Table of Content

01 January 2024, Volume 30 Issue 1

Previous Issue   

Meta Analysis

Efficacy and safety of probiotics in treatment of patients with mild cognitive impairment and Alzheimer's disease

Wu Yanjiao, Chen Liping, Hou Huaijing, Xu Ziqing, Zhang Lingyun

2024, 30(1):  1-7.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.001

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Objective　To explore the efficacy and safety of probiotics in the treatment of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods　The PubMed, Cochrane Library, EMbase, China National Knowledge Infrastructure, Database for Chinese Technical Periodicals, WanFang Data, and China Biology Medicine disc were searched to collect the studies on the efficacy and safety of probiotics in the treatment of patients with MCI and AD from their establishment to November, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analysis was performed using the RevMan 5.4.1 software. Results　A total of 10 studies involving 716 patients were included. The results of the meta-analysis showed that the Mini-Mental State Examination score of the probiotic group was better than that of the control group (MD=1.23, 95%CI 0.18-2.27, P=0.02). There was no statistical difference in the incidence of adverse reactions between the two groups (OR=0.63, 95%CI 0.25-1.63, P=0.34). Conclusion　Probiotics have positive effectiveness in improving the cognitive function of patients with MCI and AD, with satisfactory safety.

Body composition and frailty risk: a meta-analysis

Zhao Yidi, Liang Hao , Chen Muxin , Wei Lin

2024, 30(1):  8-14.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.002

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Objective　To conduct a meta-analysis on the relationship between frailty and body composition, identify the risk factors of frailty, draw reliable conclusions, and provide evidence-based basis for early intervention. Methods　The databases of China National Knowledge Infrastructure (CNKI), Sinomed, Database for Chinese Technical Periodicals, WanFang Data, Duxiu, PubMed, Web of Science, and Embase were searched for studies on frailty and body composition from their establishment to January 20, 2023. Two researchers independently screened the literatures, evaluated the quality, and extracted the data. The RevMan 5.3 software was used for the meta-analysis. Results　A total of 15 studies were included, including 14 cross-sectional studies and 1 cohort study. The total sample size was 22 774, including 3 586 patients with frailty. Seven risk factors were involved. The meta-analysis results showed that there were statistical differences in body mass index (BMI) <18.5 kg/m², BMI≥30.0 kg/m², waist circumference (female ≥88 cm and male ≥102 cm), calf circumference, and upper arm muscle circumference (MAMC) (all P<0.05), and no in the rest factors [25.0 kg/m²≤BMI<30.0 kg/m², BMI (unclassified), skeletal muscle mass, body fat mass, body fat percentage, waist circumference (unclassified)] (all P>0.05). The random effect model and fixed effect model were used to estimate the combined OR and 95% confidence interval of the included factors; it found that the consistency of other factors was good (I²=0-38%) except 25.0 kg/m²≤BMI<30.0 kg/m², BMI (unclassified), skeletal muscle mass, and waist circumference (unclassified) (I²=50%-98%). The results of this study were reliable. Conclusions　Clinical medical workers can develop frailty risk screening tables based on these influencing factors that can be measured quantitatively, and timely implement precise preventive and treatment programs for the screened population with high risk of frailty, so as to further improve the quality of life of the elderly.

New Medical Advances

Research progress on diabetic nephropathy complicated with pregnancy

Chen Wenqing, Guan Baozhang

2024, 30(1):  15-20.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.003

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The number of pregnant women with gestational diabetes has been steadily increasing worldwide. These pregnancies have elevated risk of various complications, including miscarriage, congenital abnormalities, macrosomia, fetal growth restriction, preeclampsia, preterm birth, and stillbirth. For pregnant women with diabetic nephropathy, it is crucial to assess the impact of pregnancy on kidney function and the influence of kidney disease on pregnancy outcomes. Pregnant women with normal kidney function and microalbuminuria have lower risk of kidney function loss during pregnancy, whereas those with a glomerular filtration rate < 60 ml/min and/or proteinuria ≥3 g/24 h in early pregnancy face risk of permanent kidney damage. The risk of complications for both the fetuses and mothers is associated with the severity of chronic kidney disease and glycemic control. Advancements in prenatal care have improved outcomes for both the fetuses and mothers. Preconception counseling has become a critical factor for the successful pregnancy of all diabetic women, especially those with diabetes and chronic kidney disease.

Research progress of Nrf2 signaling pathway as a new target for astaxanthin therapy

Shang Guanhua, Tian Chunmei

2024, 30(1):  20-24.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.004

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Astaxanthin is a multi-targeted fat-soluble ketocarotenoid, and has attracted much attention in recent years because of its abundant biological activity, especially its powerful antioxidant capacity. Astaxanthin has a variety of biological activities, such as antioxidant, anti-inflammatory, anti-diabetic, neuroprotective, and other effects. However, the molecular mechanisms of these therapeutic effects of astaxanthin are not fully understood, and the nuclear factor erythroid-2 related factor 2 (Nrf2) signaling pathway is one of the important signaling pathways of astaxanthin. The Nrf2 signaling pathway is a major regulator of cellular resistance to oxidative stress, and it regulates redox homeostasis as well as the expression of genes involved in cellular detoxification. This article reviews the mechanism of astaxanthin activating the Nrf2 signaling pathway and its protective effect in various diseases.

Classification and treatment progress of dyslipidemia

Wang Yuqin, Liu Shengxun, Peng Xinguo

2024, 30(1):  24-27.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.005

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In recent years, cardiovascular diseases are still an important cause of adult mortality and morbidity in China. Their occurrence is usually associated with unhealthy diet and dyslipidemia. The management of dyslipidemia is urgent. Dyslipidemia is a metabolic disease caused by a variety of complex causes. Understanding the classification of dyslipidemia and the treatment of dyslipidemia is particularly important for the prevention and treatment of cardiovascular diseases. This paper aims to summarize the concept, types, and treatment progress of dyslipidemia based on systematic literature review, so as to provide new ideas and methods for the prevention and treatment of hyperlipidemia.

Treatises

Analysis of oral microbial diversity in patients with erectile dysfunction by 16S rRNA gene sequencing

Zhou Wei, Zhu Zhanglong, Wang Wanyue, Zhou Jing, Hu Guiyao, Liu Yao, Ding Wei

2024, 30(1):  28-32.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.006

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Objective　To analyze the differences in the structure of oral microbiota between patients with erectile dysfunction (ED) and healthy controls by 16S rRNA high-throughput sequencing, and to explore the relationship between ED and oral microbiota. Methods　Fifteen ED patients who were 20-65 years old and treated at Department of Urological Surgery, First Hospital, Guizhou University of Traditional Chinese Medicine (ED group) and 15 healthy controls (normal control group) were selected. Their saliva samples were collected for the 16S rRNA high-throughput sequencing. The structures of the bacterial flora in the saliva samples of both groups were compared and analyzed. The independent-sample t test, non-parameter test, and χ² test were applied. Results　The compositions of core dominant bacteria in the salivary microbiota of the ED group and the normal control group were similar; the top ten dominant bacteria at the genus level were Fusobacterium, Reil, Neisseria, Haemophilus, Prevotella, Veillonella, Isovalinus, Streptococcus, Porphyromonas, and Actinobacteria. There were statistical differences in the abundances of different flora in the saliva samples between the two groups (all P<0.05). The abundance of Streptococcus in the ED group was significantly higher than that in the normal control group [8.59 (4.13, 11.75)% vs. 4.23 (3.25, 7.48)%], while the abundance of Fusobacterium in the ED group was significantly lower than that in the normal control group [9.38 (5.61, 14.91)% vs. 14.13 (7.92, 19.03)%], with statistical differences between the two groups (both P<0.05). Conclusions　The oral microbiota of ED patients and healthy people have the same core composition skeleton, but there are some differences in the microbiota structure, which may be closely related to the occurrence and development of ED. However, the causal relationship and its related mechanisms should be further explored.

Expressions of Wnt proteins in skin squamous cell carcinoma and basal cell carcinoma

Yuan Yanping, Zhang Lushun

2024, 30(1):  33-37.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.007

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Objective　To explore the expression patterns and clinical values of Wnt10a, Wnt10b, Wnt5a, and β-catenin in cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Methods　Thirty-three specimens from the patients with SCC and 33 specimens from the patients with BCC pathologically confirmed at Hospital Affiliated to Jiujiang University from January to December 2021 were selected. There were 28 males and 38 females; they were 45-88 years old. The expressions of Wnt10a, Wnt10b, Wnt5a, and β-catenin in the specimens were detected by the immunohistochemical staining. The χ² test was used. Results　Wnt10b, Wnt5a, and β-catenin expressed mainly in the cytoplasm and nucleus in both BCC and SCC; the positive expression rates in both tumors were 100.0%. Wnt10a did not expressed in BCC, while the positive rate in SCC was 30.3% (10/33), with a statistical difference (P<0.05). Conclusions　Wnt signaling pathway proteins obviously express in BCC and SCC, indicating that the Wnt signaling pathway plays a significant role in the tumorigenesis and development of BCC. Wnt10a can be used as a molecular marker identifying BCC and SCC.

Effect of troponin T level on prolonged mechanical ventilation in infants after cardiac surgery

Gu Xiaolin, Liu Qi, Bao Rongxing, Li Jie, Zhang Chongjian

2024, 30(1):  37-42.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.008

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Objective　To explore the effect of troponin T on prolonged mechanical ventilation in infants after cardiac surgery. Methods　One hundred and ninety-two infants with congenital heart disease who underwent cardiac surgery under cardiopulmonary bypass in Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Southern Medical University from January to April 2019 were retrospectively selected as the study objects. According to the immediate troponin T level after surgery, they were divided into a high-value group (3 798.0-10 000.0 ng/L), a middle-value group (1 827.0-3 709.0 ng/L), and a low-value group (316.2-1 801.0 ng/L), with 64 cases in each group. There were 28 girls and 36 boys in the low-value group; they were 203.00 (129.75, 274.50) days old. There were 30 girls and 34 boys in the middle-value group; they were 118.00 (16.50, 173.75) days old. There were 24 girls and 40 boys in the high-value group; they were 168.50 (78.00, 219.25) days old. The analysis of variance, rank sum test, and χ² test were used for the statistical analysis. The univariate and multivariate logistic regression models were used to analyze the correlation between postoperative troponin T level and prolonged mechanical ventilation. The univariate and multivariate linear regression models were used to analyze the correlation between postoperative troponin T level on one hand and length of stay in the intensive care unit and hospitalization time after the operation on the other hand. Results　The younger the infants were and the longer the extracorporeal circulation during surgery and the aortic cross-clamp time were, the higher the postoperative troponin T level was (all P<0.05). After adjusting the gender, days, gestational age, preoperative hemoglobin, preoperative serum creatinine, cardiopulmonary bypass time, aortic cross-clamp time, and RACHS-1 score, the multivariate regression model found that the elevated troponin T level was an independent risk factor for prolonged mechanical ventilation [OR=1.2(1.1,1.3), P<0.001]. Conclusion　The elevation of troponin T level is associated with prolonged postoperative mechanical ventilation after congenital heart surgery in infants.

Risk factors of nosocomial infection of ventilator-associated pneumonia in RICU and predictive model construction

Wang Sujuan, Li Haoxue, Liu Li, Lu Xuegeng, Wang Xue, Qu Lin

2024, 30(1):  43-47.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.009

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Objective　To analyze the risk factors of ventilator-associated pneumonia (VAP) in patients at respiratory intensive care unit (RICU), and to construct a risk prediction model and draw a graph. Methods　A total of 796 patients who received mechanical ventilation for more than 48 h and had complete clinical examination data in RICU, Inner Mongolia People's Hospital from January 1, 2020 to December 31, 2022 were selected as the study objects. The patients were divided into a VAP group (285 cases) and a non-VAP group (511 cases) according to whether the patients had infectious pneumonia after receiving mechanical ventilation for more than 48 h or removing the machines and pulling out the tubes within 48 h. The risk factors of VAP were analyzed by the univariate and multivariate logistic analyses. The R software was used to draw the nomograms. Results　The incidence of VAP in the patients was 35.80% (285/796). Cerebral infarction, antibiotics combination, central venous catheter, urinary catheter, ventilator using days, and antibiotics using days were the independent risk factors of VAP (OR=1.752, 2.406, 4.596 4.503, 1.209, and 1.093; all P<0.05). The area under the model's receiver operating characteristic curve was 0.925 (95%CI 0.907-0.944). Conclusions　The independent risk factors of VAP in RICU should be paid attention to and evaluated in time in clinical work. The predictive model for the risk factors of VAP is effective, and can provide some references in the prediction of the risk of patients with VAP.

Application of high-throughput sequencing in screening neonatal genetic metabolic diseases

Yin Huan, Lei Jufang, Chen Xiaolin, Cheng Hongbin

2024, 30(1):  47-52.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.010

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Objective　To analyze the application value of high-throughput sequencing (NGS) in screening neonatal genetic metabolic diseases. Methods　This was a prospective study. One hundred and eighty-five critical cases of acidosis or encephalopathy of unknown causes hospitalized in Neonatal Intensive Care Unit (NICU), Huangshi Maternal and Child Health Hospital from January 2021 to June 2023 were selected, including 95 boys and 90 girls. The heel blood was collected from all the subjects. The biochemical screening (tandem mass spectrometry and time-resolved immunofluorescence) and NGS screening were performed. The NGS screening was designed to capture 202 genes related to genetic metabolism, and the mutation pathogenesis was interpreted according to the relevant guidelines. The positive abnormal sites were verified by the Sanger sequencing. Results　Of the 185 neonates, 7.57% (14/185) were preterm infants and 8.11% (15/185) were from assisted reproduction; 15 (8.10%) were positive in the biochemical screening, and 5 (2.70%) were positive in the re-detection after recall, including 1 case of decreased glucose-6-phosphate dehydrogenase (G6PD), 1 case of decreased 17-hydroxyprogesterone (17α-OHP), 1 case of decreased thyroid stimulating hormone (TSH), and 2 cases of increased phenylalanine. Among the 185 newborns, 6 cases (3.24%) were positive in NGS, including 4 cases of DOUX 2, MATIA, G6PD, CYP21A2 compound heterozygous mutations and 2 cases of PAH mutation. In addition, except for the positive ones, there were 45 newborns (24.32%) who had recessive mutations and 140 negative newborns (72.43%). The results of the two screens were consistent with each other in 5 cases and not in 1 case; 3 of the 6 patients were confirmed, including 1 case of hyperphenylalaninemia, 1 case of 21-hydroxylase deficiency congenital adrenocortical hyperplasia, and 1 case of congenital hypogonadism. Taking the clinical diagnosis as the reference, the medical records to be confirmed were included in the true positive; the biochemical screening sensitivity was 83.3%, the specificity was 100.0%, and the positive predictive value was 100.0%; the NGS screening's sensitivity was 100.0%, the specificity 100.0%, and the positive predictive value was 100.0%. Conclusion　The NGS screening accuracy is high, so it can comprehensively diagnose neonatal genetic metabolic diseases.

Relationship between distribution of traditional Chinese medicine syndrome types and outcomes of patients with acute severe pancreatitis

Zhang Yonghua, Guo Min, Li Heguo, Li Chunying, Zhu Peiwen, Nie Wenshan, Wang Xiao

2024, 30(1):  52-56.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.011

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Objective　To analyze the distribution of traditional Chinese medicine syndrome types in acute severe pancreatitis, and to explore the relationship between traditional Chinese medicine syndrome types and disease outcomes. Methods　A retrospective analysis was conducted on the clinical data of 107 patients with acute severe pancreatitis admitted to First Hospital, Henan University of Chinese Medicine from May 2018 to April 2023. The distribution of traditional Chinese medicine syndrome types and their prognosis 14 days after admission were statistically analyzed. χ² and t tests were used. The Cox regression analysis model was used for the multivariate analysis. Results　The proportion of the traditional Chinese medicine syndrome types in the 107 patients from high to low were visceral excess heat syndrome (39.25%, 42/107), liver and gallbladder dampness heat syndrome (30.84%, 33/107), stasis and toxin combined syndrome (18.69%, 20/107), internal closure and external detachment syndrome (10.28%, 11/107), and liver depression and qi stagnation syndrome (0.93%, 1/107). There were no statistical differences in gender and age distributions between the patients of different syndrome types (both P>0.05), while there was a statistical difference in the distribution of causes between the patients of different syndrome types (χ²=64.08, P<0.001). The incidence of exacerbation in the patients with severe acute pancreatitis was 19.63% (21/107). The results of multivariate Cox regression analysis showed that stasis and toxin combined syndrome [risk ratio (HR)=5.307, 95% confidence interval (95%CI) 1.394-20.2015, P=0.014], internal closure and external detachment syndrome (HR=7.941, 95%CI 2.204-28.614, P=0.001), acute physiology and chronic health evaluation Ⅱ score at admission (HR=1.384, 95%CI 0.732-2.617, P=0.008), and Ranson score at admission (HR=1.639, 95%CI 1.165-2.305, P=0.005) were risk factors for the exacerbation of the patients with acute severe pancreatitis. Conclusions　The main traditional Chinese medicine syndrome of patients with acute severe pancreatitis is visceral excess heat syndrome; stasis and toxin combined syndrome and internal closure and external detachment syndrome are the influencing factors for their prognosis.

Clinical Research

Clinical efficacy of drug-coated balloons in percutaneous coronary intervention for patients with unstable angina pectoris caused by coronary heart disease

Ye Fengxiang, Liu Dongtao, Fan Zichen

2024, 30(1):  57-62.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.012

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Objective　To investigate the clinical efficacy of drug-coated balloons in percutaneous coronary intervention (PCI) for patients with unstable angina pectoris caused by coronary heart disease. Methods　Ninety-seven patients with unstable angina pectoris caused by coronary heart disease who underwent percutaneous coronary intervention in Xuzhou Renci Hospital from August 2019 to June 2022 were selected and divided into a control group (48 cases) and an observation group (49 cases) according to the treatment methods. There were 25 males and 23 females in the control group; they were (61.58±4.15) years old. There were 26 males and 23 females in the observation group; they were (61.65±4.22) years old. The control group took stent implantation treatment, and the observation group drug-coated balloon dilation treatment. Both groups were followed up for 12 months. The cardiac function, reference vessel diameters (RVD), minimum lumen diameters (MLD), late stage luminal loss, quality of life, and overall incidences of adverse cardiovascular events were compared between the two groups. t and χ² tests were applied.Results　Before the surgery, the ejection fraction (EF), cardiac output (CO), and cardiac index (CI) in control group were (75.24±7.31) %, (2.63±0.60) L/min and (4.08±0.71) L/ (min•m²), and those in the observation group (74.85±7.26) %, (2.57±0.61) L/min, and (3.37±0.71) L/(min•m²); after the surgery, the EF, CO, and CI in the control group were (86.03±10.17) %, (4.61±0.79) L/min and (4.08±0.71) L/(min•m²), and those in the observation group (86.64±10.23) %, (4.52±0.76) L/min, and (4.15±0.67) L/(min•m²); there were no statistical differences in the cardiac function between the two groups before the surgery (all P>0.05); the EF, CO, and CI increased after the surgery in both groups, with statistical differences between before and after the surgery in both groups (all P<0.05), but no between the two groups after the surgery (all P>0.05). Immediately after surgery, the RVD and MLD in the control group were (2.57±0.29) mm and (0.57±0.14) mm, and those in the observation group were (2.53±0.26) mm and (0.59±0.12) mm, respectively. Twelve months after the surgery, the RVD and MLD in the control group were (2.68±1.09) mm and (2.03±0.33) mm, and those in the observation group were (2.73±1.12) mm and (1.98±0.34) mm, respectively; immediately and 12 months after the surgery, there were no statistical differences in RVD and MLD between the two groups (all P>0.05); twelve months after the surgery, the MLD increased in both groups (both P<0.05), but there were no statistical differences in RVD and MLD between the two groups. Twelve months after the surgery, the late stage luminal loss in the observation group was (0.32±0.20) mm, while that in the control group was (0.36±0.22) mm, with no statistical difference (t=-0.937, P=0.351). There was no statistical difference in the quality of life score between the two groups before the surgery (P>0.05). Twelve months after the surgery, the scores of physiological function, physical pain, physiological function, vitality, social function, overall health, emotional function, and mental health increased in both groups, and the scores of physiological function, overall health, and mental health in the observation group were higher than those in the control group (all P<0.05). Twelve months after the surgery, there was no statistical difference in the total incidence of adverse cardiovascular events between the two groups [12.24% (6/49) vs. 8.33% (4/48); P>0.05]. Conclusion　The application of drug-coated balloons in the treatment of patients with unstable angina pectoris caused by coronary heart disease is equivalent to the stent implantation in effectiveness and safety, but the patients' quality of life after drug-coated balloon treatment is higher.

Ultrasound-guided local comprehensive intervention therapy for patients with large liver cancer

Feng Nankai

2024, 30(1):  62-66.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.013

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Objective　To observe the effect of ultrasound guided local comprehensive intervention therapy for patients with large liver cancer patients. Methods　Ninety-five patients with large liver cancer admitted to First Hospital, Nanyang Medical College from October 2020 to March 2022 were selected for the prospective study. According to the treatment indications, the enrolled patients were divided into a conventional group (45 cases) and an experimental group (50 cases). There were 25 males and 20 females in the conventional group; they were (60.44±5.23) years old. There were 30 males and 20 females in the experimental group; they were (61.32±5.17) years old. The conventional group took transcatheter arterial chemoembolization (TACE), while the experimental group took the comprehensive intervention therapy consisting of percutaneous ethanol injection (PEI), radio frequency ablation (RFA), and TACE. All the patients were followed up for one year. The short-term efficacies and long-term survival of the two groups were compared. χ² and t tests were applied. Results　The overall response rate (ORR) and disease control rate (DCR) in the experimental group were higher than those in the conventional group [80.00% (40/50) vs. 64.44% (29/45) and 90.00% (45/50) vs. 77.78% (35/45)], with statistical differences (χ²=6.034 and 5.525; both P<0.05). Before the treatment, there no statistical differences in the levels of liver function indicators between the two groups (all P>0.05). After the treatment, the levels of alanine transaminase (ALT), glutamic pyruvic transaminase (AST), and total bilirubin (TBil) in the experimental group were lower than those in the conventional group [(50.25±10.17) U/L vs. (56.39±10.47) U/L, (48.24±10.49) U/L vs. (55.16±10.33) U/L, and (15.44±5.28) μmol/L vs. (18.15±5.41) μmol/L], with statistical differences (t=2.897, 3.234, and 2.469; all P<0.05). After the treatment, the incidence of adverse reactions in the experimental group was 30.00% (15/50), which was slightly higher than that in the conventional group [28.89% (13/45)], with no statistical difference (χ²=0.030; P>0.05). The survival rates in the third, sixth, and twelfth months of the follow up in the experimental group were higher than those in the conventional group [96.00% (48/50) vs. 84.44% (38/45), 90.00% (45/50) vs. 75.56% (34/45), and 86.00% (43/50) vs. 68.89% (31/45)], with statistical differences (χ²=7.573, 7.314, and 8.380; all P<0.05). The recurrence rates in the third, sixth, and twelfth months of the follow up in the experimental group were lower than those in the conventional group [8.00% (4/50) vs. 20.00% (9/45), 16.00% (8/50) vs. 28.89% (13/45), and 20.00% (10/50) vs. 33.33% (15/45)], with statistical differences (χ²=5.980, 4.773, and 4.543; all P<0.05). Conclusion　Ultrasound-guided local comprehensive intervention therapy for patients with large liver cancer can enhance the treatment effect, effectively improve their long-term survival rate, and reduce recurrence rate, without significantly affecting their liver function or increasing the risk of adverse reactions.

Effect of laparoscopic radical gastrectomy assisted by sustained inflation on surgical efficacy and risk

Wang Meng, Zhang Shuang, Li Jia

2024, 30(1):  67-71.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.014

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Objective　To observe the impact of laparoscopic radical gastrectomy assisted by sustained inflation (SI) on surgical efficacy and postoperative risk. Methods　One hundred and twelve patients with gastric cancer admitted to First Hospital, Nanyang Medical College from January 2021 to December 2022 were selected for the randomized controlled trial. The enrolled patients were divided into an observation group and a control group by the random number table method, with 56 cases in each group. There were 30 males and 26 females in the observation group; they were (60.35±5.22) years old. There were 33 males and 23 females in the control group; they were (61.23±5.16) years old. All the patients took laparoscopic radical gastrectomy. The control group took routine anesthesia and mechanical ventilation; in addition, the observation group were assisted by SI. The perioperative hemodynamics, respiratory mechanics, oxygenation function, and the incidences of pulmonary complications (PPC) 72 h after the surgery were compared between the two groups. χ² and t were used. Results　There were no statistical differences in hemodynamics, respiratory mechanics, and oxygenation function indicators between the two groups before the establishment of pneumoperitoneum (T₀) (all P>0.05). The heart rates (HR) and mean arterial pressures (MAP) 10 (T₁) and 30 min (T₂) after the establishment of pneumoperitoneum in the observation group were (80.52±10.41) times/min, (115.75±20.61) mmHg (1 mmHg=0.133 kPa), (82.44±10.36) times/min, and (118.45±20.61) mmHg, which were lower than those in the control group [(85.25±10.36) times/min, (130.46±20.17) mmHg, (89.25±10.32) times/min, and (141.44±20.61) mmHg], with statistical differences (t=2.410, 3.817, 3.485, and 5.903; all P<0.05). The differences of alveoli-arterial oxygen pressure (A-aDO₂) and respiratory index (RI) at T₁ and T₂ in the observation group were (125.77±20.61) mmHg, (35.77±5.28), (165.33±30.61) mmHg, and (40.12±10.36), which were lower than those in the control group [(140.33±20.45) mmHg, (38.46±5.61), (192.25±30.72) mmHg, and (47.62±10.35)], with statistical differences (t=3.753, 2.613, 4.645, and 3.833; all P<0.05). The peak airway pressures (Ppeak) and mean airway pressures (Pmean) at T₁ and T₂ in the observation group were (18.44±5.16) mmHg, (6.62±1.77) mmHg, (25.61±5.32) mmHg, and (7.69±2.45) mmHg, which were lower than those in the control group [(21.33±5.62) mmHg, (7.82±2.31) mmHg, (28.45±5.66) mmHg, and (8.95±2.21) mmHg], with statistical differences (t=2.835, 3.086, 2.736, and 2.858; all P<0.05). Within 72 h after the surgery, the incidence of PPC in the observation group was lower than that in the control group [10.71% (6/56) vs. 23.21% (13/56)], with a statistical difference (χ²=5.547, P<0.05). Conclusion　Radical gastrectomy assisted by SI for patients with gastric cancer can effectively maintain the stability of perioperative hemodynamics, respiratory mechanics, and oxygenation function, and is also of great significance in reducing the risk of postoperative PPC.

High flow oxygen therapy in early prone position for patients with pneumonia associated acute respiratory failure

He Yanjia

2024, 30(1):  72-76.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.015

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Objective　To observe the effect of high flow oxygen therapy in early prone position for patients with severe pneumonia related acute respiratory failure and its effect on clinical outcomes. Methods　One hundred and twenty-three patients with pneumonia related acute respiratory failure who were treated at Nanyang First People's Hospital from January 2021 to June 2022 were selected as the study objects, and were divided into a control group (61 cases) and an observation group (62 cases) according to the treatment plans they took. There were 36 males and 25 females in the control group; they were (65.25±5.47) years old. There were 38 males and 24 females in the observation group; they were (66.14±5.28) years old. The control group took routine high-flow oxygen therapy, and the observation group took high-flow oxygen therapy in early prone position. The lung ventilation function and oxygenation function 3 and 7 d after the treatment, treatment status, and clinical outcomes were compared between the two groups. χ² and t tests were used. Results　Under different treatment regimens, the percentage of forced expiratory volume in the first second (FEV1), maximal ventilatory volume (MVV), and volume of alveolar ventilation (VA) 3 d after the treatment in the observation group were higher than those in the control group [(78.25±5.33)% vs. (75.11±5.28)%, (81.44±5.25)% vs. (78.24±5.36)%, and (3.63±0.26) L/min vs. (2.77±0.24) L/min]; the FEV1, MVV, and VA 7 d after the treatment in the observation group were higher than those in the control group [(83.36±5.31)% vs. (81.35±5.28)%, (85.45±5.26)% vs. (82.49±5.18)%, and (4.03±1.21) L/min vs. (3.26±1.19) L/min]. The oxygen partial pressure (PaO₂), oxygen saturation (SaO₂), and oxygenation index (P/F) 3 d after the treatment in the observation group were higher than those in the control group [(78.82±8.64) mmHg (1 mmHg=1.333 kPa) vs. (75.11±8.33) mmHg, (94.36±5.26)% vs. (92.11±5.17)%, and (425.33±20.47) mmHg vs. (411.35±20.36) mmHg]; the PaO₂, SaO₂, and P/F 7 d after the treatment in the observation group were higher than those in the control group [(84.37±10.29) mmHg vs. (79.44±10.77) mmHg, (97.24±3.36)% vs. (95.22±3.31)%, and (492.45±40.65) mmHg vs. (471.35±40.28) mmHg]. After the treatment, the tracheal intubation rate, oxygen inhalation time, and length of ICU hospitalization in the observation group were lower than those in the control group [19.35% (12/62) vs. 32.79% (20/61), (45.33±10.36) min vs. (50.44±10.27) min, and (5.25±1.31) d vs. (6.77±1.61) d], with statistical differences (all P<0.05). After the treatment, the incidence of adverse reactions in the observation group was 11.29% (7/62), and that in the control group was 9.84% (6/61), with no statistical difference (P>0.05). The mortality rate within one month in the observation group was lower than that in the control group [3.23% (2/62) vs. 18.03% (11/61); P<0.05]. Conclusion　High flow oxygen therapy in early prone position for patients with pneumonia related acute respiratory failure can promote their recovery of ventilation and oxygenation function, and has positive significance in optimizing their diagnosis and treatment and improving their poor prognosis.

Atomized ultrafine particle size pentylenethyclidine hydrochloride for patients with airway injury after laryngeal mask general anesthesia who take EBUS-TBNA

Liu Liying, Huang Weiwei, Dai Yanwen

2024, 30(1):  76-80.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.016

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Objective　To observe the effect of aerosol inhalation of ultrafine particle size pentylenethyclidine hydrochloride (PHC) on airway injury in patients after laryngeal mask general anesthesia who take endobronchial ultrasound-guided needle aspiration (EBUS-TBNA), and to analyze its mechanism of action. Methods　One hundred and twenty-six patients who took EBUS-TBNA at Henan Provincial People's Hospital from January 2021 to January 2022 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 63 cases in each group. There were 33 males and 30 females in the observation group; they were 38-72 (55.62±5.69) years old. There were 32 males and 31 females in the control group; they were 40-70 (56.33±5.25) years old. The observation group received nebulized inhalation of ultrafine particle size PHC as the auxiliary laryngeal mask general anesthesia. The control group received dihydroxypropaphylline injection as the auxiliary laryngeal mask general anesthesia. The inflammatory indicators, airway morphological indicators, and changes in ventilation function before and after the surgery and occurrences of postoperative airway injury were compared between the two groups.t and χ² tests were used. Results　After the surgery, the levels of interleukin-13 (IL-13), tumor necrosis factor-α (TNF-α), and fractional exhaled nitric oxide (FeNO) in the observation group were lower than those in the control group [(6.13±2.21) ng/L vs. (8.33±2.45) ng/L, (7.22±2.15) ng/L vs. (9.36±2.77) ng/L, and (23.32±2.17) ppb vs. (26.61±5.41) ppb], with statistical differences (t=5.29, 4.84, and 4.48; all P<0.05). After the surgery, the bronchial basement membrane perimeter (Pbm), total thickness of airway wall, and thickness of airway smooth muscle in the observation group were lower than those in the control group [(1.77±0.24) cm vs. (2.16±0.38) cm, (7.15±2.41) mm²/mm vs. (9.24±2.25) mm²/mm, and (3.44±0.58) mm²/mm vs. (4.41±1.27) mm²/mm], with statistical differences (t=6.89, 5.03, and 5.52; all P<0.05). The forced expiratory volume in the first second, peak expiratory flow (PEF), and forced vital capacity (FVC) in the observation group were higher than those in the control group [(85.22±10.46)% vs. (78.25±10.13)%, (422.74±80.61) L/min vs. (378.25±80.24) L/min, and (2.68±0.46) L vs. (1.92±0.74) L], with statistical differences (t=3.80, 3.11, and 6.92; all P<0.05). After the surgery, the incidence of airway injury in the observation group was lower than that in the control group [9.52% (6/63) vs. 20.63% (13/63)], with a statistical difference (χ²=4.82, P<0.05). Conclusions　Nebulized inhalation of ultrafine particle size PHC assisted laryngeal mask general anesthesia can effectively improve postoperative airway inflammation and ventilation function in patients who take EBUS-TBNA. The mechanism is related to inhibiting airway smooth muscle proliferation and promoting airway morphological recovery.

Clinical effect of low-dose dexamethasone combined with TACE for patients with primary liver cancer 

Song Lingzi, Fan Xiaobin

2024, 30(1):  81-85.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.017

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Objective　To observe the effect of low-dose dexamethasone as an adjunct to transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatic cell carcinoma (HCC). Methods　One hundred and sixteen patients with HCC admitted to First Hospital, Nanyang Medical College from January 2021 to March 2023 were selected for the randomized controlled trial. The enrolled patients were divided into a conventional group and a combined group by the random number table method, with 58 cases in each group. There were 30 males and 28 females in the conventional group; they were (65.33±5.27) years old. There were 33 males and 25 females in the combined group; they were (65.25±5.33) years old. The conventional group took routine liver protection therapy and TACE, while the combined group low-dose dexamethasone and TACE. The levels of inflammatory factors, endothelial cell function indicators, and liver cell function indicators, incidences of postoperative complications, and medication safety were compared between the two groups. χ² and t tests were applied. Results　Before the treatment, there were no statistical differences in the inflammatory factors, endothelial cell function, and liver function between the two groups (all P>0.05). After the treatment, the levels of interleukin-1 (IL-1), IL-6, and tumor necrosis factor-α (TNF-α) in the combined group were lower than those in the conventional group [(80.35±10.24) ng/L vs. (87.22±10.37) ng/L, (6.25±2.14) ng/L vs. (7.69±2.05) ng/L, and (4.25±1.47) μg/L vs. (5.33±2.06) μg/L], with statistical differences (t=3.590, 3.701, and 3.250; all P<0.05). After the treatment, the levels of 6-kelo-prototype graphic framework1α (6-kelo-PGF1α), endothelin-1 (ET-1), and nitric oxide (NO) in the combined group were (175.25±20.61) ng/L, (62.11±10.47) ng/L, and (55.19±10.25) ppb, and those in the conventional group were (158.74±20.33) ng/L, (70.25±10.33) ng/L, and (61.36±10.33) ppb, with statistical differences (t=4.343, 4.215, and 3.229; all P<0.05). The levels of alanine transaminase (ALT) and glutamic-oxaloacetic transaminase (AST) 3 and 5 d after the treatment in the combined group were lower than those in the conventional group [(48.44±5.21) U/L vs. (51.28±5.44) U/L, (47.25±5.38) U/L vs. (50.66±5.28) U/L, (36.77±5.61) U/L vs. (39.19±5.28) U/L, and (37.25±5.35) U/L vs. (40.61±5.23) U/L], with statistical differences (t=2.871, 3.445, 2.392, and 3.420; all P<0.05). The incidences of TACE related complications and drug adverse reactions in the combined group were lower than those in the conventional group [6.90% (4/58) vs. 18.97% (11/58) and 8.62% (5/58) vs. 22.41% (13/58)], with statistical differences (χ²=6.468 and 7.254; both P<0.05). Conclusions　Low-dose dexamethasone assisted TACE for patients with HCC can effectively inhibit the release of inflammatory factors and reduce vascular endothelial damage, and has a positive effect on alleviating their liver function and reducing the risk of postoperative complications. Compared with conventional liver protection drugs, low-dose dexamethasone is safer.

Clinical effects of three surgical methods for patients with moderate to severe pelvic organ prolapse

Zhang Miaomiao, Wu Kunying

2024, 30(1):  86-90.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.018

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Objective　To analyze the clinical effects of three surgical methods in the treatment of patients with moderate to severe pelvic organ prolapse (POP). Methods　One hundred and twenty patients with moderate to severe POP who were treated in Zhengzhou Maternal and Child Health Hospital from October 2020 to October 2022 were selected for the randomized controlled trial. They were divided into group A, group B, and group C by the random number table method, with 40 cases in each group. Group A were (57.16±3.59) years old; there were 24 moderate cases and 16 severe cases in POP staging. Group B were (56.94±3.51) years old; there were 22 moderate cases and 18 severe cases in POP staging. Group C were (56.08±3.54) years old; there were 19 moderate cases and 21 severe cases in POP staging. Group A took vaginal total hysterectomy and anterior-posterior vaginal wall repair; group B took laparoscopic total hysterectomy and high-sacral ligament suspension surgery; group C took laparoscopic total hysterectomy and iliopubic ligament suspension surgery. The perioperative indicators, quality of life, sexual life quality, recurrence rates, and complications were compared between the three groups. χ² test, one-way analysis of variance, and LSD-t test were used. Results　The surgical times of group B [(125.74±31.52) min] and group C [(134.97±38.21) min] were longer than that of group A [(77.45±25.06) minutes]; the intraoperative bleeding volumes of group B [(57.12±21.09) ml] and group C [(55.74±19.53) ml] were lower than that of group A [(90.76±28.91) ml]; the hospitalization times of group B [(5.29±1.46) d] and group C [(5.34±1.29) d] were shorter than that of group A [(6.85±1.53) d]; the hospitalization costs of group B [(23 523.07±5 171.05) yuan] and group C [(24 135.65±5 208.47) yuan] were higher than that of group A [(15 241.35±4 472.18) yuan]; there were statistical differences (all P<0.05). After the surgery, the scores of the pelvic floor dysfunction questionnaire (PFDI-20) in the three groups were lower than those before the surgery, and the scores of the sexual life quality questionnaire (PISQ-12) were higher than those before the surgery; the scores of PFDI-20 in group B [(8.34±2.05)] and group C (8.19±2.41)] were lower than that in the group A [(10.56±2.17); the scores of PISQ-12 in group B [(41.15±2.97)] and group C [(40.87±2.64)] were higher than that in group A [(36.21±3.82)]; there were statistical differences (all P<0.05). The recurrence rate and total incidence of complications in group B and group C were lower than those group A, with statistical differences (all P<0.05). There were no statistical differences between group B and group C in terms of surgical time, intraoperative bleeding volume, time of exhaust, hospitalization time, hospitalization cost, postoperative scores of PFDI-20 and PISQ-12, recurrence rate, and total incidence of complications (all P>0.05). Conclusions　Laparoscopic total hysterectomy combined with high-sacral ligament suspension surgery and with iliopubic ligament suspension surgery for patients with moderate to severe POP both have the advantages of less trauma, fewer complications, faster postoperative recovery, and so on, and can improve their quality of life and sexual life quality. However, these two surgical methods are time-consuming and have relatively high hospitalization cost.

Effect of 38 ℃ thermostatic storage time on safety of three surgical flushers

Wang Bo, Meng Manshi, Chen Xiaming, Chen Cuiwan, Meng Weihao

2024, 30(1):  91-94.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.019

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Objective　To investigate the effect of 38 ℃ thermostatic storage time on the safety of three surgical flushers. Methods　In January 2022, Haikou Hospital Affiliated to Xiangya Medical College, Zhongnan University purchased 0.9% sodium chloride solution in bags, electrocutting solution in bags, and other exhalative solution in bags 480 bags for each as the research objects of this experiment. Four hundred and eighty bags of each of the three surgical flushing solutions were randomly divided into 6 groups. One group was stored at room temperature (21～25 ℃) for 7 days for safety index detection and was set as a blank control group; the other five groups were stored at 38 ℃ for 2, 7, 14, 21, and 28 days, respectively, for safety index detection. One-way analysis of variance was used to compare the data between the groups. Results　The pH values and osmolal pressures of 0.9% sodium chloride solution in the 2, 7, 14, 21, and 28-day heating groups were higher than those in the blank control group, with statistical differences between the groups (F=2.46 and 2.84; both P<0.05). The pH values and osmotic pressure molar concentrations of electrolysis solution in the 2, 7, 14, 21, and 28-day heating groups were higher than those in the blank control group, with statistical differences between the groups (F=6.41 and 14.32; both P<0.05). The pH values and osmotic pressure molar concentrations of exudative solution in the 2, 7, 14, 21, and 28-day heating groups were higher than those in the blank control group, with statistical differences between the groups (F=9.07 and 14.91; both P<0.05). The bacteria culture was negative in all the 3 fluids in the blank control group and the 2, 7, 14, 21, and 28-day heating groups; the appearance of the 3 fluids had no obvious changes; no stratification, turbidity, precipitation, wall hanging, or abnormal odor were found in the 3 fluids. Conclusions　After being stored at 38 ℃ for 28 days, the pH values and osmotic pressure molar concentrations of 9% sodium chloride solution, bag electrolysis solution, and bag exudative solution increased, but all of them were within the safe ranges. At the same time, the three kinds of rinsing solution can maintain the aseptic state, without any stratification, turbidity, precipitation, wall hanging, and abnormal odor, so they can be used safely in clinic.

High-dose caffeine citrate in improvement of respiratory apnea and ventilation in premature infants

He Qing, Tian Jing

2024, 30(1):  95-99.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.020

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Objective　To observe the efficacy and safety of high-dose caffeine citrate assisted mechanical ventilation in the treatment of premature infants with respiratory apnea (AOP). Methods　One hundred and twenty-three children with AOP treated at Nanyang Central Hospital from June 2020 to March 2023 were selected for the randomized controlled trial. The enrolled children were divided into a conventional group (61 cases) and a high-dose group (62 cases) by the random number table method. Both groups received continuous positive airway pressure ventilation; the conventional group received a conventional dose of caffeine citrate to assist ventilation; the high-dose group received the maintenance dose of 10 mg/kg caffeine citrate to assist ventilation. The treatment statuses, improvement of apnea symptoms, improvement of lung function, and treatment safety were compared between the two groups. χ² and t tests were applied. Results　The ventilation time, oxygen usage time, ICU stay time, and hospitalization time in the high-dose group were shorter than those in the conventional group [(4.25±1.33) d vs. (5.28±1.77) d, (4.02±1.47) d vs. (5.14±1.46) d, (5.12±1.36) d vs. (6.65±2.43) d, and (10.25±3.41) d vs. (14.15±5.26) d], with statistical differences (t=3.65, 4.24, 4.32, and 4.89; all P<0.05). The frequencies of apnea episodes within 24, 48, and 72 h of the treatment in the high-dose group were lower than those in the conventional group [(8.44±2.23) times vs. (9.77±2.42) times, (6.36±1.47) times vs. (7.85±2.26) times, and (3.25±0.76) times vs. (4.49±1.47) times], with statistical differences (t=3.17, 4.34, and 5.89; all P<0.05). After the treatment, the tidal volume, peak time ratio, and peak volume ratio in the high-dose group were higher than those in the conventional group [(8.62±2.41) ml/kg vs. (7.33±2.25) ml/kg, (36.77±10.61)% vs. (30.25±10.42)%, and (35.66±10.33)% vs. (29.77±10.41)%], with statistical differences (t=3.07, 3.44, and 3.15; all P<0.05). After the treatment, there was no statistical difference in the incidence of adverse events between the high-dose group and the conventional group [8.06% (5/62) vs. 6.56% (4/61); χ²=0.19; P=0.661]. Conclusions　High-dose caffeine citrate assisted mechanical ventilation in the treatment of children with AOP can effectively improve their symptoms of apnea and recovery process. Compared with the conventional maintenance dose, the high maintenance dose of caffeine citrate does not significantly increase the risk of adverse events, with high safety.

Effect of arthroscopic knotless absorbable suture tape reconstruction for patients with chronic lateral ankle instability caused by anterior talofibular ligament injury

Liu Lei, Li Xuefu, Lyu Shuzhen, Ding Jianing, Hou Hao

2024, 30(1):  99-103.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.021

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Objective　To explore the effect of arthroscopic absorbable knotless suture tape reconstruction for patients with chronic lateral ankle instability caused by anterior talofibular ligament injury. Methods　A total of 110 patients with chronic lateral ankle instability caused by anterior talofibular ligament injury treated in Liaocheng Third People's Hospital from January 2020 to January 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 55 cases in each group. There were 30 males and 25 females in the control group; they were (55.48±3.57) years old. There were 35 males and 20 females in the observation group; they were (56.38±2.64) years old. The control group took traditional ligament repair surgery, and the observation group arthroscopic absorbable knotless suture tape reconstruction surgery. The American Orthopaedic Foot & Ankle Society Scores (AOFAS), Kofoed ankle function scores, and scores of Y balance test (YBT) and Perceived Ankle Instability (PAI) before and 2 months after the surgery, as well as the incidences of complications and pain scores of Visual Analogue Scale (VAS), were compared between the two groups. t and χ² tests were applied. Results　Two months after the surgery, the scores of AOFAS and Kofoed ankle function in the observation group were higher than those in the control group [(90.13±2.89) vs. (79.27±3.28) and (90.29±2.21) vs. (78.44±2.46)], with statistical differences (t=18.424 and 26.575; both P<0.05); the scores of YBT and PAI in the observation group were better than those in the control group [(88.28±2.69) vs. (78.22±1.66) and (3.02±1.22) vs. (5.34±2.30)], with statistical differences (t=23.603 and 6.609; both P<0.05). The scores of VAS 1 and 2 months after the surgery in the observation group were lower than those in the control group [(3.20±1.15) vs. (6.89±1.26) and (1.34±0.54) vs. (4.64±1.12)], with statistical differences (t=16.041 and 19.683; both P<0.05). The incidence of complications in the observation group was lower than that in the control group [16.36% (9/55) vs. 49.09% (27/55)], with a statistical difference (χ²=13.378, P<0.05). Conclusion　Arthroscopic absorbable knotless suture tape reconstruction in the treatment of patients with chronic lateral ankle instability caused by anterior talofibular ligament injury can significantly improve their ankle function and perceived ankle stability and reduce postoperative pain and complications, so it has high clinical application value.

Risk factors of acute cardiotoxicity induced by anthracyclines in patients with breast cancer

Hou Xidong, Zhou Lihua, Wen Yanyan

2024, 30(1):  103-108.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.022

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Objective　To investigate the risk factors of acute cardiotoxicity induced by anthracyclines in patients with breast cancer. Methods　The clinical data of 280 female patients with breast cancer who received anthracycline chemotherapy in Anyang Tumor Hospital from June 2021 to June 2023 were retrospectively analyzed. They were 38 to 67 (52.13±8.43) years old. Their body mass index (BMI) was 19 to 25 (22.49±2.12) kg/m². The general data of all the patients were collected. They were divided into an occurrence group (125 cases) and a non-occurrence group (155 cases) according to the criteria of acute cardiotoxicity. The baseline data of the two groups were compared; the factors with statistical significance in the baseline data were included into the multivariate logistic regression analysis model to screen the risk factors for acute cardiotoxicity in the patients. The statistical analysis was performed by t and χ² tests. Results　The incidence of acute cardiotoxicity was 44.64% (125/280); among them, 5 cases (4.00%, 5/125) had two or more electrocardiograph abnormalities. Acute cardiotoxicity occurred in all the patients within six months after the completion of chemotherapy, and the clinical manifestations of all the patients were abnormal electrocardiogram; the more common ones were sinus tachycardia [26.40% (33/125)], QTC interval change [22.40% (28/125)], T wave change [16.80% (21/125)], etc. The results of univariate analysis showed that the proportions of the patients ≥ 55 years old, with menopause, with history of diabetes, with history of hypertension, with history of hyperlipidemia, and who took the combination of trastuzumab and the combination of dextrazone in the occurrence group was higher than those in the non-occurrence group [32.00% (40/125) vs. 21.29% (33/155), 60.00% (75/125) vs. 18.71% (29/155), 31.20% (39/125) vs. 6.45% (10/155), 29.60% (37/125) vs. 12.90% (20/155), 16.00% (20/125) vs. 7.74% (12/155), 28.00% (35/125) vs. 12.90% (20/155), and 72.80% (91/125) vs. 41.94% (65/155)]; the levels of creatine kinase isoenzyme and α-hydroxybutyrate dehydrogenase in the occurrence group were higher than those in the non-occurrence group [(16.02±6.00) U/L vs. (12.54±5.01) U/L and (139.78±31.75) U/L vs. (132.78±20.45) U/L]; there were statistical differences (χ²=4.12, 50.53, 29.36, 11.90, 4.66, 9.99, and 26.72; t=5.29 and 2.23; all P<0.05). The results of multivariate logistic regression analysis showed that age, menopause, diabetes history, combined trastuzumab, creatine kinase isoenzyme, and α-hydroxybutyrate dehydrogenase were the risk factors for acute cardiotoxicity in the patients (OR=1.015, 17.133, 1.744, 4.096, 4.175, and 2.085; all P<0.05); combined dexrazoxane was a protective factor against acute cardiotoxicity in the patients (OR=0.613, P<0.05). Conclusions　Age, menopause, diabetes history, combined trastuzumab, creatine kinase isoenzyme, and α-hydroxybutyrate dehydrogenase are risk factors for acute cardiotoxicity induced by anthracycline chemotherapy in patients with breast cancer, while combined dexrazoxane is a protective factor. Therefore, relevant clinical measures should be taken accordingly to reduce the incidence of acute cardiotoxicity.

Ticagrelor and clopidogrel for patients with acute cardiac infarction undergoing percutaneous coronary intervention

Li Yuping, Huang Yuna, Zhu Jinhua, Chen Guoxing, Lin Yanxia

2024, 30(1):  109-111.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.023

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Correlation of HPV expression with TAP, CD8, and HLA in laryngeal squamous cell carcinoma and clinical significance

Li Yiqun, Yi Lijun, Chen Qingyong, Li Yunrong, Li Hong, An Shujing

2024, 30(1):  112-119.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.024

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Objective　To detect the expression levels of P16, TAP1, TAP2, HLA, and CD8 in laryngeal squamous cell carcinoma, and to explore the expression levels of TAP1, TAP2, HLA, and CD8 in laryngeal squamous cell carcinoma, and their correlations with HPV infection and the clinical significance. Methods　The tissue wax blocks from 84 patients with laryngeal squamous cell carcinoma surgically removed from Binzhou Medical University Hospital from January 2013 to December 2018 were selected as the study objects, including 68 males and 16 females; they were 45-78 years old, with a median age of 63. The expression levels of P16, TAP1, TAP2, HLA, and CD8 in the 84 cases of laryngeal squamous cell carcinoma was detected by the immunohistochemical EnVision method. The relationship between P16 and the clinicopathological features was analyzed. χ² test, Fisher exact test, and Spearman rank correlation test were used to analyze the correlation between HPV infection and the above protein expression levels. The Kaplan-Meier survival analysis was performed, and the Cox proportional risk regression model was used for the multivariate survival analysis. Results　The positive expression rate of P16 in laryngeal squamous cell carcinoma was 11.9% (10/84), while the expression was negative in the adjacent tissue. The positive rate of CD8 in laryngeal squamous cell carcinoma was 38.1% (32/84), which was lower than that in the adjacent tissue [56% (47/84)]. The positive rates of TAP1, TAP2, and HLA in the laryngeal squamous cell carcinoma tissue were 41.7% (35/84), 29.8% (25/84), and 42.8% (36/84), respectively, which were lower than those in the adjacent tissue [69% (58/84), 56% (47/84), and 57.1% (48/84)]; there was a statistical difference in the expression of TAP2 between the cancer and adjacent tissues (χ²=5.80, P<0.05). The expression of CD8 in the laryngeal squamous cell carcinoma tissue was correlated with clinical stage, and the difference was statistically significant (χ²=6.57, P<0.05). The expressions of TAP1, TAP2, HLA, and P16 were not correlated with the clinicopathological factors. The Spearman correlation analysis showed that the TAP1 expression was positively correlated with TAP2 and CD8 (r= 0.295 and 0.232, both P<0.05), and the HLA expression was positively correlated with the CD8 expression (r=0.232, P<0.05). Conclusion　The low expression levels of TAP1, TAP2, HLA, and CD8 in laryngeal squamous cell carcinoma tissue suggests that the tumor may down-regulate TAP1 and TAP2, resulting in abnormal HLA expression, thereby inhibits the immune response of CD8 and the immune response of the body, providing theoretical support for the mechanism of tumor immune escape.

Application of ultrasound-guided transverse abdominis plane block and hydromorphone in elderly patients after laparoscopic radical resection of colon cancer 

Zeng Yingyin, Wu Dongliang, Wang Pengxia, Cheng Sen, Liu Shanshan

2024, 30(1):  120-124.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.025

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Objective　To evaluate the effect applying ultrasound-guided transverse abdominis plane block (TAP) and hydromorphone in fast-track surgery (FTS) after laparoscopic radical resection for elderly patients with colon cancer. Methods　Two hundred and two elderly patients with colon cancer who underwent laparoscopic radical resection at Hospital of 73rd Group Army from April 2020 to April 2023 were selected for the randomized controlled trial, including 122 males and 80 females who were 65-85 years old. The patients were divided into a TAP group (67 cases), a TAP+H group (68 cases), and an H group (67 cases) by the random number table method. The TAP group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP; the TAP+H group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP and hydromorphone by intravenous analgesia pumps; the H group were given hydromorphone by intravenous analgesia pumps. The heart rates (HR), mean artery pressures (MAP), pain scores of Visual Analogue Scale (VAS), and numbers of injections of intravenous salvage analgesics 1, 8, and 48 h after the surgery and incidences of adverse reactions were compared between the 3 groups. t test and rank sum test were used. Results　One and eight hours after the surgery, the HR's and MAP's in the H group were higher than those in the TAP+H group [(83.93± 5.61) times/min vs. (80.62± 7.10) times/min, (88.28±4.79) mmHg (1 mmHg=0.133 kPa) vs. (81.97+5.12) mmHg, and (84.78±4.08) times/min vs. (81.18±3.90) times/min, and (91.54±5.33) mmHg vs. (82.32±5.60) mmHg], with statistical differences (t=2.01, 2.38, 2.15, and 2.04; all P<0.05). Eight and forty-eight hours after the surgery, the HR's and MAP's in the TAP group were higher than those in the TAP+H group [(85.84± 5.21) times/min vs. (81.18± 3.90) times/min, (85.61±4.91) mmHg vs. (82.32±5.60) mmHg, (87.32± 4.51) times/min vs. (86.10± 3.40) times/min, and (93.51±6.17) mmHg vs.(90.22±4.85) mmHg], with statistical differences (t=2.36, 2.83, 2.00, and 2.21; all P<0.05). Within 48 h after the surgery, the incidences of nausea and vomiting and the incidences of headache and dizziness in the TAP group (19.4% and 1.5%) and the TAP+H group (25.0% and 4.4%) were relatively lower. Conclusions　The application of ultrasound-guided transverse abdominis plane block combined with hydromorphone in fast-track surgery of elderly patients taking laparoscopic radical resection for colon cancer is effective. It enhances the analgesic effect, reduces the elderly patients' postoperative physical stress response and adverse reactions, promotes their independent eating, and achieves fast recovery.

Clinical characteristics and pregnancy outcomes of women with postplacental hematoma versus subchorionic hematoma

Zhang Yuntao, Chen Lijun

2024, 30(1):  125-129.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.026

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Objective　To explore the clinical characteristics of women with retroplacental hematoma and subchorionic hematoma, and to compare their pregnancy outcomes to enhance the clinical understanding of such hematomas. Methods　The clinical data of 160 women with intrauterine hematoma who delivered at Qilu Hospital of Shandong University from April 2021 to September 2022 and were found in the second trimester of pregnancy were collected and analyzed retrospectively. They were 20-40 years old. The gestational weeks were 12-25⁺² weeks. According to the types of hematoma, they were divided into a retroplacental hematoma group and a subchorionic hematoma group, with 80 cases in each group. The clinical characteristics and pregnancy outcomes of the two groups were comprehensively compared and analyzed. t test and χ² test were used for the statistical analysis. Results　The incidence of fetal distress in the retroplacental hematoma group was higher than that in subchorionic hematoma group [13.75% (11/80) vs. 2.50% (2/80)], with a statistical difference (χ²=6.782,P=0.009). The incidence of full-term pregnancy in the retroplacental hematoma group was lower than that in the subchorionic hematoma group [56.25% (45/80) vs. 87.50% (70/80)], with a statistical difference (χ²=19.324, P<0.001). The incidence of premature delivery in the retroplacental hematoma group was higher than that in the subchorionic hematoma group [27.50% (22/80) vs. 5.00% (4/80)], with a statistical difference (χ²=14.879, P<0.001). The incidences of premature rupture of membranes, abnormal placenta, and residual placenta in the postplacental hematoma group were higher than those in the subchorionic hematoma group [40.00% (32/80) vs. 12.50% (10/80), 37.50% (30/80) vs. 12.50% (10/80), and 31.25% (25/80) vs. 7.50% (6/80)], with statistical differences (χ²=15.626, 13.333, and 14.444; all P<0.001). The gestational weeks of delivery in the postpartum hematoma group was shorter than that in the subchorionic hematoma group [(36.12±3.02) weeks vs. (38.12±2.89) weeks], with a statistical difference (t=4.280, P<0.001). The newborns' body weight in the postpartum hematoma group was lower than that in the subchorionic hematoma group [(3 025.25±562.02) g vs. (3 323.21±578.25) g], with a statistical difference (t=3.096, P=0.002). The incidence of neonatal diseases (neonatal pneumonia, neonatal hyaline membrane disease, and neonatal hemolysis) in the retroplacental hematoma group was higher than that in the subchorionic hematoma group [17.91% (12/67) vs. 2.70% (2/74)], with a statistical difference (χ²=9.093, P=0.003). Conclusions　There are significant differences between women with retroplacental hematoma and subchorionic hematoma in hematoma volume, delivery gestational weeks, and pregnancy outcomes; the former is more likely to cause adverse pregnancy outcomes, so it is necessary to be vigilant and take effective intervention measures in time to reduce the incidence of adverse pregnancy outcomes.

Basic Research

Molecular mechanism of filiform needling and fire needling therapies in treatment of rat models of myelosuppression

Yang Xiaolin, Li Yan

2024, 30(1):  130-136.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.027

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Objective　To explore the molecular mechanism of filiform needling and fire needling in the treatment of myelosuppressive rat models. Methods　The study was from March to September 2022. Ninety-six SD rats who were 4-6 weeks old and whose body weight was 250-300 g were bought from Charles River. The rats were divided into a control group, a model group, a fire needle group, and a filiform needle group, with 24 in each group. Except the control group, the rats in the other groups were induced by cyclophosphamide (CTX) to establish the rat bone marrow suppression models. After the models were established successfully, the rats in the control group and the model group were grasped and fixed every day, but took no treatment. The rats in the fire needle group were fixed on the mouse boards in prone position according to the numbers, and took vertical acupuncture on their Zusanli points at 3 mm depth on both sides on the first, third, fifth, and seventh days after the modeling with the fire needles once every other day, for 7 consecutive days, and the needles were not left in the points. The rats in the filiform needle group were fixed on the mouse boards in prone position according to the numbers; the needles and acupoints were the same as those in the fire needle group; the needles were vertically punctured 3 mm into the points, and were left there for 6 min; the treatment started on the first day after modeling, once a day for 7 consecutive days. Ten μl blood was collected from the tail vein of the rats on the first to seventh days of intervention to measure the numbers of white and red blood cells and platelets, hemoglobin, and other blood routine indicators. The bone marrow tissue sections were made for for Wright's Giemsa staining. The flow cytometry was used to detect the bone marrow mononuclear fibroblast cycles. The expressions of cycle-related proteins in the bone marrow mononuclear fibroblasts were detected by Western blotting. LSD-t test, one-way analysis of variance, and Kruskal-Wallis test were applied. Results　The numbers of white blood cells and platelets in the model group were lower than those in the control group (all P<0.05), while the numbers of red blood cells and the contents of hemoglobin in the model group were higher than those in the control group (all P<0.05). One, five, and seven days after the treatment, the numbers of white blood cells [(3.53±0.19)×10⁹/L and (3.42±0.22)×10⁹/L vs. (3.12±0.10)×10⁹/L; (3.78±0.23)×10⁹/L and (3.65±0.29)×10⁹/L vs. (2.88±0.24)×10⁹/L; (4.08±0.43)×10⁹/L and (3.70±0.17)×10⁹/L vs. (2.27±0.12)×10⁹/L] and platelets [(79.72±3.89)×10⁹/L and (79.15±5.22)×10⁹/L vs. (70.17±2.20)×10⁹/L; (85.18±3.40)×10⁹/L and (81.88±4.97)×10⁹/L vs. (62.73±3.80)×10⁹/L; (92.18±7.64)×10⁹/L and (83.45±4.29)×10⁹/L vs. (51.92±1.64)×10⁹/L] in the fire needle group and the filiform needle group were higher than those in the model group (all P<0.05); the numbers of red blood cells [(1.36±0.03)×10¹²/L and (1.37±0.03)×10¹²/L vs. (1.52±0.03)×10¹²/L; (1.32±0.03)×10¹²/L and (1.34±0.02)×10¹²/L vs. (1.59±0.02)×10¹²/L; (1.24±0.07)×10¹²/L and (1.32±0.05)×10¹²/L vs. (1.68±0.03)×10¹²/L] and the contents of hemoglobin [(84.00±1.67) g/L and (84.33±1.86) g/L vs. (94.00±1.26)g/L; (82.00±2.68) g/L and (83.50±0.84) g/L vs. (97.83±1.17)g/L; (76.67±5.32) g/L and (81.83±3.43) g/L vs. (104.17±2.04) g/L] in the fire needle group and the filiform needle group were lower than those in the model group (all P<0.05). The numbers of bone marrow blast cells in the filiform needle group and the fire needle group were higher than that in the model group, and the rod-shaped nuclei cells were found. The percentages of bone marrow mononuclear fibroblasts in the G0/G1 phase were lower than those of the model group (all P<0.05); the change in the fire needle group was more significant than that in the filiform needle group, and the percentages of bone marrow mononuclear fibroblasts in the S phase and G2/M phase were always higher than those in the model group (all P<0.05). The relative expressions of CD4, CD6, Cylcin D1, and E2F1 proteins in the rat bone marrow mononuclear fibroblasts were significantly up-regulated in the filiform needle group and fire needle group 3 and 7 d after the treatment (all P<0.05). The expressions of cell cycle-related proteins, CD4, CD6, Cylcin D1, and E2F1, were more significantly up-regulated in the fire needle group. Conclusions　Filiform needling and fire needling both can improve cyclophosphamide-induced myelosuppression in rats. The molecular mechanism may be related to up-regulating the expressions of cell cycle-related proteins, CD4, CD6, Cylcin D1, and E2F1, in rat bone marrow mononuclear fibroblasts, thereby restoring the metabolic balance of proliferation and dormancy in bone marrow stromal cells.

Case Report

One child with giant gastric mucosal hypertrophy and literature review

Huang Meiying, Liao Binghua

2024, 30(1):  137-140.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.028

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This article analyzes a boy with giant gastric mucosal hypertrophy. This boy was 13 years old and was admitted to Second Hospital, Chinese University of Hong Kong (Shenzhen) on June 27, 2022 because of dizziness for half year and pale look for 2 months. The boy took physical examination, laboratory pathological examination, and electrolytes, renal function, cardiac enzymes, and other laboratory examinations, as well as 4-hour urine protein quantification, urine microalbumin test, and blood cell morphology examination. If the patients with giant gastric mucosal hypertrophy have mild symptoms, they are symptomatically treated. Gastrectomy may be considered when long-term stubborn bleeding causes anemia, the symptoms of anemia are severe, and various treatments are ineffective. Patients with high gastric acid secretion complain of stomach pain should be treated with antacids and antispasmodics. From the long-term perspective of clinical treatment and prevention, medical staff should not neglect the long-term development of the disease.

Nursing care of a patient with esophageal and mediastinal fistula caused by a fishbone stuck in larynx

Wang Yanyan, Su Xiangfen, Nie Anliu

2024, 30(1):  141-144.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.029

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Perforation of the esophagus is a surgical emergency with a mortality rate as high as 40%-60% if it is complicated with septicemia, mediastinal abscess, and multiple organ failure. The clinical data of a patient with esophageal and mediastinal fistula caused by a fishbone stuck in the larynx admitted to First Hospital, Guangzhou Medical University in 2022 was retrospectively analyzed. The patient was treated with splitting the left half of sternum, incising neck abscess, mediastinal abscess exploration and drainage, and left subclavian vein suture hemostasis because of mediastinal abscess. After the management of artificial airway, effective drainage of mediastinal drainage tube, nutritional support, psychological nursing, and other nursing measures, the patient was cured and discharged on the 92nd day after the surgery. By summarizing and analyzing the treatment and nursing of this case, this article may provide some references for future related research.

Nursing Care for Patients with Pulmonary Disease

Refined nursing based on three-dimensional space model for patients with AECOPD and respiratory failure 

Zong Haiyan, Zhu Ye

2024, 30(1):  145-150.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.030

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Objective　To explore the effect of refined nursing based on the three-dimensional space model for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure. Methods　Ninety-eight patients with AECOPD and respiratory failure admitted to Wuxi Second People's Hospital from August 2020 to March 2022 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 49 cases in each group. There were 31 males and 18 females in the control group; they were 51-79 (64.56±8.15) years old. There were 29 males and 20 females in the observation group; they were 53-80 (66.23±7.36) years old. The control group took routine care; in addition, the observation group took refined nursing based on the three-dimensional space model. The self-care abilities, arterial blood gas indicators, pulmonary function indicators, quality of life before and after the nursing and the incidences of complications were compared between the two groups. t and χ² tests were applied. Results　After the nursing, the scores of self-nursing skills, health knowledge, self-concept, and self-care responsibility were higher than those before the control group; the scores in the observation group were higher than those in the control group [(40.92±10.23) vs. (33.56±8.39), (49.83±12.21) vs. (39.62±9.91), (32.96±8.24) vs. (23.49±5.87), and (28.76±7.19) vs. (22.26±5.57)], with statistical differences (t=3.89, 4.55, 6.55, and 5.00; all P<0.05). After the nursing, the oxygen saturation (SaO₂), arterial oxygen partial pressure (PaO₂), percentage of forced vital capacity (FVC%), percentage of forced expiratory volume in the first second to the expected value (FEV₁%), and the percentage of forced expiratory volume in the first second to the forced vital capacity (FEV₁/FVC%) were higher than those before the nursing in both groups (all P < 0.05); the SaO₂, PaO₂, FVC%, FEV₁%, FEV₁/FVC%, and partial pressure of carbon dioxide (PaCO₂) in the observation group were better than those in the control group [(96.86±24.22)% vs. (84.12±21.03)%, (88.79±22.19) mmHg (1 mmHg=0.133 kPa) vs. (73.21±18.30) mmHg, (2.63±0.66)% vs. (2.29±0.57)%, (1.46±0.37)% vs. (1.28±0.32)%, (0.67±0.17)% vs. (0.58±0.15)%, and (46.58±11.65) mmHg vs. (58.67±4.67) mmHg], with statistical differences (t=2.78, 3.78, 2.73, 2.58, 2.78, and 4.52; all P<0.05). After the nursing, the scores of disease effect and symptom and the total score of St. George's Respiratory Questionnaire (SGRQ) were lower and the score of activity ability was higher than those before the nursing in both groups; the scores in the observation group were better than those in the control group [(20.74±4.15) vs. (29.46±5.89), (37.86±7.57) vs. (49.58±9.92), (29.56±7.39) vs. (38.76±9.69), and (62.85±12.57) vs. (52.32±10.46)], with statistical differences (t=8.47, 6.58, 6.61, and 4.51; all P<0.05). The total incidence of complications in the observation group was lower than that in the control group [6.12%(3/49) vs. 24.49%(12/49)], with a statistical difference (χ²=5.04; P<0.05). Conclusion　Refined nursing based on the three-dimensional space model for patients with AECOPD and respiratory failure is conducive to improving their lung ventilation function, self-care ability, and quality of life and reducing the incidence of complications, so it is worthy of clinical promotion.

Application of respiratory training combined with respiratory tract management in patients after radical lung cancer surgery

Bian Yuxia, Zhao Haitao, Tu Youyan

2024, 30(1):  151-155.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.031

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Objective　To analyze the effects of respiratory training combined with respiratory tract management on inflammatory indicators and clinical recovery of patients after radical lung cancer surgery. Methods　The clinical data of 80 patients with lung cancer who received radical resection of lung cancer in Lianyungang Hospital of Traditional Chinese Medicine from January 2019 to December 2022 were retrospectively analyzed. The 40 patients who received routine respiratory training and nursing were set as a control group, including 26 males and 14 females who were 59-76 (67.53±2.41) years old. The 40 patients who received respiratory training combined with respiratory management and nursing during the same period were set an observation group, including 27 males and 13 females who were 57-76 (66.97±2.41) years old. The levels of lung function recovery and inflammatory indicators and related complications were compared between the two groups. χ² and t tests were applied. Results　After the nursing, the forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume in the first second (FEV1) in the observation group were higher than those in the control group [(3.41±0.63) L vs. (3.02±0.51) L, (4.23±0.64) L/min vs. (3.81±0.72) L/min, and (1.71±0.43) L vs. (1.43±0.59) L], with statistical differences (t=3.04, 2.76, and 2.43; all P<0.05). After the nursing, the levels of interleukin-8 (IL-8), IL-10, and tumor necrosis factor-α (TNF-α) in the observation group were lower than those in the control group [(21.98±5.48) μg/L vs. (25.53±5.68) μg/L, (23.08±6.05) μg/L vs. (27.54±5.56) μg/L, and (23.97±6.45) pg/L vs. (28.53±6.25) pg/L], with statistical differences (t=2.85, 3.43, and 3.21; all P<0.05). The incidences of complications after the surgery in the observation group was lower than that in the control group [5.00% (2/40) vs. 20.00% (8/40)], with a statistical difference (χ²=4.11, P<0.05). Conclusion　Respiratory training combined with respiratory tract management for patients after radical lung cancer surgery can effectively improve their recovery of lung function and reduce the levels of inflammatory indicators and the occurrence of related complications.

Effect of hospice care of dignity therapy on hope level of patients with advanced lung cancer

Zhang Chunxiao, Sun Xiaoping

2024, 30(1):  155-159.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.032

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Objective　To explore the effect of hospice care of dignity therapy on the hope level of patients with advanced lung cancer. Methods　A total of 116 patients with advanced lung cancer admitted to Wuxi Second People's Hospital from October 2022 to April 2023 were selected as the study objects. They were divided into an observation group and a control group by the random number table method, with 58 cases in each group. There were 37 males and 21 females in the observation group; they were (64.69±5.63) years old. There were 36 males and 22 females in the observation group; they were (65.78±5.79) years old. The observation group took hospice care of dignity therapy, and the control group routine nursing. The hope levels, quality of life, and psychological states in the two groups were compared. t and χ² tests were used. Results　Before the nursing, there was no statistical difference in the hope level between the 2 groups (P>0.05). After the nursing, the total hope level and life quality score were lower than those before the nursing in both groups (all P<0.05); the scores in the observation group were higher than those in the control group [(39.67±1.47) vs. (35.17±3.05) and (84.72±5.18) vs. (67.96±5.22); both P<0.05]. The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale(SDS) were lower after than before the nursing in both groups; the scores in the observation group were lower than those in the control group after the nursing [(43.52±1.36) vs. (45.58±1.40) and (46.83±1.07) vs. (47.96±1.10); both P<0.05]. The nursing satisfaction of the observation group was higher than that of the control group [91.38% (53/58) vs. 68.97% (40/58)], with a statistical difference (P<0.05). Conclusion　Hospice care of dignity therapy for patients with advanced lung cancer can effectively improve their hope level, quality of life, psychological state, and nursing satisfaction.

Influence of empathic nursing combined with multidimensional health education guidance on patients with pulmonary tuberculosis

Sun Xiuxiang, He Junning, Wang Pengyan

2024, 30(1):  160-163.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.033

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Objective　To explore the influence of empathic nursing combined with multidimensional health education guidance on the quality of life and bad moods of patients with pulmonary tuberculosis. Methods　One hundred and ninety-eight patients with pulmonary tuberculosis treated at Qishan Hospital from May 2017 to September 2019 were selected, and were divided into a conventional group, (44.96±11.08) years old, and an experimental group, (45.14±11.15) years old, by the random number table method, with 99 cases in each group. The conventional group were given multidimensional health education guidance; in addition, the experimental group were given empathic nursing. The scores of the Quality of Life Scale (QOL) and Hamilton Anxiety Scale (HAMA), compliance rates, and incidences of adverse events were compared between the two groups. χ² and t tests were applied. Results　The scores of QOL of the experimental group and the conventional group were (22.85±4.35) and (22.85±4.96) before the nursing intervention, and were (46.95±6.85) and (40.54±5.32) after the nursing intervention; the scores in both groups were lower after than before the treatment; the score in the experimental group was lower than that in the control group after the nursing intervention (t=7.354, P<0.001). The scores of HAMA of the experimental group and the conventional group were (35.82±3.85) and (35.06±3.72) before the nursing intervention, and were (21.10±2.58) and (26.85±3.14) after the nursing intervention; after the nursing intervention, the scores of HAMA in the two groups were lower than those before the nursing intervention; the score of the experimental group was lower than that of the conventional group (t=17.068, P<0.001). One week after the nursing intervention, the compliance rate of the experimental group was higher than that of the conventional group [92.93% (92/99) vs. 80.81% (80/99); χ²=6.373, P=0.012]. The incidence of adverse events in the experimental group was lower than that in the conventional group [3.03% (3/99) vs. 12.12% (12/99); χ²=5.843, P=0.016]. Conclusion　Empathic nursing combined with multidimensional health education guidance for patients with pulmonary tuberculosis can improve their quality of life, adverse moods, and compliance rate, and effectively reduce the occurrence of adverse events during nursing.

Nursing Research

Influence of timely incentive nursing on psychological status of patients with skin cancer

Zhang Yurong, Fan Xing, Xu Fangfang, Shan Huihui

2024, 30(1):  164-168.  DOI: 10.3760/cma.j.issn.1007-1245.2024.01.034

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Objective　To analyze the effect of timely incentive nursing on the psychological status of patients with skin cancer. Methods　The clinical data of 120 patients with skin cancer admitted to Department of Dermatology, Henan People's Hospital from January 2021 to January 2023 were retrospectively analyzed. The 60 patients who took routine care were set as a control group, including 32 men and 28 women who were (41.20±2.01) years old; the 60 patients who took timely incentive nursing were set as an observation group, including 29 men and 31 women who were (41.30±2.33) years old. Through hospital observation and follow-up visit, the patients' psychological statuses were evaluated by Symptom Checklist 90 (SCL-90), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) 1 d before and 30 d after the surgery. The treatment compliance levels were compared between the two groups. The patients' survival quality was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). t and χ² tests were applied. Results　One day before the surgery, there were no statistical differences in the scores of SCL-90, SAS, SDS, EORTC QLQ-C30, and treatment compliance between the two groups (all P>0.05). Thirty days after the surgery, the scores of SCL-90, SAS, and SDS in the observation group were lower than those in the control group [(94.38±5.17) vs. (96.35±2.06), (29.41±2.35) vs. (30.32±1.36), and (27.18±1.11) vs. (28.20±2.35)], with statistical differences (t=2.742, 2.596, and 3.040; P=0.007, 0.011, and 0.003). The scores of treatment plan compliance, rehabilitation plan compliance, and recheck plan compliance of the Treatment Compliance Scale in the observation group were higher than those in the control group [(3.51±0.72) vs. (3.25±0.64), (3.19±0.36) vs. (3.06±0.25), and (2.63±0.55) vs. (2.32±0.48)], with statistical differences (t=2.091, 2.297, and 3.289; P=0.039, 0.023, and 0.001). The scores of positive and negative items of EORTC QLQ-C30 in the observation group were better than those in the control group [(45.98±6.04) vs. (43.15±5.77) and (29.33±4.06) vs. (31.15±3.12)], with statistical differences (t=2.624 and 2.753; P=0.010 and 0.007). Conclusion　Timely incentive nursing for patients with skin cancer can significantly improve their psychological state, treatment compliance level, and survival quality.

Effect of family cooperative management mode combined with resistance exercise training on quality of life of children with rheumatoid arthritis

Lu Yuting, Zhang Ruyu, Ji Fuxin

2024, 30(1):  169-173.  DOI: 10.3760/cma.j.issn.1007-1245.2023.24.035

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Objective　To explore the effect of family cooperative management mode combined with resistance exercise training in the improvement of the quality of life of children with rheumatoid arthritis. Methods A total of 120 children with rheumatoid arthritis admitted to Children's Hospital Affiliated to Zhengzhou University from February 2021 to December 2022 were selected for the prospective study, and were divided into a conventional group and an experimental group by the random number table method, with 60 cases in each group. There were 26 males and 34 females in the conventional group; they were (12.03±1.49) years old. There were 25 males and 35 females in the experimental group; they were (12.15±1.47) years old. The conventional group took traditional nursing measures. The experimental group took family cooperative management mode and resistance exercise training to intervene and train the family members of the children.Both groups were treated for 3 months. The hand grip strength and scores of pain and fatigue before and after the intervention were compared between the two groups. The quality of life of the two groups after the intervention was assessed. The negative emotion scores before and after the intervention were compared between the two groups. The satisfaction rating table was used to investigate the satisfaction degrees of the two groups. χ² and t tests were applied. Results　Before the intervention, there were no statistical differences in the hand grip strength and scores of pain and fatigue between the two groups (all P>0.05); after the intervention, the hand grip strength and scores of pain and fatigue in the experimental group were better than those in the conventional group (all P<0.05). After the intervention, the scores of physical function, mental function, health status, and social function in the experimental group were higher than those in the conventional group (all P<0.05). Before the intervention, there were no statistical differences in negative emotion scores between the two groups (both P>0.05); after the intervention, the scores of Self-rating Anxiety Scale and Self-rating Depression Scale in the experimental group were lower than those in the conventional group [(45.17±4.03) vs. (57.98±5.16) and (41.73±4.46) vs. (54.74±5.32)], with statistical differences between the two groups (both P<0.05). The total satisfaction of the experimental group was higher than that of the conventional group [96.67% (58/60) vs. 81.67% (49/60)], with a statistical difference (χ²=6.988, P=0.008). Conclusion　Family cooperative management mode combined with resistance exercise training for children with rheumatoid arthritis can improve their quality of life, relieve their pain and fatigue, and reduce their anxiety and depression, with high patient satisfaction.