Table of Content

15 January 2024, Volume 30 Issue 2

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New Medical Advances

Progress in treatment techniques for femoral shaft fractures in children

Sun Hongshuo, Zhang Zhibo, Li Peng, Du Gangqiang, Jiang Jianhao, Yang Shuye

2024, 30(2):  177-181.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.001

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Femoral shaft fractures during childhood are a frequent type of fractures, comprising 1.4%-1.7% of all childhood fractures. The children's age, weight, type of fractures, and mode of injuries all need to be taken into consideration when deciding on the best treatment. Generally, non-invasive fixation methods, such as Pavlik sling or hip herringbone cast, are used for preschool children, while internal fixation methods, such as plates, flexible intramedullary nails, and locked intramedullary nails, are preferred for school-age children. External fixation, on the other hand, is typically reserved for special cases, such as complex trauma. This article reviews the progress of research on treatment techniques for childhood femoral shaft fractures, including conservative treatment, external fixation, and closed reduction.

Review of near-infrared spectroscopy for sports injuries and functionality

Zhang Hao, Cao Zhijie, Li Xuemei, Xu Gongcheng, Li Min, Qi Hongkai, Li Zengyong, Li Wei

2024, 30(2):  182-186.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.002

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With the rise of national sports, the occurrence of sports injuries increases year by year, and at the same time, with the improvement of people's economic life, more attention is paid to the rehabilitation after sports injuries. Most of the current sports injury rehabilitation treatments mainly focus on limb function rehabilitation, but the changes in the brain function after sports injuries have also begun to receive attention from the researchers. Functional near-infrared spectroscopy (fNIRS) can be better applied in the detection of brain function in patients with sports injuries due to its anti-interference and portability. This paper summarizes the research results of sports injury rehabilitation and fNIRS, discusses the current situation and research progress of sports injury rehabilitation, and analyzes fNIRS and its application value in the study of the neural control mechanism of injured limbs after sports injuries, which puts forward new ideas to further enhance the rehabilitation effect of sports injuries.

Research progress in the preoperative evaluation methods of visceral pleural invasion

Zhuo Xuefeng, Liu Jianwei, Huang Bingtao, Zhang Jingjing, Zhang Jingyu

2024, 30(2):  187-191.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.003

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The mortality rate of lung cancer has ranked first in the world for malignant tumors. As one of the independent risk factors for the poor prognosis in patients with early-stage lung cancer, visceral pleural invasion (VPI) is closely related to the occurrence of pleural effusion in lung cancer patients, and is an important factor in predicting recurrence and metastasis after surgery. Preoperative assessment of the patients' presence of VPI is critical to the development of surgical regimen and the choice of postoperative adjuvant therapy. Although CT remains the most commonly used method for preoperative evaluation of the presence of VPI in lung cancer patients, it has significant limitations. In recent years, with the advancement of science and technology, many new methods for evaluating VPI have been applied clinically to improve the accuracy of evaluation. This study reviews the research progress of preoperative evaluation methods for VPI in patients with early-stage lung cancer.

Meta Analysis

Comprehensive evaluation of the efficacy, quality of survival, and safety of tacrolimus in the treatment of myasthenia gravis: a meta-analysis

Li Zhenzhen, Zhang Chengjuan, Hao Huihui, Ding Chuanhua, Liu Wenshan

2024, 30(2):  192-199.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.004

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Objective　To evaluate the efficacy, quality of survival, and safety of tacrolimus in the treatment of myasthenia gravis by meta-analysis. Methods　We searched CNKI, Wanfang Database, Vip Database, Web of Science, OVID, and Cochrane Library Database, and extracted the control studies of tacrolimus in the treatment of myasthenia gravis from the establishment of databases to May 2023. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, extracted the data, and evaluated the quality of included literatures by using the risk bias evaluation tool of Cochrane Collaboration Network. The data were analyzed by using RevMan 5.3 software. Results　A total of 1 007 patients were included in 14 studies, including 521 patients in the experimental group and 486 patients in the control group. The results of meta-analysis showed that the effective rate of the experimental group was higher than that of the control group [OR=5.68, 95%CI (3.33, 9.67), P<0.000 01]; the score of activities of daily living (ADL) in the experimental group was higher than that in the control group [SMD=1.37, 95%CI (1.10, 1.64), P<0.000 01]; the Quantitative MG Scoring System (QMG) score of the experimental group was lower than that of the control group [SMD=-0.47, 95%CI (-0.86, -0.09), P=0.02]; the 6 indexes of Busch score (role function, physical function, cognitive function, 6 vital forces, social function, and emotional function) in the experimental group were lower than those in the control group [SMD=-1.17, 95%CI (-1.50, -0.85), P<0.000 01; SMD=-1.72, 95%CI (-2.07, -1.37), P<0.000 01; SMD=-0.69, 95%CI (-1.00, -0.39), P<0.000 01; SMD=-1.15, 95%CI (-1.47, -0.83), P<0.000 01; SMD=-1.98, 95%CI (-2.67, -1.29), P<0.000 01; SMD=-0.69, 95%CI (-1.00, -0.39), P<0.000 01; SMD=-1.14, 95%CI (-1.78, -0.49), P=0.000 5]; the Manual Muscle Test (MMT) score of the experimental group was lower than that of the control group [SMD=-2.09, 95%CI (-2.80, -1.39), P<0.000 01]; there was no statistically significant difference in the Xu's absolute score between the experimental group and the control group [SMD=-0.34, 95%CI (-0.87, 0.19), P=0.21]; there was no statistically significant difference in the incidence of adverse reactions between the experimental group and the control group [OR=0.93, 95%CI (0.48, -1.80), P=0.83]. Conclusion　Tacrolimus can better improve the severity of myasthenia gravis patients and improve the patients' quality of life, with reliable safety. However, due to the quality limitation of the included studies, large-sample, multi-center, and high-quality randomized controlled trials are still needed to confirm its clinical efficacy and safety.

Meta-analysis of butorphanol and tramadol on chills and safety in puerperae undergoing cesarean section under combined spinal-epidural anesthesia

Zhang Chenxi, Zhao Lifang, Pang Peng, Zhang Yong

2024, 30(2):  200-204.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.005

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Objective　To evaluate the effects of butorphanol tartrate and tramadol on the control of chills and the incidence of adverse reactions such as nausea and vomiting during cesarean section under combined spinal-epidural anesthesia by using a meta-analysis system. Methods　The randomized controlled trials (RCTs) of butorphanol tartrate and tramadol on the control of chills during cesarean section under combined spinal-epidural anesthesia were retrieved from the establishment of Chinese databases such as VIP, Wanfang, and CNKI and English databases such as PubMed, EMbase, and Cochrane library to December 2022. Cochrane quality evaluation scale was used to evaluate the quality of the selected literatures, and RevMan 5.3 was used to conduct statistical analysis on the contents of the literatures. Results　A total of 15 RCTs including 1 293 patients were included in this meta-analysis. The results of meta-analysis showed that the effective control rate of chills with butorphanol tartrate was higher than that of tramadol [RR=1.07, 95% confidence interval (CI) (1.04, 1.11), P<0.000 1], and the incidence of adverse reactions such as nausea and vomiting was lower than that of tramadol [RR=0.13, 95%CI (0.09, 0.21), P<0.000 01]. Conclusion　Butorphanol tartrate can be used to control chills during cesarean section under combined spinal-epidural anesthesia, with less adverse reactions, which is a more effective and safer anesthetic drug.

Osteoarthrosis

Analysis of the treatment efficacy of different fixation methods used in the conservative treatment of acute lateral ankle ligament injury

Wu Suiqiong, Pan Yongxiong, Yang Guanggang, Lei Hang

2024, 30(2):  205-209.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.006

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Objective　To evaluate the clinical effects of different fixation methods used for acute injury of lateral ligament of the ankle. Methods　A total of 62 patients with acute injury of lateral ligament of the ankle in the Eighth Department of Orthopaedics, Guangzhou Orthopedic Hospital from January 2022 to March 2023 were selected as the research objects, and were divided into group A (21 cases), group B (20 cases), and group C (21 cases) according to different fixation methods. In group A, there were 11 males and 10 females, aged (29.48±13.10) years. In group B, there were 13 males and 7 females, aged (28.00±13.91) years. In group C, there were 13 males and 8 females, aged (26.38±12.54) years. All the patients in the three groups were treated conservatively, group A was fixed with Ossur ankle brace, group B was fixed with elastic bandage, and group C was fixed with U-shaped resin plaster. The American Orthopedic Foot and Ankle Society (AO-FAS) ankle function scores and the swing amplitudes of center of gravity when opening and closing eyes were compared among the three groups after 1 month and 2 months of treatment. Independent sample t test, paired t test, and χ² test were used. Results　After 1 month of treatment, the total score (82.62±1.56), pain score (33.62±2.16), and functional score (38.48±3.01) of the AO-FAS in group A were higher than those in group B [(76.43±2.52), (31.25±2.71), and (35.45±2.80)] and group C [(71.52±1.48), (32.67±2.39), and (28.76±2.00)], with statistically significant differences (all P<0.001). After 1 month of treatment, the swing amplitudes of center of gravity in group A when opening and closing eyes [(60.95±8.58) mm and (96.19±7.05) mm] were lower than those in group B [(74.85±8.27) mm and (102.05±7.74) mm] and group C [(74.52±5.75) mm and (101.67±4.71) mm], with statistically significant differences (all P<0.05). After 2 months of treatment, the total score (90.26±3.62), pain score (35.43±1.46), and functional score (44.43±3.46) of the AO-FAS in group A were higher than those in group B [(83.53±4.42), (31.50±1.93), and (42.45±3.46)] and group C [(83.87±3.23), (31.67±1.46), and (42.32±2.23)], with statistically significant differences (all P<0.001). After 2 months of treatment, the swing amplitudes of center of gravity in group A when opening and closing eyes [(42.19±8.48) mm and (76.12±7.81) mm] were lower than those in group B [(54.75±8.58) mm and (81.40±7.83) mm] and group C [(54.38±5.98) mm and (81.43±4.80) mm], with statistically significant differences (all P<0.05). Conclusion　After conservative treatment of acute injury of lateral ligament of the ankle, the AO-FAS functional score and proprioception of the ankle in the brace fixation group were higher than those in the other 2 fixation method groups, which maight be related to the fixation strength of plaster was too strong, the fixation strength of elastic bandage was low, but the fixation strength of brace was adjustable.

Application effect of femoral nerve block combined with intra-articular anaesthesia in knee arthroscopy

Lin Zhenzhou, Liu Mingting, Zhang Chengnian, Li Jian, Ma Mingliang

2024, 30(2):  210-213.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.007

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Objective　To evaluate the effect and safety of femoral nerve block combined with intra-articular anaesthesia in knee arthroscopy. Methods　A total of 120 patients who planned to undergo unilateral knee arthroscopic surgery due to meniscus injury, loose body, or osteoarthritis in Department of Bone and Joint Surgery, Binzhou Medical University Hospital from January to June 2022 were selected. The patients were randomly divided into a femoral nerve block combined with joint cavity infiltration anesthesia group (F/I group) and a combined spinal-epidural anesthesia group (CSEA group), with 60 patients in each group. In the F/I group, there were 32 males and 28 females, aged (38.75±11.35) years. In the CSEA group, there were 25 males and 35 females, aged (37.80±10.85) years. The differences in the number of intraoperative rescue cases, postoperative Visual Analogue Scale (VAS) score, postoperative sensory recovery time, first ambulation time, postoperative complications, hospitalization cost, and length of hospital stay were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The VAS score of the F/I group 6 h after operation was lower than that of the CSEA group [(2.08±0.61) points vs. (2.54±0.64) points], with a statistically significant difference (t=-2.484, P=0.018). The sensory recovery time of the F/I group was longer than that of the CSEA group [(6.25±0.40) h vs. (3.60±0.31) h], and the first ambulation time was shorter than that of the CESA group [(2.99±1.05) h vs. (8.14±1.88) h], with statistically significant differences (t=14.095 and -12.263, both P<0.001). The postoperative complications: the incidence of intraoperative anesthesia in the F/I group was 3.3% (2/60), the incidence of urinary retention was 0, the incidence of lower extremity venous thrombosis was 1.7% (1/60), and the incidence of nausea and vomiting was 3.3% (2/60); in the CSEA group, the incidence of postoperative anesthesia was 0, the incidence of urinary retention was 10.0% (6/60), the incidence of lower extremity venous thrombosis was 5.0% (3/60), and the incidence of nausea and vomiting was 16.7% (10/60); there were statistically significant differences in the incidence of urinary retention and nausea and vomiting between the two groups (both P<0.05). The length of hospital stay and hospitalization cost in the F/I group were (3.90±0.63) d and (9 612.67±507.15) yuan, and those in the CESA group were (5.27±0.75) d and (11 401.52±530.01) yuan, with statistically significant differences (t=-8.862 and -15.425, both P<0.001). Conclusion　Femoral nerve block combined with intra-articular infiltration anesthesia in knee arthroscopic surgery can reduce the postoperative complications, shorten the length of hospital stay, reduce the cost of hospitalization, and provide a good anesthetic effect.

Study on the therapeutic effect of arthroscopic debridement combined with osteotomy for medial compartment knee osteoarthritis 

Zhang Ye

2024, 30(2):  214-218.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.008

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Objective　To study the therapeutic effect of arthroscopic debridement combined with osteotomy for medial compartment knee osteoarthritis. Methods　A prospective study was conducted. Fifty-eight patients with medial compartment knee osteoarthritis admitted to Linyi Traditional Chinese Medical Hospital from February 2020 to August 2021 were randomly divided into an observation group and a control group by drawing lots, with 29 cases in each group. In the observation group, there were 17 males and 12 females, aged (41.12±5.84) years. In the control group, there were 19 males and 10 females, aged (40.87±6.02) years. The control group underwent arthroscopic debridement, and the observation group underwent combined osteotomy on the basis of the control group. The perioperative indexes were compared between the two groups, including the Visual Analogue Scale (VAS) score, Hospital for Special Surgery (HSS) knee score, American Knee Society Score (AKSS), Western Ontario and McMaster University (WOMAC) osteoarthritis index, levels of interleukin (IL)-17, matrix metalloproteinase-3 (MMP-3), and MMP-9 in serum and synovial fluid, and incidence of complications. t test and χ² test were used. Results　In the observation group, the operation time and postoperative VAS score, HSS score, AKSS score, and WOMAC score were (72.68±7.64) min, (2.56±0.52) points, (89.06±10.23) points, (86.24±9.85) points, and (16.24±2.86) points, and those in the control group were (50.46±6.87) min, (3.12±0.43) points, (78.69±9.93) points, (75.95±7.86) points, (20.57±3.35) points, with statistically significant differences (t=11.646, 4.469, 3.917, 4.397, and 5.294; all P<0.001). The postoperative serum levels of IL-17, MMP-3, and MMP-9 in the observation group were (4.03±1.12) ng/L, (98.97±18.76) µg/L, and (29.86±6.47) µg/L, and those in the control group were (4.96±1.09) ng/L, (146.96±19.15) µg/L, and (38.87±7.54) µg/L, with statistically significant differences (t=3.205, 9.640, and 4.884; all P<0.001). The postoperative synovial fluid levels of IL-17, MMP-3, and MMP-9 in the observation group were (5.35±1.21) ng/L, (102.96±17.84) µg/L, and (36.08±7.94) µg/L, and those in the control group were (6.98±1.14) ng/L, (162.74±18.23) µg/L, and (48.87±8.35) µg/L, with statistically significant differences (t=5.280, 12.621, and 5.978; all P<0.001). The incidence of postoperative complications was 10.34% (3/29) in the observation group and 3.45% (1/29) in the control group, with no statistically significant difference (χ²=0.269, P=0.604). Conclusion　Arthroscopic debridement  combined with osteotomy in the treatment of medial compartment knee osteoarthritis can obtain a good therapeutic effect, which can inhibit the inflammatory reaction, reduce the joint pain, and improve the knee joint function.

Magnetic resonance imaging analysis of knee bone marrow edema in children with juvenile idiopathic arthritis

Cui Pengxiang, Yang Kaihua, Yang Xin

2024, 30(2):  218-222.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.009

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Objective　To analyze the magnetic resonance imaging (MRI) manifestations of knee bone marrow edema in children with juvenile idiopathic arthritis. Methods　Retrospective analysis was used to analyze the MRI images of knee joint bone marrow edema in 126 children with juvenile idiopathic arthritis in Henan Children's Hospital from June 2020 to June 2022. There were 98 males and 28 females, aged (7.85±2.11) years, with a course of disease of (8.65±1.05) months, all of which were unilateral knee joint lesions. The synovial thickening and pannus, effusion and fluid accumulation of joint capsule, bone abnormalities, joint cartilage lesions, popliteal lymph node enlargement, abnormal meniscus and ligaments, and vascular shadows in joint cartilage were analyzed. Results　In the 126 children with juvenile idiopathic arthritis, multiple pannus covered the surface of the joint femur [66 cases (52.38%)], low signal was dominant on T1W [96 cases (76.19%)], and homogeneous equal signal was dominant on T2W [66 cases (52.38%)]. There was a small amount of synovial fluid in the 126 children with juvenile idiopathic arthritis, of whom 102 cases (80.95%) had suprapatellar bursa effusion. The main types of bone marrow edema in children with juvenile idiopathic arthritis were low signal on T1W [48 cases (38.10%)] and patchy fuzzy signal on T2W [41 cases (32.54%)], and multiple "flame" like bone marrow edema with epiphyseal cartilage as the base and facing back to the joint cavity were found in the metaphyseal end [81 cases (64.29%)]. The main joint cartilage lesions in children with juvenile idiopathic arthritis were superficial roughness [60 cases (47.62%)] and local thinning [36 cases (28.57%)]. Of the 126 children with juvenile idiopathic arthritis, 42 cases had enlarged lymph node shadows in the knee and popliteal fossa, with low signal on T1W, low signal/slightly low signal on T2W, and high signal on SPIR/3D/FFE. In children with juvenile idiopathic arthritis, the anterior and posterior corners of the meniscus were mainly deformed [45 cases (35.71%)], and collapsed and fragmented [15 cases (11.90%)], and there were multiple swelling/local wavy changes in the anterior and posterior cruciate ligaments of the knee joint [21 cases (16.67%)]. Of the 126 children with juvenile idiopathic arthritis, 72 cases showed radial enhanced vascular shadows arranged perpendicular to the cartilage surface of the femoral condyle in the knee joint cartilage. Conclusions　In the MRI manifestations of knee joints in children with juvenile idiopathic arthritis, there are multiple synovial thickening, joint cavity effusion, and bone marrow edema. Some children are accompanied by cartilage destruction and subchondral bone invasion.

Application effect of intervention strategies of motivational behavior guidance model in patients after artificial knee joint replacement

Li Zheng, Tian Yuan, Wang Shaohua

2024, 30(2):  223-227.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.010

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Objective　To explore the application effect of intervention strategies of motivational behavior guidance model in patients after artificial knee joint replacement. Methods　In this prospective study, 100 patients who received artificial knee joint replacement in Zheng zhou Orthopaedic Hospital from January 2020 to December 2022 were selected as the research objects, and were divided into an intervention group and a control group by the random number table method, with 50 cases in each group. In the intervention group, there were 29 males and 21 females, aged (62.05±3.47) years. In the control group, there were 27 males and 23 females, aged (61.89±3.52) years. The patients in the control group received routine postoperative care, and on the basis the patients in the intervention group received postoperative intervention strategies of artificial knee joint replacement based on motivational behavior guidance. Both groups were intervened until discharge. The changes of Hospital for Special Surgery (HSS) score, range of knee joint motion, and self-efficacy assessed by General Self-Efficacy Scale (GSES) before intervention and 3 months after intervention were compared between the two groups, and the incidences of postoperative complications during intervention and follow-up and patients' satisfaction with nursing were compared between the two groups. t test, χ² test, and rank sum test were used. Results　After 3 months of intervention, the HSS scores, ranges of knee joint motion, and GSES scores in both groups were higher than those before intervention, and those in the intervention group were higher than those in the control group [(68.26±6.22) min vs. (64.32±5.98) min, (88.25±10.39)°vs. (83.31±11.66)°, (32.89±2.16) min vs. (31.54±2.35) min], with statistically significant differences (t=3.229, 2.237, and 2.991; all P<0.05). During follow-up, the incidence of postoperative complications in the intervention group was lower than that in the control group [4.0% (2/50) vs. 16.0% (8/50)], with a statistically significant difference (χ²=4.000, P=0.046). The nursing satisfaction of the intervention group was higher than that of the control group at discharge [94.0% (47/50) vs. 80.0% (40/50)], with a statistically significant difference (χ²=4.332, P=0.037). Conclusion　Postoperative intervention strategies of artificial knee joint replacement constructed under the guidance of motivational behavior can effectively promote the recovery of patients' knee joint function, improve the range of knee joint motion, reduce the incidence of postoperative complications, enhance the patients' self-efficacy, and improve the patients' satisfaction with nursing work.

Cerebrovascular Disease

Construction of a nomogram model for risk prediction of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU

Gu Junling, Ni Min, Zong Haiyan, He Ping, Zhang Yan, Lu Xiaojie

2024, 30(2):  228-234.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.011

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Objective　To investigate the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in intensive care unit (ICU), and to establish a nomogram prediction model. Methods　The clinical data of 173 patients with spontaneous cerebral hemorrhage in ICU of Wuxi Second People's Hospital from June 2019 to June 2022 were retrospectively analyzed. According to whether the patients had rebleeding or not, they were divided into a rebleeding group (38 cases) and a non-rebleeding group (135 cases). The general data of the two groups were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of rebleeding in patients with spontaneous intracerebral hemorrhage in ICU. R3.4.3 software package was used to draw the nomogram model, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive efficacy of the nomogram model. The calibration curve was drawn to evaluate the discrimination of the nomogram model, and the Bootstrap method was used to test the consistency of the prediction nomogram model. t test and χ² test were used. Results　In the rebleeding group, there were 24 males and 14 females, aged (61.57±7.53) years. In the non-rebleeding group, there were 75 males and 60 females, aged (59.08±7.39) years. There were no statistically significant differences in the gender, age, body mass index (BMI), smoking history, drinking history, diabetes history, etiology classification, Glasgow Coma Scale (GCS) score, hematoma shape, hematoma location, bleeding volume, operation mode, preoperative systolic blood pressure, preoperative diastolic blood pressure, preoperative platelet count, and postoperative use of hemostatic drugs between the rebleeding group and the non-rebleeding group (all P>0.05). In the rebleeding group, the ratios of long-term use of anticoagulants, uneven hematoma density, operation timing of 3-6 h, unsatisfactory postoperative blood pressure control, and postoperative agitation and levels of preoperative blood glucose and preoperative D-dimer were higher than those in the non-rebleeding group [47.37% (18/38) vs. 24.44% (33/135), 71.05% (27/38) vs. 43.70% (59/135), 31.58% (12/38) vs. 10.37% (14/135), 18.42% (7/38) vs. 2.96% (4/135), 42.11% (16/38) vs. 22.96% (31/135), (6.39±1.02) mmol/L vs. (5.95±1.25) mmol/L, (0.51±0.04) mg/L vs. (0.43±0.05) mg/L], with statistically significant differences (χ²=7.496, 8.872, 10.476, 12.924, and 5.491, t=1.990 and 9.073; all P<0.05). Multivariate logistic regression analysis showed that long-term use of anticoagulants, uneven hematoma density, operation timing of 3-6 h, elevated preoperative D-dimer level, unsatisfactory postoperative blood pressure control, and postoperative agitation were all risk factors for rebleeding in ICU patients with spontaneous cerebral hemorrhage (all P<0.05). ROC analysis results showed that the area under the curve (AUC), sensitivity, and specificity of the nomogram for predicting rebleeding in ICU patients with spontaneous cerebral hemorrhage were 0.848 (95%CI 0.799 - 0.887), 76.32%, and 84.44%, respectively. The Bootstrap method was used to verify the model, and the consistency index (C-index) was 0.829. The calibration curve was in good agreement with the standard curve. Conclusions　Long-term use of anticoagulants, uneven hematoma density, operation timing of 3-6 h, elevated D-dimer level, unsatisfactory postoperative blood pressure control, and postoperative agitation are all risk factors for rebleeding in patients with spontaneous cerebral hemorrhage in ICU. The nomogram model based on the above influencing factors has good predictive efficacy, which is conducive to early clinical screening of rebleeding in ICU patients with spontaneous cerebral hemorrhage.

Application of repetitive transcranial magnetic stimulation combined with head-eye sensory-motor integration training in the rehabilitation treatment of post-stroke hemiplegia

Zhai Zhigang

2024, 30(2):  234-238.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.012

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Objective　To explore the application of repetitive transcranial magnetic stimulation (rTMS) combined with head-eye sensory-motor integration training in the rehabilitation treatment of post-stroke hemiplegia. Methods　A prospective research method was used. From February 2020 to February 2023, 102 post-stroke hemiplegic patients admitted to Dezhou Municipal Hospital were enrolled in the study, and were divided into a control group with odd numbers and an observation group with even numbers by the ball-drawing method. In the control group, 26 males and 25 females, aged (65.23±7.14) years, received routine rehabilitation treatment. In the observation group, 25 males and 26 females, aged (64.89±7.31) years, were given rTMS combined with head-eye sensory-motor integration training on the basis of control group, with a course of treatment of 6 weeks. The two groups were evaluated before and after treatment using the Montreal Cognitive Assessment (MoCA), simplified Fugl-Meyer Motor Function Rating Scale (FMA), modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE). The clinical efficacy and satisfaction with the rehabilitation effect were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The overall clinical treatment effectiveness rate of the observation group was 92.15% (47/51), which was higher than 76.47% (39/51) of the control group, with a statistically significant difference (χ²=4.744, P=0.029). Two months after treatment, the MoCA score, FMA score, MBI score, and MMSE score in the observation group were higher than those in the control group [(26.84±5.32) points vs. (21.34±4.51) points, (62.38±14.86) points vs. (53.81±13.27) points, (69.24±21.07) points vs. (56.75±16.53) points, (28.47±2.01) points vs. (25.06±1.94) points], with statistically significant differences (t=5.631, 3.072, 3.331, and 8.717, all P<0.05). The total satisfaction rate with the rehabilitation effect in the observation group was 90.19% (46/51), which was higher than that in the control group [72.55% (37/51)], with a statistically significant difference (χ²=5.239, P=0.022). Conclusion　rTMS combined with head-eye sensory-motor integration training has significant clinical and rehabilitation effects in the rehabilitation treatment of post-stroke hemiplegia, improving the cognitive function, motor function, and daily living ability, with popularization value.

Observation on the effect of long-term reverse moxibustion on preventing post-stroke depression in patients with acute cerebral infarction

Zhao Dan, Xu Chuanwei, Zhou Fangfang, Chen Deren, Lin Ying, Wang Yanling

2024, 30(2):  239-243.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.013

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Objective　To observe the effect of long-term reverse moxibustion on preventing post-stroke depression in patients with acute cerebral infarction. Methods　This study was a randomized controlled trial. Eighty patients with acute cerebral infarction admitted to Haibin Sanatorium of Jiangsu Province and Lianyungang Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were prospectively selected as the study objects, and were divided into a treatment group (40 cases) and a control group (40 cases) according to the random number table method. In the treatment group, there were 21 males and 19 females, aged (64.55±9.37) years. In the control group, there were 22 males and 18 females, aged (64.58±8.89) years. The control group received standardized treatment for stroke, including anti-platelet aggregation, lipid reduction, and symptomatic treatment for patients with hypertension, diabetes, and coronary heart disease. The treatment group was treated with long-term reverse moxibustion on the basis of the control group, 20 min/time, once a day, 5 days/week, lasting for 24 weeks. The scores of Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE), Barthel index (BI), and National Institutes of Health Stroke Scale (NIHSS) and the incidence of post-stroke depression were compared between the two groups before treatment and after 4, 8, 12, and 24 weeks of treatment. Independent sample t test and χ² test were used. Results　The incidences of post-stroke depression in the treatment group after 4, 8, 12, and 24 weeks of treatment were lower than those in the control group [2.5% (1/40) vs. 17.5% (7/40), 5.0% (2/40) vs. 20.0% (8/40), 10.0% (4/40) vs. 27.5% (11/40), 17.5% (7/40) vs. 37.5% (15/40)], with statistically significant differences (χ²=5.000, 4.114, 4.021, and 4.013; all P<0.05). The HAMD scores of the treatment group after 4, 8, and 12 weeks of treatment were lower than those of the control group [(7.25±2.88) points vs. (9.07±4.21) points, (9.70±2.74) points vs. (11.28±3.58) points, (12.17±2.76) points vs. (13.85±3.54) points], with statistically significant differences (t=2.261, 2.210, and 2.358; all P<0.05). The MMSE scores of the treatment group after 12 and 24 weeks of treatment were higher than those of the control group [(23.60±1.89) points vs. (22.70±1.83) points, (24.93±1.46) points vs. (23.75±1.63) points], with statistically significant differences (t=2.163 and 3.400, both P<0.05). The BI scores of the treatment group after 4, 8, 12, and 24 weeks of treatment were higher than those of the control group [(66.13±6.84) points vs. (62.88±10.35) points, (69.25±4.88) points vs. (65.75±5.26) points, (73.13±4.63) points vs. (70.38±4.58) points, (74.63±3.47) points vs. (71.75±4.46) points], with statistically significant differences (t=2.091, 3.087, 2.671, and 3.216; all P<0.05). After treatment, the NIHSS score of the treatment group was lower than that of the control group [(7.20±2.43) points vs. (11.03±2.70) points], with a statistically significant difference (t=6.655, P<0.05). Conclusion　Long-term reverse moxibustion at Baihui and Dazhui points in patients with acute cerebral infarction can promote the recovery of neurological function, improve the cognitive function, and reduce the incidence of post-stroke depression.

Effect of tirofiban on platelet activity in patients with progressive cerebral infarction and its application value

Wang Yan, Zhang Guiyue, Chen Xiang

2024, 30(2):  244-248.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.014

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Objective　To observe the effect of tirofiban on platelet activity in patients with progressive cerebral infarction (PCI) and its clinical application effect. Methods　This was a randomized controlled trial. A total of 106 PCI patients admitted to Affiliated Hospital of Traditional Chinese Medicine, Nanyang Medical College from January 2021 to March 2023 were selected as the study objects, and were divided into a routine group and an experimental group by the random number table method, with 53 cases in each group. In the routine group, 30 males and 23 females, aged (60.11±5.27) years, were treated with conventional medication; in the experimental group, 31 males and 22 females, aged (61.25±5.33) years, were treated with tirofiban on the basis. The improvement of platelet function, inflammatory response, and neurological function before and after treatment were compared between the two groups, and the drug safety was evaluated. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the platelet activity, platelet function, inflammatory indexes, and neurological function between the two groups (all P>0.05). After treatment, the levels of β-thromboglobulin (β-TG), granular membrane protein CD62P, CD63, platelet aggregation rate (PAgT), platelet adhesion rate (PAdT), interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) in the experimental group were all lower than those in the routine group [(15.44±5.16) μg/L vs. (18.25±5.27) μg/L, (55.25±10.47)% vs. (61.45±10.46)%, (10.33±3.41)% vs. (12.28±3.16)%, (35.22±10.17)% vs. (42.11±10.48)%, (28.33±5.14)% vs. (31.45±5.16)%, (60.44±10.28) ng/L vs. (67.62±10.35) ng/L, (10.15±3.22) ng/L vs. (12.37±3.19) ng/L, (7.66±2.11) mg/L vs. (8.82±2.14) mg/L], with statistically significant differences (t=2.774, 3.050, 3.054, 3.435, 3.119, 3.583, 3.566, and 2.810, all P<0.05). After 3, 7, and 14 days of treatment, the National Institutes of Health Stroke Scale (NIHSS) scores of the experimental group were lower than those of the routine group [(30.25±5.14) points vs. (33.47±5.26) points, (24.33±5.18) points vs. (27.85±5.61) points, (20.12±5.41) points vs. (23.36±5.41) points], with statistically significant differences (t=3.188, 3.356, and 3.083, all P<0.05). After treatment, there was no statistically significant difference in the incidence of drug-related adverse reactions between the two groups (P>0.05). Conclusions　Tirofiban can effectively inhibit the platelet activity in patients with PCI, which is of positive significance in improving the platelet function, reducing the inflammatory reaction, and improving the neurological function. Combined use of this drug does not significantly increase the risk of drug-related adverse reactions, with high safety.

Basic Research

Effect and mechanism of anti-CD122 antibody on psoriasis-like skin lesions in mice

Li Huarun, Wen Ju, Zheng Rongchang, Zhou Yuchan, Qin Si, Li Ting, Huang Jinping

2024, 30(2):  249-257.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.015

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Objective　To explore the effect and mechanism of anti-CD122 antibody on psoriasis-like skin lesions in mice. Methods　The study was conducted from July 1 to November 23, 2020. A total of 56 BALB/c female mice were randomly assigned to four groups: a vaseline control group (blank control group), an imiquimod model group (model group), an isotype control antibody experimental group (experimental group A), and an anti-CD122 antibody experimental group (experimental group B). The dynamic changes of psoriasis-like skin lesions were observed using the Psoriasis Area and Severity Index (PASI) score; the pathological changes of skin lesion tissues were observed under the microscope and the thickness of the epidermal layer was measured; the phenotypes and changes of T_RM cells in skin lesions were detected using the immunofluorescence double-labeling method; the expressions and changes of interleukin (IL)-15 and IL-17A in skin lesions were detected using the immunohistochemical method. Independent sample t test was used for the measurement data. Results　The immunofluorescence double-labeling showed that the number of T_RM cells in the initial lesions (3 and 6 days) of the model group [CD3⁺CD103⁺: (16.40±1.43) cell count/field of view, (29.80±2.28) cell count/field of view; CD4⁺CD103⁺: (10.80±1.77) cell count/field of view, (16.20±1.28) cell count/field of view; CD8⁺CD103⁺: (15.10±1.65) cell count/field of view, (26.05±1.43) cell count/field of view; CD122⁺CD103⁺: (16.52±1.43) cell count/field of view, (26.80±1.40) cell count/field of view] were higher than those in control group (all P<0.01). The number of T_RM cells in the initial (3 and 6 days) and re-stimulated (38 and 41 days) lesions of the experimental group B were lower than those in the model group and the experimental group A at the same time (all P<0.05), with CD8⁺ T_RM cells predominantly reduced (P<0.01). The immunohistochemical results showed that the expressions of IL-15 and IL-17A in the initial lesions (38 and 41 days) of the model group [(115.66±3.69) IOD/area, (121.65±3.36) IOD/area, (104.30±3.47) IOD/area, and (59.87±3.20) IOD/area] were higher than those of the control group [(28.15±2.25) IOD/area, (28.05±2.15) IOD/area, (25.63±2.10) IOD/area, and (25.01±2.71) IOD/area], with statistically significant differences (all P<0.05). The expressions of IL-15 and IL-17A in the initial (3 and 6 days) and re-stimulated (38 and 41 days) lesions of the experimental group B were lower than those of the model group and experimental group A at the same time (all P<0.05). Conclusions　T_RM cells, IL-15, and IL-17A might be involved in the occurrence and development of psoriasis-like skin lesions in mice. Anti-CD122 antibody can improve psoriasis-like lesions in mice, and this effect might be related to its inhibition of formation and function of T_RM cells, mainly CD8⁺T_RM cells, as well as the reduction of IL-15 and IL-17A expressions.

Treatises

Analysis of risk factors associated with blood transfusion in preterm infants with gestational age <32 weeks

Zhu Yushu, Gao Junyan, Wang Fudong, Jiang Lijun, Wu Mingfu

2024, 30(2):  258-262.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.016

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Objective　To explore the red blood cell (RBC) transfusion situation and its risk factors in preterm infants with gestational age (GA) <32 weeks, and to provide clinical basis for reducing the blood transfusion rate of premature infants. Methods　The clinical data of 130 premature infants with GA <32 weeks admitted to Affiliated Hospital of Yangzhou University from January 2018 to December 2022 were retrospectively analyzed. They were divided into a blood transfusion group and a non-blood transfusion group based on whether they received blood transfusion or not. In the blood transfusion group, there were 30 males and 31 females, with  a gestational age of (29.79±1.66) weeks. In the non-blood transfusion group, there were 36 males and 33 females, with a gestational age of (31.13±1.02) weeks. By comparing the general data, maternal information, diagnosis and treatment status, etc., and the risk factors affecting blood transfusion in premature infants with GA <32 weeks were analyzed through univariate and multivariate logistic regression analysis. Independent sample t test was used for the measurement data with normal distribution, rank sum test was used for the measurement data with skew distribution, and χ² test was used for the count data. Results　Among the 130 preterm infants with GA <32 weeks, 61 cases were treated with blood transfusion, with an incidence of 46.92%. The results of univariate analysis showed that the gestational age, birth weight, hemoglobin (Hb) value at birth, hematocrit (HCT), and small-for date-infant ratio of the blood transfusion group were all lower than those of the non-blood transfusion group [(29.79±1.66) weeks vs. (31.13±1.02) weeks, (1 334.05±304.29) g vs. (1631.45±245.64) g, (166.00±24.77) g/L vs. (184.43±19.00) g/L, (51.04±7.95)% vs. (56.35±6.37)%, 9.84% (6/61) vs. 23.19% (16/69)], with statistically significant differences (t=-5.450, -6.160, -4.689, and -4.164, χ²=4.106; all P<0.05). The amount of blood collection within 2 weeks after birth and the proportions of Apgar score 1 min after birth ≤7 points, mechanical ventilation, tracheal intubation, apnea, neonatal respiratory distress syndrome (NRDS), bronchopulmonary dysplasia (BPD), and neonatal necrotizing enterocolitis (NEC) in the blood transfusion group were all higher than those in the non-blood transfusion group [(28.63±8.25) ml/kg vs. (20.84±5.27) ml/kg, 42.62% (26/61) vs. 13.04% (9/69), 95.08% (58/61) vs. 60.87% (42/69), 19.67% (12/61) vs. 1.45% (1/69), 68.85% (42/61) vs. 34.78% (24/69), 72.13% (44/61) vs. 52.17% (36/69), 21.31% (13/61) vs. 1.45% (1/69), 14.75% (9/61) vs. 2.90% (2/69)], with statistically significant differences (t=6.324, χ²=14.398, 21.349, 11.946, 15.036, 5.448, 11.305, and 4.444; all P<0.05). The time of parenteral nutrition, the time to reach adequate feeding, the time of oxygen inhalation, and the hospitalization time in the blood transfusion group were longer than those in the non-blood transfusion group [21.00 (15.00, 31.00) d vs. 11.00 (8.00, 17.00) d, 23.00 (17.00, 33.00) d vs. 12.00 (9.00, 17.50) d, 10.00 (4.00, 28.00) d vs. 3.00 (0, 6.00) d, (47.46±19.34) d vs. (27.62±8.78) d], with statistically significant differences (Z=-5.922, -6.075, and -5.687, t=7.368; all P<0.05). Multivariate logistic regression analysis showed that birth weight <1 500 g, amount of blood collection ≥25 ml within 2 weeks after birth, parenteral nutrition time ≥14 days, and use of mechanical ventilation were all independent risk factors for blood transfusion in preterm infants with GA <32 weeks (OR=4.243, 3.462, 7.425, and 7.218, all P<0.05), while Hb ≥160 g/L at birth was a protective factor (OR=0.072, P<0.05). Conclusion　Hb ≥160 g/L at birth is a protective factor for blood transfusion in premature infants with GA <32 weeks, while birth weight <1 500 g, blood collection volume ≥25 ml within 2 weeks after birth, parenteral nutrition time ≥14 days, and use of mechanical ventilation are independent risk factors for blood transfusion in premature infants with GA <32 weeks.

Noninvasive prediction of 28-day mortality in patients with sepsis associated acute respiratory distress syndrome

Luo Xiaojie, Wang Weiwei, Wang Yimeng, Wang Yu

2024, 30(2):  263-268.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.017

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Objective　To analyze the relationships between serum lactate (Lac), D-dimer (D-D), soluble thrombomodulin (sTM), and endothelium-specific molecule-1 (ESM-1) levels and 28-day mortality in patients with sepsis associated acute respiratory distress syndrome (SAARDS). Methods　This was a cohort study. A total of 375 SAARDS patients treated in Tianjin First Central Hospital and Special Medical Center of Armed Police from January 2018 to January 2023 were selected as the study objects, including 198 males and 177 females, aged (65.26±11.35) years. According to the oxygenation index (OI) at admission, the patients were divided into a mild group [96 cases, OI >200 mmHg (1 mmHg=0.133 kPa)], a moderate group (152 cases, OI >100 - 200 mmHg), and a severe group (127 cases, OI ≤100 mmHg). They were divided into a survival group (238 cases) and a death group (137 cases) according to the survival conditions within 28 days. Spearman correlation coefficient was used to analyze the correlations between OI and serum Lac, D-D, sTM, and ESM-1 levels in SAARDS patients. Multivariate logistic regression analysis was used to analyze the independent risk factors affecting the prognosis in SAARDS patients, and the predictive value of the risk factors was analyzed using the receiver operating characteristic curve (ROC). For the measurement data conforming to normal distribution, t test was used for comparison between two groups, F test was used for comparison among multiple groups, and SNK method was used for pairwise comparison. Kruskal-Wallis test was used for the measurement data conforming to non-normal distribution, and Bonferroni correction was used for pairwise comparison. The count data were measured using χ² test. Results　Serum Lac, D-D, sTM, and ESM-1 levels were increased sequentially in the mild group, moderate group, and severe group (all P<0.001). Serum Lac, D-D, sTM, and ESM-1 levels were negatively correlated with OI (r=-0.663, -0.664, -0.690, and -0.682, all P<0.001). The proportions of septic shock, ICU time ≥10 days, and mechanical ventilation time ≥3 days, the levels of age, D-D, sTM, Lac, and ESM-1, and the Sepsis-Related Organ Failure Assessment (SOFA) score of the death group were higher than those of the survival group [65.69% (90/137) vs. 52.10% (124/238), 63.50% (87/137) vs. 52.10% (124/238), 58.39% (80/137) vs. 47.06% (112/238), (66.24±4.73) years old vs. (64.87±6.07) years old, (3.59±0.84) mg/L vs. (2.87±0.70) mg/L, (125.77±19.25) μg/L vs. (102.29±20.94) μg/L, 8.39 (7.31, 8.84) mmol/L vs. 5.62 (4.11, 8.04) mmol/L, 3.91 (3.20, 4.48) μg/L vs. 2.92 (2.31, 3.47) μg/L, 14.00 (12.00, 17.00) points vs. 12.00 (10.00, 13.00) points], but the OI was significantly lower than that of the survival group [92.74 (82.83, 156.64) mmHg vs. 183.87 (137.68, 254.56) mmHg], with statistically significant differences (χ²=5.675, 4.594, and 4.471, t=2.439, 9.232, and 10.767, Z=9.199, 9.319, 7.270, and 8.723; all P<0.05). Multivariate logistic regression analysis showed that septic shock, SOFA score, Lac, D-D, sTM, and ESM-1 were independent risk factors for poor prognosis in SAARDS patients (OR=2.625, 3.410, 1.461, 2.231, 1.048, 1.316, all P<0.05), while OI was an independent protective factor (OR=0.978, P<0.05). ROC analysis showed that serum Lac [area under the curve (AUC) = 0.786], D-D (AUC=0.748), sTM (AUC=0.797), and ESM-1 (AUC=0.788) in SAARDS patients had certain predictive value for death within 28 days. The AUC of combined prediction of the four was 0.908, which was higher than that of any single index (P<0.001). Conclusion　Serum Lac, D-D, sTM, and ESM-1 levels are independent risk factors for 28-day death in SAARDS patients, and have certain predictive value for 28-day death.

Effect of Shengshu Sanhuang decoction combined with Zijie Shengji ointment on patients with severe mixed hemorrhoids (damp heat bottom pour type) after surgery

Liu Na, Liu Xiaozhuan, Fan Huixia, Wang Yingying, Ding Jianhua

2024, 30(2):  269-274.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.018

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Objective　To explore the effect of Shengshu Sanhuang decoction combined with Zijie Shengji ointment on severe mixed hemorrhoids (damp heat bottom pour type) after surgery. Methods　This was a randomized controlled trial. A total of 188 patients with severe mixed hemorrhoids (damp heat bottom pour type) who underwent external peeling and internal ligation surgery in Shangqiu Hospital of Traditional Chinese Medicine from January 2021 to February 2023 were prospectively selected as the study objects, and were divided into group A, group B, group C, and group D according to the random number table method, with 47 cases in each group. In group A, 22 males and 25 females, aged (45.26±8.32) years, received routine intervention. In group B, 21 males and 26 females, aged (46.38±8.59) years, received routine intervention + Shengshu Sanhuang decoction. In group C, 20 males and 27 females, aged (47.13±8.67) years, received routine intervention + Zijie Shengji ointment. In group D, 23 males and 24 females, aged (45.89±8.45) years, received routine intervention + Shengshu Sanhuang decoction + Zijie Shengji ointment. Clinical indicators and levels of inflammatory factors and anal function before and after treatment were compared among the four groups, and the clinical efficacy and adverse events were compared among the four groups. t test, F test, and SNK-q test were used for the measurement data, and χ² test and rank sum test were used for the count data. Results　The pain time, edema time, bloody stool time, anal prolapse time, and wound healing time in group D [(7.15±1.59) d, (7.93±1.76) d, (6.23±1.38) d, (5.98±1.33) d, and (11.56±2.57) d] were shorter than those in group A [(8.97±1.99) d, (9.78±2.17) d, (7.82±1.74) d, (7.45±1.66) d, and (16.16±3.59) d], group B [(8.06±1.79) d, (8.86±1.97) d, (7.05±1.57) d, (6.73±1.51) d, and (14.39±3.24) d], and group C [(7.93±1.76) d, (8.75±1.94) d, (6.91±1.54) d, (6.65±1.48) d, and (13.38±2.97) d], with statistically significant differences (all P<0.05). After treatment, the levels of hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) and anal high-pressure zone length in the four groups were all lower than those before treatment, while the anal canal systolic blood pressure and anal canal resting pressure were both higher than those before treatment, with statistically significant differences (all P<0.05). After treatment, the levels of hs-CRP and TNF-α and anal high-pressure zone length in group D [(11.15±2.48) mg/L, (25.12±5.58) ng/L, and (2.47±0.54) cm] were lower than those in group A [(16.56±3.68) mg/L, (32.78±7.28) ng/L, and (3.05±0.68) cm], group B [(13.17±2.93) mg/L, (28.56±6.35) ng/L, and (2.77±0.62) cm], and group C [(12.56±2.79) mg/L, (27.88±6.21) ng/L, and (2.72±0.61) cm], with statistically significant differences (all P<0.05). After treatment, the anal canal systolic blood pressure and anal canal resting pressure in group D [(135.86±30.19) mmHg (1 mmHg=0.133 kPa) and (60.72±13.49) mmHg] were higher than those in group A [(111.38±24.75) mmHg and (49.76±11.06) mmHg], group B [(122.45±27.19) mmHg and (54.62±12.14) mmHg], and group C [(123.57±27.46) mmHg and (55.35±12.31) mmHg], with statistically significant differences (all P<0.05). The total effective rate of group D [95.74% (46/47)] was higher than that of group A, B, and C [70.21% (33/47), 80.85% (38/47), and 82.98% (39/47)], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse events among the four groups (P>0.05). Conclusion　Shengshu Sanhuang decoction combined with Zijie Shengji ointment has definite postoperative effect on patients with severe mixed hemorrhoids (damp heat bottom pour type) after surgery, which can effectively relieve the clinical symptoms, reduce the levels of inflammatory factors, and improve the anal function, with high safety.

Comparison of laser cauterization with general anesthesia microscopically supported laryngoscope and conventional microinstrumentally-supported laryngoscope resection in the treatment of vocal cord polyps

Li Ting, Kong Min, Li Liming

2024, 30(2):  275-279.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.019

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Objective　To study the application of laser cauterization with general anesthesia microscopically supported laryngoscope in the treatment of vocal cord polyps. Methods　The prospective study selected 90 patients with vocal cord polypectomy admitted to Bayannur Hospital from March 2019 to May 2022, and the patients were randomly divided into an observation group (47 cases) and a control group (43 cases) according to the envelope method. In the control group, 23 males and 20 females, aged (50.12±1.85) years, were treated with conventional microinstrumentally-supported laryngoscope resection. In the observation group, 25 males and 22 females, aged (49.75±2.18) years, were treated with laser cauterization with general anesthesia microscopically supported laryngoscope. The surgical results, Grade of Roughness, Breathiness, Asthenia, and Strain (GRBAS), Voice Handicap Index (VHI) score, Generic Quality of Life Inventory-74 (GQOL-74) score, and complications were compared between the two groups. t test and χ² test were used. Results　The overall response rate of the observation group was 93.62% (44/47), and there was no statistically significant difference compared with that of the control group [86.05% (37/43)] (χ²=1.430, P=0.232). After surgery, the total hoarseness [(1.39±0.41) in the observation group and (1.61±0.34) in the control group], rough sound [(1.36±0.50) in the observation group and (1.42±0.52) in the control group], breath sound [(0.91±0.52) in the observation group and (0.94±0.53) in the control group], and VHI score [(11.48±7.36) points in the observation group and (12.04±7.52) points in the control group] in both groups were lower than those before surgery, and the postoperative total hoarseness of the observation group was lower than that of the control group [(1.39±0.41) vs. (1.61±0.34)], with statistically significant differences (all P<0.05). The scores of physical health [(20.14±4.02) points], mental health [(22.57±4.86) points], material life [(13.54±3.57) points], and social function [(16.78±3.71) points] of the observation group were higher than those of the control group [(16.47±3.46) points, (19.67±3.76) points, (11.49±3.24) points, and (13.47±3.16) points], with statistically significant differences (t=4.621, 3.145, 2.843, and 4.535; all P<0.05). The incidence of complications of the observation group was 8.51% (4/47), which was lower than that of the control group [25.58% (11/43)], with a statistically significant difference (χ²=4.712, P=0.030). Conclusion　Compared with conventional microinstrumentally-supported laryngoscope resection, patients with vocal cord polyps treated by laser cauterization with general anesthesia microscopically supported laryngoscope have lower total hoarseness, higher postoperative quality of life, and fewer complications, which is worthy of use in clinical practice.

Effect of intestinal preparation-free on recovery and intestinal function in patients after thoracoscopic radical surgery for lung cancer

Yu Yiming, Li Xilong

2024, 30(2):  279-283.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.020

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Objective　To observe the effect of intestinal preparation-free on recovery and intestinal function in patients after thoracoscopic radical surgery for lung cancer. Methods　This was a randomized controlled trial. A total of 122 patients with lung cancer admitted to the First Affiliated Hospital of Nanyang Medical College from January 2021 to March 2023 were included. The enrolled patients were divided into a conventional group (61 cases) and an experimental group (61 cases) by the random number table method. In the conventional group, there were 40 males and 21 females, aged 48-72 (60.32±5.25) years. In the experimental group, there were 41 males and 20 females, aged 50-70 (61.42±5.31) years. All patients underwent thoracoscopic radical surgery for lung cancer. The conventional group received compound polyethylene glycol electrolyte powder for preoperative intestinal preparation, while the experimental group did not take preoperative intestinal preparation measures. The postoperative recovery, postoperative changes in gastrointestinal function and inflammatory indexes, occurrence of gastrointestinal adverse reactions, and surgical safety were compared between the two groups. χ² test and t test were used. Results　Under different treatment schemes, the operation time of the experimental group was (170.44±20.35) min, which was slightly longer than that of the conventional group [(167.35±20.46) min], with no statistically significant difference (P>0.05); the postoperative exhaust time, defecation time, and hospitalization time of the experimental group were (20.25±5.14) h, (23.36±5.42) h, and (8.76±2.47) d, which were shorter than those of the conventional group [(23.77±5.18) h, (26.62±5.41) h, and (10.36±3.22) d], with statistically significant differences (all P<0.05). Before operation, there were no statistically significant differences in the gastrointestinal function indexes between the two groups (both P>0.05). Under different treatment schemes, the levels of gastrin (GAS) and motilin (MLT) in the experimental groups were (70.22±10.37) ng/L and (78.45±10.27) ng/L, which were lower than those in the conventional group [(75.45±10.26) ng/L and (86.33±10.28) ng/L], with statistically significant differences (both P<0.05). Before treatment, there were no statistically significant differences in the inflammatory indexes between the two groups (both P>0.05). Under different treatment regimens, the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in the experimental group were (15.45±4.49) mg/L and (12.33±3.47) ng/L, which were lower than those in the conventional group [(18.77±4.18) mg/L and (15.66±4.14) ng/L], with statistically significant differences (both P<0.05). Under different treatment schemes, the incidence of gastrointestinal adverse reactions in the experimental group was 8.20% (5/61), which was lower than that in the conventional group [21.31% (13/61)], with a statistically significant difference (P<0.05); the incidence of surgery-related complications in the experimental group was 9.84% (6/61), which was slightly higher than that in the conventional group [8.20% (5/61)], with no statistically significant difference (P>0.05). Conclusions　Preoperative intestinal preparation-free can accelerate the postoperative rehabilitation process in patients undergoing thoracoscopic radical surgery for lung cancer, and has positive significance in avoiding postoperative gastrointestinal dysfunction and inflammatory reactions and reducing the risk of gastrointestinal adverse reactions. Compared with traditional preoperative intestinal preparation measures, intestinal preparation-free does not significantly increase the risk of surgery-related complications, and has high application value.

Effect of sodium nitroprusside on clinical signs and prognosis of hypertensive crisis patients

Wang Xinyin

2024, 30(2):  284-288.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.021

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Objective　To observe the effect of sodium nitroprusside on the clinical signs and prognosis of hypertensive crisis patients. Methods　This was a randomized controlled trial. A total of 90 hypertensive crisis patients admitted to the First People's Hospital of Nanyang City from March 2020 to May 2022 were included. The enrolled patients were divided into an observation group (45 cases) and a control group (45 cases) by the random number table method. In the observation group, there were 25 males and 20 females, aged 48-72 (60.48±5.17) years. In the control group, there were 23 males and 22 females, aged 50-70 (61.32±5.21) years. The control group was treated with urapidil on the basis of conventional treatment, and the observation group was treated with sodium nitroprusside on the basis of conventional treatment until the blood pressure control reached the standard. The changes of basic signs and cardiac function before and after treatment, and the recovery time of clinical symptoms and medication safety after treatment were compared between the two groups. All patients were followed up for 1 year to compare the prognosis of the two groups. χ² test and t test were used. Results　Before administration (T0), there were no statistically significant differences in the blood pressure and cardiac function between the two groups (all P>0.05). After 10 min of administration (T1), the systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (185.33±20.46) mmHg (1 mmHg = 0.133 kPa) and (131.42±20.77) mmHg, which were lower than those in the control group [(197.45±20.18) mmHg and (145.33±20.42) mmHg], with statistically significant differences (both P<0.05); the left ventricular ejection fraction (LVEF) of the observation group was higher than that of the control group [(48.72±10.33)% vs. (42.14±10.36)%], but the left ventricular end-diastolic diameter (LVDD) was lower than that of the control group [(50.25±10.37) mm vs. (56.77±10.41) mm], with statistically significant differences (both P<0.05). After 30 min of administration (T2), there were no statistically significant differences in the blood pressure and cardiac function between the two groups (all P>0.05). Under different treatment schemes, the recovery time of physical signs of the observation group was (12.33±3.41) min, the improvement time of cardiac function was (20.24±5.12) min, and the auxiliary ventilation time was (3.44±0.27) h, which were shorter than those of the control group [(14.49±3.15) min, (23.19±5.41) min, and (4.18±1.25) h], with statistically significant differences (all P<0.05). Under different treatment regiments, the incidence of drug-related adverse reactions in the observation group was 8.89% (4/45), and the incidence of cardiovascular adverse events during follow-up was 11.11% (5/45), which were lower than those in the control group [22.22% (10/45) and 26.67% (12/45)], with statistically significant differences (both P<0.05). Conclusion　Sodium nitroprusside can rapidly improve the basic signs and cardiac function of hypertensive crisis patients and accelerate the patients' rehabilitation process, with drug safety, which can improve the patients' prognosis to a certain extent.

Evaluation of the efficiency of high-resolution CT combined with maximum intensity projection reconstruction in the detection of pulmonary nodules

Liu Dengping, Zhang Jie, Song Xueyan, Lu Shan

2024, 30(2):  288-291.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.022

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Objective　The differences in the detection of pulmonary nodules between conventional thin-slice images and high resolution combined with maximum intensity projection (HR-MIP) reconstruction images were compared, and the detection efficiency of HR-MIP for pulmonary nodules was evaluated. Methods　A total of 90 patients who underwent chest CT examination in Chu Hsien-I Memorial Hospital from December 2021 to June 2022 were randomly selected, including 52 males and 38 females, aged 18-82 (43±12.5) years. Conventional thin-slice images with a thickness of 2 mm and HR-MIP reconstruction images with a thickness of 4 mm were used to observe the situation of pulmonary nodules, and the nodules were divided into <5 mm and ≥5 mm groups according to their size. The number, size, and nature of nodules (solid, part-solid, and ground glass) were recorded by two radiologists, and the time spent reading the images of each patient was recorded. The differences of nodule detection rate and time consumption were compared between the conventional and HR-MIP groups. Paired t test and χ² test were used. Results　There were 313 nodules in the 90 patients, with 255 nodules <5 mm and 58 nodules ≥5 mm. The total numbers of nodules detected in the conventional and HR-MIP groups were 253 (80.1%) and 285 (91.0%), respectively. The detection rate of HR-MIP was higher than that of conventional thin-slice images, with a statistically significant difference (χ²=13.523, P<0.001). The numbers of <5 mm and ≥5 mm nodules detected in the conventional and HR-MIP groups were 208 vs.235 and 45 vs.50, respectively. There was a statistically significant difference in the <5 mm group (χ²=12.517, P<0.001); there was no statistically significant difference in the ≥5 mm group (χ²=1.408,P=0.237). The numbers of solid, part-solid, and ground glass density nodules were 261, 22, and 30, respectively. The numbers of solid, part-solid, and ground glass density nodules in the conventional and HR-MIP groups were 210 vs.245, 15 vs.17, and 28 vs.23, respectively. There was a statistically significant difference in the detection rate of solid nodules between the two groups (χ²=34.812, P<0.001), but there were no statistically significant differences in the part-solid and ground glass nodules (χ²=0.631, P=0.407; χ²=1.231, P=0.224). The time consumption of the conventional group was (215.3±23.8) s, and that of the HR-MIP group was (133.2±19.1) s, with a statistically significant difference (t=18.013,P<0.001). Conclusions　HR-MIP reconstruction can improve the detection rate of small solid pulmonary nodules and shorten the reading time to improve diagnostic efficiency. However, part-solid and ground glass nodules still need to be carefully observed.

Changes of temporomandibular joint in adolescent patients with Class Ⅱ, Category 1 malocclusion treated with self-ligating brackets analyzed by Dolphin software

Huang Zhumei, Chen Juanjuan, Yuan Guanbao, Xie Xiaomei, Chen Xin

2024, 30(2):  292-296.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.023

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Objective　To explore the application of Dolphin software to analyze the changes of temporomandibular joint (TMJ) in the treatment of adolescent patients with Class Ⅱ, Category 1 malocclusion treated with self-ligating brackets. Methods　A retrospective study was carried out on 110 adolescent patients with Class Ⅱ, Category 1 malocclusion in the Department of Stomatology of the 73rd Group Army Hospital of the Chinese People's Liberation Army from December 2020 to March 2022. There were 48 males and 62 females, with an age of (12.21±1.02) years old. All the patients were treated with self-ligating bracket appliance. Large field cone beam computed tomography (CBCT) was taken before and after correction, and Dolphin software was introduced for fixed-point measurement. The changes of TMJ before and 2 years after correction were analyzed. Paired t test was used. Results　After correction, the left condylar internal and external diameter [(16.42±0.43) mm], right condylar internal and external diameter [(16.10±0.88) mm], left anteroposterior diameter [(8.62±0.80) mm], right anteroposterior diameter [(8.96±1.19) mm], left TMJ radius [(49.36±1.25) mm], right TMJ radius [(49.06±1.20) mm], left condylar height [(3.44±0.23) mm], and right condylar height [(3.85±0.30) mm] at the axial plane were higher than those before correction (t=2.151, 2.350, 6.914, 3.250, 2.393, 2.188, 1.984, and 9.354; all P<0.05). After correction, the left anterior joint space [(2.30±0.41) mm], right anterior joint space [(2.54±0.52) mm], left superior joint space [(2.89±0.50) mm], right superior joint space [(3.04±1.02) mm], left posterior joint space [(2.58±0.49) mm], right posterior joint space [(2.46±0.53) mm], left condylar width [(9.06±0.99) mm], and right condylar width [(10.06±1.36) mm] in the sagittal position were all greater than those before correction (t=2.231, 3.635, 1.996, 2.281, 19.761, 17.790, 2.076, and 3.286; all P<0.05). After correction, the left intra-articular space [(2.86±0.78) mm], right intra-articular space [(2.77±0.63) mm], left superior articular space [(3.04±0.52) mm], right superior articular space [(3.30±0.98) mm], left external articular space [(3.64±1.00) mm], right external articular space [(3.88±1.15) mm], left condylar width [(15.00±0.82) mm], and right condylar width [(15.12±0.99) mm] in the coronal position were all greater than those before correction (t=2.101, 2.183, 6.097, 5.189, 2.073, 2.292, 3.020, and 2.639; all P<0.05). Conclusion　According to Dolphin software analysis, the TMJ parameters change to a certain extent after the self-ligating bracket appliance is used for the treatment of adolescent patients with Class Ⅱ, Category 1 malocclusion.

Value of different electrophysiological methods in the diagnosis of cubital tunnel syndrome

Song Huanhuan, Hong Qian

2024, 30(2):  297-300.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.024

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Objective　To analyze the application value of different electrophysiological methods in the diagnosis of cubital tunnel syndrome (CuTS). Methods　A total of 45 patients (90 upper limbs) clinically diagnosed with CuTS in Nanjing University of Chinese Medicine Affiliated Lianyungang Hospital from October 2019 to October 2022 were collected as the observation group, including 31 males and 14 females, aged 26 to 81 (51.3±13.1) years. The 90 upper limbs were divided into a symptomatic limb group (50 limbs) and an asymptomatic limb group (40 limbs) according to whether there were the clinical symptoms of CuTS or not. In addition, 30 healthy volunteers (60 upper limbs) were selected as the control group, including 20 males and 10 females, aged 28 to 79 (50.3±11.6) years. Nerve conduction velocity (NCV), needle electromyography (EMG) and short-segment micro-shift conduction time (SSCT) were measured, and the relevant parameters were compared between the two groups. Independent sample t test and χ² test were used. Results　Compared with those in the control group, the motor nerve conduction velocity (MNCV) of the ulnar nerve in the observation group decreased in the wrist-lower elbow segment [(50.79±5.98) m/s vs. (59.15±5.15) m/s] and the lower-upper elbow segment [(48.07±7.14) m/s vs. (55.77±5.35) m/s], and the complex muscle action potential (CMAP) amplitude decreased in the wrist segment [(9.16±4.18) mV vs. (13.91±4.25) mV], 5 cm of lower elbow segment [(7.63±3.59) mV vs. (13.46±3.92) mV], and 5 cm of upper elbow segment [(8.27±3.73) mV vs. (13.02±3.70) mV], with statistically significant differences (all P<0.05). In the asymptomatic limb group, the abnormal rate of NCV was 12.5% (5/40), there was a statistically significant difference compared with that of SSCT detection [45.0% (18/40)] (χ²=10.313, P=0.001). Most of the compression areas detected by SSCT were located from 3 cm above the elbow to 2 cm below the elbow (total 5 cm), accounting for 96.9% of the marked areas. The compression rate of 1 cm above the elbow was the highest. Conclusions　Different electrophysiological detection methods play an important role in early diagnosis, qualitative diagnosis, and treatment. SSCT is an important detection method for early diagnosis of CuTS and identification of compression sites.

Clinical Research

Clinical efficacy and safety of Dapagliflozin combined with sacubitril valsartan in the treatment of heart failure patients with reduced ejection fraction

Chen Yuan, Zhao Ziming, Cui Liuyi, Ma Xiangyu, Shen Lei

2024, 30(2):  301-305.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.025

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Objective　To investigate the clinical efficacy and safety of Dapagliflozin combined with sacubitril valsartan in the treatment of heart failure patients with reduced ejection fraction. Methods　A total of 86 heart failure patients with reduced ejection fraction admitted to Zhengzhou Seventh People's Hospital from January 2020 to June 2021 were selected as the study objects and were divided into two groups according to the envelope randomization method. In the experimental group, the ratio of male to female was 26/17, and the age was (65.08±5.52) years old. In the control group, the ratio of male to female was 27/16, and the age was (65.21±5.37) years old. Forty-three patients in the control group were treated with sacubitril valsartan, and 43 patients in the experimental group were treated with Dapagliflozin on this basis, continuous oral administration for 3 months. The therapeutic effect, cardiac function, 6-min walking distance (6MWD), N-terminal brain natriuretic peptide precursor (NT-proBNP), and inflammatory factors were compared between the two groups. t test and χ² test were used. Results　After 3 months of administration, the total effective rate of the heart failure patients with reduced ejection fraction in the experimental group was higher than that in the control group [95.35% (41/43) vs. 79.07% (34/43)], with a statistically significant difference (P<0.05). After 3 months of administration, the levels of left ventricular end-diastolic inner diameter (LVIDd), NT-proBNP, interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor α (TNF-α) in both groups were decreased compared with those before administration, and those in the experimental group were lower than those in the control group; the left ventricular ejection fraction (LVEF) and 6MWD levels in both groups were significantly increased compared with those before administration, and those in the experimental group were higher than those in the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the experimental group and the control group [13.95% (6/43) vs. 11.63% (5/43)] (P>0.05). Conclusion　In the treatment of heart failure patients with reduced ejection fraction, Dapagliflozin combined with sacubitril valsartan has significant efficacy, which can reduce the inflammation, improve the cardiac function, increase the cardiac ejection fraction, and is safe and worthy of application.

Application value of Buzhong Yiqi decoction in immunotherapy of NSCLC with negative driver gene

Jiang Junxuan, Fang Yuan

2024, 30(2):  305-309.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.026

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Objective　To observe the application value of Buzhong Yiqi decoction in immunotherapy for driver gene negative non-small cell lung cancer (NSCLC). Methods　This was a prospective study. A total of 85 patients with driver gene negative NSCLC admitted to Tongxu County Hospital of Traditional Chinese Medicine from March 2020 to May 2022 were included. The enrolled patients were divided into a combined group (43 cases) and a conventional group (42 cases) using the random number table method. In the combined group, there were 30 males and 13 females, aged 45-65 (55.25±5.18) years. In the conventional group, there were 32 males and 10 females, aged 47-63 (56.14±5.22) years. The conventional group received routine immunotherapy, while the combined group received Buzhong Yiqi decoction on the basis. The short-term efficacy of the two groups was compared after 3 cycles of treatment, and the prognosis of the two groups was compared after 1 year of follow-up. χ² test and t test were used. Results　Under different treatment regiments, the objective response rate (ORR) and disease control rate (DCR) of the combined group were 83.72% (36/43) and 93.02% (40/43), which were higher than those of the conventional group [61.90% (26/42) and 69.05% (29/42)], with statistically significant differences (both P<0.05). Before treatment, there were no statistically significant differences in the immune function between the two groups (all P>0.05). After treatment, the CD4/CD8 in the combined group was higher than that in the conventional group, but the levels of interleukin-10 (IL-10) and interferon-γ (INF-γ) were lower than those in the conventional group, with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the expressions of multidrug-resistance-related proteins between the two groups (both P>0.05). After treatment, the relative expressions of MRP1 and ERCC1 in the combined group was (12.25±3.41) and (102.45±20.61), which were both lower than those in the conventional group [(14.39±3.18) and (115.62±20.33)], with statistically significant differences (both P<0.05). Under different treatment regimens, the incidence of toxic and side effects in the combined group was 23.26% (10/43), which was lower than that in the conventional group [38.10% (16/42)], with a statistically significant difference (P<0.05). The progression-free survival (PFS) and overall survival (OS) of the combined group were (8.22±2.41) months and (11.26±2.31) months, which were higher than those of the conventional group [(6.81±2.12) months and (9.44±2.06) months], with statistically significant differences (both P<0.05). Conclusion　Buzhong Yiqi decoction assisted immunotherapy can improve the short-term efficacy of NSCLC patients with negative driver genes to a certain extent, and has positive significance in enhancing the patients' immunity and chemotherapy tolerance, reducing the risk of toxic and side effects, and prolonging the survival cycle.

Clinical study of "three-needle" suture for laparoscopic choledocholithiasis surgery

Du Shengwang, Shi Chunqiang, Wu Xinjun, Zhang Tingting

2024, 30(2):  310-313.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.027

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Objective　To study the clinical effect of "three-needle" suture for laparoscopic choledocholithiasis surgery. Methods　Fifty patients with choledocholithiasis treated in Lianyungang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from August 2018 to May 2022 were selected and were divided into an observation group and a control group according to the random number table method, with 25 cases in each group. In the observation group, 13 males and 12 females were (48.62±13.76) years old, and the course of disease was (4.91±1.02) years. In the control group, 12 males and 13 females were (49.35±15.08) years old, and the course of disease was (5.05±1.13) years. All patients underwent laparoscopic choledocholithiasis surgery. The control group underwent conventional choledochal suture, and the observation group underwent "three-needle" suture. The operation time, intraoperative blood loss, postoperative catheterization time, postoperative drainage volume, and hospital stay were compared between the two groups. The levels of procalcitonin (PCT), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) were detected before and 1 month after operation in two groups. The incidence of complications within 1 month after operation was counted. t test and χ² test were used. Results　The operation related indexes in the observation group were better than those in the control group (all P<0.05). The levels of inflammatory factors were significantly lower in both groups 1 month after operation than those before operation, and those in the observation group were lower than those in the control group [PCT: (1.28±0.21) μg/L vs. (1.42±0.22) μg/L; CRP: (27.34±4.72) mg/L vs. (30.19±5.03) mg/L] (t=2.302 and 2.066, both P<0.05). The liver function indexes of both groups were significantly improved 1 month after operation, and the improvement degree of the observation group was significantly better than that of the control group [ALT: (61.38±10.06) U/L vs. (70.23±12.53) U/L; TBIL: (44.37±7.41) μmol/L vs. (50.43±9.43) μmol/L; AST: (63.25±10.54) U/L vs. (70.61±13.92) U/L] (t=2.754, 2.526, and 2.108; all P<0.05). The total incidence of postoperative complications in the observation group was 12.00% (3/25), which was significantly lower than that in the control group [36.00% (9/25)] (χ²=3.947, P=0.047). Conclusion　"Three-needle" suture for laparoscopic choledocholithiasis surgery is less traumatic, which can effectively reduce the inflammatory response, can promote the liver function recovery, has fewer postoperative complications, and is worthy of clinical promotion.

Application value and safety of sub-dose remifentanil combined with propofol in the maintenance of intravenous anesthesia in children

Luo Yun, Xu Guoting

2024, 30(2):  314-318.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.028

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Objective　To observe the efficacy and safety of sub-dose remifentanil combined with propofol in pediatric intravenous anesthesia maintenance. Methods　This was a randomized controlled trial. A total of 125 children who underwent surgery in the First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2023 were prospectively selected as the study objects and were divided into 3 groups by drawing lots. In the conventional dose group, the ratio of boys to girls was 22/20, the age was (9.45±1.23) years old, and the types of surgery were as follows: 22 cases of hernia surgery, 10 cases of tonsillectomy, and 10 cases of orthopedic surgery. In the sub-dose group, the ratio of boys to girls was 20/21, the age was (9.33±1.16) years old, and the types of surgery were as follows: 22 cases of hernia surgery, 10 cases of tonsillectomy, and 9 cases of orthopedic surgery. In the low-dose group, the ratio of boys to girls was 23/19, and the age was (9.52±1.31) years old, and the types of surgery were as follows: 21 cases of hernia surgery, 11 cases of tonsillectomy, and 10 cases of orthopedic surgery. The conventional dose group was given 1.00 μg/kg remifentanil combined with propofol to maintain anesthesia, the low-dose group was given 0.25 μg/kg remifentanil combined with propofol to maintain anesthesia, and the sub-dose group was given 0.50 μg/kg remifentanil combined with propofol to maintain anesthesia. The changes in basic physical signs during the perioperative period, postoperative recovery, pain relief, and anesthesia-related adverse reactions of the 3 groups were compared. χ² test, F test, and independent sample t test were used. Results　Before surgery, there were no statistically significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the 3 groups (both P>0.05). Ten min after anesthesia, the HR and MAP of the sub-dose group were (73.45±5.22) beats/min and (79.11±5.33) mmHg (1 mmHg = 0.133 kPa), which were higher than those of the conventional dose group [(70.14±5.17) beats/min and (76.62±5.41) mmHg] (both P<0.05), but there were no statistically significant differences compared with those of the low dose group [(74.49±5.23) beats/min and (80.25±5.41) mmHg] (both P>0.05). At the time of tracheal intubation, the HR and MAP of the sub-dose group were (80.33±5.26) beats/min and (81.25±5.45) mmHg, which were lower than those of the low-dose group [(83.28±5.41) beats/min and (84.49±5.18) mmHg] (both P<0.05), but there were no statistically significant differences compared with those of the conventional dose group [(79.45±5.31) beats/min and (80.44±5.32) mmHg] (both P>0.05). Thirty min after intubation, the HR and MAP of the sub-dose group were (79.45±10.13) beats/min and (80.23±10.16) mmHg, which were higher than those of the conventional dose group [(72.15±10.49) beats/min and (73.22±10.25) mmHg] but were lower than those of the low dose group [(86.39±10.22) beats/min and (87.24±10.18) mmHg] (all P<0.05). At the end of surgery, the HR and MAP of the sub-dose group were (80.24±10.32) beats/min and (83.39±10.47) mmHg, which were higher than those of the conventional dose group [(74.11±10.46) beats/min and (77.25±10.35) mmHg], but were lower than those of the low dose group [(87.15±10.36) beats/min and (90.72±10.18) mmHg] (all P<0.05). After surgery, the recovery time of the sub-dose group [(11.45±5.46) min] was shorter than that of the conventional dose group [(14.28±5.33) min] (P<0.05), and there was no statistically significant difference compared with that of the low dose group [(10.49±5.26) min] (P>0.05). The VAS score of the sub-dose group [(3.29±1.27) points] was lower than that of the low-dose group [(4.17±1.34) points] (P<0.05), but there was no statistically significant difference compared with that of the conventional dose group [(3.18±1.45) points] (P>0.05). The incidence of anesthesia-related adverse reactions in the sub-dose group was 9.76% (4/41), which was lower than that in the conventional dose group [28.57% (12/42)], with a statistically significant difference (P<0.05); it was slightly higher than that in the low-dose group [7.14% (3/42)], with no statistically significant difference (P>0.05). Conclusion　The use of 0.50 μg/kg remifentanil combined with propofol in pediatric intravenous anesthesia maintenance can effectively maintain the stability of basic signs in children during surgery, and produce significant analgesic effect, which has positive significance in promoting the children's recovery and reducing the risk of postoperative anesthesia-related adverse reactions.

Feasibility and safety analysis of dinoprostone and cervical dilator balloon for cervical ripening and induction of labor in full-term puerperae

Gao Ying, Chen Lijuan

2024, 30(2):  319-323.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.029

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Objective　To explore the feasibility and safety of dinoprostone and cervical dilation balloon for cervical ripening and induction of labor in full-term puerperae. Methods　Eighty cases of full-term puerperae who gave birth in Xuzhou First People's Hospital from January 2020 to March 2023 were selected as the research subjects for the prospective study. According to their hospitalization ID number, they were divided into two groups, namely dinoprostone group and balloon group. The age of the dinoprostone group was (28.67±2.17) years old; there were 30 cases of primipara and 10 cases of parturient; the gestational age was 37-41 (39.12±1.23) weeks; dinoprostone suppository was used to promote cervical ripening. The age of the balloon group was (28.44±2.12) years old; there were 31 cases of primipara and 9 cases of parturient; the gestational age was 37-42 (39.23±1.19) weeks; cervical dilation balloon was used to promote cervical ripening. The cervical Bishop score, cervical ripening effect, maternal delivery, occurrence of adverse reactions, and induced labor outcomes were compared between the two groups. Independent sample t test and χ² test were used. Results　The Bishop score of the dinoprostone group after induced labor was (8.58±0.51) points, and there was no statistically significant difference compared with that of the balloon group [(8.62±0.58) points] (t=0.328, P=0.744). The total effective rate of the dinoprostone group was 92.50% (37/40), and there was no statistically significant difference compared with that of the balloon group [95.00% (38/40)] (χ²=0.213, P=0.644). The time from intervention to labor, the first stage of labor, the total stage of labor, and the time from intervention to vaginal delivery in the dinoprostone group were (14.68±3.81) h, (5.67±2.23) h, (6.12±2.24) h, and (34.21±5.49) h, which were shorter than (20.22±4.26) h, (7.23±1.12) h, (8.02±1.22) h, and (45.25±6.58) h in the balloon group (t=6.131, 3.954, 4.711, and 8.148, all P<0.001). The incidences of premature rupture of membranes and overcontraction in the balloon group were 2.50% (1/40) and 0, which were lower than those in the dinoprostone group [22.50% (9/40) and 25.00% (10/40)] (χ²=7.314 and 11.429, both P<0.05). There were no statistically significant differences in the induced labor outcomes between the dinoprostone group and the balloon group (all P>0.05). Conclusions　For puerperae with full-term delivery, it is safe and effective to choose cervical dilation balloon or dinoprostone to promote cervical ripening and induced labor. However, the use of dinoprostone can shorten the labor time and total labor process, which is suitable for high-risk puerperae who need to shorten the labor process. However, it is easy to cause excessive uterine stimulation and large fluctuations in blood pressure, resulting in excessive uterine contractions and premature rupture of membranes. Therefore, the appropriate method should be selected based on individual cases.

Nursing Research

Effects of catheterization at different stages on children with congenital microtia undergoing auricle reconstruction

Wu Yin, Li Fangwei, Liu Fei, Li Mingli, Li Xiumei, Wu Yanqun

2024, 30(2):  324-328.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.030

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Objective　To explore the effect of catheterization at different stages on children with congenital microtia undergoing auricle reconstruction. Methods　This was a randomized controlled trial. From January to December 2022, 64 patients with congenital microtia undergoing auricular reconstruction (phase 1 auricular reconstruction by skin expansion method) in Plastic and Cosmetic Laser Center of Guangdong Second People's Hospital were selected and were divided into a control group and a study group according to the random number table method, with 32 cases in each group. The included patients were (9.3±2.8) years old, with 44 boys and 20 girls. The control group underwent routine catheterization in the ward before surgery, and the study group underwent catheterization in the operating room after general anesthesia. The application effects of the two nursing models were analyzed and compared, and the changes of blood pressure and heart rate, success rate of catheterization, pain and discomfort, anxiety and fear, number of cases of urethral injury, and agitation during anesthesia resuscitation were compared between the patients with catheterization at different stages. χ² test and t test were used. Results　There were statistically significant differences in the systolic blood pressure [(16.10±1.96) kPa vs. (18.14±1.83) kPa], diastolic blood pressure [(10.10±1.70) kPa vs. (10.97±1.64) kPa], and heart rate [(98.09±1.58) beats/min vs. (120.41±3.90) beats/min] in the control group before and after catheterization (t=4.303, 2.083, and 30.006; all P<0.05). There were no statistically significant differences in the systolic blood pressure [(16.39±1.80) kPa vs. (16.66±2.06) kPa], diastolic blood pressure [(10.10±1.70) kPa vs. (10.50±1.57) kPa], or heart rate [(98.14±1.61) beats/min vs. (98.93±6.43) beats/min] in the study group before and after catheterization (t=0.558, 0.978, and 0.674; all P>0.05). In the study group, there were 30, 0, 8, and 1 cases of one-time successful catheterization, pain and discomfort, anxiety and fear, and agitation during anesthesia resuscitation, and there were 24, 26, 30, and 28 cases in the control group, with statistically significant differences between the two groups (all P<0.05). Conclusion　The whole-process nursing method of urethral catheterization after general anesthesia can reduce the psychological burden and complications in children with congenital microtia undergoing auricle reconstruction, and improve the comfort of urethral catheterization, which is worthy of widespread promotion and application in nursing clinic.

Role of fistula-specific care team in patients with arteriovenous fistula pseudoaneurysm

Tian Yuanru, Sun Xiaomin, Wei Yaqiong

2024, 30(2):  328-332.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.031

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Objective　To explore the application effect of internal fistula special group nursing in patients with arteriovenous fistula pseudoaneurysm. Methods　This was a randomized controlled trial. A total of 60 patients with arteriovenous fistula pseudoaneurysm collected from Lianyungang Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected as the research objects, and were divided into two groups according to the random grouping method with 30 patients in each group. In the control group, there were 22 males and 8 females, aged (48.52±10.21) years. In the observation group, there were 21 males and 9 females, aged (49.15±10.16) years. The control group received routine internal fistula nursing, and the observation group received internal fistula special group nursing on the basis. The surgical rate of pseudoaneurysms, size of pseudoaneurysms, number of pseudoaneurysms, and incidence of complications were compared between the two groups after intervention. Independent sample t test and χ² test were used. Results　After intervention, the size of pseudoaneurysms in the observation group was smaller than that in the control group [(2.38±0.72) cm vs. (2.86±0.87) cm], with a statistically significant difference (t=2.328, P=0.023). The number of pseudoaneurysms in the observation group was less than that in the control group [(1.07±0.58) vs. (1.40±0.61)], with a statistically significant difference (t=2.147, P=0.036). There was no statistically significant difference in the surgical rate of pseudoaneurysms between the two groups (P>0.05). The incidence of pseudoaneurysm related complications in the observation group was lower than that in the control group [10.00% (3/30) vs. 33.33% (10/30)], with a statistically significant difference (χ²=4.812, P=0.028). Conclusion　In the face of patients with arteriovenous fistula pseudoaneurysm, taking special group nursing measures for internal fistula can reduce the incidence of complications of pseudoaneurysm, and improve the prognosis in patients with pseudoaneurysm to a certain extent, which is worthy of clinical promotion and adoption.

Effect analysis of application of nurse-led functional training APP management platform in rehabilitation period after craniocerebral injury operation

Shen Hongmei, Zhang Yanan, Chang Jianghua

2024, 30(2):  333-337.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.032

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Objective　To analyze the effect of nurse-led functional training APP management platform in the rehabilitation of craniocerebral injury after operation. Methods　A total of 146 patients with craniocerebral injury who underwent surgical treatment in Xinxiang Central Hospital from April 2020 to June 2021 were selected as the study objects, and were divided into a control group and an observation group according to the propensity score, with 73 cases in each group. In the control group, there were 43 males and 30 females, aged (55.18±2.34) years. In the observation group, there were 41 males and 32 females, aged (55.27±2.26) years. The control group received routine continuous nursing, while the observation group received nurse-led function training APP management platform nursing. The general information of the two groups was compared; the mastery of rehabilitation knowledge and the score of Chinese version of Fugl-Meyer Motor Function Assessment Scale (FMAS) were compared between the two groups; the score of Quality of Life after Traumatic Brain Injury Scale (QOLIBRI) was compared between the two groups. t test and χ² test were used. Results　The mastery rates of basic knowledge of disease [95.89% (70/73)], assessment of physical disorders [97.26% (71/73)], and functional training [97.26% (71/73)] in the observation group were higher than those in the control group [84.93% (62/73), 82.19% (60/73), and 80.82% (59/73)], with statistically significant differences (all P<0.05). The upper limb score [(53.27±9.24) points], lower limb score [(28.49±2.78) points], and total score of FMAS [(81.76±12.02) points] in the observation group were higher than those in the control group [(45.37±8.34) points, (20.47±2.15) points, and (65.84±10.49) points], with statistically significant differences (all P<0.05). After 2 weeks of nursing, the satisfaction score with all aspects of the body of the observation group was (104.29±7.24) points, which was higher than that of the control group [(86.49±6.34) points], while the score of whether it was troubled was lower than that of the control group [(30.27±3.29) points vs. (41.37±5.34) points], with statistically significant differences (both P<0.05). Conclusion　The application of nurse-led functional training APP management platform in patients after craniocerebral injury operation is helpful to enhance their understanding of rehabilitation knowledge, enhance their compliance with rehabilitation training, promote the recovery of limb function, and improve their quality of life.

Study on the status quo and influencing factors of self-compassion in patients recovering from moderate to severe burns

Liang Yan, Ren Le

2024, 30(2):  338-343.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.033

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Objective　To investigate the current situation and influencing factors of self-compassion in patients recovering from moderate to severe burns. Methods　A total of 286 cases of moderate and severe burns during the convalescent admitted to the First Affiliated Hospital of Nanyang Medical College from January 2020 to December 2022 were selected as the study objects by the convenient sampling method, including 159 males and 127 females, aged 18-60 years. General information questionnaire, Self-Compassion Scale (SCS), Experiences in Close Relationship Scale-Short Form (ECR-S), and Social Support Rating Scale (SSRS) were used to investigate. Independent sample t test, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression analysis were used. Results　The scores of self-compassion, attachment anxiety, attachment avoidance, and social support were (61.25±10.52), (76.14±5.59), (69.02±5.43), and (35.29±5.29) points in the 286 patients recovering from moderate to severe burns. The scores of attachment anxiety and attachment avoidance were negatively correlated with the score of self-compassion (r=-0.316 and -0.332, both P<0.05), while the score of social support was positively correlated with the score of self-compassion (r=0.325, P<0.05). Multiple linear regression analysis showed that marital status, family per capita monthly income, educational background, daily living ability, attachment anxiety, attachment avoidance, and social support were the main factors affecting self-compassion (all P<0.05), accounting for 33.2% of the total variation. Conclusions　The self-compassion in patients with moderate and severe burns in the convalescent period is generally at a moderate and low level. Medical staff should attach importance to the assessment of patients' self-compassion ability, and formulate targeted interventions based on self-compassion building factors and influencing factors, so as to effectively meet the patients' individual health needs, improve their daily life ability, improve their self-compassion level, and ultimately improve their mental health level and promote the prognosis.

Effect of standardized feeding procedures on enteral nutrition tolerance in patients with sepsis

Li Lanxiang, Chen Huiyao

2024, 30(2):  343-347.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.034

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Effect of traditional Chinese medicine application combined with standard nursing on the prognosis of elderly patients with severe pneumonia

Dang Zhen, Gao Yujiao, Jia Jizong

2024, 30(2):  348-352.  DOI: 10.3760/cma.j.issn.1007-1245.2024.02.035

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Objective　To explore the effect of traditional Chinese medicine application combined with standard nursing on the prognosis of elderly patients with severe pneumonia. Methods　A randomized controlled trial was conducted on 94 elderly patients with severe pneumonia admitted to Henan Provincial Hospital of Traditional Chinese Medicine from August 2020 to July 2022. They were randomly divided into an experimental group and a conventional group with the random number table method, with 47 patients in each group. There were 29 males and 18 females in the conventional group, aged (70.96±6.22) years, and they received routine treatment and nursing. There were 27 males and 20 females in the experimental group, aged (71.84±6.12) years, and they received traditional Chinese medicine application combined with standard nursing on the basis of the conventional group. The remission time of symptoms and signs, hospitalization time, pulmonary function indexes [including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF)], arterial blood gas indexes [including partial pressure of blood oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), and saturation of blood oxygen (SaO₂)], clinical efficacy, and complication rates of the two groups were compared. The statistical methods adopted were t test and χ² test. Results　The disappearance time of cough, shortness of breath, and lung moist rales, and hospitalization time in the experimental group were shorter than those in the conventional group [(5.41±1.26) d vs. (6.73±1.46) d, (2.76±0.92) d vs. (3.44±1.13) d, (5.95±0.60) d vs. (7.22±1.63) d, (19.74±3.02) d vs. (23.48±5.16) d], with statistically significant differences (t=4.692, 3.199, 3.346, and 4.289; all P<0.05). After 14 days of treatment, the FVC, FEV1, PEF, PaO₂, and SaO₂ in the experimental group were higher than those in the conventional group [(2.92±0.65) L vs. (2.55±0.51) L, (2.78±0.60) L vs. (2.48±0.47) L, (7.05±0.88) L/s vs. (6.17±0.79) L/s, (85.29±5.57) mmHg vs. (81.72±4.23) mmHg (1 mmHg = 0.133 kPa), (95.72±8.84)% vs. (90.41±7.52)%], and the PaCO₂ was lower than that in the conventional group [(44.83±5.32) mmHg vs. (47.45±6.19) mmHg], with statistically significant differences (t=3.070, 2.698, 5.102, 3.499, 3.174, and 2.201; all P<0.05). The total effective rates of the experimental group and the conventional group were 89.36% (42/47) and 72.34% (34/47), respectively, and the total incidences of complications were 10.64% (5/47) and 27.66% (13/47), respectively, with statistically significant differences (both χ²=4.398, both P=0.036). Conclusion　Traditional Chinese medicine application combined with standard nursing can promote the disappearance of symptoms and signs in elderly patients with severe pneumonia, improve the lung function, blood oxygen, and curative effect, reduce the complications, shorten the hospital stay, and has a definite effect.