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Table of Content

    01 February 2024, Volume 30 Issue 3
    New Medical Advances

    Research progress on relationship between iron death and chemotherapy resistance in patients with breast cancer

    Yu Xiaojie, Cheng Lihao, Zhang Hao, Zhang Haojie, Yang Zhenlin
    2024, 30(3):  353-356.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.001
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    As a common malignant tumor in women, breast cancer has risen to the top of female malignant tumors, and has serious impact on women's health. At present, although there are various treatment methods for breast cancer, due to the high degree of malignancy and chemotherapy resistance of patients, the clinical treatment effect is not good, which seriously affects the patients' prognosis and survival. Iron death is a novel form of cell death characterized by intracellular iron overexpression and lipid reactive oxygen species accumulation. Studies have found that iron death is related to the occurrence, development, and evolution of breast cancer, so inducing iron death can inhibit the proliferation and distant metastasis of breast cancer cells, enhance the efficacy of chemotherapy drugs, and reverse the chemotherapy resistance of breast cancer. Therefore, inducing iron death may become a new strategy for clinical treatment of patients with breast cancer. In this paper, the mechanism of chemotherapy resistance and iron death in breast cancer and the research progress in the treatment of patients with breast cancer are reviewed.

    Research progress of exemption from radiotherapy after breast-conserving surgery in patients with early-stage breast cancer

    Liu Ming, Liu Shuai, Zhang Nan
    2024, 30(3):  357-362.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.002
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    Radiotherapy after breast-conserving surgery for patients with breast cancer is the standard treatment modality for early-stage breast cancer. Due to advances in imaging, surgery, and molecular pathology, downgrading of radiotherapy or even reasonable exemption from radiotherapy can be performed in low-risk patients with breast cancer to minimize the adverse effects of radiotherapy. This article reviews the evolutionary process of radiotherapy downgrading in breast cancer and the role of relevant pathological tests and genetic tests in assessing the prognosis of patients with breast cancer in radiotherapy, and discusses relevant trials on patients with hormone receptor-positive breast cancer combining multiple molecular tests for exemption from radiotherapy to identify patient groups that can be safely exempted from radiotherapy after breast-conserving surgery using available tumor biology and molecular predictions.

    Progress of dexmedetomidine for intrathecal injection

    Liu Shujiao, Zhang Quanyi
    2024, 30(3):  362-366.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.003
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    In order to improve the quality of anesthesia, reduce the amount of intrathecal local anesthetics, and decrease the incidence of adverse reactions, the application of intrathecal local anesthetics and intrathecal adjuvant drugs has received more and more attention. Dexmedetomidine, as a kind of highly selective, specific, and potent α2-adrenergic agonist, has been a hotspot drug in research. Its analgesic effects have been proved in a variety of surgeries, but the analgesic mechanism of its intrathecal application and the issue of safety are still difficult problems in the clinical research. In order to better improve the quality of anesthesia and promote the advancement of the medical cause, the review on the progress of the research on the use of dexmedetomidine for intrathecal injection is described.

    Meta Analysis

    Meta-analysis on impact of prehabilitation on clinical outcomes after surgery of patients with colorectal cancer

    Zhang Kaisi, Ma Jindong, Zhang Qihui, Chen Qiangpu
    2024, 30(3):  367-373.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.004
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    Objective To explore the effect of prehabilitation on the clinical outcomes after surgery of patients with colorectal cancer. Methods The PubMed, Embase, Cochrane Library, and Web of Science were searched to collect relevant literatures of the effects of prehabilitation for patients undergoing colorectal cancer surgery from their establishment to March, 2023. Two reviewers independently evaluated the quality of the included studies. The RevMan 5.3 software was used for the meta-analysis of the total incidence of postoperative complications, time to first anal exhaust, incidences of gastrointestinal dysfunction, pneumonia, and anastomotic leakage, hospital stay, and mortality. Results A total of 13 articles with a sample size of 8 311 cases were enrolled, including 3 033 cases in the prehabilitation group and 5 278 cases in the control group. The meta-analysis results showed that the prehabilitation group had a lower incidence of postoperative complications (OR=0.55, 95%CI 0.39-0.77, P<0.05), shorter time to first anal exhaust (WMD=-0.70, 95%CI -1.29 to -0.11, P<0.05), and a lower incidence of gastrointestinal dysfunction (OR=0.53, 95%CI 0.43-0.65, P<0.05) than the control group. There were no statistical differences in the incidences of postoperative pneumonia and anastomotic leakage, hospital stay, and mortality between the two groups (all P>0.05). Conclusion Prehabilitation can reduce the total incidence of postoperative complications in patients with colorectal cancer, shorten the time to first anal exhaust, decrease the incidence of gastrointestinal dysfunction, and improve their clinical outcomes.

    Meta-analysis on clinical efficacies of laparoscopic and traditional open surgery for patients with external abdominal hernia

    Fu Andi, Zhou Shiyong, Chen Keke, Lin Zhongzhi, Shi Yingfei, Wang Zhenhao
    2024, 30(3):  374-380.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.005
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    Objective To systematically evaluate the clinical efficacies of laparoscopic and traditional open surgery for patients with abdominal external hernia, and to provide support for seeking better treatment methods and evidence-based medicine. Methods The authors comprehensively searched the literatures on external abdominal hernia published at home and abroad from the establishment of these databases to January 3, 2023, and searched for the randomized controlled trials about laparoscopic treatment (experimental group) and traditional open surgery (control group) of patients with external abdominal hernia. A total of 468 relevant literatures were collected. Data extraction and quality evaluation were conducted for the clinical studies that met the inclusion criteria; meta-analysis was performed on the included literatures using the Review Manager 5.4 software. Results Finally, 13 literatures were included, with a total of 1 044 patients, including 527 in the experimental group and 517 in the control group. The results of meta-analysis showed that the hospitalization time in the experimental group was shorter than that in the control group, with a statistical difference (SMD=-2.16, 95%CI -2.36- -1.96, Z=21.20, P<0.000 01). The incidence of clinical complications in the experimental group was lower than that in the control group, with a statistical difference (OR=0.21,95%CI 0.13-0.34, Z=6.25, P<0.000 01). The incidence of postoperative infection in the experimental group was lower than that in the control group (P<0.000 01). Compared with the control group, the experimental group had more advantages in improving postoperative urinary retention, postoperative pain, and hematoma (all P<0.000 01). Conclusion Compared with traditional open surgery, laparoscopic hernia repair shortens the hospitalization time, reduces postoperative complications, and improves the patients' quality of life.

    Cerebrovascular Disease

    Research progress of post-stroke fatigue

    Fan Lele, Ma Liang, Zhai Huaixiang, Shi Tong
    2024, 30(3):  381-385.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.006
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    Post-stroke fatigue is a common complication after stroke, and has serious impact on the rehabilitation and quality of life of stroke patients. This article reviews the epidemiology, commonly used assessment tools, influencing factors, pathophysiological mechanism, and treatment of post-stroke fatigue.

    Susceptibility weighted angiography in evaluation of ischemic penumbra in patients with acute ischemic stroke

    Zhou Jianguo, Fu Dayong, Sun Zhenhu, Ma Xianjun, Zhang Yunyun
    2024, 30(3):  386-389.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.007
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    Objective To analyze the clinical value of susceptibility weighted angiography (SWAN) in evaluating the location and range of ischemic penumbra (IP) in patients with acute ischemic stroke. Methods Twenty-five patients with acute ischemic stroke who underwent magnetic resonance imaging examination at Lianyungang Hospital, Nanjing University of Chinese Medicine from January 2019 to December 2022 were selected, including 15 males and 10 females who were (55.7±14.4) years old. The diffusion weighted imaging (DWI), T2 weighted liquid attenuation inversion recovery sequence (T2 Flair), SWAN, and three-dimensional arterial spin labeling (3D ASL) sequences were performed on all the patients. The high signal area displayed on DWI and the low signal area displayed on the apparent diffusion coefficient (ADC) map were determined as the infarct core area. The SWAN sequence was analyzed to indicate the positive area of prominent vascular sign (PVS). The 3D ASL sequence indicates differences in the mismatch range between the low perfusion area of cerebral blood flow (CBF) and the infarct core interval. The independent-sample t test was applied. Results The mismatch range of SWAN-DWI was (2 289.42±721.47) mm2, and that of 3D ASL-DWI was (2 331.59±730.71) mm2, with no statistical difference between the two (t=0.205, P=0.838). Conclusion PVS prompted by magnetic resonance SWAN sequence can be used to evaluate the location and range of IP, and provide image basis for the selection of clinical treatment.

    Value of diffusion-weighted magnetic resonance imaging combined with serum CRP in identifying time window of acute ischemic cerebral infarction

    Li Jing, Tian Hongzhe, Li Bo, Li Li
    2024, 30(3):  390-393.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.008
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    Objective To evaluate the value of diffusion-weighted magnetic resonance imaging (DWI) combined with serum C-reactive protein (CRP) in identifying the time window of acute ischemic cerebral infarction. Methods A retrospective analysis was conducted on the clinical data of 195 patients with acute cerebral infarction admitted to Baoji Central Hospital from June 2021 to June 2023. There were 111 males and 84 females; they were 57-75 years old. The patients were divided into an ultra-acute stage group (course of disease ≤ 6 h; 67 cases), an acute stage group (course of disease of 6-72 h; 79 cases), and a subacute stage group (course of disease of ≥72~168 h; 49 cases) according to the time from onset to magnetic resonance imaging examination. The DWI examination results [apparent diffusion coefficient (ADC)] and CRP levels of the three groups were compared. The value of DWI combined with CRP in identifying the time window of acute cerebral infarction was analyzed using the receiver operating characteristic curve (ROC). t and F tests were applied. Results The ADC of the affected side in the ultra-acute stage group [(0.33±0.08)×10-3 mm2/s] was significantly lower than those in the acute stage group [(0.40±0.09)×10-3 mm2/s] and the subacute stage group [(1.56±0.25)×10-3 mm2/s], with a statistical difference between the 3 groups (F=34.455, P<0.05). In the ultra-acute stage group and the acute stage group, the ADC values of the affected sides were significantly lower than those of the healthy sides (both P<0.05). In the subacute stage group, the ADC value of the affected side was significantly higher than that of the healthy side (P<0.05). The CRP level in the ultra-acute stage group [(9.39±3.03) mg/L] was significantly higher than those in the acute stage group [(6.01±1.27) mg/L] and the subacute stage group [(5.48±1.33) mg/L] (q=16.09 and 712.295; both P<0.05); there was no statistical difference in CRP level between the acute stage group and the subacute stage group (q=1.933; P>0.05). The ROC showed that the area under the curve (AUC), sensitivity, and specificity of ADC value for distinguishing acute ischemic cerebral infarction from ultra-acute phase were 0.587, 100.00%, and 38.38%. The AUC, sensitivity, and specificity of CRP were 0.888, 73.13%, and 96.87%. The AUC, sensitivity, and specificity of ADC value combined with CRP were 0.918, 85.07%, and 86.72%. Conclusions Both ADC value and serum CRP level in patients with acute ischemic cerebral infarction can be used to identify the time window. ADC has high sensitivity while CRP has high specificity for identifying ultra-acute ischemic cerebral infarction. Combination of the two can optimize the differentiation efficiency.

    Characteristics of intracranial arterial wall plaques on CTA plain scan and HR-MRI in patients with posterior circulation ischemia

    Yue Yuxue, Tang Xueke
    2024, 30(3):  394-398.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.009
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    Objective To explore the characteristics of intracranial arterial wall plaques on plain CT angiography (CTA) and high-resolution magnetic resonance imaging (HR-MRI) in patients with posterior circulation ischemia. Methods One hundred patients with posterior circulation ischemia treated at Liaocheng Third People's Hospital from March 2019 to May 2023 were selected, including 49 patients with transient ischemic attack (TIA) and 51 patients with cerebral infarction. There were 58 males and 42 females; they were (57.76 ± 8.92) years old. The CTA judgment of cerebral vascular stenosis and collateral circulation and the detection of plaques by CTA and HR-MRI were analyzed. The differences in HR-MRI plaque parameters between the with patients TIA and cerebral infarction were analyzed. The consistency analysis was conducted using Kappa test. The differences between groups were analyzed using t test or χ2 test. Results The Kappa value of the results of CTA judging cerebral vascular stenosis compared to digital subtraction angiography (DSA) was 0.761 (P<0.05); the accuracy of CTA in judging cerebral vascular stenosis was 85.00% (85/100). The Kappa value of CTA in determining cerebral vascular collateral circulation compared to DSA was 0.820 (P<0.05); the accuracy of CTA in determining cerebral vascular collateral circulation was 91.00% (91/100). The detection rates of plaques in the patients with cerebral infarction by CTA and HR-MRI were 92.16% (47/51) and 90.20% (46/51), respectively, which were higher than those in the patients with TIA [77.55% (38/49) and 73.47% (36/49)] (χ2=4.181 and 4.737; both P<0.05). Comparison of HR-MRI plaque parameters: the plaque area of cerebral infarction, plaque load, and remodeling index in the patients with cerebral infarction were higher than those in the patients with TIA [(5.86±0.92) mm2 vs. (3.94±0.82) mm2,(26.17±4.82)% vs. (21.14±4.43)%, and (1.19±0.19) vs. (1.10±0.20)], with statistical differences (t=-11.001, -5.427, and -2.308; all P<0.05). The proportions of positive remodeling, vulnerable plaques, and plaques located on the ventral or upper wall in the patients with cerebral infarction were higher than those in the patients with TIA [82.35% (42/51) vs. 63.27% (31/49), 72.55% (37/51) vs. 34.69% (17/49), and 76.47% (39/51) vs. 36.73% (18/49)], with statistical differences (χ2=4.619, 14.417, and 16.099; all P<0.05). Conclusions CTA has certain value in judging cerebral vascular stenosis and collateral circulation in patients with posterior circulation ischemia. At the same time, there are significant differences in HR-MRI plaque parameters between patients with TIA and cerebral infarction of posterior circulation ischemia.

    Therapeutic effect of acupuncture and moxibustion combined with proprioceptive neuromuscular facilitation for patients with limb dysfunction after stroke

    Lyu Yunliang, Wan Cailing, Wang Futao, Chang Liguo
    2024, 30(3):  398-403.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.010
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    Objective To explore the curative effect of acupuncture and moxibustion combined with proprioceptive neuromuscular facilitation (PNF) for patients with limb dysfunction after stroke. Methods Ninety-eight patients with limb dysfunction after stroke admitted to Liaocheng Third People's Hospital from January 2022 to January 2023 were selected for the randomized controlled trial. They were divided into a single group and an experimental group by the random number table method, with 49 patients in each group. There were 30 males and 19 females in the single group; they were (62.67±6.71) years old. There were 29 males and 20 females in the experimental group; they were (63.75±6.76) years old. The single group were treated with PNF, and the experimental group with PNF, acupuncture, and moxibustion. The total clinical response rates and related scores [Berg Balance Scale (BBS), Neurological Deficit Scale (NIHSS), Modified Barthel Index (MBI), and Functional Comprehensive Assessment Scale (FCA)], limb function [Free Hand Muscle Strength Scale (MMT) and Fugl Meyer Motor Function Score (FMA)], and gait spatiotemporal parameters (stride speed, stride length, stride frequency, affected side swing phase, affected side support phase, and bilateral support phase level), and kinematic parameters [peak joint torque (hip, knee, and ankle) and maximum flexion and extension angle (hip and knee)] before and after the treatment were compared between the two groups. t and χ2 tests were applied. Results The total clinical effective rate after the treatment of the experimental group was higher than that of the single group [95.92% (47/49) vs. 79.59% (39/49)], with a statistical difference (χ2=4.653; P=0.031). The scores of FCA, MBI, BBS, and NIHSS in the experimental group were (65.19±4.23), (73.82±8.56), (43.18±3.45), and (3.15±1.17); the scores in the single group were (61.86±5.35), (66.79±5.98), (34.59±2.80), and (5.27±2.38); there were statistical differences between the two groups (t=3.418, 4.713, 13.533, and 5.596; all P<0.05). After the treatment, the scores of upper and lower limb FAM and MMT in the experimental group were higher than those in the single group [(55.79±6.55) vs. (49.65±5.25), (27.06±3.67) vs. (24.68±3.35), and (4.07±0.62) vs. (3.46±0.87)], with statistical differences (t=5.120, 3.353, and 3.997; all P<0.05). After the treatment, the stride frequency, stride length, stride speed, and affected side swing phase level in the experimental group were higher than those in the single group [(107.76±10.96) steps/min vs. (95.19±9.25) steps/min, (40.67±6.48) cm vs. (36.50±5.71) cm, (0.63±0.13) m/s vs. (0.45±0.11) m/s, and (42.84±6.01)% vs. (39.76±5.24)%]; the levels of the affected side support phase and bilateral support phase in the experimental group were lower than those in the single group [(57.21±5.01)% vs. (61.89±5.06)% and (31.16±6.11)% vs. (37.46±7.06)%]; there were statistical differences (t=6.135, 3.380, 7.399, 2.704, 4.601, and 4.723; all P<0.05). After the treatment, the peak torque of hip joint, the maximum flexion and extension angle of hip joint, the peak torque of knee joint, the maximum flexion and extension angle of knee joint, and the peak torque of ankle joint in the experimental group were bigger than those in the single group [(0.64±0.13) Nm vs. (0.55±0.11) Nm, (34.35±7.09)° vs. (29.64±6.71)°, (1.59±0.32) Nm vs. (1.37±0.31) Nm, (49.46±8.02)° vs. (42.98±7.61)°, and (1.59±0.27) Nm vs. (1.45±0.24) Nm], with statistical differences (t=3.700, 3.378, 3.457, 4.103, and 2.713; all P<0.05). Conclusion Acupuncture and moxibustion + PNF for patients with limb dysfunction after stroke can improve the curative effect and their limb muscle strength, balance ability, motor function, walking ability, nerve injury, and quality of life.

    Effect of dihydroergotoxine combined with ginkgo biloba extract injection for elderly patients with ischemic cerebrovascular disease

    Hou Fangfang, Yan Liping, Liu Chenyang
    2024, 30(3):  404-408.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.011
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    Objective To explore the efficacy and safety of dihydroergotoxine combined with ginkgo biloba extract injection for elderly patients with ischemic cerebrovascular disease. Methods In this prospective study, 90 elderly patients with ischemic cerebrovascular disease treated at Department of Neurology, Xi'an Gaoxin Hospital from March 2021 to January 2023 were divided into a control group and an observation group according to the treatment order, with 45 cases in each group. There were 25 males and 20 females in the observation group; they were 67-76 (69.72±4.03) years old. There were 22 males and 23 females in the control group; they were 66-78 (69.58±4.26) years old. Both groups were routinely treated; in addition, the observation group were treated with dihydroergotoxine and ginkgo biloba extract injection, and the control group with dihydroergotoxine. Both groups were treated for 2 weeks. The hemodynamic and cerebral blood flow indicators (blood low shear viscosity, blood high shear viscosity, and plasma viscosity), brain blood flow indicators (cerebrovascular peripheral resistance and end diastolic blood flow velocity of carotid artery), and scores of National Institute of Health Stroke Scale (NIHSS) and Activities of Daily Living (ADL) after the treatment in both groups were recorded and compared. The clinical efficacies and incidences of adverse reactions were compared between the two groups. χ2 and t tests were used. Results After the treatment, the blood low shear viscosity, blood high shear viscosity, and plasma viscosity in the observation group were lower than those in the control group [(7.13±1.21) mPa·s vs. (8.26±1.46) mPa·s, (4.89±0.88) mPa·s vs. (5.78±1.04) mPa·s, and (1.59±0.31) mPa·s vs. (1.86±0.34) mPa·s], with statistical differences (t=4.00, 4.38, and 3.94; all P<0.05). The end diastolic blood flow velocity of carotid artery and cerebrovascular peripheral resistance in the observation group were better than those in the control group [(96.48±5.31)cm/s vs. (89.46±4.82) cm/s and (1.68±0.23) kPa·s/ml vs.(1.96±0.25) kPa·s/ml], with statistical differences (t=6.57 and 5.53; both P<0.05). After the treatment, the scores of ADL and NIHSS in the observation group were better than those in the control group [(69.74±5.19) vs. (56.64±5.33) and (5.12±1.13) vs. (8.18±1.45)], with statistical differences (t=11.81 and 11.17; both P<0.05). The total effective rate in the observation group was higher than that in the control group [91.11% (41/45) vs. 73.33% (33/45)], with a statistical difference (χ2=4.87; P<0.05). There was no statistical difference in the total incidence of adverse reactions during the treatment between the observation group and the control group [6.67% (3/45) vs. 8.89% (4/45); χ2=0.16; P>0.05]. Conclusion In the treatment of elderly Patients with ischemic cerebrovascular disease, the combination of dihydroergotoxine and ginkgo biloba extract injection demonstrates significant clinical efficacy and good safety.

    Effect of eurecline and butylphthalein for patients with acute cerebral infarction

    Wang Lingzhi, Du Yuanyuan, Liu Yan
    2024, 30(3):  409-413.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.012
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    Objective To analyze the effects of eurecline and butylphthalein on cognitive function, vascular endothelial function, and daily living ability in patients with acute cerebral infarction. Methods A total of 100 patients with acute cerebral infarction treated in Bayannur City Hospital from March 2021 to March 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by lottery, with 50 cases in each group. There were 24 males and 26 females in the control group; they were (60.17±8.92) years old. There were 27 males and 23 females in the control group; they were (59.45±8.42) years old. The control group took intravenous infusion of eurekline. The observation group took eurecline and butylphthalein. The clinical efficacies, cerebral blood flow parameters [plasma viscosity, whole blood viscosity, fibrinogen (FIB)], vascular endothelial function [vascular endothelial growth factor (VEGF), endothelin-1 (ET-1), and nitric oxide (NO)], and scores of Montreal Cognitive Assessment Scale (MoCA) and Modified Barthel Index (MBI) before and after the treatment, and incidences of adverse reactions were compared between the two groups. The independent-sample t test, paired t test, and χ2 test were used. Results The total effective rate of the observation group was significantly higher than that of the control group [92.00% (46/50) vs. 76.00% (38/50)], with a statistical difference (χ2=4.962; P=0.029). After the treatment, the plasma viscosity, whole blood viscosity, and level of FIB in the observation group were lower than those in the control group [(1.74±0.52) mPa·s vs. (2.05±0.60) mPa·s, (16.59±6.33) mPa·s vs. (21.37±6.54) mPa·s, and (2.34±0.78) g/L vs. (2.93±0.72) g/L], with statistical differences (t=2.761, 3.714, and 3.930; all P<0.05). After the treatment, the levels of ET-1, NO, and VEGF in the observation group were better than those in the control group [(48.53±5.49) ng/L vs. (54.61±6.52) ng/L, (45.54±6.80) μmol/L vs. (38.22±5.71) μmol/L, and (54.21±8.35) ng/L vs. (49.64±6.08) ng/L], with statistical differences (t=5.044, 5.829, and 3.129; all P<0.05). After the treatment, the scores of MBI, MoCA, and NIHSS in the observation group were better than those in the control group [(68.37±12.54) vs. (55.91±11.47), (24.67±3.21) vs. (21.13±3.95), and (7.65±1.13) vs. (10.21±1.84)], with statistical differences (t=5.184, 4.918, and 8.383; all P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group [14.00% (7/50) vs. 10.00% (5/50); χ2=0.379,P=0.538]. Conclusion Eurecline combined with butylphthalein for patients with acute cerebral infarction can significantly improve the therapeutic effect and their cerebral microcirculation and vascular endothelial function and promote their recovery of cognitive function and daily living ability, and has high safety, so it is worthy of clinical promotion.

    Phosphatidylserine soft capsules and intravascular treatment in treatment of patients with ischemic stroke

    Tian Meng, Feng Tao, Zhuang Weisheng
    2024, 30(3):  414-418.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.013
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    Objective  To observe the value of phosphatidylserine soft capsules and intravascular treatment (EVT) in the treatment of patients with ischemic stroke. Methods  This was a prospective study. One hundred and twenty-three patients with ischemic stroke treated at First Hospital, Nanyang Medical College from January 2021 to January 2023 were selected as the study objects, and were divided into a combined group (63 cases) and a control group (60 cases) by the random number table method. There were 32 males and 28 females in the control group; they were (61.22±5.33) years old. There were 33 males and 30 females in the combined group; they were (60.61±5.11) years old. The control group took routine treatment and EVT. The combined group took phosphatidylserine soft capsules and EVT. The improvement of vascular endothelial cell function, platelet function, and coagulation function and neurological rehabilitation of the two groups were compared. t and χ2 tests were applied. Results  Before the treatment, there were no statistical differences in vascular endothelial cell injury markers, platelet activity indicators, coagulation indicators, and brain nerve function indicators between the two groups (all P>0.05). After the treatment, the levels of endothelin-1 (ET-1), thrombomodulin (TM), von Willebrand factor (vWF), β-thromboglobulin (β-TG), granule membrane protein CD62P, CD63, D-dimer (D-D), coagulation factor Ⅱ (FVⅡ), and coagulation factor Ⅶ (FVⅦ) in the combined group were lower than those in the control group [(50.11±10.26) ng/L vs. (56.28±10.32) ng/L, (30.61±5.37) μg/L vs. (33.49±5.28) μg/L, (90.25±10.33)% vs. (96.27±10.15)%, (15.28±5.17) μg/L vs. (18.33±5.41) μg/L, (56.32±10.41)% vs. (61.55±10.28)%, (10.44±3.65)% vs. (12.41±3.62)%, (188.45±50.61) μg/L vs. (211.27±50.66) μg/L, (122.36±20.61)% vs. (135.44±20.66)%, (105.25±20.71)% vs. (120.33±20.71)%], with statistical differences (t=3.324, 2.998, 3.258, 3.197, 2.802, 3.004, 2.498, 3.514, and 4.037; all P<0.05). Under different treatment regimens, the scores of National Institutes of Health Stroke Scale (NIHSS) 3, 7, and 14 after the treatment in the combined group were lower than those in the control group [(25.22±5.17) vs. (28.61±5.47), (21.44±5.28) vs. (24.19±5.26), and (18.45±5.33) vs. (21.32±5.14)], with statistical differences (t=3.534, 2.893, and 3.037; all P<0.05). Conclusion  Phosphatidylserine soft capsules assisted with EVT for patients with ischemic stroke can effectively alleviate their vascular endothelial damage, inhibit platelet activity, improve their coagulation function, and promote their recovery of brain nerve function.

    Effect of pharmaceutical intensive intervention for community hypertensive patients and prevention of ischemic stroke

    Zhai Liuqun, Zheng Hua, Li Yu, Fu Hai'er, Li Meng, Zhao Yuanyuan, Wang Luxun, Ren Mengyuan
    2024, 30(3):  419-424.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.014
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    Objective To investigate the effect of pharmaceutical intensive intervention for community hypertensive patients and to predict the risk of ischemic stroke in 10 years. Methods A total of 180 patients with hypertension treated at Community Health Service Center of Dongdajie, Zhengzhou from October 2021 to July 2022 were selected for the randomized controlled trial, and were divided into a control group and an intervention group by the random number table method, with 90 cases in each group. There were 39 females and 51 males in the control group; they were (63.17±4.27) years old. There were 41 females and 49 males in the intervention group; they were (63.49±4.05) years old. The control group took routine clinical intervention; in addition, the intervention group took pharmaceutical intensive intervention. The systolic and diastolic blood pressures and levels of fasting blood glucose, glycated hemoglobin, total triglyceride, total cholesterol, and low density lipoprotein before and after the intervention were compared between the two groups. The Modified Flamingham Stroke Scale was used to predict the 10-year stroke risk of the two groups. The Chinese version of Depression-Anxiety-Stress Scale (DASS-21), Medical Coping Style Questionnaire (MCMQ), Self-care Ability Scale (ESCA), and Morisky Medication Compliance Scale (MMAS-8) were used to evaluate all the patients. χ2 test, t test and rank sum test were used. Results After the intervention, the systolic and diastolic blood pressures in the intervention group were lower than those in the control group [(118.63±7.15) mmHg (1 mmHg=0.133 kPa) vs. (130.56±10.53) mmHg and (80.71±8.25) mmHg vs. (93.11±9.34) mmHg], with statistical differences (t=8.892 and 9.440; both P<0.001). The levels of fasting blood glucose, total triglyceride, glycated hemoglobin, total cholesterol, and low density lipoprotein in the intervention group were lower than those in the control group [(5.23±0.65) mmol/L vs. (5.79±0.74) mmol/L, (1.38±0.14) mmol/L vs. (1.51±0.16) mmol/L, (5.72±0.56)% vs. (6.18±0.69)%, (4.80±0.34) mmol/L vs. (5.11±0.41) mmol/L, and (2.37±0.34) mmol/L vs. (2.69±0.41) mmol/L], with statistical differences (t=5.394, 5.801, 4.911, 5.521, and 5.700; all P<0.001). After the intervention, the 10-year risk of stroke in the intervention group was lower than that in the control group [low risk: 38.89% (35/90) vs. 23.33% (21/90); middle risk: 44.44% (40/90) vs. 45.56% (41/90); high risk: 16.67% (15/90) vs. 31.11% (28/90)], with a statistical difference (Z=2.523, P<0.001). The score of DASS-21 in the intervention group was lower than that in the control group [(16.13±3.04) vs. (23.23±6.07); t=9.922; P<0.001]. The scores of MCMQ, ESCA, and MMAS-8 in the intervention group were higher than those in the control group [(70.11±9.09) vs. (58.34±8.95), (102.05±21.01) vs. (75.14±15.19), and (14.25±4.24) vs. (11.12±3.20)], with statistical differences (t=8.753, 9.847, and 5.590; all P<0.001). Conclusion Pharmaceutical intensive intervention for community hypertensive patients can improve their blood pressures, regulate their blood lipids and blood glucose, reduce the risk of stroke in 10 years, relieve their anxiety, and increase their self-management ability, treatment enthusiasm, and medication compliance.

    Application of remimazolam tosylate in interventional thrombectomy for patients with intracranial embolization

    Hu Hongping, Zhang Yuexiao, Zhang Hongkai, Wang Jingwei, Yang Jiafu
    2024, 30(3):  424-429.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.015
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    Objective To study the efficacy and safety of remimazolam tosylate in anesthesia for interventional thrombectomy for patients with intracranial vascular embolism. Methods Eighty patients with intracranial vascular embolism who underwent interventional thrombectomy at Liaocheng Third People's Hospital from October 2021 to March 2023 were selected for the randomized controlled trial, and were divided into a mazolam combined with dezocine group (R+D group) and a propofol combined with dezocine group (P+D group) by the random number table method, with 40 cases in each group. There were 23 males and 17 males in the R+D group; they were (61.7±7.4) years old. There were 21 males and 19 females in the P+D group; they were (61.5±7.6) years old. The efficacies, adverse reactions, renal function, inflammatory factors, and T lymphocytes were compared between the R+D group and the P+D group. The mean artery pressures (MAP), heart rates (HR), and blood oxygen saturations (SpO2) were compared between the two groups after entering the room (T0), after the completion of anesthesia induction (T1), during the maintenance of anesthesia (T2), at the beginning of the operation (T3), after the operation (T4), and when they woke up after the operation (T5). The independent-sample t test and χ2 test were applied. Results The operation time, recovery time, ICU time, first feeding time, time to get out of bed, and incidences of hypotension, respiratory depression, and intraoperative body movement reaction in the R+D group were all lower than those in the P+D group [(67.8±9.2) min vs. (81.4±10.6) min, (16.9±4.5) min vs. (27.1±5.2) min, (2.6±0.9) d vs. (3.9±1.1) d, (1.3±0.5) d vs. (1.8±0.7) d, (3.1±0.8) d vs. (4.6±1.1) d, 12.5% (5/40) vs. 40.0% (16/40), 12.5% (4/40) vs. 37.5% (15/40), and 7.5% (3/40) vs. 35.0% (14/40)], with statistical differences (all P<0.05). The MAP, HR, and SpO2 at T1, T2, T3, T4, and T5 in the R+D group were lower than those in the P+D group. After the treatment, the levels of hs-CRP, TNF-α, IL-6, S100B, and MBP in the R+D group were lower than those in the P+D group [(4.1±0.7) mg/L vs. (8.2±1.1) mg/L, (10.3±2.1) pg/L vs. (16.7±3.1) pg/L, (8.5±1.2) pg/L vs. (11.4±1.5) pg/L, (1.1±0.3) ng/L vs. (1.6±0.5) ng/L, and (3.7±0.8) μg/L vs. (4.6±1.1) μg/L]; the levels of CD3+, CD4+, CD8+, and Tau protein in the R+D group were higher than those in the P+D group [(59.7±3.2)% vs. (56.1±2.8)%, (29.5±1.9)% vs. (27.3±1.8)%, (17.2±1.5)% vs. (15.4±1.4)%, and (28.5±4.3) μg/L vs. (24.3±3.9) μg/L]; there were statistical differences (all P<0.05). Conclusion Remimazolam tosylate has the advantages of good sedation effect and high safety in anesthesia for interventional thrombectomy for patients with intracranial vascular embolization, and has little impact on the patients' inflammatory response and immune function.

    Influence of comprehensive nursing on rehabilitation of patients undergoing cerebrovascular intervention

    Long Xiaoxia
    2024, 30(3):  430-433.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.016
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    Objective To study the effect of comprehensive nursing on the rehabilitation of patients undergoing cerebrovascular intervention. Methods Sixty-eight patients who took cerebrovascular intervention in Yunfu Hospital of Traditional Chinese Medicine from January 2021 to July 2022 were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number table method, with 34 cases in each group. There were 19 males and 15 females in the control group; they were (59.34±5.50) years old. There were 18 males and 16 females in the observation group; they were (60.02±4.19) years old. The control group took routine nursing care; in addition, the observation group strengthened preventive and psychological care (comprehensive care). The incidences of postoperative complications, clinical indicators, scores of self-evaluation anxiety and depression scales, and nursing satisfaction were compared between the two groups. t and χ2 tests were applied. Results The incidence of postoperative complications in the observation group was lower than that in the control group [11.76% (4/34) vs. 41.18% (14/34)], with a statistical difference between the two groups (χ2=7.556, P=0.006). There were statistical differences in intubation duration, fasting duration, time staying in bed, and hospital stay between the control group and the observation group [(6.72±1.64) d vs. (4.81±0.89) d, (5.93±1.34) d vs. (5.01±1.21) d, (6.80±2.04) d vs. (4.15±1.21) d, and (13.05±3.60) d vs. (9.89±2.75) d; all P<0.05]. The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the control group were higher than those in the observation group [(46.42±10.31) vs. (34.73±10.98) and (44.67±9.53) vs. (35.98±8.64)], with statistical differences between the two groups (both P<0.05). The overall satisfaction rate in the control group was lower than that in the observation group [88.24% (30/34) vs. 97.06% (33/34)], with no statistical difference between the two groups (P>0.05). Conclusion The comprehensive nursing mode is conducive to the rehabilitation of patients undergoing cerebrovascular intervention.

    Application of medical team resource management mode in patients with acute ischemic stroke

    Zheng Zhijin, Zhang Li, Su Jing
    2024, 30(3):  434-438.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.017
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    Objective To explore the effect of adopting the medical team resource management mode in first aid green channel for patients with acute ischemic stroke (AIS). Methods A retrospective study was conducted on the clinical data of 72 patients with AIS admitted to Xuchang Central Hospital from January 2020 to February 2022. The 36 patients who took the routine first aid green channel at the emergency from January 2020 to January 2021 were set as a control group, including 17 females and 19 males who were (60.56±3.89) years old. The 36 patients with AIS who took the medical team resource management mode at the emergency department from February 2021 to February 2022 were set as an observation group, including 16 females and 20 males who were (60.59±3.91) years old. The first aid efficiencies, neurological function, daily living ability, disability rates, quality of life, and patients' satisfaction degrees were compared between the two groups. t and χ2 tests were applied. Results The emergency triage time, emergency detention time, and time from treatment to thrombolysis in the observation group were shorter than those in the control group [(3.68±1.15) min vs. (5.09±1.23) min, (39.42±3.18) min vs. (46.24±3.25) min, and (55.23±5.40) min vs.(64.79±5.53) min; t=5.024, 8.999, and 7.421; all P<0.001]. The scores of National Institutes of Health Stroke Scale (NIHSS) and the Ability of Daily Living Scale (ADL) at discharge in the observation group lower than those in the control group [(6.51±1.50) vs. (8.93±1.54) and (21.35±2.16) vs. (25.50±2.19); t=6.754 and 8.095; both P<0.001]. The disability rate in the observation group was lower than the that in the control group [2.78% (1/36) vs. 16.67% (6/36); χ2=3.956; P=0.047]. The score of stroke quality of life scale (SS-QOL) at discharge in the observation group was higher than that in the control group [(140.84±6.83) vs. (119.92±6.64); t=13.177; P<0.001]. The scores of first aid methods, safety management, humanistic care, and nursing attitude of satisfaction and the total score in the observation group were higher than those in the control group [(21.26±1.18) vs. (18.98±1.13), (21.85±1.23) vs. (19.94±1.20), (21.96±1.25) vs. (18.54±1.16), (21.80±1.43) vs. (19.06±1.30), and (84.43±3.34) vs. (75.54±3.26); t=8.373, 6.669, 12.033, 8.507, and 11.429; all P<0.001]. Conclusion Adopting the medical team resource management mode in the first aid green channel for patients with AIS can improve the efficiency of first aid and their neurological function, daily living ability, prognosis, and satisfaction degree.

    Collumn of Orthopedics

    Wrist arthroscopic assisted Wristore external fixator for patients with Barton fractures

    Liu Lei, Lyu Shuzhen, Liu Jun, Wang Zhongying, Liu Xuemiao
    2024, 30(3):  439-443.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.018
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    Objective To investigate the effect of wrist arthroscopic assisted Wristore external fixator for patients with Barton fractures. Methods A total of 100 patients with Barton fractures treated in Liaocheng Third People's Hospital from December 2019 to December 2022 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 50 cases in each group. There were 26 males and 24 females in the control group; they were (40.26±3.58) years old. There were 22 males and 28 females in the observation group; they were (43.55±2.44) years old. The control group took routine treatment; in addition, the observation group took wrist arthroscopy-assisted Wristore external fixation. The scores of Gartland-Werley wrist function and Visual Analogue Scale (VAS), joint mobility, and incidences of complications were compared between the two groups. t and χ2 tests were applied. Results After the treatment, the score of Gartland-Werley wrist function in the observation group was lower than that in the control group [(5.29±0.61) vs. (12.42±2.90)], with a statistical difference (t=17.013; P<0.05). The scores of VAS 1 week and 1 month after the surgery in the observation group were lower than those in the control group [(3.24±1.16) vs. (6.88±1.33) and (1.45±0.94) vs. (4.63±1.11)], with statistical differences (t=14.585 and 15.459; both P<0.05). The joint mobility of the observation group was better than that of the control group [82% (41/50) vs. 42% (21/50)], with a statistical difference (t=16.978; P<0.05). The incidence of complications in the observation group was lower than that in the control group [12% (6/50) vs. 48% (24/50)], with a statistical difference (χ2=15.429; P<0.05). Conclusion Wrist arthroscopy-assisted Wristore external fixation in the treatment of patients with Barton fractures is effective, and can significantly improve their wrist function, reduce their pain level, increase their joint mobility, and reduce the incidence of complications, so it is worth for widespread application in clinical practice.

    Effect of thumbtack needles combined with Bingxiao San for patients with ankle fractures during perioperative period

    Xu Haixia, Luo Haixia, Zhuo Dongyan, Li Yawei, Zhou Yingguang
    2024, 30(3):  443-448.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.019
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    Objective To observe the effect of thumbtack needles combined with Bingxiao San for patients with ankle fractures during perioperative period. Methods From December 2021 to March 2023, 60 patients with ankle fractures treated at Department of Orthopedics and Traumatology, Lianyungang Hospital of Traditional Chinese Medicine were selected for the randomized controlled trial. The patients were divided into a treatment group and a control group by the random number table method, with 30 cases in each group. In the treatment group, there were 15 males and 15 females who were (50.70 ± 17.57) years old; there were 16 cases of left ankle fractures and 14 cases of right ankle fractures; there were 2 cases of medial malleolus fractures, 6 cases of lateral malleolar fractures, 14 cases of bimalleolar fractures, and 8 cases of trimalleolus fractures. In the control group, there were 14 males and 16 females who were (51.87±19.43) years old; there were 14 cases of left ankle fractures and 16 cases of right ankle fractures; there were 2 cases of medial malleolus fractures, 5 cases of lateral malleolar fractures, 16 cases of bimalleolar fractures, and 7 cases of trimalleolus fractures. Open reduction and internal fixation of ankle fractures was given to all the patients, and they were treated routinely after the surgery. In addition to the above-mentioned treatments, the treatment group were acupunctured Neiguan and Hegu by thumbtack needles and took Bingxiao San for a course of 1 week. The number of days to be operated on was recorded. The patients' score of Visual Analogue Scale (VAS), ankle circumference, score of traditional Chinese medicine syndromes, local skin temperature, ankle mobility, and the number of episodes of nausea and vomiting were measured 1 and 7 days after the surgery. χ2, t, and Wilcoxon rank-sum tests were used. Results The number of days to undergo surgery in the treatment group was less than that in the control group [(3.57±2.14) d vs. (5.00±2.08) d], with a statistical difference (P<0.05). One day after the surgery, the VAS score, ankle circumference, skin temperature, plantar flexion angle, dorsiflexion angle, and score of traditional Chinese medicine symptoms in the treatment group were (6.70±0.84), (59.23±2.06) cm, (36.34±0.14) ℃, (11.30±1.12)°, (9.03±1.13)°, and (16.03±2.61), and those in the control group were (6.67±0.96), (59.17±1.93) cm, (36.30±0.10) ℃, (11.53±1.33)°, (9.40±1.07)°, and (15.77±2.27), respectively, with no statistical differences (all P>0.05). Seven days after the surgery, the VAS score, ankle circumference, skin temperature, and score of traditional Chinese medicine symptoms in the treatment group were lower than those in the control group [(2.30±0.75) vs. (3.03±0.89), (56.23±1.74) cm vs. (57.33±1.97) cm, (36.07±0.08) ℃ vs. (36.13±0.09) ℃, and (7.30±2.37) vs. (9.07±2.15)], and the plantar flexion angle and dorsiflexion angle in the treatment group were higher than those in the control group [(28.77±1.07)° vs. (25.40±1.40)° and (18.30±1.95)° vs. (15.67±1.40)°], with statistical differences (all P<0.05). The effective rate of the treatment group was higher than that of the control group [93.3% (28/30) vs. 80.0% (24/30)], with a statistical difference (P<0.05). Nausea and vomiting occurred twice in the treatment group, and 4 times in the control group, with no statistical difference (P>0.05). Conclusion Thumbtack needles combined with Bingxiao San for patients with ankle fractures after surgery can effectively reduce the occurrence of ankle pain and local heating, and improve their activity function, clinical symptoms, postoperative recovery, and quality of life.

    Effect of systematic pain nursing for patients with lower tibiofibular combined injury after surgery

    Liu Yanhui, Cheng Yadong, Chen Dongning
    2024, 30(3):  448-452.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.020
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    Objective To explore the effect of systematic pain nursing for patients with lower tibiofibular combined injury after surgery. Methods One hundred and five patients with lower tibiofibular combined injury treated at Xinzheng Public People's Hospital from July 2019 to January 2023 were selected for the randomized controlled trial. All of them were surgically treated. They were divided into a control group (52 cases) and an observation group (53 cases) by the random number table method. There were 27 males and 25 females in the control group; they were 20-56 (35.64±5.26) years old. There were 29 males and 24 females in the observation group; they were 22-57 (36.11±6.03) years old. The control group took routine care; in addition, the observation group took systematic pain care. The scores of Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Inventory (PSQI), Self-rating Anxiety Scale (SAS), Kolcaba Comfort Scale (GCQ), and Comprehensive Quality of Life Questionnaire 74 (GQOL-74) were compared between the two groups. t test, χ2 test, and analysis of variance for repeated measurements were used. Results Three days after the surgery and when they discharged, the scores of VAS in the observation group were lower than those in the control group [(2.36±0.63) vs. (3.02±0.71) and (2.01±0.33) vs. (2.67±0.52); t=5.041 and 7.781; both P<0.05]. When they discharged, the scores of SAS, PSQI, and GCQ in the observation group were better than those in the control group [(41.24±5.28) vs. (45.67±5.30), (7.35±0.84) vs. (9.24±1.03), and (93.74±6.79) vs. (88.90±8.13); t=4.290, 10.313, and 3.313; all P<0.05]. When they discharged, the score of GQOL-74 in the observation group was higher than that in the control group [(82.34±6.54) vs. (79.01±5.49); t=2.823; P=0.006]. Conclusion Systematic pain nursing for patients with lower tibiofibular combined injury after surgery can significantly alleviate their pain and alleviate sleep disorders, and improve their hospital comfort, emotional state, and quality of life.

    Effect and mechanism of Yougui Pills assisting bone marrow mesenchymal stem cells on healing of osteoporotic fractures in rabbits

    Zhu Jun, Yao Shuaihui, Guo Xiaolei
    2024, 30(3):  453-459.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.021
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    Objective To explore the effect and possible mechanism of Yougui Pills assisting bone marrow mesenchymal stem cells (BMSCs) on healing of osteoporotic fractures in rabbits. Methods This study was from January to June 2023. Fifty rabbits were divided into a normal control group, a model control group, a Yougui pill group, a BMSCs group, and a combined treatment group, with 10 in each group. Osteoporosis fracture models were established in all groups except the normal control group, and corresponding drugs were given. After the treatment, the bone mineral density (BMD), trabecular number, trabecular thickness, trabecular dispersion, elastic modulus, stiffness, maximum stress, and maximum bearing capacity of femur were measured. The levels of Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) gene and protein in femur were determined by real time polymerase chain reaction and Western blotting. One-way analysis of variance and LSD-t test were used to analyze the data. Results The BMD, number of bone trabeculae, thickness of bone trabeculae, elastic modulus, stiffness, maximum stress, maximum bearing capacity, and levels of JAK2 and STAT3 mRNA and protein of femurs in the model control group were lower than those in the normal control group (P<0.05), and the trabecular dispersion in the model control group was higher than that in the normal control group (all P<0.05). The BMD, number of bone trabeculae, thickness of bone trabeculae, elastic modulus, stiffness, maximum stress, maximum bearing capacity, and levels of JAK2 and STAT3 mRNA and protein of femurs in the Yougui pill group, the BMSCs group, and the combined treatment group were higher than those in the model control group (all P<0.05). The trabecular bone dispersions in the Yougui pill group, the BMSCs group, and the combined treatment group were lower than that in the model control group (all P<0.05). The femoral BMD [(1.76±0.13) g/cm3], trabecular number [(5.87±0.24) pieces/mm], trabecular thickness [(0.14±0.03) mm], femoral elastic modulus [(343.27±21.04) MPa], stiffness [(904.25±73.25) N/mm], maximum stress [(32.63±3.17) N/mm2], maximum bearing capacity [(358.85±13.02) N], and levels of JAK2 and STAT3 mRNA [(3.45±0.26) and (3.60±0.28)] and protein [(0.82±0.05) and (0.84±0.05)] in the combined treatment group were higher than those in the Yougui pills group [(1.41±0.15) g/cm3, (3.88±0.28) pieces/mm, (0.10±0.02) mm, (304.62±20.41) MPa, (698.52±69.55) N/mm, (25.34±3.22) N/mm2, (297.34±13.24) N, (2.58±0.26), (2.29±0.23), (0.60±0.05), and (0.53±0.07)] and the BMSCs group [(1.47±0.14) g/cm3, (3.89±0.28) pieces/mm, (0.09±0.03) mm, (299.54±16.94) MPa, (720.33±69.48) N/mm, (23.24±3.13) N/mm2, (289.38±13.13) N, (2.63±0.25), (2.30±0.24), (0.59±0.06), and (0.53±0.08)] (all P<0.05); the bone trabecular dispersion [(0.34±0.02) mm] in the combined treatment group was lower than those in the Yougui pills group [(0.42±0.03) mm] and the BMSCs group [(0.43±0.03) mm] (both P<0.05). Conclusions Yougui pills assisting BMSCs can significantly promote the healing of osteoporotic fractures in rabbits; the mechanism may be related to the activation of the JAK2/STAT3 signaling pathway of femur in rabbits with osteoporotic fractures.

    Application of failure mode and effect analysis in postoperative care for fracture patients

    Yang Jing, Liu Yangzi
    2024, 30(3):  460-464.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.022
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    Objective To analyze the application and influence of failure modes and effect analysis in postoperative care for fracture patients. Methods Sixty fracture patients surgically treated at Jinan Central Hospital from January to December 2022 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. There were 19 men and 11 women in the control group; they were (49.20±2.01) years old. There were 17 men and 13 women in the observation group; they were (49.46±2.33) years old. The control group took routine care; the observation group took the nursing intervention of the failure mode and effect. analysis Through hospital investigation and follow-up, the motor function and quality of life were evaluated by the Fugl-Meyer Assessment (FMA) and European Quality of Life 5-Dimensions (EQ-5D) on the day of admission and 30 d after the surgery. The incidences of complications within 30 d after the surgery were compared between the two groups. t and χ2 tests were applied. Results Thirty days after the surgery, the scores of reflex activity, synergy movement, separated movement, and coordination/speed in the observation group were higher than those in the control group [(4.65±0.77) vs. (4.01±1.02), (12.03±1.37) vs. (11.30±1.26), (3.03±1.22) vs. (2.49±1.01), and (2.59±0.92) vs. (2.10±0.89)], with statistical differences (t=2.743, 2.148, 2.075, and 2.097; all P<0.05). Thirty days after the surgery, the scores of mobility, self-management ability, activity, pain/uncomfortableness, and depression or anxiety in the observation group were higher than those in the control group [(2.01±0.64) vs. (1.78±0.14), (1.95±0.43) vs. (1.72±0.34), (1.82±0.26) vs. (1.67±0.27), (2.01±0.27) vs. (1.90±0.12), and (1.92±0.14) vs. (1.78±0.30)], with statistical differences (t=2.013, 2.298, 2.192, 2.039, and 2.316; all P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group [3.33% (1/30) vs. 20.00% (6/30)], with a statistical difference (χ2=4.043; P=0.044). Conclusion Failure mode and effect analysis for fracture surgery patients can significantly improve their motor function and quality of life, and effectively reduce the incidence of complications.

    Effect of seamless nursing in operation room combined with diversified health education for patients with femoral fractures undergoing internal fixation

    Wang Jing, Yang Xindi, Song Yuanzheng
    2024, 30(3):  465-469.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.023
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    Objective To explore the effect of seamless nursing in operation room combined with diversified health education on psychological state, rehabilitation quality, and nursing satisfaction of patients with femoral fractures undergoing internal fixation. Methods A total of 99 patients femoral fractures who underwent internal fixation of in the operation room in Tengzhou Central People's Hospital, Jining Medical College from June 2021 to December 2022 were selected for the randomized controlled trial, and were divided into an observation group (50 cases) and a control group (49 cases) by the random number table method. There were 34 males and 15 females in the control group; they were (57.23±5.78) years old. There were 36 males and 14 females in the observation group; they were (57.36±5.89) years old. The control group took routine nursing intervention; in addition, the observation group took seamless nursing in the operation room and diversified health education. The perioperative mood states [assessed by mood state (POMS) scale], rehabilitation quality [assessed by Harris Hip Score Scale (HHS) and Functional Independence Measurement Scale (FIM)], cognitive levels, incidences of complications, and nursing satisfaction were compared between the two groups. t test and χ2 test were used. Results After the intervention, the negative mood score of the observation group was lower than that of the control group [(74.84±4.06) vs. (85.70±4.97)], and the positive mood score of the observation group was higher than that of the control group [(27.74±3.56) vs. (18.22±3.55)], with statistical differences (t=-11.918 and 13.322; both P<0.05). After the intervention, the scores of treatment-related knowledge, disease-related knowledge, and self-care-related knowledge of cognitive level in the observation group were higher than those in the control group [(4.08±0.42) vs. (3.32±0.82), (3.98±0.41) vs. (3.19±0.52), and (4.05±0.29) vs. (3.27±0.46)], with statistical differences (t=5.821, 8.403, and 10.114; all P<0.05). The scores of HHS and FIM in the observation group were higher than those in the control group [(86.48±4.56) vs. (72.32±3.82) and (112.26±10.58) vs. (86.71±9.26)], with statistical differences (t=15.968 and 12.776; both P<0.05). The nursing satisfaction of the observation group was higher than that of the control group [92.00% (46/50) vs. 75.51% (37/49)], with a statistical difference (χ2=4.966; P=0.026). The total incidence of complications in the observation group was lower than that in the control group [6.00% (3/50) vs. 20.45% (11/49)], with a statistical difference (χ2=5.515; P=0.059). Conclusion Seamless nursing combined with diversified health education during perioperative period and after discharge for patients with femoral fractures after internal fixation can improve their psychological state, quality of rehabilitation, cognitive level of disease, and nursing satisfaction, and reduce the occurrence of complications, so it is worthy of application in clinical nursing.

    Visual acupotomy assisted with nonsteroidal anti-inflammatory drugs in treatment of patients with cervical spondylosis

    Wu Meng, Liu Chunyan
    2024, 30(3):  470-474.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.024
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    Objective To observe the efficacy and safety of visual acupotomy assisted with nonsteroidal anti-inflammatory drugs in the treatment of patients with cervical spondylosis. Methods One hundred and six patients with cervical spondylosis treated at First Hospital, Nanyang Medical College were selected for the randomized controlled trial, and were divided into a conventional group and an acupotomy group by the random number table method. There were 30 males and 23 females in the conventional group; they were (35.44±5.17) years old. There were 31 males and 22 females in the acupotomy group; they were (36.15±5.22) years old. The conventional group were treated with manual manipulation and nonsteroidal anti-inflammatory drugs, and the acupotomy group with visual acupotomy and nonsteroidal anti-inflammatory drugs. The pain relief, improvement in cervical mobility, and improvement in cervical physiological structure and function before and after the treatment and incidences of complications were compared between the two groups. t and χ2 tests were applied. Results The scores of Visual Analogue Scale (VAS) 1, 2, and 4 weeks after the treatment in the acupotomy group were lower than those in the conventional group [(4.55±1.27) vs. (5.65±2.08), (3.24±0.38) vs. (4.41±1.09), and (2.56±0.21) vs. (3.07±0.46)], with statistical differences (t=3.286, 7.379, and 7.343; all P<0.05). After the treatment, the cervical spine flexion activity, backward extension activity, and left and right rotation activity in the acupotomy group were higher than those in the conventional group [(62.41±10.27)° vs. (55.46±10.27)°, (60.45±10.24)° vs. (54.33±10.25)°, and (45.22±10.36)° vs. (39.16±10.21)°], with statistical differences (t=3.484, 3.075, and 3.046; all P<0.05). After the treatment, the Cobb angle of cervical spine, the curvature of cervical spine, and the score of Japanese Orthopedic Association (JOA) in the acupotomy group were higher than those in the conventional group [(18.24±4.41)° vs. (15.45±4.36)°, (7.63±2.25)° vs. (6.42±2.07)°, and (23.36±5.41) vs. (20.18±5.22)], with statistical differences (t=3.275, 2.881, and 3.080; all P<0.05). There was no statistical difference in the incidence of complications between the acupotomy group and the conventional group [11.32% (6/53) vs. 7.55% (4/53); χ2=0.832; P=0.362]. Conclusions Visual acupotomy assisted with nonsteroidal anti-inflammatory drugs in the treatment of patients with cervical spondylosis can effectively relieve their pain and has positive significance in promoting their recovery of cervical activity, physiological structure, and function. This treatment does not significantly increase the risk of related complications, with high safety.

    Application of core stabilization training in rehabilitation after surgery of elderly patients with thoracolumbar compression fractures

    Lei Qipeng, Li Jianfeng
    2024, 30(3):  474-478.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.025
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    Objective To observe the application effect of core stabilization training in rehabilitation after surgery of elderly patients with thoracolumbar compression fractures. Methods One hundred and eighteen patients with thoracolumbar compression fractures treated at Tongxu County Hospital of Traditional Chinese Medicine from January 2021 to October 2022 were selected for the randomized controlled trial, and were divided into a routine group and a rehabilitation group by the random number table method, with 59 cases in each group. There were 30 males and 29 females in the routine group; they were (65.22±5.36) years old. There were 32 males and 27 females in the rehabilitation group; they were (66.18±5.22) years old. The routine group did routine postoperative rehabilitation training; in addition, the rehabilitation group did core stabilization training. All the patients were followed up for 6 months. The injured vertebral structure, recovery of vertebral pain, improvement of vertebral function and body balance ability, and rehabilitation were compared between the two groups. t and χ2 were applied. Results After the intervention, the anterior edge height of the injured vertebrae in the rehabilitation group was higher than that in the routine group [(75.22±10.31)% vs. (70.23±10.46)%]; the posterior convex angle of the injured vertebrae and the Cobb angle in the rehabilitation group were lower than those in the routine group [(13.28±3.11)° vs. (15.62±3.25)° and (10.36±3.22)° vs. (12.41±3.25)°]; there were statistical differences (t=2.610, 3.996, and 3.442; all P<0.05). One, three, and six months of the follow up, the scores of Visual Analogue Scale and Oswestry Disability Index (ODI) in the rehabilitation group were lower than those in the routine group [(4.14±1.25) vs. (5.22±1.88), (3.06±0.77) vs. (4.24±1.06), and (2.45±0.31) vs. (3.07±0.45); (30.45±5.27) vs. (33.49±5.25), (25.66±5.14) vs. (28.42±5.31), and (21.44±5.27) vs. (24.33±5.46)], with statistical differences (t=3.675, 6.918, 8.715, 3.139, 2.869, and 2.925; all P<0.05). One, three, and six months of the follow up, the scores of Berg Balance Scale (BBS) in the rehabilitation group were higher than those in the routine group [(45.25±5.16) vs. (42.25±5.11), (50.27±5.35) vs. (47.62±5.32), (55.26±5.43) vs. (52.11±5.44)]; the hospitalization time and fracture healing time in the rehabilitation group were shorter than those in the routine group [(5.21±1.46)d vs. (7.35±2.47)d and (10.21±3.45) weeks vs. (12.27±3.28) weeks]; there were statistical differences (t=3.173, 2.698, 3.148, 5.729, and 3.324; all P<0.05). Conclusion Core stabilization training for elderly patients with thoracolumbar compression fractures can effectively improve their vertebral structure and alleviate their vertebral pain, and is of great significance in promoting their recovery of vertebral function and balance ability and accelerating their rehabilitation process.

    Effect of targeted radiofrequency thermocoagulation combined with core muscle training for patients with lumbar disc herniation

    Hu Xiaoli, Fan Houbao, Xu Feng, Zhu Min, Liu Pei, Zhang Shuai
    2024, 30(3):  479-483.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.026
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    Objective To explore the effect of targeted radiofrequency thermocoagulation combined with core muscle training in the treatment of patients with lumbar disc herniation. Methods A total of 92 patients with lumbar disc herniation admitted to Department of Orthopedics and Traumatology of Traditional Chinese Medicine, Xuzhou First People's Hospital from January 2021 to January 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group, with 46 cases in each group. There were 25 males and 21 females in the observation group; they were (42.23±10.57) years old; their disease course was (36.24±11.71) months. There were 28 males and 18 females in the control group; they were (43.37±9.82) years old; their disease course was (38.58±12.39) months. The control group took targeted radiofrequency thermocoagulation, and the observation group took targeted radiofrequency thermocoagulation and did core muscle training. The pain degrees [Visual Analog Scale (VAS)], lumbar function, therapeutic effects, and incidences of complications were compared between the two groups. The enumeration data were analyzed by the χ2 test; the measurement data conforming to normal distribution were analyzed by repeated measurement ANOVA and SNK-q test. Results There were statistical differences in the scores of VAS and lumbar function between the two groups (Fbetween groups=5.236, Ftime=6.025, Finteraction=5.842; Fbetween groups=12.364, Ftime=11.482, Finteraction=14.217; all P<0.05). Seven days and 1, 3, and 6 months after the treatment, the scores of VAS and lumbar function in the observation group were lower than those in the control group [(4.02±1.46) vs. (4.76±1.78), (3.22±1.34) vs. (3.85±1.55), (2.21±1.11) vs. (2.74±1.37), and (1.03±0.42) vs. (1.65±0.69);(25.21±7.31) vs. (28.34±7.65), (15.37±6.85) vs. (18.35±7.42), (10.05±5.32) vs. (12.65±6.51), and (5.53±3.64) vs. (7.45±3.87)], with statistical differences (all P<0.05). The scores of VAS and lumber function were lower 7 d and 1, 3, and 6 months after than before the treatment in both groups (all P<0.05). The excellent and good rates 1, 3 and 6 months after the treatment in the observation group were higher than those in the control group [69.57% (32/46) vs. 45.65% (21/46), 82.61% (38/46) vs. 63.04% (29/46), and 93.48% (43/46) vs. 73.91% (34/46)], with statistical differences (χ2=5.386, 4.449, and 6.452; all P<0.05). After the treatment, the incidence of complications in the observation group was lower than that in the control group [6.52% (3/46) vs. 21.74% (10/46)], with a statistical difference (χ2=4.389; P=0.036). Conclusion Targeted radiofrequency thermocoagulation combined with core muscle training for patients with lumbar disc herniation can relieve their pain, improve their lumbar function, and reduce the occurrence of complications, with significant therapeutic effect.

    Qualitative study on psychological experience of patients with thoracolumbar fractures and nerve injury

    Liu Jianxia, Niu Luye, Li Yanan, Zhu Xiaoguang
    2024, 30(3):  484-488.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.027
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    Objective To understand the psychological experience of patients with thoracolumbar fractures and nerve injury, and to provide scientific basis for clinical intervention. Methods Using the phenomenological analysis method in qualitative research, 13 patients with thoracolumbar fractures and nerve injury admitted to Zhengzhou Orthopedic Hospital from January to December 2022 were selected, including 10 males and 3 females; they were 29-49 (38.77±6.93) years old. Face-to-face structured interviews were conducted on them. The data were analyzed and summarized by the Colaizzi 's 7-step analysis method. Results After reading, organizing, analyzing, categorizing, and refining, a total of four themes were identified, including urgent knowledge needs, psychological impact of diseases, nursing need, and heavy family burden. Conclusion Patients with thoracolumbar fractures accompanied by nerve injury have different psychological needs, and understanding their true psychological experience is helpful for nursing staff to attach great importance to their psychological confusion and needs, and then take targeted nursing interventions timely to improve their psychological status.

    Clinical Research

    Neuroendoscopic transsphenoial surgery versus microscopic transsphenoial surgery for patients with pituitary adenomas

    Yang Gongli, Chen Jing
    2024, 30(3):  489-493.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.028
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    Objective To investigate the efficacies of neuroendoscopic transsphenoial surgery versus microscopic transsphenoial surgery for patients with pituitary adenomas and the effects on the levels of serum adrenocorticotropic hormone (ACTH), prolactin (PRL), and growth hormone (GH). Methods Eighty patients with pituitary adenomas diagnosed and treated in Shanxian Central Hospital from May 2015 to May 2023 were selected for the randomized controlled trial, and were divided into a study group and a control group by the random number table method, with 40 cases in each group. There were 23 males and 17 females in the study group; they were (50.29±5.25) years old. There were 20 males and 20 females in the control group; they were (51.09±5.21) years old. The study group took neuroendoscopic transsphenoial approach resection, while the control group microscopic transsphenoial approach resection. The operation times, intraoperative bleeding volumes, hospitalization times, tumor resection rates, levels of ACTH, PRL, and GH, and incidences of complications were compared between the two groups. Independent sample t and χ2 tests were applied. Results The operation time, hospitalization time, and intraoperative bleeding volume in the study group were less than those in the control group [(81.67±12.03) min vs. (114.35±11.68) min, (7.51±1.18) d vs. (11.07±1.24) d, and (72.59±8.14) ml vs. (85.26±8.31) ml], with statistical differences (t=12.327, 13.154, and 6.889; all P<0.01). The complete resection rate in the study group was higher than that in the control group [87.50% (36/40) vs. 70.00% (28/40); χ2=3.660; P=0.056]. Seven days after the operation, the serum levels of ACTH, PRL, and GH in the study group were lower than those in the control group [(15.37±4.19) pmol/L vs. (20.01±4.38) pmol/L, (1.33±0.48) nmol/L vs. (1.71±0.52) nmol/L, and (0.88±0.31) nmol/L vs. (1.09±0.37) nmol/L], with statistical differences (t=4.841, 3.396, and 2.752; all P<0.05). The incidence of complications in the study group was lower than that in the control group [10.00% (4/40) vs. 27.50% (11/40)], with a statistical difference (χ2=4.021; P=0.045). Conclusion The neuroendoscopic approach for pituitary adenoma resection is more conducive to promoting the patients' recovery of postoperative hormone levels and reducing the incidence of complications compared to the microscopic approach.

    Application effect of initial specimen diversion technique in blood collection for blood culture in elderly patients with fractures

    Liu Yun, Shao Changsheng, Song Yuanzheng, Liu Zhi, Yang Ximing
    2024, 30(3):  493-498.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.029
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    Objective To investigate the effect of initial sample transfer technique in reducing blood culture contamination rate in elderly patients with fractures without specified equipment or procedures. Methods Four hundred elderly patients with fractures who were hospitalized in Department of Orthopedics, Tengzhou Central People's Hospital from January 2019 to March 2023 and needed to collect blood culture samples due to suspected or confirmed bloodstream infection were selected for the randomized control trial, and were divided into a control group and an observation group by the random number table method. In the control group, there were 204 patients (86 males and 118 females); they were 61 to 99 (81.74±7.96) years old; 72 cases suffered upper limb fractures, 90 cases lower limb fractures, 30 cases spine fractures, and 12 cases pelvis and acetabular fractures. In the observation group, there were 196 patients (90 males and 106 females); they were 60 to 94 (80.36±8.23) years old; 64 cases suffered upper limb fractures, 88 cases lower limb fractures, 34 cases spinal fractures, and 10 cases pelvic and acetabular fractures. The blood of the control group was collected by the standard method. The initial specimen diversion technique was used for blood collection in the observation group. The baseline data, true positive rates, and contamination rates of blood cultures were compared between the two groups. The microbiological characteristics of positive blood cultures and the proportion of each strain were analyzed. Independent sample t test, χ2 test, or Fisher's exact test were used. Results There was no statistical difference in the true positive rate of blood culture between the two groups (χ2=0.249, P>0.05). The contamination number/rate in the observation group was significantly lower than that in the control group [0.51% (1/196) vs. 4.90% (10/204)], with a statistical difference (χ2=7.209, P<0.05). Most of the strains isolated from the contaminated blood cultures in both groups were coagulase-negative staphylococcus; the most common cause of true bacteremia was Enterobacteriaceae species, followed by Staphylococcus aureus. The rate of intravenous vancomycin injection in the patients with blood culture contamination was significantly higher than that in the patients with negative blood cultures, with a statistical difference (P<0.05). The rate of additional blood culture extraction in the patients with blood culture contamination [63.64% (7/11)] was 39.87% higher than that in the patients with negative blood culture [23.77%(82/345)], with a statistical difference (χ2=7.036, P<0.05). The mean hospital stay in the patients with blood culture contamination was 2.97 d (95%CI 1.5-3.0 d) days longer than that in the patients with negative blood cultures. Conclusions The use of initial specimen diversion technique can significantly reduce blood culture contamination without affecting the true positivity of blood cultures. This novel approach is practical and safe for patients as a simple and effective measure that does not compromise the sensitivity of blood cultures and does not need expensive equipment.

    Intestinal flora imbalance in patients with polycystic ovary syndrome and its relationship with insulin resistance

    Liu Ying, Fan Li
    2024, 30(3):  498-502.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.030
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    Objective To investigate the intestinal flora imbalance in patients with polycystic ovary syndrome (PCOS) and its relationship with insulin resistance. Methods Fifty (25.98±0.95) years old patients with PCOS treated at Shiyan People's Hospital from June 2020 to June 2022 were selected as a study group. Fifty (26.02±1.01) years old healthy women with regular menstruation during the same period were selected as a healthy control group. All the subjects were tested for insulin resistance. The characteristics of intestinal flora distribution were analyzed. The intestinal flora distribution characteristics and insulin indicators of the two groups were compared to analyze the intestinal flora imbalance and its correlation with insulin resistance in the patients with PCOS. t test and χ2 test were used for the statistical analysis. Results After the cluster analysis, 372 operational taxonomic unit (OTU) representative sequences were obtained, including 60 OTU sequences specific to the study group and 90 OTU sequences specific to the healthy control group; there were 111 shared OTU sequences in the two groups; the results of Alpha analysis showed that the number of OTU and Shannon index in the study group were lower than those in the healthy control group (both P<0.05). The relative abundance of Firmicutes at the phylum level in the study group was higher than that in the healthy control group, and the relative abundance of Bacteroidetes in the study group was lower than that in the healthy control group (both P<0.05); the relative abundances of Brucella, Bacteroidetes, and Faecobacter at the genus level were lower than those in the healthy control group, and the relative abundance of Eubacterium Hoveri in the study group was higher than that in the control group (all P<0.05). The fasting insulin (FINS) and insulin resistance index (HOMA-IR) in the study group were higher than those in the healthy control group [(9.55±1.98) mIU/L vs. (6.71±1.92) mIU/L and (2.08±0.50) vs. (1.49±0.40); both P<0.05]. Bacteroides was positively correlated with HOMA-IR (r=0.281, P<0.05), and fecal bacillus negatively with HOMA-IR (r=-0.331, P<0.05). Conclusion Patients with PCOS have microflora dysregulation, and the occurrence of intestinal microflora dysregulation is closely related to insulin resistance. The detection of their intestinal microflora level can provide references and basis for the clinical diagnosis and treatment of patients with PCOS.

    Case Report

    One case of refractory adenosarcoma of uterus

    Shi Juanjuan, Du Chao, Li Nan, Han Shanshan, Cui Xiujuan
    2024, 30(3):  503-507.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.031
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    Adenosarcoma of uterus is considered to be a low grade malignant uterine tumor. It has a low incidence and lacks specific clinical manifestations and laboratory and radiographic examinations. Most patients with adenosarcoma of uterus have good prognosis. This paper reports the diagnosis and treatment of a patient with refractory adenosarcoma of uterus who had metastasis rapidly and died after surgery, so as to improve the clinicians' understanding about this disease and take individualized treatment.

    One case of ultrasonic manifestations of ovarian malignant mixed Mullerian tumor

    Wang Mengdie, Guo Xinmin
    2024, 30(3):  508-510.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.032
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    Ovarian malignant mixed Mullerian tumor (OMMMT) is a rare and highly invasive tumor; most patients are diagnosed at an advanced stage due to its atypical clinical manifestations. To enhance the accuracy diagnosing the disease and provide a basis for clinical treatment strategies, a retrospective analysis of the clinical data and ultrasound images of the patient with OMMMT confirmed by operation and pathology at Guangzhou Red Cross Hospital, Jinan University in September 2020 was conducted. The ultrasound findings showed that a mixed echogenic mass was observed in the pelvic cavity, with a long diameter exceeding the viewing window, a transverse diameter of 161 mm, and an anteroposterior diameter of 111 mm. The mass exhibited an irregular shape and an uneven cystic wall with varying thicknesses around its periphery. The inner wall was not smooth, and the internal echogenicity of the mass was heterogeneous. Additionally, there were echogenic septa of varying thickness, irregular nodular hypoechoic protrusions, and non-echoic regions within the mass. The mass was closely associated with the cervix and there was no evidence of normal uterine or bilateral ovarian echoes during the examination. Color Doppler flow imaging showed strip-like blood flow signals on the periphery and septum of a palpable mass, and abundant blood flow signals within a nipple-like protrusion, with the detection of arterial spectrum signals; the PSV was 12.1 cm/s, and RI=0.59.

    Ommaya sac implantation for one patient with hydrocephalus after monocytotic Listeria meningitis

    Sheng Qi, Wang Qizheng, Liu Xiaoma, Dong Gaolei, Liu Ruifang, Chen Qifu, Zhao Yu
    2024, 30(3):  511-514.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.033
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    Nursing Research

    Effect of refined care combined with clinical care pathways for patients undergoing interventional procedures for cardiovascular diseases

    Jia Xiaohui, Ding Xinxin, Pan Yajuan
    2024, 30(3):  515-519.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.034
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    Objective To explore the effect of refined nursing care combined with clinical nursing pathways for patients undergoing interventional procedures for cardiovascular diseases. Methods Eighty five patients with cardiovascular diseases who underwent interventional procedures at Fuwai Central China Cardiovascular Hospital between February 2021 and February 2022 were selected for this study. They were divided into a control group (43 cases) in ward A and a study group (42 cases) in ward B according to the wards they stayed. There were 25 males and 18 females in the control group; they were 40-75 (58.47±6.49) years old. There were 28 males and 14 females in the study group; they were 40-73 (57.62±6.40) years old. The control group took routine nursing interventions; in addition, the study group took refined care and clinical nursing pathway intervention. The intervention effects, psychological status, and incidences of postoperative complications were compared between the two groups. t and χ2 tests were applied. Results The nursing satisfaction rate of the study group was higher than that of the control group [95.24% (40/42) vs. 74.42% (32/43)], with a statistical difference (χ2=5.59, P<0.05). The hospitalization time of the study group was shorter than that of the control group [(9.58±1.92) d vs. (12.31±2.46) d], with a statistical difference (t=5.70, P<0.05). After the intervention, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) of the study group were lower than those of the control group [(39.47±4.39) vs. (42.15±4.68) and (40.35±4.48) vs. (43.56±4.84)], with statistical differences (t=2.72 and 3.17; both P<0.05). The incidence of complications in the study group was lower than that in the control group [2.38% (1/42) vs. 18.60% (8/43)], with a statistical difference (χ2=4.32, P<0.05). Conclusion Refined nursing care combined with clinical nursing pathways for patients undergoing interventional surgery for cardiovascular diseases can obviously improve their psychological status and reduce postoperative complications, and has good clinical nursing effect.

    Qualitative research on cardiovascular disease patients' risk communication experience from perspective of risk management

    Mei Xingyan, Lyu Meirong, Li Yurong, Wu Tiantian, Yang Shuhong, Jia Qingyun, Zhang Xiao
    2024, 30(3):  519-524.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.035
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    Objective To explore the feelings and inner experiences of cardiovascular disease patients on risk communication, and to clarify the needs and expectations of patients on risk management. Methods From September to November 2022,a total of 12 patients with cardiovascular diseases treated at Department of Cardiology, Linyi People's Hospital were selected by the purposive sampling for semi-structured interviews, including 7 males and 5 females. They were 42 to 71 years old. The data were analyzed by the Colaizzi's analysis method, and the theme-words were extracted. Results A total of 3 themes and 8 subthemes were extracted: including confusion of risk communication (lack of awareness, loss and forgetting of communication information, and difficulty in distinguishing information), risk communication attitude and response (active and passive communication, drawing on advantage and avoiding disadvantage communication, and alternative communication), risk communication cognition and expectation (risk communication information requirements and expecting diverse communication). Conclusions Medical staff should change patients' risk communication cognition and provide individualized risk communication strategies to improve their risk management ability.

    Effect of self-care mode under framework of chronic disease trajectory for elderly patients with gastric carcinoma undergoing gastrectomy

    Cui Yuxia, Du Bing, Gao Fengshuang
    2024, 30(3):  524-528.  DOI: 10.3760/cma.j.issn.1007-1245.2024.03.036
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    Objective To investigate the effect of self-care mode under the framework of chronic disease trajectory on the prognostic survival quality of elderly patients with gastric carcinoma undergoing gastrectomy. Methods A total of 98 patients who underwent gastrectomy for gastric carcinoma at Henan Provincial People's Hospital from March 2020 to March 2022 were selected and divided into a control group (47 cases) and an experimental group (51 cases) according to whether they received the self-care mode under the framework of chronic disease trajectory after the surgery. There were 26 males and 21 females in the control group; they were (76.90±6.43) years old. There were 26 males and 25 females in the experimental group; they were (73.76±6.38) years old. The control group took conventional nursing care; in addition, the experimental group took the chronic disease trajectory stage-guided self-care mode (CDTIM). The scores of Post-Gastrectomy Syndrome Assessment Scale (PGSAS-45), unplanned admission rates within 1 month after surgery, scores of Psychological Resilience Scale (CD-RISC), and patient satisfaction were compared between the two groups after the nursing intervention. χ2 and t tests were applied. Results After the nursing intervention, the score of PGSAS-45 in the experimental group was higher than that in the control group [(510.25±90.66) vs. (470.26±70.06)], with a statistical difference (t=10.002, P<0.05). After the nursing intervention, the unplanned admission rate in the experimental group was lower than that in the control group [19.61% (10/51) vs. 38.30% (18/47)], with a statistical difference (χ2=4.19, P<0.05). After the nursing intervention, the score of CD-RISC in the experimental group was higher than that in the control group [(66.15±10.25) vs. (57.25±8.39)], with a statistical difference (t=4.826, P<0.05). After the nursing intervention, the score of patient satisfaction in the experimental group was higher than that in the control group [(95.26±10.33) vs. (92.22±9.39)], with a statistical difference (t=2.672, P<0.05). Conclusion The self-care mode under the framework of chronic disease trajectory for elderly patients after gastrectomy for gastric carcinoma is effective and can improve their prognostic survival quality, so it is worthy of clinical promotion.