Table of Content

01 December 2023, Volume 29 Issue 23

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New Medical Advances

Complications of intramedullary nailing in the treatment of infra-isthmal femoral fracture

Geng Zeyue, Zhang Xingkai, Du Gangqiang, Zhou Nan, Zhao Dongyang, Wang Zhigang

2023, 29(23):  3321-3324.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.001

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Infra-isthmal femoral fracture is commonly treated with intramedullary nailing, but there are several variances and issues related to different intramedullary fixation strategies in terms of opening site, nail placement, and postoperative follow-up. This paper reviews the literatures on the use of paralleling and retrograde intramedullary fixation in the treatment of infra-isthmal femoral fracture and documents the complications and solutions mentioned to provide a reference for the selection of proper intramedullary fixation and minimizing the complications.

Progress in the application of esketamine in clinical anesthesia

Zhang Chenxi, Wang Pengfei, Pan Xin, Liu Ziyi, Zhang Yong

2023, 29(23):  3325-3329.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.002

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In recent years, with the improvement of people's living standards and quality of life, the demand for comfortable medical care has become more urgent, which has also promoted the development of enhanced recovery after surgery (ERAS). ERAS advocates for multimodal analgesia, which involves reducing the use of opioids and enhancing the analgesic effect after surgery through combined anesthesia, combination therapy, and other methods, in order to accelerate the patients' postoperative recovery. Ketamine, as an NMDA (N-methyl-D-aspartate) receptor blocker, has always been used in clinical practice, but some possible adverse reactions limit its further use. With the introduction of esketamine abroad, which has higher potency and fewer adverse reactions, there are still few relevant clinical trials in China, and there is still a lack of sufficient clinical trials to verify its safety and effectiveness. Anesthesiologists still have doubts and concerns about its use. Therefore, this article systematically discusses the common application of esketamine in department of anesthesia, in order to provide some support and reference.

Research progress on the application of vitamin C in respiratory tract infection

Xiao Xi, Shi Doufei

2023, 29(23):  3330-3335.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.003

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In recent years, vitamin C has been widely used in the adjuvant treatment of diseases such as respiratory tract infection, but its effectiveness has been questioned. This paper discusses the effect of vitamin C on respiratory infectious diseases, and reviews its mechanism of action, dosage, and adverse reactions. For decades, a large number of studies have confirmed that vitamin C has a certain impact on the prevention and treatment of respiratory infectious diseases by reducing oxidative stress, reducing inflammatory response, regulating immunity, improving circulation, resisting pathogenic microorganisms, and protecting lung. Some studies have shown that the application of vitamin C may have no significant effect on disease treatment. Age, weight, gender, and other factors may affect the demand for vitamin C. Since the advent of vitamin C, a large number of animal model experiments and clinical studies have reported its effectiveness in infectious diseases, and it has the characteristics of high safety, low price, and familiar to the people. The clinical value of vitamin C should not be denied.

Role of PP1A in cancer and research progress

Si Hang, Wang Nana, Liu Susu, Zhang Qian

2023, 29(23):  3336-3340.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.004

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Protein phosphatases are a group of proteins that widely exist in human cells and catalyze protein dephosphorylation. The phosphoprotein phosphatase catalytic subunits (PPPCs) superfamily is a group of protein phosphatases that primarily dephosphorylate serine/threonine residues. The protein phosphatase-1 (PP1) is involved in most eukaryotic phosphorylation reaction and participates in regulating a variety of biological activities. The catalytic subunit α of PP1 (PP1A) is the most important subtype of the PP1 catalytic subunit encoded by PPP1CA, which plays an important role in the survival and metastasis of a variety of tumors, but it also exhibits inhibitory effect in tumors, which makes it a possible new target for tumor treatment. Therefore, this article aims to review the key role of PP1A in a variety of tumors and evaluate its potential as a novel target for tumor therapy.

Advances in nutritional evaluation methods for patients with liver cirrhosis

Fu Zhipeng, Zheng Sheng, Yang Juan

2023, 29(23):  3341-3344. 

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Early assessment of nutritional status in patients with cirrhosis and timely nutritional support are of great significance to shorten the hospital stay and reduce the incidence of complications and mortality in patients with cirrhosis. Therefore, the selection of nutritional assessment tools is very important. The current nutritional assessment methods for cirrhosis include nutritional risk screening methods and nutritional assessment methods. In this paper, the advantages and disadvantages and research progress of nutritional risk screening methods and nutritional assessment methods for cirrhosis are summarized and analyzed, so as to clarify the application value of each tool in patients with cirrhosis and provide reference for establishing the gold standard of nutritional evaluation for patients with cirrhosis.

Scientific Research

Clinical observation on the treatment of pelvic floor muscle hypertonicity with third-generation electrophysiological technique based on pelvic floor anatomy

Chen Zekai, Heng Baoli, Chen Jie

2023, 29(23):  3345-3350.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.006

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Objective　To explore the clinical efficacy of third-generation electrophysiological technique based on pelvic floor anatomy in the treatment of pelvic floor muscle hypertonicity. Methods　A retrospective analysis was performed on 36 male patients admitted to the First Affiliated Hospital of Jinan University from October 2022 to May 2023, with an age of 21-82 (48.47±19.68) years old. All of them were diagnosed as pelvic floor muscle hypertonicity. The clinical manifestations were characterized by dysuria such as urine waiting, fine urine line, urine interruption, and even urinary retention, with frequent urination, nocturnal urination, some accompanied by difficulty in defecation. Digital rectal examination showed tension of the anal sphincter. Color ultrasound indicated a prostate size of 23-43 (32.42±5.24) g. Three of 36 patients had catheters retained due to urinary retention. Each patient took tamsulosin sustained-release capsules (0.2 mg qn) or silodosin capsules (4 mg bid) for 2-4 weeks, and the clinical symptoms did not improve. Twenty-six patients with difficulty in defecation were treated with percutaneous low-frequency pulse electrical stimulation. Before treatment, infrared thermal imaging detection was provided for each patient to visualize the selection of personalized electrotherapy parameters, to perform precise treatment. After every 10 treatments, infrared thermal imaging detection was repeated to adjust electrical stimulation treatment parameters. Paired t test and χ² test were used. Results　After electrostimulation treatment, the urinary waiting time [(2.39±1.44) s] was shorter than that before treatment [(41.21±12.25) s], the maximum urinary flow rate (Q_max) [(16.06±1.90) ml/s] was higher than that before treatment [(7.46±1.39) ml/s], the frequency of urination [(6.00±0.71) times] was lower than that before treatment [(10.76±1.50) times], and the frequency of nocturnal urination [(0.45±0.50) times per night] was lower than that before treatment [(2.06±1.22) times per night], with statistically significant differences (all P<0.000 1). After treatment, the catheter was pulled out in all the patients with urinary retention and the urination was smooth. The incidence of difficulty in defecation was 72.0% (26/36) before treatment and 0 after treatment. Conclusions　In adopting α1-receptor blockers are ineffective in treating dysuria and accompanied by a history of difficulty in defecation, pelvic floor muscle hypertonicity should be considered. The third-generation electrophysiological technology has achieved satisfactory short-term clinical efficacy in the treatment of pelvic floor muscle hypertonicity. With the increase of treatment cases, the long-term clinical efficacy of the technology will be further confirmed, providing a reliable new method for the treatment of pelvic floor muscle hypertonicity.

Comparison of outcomes between low-intensity extracorporeal shock wave and low-frequency transcutaneous electrical nerve stimulation in refractory type ⅢB prostatitis

Li Yuanchao, Meng Dongru, Li Wenhua, Gao Zhanfeng, Bian Jun, Lai Dehui, Ou Haining, Huang Tao, Lin Jiaxi

2023, 29(23):  3350-3355.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.007

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Objective　To investigate the therapeutic effects of low-intensity extracorporeal shock wave and low-frequency transcutaneous electrical nerve stimulation (TENS) on refractory type ⅢB prostatitis, and analyze their complications and safety. Methods　This was a randomized controlled trial. From June 2021 to October 2022, 104 patients with refractory type ⅢB prostatitis in the Fifth Affiliated Hospital of Guangzhou Medical University were prospectively selected as the research objects. They were divided into two groups by the random number table method, with 52 patients in each group. The study group was 24-42 (33.1±7.3) years old, with symptoms lasting for 3-23 (17.1±2.2) months, and low-intensity extracorporeal shock wave was used. The control group was 26-40 (32.0±8.5) years old, with symptoms lasting for 3-22 (17.5±2.8) months, and low-frequency TENS was used. After 4 weeks of treatment, the clinical symptoms of the two groups were scored by the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), and the complications and safety of the two groups were analyzed. Statistical methods used were t test and χ² test. Results　Before treatment, there were no statistically significant differences in the scores of pain or discomfort, urination symptoms, and quality of life impact and NIH-CPSI total score between the two groups (all P>0.05). After treatment, the scores of pain or discomfort, urination symptoms, and quality of life impact and NIH-CPSI total score of the study group were lower than those of the control group [(9.21±2.10) points vs. (11.30±2.90) points, (5.13±0.60) points vs. (6.52±0.56) points, (5.10±1.10) points vs. (7.10±1.40) points, (20.26±1.05) points vs. (22.83±0.65) points], with statistically significant differences (t=4.209, 12.213, 8.100, and 15.007, all P<0.05). The total effective rate of the study group [71.15% (37/52)] was higher than that of the control group [42.31% (22/52)], with a statistically significant difference (χ²=8.814, P=0.003). No significant adverse reactions or complications were found during the treatment of both groups. Conclusion　The effect of low-intensity extracorporeal shock wave therapy on refractory type ⅢB prostatitis is superior to traditional low-frequency TENS therapy, and low-intensity extracorporeal shock wave therapy is more convenient, easy to accept, safe, and reliable for patients, which is worth further promotion in clinical practice.

Evaluation and intervention of cerebrovascular function in patients with asymptomatic carotid artery stenosis in Liwan community

Xu Xuan, Qi Feng, Yu Ke, Liu Zuyou, Liang Xiaojun, Feng Lijuan

2023, 29(23):  3355-3359.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.008

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Objective　To evaluate the cerebrovascular function and intervene with risk factors in asymptomatic patients with moderate to severe carotid artery stenosis in Liwan community, and to explore the relationship between change in cerebrovascular reserve capacity and cerebrovascular events in asymptomatic patients with moderate to severe carotid artery stenosis. Methods　It was a prospective study. A total of 2 315 chronic disease patients were screened from Liwan District, Guangzhou City from January 2020 to December 2021, including 262 asymptomatic patients with moderate to severe carotid artery stenosis (175 patients with moderate stenosis and 87 patients with severe stenosis). Among them, 5 asymptomatic patients with severe carotid artery stenosis were referred to the neurointerventional department for carotid artery surgery, and the other 257 asymptomatic patients with moderate to severe carotid artery stenosis [153 males and 104 females, aged (75.08±2.88) years] were enrolled. The enrolled patients undergo cerebrovascular function assessment, risk factor intervention, antiplatelet aggregation, and lipid-lowering treatment. The change of cerebrovascular reserve capacity and incidence of cerebral ischemic events were recorded one year later. t test and χ² test were used. Results　A total of 4 asymptomatic patients with moderate to severe carotid artery stenosis had ischemic events, with an incidence of 1.5% (4/257) in the next year. The age [(78.50±2.88) years old], smoking rate [100.0% (4/4)], and prevalence rate of hyperlipidemia [100.0% (4/4)] in the patients with cerebral ischemic events were higher than those in the patients without cerebral ischemic events [(75.02±2.85) years old, 44.3% (112/253), and 45.5% (115/253)], with statistically significant differences (t=2.413, χ²=4.939 and 4.712; all P<0.05). The cerebrovascular reserve capacity at enrollment [(17.09±0.69)%], the cerebrovascular reserve capacity 1 year after enrollment [(17.89±0.37)%], and the increase of cerebrovascular reserve capacity [(0.80±0.57)%] of the patients with cerebral ischemic events were lower than those of the patients without cerebral ischemic events [(21.99±2.04)%, (25.38±2.02)%, and (3.39±2.15)%], with statistically significant differences (t=4.790, 7.372, and 2.397, all P<0.05). The proportion of males [69.5% (57/82)], smoking rate [54.9% (45/82)], diabetes rate [51.2% (42/82)], age [(76.58±2.03) years old], and low density lipoprotein [(4.11±0.71)mmol/L] in the asymptomatic patients with severe carotid artery stenosis were all higher than those in the asymptomatic patients with moderate carotid artery stenosis [54.9% (96/175), 40.6% (71/175), 37.1% (65/175), (74.37±2.95) years old, and (3.55±1.07)mmol/L], with statistically significant differences (χ²=4.978, 4.615, and 4.553, t=6.118 and 4.264; all P<0.05). After 1 year of treatment, the increase of cerebrovascular reserve capacity in the moderate stenosis group [(3.68±2.25)%] was significantly higher than that in the severe stenosis group [(2.64±1.74)%], with a statistically significant difference (t=3.689, P<0.05). At enrollment and 1 year later, the mean blood flow velocity before CO₂ inhalation, the mean blood flow velocity after CO₂ inhalation, and the cerebrovascular reserve capacity in the moderate stenosis group were higher than those in the severe stenosis group [(64.68±3.42) cm/s vs. (60.76±5.19) cm/s, (79.21±4.78) cm/s vs. (73.40±6.09) cm/s, (22.43±2.08)% vs. (20.80±1.72)%, (65.41±3.05) cm/s vs. (60.86±3.86) cm/s, (82.50±4.16) cm/s vs. (75.12±4.62) cm/s, (26.12±1.95)% vs. (23.44±1.54)%], with statistically significant differences (t=7.173, 8.294, 6.185, 10.201, 12.799, and 10.925, all P<0.05). Conclusions　There is a correlation between change in cerebrovascular reserve capacity and the risk of ischemic events in asymptomatic patients with moderate to severe carotid artery stenosis. Improving cerebrovascular reserve capacity through primary prevention can reduce the occurrence of cerebrovascular events.

Prognostic significance of pretreatment peripheral blood monocyte count in diffuse large B-cell lymphoma

Zhang Jinping, Fan Liping, Huang Zhenyu, Huang Xiaoling, Huang Haobo

2023, 29(23):  3360-3365.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.009

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Objective　To explore the prognostic value of pretreatment peripheral blood monocyte count in patients with diffuse large B cell lymphoma (DLBCL). Methods　A total of 641 newly diagnosed patients with DLBCL who were admitted to Fuzhou Second Hospital and Fujian Medical University Union Hospital from Jan 2016 to Dec 2021 were selected for the retrospective analysis, including 378 males and 263 females, aged 14-86 years. Receiver operating characteristic curve (ROC) analysis was performed to determine the optimal cut-off value of pretreatment peripheral blood monocyte count for prognosis in patients with DLBCL. The patients were divided into two groups, a high level group and a low level group, according to the cut-off value. The differences of clinical and laboratory characteristics, overall survival (OS), and progression-free survival (PFS) between the two groups were compared by χ² test and log-rank test, respectively. The relationships between these characteristics and prognosis were analyzed by univariate and multivariate regression analysis. Results　Compared with the low level group with pretreatment peripheral blood monocyte count, the proportions of patients with age >60 years old [44.70% (97/217) vs. 36.32% (154/424)], males [70.51% (153/217) vs. 53.07% (225/424)], lactate dehydrogenase (LDH) level above the upper limit of normal (ULN) [68.20% (148/217) vs. 40.80% (173/424)], high Eastern Cooperative Oncology Group (ECOG) score (2-4 points) [31.34% (68/217) vs. 16.27% (69/424)], Ann Arbor stage Ⅲ-Ⅳ [84.79% (184/217) vs. 58.73% (249/424)], site of extranodal lesions >1 [48.39% (105/217) vs. 30.42% (129/424)], B symptoms [31.34% (68/217) vs. 16.75% (71/424)], and high International Prognostic Index (IPI) score (3-5 points) [59.45% (129/217) vs. 32.08% (136/424)] and incidence of recurrence/refractory [34.56% (75/217) vs. 23.11% (98/424)] were higher in the high level group (all P<0.05). Univariate analysis showed that presence of B symptoms, LDH > ULN, high ECOG score (2-4 points), Ann Arbor stage Ⅲ-Ⅳ, site of extranodal lesions >1, non-germinal center B-cell (non-GCB) subtype, and high pretreatment peripheral blood monocyte count were associated with OS and PFS in the DLBCL patients (all P<0.05). Multivariate analysis showed that LDH > ULN, high ECOG score (2-4 points), and non-GCB subtype were independent poor prognostic factors for OS in the DLBCL patients (all P<0.05); high ECOG score (2-4 points), site of extranodal lesions >1, and non-GCB subtype were independent poor prognostic factors for PFS in the DLBCL patients (all P<0.05); high peripheral blood monocyte count was an independent poor prognostic factor for OS in the DLBCL patients (HR=1.80, 95%CI 1.14-2.82, P<0.01), but not an independent poor prognostic factor for PFS. Conclusion　High level of pretreatment peripheral blood monocyte count is an independent poor prognostic factor for OS in patients with DLBCL.

Application of precision medicine guidance in exercise rehabilitation after ASO intervention

Lang Zheng, Wang Zhe, Yao Xiaojun

2023, 29(23):  3366-3369.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.010

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Objective　To observe the effect of exercise rehabilitation training under the guidance of precision medicine on the vascular endothelial function and prognosis in patients after intervention of arteriosclerosis obliterans (ASO). Methods　This was a prospective cohort study. A total of 123 ASO patients admitted to Nanyang First People's Hospital from January 2020 to March 2022 were selected as the study objects, and were divided into a routine group (61 cases) and a rehabilitation group (62 cases) by the random number table method. In the routine group, there were 33 males and 28 females, aged 45-75 (61.36±5.25) years. In the rehabilitation group, there were 32 males and 30 females, aged 43-77 (60.45±5.13) years. Routine rehabilitation exercise was performed in the routine group, and exercise rehabilitation training based on precision medicine was performed in the rehabilitation group. The enrolled patients were followed up for one year to compare their self-management ability, vascular endothelial function, and occurrence of related complications. t test and χ² test were used. Results　After intervention, the scores of Exercise of Self-care Agency Scale (ESCA) and General Self-Efficacy Scale (GSES) in the rehabilitation group [(125.44±20.61) points and (2.66±0.25) points] were higher than those in the routine group [(110.33±20.47) points and (1.92±0.61) points], with statistically significant differences (t=4.079 and 8.829, both P<0.001). At the end of follow-up, the flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) [(12.25±3.14)% and (9.85±2.41)%] in the rehabilitation group were higher than those in the routine group [(10.11±3.47)% and (8.22±2.16)%], while the pulse wave velocity (PWV) [(10.24±3.45) m/s] was lower than that in the routine group [(12.41±3.12) m/s], with statistically significant differences (t=3.588, 3.948, and 3.657, all P<0.001). At the end of follow-up, the incidence of related complications in the rehabilitation group was 6.45% (4/62), which was lower than that in the routine group [18.03% (11/61)], with a statistically significant difference (χ²=6.242, P<0.05). Conclusions　The guidance of precision medicine can effectively improve the health cognition level in patients after ASO intervention and enhance their self-management ability. The exercise rehabilitation training based on precision medicine can promote the recovery of vascular endothelial function, and has a positive role in reducing the risk of related complications.

Analysis of the efficacy and safety of ESD and EMR in the treatment of early gastric cancer

Cheng Meilin, Yang Jingduan

2023, 29(23):  3370-3374.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.011

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Objective　To observe the effects of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) on the expression of serum tumor markers in early gastric cancer, and the correlation between different surgical procedures and the incidence of adverse prognosis. Methods　This study conducted a retrospective analysis on 110 patients with early gastric cancer admitted to the First Affiliated Hospital of Nanyang Medical College from May 2020 to April 2021. According to different treatment methods, 60 patients who underwent ESD surgery were classified as the ESD group [35 males and 25 females, aged (50.33±5.31) years], and 50 patients who underwent EMR surgery were classified as the EMR group [30 males and 20 females, aged (51.25±5.17) years]. The treatment and prognosis of the two groups were compared. The correlation between different treatment methods and the incidence of adverse prognosis in early gastric cancer was tested by Spearman correlation coefficient. t test was used for the measurement data and χ² test was used for the count data. Results　Under different surgical protocols, the complete resection rate [91.67% (55/60)] and curative resection rate [83.33% (50/60)] of lesions in the ESD group were higher than those in the EMR group [70.00% (35/50) and 60.00% (30/50)], and the non-curative resection rate [8.33% (5/60)] was lower than that in the EMR group [30.00% (15/50)], with statistically significant differences (χ²=15.156, 9.630, and 15.156; all P<0.05). Before surgery, there were no statistically significant differences in the serum tumor markers between the two groups (all P>0.05). After surgery, the levels of carcinoembryonic antigen (CEA) [(6.41±2.11) μg/L], carbohydrate antigen 19-9 (CA19-9) [(37.22±5.18) U/ml], carbohydrate antigen 724 (CA724) [(35.12±5.47) U/ml] in the ESD group were lower than those in the EMR group [(8.24±3.13) μg/L, (40.16±5.33) U/ml, and (38.44±5.63) U/ml], with statistically significant differences (t=3.644, 2.925, and 3.128; all P<0.05). The postoperative 1-year recurrence rate and mortality rate of the ESD group were 10.00% (6/60) and 6.67% (4/60), which were both lower than those of the EMR group [24.00% (12/50) and 18.00% (9/50)], and the postoperative 2-year recurrence rate and mortality rate were 16.67% (10/60) and 11.67% (7/60), which were both lower than those of the EMR group [32.00% (16/50) and 24.00% (12/50)], with statistically significant differences (χ²=6.945, 5.936, 6.382, and 5.187; all P<0.05). According to Spearman correlation coefficient test, ESD surgery was negatively correlated with the incidence of adverse prognosis in early gastric cancer (r=-0.155 and -0.147, both P<0.001), while EMR surgery was positively correlated with the incidence of adverse prognosis in early gastric cancer (r=0.254 and 0.251, both P<0.001). Conclusions　Compared with EMR surgery, ESD surgery for early gastric cancer can significantly improve the lesion resection rate and downregulate the expression of tumor markers. Choosing ESD surgery can also effectively improve the prognosis, and reduce the risk of disease recurrence and death.

Application of norcantharidin tablets in assisted ERCP surgery for esophageal cancer

Feng Dongdong, Yang Mingzhen

2023, 29(23):  3374-3378.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.012

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Objective　To observe the control efficiency of norcantharidin tablets assisted endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of esophageal cancer on postoperative biliary tract infection. Methods　This study selected 115 esophageal cancer patients admitted to the First Affiliated Hospital of Nanyang Medical College from May 2021 to December 2022 as the research subjects. The enrolled patients were randomly divided into an observation group [58 cases, 35 males and 23 females, aged (60.45±5.17) years] and a control group [57 cases, 34 males and 23 females, aged (61.22±5.32) years] using computer randomization. The control group was treated with ERCP, and the observation group was treated with norcantharidin tablets as an adjunct to ERCP. The inflammatory indexes, immune function indexes, tumor markers, and postoperative adverse events were compared between the two groups. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the levels of inflammatory indexes, immune function indexes, and tumor markers between the two groups (all P>0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α) [(3.52±0.46) ng/L], interleukin-6 (IL-6) [(135.45±10.69) ng/L], and IL-8 [(15.22±5.24) μg/L] in the observation group were lower than those in the control group [(4.79±1.24) ng/L, (140.77±10.88) ng/L, and (18.44±5.27) μg/L], with statistically significant differences (t=7.306, 2.645, and 3.286; all P<0.05). After treatment, the levels of total T cells (CD3) [(65.29±10.76)%], interferon-γ (IFN-γ) [(10.21±3.44) ng/L], and IL-12 [(61.25±10.71) μg/L] in the observation group were higher than those in the control group [(60.77±10.31)%, (8.24±2.39) ng/L, and (56.25±10.15) μg/L], with statistically significant differences (t=2.300, 3.561, and 2.569; all P<0.05). After treatment, the levels of carcinoembryonic antigen (CEA) [(4.24±1.36) μg/L], carbohydrate antigen 19-9 (CA19-9) [(7.49±2.11) U/ml], and carbohydrate antigen 50 (CA50) [(5.11±1.27) μg/L] in the observation group were lower than those in the control group [(5.82±1.25) μg/L, (10.61±4.24) U/ml, and (7.25±2.14) μg/L], with statistically significant differences (t=6.483, 5.009, and 6.535; all P<0.05). After treatment, the incidence of adverse events in the observation group was 6.90% (4/58), which was lower than that in the control group [17.54% (10/57)], with a statistically significant difference (χ²=5.277, P<0.05). Conclusion　Norcantharidin tablets assisted with ERCP can effectively alleviate the inflammatory response and enhance the immune function in patients with esophageal cancer, while also can downregulate the tumor marker levels and reduce the risk of adverse events such as biliary tract infection.

Application of sequential therapy of cephalosporins in the treatment of neonatal pneumonia

He Qing, Tian Jing

2023, 29(23):  3379-3382.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.013

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Objective　To observe the efficacy and safety of sequential therapy of cephalosporins in the treatment of neonatal pneumonia. Methods　This was a prospective cohort study. A total of 100 neonatal pneumonia admitted to Nanyang Central Hospital from January 2021 to January 2023 were selected as the study objects, and were divided into a sequential group and a routine group by the random number table method, with 50 cases in each group. In the routine group, there were 32 boys and 18 girls, aged (19.33±5.25) d. In the sequential group, there were 30 boys and 20 girls, aged (19.16±5.48) d. The routine group was treated with routine drugs, and the sequential group was given sequential therapy of cephalosporins. The changes in inflammatory factors before and after treatment, post-treatment recovery, medical costs, and medication safety were compared between the two groups. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the inflammatory factors between the two groups (all P>0.05). After treatment, the levels of C-reactive protein (CRP) [(6.65±2.33) mg/L], interleukin-6 (IL-6) [(133.65±20.74) ng/L], and procalcitonin (PCT) [(0.41±0.15) μg/L] in the sequential group were lower than those in the routine group [(7.95±2.12) mg/L, (145.77±20.61) ng/L, and (0.73±0.21) μg/L], with statistically significant differences (t=2.918, 2.931, and 8.768; all P<0.05). Under different treatment regimens, the disappearance time of cough [(10.24±3.25) d], the disappearance time of inspiratory triple concave sign [(7.67±2.46) d], and the fever reduction time [(3.11±0.74) d] in the sequential group were shorter than those in the routine group [(12.77±2.28) d, (8.85±2.14) d, and (4.25±1.71) d], and the bacterial clearance rate [92.00% (46/50)] was higher than that in the routine group [76.00% (38/50)], with statistically significant differences (t=4.506, 2.559, and 4.326, χ²=4.762; all P<0.05). The duration of hospitalization [(12.23±4.14) d] and the total duration of treatment [(20.27±5.11) d] in the sequential group were shorter than those in the routine group [(15.22±5.27) d and (23.11±5.16) d], and the total medical expense [(23.35±5.17) hundred yuan] was lower than that in the routine group [(26.72±5.31) hundred yuan], with statistically significant differences (t=3.155, 2.765, and 3.215; all P<0.05). Under different treatment regimens, the incidence of adverse drug reactions in the sequential group [10.00% (5/50)] was lower than that in the routine group [30.00% (15/50)], with a statistically significant difference (χ²=6.250, P=0.012). Conclusion　Sequential therapy of cephalosporins in the treatment of neonatal pneumonia can effectively inhibit the levels of inflammatory factors in children and accelerate the rehabilitation process, which has positive significance in shortening the children's treatment cycle, reducing the medical costs, and reducing the risk of adverse drug reactions.

Study on the effect of Changpu Madan decoction combined with sodium valproate on rehabilitation of post-stroke epilepsy patients

Li Linlin, Deng Qian

2023, 29(23):  3383-3387.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.014

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To observe the effect of Changpu Madan decoction combined with sodium valproate on the rehabilitation of neurological and motor function in patients with post-stroke epilepsy. Methods　This article was a prospective study. A total of 121 patients with post-stroke epilepsy in the First Affiliated Hospital of Nanyang Medical College from January 2021 to December 2022 were selected as the study objects, and were divided into a control group (60 cases) and a combination group (61 cases) by the random number table method. In the control group, 32 males and 28 females, aged (61.22±5.33) years, were treated with sodium valproate. In the combination group, 31 males and 30 females, aged (60.33±5.25) years, were treated with Changpu Madan decoction combined with sodium valproate. The seizure statuses of the two groups before and after treatment were compared, as well as improvement of brain nerve function and motor function, and medication safety. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the seizure status, brain nerve function, and motor function between the two groups (all P>0.05).After treatment, the number of seizures [(2.15±0.27) times/month] and duration of symptoms [(1.25±0.36) min/time] in the combination group were lower than those in the control group [(3.31±0.42) times/month and (2.29±0.46) min/time], with statistically significant differences (t=18.102 and 13.862, both P<0.05). After treatment, the levels of neuron-specific enolase (NSE) [(35.25±10.61) μg/L] and neuro filament light chain (NF-L) [(1 033.46±200.27) μg/L] in the combination group were lower than those in the control group [(42.11±10.77) μg/L and (1 192.72±200.64) μg/L], while the score of Mini-Mental State Examination (MMSE) [(26.11±5.15) points] was higher than that in the control group [(23.32±5.19) points], with statistically significant differences (t=3.560, 4.370, and 2.968; all P<0.05). After treatment, the upper limb and lower limb scores of Fugl-Meyer Motor Function Assessment (FMA) in the combination group were higher than those in the control group [(58.44±10.33) points vs. (51.15±10.11) points, (28.72±5.31) points vs. (25.21±5.28) points], with statistically significant differences (t=3.923 and 3.643, both P<0.05). After treatment, there was no statistically significant difference in the incidence of drug-related adverse reactions between the combination group [6.56% (4/61)] and the control group [5.00% (3/60)] (χ²=0.223, P>0.05). Conclusions　The combination of Changpu Madan decoction and sodium valproate in the treatment of post-stroke epilepsy can effectively promote the recovery of epilepsy symptoms in patients, and has a positive significance in improving their brain nerve function and motor function. The combined medication method does not significantly increase the risk of drug-related adverse reactions, with high safety.

Application of 8S management mode in the whole process management of ventilator pipeline in disinfection supply center

Zhang Hongmei, Cheng Juanjuan

2023, 29(23):  3387-3391.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.015

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Objective　To analyze the application effect of 8S management mode in the whole process management of ventilator pipeline in disinfection supply center. Methods　In the retrospective analysis, 108 sets of ventilator pipelines under routine management in Disinfection Supply Center, Wuxi Second People's Hospital from January to December 2021 were included in the control group, and 135 sets of ventilator pipelines under 8S management mode from January to December 2022 were included in the observation group. The cleaning time, re-washing rate, cleaning qualified rate, damage rate, replacement frequency, and service life of the two groups of ventilator pipeline were compared. The work quality levels of 34 staff before and after the implementation of 8S management mode were compared with a self-made quality management scale. There were 18 men and 16 women, aged (28.36±2.15) years. χ² test and t test were used. Results　The instrument cleaning time of ventilator pipeline cleaning in the observation group [(64.31±10.76) min] was shorter than that in the control group [(67.44±11.25) min], the re-washing rate [2.22% (3/135)] and damage rate [1.48% (2/135)] were lower than those in the control group [8.33% (9/108) and 6.48% (7/108)], and the cleaning qualified rate [99.26% (134/135)] was higher than that in the control group [94.44% (102/108)], with statistically significant differences (t=2.208, χ²=4.773, 4.206, and 4.972; all P<0.05). The frequency of ventilator pipeline replacement [(4.42±0.71) times/year] in the observation group was lower than that in the control group [(4.69±0.85) times/year], and the service life [(7.33±1.25) months] was higher than that in the control group [(6.95±1.65) months], with statistically significant differences (t=2.698 and 2.042, both P<0.05). After the implementation of 8S management mode, the scores of device function examination [(22.34±1.01) points], safety identification [(20.49±1.30) points], device cleaning and disinfection [(22.35±0.76) points], and risk prevention [(22.34±1.85) points] and total score [(96.01±1.78) points] were all higher than those before the implementation [(21.65±1.65) points, (19.36±2.32) points, (21.88±0.98) points, (20.35±1.25) points, and (93.42±2.01) points], with statistically significant differences (t=2.080, 2.478, 2.209, 5.197, and 5.625; all P<0.05). Conclusions　The 8S management mode can significantly shorten the equipment cleaning time of ventilator pipelines, improve the work efficiency, reduce the re-washing rate, damage rate, and replacement frequency, and improve its service life. On this basis, the quality management level of the staff in disinfection supply center can be greatly improved.

Clinical significance of SWAN-rLMC score and change in cerebral blood flow for prognostic evaluation in patients with chronic middle cerebral artery occlusion

Xu Kaixi, Xu Xingru, Chen Xinjian, Wang Jin, Ma Xianjun, Zuo Taosheng, Chen Yuchen, Gu Baodong, Meng Yun, Yin Xindao

2023, 29(23):  3392-3398.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.016

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Objective　To investigate the clinical significance of regional leptomeningeal collateral (rLMC) score of susceptibility weighted angiography (SWAN) and cerebral blood flow (CBF) change of three dimensional pseudo continuous arterial spin labeling (3D-PCASL) in the prognosis assessment for patients with chronic middle cerebral artery occlusion (CMCAO). Methods　The clinical data of 35 patients with CMCAO admitted to Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2017 to January 2022 were analyzed retrospectively, including 21 males and 14 females, aged (66.57±10.28) years. All patients underwent routine magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), SWAN, and 3D-pcASL examinations. The SWAN-rLMC score >12 points was defined as a poor collateral circulation (17 cases), and ≤12 points as a good collateral circulation (18 cases). Independent sample t test, Mann-Whitney U test, and χ² test were used to compare the data between the two groups, and the relationship between the good and bad SWAN-rLMC scores and CBF was analyzed. The area under the receiver operating characteristic curve (ROC-AUC) and the optimal cutoff value were used to evaluate the values of SWAN-rLMC score and CBF perfusion in determining the patients' prognosis. Results　Of the 35 patients with CMCAO, 15 were on the right side and 20 were on the left side. SWAN showed asymmetrical cortical venous sign (CVS) of posterior cerebral artery (PCA) in 26 cases, asymmetrical deep medullary vein (DMV) adjacent to lateral ventricle body in 21 cases, and both DMV and CVS dilation in 19 cases. Among the 18 cases with good SWAN-rLMC score, 12 cases had equal or high perfusion, while 16 cases had low perfusion in the 17 cases with poor SWAN-RLMC score. During follow-up, 17 patients had a poor prognosis [6 cases of cerebral infarction, 10 cases of transient ischemic attack (TIA), and 1 death]. According to the SWAN-rLMC score, the CBF of the affected side in the poor collateral circulation group [(31.76±10.72) ml·100 g^-1·min^-1] was lower than that in the good collateral circulation group [(48.82±18.63) ml·100 g^-1·min^-1], with a statistically significant difference (t=3.296, P<0.05). There was a statistically significant difference in the perfusion of the affected side between the good and poor collateral circulation groups (χ²=16.431, P<0.001). According to Mann-Whitney U test, the perfusion in the good collateral circulation group was better than that in the poor collateral circulation group, with a statistically significant difference (Z=3.660, P<0.001). The good prognosis rate of the good collateral circulation group with SWAN-rLMC score was higher than that of the poor collateral circulation group, and the good prognosis rate of the equal and high perfusion group was higher than that of the low perfusion group, with statistically significant differences (χ²=17.927 and 21.898, both P<0.001). The AUC values of SWAN-rLMC score and CBF perfusion in the assessment of poor prognosis were 0.858 and 0.882, respectively, with good recognition ability. The AUC value of the combination of SWAN-rLMC score and CBF perfusion was 0.954, with a statistically significant difference compared with AUC_SWAN-rLMC (Z=2.145, P<0.05). Conclusions　The improved SWAN-rLMC score and 3D-pcASL are imaging methods to evaluate collateral circulation, which can directly reflect the changes of cerebral oxygen metabolism, cerebral perfusion, and collateral circulation. The combined application of the two is conducive to providing individual quantitative basis for clinical prevention, treatment, and prognosis assessment, which has important clinical significance.

Application of enhanced recovery after surgery in the perioperative period of endoscopic myringoplasty

Xiong Huiqiang, Pan Honggui, Cao Xiaoqing, Gan Wenwu

2023, 29(23):  3399-3402.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.017

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Objective　To investigate the efficacy and safety of enhanced recovery after surgery (ERAS) in the perioperative period of endoscopic myringoplasty. Methods　This was a randomized controlled trial. A total of 40 patients with chronic suppurative otitis media stationary phase who underwent endoscopic myringoplasty in Fengcheng People's Hospital from January 2021 to June 2022 were prospectively selected as the study objects, and were divided into a ERAS group (20 cases) and a control group (20 cases) by the random number table method. In the ERAS group, there were 4 males and 16 females, aged (45.7±11.6) years, and the perioperative management was performed using ERAS model. In the control group, 5 males and 15 females, aged (46.5±12.4) years, were treated with traditional perioperative management. The preoperative anxiety, postoperative comfort, pain, adverse reactions, length of stay, and hospitalization cost were compared between the two groups. t test and χ² test were used. Results　The preoperative Self-rating Anxiety Scale (SAS) score of the ERAS group was (27.31±1.54) points, which was lower than that of the control group [(34.82±5.13) points], with a statistically significant difference (t=6.270, P<0.001). On day 1 and day 2 after surgery, the Kolcaba General Comfort Questionnaire (GCQ) score of the ERAS group was higher than that of the control group [(89.53±7.85) points vs. (83.24±7.21) points, (87.31±7.67) points vs. (81.03±8.45) points], but the VAS score was lower than that of the control group [(1.73±1.12) points vs. (3.00±1.31) points, (1.59±1.06) points vs. (2.78±1.27) points], with statistically significant differences (t=2.639, 2.461, 3.295, and 3.217, all P<0.05). There were no statistically significant differences in the length of stay or hospitalization cost between the two groups (t=0.914 and 1.464, both P>0.05). There was no bleeding in the ear incision, and no adverse events such as vertigo, nausea, vomiting, or aspiration occurred in the two groups. Conclusion　ERAS has definite effects in the perioperative period of endoscopic myringoplasty, which can relieve the preoperative anxiety, reduce the postoperative pain, and improve the postoperative comfort.

Distribution characteristics and countermeasures of pathogens in oral implant infection

Chen Xinhua, Li Hongyan, Li Zhanqing, Lyu Yang, Liu Xiuping

2023, 29(23):  3403-3406.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.018

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Objective　To observe the distribution characteristics of common pathogens in oral implant infection, and discuss the specific countermeasures. Methods　A total of 159 patients who received oral implant treatment in Sanmenxia Hospital of the Yellow River from March 2020 to March 2022 and 9 patients who had peri-implant infection after oral implant treatment in other hospitals during the same period were selected for retrospective analysis. According to whether postoperative infection occurred, the patients were divided into a non-infected group [146 cases, 77 males and 69 females, aged (52.71±0.42) years] and an infected group [13 cases, 7 males and 6 females, aged (52.54±0.38) years]. The general and clinical data of the two groups were collected and compared. The main factors leading to peri-implant infection were summarized through single-factor and multi-factor analysis, and the specific prevention and control measures were proposed based on the analysis results. t test and χ² test were used. Results　Forty-five strains of pathogenic bacteria were isolated from the implants of 13 patients, and the main types of pathogenic bacteria were anaerobic bacteria [62.22% (28/45)] and aerobic bacteria [26.67% (12/45)]. Multivariate logistic regression analysis showed that long-term smoking, drinking, diabetes, poor osseointegration, and bad oral hygiene habits were all risk factors that could lead to peri-implant infection (OR=3.125, 2.614, 3.215, 3.126, and 3.198; P=0.013, 0.017, 0.042, 0.016, and 0.015). Conclusions　The pathogens of peri-implant infection are mostly anaerobic and aerobic bacteria. The occurrence of patients' infection should be related to their own smoking, drinking, diabetes, and bad oral hygiene habits. Poor osseointegration is also an important factor of peri-implant infection. Patients should be instructed to quit smoking, quit drinking, maintain oral hygiene, control blood glucose, and pay close attention to the osseointegration of implants to prevent infection.

Evaluation of the effect of Ningbitai capsules combined with surgery in the treatment of chronic prostatitis complicated with benign prostatic hyperplasia

Zhao Zongyong, Ren Zhishang, Xu Long, Diao Tongxiang

2023, 29(23):  3407-3411.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.019

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Objective　To analyze the application value of Ningbitai capsules combined with surgery in the treatment of chronic prostatitis (CP) with benign prostatic hyperplasia (BPH). Methods　The clinical data of 76 patients with CP complicated with BPH admitted to Liaocheng Third People's Hospital from June 2019 to June 2022 were retrospectively collected, and they were divided into two groups according to different treatment methods, with 38 cases in each group. The observation group was (61.58±6.44) years old, and the control group was (62.31±7.28) years old. All patients underwent transurethral plasmakinetic resection of prostate (PKRP). The control group was given routine treatment, and the observation group was given Ningbitai capsules on the basis of the control group. The medication started 2 weeks before surgery and continued till 2 weeks after surgery, for a total of 1 month.The operation-related indexes, levels of inflammatory markers [macrophage inflammatory protein-1α (MIP-1α), vascular cell adhesion molecule-1 (VCAM-1), and interleukin-6 (IL-6)] before treatment, 1 d before surgery, and 2 weeks after surgery, and urodynamic indexes [maximum urinary flow rate (Qmax), residual urine volume (PVR), and bladder stability], National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) scores, and International Prostatitis Symptom Scale (IPSS) scores before treatment, 1 day before surgery, and 3 months after surgery were compared between the two groups. Independent sample t test and paired t test were used. Results　The operation time, hospital stay, and intraoperative blood loss were (51.49±12.44) min, (5.19±0.98) days, and (79.58±8.13) ml in the observation group, and (68.73±14.35) min, (6.08±1.22) days, (98.55±10.24) ml in the control group, respectively, with statistically significant differences (t=5.596, 3.506, and 8.944, all P<0.01). Serum MIP-1α, VCAM-1, and IL-6 levels in the observation group were (14.95±2.18) µg/L, (72.58±8.51) ng/L, and (185.73±32.62) ng/L 1 day before surgery, those were (6.51±1.38) µg/L, (40.28±8.75) ng/L, and (119.24±35.58) ng/L 2 weeks after surgery, and the results in the control group were (16.83±2.27) µg/L, (81.44±8.22) ng/L, and (215.37±31.11) ng/L 1 day before surgery and (8.11±1.44) µg/L, (54.56±7.93) ng/L, and (153.15±39.48) ng/L 2 weeks after surgery, with statistically significant differences (t=3.682, 4.616, 4.053, 4.945, 7.454, and 3.993, all P<0.001). The Qmax, bladder stability, and PVR in the observation group 3 months after surgery were (12.39±2.47) ml/s, (174.65±15.32) ml, and (44.66±15.26) ml, those in the control group were (9.25±2.31) ml/s, (154.51±16.83) ml, and (62.79±14.93) ml, with statistically significant differences (t=5.724, 5.455, and 5.235, all P<0.001). The NIH-CPSI score of the observation group was (17.17±2.11) 1 day before surgery and (7.84±1.08) points 3 months after surgery, while those of the control group were (19.16±2.15) and (10.29±1.25) points (t=4.072 and 9.143, both P<0.001). The IPSS score of the observation group was lower than that of the control group 3 months after surgery [(8.17±1.43) points vs. (11.22±1.68) points] (t=8.552, P<0.001). Conclusion　Ningbitai capsules combined with PKRP in the treatment of CP with BPH can reduce the inflammatory reaction, improve the urodynamics, and helps to recover.

Application of artificial intelligence in medical image diagnosis based on science and technology novelty search

Tang Dan, Wang Yaodong

2023, 29(23):  3412-3416.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.020

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Objective　According to the statistics of the research projects of artificial intelligence (AI) technology in the field of medical image diagnosis, the research characteristics and direction of medical AI in Guangdong province were analyzed, to provide reference basis for the development planning of medical AI in Guangdong province. Methods　The AI-related items in the novelty search system were analyzed, the research and application of AI technology such as machine learning and deep learning in medical image diagnosis were statistically analyzed, and literature comparison was made. Results　From 2016 to 2022, a total of 50 applications related to medical AI and imaging diagnosis were received. AI researches focused on the application of ultrasound, CT, MRI, and other technologies. The key technologies of AI used were deep learning and machine learning, and some projects used different auxiliary diagnosis systems. Conclusions　Medical imaging diagnosis is an important research direction in medical AI research in Guangdong province. Preliminary progress has been made in the research. Relevant management departments should strengthen their investment and effective guidance in the research of medical AI in imaging diagnosis, attach importance to originality, cultivate interdisciplinary talents who combine medicine and computer engineering, and expand and strengthen the medical AI industry.

Basic Research

Effect of Zhisanzhen acutherapy on learning and memory abilities of PSCI rats

Weng Yujun, Chen Zhining, Liang Weihai, Yu Yongsen, Lin Guowei, Tang Liang, Liu Xiaojun

2023, 29(23):  3417-3421.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.021

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Objective　To analyze the effect of Zhisanzhen acutherapy on learning and memory abilities of rats with post-stroke cognitive impairment (PSCI). Methods　The animal experimental research was conducted from August 2 to October 3, 2022. Forty-five SPF SD male rats were randomly divided into a sham-operation group, a PSCI control group, and a Zhisanzhen group, with 15 rats in each group. The rat model of PSCI was established by middle cerebral artery occlusion (MCAO) method. Morris water maze test was used to determine the differences in learning and memory abilities in rats. The rats in the three groups were intervened for 21 days. The escape latency and swimming distance of rats in the three groups were tested by Morris water maze test after intervention. Analysis of variance was used for comparison among multiple groups, LSD-t test was used for pairwise comparison between groups, and paired t test was used for self-control within groups. Results　Finally, 12 rats survived in the Zhisanzhen group, 11 in the PSCI control group, and 12 in the sham-operation group. After modeling/sham-operation, there were statistically significant differences in the escape latency [(51.94±8.19) s, (53.13±6.28) s, and (41.66±6.65) s] and swimming distance [(1 242.25±100.72) cm, (1 192.28±137.72) cm, and (702.92±85.60) cm] among the three groups (F=4.060 and 4.240, both P<0.05). Compared with the sham-operation group, the escape latency and swimming distance of the rats in the PSCI control group and the Zhisanzhen group were significantly extended, with statistically significant differences (t=2.228, 2.219, 2.304, and 2.343, all P<0.05). Compared with the PSCI control group, there were no statistically significant differences in the escape latency or swimming distance in the Zhisanzhen group (t=1.620 and 1.866, both P>0.05). Compared to those before modeling, the escape latency [(51.94±8.19) s vs. (37.32±6.19) s, (53.13±6.28) s vs. (35.90±6.08) s] and swimming distance [(1 242.25±100.72) cm vs. (623.52±42.22) cm, (1 192.28±137.72) cm vs. (629.36±39.87) cm] of the Zhisanzhen group and the PSCI control group after modeling were increased, with statistically significant differences (t=2.713, 2.692, 2.208, and 2.276, all P<0.05). Compared to those before sham-operation, there were no statistically significant differences in the escape latency or swimming distance of the rats after sham-operation (t=1.478 and 1.372, both P>0.05). After acupuncture intervention, the escape latency of the rats in the Zhisanzhen group was significantly shortened compared with that before acupuncture intervention [(45.64±7.70) s vs. (51.94±8.19) s], and the swimming distance was significantly reduced [(887.35±92.47) cm vs. (1 242.25±100.72) cm], with statistically significant differences (t=2.245 and 2.211, both P<0.05). After acupuncture intervention, the escape latency and swimming distance of the rats in the PSCI control group and the sham-operation group were not significantly different from those before intervention (t=1.602, 1.370, 1.681, and 1.824, all P>0.05). After acupuncture intervention, there were statistically significant differences in the escape latency [(45.64±7.70) s, (56.33±10.32) s, and (39.17±5.35) s] and swimming distance [(887.35±92.47) cm, (1 292.29±104.52) cm, and (621.33±56.41) cm] among the three groups (F=4.270 and 4.320, both P<0.05). Compared with the sham-operation group, the escape latency and swimming distance of the rats in the PSCI control group and the Zhisanzhen group were extended, with statistically significant differences (t=2.508, 2.482, 2.473, and 2.318, all P<0.05). Compared with the PSCI control group, the escape latency and swimming distance of the rats in the Zhisanzhen group were decreased, with statistically significant differences (t=2.261 and 2.201, both P<0.05). Conclusion　Zhisanzhen acutherapy may improve the learning and memory abilities of PSCI rats.

Treatises

Molecular mechanism of Salvia miltiorrhiza inhibiting FASN expression in the treatment of bladder cancer based on network pharmacology analysis

Gui Zhiming, Huang Jian, Li Shihao, Wu Haokai, Wang Qianliang

2023, 29(23):  3422-3429.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.022

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Objective　To study the active ingredients and potential molecular targets of Salvia miltiorrhiza and reveal the molecular mechanism of Salvia miltiorrhiza in the treatment of bladder cancer by using the ideas and methods of network pharmacology. Methods　The study was conducted from January 2022 to June 2023. The active ingredients in Salvia miltiorrhiza with oral bioavailability (OB) ≥30% and drug-likeness (DL) ≥0.18 were analyzed based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), and then the downstream targets of the active ingredients were obtained for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) function enrichment analysis, which were included in the bladder cancer dataset in the Cancer Genome Atlas (TCGA) database for risk regression analysis, combined with the expression levels of risk genes and survival prognosis information to screen the potential therapeutic targets of Salvia miltiorrhiza in bladder cancer, and validation and in vitro treatment experiments were carried out in bladder cancer cell lines. Results　A total of 65 active ingredients in Salvia miltiorrhiza could act on 270 downstream target proteins, and its function enrichment analysis focused on nitrogen metabolism, bladder cancer, endocrine resistance, prostate cancer, and neuroactive ligand receptor interaction, which indicated that Salvia miltiorrhiza had the potential to treat bladder cancer. Sequencing data of bladder cancer patients showed that 44 genes had prognostic value in bladder cancer (P<0.05). The study further successfully constructed a risk regression model based on 18 genes among which [AUC (area under the curve)=0.819]. Combined with the expression levels of genes in cancer and adjacent cancer, MMP9, MAOA, PSMB5, HCAR and FASN were screened as molecular targets of Salvia miltiorrhiza for bladder cancer treatment, among which FASN had the highest risk coefficient (core=0.007 412). Cell experiment showed that the expression of FASN in bladder cancer cell line J82 was significantly increased, while after treatment with Salvia miltiorrhiza (IC50=10 mg/L), the proliferation, invasion, and migration of bladder cancer cells were significantly reduced, and the expression of FASN protein was also reduced. Conclusion　This study revealed the effective active ingredients of Salvia miltiorrhiza and its molecular targets for bladder cancer treatment, and provided the necessary experimental basis and theoretical basis for the clinical application of Salvia miltiorrhiza in the treatment of bladder cancer.

Analysis of the relationships between different feeding manners and iron-deficiency anemia in 6-month-old infants

Lin Huifang, Guo Yong, Wu Jieling

2023, 29(23):  3429-3431.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.023

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Objective　To analyze the relationships between different feeding manners and iron deficiency anemia in 6-month-old infants. Methods　A total of 623 6-month-old infants who accepted health care and blood routine test in Guangdong Women's and Children's Hospital from December 2022 to February 2023 were selected, including 364 boys with a birth weight of (3.22±0.33) kg and 259 girls with a birth weight of (3.11±0.33) kg. They were divided by feeding manners into a breast-feeding group (201 cases, exclusive breast-feeding from birth to 6 months old), an artificial feeding group (289 cases, exclusive infant formula feeding after birth), and a mixed feeding group (133 cases, partial breast-feeding + infant formula feeding after birth). The anemia related indexes such as hemoglobin in the blood routine of the three groups were sorted out and the anemia conditions in the three groups were analyzed. χ² test was used. Results　The incidence of iron deficiency anemia in the 6-month-old infants was 22.3% (139/623), all of which were mild anemia. The incidence of iron deficiency anemia in the breast-feeding group [30.8% (62/201)] was higher than that in the artificial feeding group [15.9% (46/289)] and the mixed feeding group [23.3% (31/133)], with a statistically significant difference (χ²=15.340, P<0.001). Conclusions　Breast feeding infants have a higher prevalence of iron deficiency anemia, but mostly are mild anemia. Breast milk is still the most ideal natural food for infants, but iron-rich complementary food should be added promptly and reasonably, in order to prevent iron deficiency anemia.

Value of interleukin-33 in the diagnosis of bacterial, fungal, and viral enteritis in children

Huang Hai, Wang Hongli, Li Huiwen, Chen Huan, Chen Peiyu

2023, 29(23):  3432-3435.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.024

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Objective　To investigate the value of serum interleukin-33 (IL-33) level in the diagnosis of bacterial, fungal, and viral enteritis in children. Methods　A total of 72 children with bacterial enteritis [38 boys and 34 girls, aged (9.6±3.2) years], 48 children with fungal enteritis [26 boys and 22 girls, aged (10.7±3.8) years], and 67 children with viral enteritis [33 boys and 34 girls, aged (10.3±3.6) years] admitted to Department of Gastroenterology, Guangdong Provincial Clinical Research Center for Child Health from June 2022 to June 2023 were selected. Another 60 cases of healthy volunteers were selected as the control group, including 30 boys and 30 girls, aged (10.9±4.2) years. The enzyme-linked immunosorbent assay (ELISA) kits were applied to monitor the IL-33 level in the serum of all the children. The diagnostic value of serum IL-33 in children with bacterial, fungal, and viral enteritis was evaluated using the receiver operating characteristic curve (ROC). Independent sample t test, ANOVA, and χ² test were used. Results　The serum IL-33 level was (72.03±32.25) ng/L in the healthy controls, (129.01±50.79) ng/L in the bacterial enteritis group, (100.47±45.65) ng/L in the fungal enteritis group, and (100.16±48.58) ng/L in the viral enteritis group. The levels of serum IL-33 in the bacterial enteritis group, the fungal enteritis group, and the viral enteritis group were higher than that in the healthy controls (t=7.516, 3.788, and 3.797, all P<0.001), and the levels of serum IL-33 in the bacterial enteritis group and the viral enteritis group were lower than that in the bacterial enteritis group (t=3.138 and 3.417, P=0.002 and 0.001), but there was no statistically significant difference between the fungal enteritis group and the viral enteritis group (t=0.034, P=0.973). The areas under the curve of IL-33 in the diagnosis of bacterial, fungal, and viral enteritis in children were 0.826 9, 0.669 8, and 0.669 9, respectively. Conclusion　IL-33 has a high diagnostic value for bacterial, fungal, and viral enteritis in children, especially in bacterial enteritis.

Clinical analysis of 48 cases of infectious mononucleosis in children

Chen Buxin, Jia Jinrong, Zhu Can, Long Xuewei

2023, 29(23):  3436-3438.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.025

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Clinical analysis of 62 cases of mycoplasma pneumoniae pneumonia mutated by A2063G gene of 23Sr RNA

Jia Jinrong, Chen Buxin, Yu Weijun, Long Xiaohui, Jiang Weiyi

2023, 29(23):  3439-3442.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.026

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Therapeutic effect of aerosol inhalation of budesonide combined with ipratropium bromide in the treatment of children with bronchopneumonia

Chen Lijuan, Liu Xiaodan, Chen Min, Jiang Xiaohua

2023, 29(23):  3443-3447.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.027

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Objective　To investigate the efficacy of aerosol inhalation of budesonide combined with ipratropium bromide in the treatment of children with bronchopneumonia and its effects on the levels of serum interleukin (IL)-6 and IL-17A. Methods　It was a randomized controlled trial. A total of 106 children with bronchopneumonia admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2022 to May 2023 were prospectively selected as the research subjects and were divided into two groups with 53 cases in each group by the sealed envelope method. In the control group, 29 males and 24 females, aged (5.23±1.16) years, were given budesonide aerosol inhalation therapy. In the observation group, 28 males and 25 females, aged (5.28±1.21) years, were given aerosol inhalation of budesonide + ipratropium bromide. The two groups were compared from the aspects of efficacy, disappearance time of clinical symptoms and signs, changes in immune function, changes in serum inflammatory factor levels, changes in serum procalcitonin (PCT) levels, and drug safety. Independent sample t test, paired t test, and χ² test were used. Results　The total effective rate of the observation group was higher than that of the control group [96.23% (51/53) vs. 79.25% (42/53)] (χ²=7.102, P=0.008). The disappearance time of cough, shortness of breath, pulmonary rales, fever, and chest film shadow in the observation group were shorter than those in the control group (t=17.453, 8.190, 10.529, 10.266, and 15.488, all P<0.001). After treatment, the levels of T lymphocyte subsets (CD3⁺, CD4⁺, and CD8⁺), inflammatory factors, and PCT in the two groups were significantly different from those before treatment (all P<0.05); the levels of CD3⁺ and CD4⁺ in the observation group were higher than those in the control group, and the level of CD8⁺ was lower than that in the control group, with statistically significant differences (t=4.614, 7.970, and 9.020, all P<0.001); the levels of inflammatory factors in the observation group were lower than those in the control group (all P<0.001); the serum PCT level in the observation group was lower than that in the control group [(1.12±0.17) µg/L vs. (2.71±0.23) µg/L], with a statistically significant difference (t=40.472, P<0.001). There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group [9.43% (5/53) vs. 7.55% (4/53), χ²=0.121, P=0.727]. Conclusion　There are multiple treatment options for children with bronchial pneumonia, but the choice of aerosol inhalation of budesonide + ipratropium bromide has distinct advantages, which can improve their immune function, promote the repair of lung injury, reduce their inflammatory response, and promote the disappearance of symptoms and signs as soon as possible, with guaranteed safety and high promotion value.

Efficacy of canagliflozin in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease

Hao Zirui, Wen Yingzhen, Cai Tian, Li Guiping

2023, 29(23):  3448-3452.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.028

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Objective　Non-alcoholic fatty liver disease (NAFLD) is often accompanied by type 2 diabetes mellitus (T2DM). The current study was to evaluate the effect of canagliflozin, in addition to lifestyle modification and metformin, on T2DM patients with NAFLD. Methods　This was a randomized clinical trail and 120 patients diagnosed as T2DM with NAFLD in Huizhou Third People's Hospital from October 2021 to September 2022 were randomly divided into a control group and an intervention group. In the intervention group, there were 38 males and 22 females, aged (50.5±7.0) years. In the control group, there were 37 males and 23 females, aged (51.3±8.2) years. The control group received lifestyle intervention combined with metformin 1.0 g bid, and the intervention group was additionally treated with 100 mg qd of canagliflozin in addition to the control group. Both groups were treated for 12 weeks. Serum biochemical indexes and fatty liver related indexes in the two groups were measured before and after treatment for 12 weeks, and the rates of genitourinary system infection and hypoglycemia in the two groups during treatment were also compared. Student t test, rank sum test, and χ² test were used. Results　After 12 weeks of treatment, the levels of fasting blood glucose and glycosylated hemoglobin in the intervention group were lower than those in the control group [(6.7±0.5) mmol/L vs. (7.0±0.6) mmol/L, (7.0±0.5)% vs. (7.3±0.6)%], the level of triacylglycerol was lower and the level of high-density lipoprotein cholesterol was higher [1.87 (0.54, 2.21) mmol/L vs. 2.02 (0.60, 2.39) mmol/L, (1.00±0.09) mmol/L vs. (0.92±0.11) mmol/L], with statistically significant differences (all P<0.05). The plasma transaminase levels in the intervention group were lower than those in the control group, with statistically significant differences (all P<0.05). Compared with those in the control group, the liver fibrosis indexes, liver stiffness [(7.1±3.0) kPa vs. (9.5±3.3) kPa], and liver fat content [(10.8±5.6)% vs. (13.7±5.2)%] in the intervention group were significantly lower, with statistically significant differences (all P<0.05). There were no statistically significant differences in the incidences of adverse reactions between the two groups (all P>0.05). Conclusion　For T2DM patients with NAFLD, the addition of 12 weeks' treatment of canagliflozin can significantly improve the blood glucose and lipid metabolism disorders and can also improve NAFLD in addition to lifestyle intervention and metformin treatment. This study can provide some reference for clinicians in the treatment of T2DM patients with NAFLD.

Clinical Research

Effect of pulmonary function monitoring combined with exercise for weight loss on symptom control in children with cough-variant asthma

Tan Zhiyong

2023, 29(23):  3453-3456.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.029

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Objective　To study the effect of pulmonary function monitoring combined with exercise for weight loss on symptom control in children with cough-variant asthma. Methods　A total of 100 children with cough variant asthma admitted to Shaoguan Maternal and Child Health  Care Hospital from January 2020 to January 2023 were divided into an observation group and a control group, with 50 cases in each group. In the observation group, there were 23 boys and 27 girls, aged 5-12 (8.09±1.14) years. In the control group, there were 28 boys and 22 girls, aged 5-12 (7.89±1.54) years. The control group was treated routinely, and the observation group was treated with pulmonary function monitoring and exercise for weight loss on the basis. The clinical efficacy, symptom score, pulmonary function indexes, inflammatory factors, and prognosis of the two groups were evaluated. Independent sample t test and χ² test were used. Results　The total effective rate of the observation group was 92.00% (46/50), which was higher than that of the control group [74.00% (37/50)] (χ²=5.741, P=0.017). After treatment, the forced expiratory volume in the first second (FEV1), peak-to-volume ratio (VPEF/VE), and peak-to-time ratio (TPTEF/TE) in the observation group were higher than those in the control group (all P<0.05). After treatment, the scores of cough, nasal congestion, dry and itchy pharynx, and chest tightness and shortness of breath in the observation group were lower than those in the control group (all P<0.05). After treatment, the levels of inflammatory factors [hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α)] in the observation group were lower than those in the control group (all P<0.05). After treatment, the score of St. George's Respiratory Questionnaire (SGRQ) and Borg dyspnea score in the observation group were lower than those in the control group, and the 6-min walking distance (6MWD) was higher than that in the control group (all P<0.05). Conclusion　Pulmonary function monitoring combined with exercise for weight loss is a good intervention for children with cough variant asthma, which can control the children's symptoms, improve the lung function, reduce the levels of inflammatory factors, and promote the rehabilitation.

Efficacy of integrated Chinese and Western medicine in the treatment of eczema in children

Gu Zhaoxiong, Liang Yanbing, Xu Xiaojie, Luo Qianhong

2023, 29(23):  3457-3461.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.030

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Objective　To evaluate the treatment plan of integrative Chinese and Western medicine for eczema in children, which is mainly characterized by pediatric massage. Methods　Through the research of evidence-based medical literatures and expert consultations, combined with the characteristic therapy of traditional Chinese medicine (TCM) pediatric massage, a new treatment scheme of integrated Chinese and Western medicine was finally formed. A total of 80 children with eczema admitted to People's Hospital of Xinxing County and Xinxing Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were selected as the research objects for a prospective study, and were divided into a treatment group and a control group by the simple random method, with 40 cases in each group. The control group included 21 boys and 19 girls, aged (4.38±1.05) years. The treatment group included 23 boys and 17 girls, aged (4.43±1.13) years. The treatment measures of the control group were selected according to the patients' condition, including disease treatment, basic nursing, antihistamine tablets, immune system modulators, etc. The treatment group was combined with pediatric massage characteristic therapy on the basis of conventional treatment. The treatment lasted for 2 weeks. The clinical efficacy was evaluated after 1 course of treatment, and the scores of Scoring Atopic Dermatitis (SCORAD) and Children's Dermatology Life Quality Index (CDLQI) were compared between the two groups. The long-term efficacy was followed up at 4, 5, and 8 weeks. t test and χ² test were used. Results　After 2 weeks of treatment, the total effective rate was 72.5% (29/40) in the control group and 92.5% (37/40) in the treatment group, with a statistically significant difference (χ²=5.541, P=0.019). Before treatment, the scores of SCORAD and CDLQI of the control group were (42.77±12.51) points and (16.93±5.61) points, and those of the treatment group were (41.20±13.68) points and (15.60±5.82) points, without statistically significant differences (t=0.537 and 1.036, P=0.593 and 0.303). After 2 weeks of treatment, the scores of SCORAD and CDLQI of the control group were (23.25±14.72) points and (11.00±6.96) points, those of the treatment group were (13.20±12.71) points and (7.47±6.47) points, and there were statistically significant differences before and after treatment in the same group (t=9.943, 9.596, 15.441, and 10.377, all P<0.001). There were statistically significant differences between the treatment group and the control group after treatment (t=3.268 and 2.346, P=0.002 and 0.022). At 4, 5, and 8 weeks of follow-up, the recurrence rates were 41.4% (12/29), 51.7% (15/29), and 58.6% (17/29) in the control group, and 10.8% (4/37), 16.2% (6/37), and 18.9% (7/37) in the treatment group, with statistically significant differences (χ²=8.272, 9.448, and 11.074, all P<0.01). Conclusion　Integrated Chinese and western medicine in the treatment of pediatric eczema not only has a definite short-term effect, but also has a stable long-term effect and a low recurrence rate.

Nursing Research

Intraoperative care of valve-in-valve implantation treatment with J-Valve interventional valve for biovalvular decay in different valve positions

Song Haijuan, Xie Qing, Chen Xiaoxia, Liu Xiaomin, Guo Haijiang, Zhuang Jian

2023, 29(23):  3462-3466.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.031

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Objective　To summarize the early results and intraoperative nursing experiences of valve-in-valve implantation treatment with J-Valve interventional valve in patients with biovalvular decay in different valve positions. Methods　From April 2020 to August 2021, 39 patients who underwent valve-in-valve implantation treatment due to the decay of surgical biological valves in different valve positions in Guangdong Provincial People's Hospital were selected as the research subjects, including 19 males and 20 females, with an age of (72.6±10.8) years old, all of whom were treated with J-Valve interventional valve. Targeted intraoperative nursing plans were implemented, condition monitoring, safety nursing, and surgical nursing cooperation were strengthened, and effective nursing interventions were taken to urgently respond to intraoperative complications. The duration of treatment in intensive care unit (ICU) and hospital stay, postoperative complications such as stroke, permanent pacemaker implantation, and pericardial effusion, and nursing satisfaction during hospitalization were observed. Results　There were no deaths during surgery in 35 patients who underwent transcatheter mitral valve-in-valve implantation alone, 1 case had emergency thoracotomy due to interventional valve displacement to the left ventricle, 1 case had chest reopening to stop bleeding due to cardiac tamponade, and 1 case had mild left ventricular outflow tract obstruction. Except for 1 case who underwent craniotomy due to intracranial hemorrhage within 30 days after surgery, no cases developed complications of stroke, permanent pacemaker implantation, pericardial effusion, and readmission due to cardiogenic disease. Among the remaining 4 cases who did not have transcatheter mitral valve-in-valve implantation alone, 1 case with transapical aortic valve-in-valve implantation and 1 case with transatrial tricuspid valve-in-valve implantation successfully completed surgical treatment without intraoperative and postoperative complications. One case who underwent transapical mitral-aortic valve-in-valve implantation died of severe pulmonary hemorrhage and multi-organ failure 16 days after surgery. One case who underwent transapical mitral valve-in-valve implantation + transcatheter aortic valve replacement + mitral perivalvular leakage closure died of septic shock caused by fungal infection in the lungs 10 days after surgery. The statistical results of nursing satisfaction questionnaire during hospitalization were satisfactory. Conclusions　Mitral valve-in-valve implantation treatment with J-Valve interventional valve in high-risk patients with biovalvular decay has achieved good early clinical results, and can also be safely applied in the treatment of intravalvular valves with aortic or tricuspid valve decay, providing a new alternative to surgery for patients with biovalvular decay in different valve positions, but it is still necessary to be very cautious when performing multi-valve interventional surgery during the same period. In the process of surgical treatment, the implementation of scientifically based nursing plans can effectively prevent the complications, promote the early recovery, and improve the nursing satisfaction.

Effect of acupoint massage combined with sitting Baduanjin in improving constipation after cerebrovascular disease operation

Zeng Aiqing, Sun Chi, Yu Lu, Xia Rui

2023, 29(23):  3466-3470.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.032

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Objective　To study the effect of acupoint massage combined with sitting Baduanjin in improving constipation after cerebrovascular disease operation. Methods　This study was a randomized controlled trial. One hundred patients with constipation after cerebrovascular disease operation who were hospitalized in the Second Affiliated Hospital of Nanchang University between July 2021 and January 2023 were divided into two groups with 50 cases in each group according to the random number table method. In the control group, 28 males and 22 females, aged (61.25±3.25) years, were given conventional care; in the experimental group, 30 males and 20 females, aged (62.03±3.31) years, were given acupoint massage combined with sitting Baduanjin on the basis of the control group for 4 consecutive weeks. The quality of life, defecation score, and stool trait typing were compared between the two groups. χ² test, rank sum test, and t test were used. Results　After 2 and 4 weeks of treatment, the PAC-QOL scores in the experimental group were (46.38±4.85) points and (35.17±2.46) points, which were lower than those in the control group [(54.25±5.35) points and (41.05±4.23) points], with statistically significant differences (t=7.706 and 8.497, both P<0.001). After 2 and 4 weeks of treatment, the defecation scores in the experimental group were (1.42±0.38) points and (1.02±0.18) points, which were lower than those in the control group [(1.64±0.46) points and (1.26±0.27) points], with statistically significant differences (t=2.67 and 5.230, both P<0.05). After 2 and 4 weeks of treatment, Bristol's stool characteristics were classified as type Ⅰ (10 cases, 0), type Ⅱ (16 cases, 2 cases), type Ⅲ (16 cases, 10 cases), type Ⅳ (8 cases, 22 cases), and type Ⅴ (0, 16 cases) in the experimental group, which were better than those in the control group [type Ⅰ (13 cases, 0 cases), type Ⅱ (23 cases, 10 cases), type Ⅲ (12 cases, 15 cases), type Ⅳ (2 cases, 15 cases), and type Ⅴ (0, 10 cases)], with statistically significant differences (Z=2.221 and 2.667, P=0.026 and 0.008). Conclusion　Acupoint massage combined with sitting Baduanjin can effectively change the stool characteristics after cerebrovascular disease operation, promote the defecation, and improve the constipation and quality of life.

Influence of diversified high-quality nursing on self-efficacy and quality of life in one-eyed cataract patients

Huang Liqi, Mo Wuling, Lu Sufen

2023, 29(23):  3471-3473.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.033

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Objective　To explore the nursing effect of diversified high-quality nursing on self-efficacy and quality of life in one-eyed cataract patients. Methods　Using the convenient sampling method, 120 patients with one-eyed cataract were selected from Zhongshan Ophthalmic Center, Sun Yat-sen University from July 2021 to March 2022 as the research objects. The surgical method was phacoemulsification + intraocular lens implantation. Among them, 58 cases were female, with an age of (56.03±10.77) years old; 62 cases were male, with an age of (57.20±11.64) years old. They were given diversified high-quality nursing. The General Self-efficacy Scale (GSES) and Visual Function Quality of Life Scale were used to compare the scores of self-efficacy and quality of life before and 1 week after surgery. Paired t test was used. Results　One week after surgery, the patients' self-efficacy score increased from (19.61±5.58) before surgery to (30.15±5.58), with a statistically significant difference (t=4.397, P=0.001); the quality of life score increased from (36.15±17.97) before surgery to (81.01±13.74), with a statistically significant difference (t=15.361, P<0.001). Conclusion　Diversified high-quality nursing can effectively improve the general self-efficacy in one-eyed cataract patients and improve the quality of life after surgery, which is worth promoting and applying in clinical practice.

Construction and application of evidence-based neurogenic bladder management protocol

Qiu Xia, Zi Qinglan, Feng Xiaohong, Peng San, Wang Jieqiong, Xie Keji

2023, 29(23):  3474-3478.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.034

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Objective　To construct an evidence-based neurogenic bladder management protocol and evaluate its application effect. Methods　Patients with neurogenic bladder from Urinary Surgery, Guangzhou First People's Hospital were selected by convenience sampling. According to the date of first visit, 51 patients from July 2022 to January 2023 were recruited to the control group, who were given routine management, including 26 males and 25 females, with an age of (56.12±9.20) years old; 51 patients from February 2023 to July 2023 were recruited to the observation group, who were given evidence-based neurogenic bladder management, including 23 males and 28 females, with an age of (55.80±7.02) years old. The psychological status [Self-rating Anxiety Scale (SAS) score and Self-rating Depression Scale (SDS) score] and bladder function recovery (bladder capacity, maximum urine output, and residual urine volume) of the two groups were compared before and after management. Independent sample t test was used for the measurement data and χ² test was used for the count data. Results　Before management, there were no statistically significant differences in the score of SAS or SDS between the two groups (P=0.694 and 0.275). After management, the SAS score of the observation group was lower than that of the control group [(19.89±3.51) points vs. (26.20±3.38) points] (P<0.001), and the SDS score of the observation group was lower than that of the control group [(34.86±2.42) points vs. (47.23±4.59) points] (P<0.001). Before management, there were no statistically significant differences in the bladder function indexes between the two groups (all P>0.05). After management, the bladder capacity of the observation group was higher than that of the control group [(371.66±62.67) ml vs. (344.51±60.35) ml] (P<0.05), the maximum urine output of the observation group was higher than that of the control group [(243.37±56.79) ml vs. (197.48±49.90) ml] (P<0.001), and the residual urine volume of the observation group was lower than that of the control group [(89.69±17.59) ml vs. (99.55±20.96) ml] (P<0.05). Conclusion　Evidence-based neurogenic bladder management can improve the negative emotions and bladder function in patients with neurogenic bladder.

Application of Shuxin Humai exercise based on the timing theory in the rehabilitation for patients with chronic heart failure

Huang Tingting, He Jianru, Jin Lili, Li Yanping, Chen Yongchen

2023, 29(23):  3478-3482.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.035

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Objective　To study the application of Shuxin Humai exercise based on the timing theory in the rehabilitation for patients with chronic heart failure, and to explore the influence on patients' life quality and cardiac reserve function. Methods　A total of 60 patients with chronic heart failure who were admitted to the Cardiovascular Department of Guangdong Second Traditional Chinese Medicine Hospital from January 2022 to February 2023 were selected and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. In the observation group, there were 18 males and 12 females, the age was 53-78 (60.37±5.51) years old, and the course of disease ranged from 3 to 20 (7.34±2.38) years. In the control group, there were 20 males and 10 females, the age was 56-76 (61.85±3.56) years old, and the course of disease ranged from 3 to 23 (7.46±2.49) years. The control group received treatment and routine care according to the diagnosis and treatment norms of heart failure, which was given routine discharge education and exercise rehabilitation guidance 48 h before discharge, and followed up regularly. The observation group was given 6-month Shuxin Humai resistance exercise based on the timing theory on the basis of the control group, and was given technical guidance during the telephone visit after discharge. The cardiac reserve function, treatment efficiency, and nursing satisfaction were compared between the two groups before and after nursing. Independent sample t test and χ² test were performed. Results　(1) The comparison of cardiac reserve function between the two groups showed that the therapeutic indexes in the observation group were significantly better than those in the control group after intervention, with statistically significant differences (all P<0.05). (2) The total effective rate of the observation group was 90.0% (27/30), and that of the control group was 63.3% (19/30), with a statistically significant difference between the two groups (P<0.05). (3) The nursing satisfaction of the observation group was 100.0% (30/30), and that of the control group was 76.7% (23/30), with a statistically significant difference between the two groups (P<0.05). Conclusion　Progressive adherence to Shuxin Humai resistance exercise can not only effectively improve the cardiac reserve function in patients with heart failure, and can also improve their quality of life.

Effect of B-ultrasound assisted localization on ACTH intramuscular injection in children with infantile spasms

Shen Huiling, Jiang Jianmin, He Yanbing, Liang Wei, Li Xiaojing, Wu Wenlin

2023, 29(23):  3483-3486.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.036.

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Objective　To explore the clinical nursing method of intramuscular injection with adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms (IS). Methods　A total of 67 children who were admitted to the neurology ward of Guangzhou Women and Children's Medical Center from December 2019 to January 2022 and received intramuscular injection with ACTH for the treatment of IS, including 35 boys and 32 girls, with an age of (9.02±1.23) months old, were divided into 34 cases in the experimental group and 33 cases in the control group according to the random number table method. The control group used conventional intramuscular injection method. The experimental group used B-ultrasound to measure the thickness of the buttock muscle layer before intramuscular injection to determine the intramuscular injection depth, used an injection needle with a length of 3.7 cm for intramuscular injection in the buttocks. During the treatment period, the children were kept in a clean single room. The children were given overall care such as oral cavity, skin, medication, and infection prevention, and the parents of the children were provided with psychological care, health education, and other nursing interventions. The incidence of adverse reactions at the injection site (including induration at the injection site and hospital infection) and the effective completion rate within the treatment cycle were compared between the two groups. Independent sample t test and χ² test were used. Results　In the control group, the incidence of induration at the injection site was 84.85% (28/33), and the effective completion rate within the treatment cycle was 75.76% (25/33). In the experimental group, the incidence of induration at the injection site was 17.65% (6/34), and the effective completion rate within the treatment cycle was 97.06% (33/34). There were statistically significant differences in the above indexes between the two groups (both P<0.001). Conclusion　Intramuscular injection with ACTH assisted by B-ultrasound can effectively reduce the injection-related adverse events and improve the completion rate of treatment in children with IS.

Application of efficacy theory-oriented nursing intervention in patients with multiple myeloma complicated with renal failure

Yang Ling, Han Huanmei, Zhou Lihua, Zhang Tao, Hu Haomin, Zhang Zhifang, Liu Xinxin

2023, 29(23):  3487-3491.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.037

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Objective　To explore the application effect of efficacy theory-oriented nursing intervention in patients with multiple myeloma complicated with renal failure. Methods　This was a randomized controlled trial. A total of 98 patients with multiple myeloma complicated with renal failure admitted to Hematology Department, The Second Affiliated Hospital of Shandong First Medical University from April 2020 to March 2023 were selected, and were divided into a control group (49 cases) and an observation group (49 cases) by the random number table method. The control group included 31 males and 18 females, aged (53.42±6.41) years. The observation group included 30 males and 19 females, aged (53.29±6.47) years. The control group was treated with routine nursing, and the observation group was treated with efficacy theory-oriented nursing intervention. Both groups were intervened for 3 months. The Chronic Disease Self-efficacy Scale (CDSES) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Self-perceived Burden Scale (SPBS) score, and complication rate were compared between the two groups. t test and χ² test were used. Results　After nursing, the scores of completing self-management, general self-management, achieving results, and dealing with problems of the CDSES in the observation group were (5.92±1.23), (6.15±1.20), (5.64±1.29), and (5.78±1.47) points, respectively, which were higher than those in the control group [(5.34±1.21), (5.62±1.19), (5.03±1.31), and (5.12±1.44) points], with statistically significant differences (t=2.394, P=0.019; t=2.195, P=0.031; t=2.323, P=0.022; t=2.245, P=0.027). After nursing, the scores of APACHEⅡ and SPBS in the observation group were (18.22±1.95) points and (21.15±3.39) points, respectively, which were lower than those in the control group [(19.14±2.11) points and (22.66±3.41) points], with statistically significant differences (t=2.241, P=0.027; t=2.198, P=0.030). The incidence of post-nursing complications in the observation group was 8.16% (4/49), lower than that in the control group [24.49% (12/49)], with a statistically significant difference (χ²=4.780, P=0.029). Conclusion　The application of efficacy theory-oriented nursing intervention in the nursing for multiple myeloma patients with renal failure can improve their self-efficacy, improve their health status and self-perception, and reduce the incidence of complications.

Application of Internet + nursing service in elderly patients after hip replacement at home

Li Peijun, Chen Cuiping, Lin Xi, Zhuo Shuyu, Li Xiaofang, Peng Min

2023, 29(23):  3492-3496.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.038

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Objective　To explore the construction and practical results of the model system based on Internet + nursing service, and to analyze its role in elderly patients after hip replacement at home. Methods　This study was a randomized controlled trial. A total of 60 elderly patients at home who had undergone hip replacement surgery in Guangzhou First People's Hospital from June 2022 to June 2023 were selected as the study subjects, including 35 males and 25 females, with an age of (68.37±5.24) years old. They were divided into a control group and an observation group by the random number table method, 30 cases in each group. The control group adopted routine nursing service, and the observation group constructed and applied the Internet + nursing service model. The Harris hip function score, Barthel index, and complication rate were compared between the two groups. Independent sample t test and χ² test were used. Results　The Harris hip function scores of the observation group 1, 3, and 6 months after intervention were (59.66±5.27), (73.25±2.39), and (87.54±3.78), respectively, the Harris hip function scores of the control group 1, 3, and 6 months after intervention were (53.21±5.18), (64.28±2.18), and (75.67±2.21), respectively, and the Harris hip function scores of the observation group 1, 3, and 6 months after intervention were better than those of the control group (t=4.781, 15.188, and 14.848, all P<0.001). The Barthel indexes of the observation group 1, 3, and 6 months after intervention were (55.46±2.29), (73.66±3.39), and (82.97±3.77), respectively, the Barthel indexes of the control group 1, 3, and 6 months after intervention were (49.21±2.18), (68.61±2.85), and (74.42±3.51), respectively, and the Barthel indexes of the observation group 1, 3, and 6 months after intervention were better than those of the control group (t=10.827, 6.245, and 9.091, all P<0.001). The incidence of complications was 6.67% (2/30) in the observation group and 20.00% (6/30) in the control group, and the incidence of complications in the observation group was relatively low (P<0.05). Conclusion　Internet + nursing service plays an important role in elderly patients after hip replacement at home, which effectively improves their quality of life, with a low incidence of complications and high clinical nursing significance, and is worthy of further study.

Investigation and analysis of disease cognition among parents of children with inflammatory bowel disease

Liu Liying, Wei Lijuan, Zhang Miaoxian, Tang Yingyu, Zhang Chaomi

2023, 29(23):  3497-3500.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.039

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Objective　To investigate the current status of disease cognition among parents of children with inflammatory bowel disease and analyze the characteristics. Methods　A Chinese version of the Crohn's and Colitis Knowledge Score was used to conduct a survey on 157 parents of children with inflammatory bowel disease in Guangzhou Women and Children's Medical Center from June 2021 to October 2022 using a convenient sampling method. There were 93 boys and 64 girls. The age range of the children was 3 months to 18 years old, with an average age of (9.80±4.78) years old. The parents' disease knowledge scores and correct answer rates were analyzed. Results　The disease knowledge score in the parents of children with inflammatory bowel disease was 6 (2,9) points. Among them, the score of dietary knowledge was 1 (0,1) points, the score of drug knowledge was 3 (1,5) points, the score of general knowledge was 1 (0,1) points, and the score of complication knowledge was 2 (0,2) points. Among the 24 knowledge items, 8 items were unknown to parents of children with inflammatory bowel disease by more than 70%. Conclusion　The parents of children with inflammatory bowel disease have a low level of disease knowledge, and nursing staff need to provide personalized intervention measures based on the specific situation of the parents' disease cognition to improve their disease knowledge level.

Clinical study on immediate pain-relieving effect of medication-separated moxibustion nursing intervention after intrauterine invasive operation

Zhang Aiyu

2023, 29(23):  3501-3506.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.040

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Objective　To discuss the immediate pain-relieving effect of medication-separated moxibustion nursing intervention after intrauterine invasive operation, and provide a clinical basis for the promotion of medication-separated moxibustion in pain-relieving after surgery. Methods　It was a randomized controlled trial. A total of 95 female infertility patients aged (32.40±4.32) years and scoring to severe pain after intrauterine invasive operation in Yantai Yantaishan Hospital from January 2020 to June 2022 were selected, and were randomly divided into a control group (31 cases), a heat patch group (32 cases), and a medication-separated moxibustion group (32 cases). The control group received routine pain nursing care after surgery, the heat patch group received one-time heat patch application on the lower abdomen based on pain nursing, and the medication-separated moxibustion group received acupoint application and medication-separated moxibustion care based on pain nursing. The Numeric Rating Scale (NRS) scores at each time point, pain disappearance time, pain control efficiency, and comfort level [General Comfort Questionnaire (GCQ)] of the three groups were compared, and the pain relief effect was evaluated. One-way analysis of variance, χ² test, and linear regression analysis were used. Results　(1) NRS score: the differences of average NRS score between the moxibustion group and the control group at 5 and 10 min after intervention were 1.54 points (95%CI: 0.89-2.19; P<0.001) and 2.91 points (95%CI: 2.18-3.63; P<0.001); the differences between the moxibustion group and the heat patch group were 1.41 points (95%CI: 0.76-2.05; P<0.001) and 2.00 points (95%CI: 1.28-2.72; P<0.001); the average difference between groups reached a large effect size; the NRS score of the heat patch group was lower than that of the control group, but only the difference of average NRS score at 10 min after intervention was 0.91 points (95%CI: 0.18-1.63; P<0.05). (2) Pain disappearance time: the pain disappearance time of the control group, the heat patch group, and the moxibustion group were (38.23±15.41) min, (26.09±13.48) min, and (15.50±7.99) min, respectively. The pain disappearance time of the moxibustion group was shorter than those in the other two groups, with statistically significant differences (both P<0.001). (3) Pain control efficiency: the NRS reduction degree in the moxibustion group was higher than those in the control group and the heat patch group 5 min after intervention, reaching a large effect size, with statistically significant differences (all P<0.001); there was no statistically significant difference between the heat patch group and the control group (P>0.05). The pain control efficiency in the moxibustion group was higher than those in the control group and the heat patch group, with statistically significant differences (both P<0.001). (4) Satisfaction with pain control: that in the moxibustion group was higher than those in the heat patch group and the control group (both P<0.001). (5) GCQ score: the scores of physiological, psychological, and social and cultural dimensions and the total comfort of the moxibustion group were higher than those of the control group and the heat patch group, with statistically significant differences (all P<0.001). Linear regression analysis showed that NRS score had a significant negative effect on GCQ score 10 min after intervention (r=-0.735, P<0.001). Conclusions　Doing medication-separated moxibustion to patients with severe pain after intrauterine invasive operation can effectively relieve the pain, reduce the pain discomfort time, and improve the comfort. The pain-relieving effect of medication-separated moxibustion is better is that of heat patch, which is recommended to relieve the pain after uterine operation examination.

Application of PDCA cycle management in animal bite wound management in emergency department

Xu Jinyun

2023, 29(23):  3507-3510.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.041

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Objective　To explore the application effect of PDCA (plan-do-check-action) cycle management in animal bite wound management in emergency department. Methods　A retrospective analysis was conducted on the clinical data of 200 animal bite patients admitted to the emergency department of the First Affiliated Hospital of Xiamen University from January to June 2023. From January to March 2023, 100 patients admitted during the routine emergency management period were set as the control group; from April to June 2023, 100 patients admitted during the PDCA cycle management were set as the observation group. The control group included 56 males and 44 females, aged (40.29±6.43) years; the observation group included 59 males and 41 females, aged (39.63±6.89) years. The quality of emergency management, wound healing level, wound healing status, and degree of wound pain were compared between the two groups. t test, χ² test, and rank sum test were used. Results　The incidence of difficult to clean and easy to slip in the observation group was lower than that in the control group [0 vs. 6.00% (6/100)], and the compliance rate for wound flushing [98.00% (98/100)], seat comfort rate [97.00% (97/100)], and wound management standardization rate [99.00% (99/100)] were higher than those in the control group [89.00% (89/100), 85.00% (85/100), and 91.00% (91/100)], with statistically significant differences (χ²=4.296, 6.664, 8.791, and 6.737; P=0.038, 0.010, 0.003, and 0.009). The wound healing effect of the observation group was better than that of the control group, and the degree of wound pain was less than that of the control group, with statistically significant differences (Z=4.521 and 3.443, both P<0.05). The wound healing time and scar width in the observation group were (9.63±2.11) d and (35.36±4.05) mm, which were shorter than those in the control group [(12.47±3.48) d and (43.31±5.64) mm], and the number of visits was less than that in the control group [(4.35±0.58) vs. (5.11±0.76)], with statistically significant differences (t=6.978, 11.594, and 7.950, all P<0.001). Conclusion　PDCA cycle management can improve the quality of emergency management, standardize the animal wound management, and accelerate the wound healing.

Application of target flow diagram real - scene image management in the management of orthopedic implants in disinfection supply room

Leng Minjuan, Lu Wanting

2023, 29(23):  3511-3514.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.042

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Objective　To study the application of target flow diagram real - scene image management in the management of orthopedic implants in disinfection supply room. Methods　This study was a prospective randomized controlled trial. Two hundred orthopedic implants from the Disinfection Supply Center of Wuxi Second People's Hospital from December 2020 to December 2021 were selected as the control group for routine disinfection management. Two hundred orthopedic implants from the Disinfection Supply Center of Wuxi Second People's Hospital from January 2022 to January 2023 were selected as the research group to implement target flow diagram real - scene image management. The disinfection efficiency, cleaning time, qualified rates of disinfection, and incorrect handover rates of the two groups were compared. Independent sample t test and χ² test were used. Results　The disinfection efficiency questionnaire score and cleaning time of orthopaedic implants in the control group were (49.42±1.50) points and (39.98±1.50) min, and those in the research group were (49.78±1.65) points and (39.52±1.46) min. The disinfection efficiency of the research group was higher than that of the control group (P<0.05), and the cleaning time of the study group was shorter than that of the control group (P<0.05). The qualified rates of 5x magnifying glass test, microbial culture test, and Jelli paper test in the control group were 97.00% (194/200), 96.00% (192/200), and 96.50% (193/200), those in the research group were 100.00% (200/200), 99.50% (199/200), and 100.00% (200/200), and the qualified rates of instrument cleaning and disinfection in the research group were higher than those in the control group (all P<0.05). The incorrect handover rate of the control group was 3.00% (6/200), no incorrect handover occurred in the research group, and the incorrect handover rate of the research group was lower than that of the control group (χ²=4.230, P=0.040). Conclusion　Target flow diagram real - scene image management can effectively improve the cleaning and disinfection efficiency of orthopedic implants in the disinfection supply room and reduce the risk of incorrect device handover.

Epidemiology

Analysis of epidemiological characteristics of public health emergencies in Panyu District, Guangzhou from 2013 to 2022

Luo Jianbin, Yang Yanjun, Wu Shaomin, Xie Dan

2023, 29(23):  3515-3519.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.043

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Objective　The epidemiological characteristics of public health emergencies in Panyu District of Guangzhou were analyzed to provide a basis for formulating effective prevention and control measures. Methods　The relevant information of public health emergencies from 2013 to 2022 in Panyu District, Guangzhou was obtained from the subsystem "Public Health Emergency Management Information System" of the "China Disease Prevention and Control Information System", and the SPSS 25.0 software was used for statistical analysis. χ² test was used. Results　From 2013 to 2022, a total of 740 public health emergencies were reported in Panyu District, Guangzhou, including 732 infectious disease incidents (98.92%) and 8 poisoning incidents (1.08%); 728 (98.38%) ungraded incidents and 12 general events (1.62%). There were 5 deaths, all of which were human infection with H7N9 avian influenza. The number of infectious disease events reported in order of infectious disease category was Class B infectious diseases, other infectious diseases, Class C infectious diseases, and Class A infectious diseases. According to the transmission route, it was respiratory infectious diseases, intestinal infectious diseases, and natural sources and insect-borne infectious diseases. Among the infectious disease events, the new coronavirus infection mainly occurred from October to November, and the peak incidence of other infectious diseases was in January to March and December. The site of onset was mainly school/childcare facilities, and the main diseases were varicella and norovirus diarrhea. All poisoning incidents were food poisoning, mainly puffer fish, followed by Staphylococcus aureus. Conclusions　Schools/childcare facilities are key places for the prevention and control of infectious disease public health emergencies, and should further do a good job in monitoring, early warning, and reporting of relevant diseases while strengthening the publicity and education of respiratory and intestinal infections. It is necessary to strengthen the early detection and early diagnosis and treatment of seriously ill patients, strengthen the publicity and education on the prevention of food poisoning such as puffer fish poisoning, and enhance the public's awareness of self-prevention.

Epidemiological characteristics of varicella in Panyu District, Guangzhou from 2013 to 2022

Li Xiaoling, Yang Yanjun, Wu Shaomin, Xie Dan

2023, 29(23):  3520-3524.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.044

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Objective　The epidemiological characteristics of varicella and public health emergencies in Panyu District, Guangzhou from 2013 to 2022 were analyzed to provide reference for the formulation of varicella prevention and control measures. Methods　The data of varicella epidemic in Panyu District, Guangzhou from 2013 to 2022 were collected from the "China Disease Prevention and Control Information System - Monitoring and Reporting Management System", and were analyzed in combination with demographic data. The non-parametric test for multiple independent samples and χ² test were used. Results　From 2013 to 2022, a total of 35 080 cases of varicella were reported in Panyu District, with no deaths, and the average annual incidence rate was 193.05/100 000, showing an overall downward trend (χ²=10 644.262, P˂0.001), with the highest reported incidence in 2017 (371.14/100 000) and the lowest in 2022 (67.54/100 000). It occurred in all months of the year, with a peak incidence occurring in the autumn and winter (from November to January). The time from onset to diagnosis was 2 (1,3) days. The varicella cases had been reported in 16 towns/subdistricts under its jurisdiction, and the top three cumulative reported cases were in Nancun Town (4 578 cases, 13.05%), Shiqiao Street (4 089 cases, 11.66%), and Zhongcun Street (3 736 cases, 10.65%). The average annual incidence rate of each town/street was between 59/100 000-231/100 000, with a statistically significant difference (χ²=3 319.790, P˂0.001), among which the top three annual incidence rates were in Zhongcun Street (231.25/100 000), Xiaoguwei Street (209.19/100 000), and Shiqiao Street (177.38/100 000). The ratio of male to female was 1.18:1, and the male and female annual incidences were 165.08/100 000 and 157.80/100 000, respectively, with a statistically significant difference (χ²=23.057, P˂0.001). The age of the cases was (13.06±10.22) years old, and the most cases occurred at the age of 5 to 7 years old, and the top three age groups were 6- years old (2 290 cases, 6.53%), 5- years old (2 282 cases, 6.51%), and 7- years old (1 970 cases, 5.62%). The occupations of the cases were mainly concentrated in students, nursery children, and scattered children, accounting for 74.87% (26 263/35 080), of whom students accounted for the most, accounting for 43.80% (15 366/35 080). Conclusions　From 2013 to 2022, varicella cases in Panyu District, Guangzhou City were mainly primary school students, especially children aged 5-7 years. The reported cases have decreased significantly in recent years, and the outbreak of varicella is mainly in schools, so it is necessary to further shorten the diagnosis time after the onset of cases, improve the immunization level of school-age children, and strengthen school varicella epidemic surveillance and prevention and control knowledge publicity and education.

Nursing Research

Epidemiological and genotype study of hand-foot-and-mouth disease during and after the COVID-19 pandemic from 2022 to 2023

Xiao Xue, Liang Yuting, Gu Rui, Li Li, Chen Juan, Zhong Jiayu

2023, 29(23):  3525-3528.  DOI: 10.3760/cma.j.issn.1007-1245.2023.23.045

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Objective　To study the epidemiology of hand-foot-and-mouth disease (HFMD) and the spectrum of genotypes in the other enteroviruses (EVs) [non- enterovirus 71 (EV71) and non- Coxsaekievirus group A 16 (CA16)] in Guangzhou and Foshan area during and after the COVID-19 pandemic from 2022 to 2023. Methods　EV universal type, EV71, and CA16 were detected by real time fluorescent reverse transcription polymerase chain reaction (RT-PCR) respectively for suspected HFMD samples from 2022 to 2023. The positive specimens of non-EV71 and non-CA16 were amplified and sequenced based on 5′ UTR primers. The spectrum of genotypes was analyzed with BLAST in NCBI on the basis of 5'-UTR primers. Results　A total of 362 suspected HFMD specimens were collected in 2022, 47 (12.98%) of which were positive by real time simultaneous three virus detections. Among which, the positive rates of EV71, CA16, and non-EV71 and non-CA16 were 0, 1.38% (5/362), and 11.60% (42/362), respectively. A total of 297 suspected HFMD specimens were collected in 2023, 100 (33.67%) of which were positive by simultaneous three virus detections. Among which, the positive rates of EV71, CA16, and non-EV71 and non-CA16 were 0, 2.36% (7/297), and 31.31% (93/297), respectively. Sequence analysis of 51 non-EV71 non-CA16 positive samples showed that there were 9 genotypes of non-EV71 non-CA16 EVs detected from 2022 to 2023, which were CA6, CA10, CA4, CA2, CA8, CB5 (Coxsaekievirus group B 5), CB2, CB3, and E30 (echovirus 30), among which, CA6 accounted for 27.45% (14/51), followed by CA10, accounting for 15.69% (8/51). Conclusions　The EV infection rate after the COVID-19 pandemic in 2023 was higher than that in 2022 during the COVID-19 pandemic. The non-EV71 and non-CA16 EVs were the main causative agent of HFMD during 2022-2023. The sequence analysis showed that CA6 and CA10 were the most prevalent pathogens of non-EV71 and non-CA16 EVs, so, more attention should be paid to CA6 and CA10 of other type EVs.