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    15 February 2022, Volume 28 Issue 4
    Scientific Research
    Feasibility analysis of constructing a model of "heart failure-hypertension" comorbidity risk assessment in elderly people based on medical big data
    Yu Jianhui, Ma Jing, Mao Li, Yang Hong
    2022, 28(4):  446-449.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.001
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    Objective To construct a model of "heart failure-hypertension" comorbidity risk assessment in elderly people based on medical big data and analyze its feasibility. Methods A total of 500 hypertensive patients treated in The Second Medical Center, Chinese PLA General Hospital from January 1, 2020 to June 1, 2021 were selected as subjects and were divided into a heart failure group (124 cases) and a non-heart failure group (376 cases) according to whether combined with heart failure. In the heart failure group, there were 88 males and 36 females, with an age of (74.25±4.38) years old; in the non-heart failure group, there were 234 males and 142 females, with an age of (73.66±5.25) years old. The clinical data of the two groups were analyzed retrospectively. Univariate and multivariate logistic regression analysis were used to analyze the comorbidity risk of "heart failure-hypertension" and model it, and the receiver operating characteristic curve (ROC) was used to test the model effect. χ2 test was used for the count data and independent sample t test was used for the measurement data. Results Blood pressure level, body mass index (BMI), concomitant infection, concomitant hyperlipidemia, concomitant hyperuricemia, concomitant left ventricular hypertrophy, and smoking were influence factors for heart failure-hypertension comorbidity (OR=1.071, 0.852, 1.835, 1.978, 2.002, 2.552, and 1.988; all P<0.05). The area under the curve (AUC) was 0.852, the sensitivity was 0.685, the specificity was 0.835, and the Youden index was 0.521. The AUC was over 0.7, which indicated a moderate predictive efficiency. Conclusions The prevalence of heart failure in elderly hypertensive patients is high, blood pressure level, BMI, concomitant infection, concomitant hyperlipidemia, concomitant hyperuricemia, concomitant left ventricular hypertrophy, and smoking are influence factors for heart failure-hypertension comorbidity, and the risk assessment model has a good predictive efficiency.
    Progress in the protective effect and mechanism of arginine on lung injury
    Su Xinyan, Jin Can, Chi Yongxue
    2022, 28(4):  449-452.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.002
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    Acute lung injury has a high morbidity and high mortality, but there is no clinically specially effective treatment for acute lung injury, so how to prevent and treat acute lung injury is still important for current research subjects. Arginine is a nitrogen carrier which is necessary for the synthesis of urea, polyamines, proline, and other proteins in healthy adults. It has immunomodulatory activity and can reduce inflammation. Studies have shown that arginine prevents or treats lung injury by producing a large amount of nitric oxide, etc. or producing immune effects. In order to understand the current research status of applying arginine in the treatment of lung injury, this article focuses on the protective effect of arginine on lung injury, and provides new ideas for clinical treatment of lung injury.
    Relationship between red blood cell distribution width and left ventricular diastolic dysfunction in patients with chronic kidney diseases
    Gao Min, Li Qijun, Jiang Wengong, Lyu Lu
    2022, 28(4):  453-458.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.003
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    Objective To investigate the relationship between red blood cell distribution width (RDW) and left ventricular diastolic dysfunction (LVDD) in patients with chronic kidney diseases (CKD), and to evaluate the predictive value of RDW for LVDD in CKD patients. Methods Adult CKD patients who were hospitalized and underwent echocardiography in The First Affiliated Hospital of Guangdong Pharmaceutical University from January 2015 to February 2020 were selected, including 83 males and 49 females. The general data, medical history, blood routine, biochemical indexes, and echocardiographic indexes were recorded. The general data and clinical indicators were compared between the normal left ventricular diastolic function group and the LVDD group. Independent sample t test was used for inter-group comparison of the measurement data with normal distribution, non-parametric rank sum test was used for inter-group comparison of the measurement data with abnormal distribution, Chi-square test was used for inter-group comparison of the count data, Spearman rank correlation was used for correlation analysis, and binary logistic regression analysis was used for risk factor analysis of LVDD. Receiver operating characteristic curve (ROC) and area under curve (AUC) were used to evaluate the predictive value of RDW for LVDD. Results There were 59 cases in the normal left ventricular diastolic function group and 73 cases in the LVDD group. The systolic blood pressure and RDW of the LVDD group were higher than those of the other group (both P<0.05); the proportion of coronary heart disease in the LVDD group was higher than that in the other group (P=0.037); left ventricular mass index (LVMI) and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio (E/e') of the LVDD group were significantly higher than those of the other group, and e' was lower than that of the other group (all P<0.05). Univariate correlation analysis showed that RDW was positively correlated with E/e', interventricular septal thickness (IVST), phosphorus (P), calcium-phosphorus product (Ca×P), cystatin C (CysC), and brain natriuretic peptide (BNP) (all P<0.05), and negatively correlated with estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) (both P<0.05). E/e' was positively correlated with left ventricular end-diastolic dimension (LVDd), LVMI, end-systolic volume (ESV), end-diastolic volume (EDV), ratio of early to late diastolic peak velocity of mitral flow (E/A), P, Ca×P, CysC, and RDW (all P<0.05), and negatively correlated with e', eGFR, Hb, total cholesterol (TC), and low density lipoprotein (LDL) (all P<0.05). Multivariate logistic regression analysis showed that RDW was a risk factor of LVDD (OR>1), and Hb was a protective factor of LVDD (OR<1). ROC analysis showed that the AUC of LVDD predicted by RDW was 0.612, the sensitivity was 78.9%, and the specificity was 50.8%. Conclusions LVDD is more likely to occur in CKD patients. Detection of RDW is of certain value in predicting LVDD in CKD patients.
    Significance of CYP2C19 gene in guiding antiplatelet therapy after OPCAB
    Zhang Xianfen, Zhang Dianbao, Han Wanqing, Wang Yongsheng
    2022, 28(4):  459-463.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.004
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    Objective To investigate whether dual antiplatelet therapy guided by CYP2C19 gene detection results can reduce the incidence of major adverse cardiovascular events (MACE) and its impact on bleeding complications after off-pump coronary artery bypass grafting (OPCAB). Methods A total of 158 patients scheduled for OPCAB in The First Affiliated Hospital of Henan University of Science and Technology from January 2018 to September 2020 were divided into a gene guidance group and a traditional treatment group with the random number table. The gene guidance group was subdivided into a fast metabolizing subgroup and a non-fast metabolizing subgroup according to CYP2C19 gene. The patients in the fast metabolizing subgroup were given aspirin combined with clopidogrel antiplatelet therapy after OPCAB, and the patients in the non-fast metabolizing subgroup were given aspirin combined with ticagrelor. The traditional treatment group was randomly subdivided into a clopidogrel subgroup and a ticagrelor subgroup, and the patients were treated with aspirin combined with clopidogrel or ticagrelor respectively. The incidences of MACE and bleeding within 30 days and 6 months after surgery were compared. Independent sample t test was used for the measurement data, and χ2 test was used for the count data. Results Among 158 patients, 31 patients withdrew from the study because they did not meet the criteria, and 127 patients were eventually enrolled. There were 63 patients in the gene guidance group, including 42 males and 21 females, aged (62.65±7.88) years, and there were 20 patients in the fast metabolizing subgroup and 43 patients in the non-fast metabolizing subgroup according to CYP2C19 gene. There were 64 patients in the traditional treatment group, including 45 males and 19 females, aged (61.91±8.99) years, and they were randomly subdivided into a clopidogrel subgroup (32 cases) and a ticagrelor subgroup (32 cases). The incidence of MACE within 30 days after surgery was 1.6% (1/63) in the gene guidance group and 10.9% (7/64) in the traditional treatment group, respectively, with a statistically significant difference between the two groups (χ2=4.703, P=0.030); the incidence of MACE within 6 months after surgery was 3.2% (2/63) in the gene guidance group and 14.1% (9/64) in the traditional treatment group, respectively, with a statistically significant difference between the two groups (χ2=5.757, P=0.029). The incidence of bleeding within 30 days after surgery was 6.3% (4/63) in the gene guidance group and 10.9% (7/64) in the traditional treatment group, respectively, without statistically significant difference between the two groups (χ2=0.845, P=0.358); the incidence of bleeding within 6 months after surgery was 7.9% (5/63) in the gene guidance group and 12.5% (8/64) in the traditional treatment group, respectively, without statistically significant difference between the two groups (χ2=0.720, P=0.396). Conclusion Precise dual antiplatelet therapy based on CYP2C19 gene detection can reduce the incidence of MACE after OPCAB without increasing the risk of bleeding.
    Multiphase contrast-enhanced MSCT in TN staging of colorectal cancer: comparative study with pathology
    Liu Siping, Mao Haiyan
    2022, 28(4):  464-467.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.005
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    Objective To investigate the value of multi-slice spiral computed tomography (MSCT) in diagnosing T-stage and N-stage of colorectal cancer (CRC) before surgery. Methods This was a retrospective study. A total of 73 pathology-confirmed colorectal cancer patients scheduled for surgery in Affiliated Hospital of Yangzhou University and Yangzhou Hospital of Traditional Chinese Medicine were retrospectively included from January 2018 to December 2020, including 48 males and 25 females, aged (65.3±10.8) years. All patients underwent triphasic contrast-enhanced MSCT examination before surgery. Two experienced radiologists blindly reviewed the CT images, and CT based TN stages were determined in consensus. The accuracy of CT based TN staging was analyzed with a Kappa consistency test, with the postoperative pathology as reference standard. The count data were tested by χ2 test. Results The overall diagnostic accuracy of preoperative T stage was 91.78% (67/73), including 84.61% (11/13) for T1-2, 93.55% (29/31) for T3, and 93.10% (27/29) for T4, and the diagnostic accuracy of T3 and T4 was significantly higher than that of T1-2, with a statistically significant difference (χ2=5.24, P<0.05). The Kappa value of the consistency test between CT T staging and pathological staging was 0.869, indicating a very good consistency between the two. The overall diagnostic accuracy of preoperative N stage was 73.97% (54/73), which was significantly lower than that of T stage; the diagnostic accuracy was 65.62% (21/32) for N0, 79.17% (19/24) for N1, and 82.35% (14/17) for N2; the diagnostic accuracy of N0 was significantly lower than that of N1 and N2, with a statistically significant difference (χ2=6.72, P<0.05). The Kappa value of the consistency test between CT N staging and pathological staging was 0.611, indicating a good consistency between the two. Conclusions Application of multi-phase contrast-enhanced MSCT can improve the diagnostic performance in diagnosing TN-stage for colorectal cancer patients before surgery, and provide valuable reference evidences in performing suitable planning for colorectal cancer patients in the clinical setting.
    Discussion on the application value of the climbing plan in the competency training of ultrasonic postgraduates
    Liu Tao, Chen Tingwei, Yan Baomei, Shen Huawei, Zou Huimin, Yuan Xiaoyan, Liang Weixiang
    2022, 28(4):  468-471.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.006
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    At present, with the enhancement of the domestic economic level and the improvement of people's health awareness, ultrasound has become one of the main projects in physical examination, since it's noninvasive, economic, and convenient. The demand of ultrasound doctors is also growing. The professional postgraduates are an important part of professional development in the ultrasonic medicine who own four certificates. How to better cultivate professional postgraduates with solid clinical practice ability and scientific research quality to meet the current demand is one of the challenges in the development of postgraduate education in ultrasound medicine.

    Application effect of butylphthalide soft capsules and idebenone in elderly patients with vascular dementia

    Li Yufeng
    2022, 28(4):  471-474.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.007
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    Objective To explore the clinical value of butylphthalide combined with idebenone in the treatment of elderly patients with vascular dementia. Methods The retrospective analysis selected 165 elderly patients with vascular dementia admitted to Hebi Chaoyang Ren'ai Hospital from January 2020 to June 2021 as the research objects. After analyzing the patients' medical records, all patients were divided into a control group (82 cases) and a study group (83 cases) according to different medication regimens. There were 42 males and 40 females in the control group, aged (69.27±2.51) years; there were 44 males and 39 females in the study group, aged (69.50±2.76) years. The control group received butylphthalide treatment, the study group received butylphthalide combined with idebenone treatment, and both groups were treated for 2 months. The carotid peak systolic velocity (PSV), Montreal Cognitive Assessment Scale (MoCA) score, resistance index (RI), Stroke Special Quality of Life Scale (SS-QOL) score, and end diastolic velocity (EDV) before and after treatment and adverse reactions were compared between the two groups. Independent sample t test was used for inter-group comparison of the measurement data, paired t test was used for intra-group comparison of the measurement data, and χ2 test was used for the count data. Results The MoCA score of the study group after treatment was higher than that of the control group [(23.43±2.75) points vs. (19.79±2.91) points], with a statistically significant difference (P<0.05). Before treatment, there were no statistically significant differences in the carotid hemodynamic indexes between the two groups (all P>0.05); after treatment, the EDV and PSV of the study group were (19.93±4.96) cm/s and (75.95±10.25) cm/s, respectively, higher than those of the control group [(17.55±5.21) cm/s and (70.16±15.16) cm/s], the RI was (0.60±0.07), lower than that of the control group [(0.66±0.17)], with statistically significant differences (all P<0.05). Before treatment, there was no statistically significant difference in the SS-QOL score between the two groups (P>0.05); after treatment, the scores of self-care ability, physical state, psychological state, and life impact of SS-QOL of the study group were (49.35±8.16) points, (52.35±9.44) points, (39.86±6.28) points, and (40.13±5.52) points, respectively, which were higher than those of the control group [(43.55±7.84) points, (46.61±8.93) points, (34.34±6.55) points, and (35.41±6.15) points], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Butylphthalide combined with idebenone can effectively improve the hemodynamic indexes of cerebral artery in elderly patients with vascular dementia, and improve their quality of life and MoCA score.
    Serum Lp-PLA2 level on admission for predicting early stroke risk after transient ischemic attack
    Qian Mingyue, Zhang Haojiang, Ge Zhonglin, Yu Shanhua
    2022, 28(4):  475-479.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.008
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    Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level on admission for early stroke risk after transient ischemic attack (TIA). Methods A total of 179 TIA patients were retrospectively enrolled in Department of Neurology, The Second People's Hospital of Lianyungang from August 2015 to November 2019, including 100 males and 79 females, aged (66.2±7.8) years. TIA patients were divided into a stroke group (28 cases) and a non-stroke group (151 cases) after 3 months of follow up. Multivariate logistic regression analysis was used to identify the independent risk factors for stroke. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of Lp-PLA2 for stroke risk after TIA. Independent sample t test was used for inter-group comparison of the measurement data conforming to normal distribution, Mann-Whitney U test was used for inter-group comparison of the measurement data conforming to abnormal distribution, and χ2 test or Fisher's exact test was used for inter-group comparison of the count data. Results The baseline systolic blood pressure, serum LP-PLA2 level, proportion of duration of symptom ≥60 min, ABCD2 score, vascular stenosis rate, and unstable plaque rate in the stroke group were (158.4±27.4) mmHg (1 mmHg=0.133 kPa), (286.5±18.9) μg/L, 39.2% (11/28), 6.00 (5.00, 6.00) points, 78.6% (22/28), and 78.6% (22/28), higher than those in the non-stroke group [(146.3±25.2) mmHg, (230.5±17.2) μg/L, 13.2% (20/151), 4.00 (3.00, 5.00) points, 36.4% (55/151), and 38.4% (58/151)], and the usage rate of dual antiplatelet drugs was 60.0% (15/28), lower than that in the non-stroke group [83.3% (115/151)], with statistically significant differences (all P<0.05). After adjusting for confounders, multivariate logistic regression analysis showed that baseline systolic blood pressure, LP-PLA2, duration of symptoms ≥60 min, ABCD2 score, vascular stenosis, and unstable plaque were independent risk factors for stroke (all OR>1), and dual antiplatelet therapy was a protective factor for stroke (OR<1). The area under curve of LP-PLA2 for predicting early stroke was 0.752 (95%CI: 0.657-0.848; Z=5.142, P<0.001), the optimal cut-off value was 212.6 μg/L, the sensitivity was 85.66%, and the specificity was 52.67%. Conclusion Higher serum Lp-PLA2 level on admission is an independent risk factor of early stroke after TIA, and has predictive value for early stroke risk after TIA.
    Reliability and validity of the Chinese version of Circadian Type Inventory in medical students
    Wang Xiaohan, Wu Songqi, Fu Yue, Fei Wengling, Ma Yuanyuan, Wang Guodong, Wu Caiqin
    2022, 28(4):  479-483.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.009
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    Objective To translate the latest 11-item Circadian Type Inventory (CTI), and to verify its reliability and validity among undergraduates in medical universities. Methods The Chinese version of CTI (C-CTI) was formed in the light of the modified Brislin translation model. A total of 308 undergraduates from Shanghai University of Traditional Chinese Medicine (sample 1) and 224 undergraduates from Xinxiang Medical University (sample 2) were selected for investigation by the convenient sampling between January and June 2018, and the reliability and validity of the C-CTI were tested. ① The critical ratio method and correlation analysis method were used to test the identity and homogeneity of the items; ② the expert consultation was used to test the content validity of the C-CTI; ③ the reliability of the C-CTI was tested by Cronbach coefficient, split reliability, and retest reliability. Independent sample t test was used for the measurement data. Pearson correlation analysis was used for correlation analysis. Results In the sample 1, there were 76 males and 207 females, 5 unknown cases, with an average age of 20.45 years old; in the sample 2, there were 27 males and 197 females, with an average age of 19.80 years old. The C-CTI included 11 items and 2 dimensions. The total variance contribution rate was 48.109%, and the Cronbach's α coefficients of circadian rhythm stability and amplitude were 0.817 and 0.654. The range of item-level content validity index (I-CVI) was from 0.83 to 1.00, the average of scale-level content validity index (S-CVI/Ave) was 0.95, and each item was related to the overall score (r=0.265-0.684, all P<0.001). Conclusion The C-CTI is suitable and robust enough for evaluating the circadian rhythm types among medical students.
    Advances in the application of ultrasound radiomics in breast cancer
    Wu Xueting, Chen Xiaoyi, Wu Yiwen, Cai Yongna, Xiao Mingyue, Chen Fengjuan, Han Qianglin, Qiu Shaodong, Zhu Zhiming, Chen Fei
    2022, 28(4):  484-487.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.010
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    The incidence of breast cancer in the world is increasing year by year, and its mortality ranks first in all tumors, which has become significant threat to female physical and mental health. To reduce the mortality, enhance the quality of life, and improve the survival rate in patients, early detection, diagnosis, and treatment are essential. Ultrasound radiomics is an emerging field that can extract high-throughput quantitative image features from ultrasound images. In recent years, ultrasound radiomics has been widely applied in the differential diagnosis and prognosis and treatment evaluation of breast cancer. This review summarizes recent radiomics research on tumor diagnosis, prediction of molecular tumor subtype, and prediction of axillary lymph node metastases.
    Influence of the concept of enhanced recovery after surgery to guide laparoscopic total hysterectomy on post-menopausal women's postoperative analgesia and gastrointestinal function recovery
    Zhang Lei, Sun Danli, Zhou Yajuan, Peng Xing, Yang Yijun
    2022, 28(4):  488-491.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.011
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    Objective To explore the influence of the concept of enhanced recovery after surgery (ERAS) to guide laparoscopic total hysterectomy on post-menopausal women's postoperative analgesia and gastrointestinal function recovery. Methods From January 1, 2016 to December 31, 2020, a total of 94 post-menopausal women who underwent laparoscopic total hysterectomy were selected as the research subjects in Huai'an First Hospital Affiliated to Nanjing Medical University. According to different perioperative intervention methods, they were divided into a control group (46 cases) and an experimental group (48 cases). The control group was (52.34±7.46) years old, and the experimental group was (52.17±7.32) years old. Both groups of patients were treated with laparoscopic total hysterectomy. Among them, the patients in the control group received traditional perioperative treatment, and the patients in the experimental group received perioperative treatment with the concept of ERAS. Relevant rehabilitation indicators, postoperative gastrointestinal function recovery, Visual Analogue Scale (VAS) scores at different time points after surgery, and complications were compared between the two groups. Independent sample t test was used for comparison of the measurement data between groups, paired t test was used for comparison of the measurement data within groups, and χ2 test was used for the count data. Results There were no statistically significant differences in the intraoperative blood loss and operation time between the two groups (both P>0.05), and the postoperative hospital stay in the experimental group was shorter than that in the control group [(4.38±0.62)d vs. (6.97±1.04)d] (P<0.05). In the experimental group, the first postoperative anal exhaust time, the first postoperative defecation time, and the first postoperative feeding time were (21.61±4.28) h, (60.35±6.14) h, and (1.34±0.36) d, respectively, which were shorter than those in the control group [(25.49±5.56) h, (64.28±7.32) h, and (3.58±0.67) d], with statistically significant differences (all P<0.05). The VAS score 48 h after surgery was lower than that 6 h after surgery in both groups, and the VAS scores in the experimental group 6 h and 48 h after surgery were (3.21±0.46) points and (1.17±0.22) points, respectively, lower than those in the control group [(5.56±0.74) points and (3.24±0.43) points], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total complication rate between the two groups within 7 days after surgery (P>0.05). Conclusion The concept of ERAS to guide laparoscopic total hysterectomy can promote the recovery of gastrointestinal function in postmenopausal women, reduce postoperative pain, and is safe and reliable.
    Application of apparent diffusion coefficient to identify low- and medium-high-grade prostate cancer
    Zhang Subo, Xu Yongjun, Liu Jingfang, Xia Jiabao, Zhang Haijun
    2022, 28(4):  492-496.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.012
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    Objective To investigate the application value of the apparent diffusion coefficient (ADC) in identifying low grade from medium-high-grade prostate cancer. Methods MRI examinations of patients with pathologically confirmed prostate cancer with an average age of 65 years old in The Second People's Hospital of Lianyungang from March 2017 to June 2021 were collected. According to the postoperative pathological findings, they were divided into a low-grade group (Gleason score 6, 20 cases) and a medium-high-grade group (Gleason score 7, 38 cases). All patients underwent complete MRI scan and diffusion weighted imaging (DWI) examination, and the minimum ADC (ADCmin), mean ADC (ADCmean), and normalized ADC (ADCn) values of the lesions were measured respectively, and the differences in ADCmin, ADCmean, and ADCn values between the two groups were compared by independent sample t test. The receiver operating characteristic curves (ROCs) of three different ADC values for identifying prostate cancer were plotted, and the area under the curve (AUC) was obtained to evaluate the effectiveness of each index in the differential diagnosis of low-grade and medium-high-grade prostate cancer. The Z test was used to compare the differences of AUCs. Results The ADCmin, ADCmean, and ADCn values of the low-grade group were (0.734±0.063) ×10-3 mm2/s, (0.816±0.091) ×10-3 mm2/s, and (0.631±0.037) ×10-3 mm2/s, respectively, which were higher than those in the medium-high-grade group [(0.646±0.055) ×10-3 mm2/s, (0.698±0.059) ×10-3 mm2/s, and (0.570±0.023) ×10-3 mm2/s], with statistically significant differences (all P<0.05). The AUC of three ADC values in differentiating pathological grade of prostate cancer was 0.919 of ADCn, 0.867 of ADCmin, and 0.809 of ADCmean. Conclusions ADCmin, ADCmean, and ADCn all can be used to identify low grade from medium-high-grade prostate cancer, among which ADCn has the highest efficacy and can provide a reasonable imaging basis for clinical selection of treatment plans.

    Ejaculatory duct cyst complicated with prostatic cyst stones: a case report and literature review
    Yang Guoshang, Ruan Li, Li Gang, Li Zhengming
    2022, 28(4):  497-500.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.013
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    Objective To investigate the clinical application value of transurethral seminal vesiculoscopy technique in the diagnosis and treatment of hemospermia, and to explore the etiologies, diagnosis, and necessity of surgical operation of hemospermia. Methods We retrospectively analyzed the diagnosis and treatment of a case of right ejaculatory duct cyst complicated with prostatic cyst calculi admitted to Guangzhou Red Cross Hospital Affiliated to Jinan University on September 21, 2020. According to literatures reported, we discussed the diagnosis and treatment strategies of hemospermia. Results The patient was admitted for hematospermia, the right seminal vesicle opening swollen showed during operation, which resulted in seminal vesiculoscopy entering difficultly. A large number of calculi were found on the right side of the prostatic capsule, and the wall of the right small cyst had oozing and edema. The calculi were crushed and removed. The curative effect was satisfactory after 1 month's follow-up. Conclusion The etiology of hemospermia is various, and transurethral seminal vesiculoscopy has an important value in the diagnosis and treatment of the disease.
    Investigation and analysis of current situation of high-risk early warning assessment ability for midwives in Guangzhou
    Li Kexin, Huang Meiling, Jiang Ziyan, Cai Yixiang
    2022, 28(4):  500-504.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.014
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    Objective To understand the current situation of high-risk early warning assessment ability for midwives in Guangzhou, and to analyze its influencing factors. Methods From September 2020 to June 2021, a self-compiled questionnaire survey was conducted among midwives from 6 hospitals in Guangzhou by the objective sampling method. The content of the questionnaire included three parts, namely basic information, self-assessment of midwives' high-risk early warning assessment ability, and the training status of midwives' high-risk early warning assessment ability. χ2 test was used for the count data, and independent sample t test or one-way ANOVA was used for the measurement data. Results A total of 148 valid questionnaires were collected, with an effective recovery rate of 91.4% (148/162). All midwives in the survey were female, 40.5% (60/148) of midwives were aged from 26 to 35 years old, 65.5% (97/148) of midwives were in grade 3A hospitals, 81.8% (121/148) of midwives had a bachelor's degree or above, and 61.5% (91/148) of midwives had strict training and assessment standards in their hospitals. The main reasons affecting midwives' high-risk early warning assessment ability were that the relevant departments of hospitals did not pay attention to it and the hospital conditions were limited. The higher the midwives' age, working experience, and professional titles were, the stronger the ability of high-risk early warning assessment they had (all P<0.05). The attention paid to midwives' high risk early warning assessment ability by grade 3A hospitals was higher than that by grade 3B and below hospitals, with a statistically significant difference (χ2=15.32, P=0.02); 48.0% (12/25) of midwives in grade 2 and below hospitals did not meet the requirements of high-risk pregnancy training, which was higher than 30.8% (8/26) in grade 3B hospitals and 21.6% (21/97) in grade 3A hospitals (χ2=9.65, P=0.04). Conclusion At present, the midwives' overall high-risk early warning assessment ability is in an intermediate level in Guangzhou. It is suggested to establish unified training system and examination standard of relevant early warning, so as to improve the ability of high-risk early warning assessment in a normalizing way.

    Application of project-achieving quality control circle activities in constructing a single-disease-oriented whole-process model of nursing service

    Wu Shaoli, Ye Yanfen, Wang Haiying, Feng Yanying, Huang Ximei, Shi Guang
    2022, 28(4):  505-510.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.015
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    Objective To explore the application of project-achieving quality control circle in constructing a single-disease-oriented whole processmodel of nursing service, and provide a theoretical support for the single-disease-oriented whole process model of nursing service. Methods Before the activities, 351 patients with the top 10 diseases admitted to the Department of Rheumatism and Kidney Disease, Central Hospital of Panyu District from November 2018 to April 2019 (before the implementation of quality control circle activities) were selected as a control group, of whom there were 167 males and 184 females, with an age of 56 (44,69) years old. A quality control circle group was set up, "constructing a single-disease-oriented whole-process model of nursing service" was selected as the theme of the activities, and the activities were carried out in accordance with the processof project-achieving quality control circle activities, namely setting goals and conducting feasibility analysis, putting forward plans and determining the best plan, formulating and implementing countermeasures according to the best plan, checking the effects and standardizing management after implementation of all measures, and finally summarizing the activities and putting forward future plans. After the activities, 368 patients with the same diseases admitted to the Department of Rheumatism and Kidney Disease, Central Hospital of Panyu District from December 2019 to May 2020 (after the implementation of quality control circle activities) were selected as an experimental group, of whom there were 168 males and 200 females, with an age of 46 (61,71) years old.The tangible and intangible results before and after the activities were evaluated.Mann-whitney U test was used for comparison of non-normally distributed measurement data between groups, and χ2 test was used for comparison of count data between groups. Results After the quality control circle activities, the score rate of nursing quality, satisfaction score, and length of stay in patients of our department were 92.50% (22 126/23 920), 94.55 (89.09, 98.18) points, and 7 (5, 9) d, respectively, and those were 84.29% (19 231/22 815), 87.27 (78.18, 96.36)points, and 7 (5,10) d respectively before the quality control circle activities; there were statistically significant differences between the two groups (all P<0.05).Before and after the quality control circle activities, the implementation rate of nursing plan and the evaluation score of nurse business round were 47.97% (876/1 826), 70.00 (65.00, 76.00) points and 81.40% (1 558/1 914), 70.00 (65.25, 80.00) points respectively; there were statistically significant differences between the two groups (both P<0.05). In addition, we successfully applied for a science and technology plan project in Panyu District, Guangzhou City, and won multiple awards such as the High-quality Nursing Service Quality Improvement Project, and gained more intangible results. Conclusions The single- disease-oriented whole-process nursing service model is conducive to improving the patients' nursing quality and satisfaction, reducing the length of stay, and improving the implementation rate of nurses' nursing plan and ability to perform business rounds. The project-oriented quality control circle activities contribute to the improvement of nurses' service awareness, problem-solving ability, and innovation ability, and provide a foundation for the implementation of single-disease-oriented whole-process nursing service model.
    Clinical observation on stick needle for cervical vertigo 
    Huang Shi, Lei Zhi, Zhou Shuangwu, Li Huafeng, Liang Wen, Tan Yongzhen
    2022, 28(4):  511-514.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.016
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    Objective To analyze the efficacies of two different traditional Chinese medicine (TCM) therapies in cervical vertigo. Methods A total of 320 cervical vertigo patients who were treated in The Second Affiliated Hospital of Guangzhou Medical University from March 2019 to July 2021 were selected. According to the random number table, 160 cases undergoing acupotomy therapy were included in the control group, and 160 cases undergoing stick needle therapy were included in the observation group. In the control group, there were 89 males and 71 females, aged (53.25±6.78) years; in the observation group, there were 92 males and 68 females, aged (53.40±6.20) years. The improvement rate of vertigo, the pain scores of shoulder, neck, and head, and upper limb numbness score were compared between the two groups. The count data were tested by chi-square test, and the measurement data were tested by independent sample t test between groups and paired t test within groups. Results The effective rate of vertigo improvement in the control group was 98.13% (157/160), which was higher than that in the observation group [80.63% (129/160)], with a statistically significant difference (P<0.05). After treatment, the pain scores of neck and shoulder and head in the observation group were (1.48±0.38) points and (0.82±0.20) points, respectively, which were lower than those in the control group [(2.98±0.40) points and (1.58±0.22) points], with statistically significant differences (both P<0.05). There was no statistically significant difference in the upper limb numbness score between the two groups before or after treatment (both P>0.05); the upper limb numbness scores in the two groups after treatment were (1.90±0.58) points and (1.94±0.52) points, respectively, which were lower than (5.40±1.35) points and (5.32±1.48) points before treatment, with statistically significant differences (both P<0.05). Conclusions Stick needle therapy has fair effects for shoulder, neck, and head pain symptoms in cervical vertigo patients; acupotomy has better effects on cervical vertigo symptom. Both therapies can improve the upper limb numbness symptom. Therefore, the proper therapy can be selected according to patients' conditions.
    Special Subject

    Experience of construction and nursing management of transitional wards under emergency situation in epidemic closed and controlled areas in Guangzhou

    Liu Yu, Xu Jianying, Deng Lili, Guan Lijuan, Li Jianji, Lin Jingxia, Wu Qiaomei, Yang Liming
    2022, 28(4):  516-519.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.017
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    Facing the implementation of emergency sealing and closed management in the area where the hospital is located, how to transform general wards into transition wards for patients from medium- and high-risk areas, so that patients in the areas can be treated in time, and ensure the quality of nursing and the safety of medical staff is a very important problem. This paper summarizes how to reconstruct general wards and carry out scientific and effective nursing management according to original environment and personnel conditions, so as to treat patients in sealed areas. It is of practical reference value to deal with the COVID-19 epidemic situation in the area of control effectively.

    Risk identification and hierarchical management strategies of patients in comprehensive isolation ward of epidemic closed and controlled areas in Guangzhou
    Cao Ying, Yang Liming, Lin Jingxia, Liu Yu, Zhang Xiaochun, Yang Yanting, Deng Lili
    2022, 28(4):  520-522.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.018
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    Objective To identify the risk of patients in the closed and controlled areas, and to develop regional and hierarchical management strategies. Methods Based on the requirements of COVID-19's prevention and control, combined with the experience of the previous isolation ward and the situation of admission in our hospital, we established a standardized mode of patient identification from risk to district management. Results An accurate prevention and control mode from admission process to ward hierarchical management was constructed. During the 21 days of the closure period, the isolated ward achieved "zero infection and zero missed diagnosis", 159 patients were successfully treated and shunted, and 9 green channel operations were performed. Conclusion According to the risk level of patients in the isolation ward, effective prevention and control can optimize the patients' admission process and speed up the turnover.
    Epidemic control and prevention strategies at a hemodialysis center
    Peng Lu, Deng Lili, Zhang Xiaolei, Lin Jingxia
    2022, 28(4):  523-526.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.019
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    Application of fine process in large-scale nucleic acid screening in sealed areas
    Zhao Di, Deng Lili, Hu Xingping
    2022, 28(4):  526-528.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.020
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    During the control period from June 3, 2021 to June 23, the nursing staff from Fangcun Hospital, Guangdong Hospital of Traditional Chinese Medicine rapidly and safely collected pharyngeal swabs from the people in the sealed areas, with no infection in the medical staff. This article aims to explore and summarize the fine process of the large-scale nucleic acid screening and pharyngeal swab collecting by the nursing staff in the sealed areas, and to provide beneficial theoretical basis and experiences for future large-scale nucleic acid screening.
    Treatises
    Chromosome analysis of 103 fetuses with isolated aberrant right subclavian artery
    Xiao Zhen, Shang Ning, Feng Jingxu, Liao Minyan, Ma Qiuping
    2022, 28(4):  529-531.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.021
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    Objective To explore the incidence and type of chromosomal abnormalities in fetuses with isolated aberrant right subclavian artery (ARSA) and provide evidences for the prenatal management and clinical consultation. Methods A total of 103 fetuses who were diagnosed as isolated ARSA from January 2015 to December 2020 were selected from the Department of Ultrasound of Guangdong Maternal and Child Health Hospital. All fetuses were screened for Down's syndrome during the first trimester, and grade Ⅲ prenatal ultrasound, fetal echocardiography, and chromosome examination during the second and third trimester. The age of pregnant women was (31.1±5.30) years old. Results There were 9 cases of chromosome abnormalities (8.7%) in all fetuses with isolated ARSA, including 2 cases of trisomy 21, 2 cases of Turner syndrome, 3 cases of unknown copy number variation (CNV), 1 case of 17p12 deletion, and 1 case of 47XYY. Neither trisomy 18 nor 22q11 microdeletion cases were found. Conclusions Isolated ARSA may be the only prenatal predictor of trisomy 21 and other chromosome abnormalities. Prenatal ultrasonography of ARSA has certain clinical value.
    Effect of panax notoginseng saponins on functional imbalance of T helper 1 and T helper 2 cells in elderly patients with unstable angina pectoris
    Guo Zhihua, Lu Pei, Lu Xiaoyan, Huang Shuyan, Chen Xing
    2022, 28(4):  532-536.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.022
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    Objective To observe the clinical efficacy of panax notoginseng saponins (PNS) for elderly patients with unstable angina pectoris (UAP) and its effect on cytokines secreted by T helper (Th) cells. Methods A total of 70 elderly patients with UAP in The Second Affiliated Hospital of Guangzhou Medical University from June 2014 to June 2018 were divided into a routine treatment group and a PNS group with 35 cases in each group, with 30 elderly persons of healthy examination as a control group. In the routine treatment group, there were 21 males and 14 females, aged (70.5±8.1) years; in the PNS group, there were 20 males and 15 females, aged (71.7±10.2) years; in the control group, there were 18 males and 12 females, aged (70.7±8.8) years. The patients in the routine treatment group received the routine treatment regimen, and the patients in the PNS group were additionally given PNS. All objects of study were detected for serum alanine transaminase, creatinine, and some other biochemical indices. The expression levels of interferon γ (IFN-γ) secreted by Th1 cells and interleukin-4 (IL-4) secreted by Th2 cells in plasma were detected by the enzyme-linked immunosorbent assay (ELISA) kit, and the ratio of IFN-γ and IL-4 was calculated as the functional balance index of Th1/Th2 cells. The clinical efficacy was observed for patients both in the routine treatment group and the PNS group. χ2 test or rank sum test was used for the count data, independent sample t test was used for inter-group comparison of the measurement data, and paired t test was used for intra-group comparison of the measurement data. Results Compared with those in the control group, the levels of IFN-γ and Th1/Th2 in elderly UAP patients significantly increased before treatment (both P<0.05), while the level of IL-4 significantly decreased (P<0.05). Compared with those before treatment, the levels of IFN-γ and Th1/Th2 in elderly UAP patients significantly decreased after treatment (both P<0.05), while the level of IL-4 significantly increased (P<0.05). The levels of plasma IFN-γ and Th1/Th2 in the PNS group were significantly lower than those in the routine treatment group (both P<0.05), but there was no statistically significant difference in the level of IL-4 between the two groups (P>0.05). The total effective rate in the PNS group was significantly higher than that in the routine treatment group [91.4% (32/35) vs. 80.0% (28/35)] (P<0.05). Conclusion PNS can increase clinical efficacy for elderly patients with UAP, which may be due to its inactivation of Th1 cells and improvement of Th1/Th2 cell functional imbalance.

    Comparative study of two kinds of extracorporeal shock waves in the treatment of scapulohumeral periarthritis

    Yang Qianfang, Zhang Jin, Cao Xuebing
    2022, 28(4):  536-539.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.023
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    Objective By comparing the efficacies of electromagnetic and electro-hydraulic shock waves in the treatment of scapulohumeral periarthritis, in order to find a safe, effective, and highly compliant treatment scheme for the treatment of scapulohumeral periarthritis. Methods A total of 88 patients (49 female patients and 39 male patients, aged 45 to 75 years) who received scapulohumeral periarthritis related treatment in the outpatient or inpatient department of rehabilitation medicine of Guangzhou First People's Hospital from June 2016 to June 2020 were simply randomly divided into an electromagnetic shock wave source group (research group) and an electro-hydraulic shock wave source group (control group), once a week, a total of 3 times, supplemented by routine functional rehabilitation. Pain and motion of shoulder were assessed and recorded before treatment and 1, 2, and 3 weeks after treatment. The measurement data were compared by one-way ANOVA before and after treatment, independent sample t test was used for comparison between groups, and the count data were tested by χ2 test. Results There were no statistically significant differences in the age, gender, body weight, or heart rate between the two groups (all P>0.05). In the research group, the scores of pain and motion of shoulder were (2.11±0.25) points and (2.54±1.02) points before treatment and (0.89±0.43) points and (1.02±0.87) points 3 weeks after treatment, respectively, with statistically significant differences (P=0.003, 0.007). In the control group, the scores of pain and motion of shoulder were (2.03±0.29) points and (2.55±1.15) points before treatment and (0.90±0.35) points and (1.01±0.79) points 3 weeks after treatment, respectively, with statistically significant differences (P=0.001, 0.014). After 1, 2, and 3 weeks of treatment, there were no statistically significant differences in the scores of pain and motion of shoulder between the research group and the control group (all P>0.05). Conclusions Electromagnetic shock wave and electro-hydraulic shock wave have the same safety and effectiveness in the treatment of scapulohumeral periarthritis, but the magnetic field and energy output of electromagnetic shock wave are stable and does not produce electric spark or noise, so it is more worthy of clinical promotion.
    Therapeutic effect of rapid soft-channel puncture of the skull guided by 3D printing plate in the treatment of moderate and small amount of hypertensive intracerebral hemorrhage in basal ganglia
    Wang Yongsheng, Wang Zhiqiang, Li Shuqing, Zhou Shicong, Wang Zongbao
    2022, 28(4):  540-544.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.024
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    Objective To explore the therapeutic effect of rapid soft-channel puncture of the skull guided by 3D printing plate in the treatment of moderate and small amount of hypertensive intracerebral hemorrhage in basal ganglia. Methods A total of 124 patients with moderate and small amount of hypertensive intracerebral hemorrhage in basal ganglia treated by rapid soft-channel puncture of the skull in Department of Neurosurgery, Binzhou Central Hospital from Jun 2017 to Oct 2020 were divided into a control group and a research group by the random number table with 62 cases in each group. There were 29 males and 33 females in the research group, aged (56.9±2.4) years; there were 34 males and 28 females in the control group, aged (55.2±3.6) years. The research group received rapid soft-channel puncture of the skull guided by 3D printing plate, while the control group received rapid soft-channel puncture of the skull and drainage after preoperative CT positioning. Then the duration of operation, hematoma puncture accuracy, duration of bearing draining tube, rate of clearance of hemotoma, and postoperative intracranial infection rate were compared. Independent sample t test was used for the measurement data, and Fisher's exact test or χ2 test was used for the count data. Results The duration of operation, hematoma puncture accuracy, duration of bearing draining tube, and hematoma removal in the research group were significantly better than those in the control group [(26.90±2.40) min vs. (48.06±3.74) min, 100.00% (62/62) vs. 88.71% (55/62), (3.15±0.26) d vs. (4.62±0.82) d, (3.56±1.26) ml vs. (6.94±2.26) ml], with statistically significant differences between the two groups (all P<0.05); there was no statistically significant difference in the postoperative intracranial infection rate between the two groups (P=0.057). Conclusion Rapid soft-channel puncture of the skull guided by 3D printing plate is a safe and reliable new technology in the treatment of moderate and small amount of hypertensive intracerebral hemorrhage in basal ganglia compared with rapid soft-channel puncture of the skull and drainage after preoperative CT positioning, with better clinical effect, which has a wide range of clinical applications.
    Clinical Research

    Clinical effect of Shugan Jieyu capsules combined with amisulpride in the treatment of schizophrenia of liver-spleen discordance

    Hu Yali
    2022, 28(4):  545-547.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.025
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    Objective To explore the clinical effect of Shugan Jieyu capsules combined with amisulpride in the treatment of schizophrenia of liver-spleen discordance. Methods A total of 85 patients with schizophrenia of liver-spleen discordance confirmed in Sanmenxia Rehabilitation Hospital were enrolled between March 2019 and March 2021. They were simply randomly divided into an observation group and a control group, including 42 cases treated with amisulpride in the control group and 43 cases treated with Shugan Jieyu capsules and amisulpride in the observation group. All patients were continuously treated for 6 weeks. There were 23 males and 20 females in the observation group, with an age of (40.35±6.17) years old; there were 18 males and 24 females in the control group, with an age of (41.27±6.24) years old. The clinical curative effect in both groups was evaluated after treatment. The scores of traditional Chinese medicine (TCM) syndromes before and after treatment and the incidence of adverse reactions during treatment were compared between the two groups. Independent sample t test was used for inter-group comparison of the measurement data, paired t test was used for intra-group comparison of the measurement data, and χ2 test was used for the count data. Results The effective rate of the observation group was 95.35% (41/43), which was higher than that of the control group [80.95% (34/42)] (P<0.05). After 6 weeks of treatment, the scores of flank distension and pain, poor appetite, and fatigue and laziness in the observation group were (2.08±0.28) points, (1.96±0.37) points, and (2.17±0.21) points, respectively, which were lower than those in the control group [(2.23±0.22) points, (2.17±0.24) points, and (2.32±0.27) points] (all P<0.05). The incidence of adverse reactions was 13.95% (6/43) in the observation group and 9.52% (4/42) in the control group, without statistically significant difference (P>0.05). Conclusion Shugan Jieyu capsules combined with amisulpride can significantly improve the clinical curative effect in patients with schizophrenia of liver-spleen discordance.

    Efficacy of cetuximab combined with three-dimensional conformal radiotherapy for patients with advanced esophageal cancer

    Wu Shanshan, Ma Wenjun
    2022, 28(4):  548-551.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.026
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    Objective To investigate the efficacy of cetuximab combined with three-dimensional conformal radiotherapy in the treatment of advanced esophageal cancer and its influence on serum tumor markers levels, neovascularization indexes levels, and survival. Methods A total of 106 patients with advanced esophageal cancer admitted to Nanyang First People's Hospital from January 2020 to August 2021 was selected as the research objects. After analyzing the patients' medical records, the patients were divided into a control group and an observation group according to different treatment options, with 53 cases in each group. The control group received three-dimensional conformal radiotherapy, and the observation group received cetuximab combined with three-dimensional conformal radiotherapy. The control group included 30 females and 23 males, aged (58.69±1.28) years; the observation group included 31 females and 22 males, aged (57.96±1.32) years. The therapeutic efficacy, serum tumor markers levels [carbohydrate antigen 125 (CA125), cytokeratin protein fragment 19 (CYFA21-1), and serum carcinoembryonic antigen (CEA)], neovascularization indexes levels [transforming growth factor β1 (TGF-β1) and vascular endothelial growth factor (VEGF)], survival status, and adverse reactions were compared between the two groups. The measurement data were tested by independent sample t test and the count data were tested by χ2 test. Results The total effective rate of the observation group was 75.47% (40/53), higher than 49.06% (26/53) in the control group (P<0.05). There were no statistically significant differences in the serum tumor markers between the two groups before treatment (all P>0.05), and the levels of CA125, CYFA21-1, and CEA in the observation group were lower than those in the control group after treatment (all P<0.05). There were no statistically significant differences in TGF-β1 and VEGF between the two groups before treatment (both P>0.05), and the levels of TGF-β1 and VEGF in the observation group were lower than those in the control group after treatment (both P<0.05). The survival rate of the observation group (60.38%, 32/53) was higher than that of the control group (37.74%, 20/53) (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group (18.87%, 10/53) and the control group (22.64%, 12/53) (P>0.05). Conclusion Cetuximab combined with three-dimensional conformal radiotherapy for patients with advanced esophageal cancer can significantly improve their levels of serum tumor markers and neovascularization indicators, increase the survival rate, which is safe and effective.
    Analysis of risk factors of deep venous thrombosis in 60 years old inpatients undergoing PICC catheterization
    Song Dan
    2022, 28(4):  552-555.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.027
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    Objective To analyze the risk factors of deep venous thrombosis in ≥60 years old inpatients undergoing peripherally inserted central catheter (PICC). Methods A total of 117 elderly patients who underwent PICC catheterization in The First Affiliated Hospital of Henan University of Science and Technology between September 2018 and September 2020 were selected as the research subjects, including 76 males and 41 females, aged (74.73±4.36) years. The observation period was 6 weeks from the first day of catheterization, and color Doppler ultrasound was performed weekly to detect the presence or absence of deep venous thrombosis. According to the examination results, the patients were divided into a thrombosis group (21 cases) and a non-thrombosis group (96 cases). χ2 test was used to analyze the possible factors of deep vein thrombosis in elderly patients, and multivariate logistic regression equation was used to summarize the risk factors of deep vein thrombosis in elderly patients. Results Among the patients with deep venous thrombosis, there were 16 cases (76.19%) of asymptomatic thrombosis and 5 cases (23.81%) of symptomatic thrombosis. Multivariate logistic regression analysis showed that age (OR=9.034), location of catheter tip (OR=10.496), catheter type (OR=3.370), long-term bed rest (OR=6.573), malignant tumors (OR=5.270), history of chemotherapy (OR=4.655), history of catheterization (OR=5.191), and history of thrombosis (OR=3.168) all were related risk factors of deep vein thrombosis (all P<0.05). Conclusion Deep vein thrombosis of upper limb in elderly patients after PICC catheterization is related to factors such as age, catheter tip position, presence or absence of long-term bed rest, presence or absence of malignant tumors, chemotherapy history, catheterization history, and thrombosis history.
    Case Report
    Ultrasonic diagnosis of dermatofibrosarcoma protuberans: one case report
    Zhang Lisu, Fang Haiyan, Liang Yinying, Huang Jun
    2022, 28(4):  556-558.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.028
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    Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma in the clinical practice and is easy to be misdiagnosed as other common benign tumors of the skin, so it is necessary to strengthen the understanding on this disease for sonologists to provide important values for clinical preoperative diagnosis and treatment. To investigate the ultrasound features and differential diagnosis of DFSP and improve the preoperative diagnostic accuracy, the clinical data and ultrasound images of a patient with DFSP confirmed by operation and pathology received by The First Affiliated Hospital of Jinan University in July 2019 were retrospectively analyzed. Ultrasound findings showed that a mixed echo nodule was observed in the skin layer of the right breast, ranging about 12 mm×24 mm, with a clear boundary, irregular shape, heterogeneous echo, and strip-like hyper echo. Color Doppler flow imaging (CDFI) showed increased blood flow signals in the nodule.
    Bilateral thalamic stroke due to occlusion of the artery of Percheron in 1 young patient treated with intravenous thrombolysis
    Li Zhixia, Yue Xianghai, Sun Xinhu, Zhan Xia
    2022, 28(4):  559-562.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.029
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    Artery of Percheron (AOP) is a variant of thepara-median thalamic artery, and thalamic infarction due to its occlusion accounts for 4%-18% of all thalamic infarction. Bilateral thalamic infarction is rare in posterior circulation infarction, accounting for only 11% of all posterior circulation infarction. The etiology of stroke in young people is different from and more complex than that in the elderly. This paper reported 1 young patient with bilateral thalamic infarction received by Weihai Central Hospital in July 2021, who was treated with intravenous thrombolysis according to multimodal imaging, and analyzed the characteristics of the case combined with relevant literatures.

    Nursing Research
    Application of PBL-Seminar combined with catfish effect in new technical ability training for ICU nurses
    Chen Ying, Xu Qingmei, Zhang Lei
    2022, 28(4):  563-568.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.030
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    Objective To explore the application effect of problem-based learning (PBL)-Seminar combined with catfish effect in new technical ability training for intensive care unit (ICU) nurses. Methods Sixty clinical nurses who were fully competent in ICU of Tengzhou Central People's Hospital Affiliated to Jining Medical College from January 1, 2020 to January 1, 2021 were randomly selected as the research objects, including 12 males with an age of (33.52±1.2) years old and 48 females with an age of (34.48±1.4) years old. They were simply randomly divided into an observation group and a control group, with 30 nurses in each group. The control group received new technical training in PBL-Seminar mode, and the observation group received new technical training for ICU nurses with PBL Seminar combined with catfish effect. After the training of the two groups, the training effect was subjectively and objectively evaluated by means of performance assessment and questionnaire survey. After the training, the mastery of new technologies in the department, the competence of nurses, and the satisfaction score of doctors for nurses were compared and analyzed. χ2 test was used for the count data, and independent sample t test was used for the measurement data. Results In the observation group, the scores of nurses' mastery of extracorporeal membrane oxygenation (ECMO) management technology, nasojejunal tube placement technology, dual plasma molecular adsorption system (DPMAS) technology, and severe ultrasound nursing technology were (22.16±1.06) points, (21.94±1.16) points, (20.66±1.86) points, and (24.08±2.22) points, which were significantly higher than those in the control group [(16.08±2.32) points, (15.78±1.96) points, (14.84±2.18) points, and (18.92±1.04) points], with statistically significant differences (all P<0.001). In the observation group, the competency scores of basic nursing, specialized theory and practice, safety management, quality control, emergency coordination, infection control management, teaching and research, and other competencies were (10.06±0.76) points, (9.88±0.75) points, (14.56±0.82) points, (6.12±0.85) points, (14.32±0.65) points, (9.87±1.55) points, (8.95±1.76) points, and (7.00±1.25) points, which were significantly higher than those in the control group [(6.12±1.84) points, (5.86±2.10) points, (9.22±2.12) points, (3.66±1.96) points, (10.06±2.15) points, (7.45±1.00) points, (5.01±0.71) points, and (5.21±0.92) points], with statistically significant differences (all P<0.001). In the observation group, the scores of doctors' satisfaction evaluation on nurses' work in terms of observation ability, rescue cooperation ability, communication and cooperation ability, and emergency handling ability were (22.8±1.6) points, (23.2±1.5) points, (23.5±1.6) points, and (22.4±1.5) points respectively, which were significantly higher than those in the control group [(17.8±2.6) points, (18.2±2.4) points, (18.0±2.9) points, and (17.4±3.0) points], with statistically significant differences (all P<0.001). Conclusion PBL-Seminar combined with catfish effect is beneficial to accelerate the ICU nurses' mastery of new technologies, improve the ICU nurses' job competence, and improve doctors' satisfaction on ICU nurses' work, which is worth promoting and applying in ICU.
    Investigation and research on ICU nurses' cognition status of peripheral catheter indwelling and maintenance
    Yang Kun
    2022, 28(4):  568-571.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.031
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    Preventive Medicine
    Study on the correlations between dietary behaviors and BMI, diabetes, and hypertension of physical examination population
    Gu Sicun, Liu Qin
    2022, 28(4):  572-576.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.032
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    Objective To investigate the dietary behaviors of physical examination population, and to explore the correlations between dietary behaviors and body mass index (BMI), diabetes, and hypertension. Methods A cross-sectional survey on the physical examination population were carried out in The 73rd Army Hospital of the Chinese People's Liberation Army from March to May 2021. The Eating Behavior Evaluation Scale (EBES) for adults was used to investigate the dietary behaviors. The total score and the scores of each dimension of EBES were compared between different BMI groups, diabetic and non-diabetic groups, hypertensive and non- hypertensive groups. One-way ANOVA was used for inter-group comparison of the measurement data, LSD method was used for pairwise comparison, and independent sample t test was used for comparison between groups. Pearson correlation analysis was used to analyze the correlation between EBES score and BMI, and Spearman correlation analysis was used to analyze the correlations between EBES score and diabetes and hypertension. Results A total of 335 physical examination populations were included in the final analysis, including 187 males and 148 females, 38 cases (11.34%) of low body weight, 221 cases (65.97%) of normal body weight, 55 cases (16.42%) of pre-obesity, and 21 cases (62.69%) of obesity, 37 cases of diabetes (11.05%), and 44 cases of hypertension (13.13%). The total score and scores of snacks, healthy eating concepts, convenience, taste preferences, eating rule, emotional impact, eating speed, and eating habit dimension of EBES in the normal body weight group were higher than those in the pre-obesity group and obesity group, with statistically significant differences (all P<0.001). The total score and scores of healthy eating concepts, convenience, emotional impact, eating speed, and eating habit dimension of EBES in the diabetic group were lower than those in the non-diabetic group, with statistically significant differences (all P<0.05). The total score and scores of healthy eating concepts, eating rule, emotional impact, eating speed, and eating habit dimension of EBES in the hypertensive group were lower than those in the non-hypertensive group, with statistically significant differences (all P<0.05). BMI was negatively correlated with the scores of snacks, healthy eating concepts, convenience, taste preferences, eating rule, emotional impact, eating speed, and eating habit dimension and total score of EBES (r=-0.298, -0.235, -0.274, -0.262, -0.158, -0.180, -0.217, -0.271, -0.352; all P<0.05); diabetes was negatively correlated with the scores of healthy eating concepts, convenience, emotional impact, eating speed, and eating habit dimension and total score of EBES (r=-0.281, -0.158, -0.149, -0.270, -0.232, -0.131; all P<0.05); hypertension was negatively correlated with the scores of healthy eating concepts, eating rule, emotional impact, eating speed, and eating habit dimension and total score of EBES (r=-0.307, -0.114, -0.122, -0.273, -0.207, -0.137; all P<0.05). Conclusions BMI, diabetes, and hypertension are negatively correlated with the scores of relevant dimensions and total score of EBES. Physical examination populations with obesity, diabetes, and hypertension have different types of unhealthy dietary behaviors.
    A retrospective study on inoculation of inactivated vaccine against COVID-19 in staff of a hospital
    Mao Xiaofen, Yang Bo, Tang Li, Gong Tingting, Zuo Hui, Wu Limei
    2022, 28(4):  577-581.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.033
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    Prevention and strategies of infectious complications in retrograde ureteroscopy
    Yang Yiming, Zhang Jianfeng, Guan Denghai, Liu Jianjun
    2022, 28(4):  582-585.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.034
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    With the development and popularity of retrograde ureteroscopy in the treatment of urinary calculi, the incidence of postoperative urogenic sepsis increases. Urinary calculi and urinary tract infection are inseparable, and a large part of the economic burden is biased to infection-related calculi. Urinary tract infection is the most common postoperative complication after calculi surgery, and the further development of urogenic sepsis is life-threatening. The risk of infection is influenced by various factors, including comorbidities, anatomic abnormalities, surgical factors, and local antimicrobial sensitivity. Understanding these risks and appropriate steps to mitigate them are important parts of reducing postoperative morbidity and mortality. The purpose of this article is to review current literatures for the prevention and management of calculi associated infection complications associated with retrograde ureteroscopy.
    Research progress of RBP4 and cardiovascular diseases
    Liu Zhen, Sun Jingwu, Zhang Ning, Shi Xinye, Liu Jingyang
    2022, 28(4):  586-589.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.035
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    Retinol-binding protein 4 (RBP4) is a member of the lipoprotein-troponin family. RBP4 is the only retinol (vitamin A) -specific transporter secreted by liver and adipose tissue, and plays an important role in insulin sensitivity. Despite the association between the level of RBP4 and the risk of cardiovascular diseases, there are few studies focused on the relationship between RBP4 and cardiovascular diseases. To sum up, it is of great significance to explore the role of RBP4 in cardiovascular diseases for the prevention, screening, and treatment of cardiovascular diseases. This article reviews the relationships between RBP4 and its related diseases.
    Application of hepatocyte growth factor and bone morphogenetic protein in cardiovascular diseases
    Fu Lin, Diao Shuling
    2022, 28(4):  589-592.  DOI: 10.3760/cma.j.issn.1007-1245.2022.04.036
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    Hepatocyte growth factor is a multi-effect mesenchymal factor with various biological activities, which can regulate the growth, movement, and morphology of cells, promote the angiogenesis, resist the fibrosis, and inhibit the apoptosis, and plays an important role in protecting cardiovascular cells. Bone morphogenetic protein (BMP) is a member of transforming growth factor-β superfamily. In recent years, there have been more and more researches on the relationship between BMP and cardiovascular disease formation. Different types of BMP are significantly differently distributed in various tissues and organs of the body, and BMP plays a certain role in the pathological formation of vascular artery calcification, vascular inflammation, and atherosclerosis. Therefore, the in-depth study on hepatocyte growth factor and BMP can provide a new idea for the prevention, diagnosis, and treatment of clinical cardiovascular diseases. This study summarizes the application of hepatocyte growth factor and BMP in cardiovascular diseases.