Orthopedic Foot & Ankle Society (AOFAS) quantified rehabilitation training on postoperative rehabilitation of patients with ankle fracture. Methods　In this prospective randomized controlled trial, 86 patients with ankle fracture who received treatment in Yantai Mountain Hospital from June 2020 to June 2022 were selected as the research objects, and were divided into a control group and a study group by the random number table method, with 43 cases in each group. In the control group, there were 21 males and 22 females; they were (48.69±13.21) years old. In the study group, there were 19 males and 24 females; they were (48.71±13.19) years old. The control group took routine rehabilitation training, and the study group took AOFAS quantified rehabilitation training. One patient in the control group and one in the study group were lost to the follow up, and 84 patients completed the study. The ankle joint function and daily living ability of the two groups were observed the next day after admission and 12 weeks after the operation. The t and χ² tests were used. Results　Twelve after the operation, the scores of Ankle Joint Functional Assessment Tool (AJFAT) and Physical Self-maintenance scale (PSMS) were higher than those the next day of operation in both groups; the scores in the study group were higher than those in the control group [(38.25±6.85) vs. (34.26±7.12) and (17.63±2.19) vs. (16.52±2.26)], with statistical differences (t=2.617 and 2.286; both P<0.05). Conclusion　AOFAS quantified rehabilitation training for patients with ankle fracture can effectively improve their ankle joint function and ability of daily living activities.

Nursing care for one patient after total knee arthroplasty who has been taking maintenance hemodialysis for 35 years

Yin Yan, Quan Zilin, Hu Xia, Kang Xiaoli, Song Li, Chen Cheng, Cui Dongmei, Zhao Liyan

2023, 29(22):  3305-3309.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.037

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Application of task-driven teaching method combined with Sandwich teaching method in teaching of orthopedic nursing interns

Zheng Yanhua, Chen Shaohua, Hu Tianhong

2023, 29(22):  3309-3313.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.038

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Objective　To explore the application effect of the task-driven teaching method combined with the Sandwich teaching method in teaching of orthopedic nursing interns. Methods　Fifty-nine nursing interns who interned in Department of Orthopedics, Guangdong Traditional Chinese Medicine Hospital from June 2020 to August 2021 were selected as the research objects. They were divided into a control group (28 ones) and an experimental group (31 ones) according to the different nursing teaching methods. The control group consisted of 24 females and 4 males who were (21.25 ± 0.65) years old; they were taught using the conventional teaching methods. The experimental group consisted of 28 females and 3 males who were (21.71±0.59) years old; they were taught by the task-driven teaching method, the Sandwich teaching method, and the conventional teaching methods. The learning initiative (ALS) and critical thinking ability (CTDI-CV), theoretical knowledge assessment scores, operational practice assessment scores, and teaching satisfaction were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test for the count data. Results　At the time of admission, there were no statistical differences in the scores of ALS and CTDI-CV between the two groups (both P>0.05). At the time of graduation, the scores of ALS and CTDI-CV in the experimental group were higher than those in the control group [(75.48±6.34) vs. (67.18±6.57) and (284.29±7.69) vs. (267.39±9.42)], with statistical differences (t=4.936 and 7.578; both P<0.001). The scores of theoretical knowledge assessment and practical operation assessment in the experimental group were higher than those in the control group [(88.06±6.53) vs. (80.29±8.70) and (87.68±5.71) vs. (78.96±7.09)], with statistical differences (t=3.910 and 5.221; both P<0.001). The overall satisfaction rate in the experimental group was higher than that in the control group [93.5% (29/31) vs. 75.0% (21/28)], with a statistical difference (χ²=3.915, P<0.05). Conclusions　The application of the task-driven teaching method and the Sandwich teaching method in teaching of orthopedic nursing interns can fully mobilize their initiative in self-learning, strengthen their critical thinking ability, and improve their theoretical knowledge, operational practice ability, and teaching satisfaction in the specialized field.

Dietary compliance of middle-aged and elderly hyperphosphatemic patients taking hemodialysis and influencing factors

Zheng Shuqian, Yang Fuman, Tong Hongxia

2023, 29(22):  3314-3317.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.039

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Objective　To explore the current status and influencing factors of dietary compliance of middle-aged and elderly patients with hyperphosphatemia undergoing hemodialysis. Methods　Eighty middle-aged and elderly patients with hyperphosphatemia undergoing hemodialysis at Nansha Hospital, Guangzhou First People's Hospital from January 2019 to February 2021were selected as the study objects, including 45 males and 35 females who were (51.28±2.31) years old. All the patients underwent a questionnaire survey by the low phosphorus diet compliance questionnaire and Social Support Rating Scale (SSRS), and the results were analyzed. t and χ² tests were applied. Results　The dietary compliance score of the 80 patients was (58.55±8.21). Gender and age had little impact on the patients' dietary compliance, and there were no statistical differences (both P>0.05). The education level, SSRS score, and hemodialysis time had significant impact on the patients' dietary compliance, and there were statistical differences (all P<0.05). After the nursing, the patients' blood phosphorus, blood calcium, and calcium phosphorus product indicator were significantly better than those before the nursing, with statistical differences (all P<0.05). Conclusions　The dietary compliance of middle-aged and elderly patients with hyperphosphatemia undergoing hemodialysis is low. The patients' education level, SSRS score, and hemodialysis time are the main factors affecting their dietary compliance. Reasonable interventions can improve their dietary compliance and treatment effectiveness.

Application of OKR management system in management for patients taking maintenance hemodialysis

Tang Qinmei, Jiang Dan, Liu Shengzi, Zhou Lifang, Xu Penghui, Li Caixia, Pan Ling, Fu Xia

2023, 29(22):  3318-3320.  DOI: 10.3760/cma.j.issn.1007-1245.2023.22.040

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